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Pearl River Patch: New NY Rules Burden Therapists Helping the Very Young

By Lanning Taliaferro, 10.6.15

Assemblymembers Ellen Jaffee and Richard N. Gottfried hosted a roundtable discussion recently on the New York State Early Intervention Program and the new third party “fiscal agent” system.

What once was a model program helping very young children who need physical, cognitive or occupational therapy has crumbled under the weight of a bureaucratic change meant to make sure the state gets reimbursed for the costs, they said.

Here’s the background: In 2013 the NYS Early Intervention Program started using third party “fiscal agents” in the collection of payments for early intervention services (known as EI). EI service providers send claims to a “fiscal agent” who routes them to private insurance and Medicaid payers.

The objective of this new system was to improve the terrible collection rates from private insurers. Previously they contributed only 2-3 percent of the total statewide program cost, Jaffee said.

But the system is so burdensome that it is putting people out of business, she said. And to add insult to injury, it’s not usually successful in making insurers cough up payments, Gottfried said.

“The testimony made clear that New York’s once model EI program has deteriorated because of the state’s benign neglect and is failing the toddlers it was supposed to help,” said Assemblyman Tom Abinanti, (D-Westchester), who attended. “As a result of Executive branch ’reforms,’ there is no outreach to those who need service, many therapists have fled and those remaining are drowning in paperwork.”

The purpose of the Oct. 1 roundtable at Rockland Community College was to open up a dialogue between stakeholders regarding how the fiscal agent system is operating; what improvements service providers have experienced since the transition and what administrative, technical, or other obstacles remain; and whether the fiscal agent system is proving to be a wise investment of state funds that improves the rate of commercial insurance reimbursements and improves the services to the children served by the Early Intervention program.

“Early Intervention providers and programs are essential for infants and young children and their families. These programs provide physical therapy and other therapeutic services to address developmental delays and disabilities at a critical time in these young lives,” Jaffee said. “And yet these programs are expected to fit into a medical billing system that is burdensome both administratively and financially making it more difficult for children and their families to access Early Intervention services and forcing many providers, who are primarily women, to close their doors, limiting services and creating long waiting lists.”

It all needs to be fixed, said Jaffee (D-Suffern), Chair of the Assembly Standing Committee on Oversight, Analysis and Investigation. “What is abundantly clear is that we must provide additional resources, improve the rate of insurance reimbursements, and seek revisions to administrative obstacles, to ensure that our young children and their families served by Early Intervention services do not suffer because of a heavily bureaucratic, under funded system.”

Jaffee was appointed chair of the Assembly Standing Committee on Oversight, Analysis and Investigation in February of 2015. The committee’s mission includes strengthening State accountability and efficiency, while protecting the disadvantaged and underserved; ensuring that State agencies and programs function effectively and in compliance with state laws; and reviewing whether State laws are being followed in accordance with legislative intent.

“There has been some progress by the state’s fiscal agent to fix some serious administrative problems, but the bottom line is that the Health Department’s model cannot work. It’s wrong to make providers struggle with endless paperwork trying to bill commercial insurance companies that usually produces no payment,” said Gottfried (D-Manhattan), Assembly Health Committee Chair. “This forum was a good opportunity for the fiscal agent and legislators to hear concerns directly. We need real change in the system and increased compensation for providers to help cover their administrative costs imposed by the new billing system.”