Coverage of Early Intervention Services Questions and Answers 4-21-2022

Chapter 820 of the Laws of 2021 (“Chapter 820”) amended the Public Health Law and Insurance Law with regard to early intervention services, creating an early intervention program (“EIP”) services pool and repealing Insurance Law §§ 3216(i)(25)(F), 3221(l)(17)(F), 3235-a, and 4303(ee)(6), ending insurers’ obligation to pay for early intervention services claims effective January 1, 2022.

Q-1. Will Child Health Plus, the Essential Plan, or Medicaid Managed Care plans continue to be billed for EIP claims?

  • Claims for EIP services provided on and after January 1, 2022 will no longer be billed to commercial insurance, Child Health Plus, and the Essential Plan.  The State Fiscal Agent (“SFA”) will continue to bill claims to Medicaid, including Medicaid Managed Care plans.

Q-2. Do all EIP claims originate from the SFA?

  • Most EIP claims are processed by the SFA.  However, for Assistive Technology Devices, claims may have been sent directly to insurers from the vendor.  Insurers are not responsible for paying claims for such devices that were provided on and after January 1, 2022

Q-3. Will insurers continue to receive EIP claims from the SFA for services after January 1, 2022?

  • No. As of March 22, 2022, the SFA completed its system changes and will no longer send EIP claims to insurers.  If insurers receive claims for EIP services provided after January 1, 2022 from the SFA, they are not responsible for reimbursing the claims.  All such claims will be voided by the SFA.

Q-4. If an insurer received an EIP claim for services after January 1, 2022 and reimbursed the claim in full or in part how does the insurer recoup the funds?

  • Any claims paid for services provided after January 1, 2022 will be voided by the SFA in the EIP billing system.  Insurers will need to request reimbursement of the voided claims directly from the EIP provider.  For assistance, insurers should contact the SFA by email at [email protected].com or by phone at (866) 315-3747.