Legislation – S.5560-A / A.5539

July 26, 2021 | ACTS in Albany

Date: 07/26/2021

To Governor Cuomo (and staff),

Shortly the Senate will be delivering S.5560-A / A.5339 for your consideration. This legislation would end direct billing to commercial insurance of Early Intervention services by adding the Program to the “Covered Lives” fund with a fair assessment.

The Assembly and the Senate passed the legislation with OVERWHELMING bi-partisan support. The reason for such a clarion affirmative vote is clear.

The Early Intervention Program which serves nearly 70,000 toddlers with learning or developmental disabilities is in trouble… and this legislation will insure its viability AND save the State and Counties tens of millions of dollars each year.

Since 2013 providers have been tasked with billing work to commercial insurance for remittance. This was formerly a responsibility of Counties. However the administrative overburden and miniscule return from commercial insurance caused Counties to seek elimination of that billing task. In the succeeding years that providers have been required to do that billing work there has been no change in the rate of reimbursement by commercial insurance from the years when that was a County government responsibility. They still REJECT about 85% of the claims submitted to them. Contrast that with Medicaid that APPROVES and reimburses over 70% of the same service claims in the Early Intervention Program.

The overall amount of reimbursed claims by commercial insurance of the grand total continues to be LESS THAN 2% per year…about $12 million, in spite of being billed nearly $80 million for Early Intervention services. The difference in what commercial insurance is billed and what they remit must be underwritten by the State and Counties. In other words, the State and Counties are subsidizing commercial insurance for their failure to fairly pay on Early Intervention claims.

But worse still, this crushing administrative burden now placed on service providers has driven agencies and therapists out of the Early Intervention field. The cost of this futile insurance billing and the time consumed doing this work, (which was never intended to be a provider responsibility), as well as the inevitable delays in insurance adjudicating the claims, has contributed to the loss of providers and a significant capacity problem in the Program. There are simply too few agencies and therapists to meet the demand of toddlers who desperately need these services. That has led to waiting lists for families and in some cases the unavailability of services that at risk toddlers deserve.

Moreover, successful Early Intervention avoids or at least mitigates the need later for more expensive Pre School and School Age Special Education. That saves School Districts and Counties untold tens of millions of dollars each year and lowers the State expense of “Public and Private Excess Cost Aid” in the State budget School Runs each year.

The pending legislation will address these long standing problems and finally require commercial insurance to reimburse their fair share of Early Intervention costs…albeit at a lower rate than Medicaid, but nonetheless a reasonable percentage. The State and Counties would each save over ten million dollars every per year. And the law would finally relieve service providers of the futile, costly and time consuming task of billing commercial insurance and chasing those claims.

This legislation is STRONGLY SUPPORTED by the New York State Association of Counties (NYSAC) and the New York State Association of County Health Officials (NYSACHO). Of course it is ENDORSED by scores of organizations throughout the State that represent children with disabilities and their families. The legislation is also RECOMMENDED to be enacted into law by the Early Intervention Coordinating Council (EICC), the official advisory body of the Bureau of Early Intervention.

Many of the over 800 bills passed by the State Legislature this past session are very important. However none will rescue such a critical endeavor as addressing the needs of at risk toddlers while also saving the State and local governments millions of dollars each year in unfair expenditures that rightly should be remitted by commercial insurance.

This is legislation that needs and merits the Governor’s approval.

Sincerely, Steven Sanders
Executive Directo
Agencies for Children’s Therapy Services (ACTS
90 State Street
Albany, New York 12207