Current through Register Vol. 50, No. 9, September 20, 2024
A. The
department shall have the authority to establish a statewide system of payments
in accordance with 34 CFR part 303.
B. In implementing the system of payments:
1. the department establishes a schedule of
monthly cost participation for early intervention services per qualifying
family. Cost participation sh all be based on a sliding scale;
2. application of the familys cost share
using the sliding scale will include the familys adjusted gross income, family
size, financial hardship, extraordinary expenses associated with the eligible
child, and Medicaid eligibility;
a.
extraordinary expenses may include but are not limited to unreimbursed medical
expenses, equipment, home modifications, or other costs associated with the
child with a disability;
b.
extraordinary expenses must have been incurred during the calendar year that
the familys cost share for individualized family services plan (IFSP) services
is applied;
c. the family will be
required to produce invoices, receipts, or other documents which establish the
costs and payment for these expenses;
d. the family may request a reassessment of
their costs based on extraordinary expenses at any time if there are
significant changes affecting the determination of the cost participation
amount. The request will be in writing and submitted to the service
coordinator;
e. the request for
reassessment will be considered by the designated EarlySteps office for a
determination of the familys request. The family and the service coordinator
will receive the departments written response;
3. the sliding scale shall utilize the most
recent federal poverty guidelines issued in the Federal
Register by the United States Department of Health and Human Services
as the basis for determining the income threshold based on family size for
eligibility for cost participation;
4. the department shall not assess any fee or
other charge through the cost participation schedule upon a family which has an
annual income of less than 300 percent of the federal poverty level;
5. the department shall not assess fees or
other charges through the cost participation schedule which totals more than 3
percent of the monthly income level for a family of
four, according to the federal poverty guideline schedule
which will be updated annually;
6. once the familys income has been verified
with the required documentation and the IFSP services have been determined by
the IFSP team, the following will occur:
a.
the system point of entry office will issue the cost participation statement to
notify the family of their assessed costs which will be reviewed with the
family and a copy provided;
b.
following the submission of service claims by the childs provider, the Central
Finance Office (CFO) will mail a monthly explanation of payment statement (EOP)
to the family for payment. The EOP will include a notice of the familys right
for reconsideration of their financial status and their right to apply for
exemption from cost participation due to financial hardship;
c. families will remit reimbursement to the
CFO at the address provided in the EOP;
7. when a family is not complying with the
cost participation requirements and procedures for suspending services, the
following will occur related to the status of the childs services;
a. a notice will be issued to the family, to
the service coordinator and to the designated EarlySteps office;
b. the CFO will notify the department when
the family is in arrears for a duration of three months at which time the
service coordinator will discuss the familys options with the family and assist
the department with its determination of the status of the childs IFSP
services;
c. if the family provides
its consent, a copy of the notice that the family is in arrears with payment
for three months will be sent to the representative and senator in whose
district the family resides;
d. the
department will make a written determination regarding the status of the childs
IFSP services following review of information provided by the service
coordinator and the family. Families will be offered the option to continue to
receive services available at no cost if they choose according to the no-cost
provisions which follow;
e. the
department shall not limit early intervention services for a child in any month
if the cost for the services in that month exceeds the maximum contribution
from the childs family.
C. Parents who have public insurance
(Medicaid) and elect not to assign such right of recovery or indemnification to
the department or choose not to release financial information will be assessed
the cost for each early intervention service listed on the IFSP according to
the most current service rate schedule and the cost participation
schedule.
D. No-Cost Provision: the
following services that a child is otherwise entitled to receive will have no
costs assessed to the parents:
1. child find
activities;
2. evaluation and
assessment for eligibility and IFSP planning;
3. service coordination, administrative and
coordinative activities related to the development review, and evaluation of
the IFSP; and
4. implementation of
procedural safeguards and other components of the statewide system related to
§464 of Act 417.
E. The
department will provide written, prior notification to families for use of
Medicaid according to the requirements of
34 CFR
303.414. This notice includes a statement
that there are no costs charged by the department for use of the eligible
childs Medicaid. The notification also includes a statement of the process for
resolutions of disputes regarding decisions related to use of Medicaid, failure
to pay for services and/or the states determination of a familys ability to
pay.
F. Dispute Resolution Process
1. The procedures used by the department to
resolve such disputes will not delay or deny the parents rights or the childs
ability to access timely services.
2. The dispute resolution process can be
initiated by the parent according to OCDDs policy for handling system
complaints when the parent wishes to contest the imposition of a fee or the
departments determination of the parents ability to pay.
G . Parental Consent. The department will
obtain parental consent prior to the use of the childs Medicaid according to
the following.
1. EarlySteps will obtain
written consent for the use of the childs Medicaid using its established
consent for services form.
2.
Parental consent will be obtained prior to the initial provision of an early
intervention service in the IFSP.
3. Parental consent will be obtained when an
increase in frequency, length, duration, or intensity of a service is
determined in the childs IFSP.
4.
If the parent does not provide consent for the use of the childs Medicaid, the
department will make available only those early intervention services on the
IFSP for which the parent has provided consent.
5. Parents may withdraw consent for use of
their childs Medicaid at any time.
H. Determination of Family Cost. Families are
liable for the costs of services that their child receives while enrolled in
EarlySteps as follows:
1. The aggregate
contributions made by the parent shall not exceed the aggregate cost of the
early intervention services received by the child and family (factoring in any
amount received from other sources for payment for that service).
2. At least annually, or at any time the
department determines that a reassessment of the parents financial
circumstances is warranted, the department shall conduct such reassessment of
financial status.
3. The parent has
the right to request a reassessment at any time if there are significant
changes affecting the determination of the cost participation amount.
4. Families who have the ability to pay and
choose not to pay may be determined as ineligible to continue to receive
services until payment is made.
5.
The inability of the family of the eligible infant or toddler will not result
in a delay or denial of services if the family does not meet the cost
participation income requirements or for services for which there are no
costs.
AUTHORITY NOTE:
Promulgated in accordance with
R.S.
28:821 et
seq.
