State Health Department Takes Action to Issue Payments to Early Intervention Providers
ALBANY, N.Y. (August 13, 2013) – The New York State Department of Health (DOH) today announced it will issue state-funded "safety net payments" to early intervention providers in response to provider concerns about the lack of payment of claims submitted to insurance companies. The Department's decisive action is in response to a large number of insurance companies' lack of compliance with recently enacted Early Intervention Program reforms.
The Early Intervention Program provides services to children with developmental delays aged birth to three. Approximately 69,000 children were served in the program in 2011-12 across the state. Services provided include physical, occupational and speech therapies and special education. Historically in the program, more than 30 percent of enrolled children have some form of private health insurance coverage; insurers have paid only 2 percent of the costs of services. As part of a series of program reforms enacted April 1, 2013, participating therapists now bill insurers through DOH's contracted fiscal agent. These reforms provide fiscal and mandate relief for local governments.
Since April 1, 2013, under this new system, DOH, through its fiscal agent, has issued payments to providers totaling more than $133 million, including Medicaid and local government funding. Unfortunately, most insurance payments remain outstanding resulting in cash flow problems for providers. While nearly 400,000 claims have been submitted by providers to insurers, only about 75,000 – less than 20 percent - have been adjudicated.
To ensure providers of early intervention services receive timely payment, insurers' prompt response to claims is essential. Payments of any claims – in part or in whole - are only possible after the insurer adjudicates the claim. Under changes to Insurance Law and Public Health Law, insurance companies are required to accept claims from DOH's fiscal agent and issue payments for covered services directly to early intervention providers. Regrettably, many insurers have been incorrectly issuing payments to families or other therapists, not sending the required information about the results of the claim adjudication process to DOH's fiscal agent, or not responding to claims at all.
The Early Intervention Program for infants and toddlers with disabilities or developmental delays is vital to the healthy development of New York's youngest residents. The Department is strongly urging insurers to comply with these important reforms. In the interim, DOH is issuing these safety net payments to providers to bring financial relief and ensure continued availability of essential services to developmentally disabled children in the Early Intervention Program and their families.
On July 26, 2013, DOH notified counties and providers of the option for counties to issue "Preliminary Escrow Payments" to interested providers, using county Early Intervention funding. Unfortunately, very few counties opted to participate.
Early Intervention providers requesting safety net payments will receive 75 percent of the amount of their unpaid claims to insurers for the period April 1, 2013 through July 29, 2013 for which no known payment or denial has been received. The safety net payments will be reconciled between October 1, 2013 and July 31, 2014 when providers' claims are paid by insurers and the counties. Providers will receive full payment for 100 percent of outstanding claims.
For additional information, Early Intervention providers may contact DOH's Bureau of Early Intervention at (518) 473-7016.