Relates to the reimbursement of local services provided to persons with a disability

Summary of provisions

Section 1 amends article 43 of the mental hygiene law related to fees for service by adding a new section 43.13 to provide for the reimbursement of a service furnished by a local service provider while the commissioner approves the service, provided that such approval is ultimately granted. This section also provides that if a service is ultimately not approved and reimbursement has already occurred, such reimbursement shall be returned to the Office for People with Developmental Disabilities within sixty days of notice of such denial.

Section 2 provides the effective date.

Existing law

Pursuant to § 13.13 of the Mental Hygiene Law, local services for persons with developmental disabilities shall be planned, financed, and implemented in accordance with the provisions of this chapter.

Pursuant to § 13.13 of the Mental Hygiene Law, the Commissioner of the Office for People with Developmental Disabilities shall plan, promote, establish, develop, coordinate, evaluate, and conduct programs and services of prevention, diagnosis, examination, care, treatment, rehabilitation, training, and research for the benefit of individuals with developmental disabilities. Such programs shall include, but are not limited to, inpatient, outpatient, partial hospitalization, day care, emergency, rehabilitative, and other appropriate treatments and services. The commissioner shall take all actions necessary, desirable, or proper to implement the purposes of this chapter, and to carry out the purposes and objectives of the Office within the amounts made available therefore by appropriation, grant, gift, devise, bequest, or allocation from the Mental Health Service Fund established under § 97-f of the Finance Law. The activities described here may be undertaken in cooperation and agreement with other offices, departments, or agencies of the state, local or federal government, or with other organizations and individuals.

Pursuant to § 13.17(c) of the Mental Hygiene Law, the Commissioner of the Office for People with Developmental Disabilities may authorize other offices of the Department and any public or private non-profit organization or political subdivision of the state to deliver supports and services to individuals with development disabilities, not inconsistent with the programs and objectives of the Office in any facility under the commissioner's jurisdiction. The commissioner may permit any facility under the commissioner's jurisdiction to operate programs for persons with mental disabilities, not inconsistent with programs and objectives of the Department, under contracts or agreements with other offices within the Department.

Justification

Services rendered to persons with developmental disabilities by local service providers and agencies must be approved the Office for Persons with Developmental Disabilities (OPWDD). Generally, an individual, or a family member on the behalf of an individual, will approach a local service provider seeking disability services. That individual is then referred to OPWDD for an evaluative process during which OPWDD will determine the services that are available to the person and which centers provide the approved services. A family may choose only from the services and centers approved through OPWDD's assessment.

A local provider is proscribed from providing any service to a person with a developmental disability until such service is approved by OPWDD. Often, an initial placement in a particular program or the rendering of specific services is inappropriate for the individual requiring the service. This may result in extraordinary hardships for both the individual and that person's caregivers, especially when the inappropriate placement results in physical or emotional harm to the individual, or when abridgement in service results in a lapse of day care thus forcing the caregiver to modify his or her own employment obligations. Furthermore, local service providers cannot help facilitate the evaluation and approval process and are prevented from advocating on behalf of their clients and families.

In an effort to offer the necessary services and treatments to all of their clients in a streamlined and consistent manner, local service providers often provide uncompensated care. But uncompensated care does not mean that the services provided were not approved by OPWDD. Rather, the uncompensated care may have been administered while the individual was still being approved, or during an interim period when OPWDD had not yet approved a more appropriate placement or treatment for that person's particular needs.

This bill requires that if a person with developmental disabilities qualifying for such a program and has entered into a program or received a service furnished by a local service provider, and subsequently enters into a different program or receives a different service not yet approved by OPWDD, the local service provider must be reimbursed the cost of that program or service as if it had been approved prior to such person's admission to the program, provided that such approval is ultimately granted by the Department. While only those services that are ultimately approved by OPWDD quality for reimbursement during the interim period, this bill will promote the consistent delivery of necessary services to persons with developmental disabilities and ensure local service providers are appropriately compensated for the rendering of such approved services. This legislation will foster the relationship between all of these parties, including individuals with developmental disabilities and their families, local service providers, and OPWDD. As such it is imperative that this bill is enacted.

Legislative history

New Bill.

Fiscal implications

Minimal.

Effective date

This act shall take effect immediately.