2557 - Financial responsibility and reimbursement.
§ 2557. Financial responsibility and reimbursement. 1. The approved costs for an eligible child who receives an evaluation and early intervention services pursuant to this title shall be a charge upon the municipality wherein the eligible child resides or, where the services are covered by the medical assistance program, upon the social services district of fiscal responsibility with respect to those eligible children who are also eligible for medical assistance. All approved costs shall be paid in the first instance and at least quarterly by the appropriate governing body or officer of the municipality upon vouchers presented and audited in the same manner as the case of other claims against the municipality. Notwithstanding the insurance law or regulations thereunder relating to the permissible exclusion of payments for services under governmental programs, no such exclusion shall apply with respect to payments made pursuant to this title. Notwithstanding the insurance law or any other law or agreement to the contrary, benefits under this title shall be considered secondary to any plan of insurance or state government benefit program under which an eligible child may have coverage. Nothing in this section shall increase or enhance coverages provided for within an insurance contract subject to the provisions of this title. 2. The department shall reimburse the approved costs paid by a municipality for the purposes of this title, other than those reimbursable by the medical assistance program or by third party payors, in an amount of fifty percent of the amount expended in accordance with the rules and regulations of the commissioner. Such state reimbursement to the municipality shall not be paid prior to April first of the year in which the approved costs are paid by the municipality. 3. The department may perform audits, which may include site visitation, to all or any of the following: municipalities; service coordinators; evaluators or providers of early intervention services. The department shall provide the municipalities with a copy of the findings of such audits. Early intervention program state aid reimbursement or portion thereof may be withheld if, on post-audit and review, the commissioner finds that the early intervention services were not provided or those provided were not in substantial conformance with the rules and regulations established by the commissioner or that the recipient of such services was not an eligible child as defined in section twenty-five hundred forty-one of this title. In the event that the commissioner determines that there may be a withholding of state reimbursement to any municipality under this section, he shall inform the state early intervention coordinating council and the relevant local early intervention coordinating council and shall consider alternative courses of action recommended within sixty days by either body prior to withholding state reimbursement. 3-a. Each municipality may perform an audit, which may include site visitation, of evaluators and providers of such services within its municipality in accordance with standards established by the commissioner. The municipality shall submit the results of any such audit to the commissioner for review and, if warranted, adjustments in state aid reimbursement pursuant to subdivision three of this section, as well as for recovery by the municipality of its share of any disallowances identified in such audit. 4. The commissioner shall collect data, by municipality, on the early intervention program authorized under this title for purposes of improving the efficiency, cost effectiveness, and quality of such program. Such municipality data collection shall include but not be limited to:(a) The number and ages of children enrolled in the early intervention program; (b) The total number of children, within a municipality, receiving a single service, the percentage of those children by service type, and the average frequency of visits per week for such service type; (c) The total number of children, within a municipality, receiving multiple services, the percentage of those children by service type, the average frequency of visits per week for such service type and the average number of service types that each child receives; (d) The number of New York state approved agencies, institutions, or organizations providing early intervention services by service specialty or specialties and the number of New York state approved independent providers of early intervention services by service specialty or specialties; (e) The number and percentage of children receiving a single service by type of New York state approved service provider, and the number and percentage of children receiving multiple services by type of New York state approved service provider; (f) The overall number of New York state approved evaluators. The number of approved evaluators who also provide services to early intervention children they have evaluated; (g) The number of families receiving family supportive services such as family training, counseling, parent support groups, and respite; (h) The types of clinical practice guidelines, evaluation tools and testing instruments used by municipalities to establish eligibility or need for early intervention services; (i) Both service, cost and payment oversight mechanisms used by counties to ensure quality and efficient delivery of early intervention services; (j) The number of children that have third party reimbursement; (k) The number of claims submitted to third party payors by municipality. The percentage of claims denied by third party payors. The reasons for the denials. The commissioner shall collect and analyze such data elements to determine service and utilization patterns and to enhance the department's ongoing provision of program oversight and guidance. In addition, the commissioner shall report for the period July first, two thousand three to December thirty-first, two thousand three, and for each calendar year thereafter, to the governor and the legislature, by March first of each year, the information and analysis required by this subdivision. 5. The department shall contract with an independent organization to act as the fiscal agent for the department. A municipality may elect to utilize the services of such organization for early intervention program fiscal management and claiming as determined by the commissioner or may select an independent agent to act as the fiscal agent for such municipality or may act as its own fiscal agent.