Int. No. 1111
By Council Members Joseph, Gutiérrez, Dinowitz, Hanif, Cabán, Louis, Hudson, Farías and Brooks-Powers
A Local Law to amend the administrative code of the city of New York, in relation to requiring the department of education to report on Medicaid reimbursements
Be it enacted by the Council as follows:
Section 1. Title 21-A of the administrative code of the city of New York is amended by and adding a new chapter 45 to read as follows:
CHAPTER 45
REPORTING ON MEDICAID REIMBURSEMENTS
§ 21-1018 Reporting on Medicaid reimbursements. a. Definitions. For purposes of this section, the following terms have the following meanings:
Claim. The term “claim” means a claim for reimbursement.
Claimable service event. The term “claimable service event” means a service event that may qualify for reimbursement and for which the department has determined that every requirement necessary to submit a claim has been satisfied.
Eligible student health service. The term “eligible student health service” means a service for which the department may seek reimbursement pursuant to the New York state preschool/school supportive health services program (SSHSP) or successor programs, including physical therapy services, occupational therapy services, speech therapy services, psychiatric evaluations, psychiatric counseling, skilled nursing services, medical evaluations, medical specialist evaluations, audiological evaluations, and special transportation services.
Eligible student IEP health service. The term “eligible student IEP health service” means an eligible student health service that IEPs can require a student to receive in a specified manner.
Potentially claimable service event. The term “potentially claimable service event” means a service event that is provided to a student and that could qualify for reimbursement if all applicable claiming requirements are satisfied, regardless of whether the department has determined that it is a claimable service event.
Recorded service event. The term “recorded service event” means a service event that the department or a provider providing services on behalf of the department records as having been provided.
Reimbursement. The term “reimbursement” means a monetary reimbursement from Medicaid.
Service event. The term “service event” means any discrete unit of service for which reimbursement may be sought including, as applicable, an individual treatment, therapy, counseling or nursing encounter; an evaluation or re-evaluation; or a transportation trip or other unit used to make a claim.
b. Quarterly report on Medicaid reimbursement. On a quarterly basis, the chancellor shall submit to the speaker of the council and post conspicuously on the department’s website a report regarding eligible student health services provided during the preceding fiscal quarter. Such report shall include the following information separately for each eligible student health service citywide; by borough; and by community school district, district 75 or district 79:
1. The number of recorded service events that were also potentially claimable service events;
2. The number of potentially claimable service events that were also claimable service events;
3. The number of claimable service events for which the department submitted a claim;
4. The number of service events for which the department submitted a claim that were:
(a) Reimbursed by Medicaid;
(b) Denied by Medicaid;
(c) Remain pending; and
(d) Remain otherwise resolved;
5. The total dollar amount corresponding to service events that were:
(a) Claimed by the department;
(b) Reimbursed by Medicaid;
(c) Denied by Medicaid;
(d) Remain pending; and
(e) Remain otherwise resolved; and
6. The number of potentially claimable service events for which no claim was submitted, disaggregated by the primary reason a claim was not submitted, including:
(a) missing, insufficient, or invalid consent or consent documentation;
(b) missing, insufficient, or invalid medical order or referral, or related documentation;
(c) missing, insufficient, or invalid provider credentials or documentation;
(d) missing, insufficient, or invalid documentation of the service event;
(e) missing, insufficient, or invalid billing information;
(f) inability to verify student information including Medicaid enrollment;
(g) expiration of the applicable period to make a claim; or
(h) any other reason.
c. IEP service category reporting. Separately for each type of eligible student IEP health service, the department shall additionally report citywide; by borough; and by community school district, district 75 or district 79:
1. The number of service events that were required to be provided pursuant to IEPs during the reporting period;
2. The number of service events that were required to be provided pursuant to IEPs during the reporting period that were also recorded service events; and
3. The number of service events that were required to be provided pursuant to IEPs during the reporting period, for which the department has no record that the service was provided.
d. Additional disaggregation. The information required by subdivisions c and d of this section shall be additionally disaggregated by whether the service events are associated with department schools or whether they are associated with nonpublic schools or other settings in which the department is responsible for such services.
e. Privacy. No information that is otherwise required to be reported pursuant to this section shall be reported in a manner that would violate any applicable provision of federal, state or local law relating to the privacy of student information or that would interfere with law enforcement investigations or otherwise conflict with the interests of law enforcement. If a category contains between one and five students, or allows another category to be narrowed to between one and five students, the number shall be replaced with a symbol. A category that contains zero students shall be reported as zero, unless such reporting would violate any applicable provision of federal, state or local law relating to the privacy of student information.
3. This local law takes effect immediately.
AC
LS # 25467
10/1/2026 12:45 pm