Early Intervention Reimbursement Bill Passes NY Assembly and State

New York Assemblywoman Amy Paulin's legislation to increase insurance payments to counties for early intervention services (A. 384-B) has passed both houses and awaits the governor's signature.

"This legislation will provide significant mandate relief for Westchester County. The dollars they recoup will be substantial," Paulin said.

When early intervention (EI) services, such as speech pathology or physical therapy, are provided to a child, the municipality must pay 100 percent of the costs up front and then seek reimbursement from the child's insurance provider. However, reimbursement from insurance companies has been minimal and uneven across the state, leaving the cost for EI services to be paid by state and municipal tax dollars.

The New York State Association of Counties has reported that approximately $95.5 million was billed to commercial insurers and only $10.6 million was recouped, for a rate of 11 percent. This legislation seeks to correct the top reasons why insurance companies deny claims for EI services by:

1. Increasing the time for a municipality to file a claim
2. Requiring parents to provide a written referral from the child's primary care provider showing medical necessity
3. Requiring the insurance company to supply the municipality with information on the child's benefits
4. Requiring parents to inform the county of their child's insurance coverage.

As a result, more claims will be paid, and Westchester and other counties will be able to collect more of the money that they are entitled to.
 
"This is a change that the Westchester County Board of Legislators has sought for nearly a decade, and we greatly appreciate Assemblywoman Paulin and the state legislators' efforts," County Legislator Jim Maisano said. "This will save taxpayers money."
 
Paulin worked closely with the county, Assemblyman Joseph Morelle - Chair of the Assembly Insurance Committee, the New York State Association of County Health Officials, and insurance companies to arrive at an agreement on the legislation.
 
"Being able to process early intervention claims more efficiently, thanks to this new legislation, will create greater cooperation between insurers and local governments," said Westchester Board of Legislators Chairman Ken Jenkins (D-Yonkers). "As Assemblywoman Paulin knows, streamlining processes drive down costs and save taxpayers' dollars, as in this case.  Now we look forward to the Governor signing the bill."