Jul 29, 2013
New York State Department of Health
Bureau of Early Intervention Electronic Mailing List
Important Announcement – Preliminary Payments
Dear Colleague:
This correspondence is to announce that, to address urgent payment concerns providers have raised to the Department of Health (Department), the Department, in collaboration with participating municipalities, has arranged for temporary one –time Preliminary Escrow Payments (PEPs) to certain Early Intervention Program providers. The PEPs will be calculated based upon 75% of the amount of outstanding commercial insurance claims submitted in the period April 1, 2013 through July 29, 2013 as detailed below. Availability of these payments is subject to the agreement of municipalities to participate in the funding of PEPS.
On April 1, 2013, in accordance with reforms enacted in the SFY 2012-13 budget, the Early Intervention Program transitioned from local to State management of payments to providers through a contract with a State Fiscal Agent. The Department has been carefully monitoring the transition and its impact on payment to EIP providers. Significant progress has been made in implementing the new system of payment, with over $100 million in payments having been disbursed to providers. The overwhelming majority of these payments have been made from Medicaid and through the escrow accounts funded by localities. Unfortunately, while $25 million has been billed to commercial insurers, less than 1% of this amount has been paid. We understand that payment to providers for commercial insurance claims has been delayed as a result of numerous issues including insurers that have misdirected payment to families and rendering therapists, remittance information that has been sent to providers rather than the fiscal agent, and many insurers that have yet to respond to submitted claims.
The Department understands from providers that delays in adjudication of commercial insurance claims have resulted in financial hardship. The Department has further determined that there is significant risk that children and families will not receive services in their Individualized Family Service Plans.
Therefore, if authorized by the municipality, the Department will be issuing PEPs early in August to EIP providers that submitted claims to commercial insurers during the period April 1, 2013 through July 29, 2013 which are still being adjudicated by insurers and for which no known payment or denial has been issued to such provider. The payment amount will be calculated as 75% of the total dollar value of outstanding commercial insurance claims billed at the State rate by the EIP provider during this time period.
Providers will be expected to continue to work with the Interim and final State Fiscal Agents and insurers to complete the adjudication process of the outstanding commercial insurance claims on which the PEP is based, and to continue to seek insurance reimbursement for services rendered to commercially insured families.
Subject to county participation, to receive a PEP, EIP providers must complete an agreement, which will be posted on EIBilling.com, including agreeing to a recoupment schedule for repayment of the PEP. Recoupment will be in the amount of a deduction of 25% of all subsequent payments issued to the provider from the escrow account, beginning September 1, 2013. Recoupment must be completed by March 31, 2014.
The estimated amount of the PEP available to each provider, based on total amount of outstanding commercial insurance claims, will be posted on EIBilling.com on Monday, July 29, 2013. Providers will be able to monitor whether the municipalities within which they deliver services have agreed to participate on EIBilling.com. Agreements will only be accepted from providers, and PEP payments will only be made, for those counties that are participating. If providers conduct EIP business in more than one municipality, the final amount of total payment made to the provider will be determined by municipal participation. Payment will be made only for municipalities that authorize the Department to issue payments from the escrow account and deposit funds in the account for this purpose. Payment will not be available to EIP providers until such time the Department receives these authorizations and deposits
The agreement will also be posted on EIBilling.com by Tuesday, July 30. Providers must complete and return the agreement to the Department as soon as possible. Payment will not be issued until the agreement is signed, returned, and received by the Department.
Participation in the PEP is voluntary to providers, and subject to municipal participation in funding of the PEP. The Department is collaborating with municipalities to make these temporary one-time payments available while continuing to work with providers, insurers, and municipalities improve the timeliness of adjudication of commercial insurance claims.
Questions should be directed to BEI@health.state.ny.us.
Please do not reply to this e-mail announcement.
Thank You.