What's happening
This bill requires health insurance policies to cover early intervention services for children and sets rules for claim approval and payment.
Why it matters
Streamlines access to early intervention services. by allowing an approved individualized family services plan to automatically satisfy insurance requirements for precertification, preauthorization, and medical necessity, reducing administrative barriers and speeding up care for children.
Standardizes payment rates for services. by requiring insurers to pay for covered early intervention services at rates set by the state health commissioner, which could help ensure consistent reimbursement and financial stability for service providers.
Prevents insurers from denying claims for technicalities. such as where the service is provided, how long the child’s condition lasts, or whether the provider is in-network, thereby expanding access and reducing the risk of families facing unexpected out-of-pocket costs or coverage denials.
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Who cares
Families of children receiving early intervention services
The bill would bar insurers from denying claims based on service location, specified limits tied to the child's condition or prospects for improvement, or a provider's out-of-network status.
Health insurers and HMOs
For otherwise covered services, the bill would require acceptance of a certified individualized family services plan as meeting precertification, preauthorization and medical necessity requirements, with payment at rates established by the health commissioner.
Early intervention service providers
Providers would have to redact information in individualized family services plans that insurers do not need for payment, while gaining protection against claim denials based on network status.
Early intervention officials and their designees
Their certification of individualized family services plans would satisfy insurers' authorization and medical necessity requirements for covered services.
Headline styles
Cover Early Intervention Therapy
Plain English, a few words. Used as the page title.
Sponsors
2 Co-sponsors
History
- Referred to insurance
- Referred to insurance
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Cover Early Intervention Services
In Assembly Committee · Insurance · Sponsor Amy Paulin
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
3737
2019-2020 Regular Sessions
IN SENATE
February 13, 2019
Introduced by Sens. BRESLIN, GRIFFO -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance
AN ACT to amend the insurance law, in relation to coverage of early intervention services
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Subsection (a) of section 3235-a of the insurance law, as added by section 3 of part C of chapter 1 of the laws of 2002, is amended and two new subsections (e) and (f) are added to read as follows:
(a) No policy of accident and health insurance, including contracts issued pursuant to article forty-three of this chapter, shall exclude coverage for otherwise covered services [solely on the basis that the services constitute early intervention program services] that are provided under title two-A of article twenty-five of the public health law.
(e) Where a service provided to an insured under the early intervention program is a covered service under the insurer's policy or contract, the individualized family services plan, upon certification by the early intervention official, as defined in section twenty-five hundred forty-one of the public health law, or such official's designee, shall be deemed to meet any precertification, preauthorization, and medical necessity requirements imposed on benefits under the policy or contract; provided, however, that the provider shall remove or redact any information contained in the insured's individualized family services plan that is not required by the insurer for payment purposes. Payment for a service covered under the policy or contract that is provided under the early intervention program shall be at rates established by the commissioner of health for such service pursuant to regulations.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD00618-01-9
S. 3737 2
(f) No insurer, including a health maintenance organization issued a certificate of authority under article forty-four of the public health law and a corporation organized under article forty-three of this chapter, shall deny payment of an early intervention claim based on the following:
(1) the location where services are provided;
(2) the duration of the child's condition and/or that the child's condition is not amenable to significant improvement within a certain period of time as specified in the policy; or
(3) that the provider of services is not a network or participating provider.
§ 2. This act shall take effect immediately.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
An act to amend the insurance law, in relation to coverage of early intervention services
Purpose
To amend the insurance law to ensure recoupment from commercial insurers for the cost of the early intervention program.
Summary of provisions
Section one amends subsection (a) of section 3235-a of the insurance law, as added by section 3 of part C of chapter 1 of the laws of 2002, to prohibit accident and health insurance policies from excluding from coverage services provided under title two-A of article twenty-five of the public health law. Section one also amends section 3235-a to add two new subsections (e) and (f). New subsection (e) provides that where a service provided to an insured under the early intervention program is a covered service under the insurer's policy, the individualized family services plan, upon certification by the early intervention official, shall be deemed to meet any precertification, preauthorization and medical necessity requirements imposed on benefits under the policy. The early intervention official shall remove or redact any information contained in the individualized family services plan that is not required by the insurer for payment purposes. Payment of a service covered under the insurance policy shall be at rates established by the Commissioner of Health for such service pursuant to regulations. New subsection (f) provides that no insurer, including a health maintenance organization, shall deny payment of an early intervention cl aim based on the location where services are provided, the duration of the child's condition and/or that the child's condition is not likely to signif- icantly improve within the time specified in the policy, or that the provider is not a network or participating provider.
Read the full memo (604 words)
Section two provides the effective date.
Justification
Although public and private commercial insurance is required by law to be maximized in financing early intervention (El) services, reimburse- ment from third party payers, other than Medicaid, have been minimal leaving the cost of this entitlement to be paid by state and municipal tax dollars.
In recognition of the need to improve recoupment of insurance monies to help pay for El, the Third Party Reimbursement Task Force of the New York State Early Invention Coordinating Council was convened in 1999. That Task Force examined data on billing and recoupment and found that private insurance collection was at a low rate of 9%. An updated survey conducted by the New York State Association of County Health Officials of billing and recoupment in 2000 found that, while, the amount billed to insurers had almost doubled, the recoupment rate remained a low 11%.
The Task Force also consulted with experts from Massachusetts, Indiana and Virginia, all states that have included in state law the specific requirements necessary to ensure insurance payments for El. Experts from these three states indicated that requiring insurers to pay for El services minimally impacted insurance premiums and that insurers may in fact have saved money in the long run due to the therapeutic inter- ventions under El. Experts from the three states confirmed the Task Force's finding that the single most important factor to improve collections as well as reducing administrative burdens was legislation requiring private commercial insurers to pay for El.
Current insurance law does not include the necessary language to insure that payments are made nor does the language preclude the majority of reasons given for FT denials. As a result, it is necessary that specific language be adopted to fix this problem.
Legislative history
2017-18 - S.3155/A.2026 2015-16 - S. 1946/A. 135 - Insurance Committee.
Fiscal implications
None to the state, savings for municipalities.
Effective date
Immediate.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.