New Hampshire Code of Administrative Rules
He - Department of Health and Human Services
Subtitle He-M - Former Division of Mental Health and Developmental Services
Chapter He-M 500 - DEVELOPMENTAL SERVICES
Part He-M 510 - FAMILY-CENTERED EARLY SUPPORTS AND SERVICES
Section He-M 510.14 - Utilization of Public and Private Insurance

Universal Citation: NH Admin Rules He-M 510.14

Current through Register No. 40, October 3, 2024

(a) When a child is covered by private insurance or enrolled in Medicaid, the FCESS program shall use these benefits to pay for FCESS in accordance with (b) - (k) below.

(b) The FCESS program shall not use the private insurance of a parent or child to pay for FCESS unless the parent provides parental consent. This includes the use of private insurance when such use is a prerequisite for the use of Medicaid.

(c) When an FCESS program uses a child's private insurance, the program shall not collect costs associated with the use of private insurance from the child's family, including the cost of deductibles, coinsurance and co-pays.

(d) When private insurance is used to pay for FCESS, the FCESS program shall obtain parental consent at the following times:

(1) When an FCESS program seeks to use the child's private insurance to pay for the initial provision of an FCESS identified in the IFSP; and

(2) Each time there is an increase in the provision of services and a related change in the child's IFSP.

(e) When obtaining consent under (d) above or initially using benefits under a private insurance policy, an FCESS program shall provide to the child's parents:

(1) A copy of the system of payments described in He-M 510.14; and

(2) Notice of the potential costs to the parent when private insurance is used to pay for early intervention services, including premiums or other long-term costs associated with annual or lifetime health insurance coverage caps.

(f) An FCESS program shall not delay or deny the provision of any services in the IFSP when a parent does not provide consent to use private insurance.

(g) If a parent does not provide consent to use private insurance, an FCESS program shall utilize funds available in contract with the department, including federal funds available pursuant to 34 CFR 303.510(a), for the provision of any services in the IFSP.

(h) If funds are utilized pursuant to (g) above, the parent shall not be required to reimburse any such funds.

(i) When Medicaid benefits are used to pay for FCESS, the FCESS program shall provide written notice to the child's parents that includes:

(1) A statement of the no-cost protection provisions in 34 C.F.R. § 303.520(a)(2);

(2) Pursuant to (k) below, a statement that a parent's refusal to enroll in Medicaid shall not delay or cause to be denied the provision of any services in the child's IFSP; and

(3) A description of the general categories of costs that the parent would incur as a result of participating in Medicaid, including the required use of private insurance as the primary insurance.

(j) An FCESS program shall not require a parent to sign up for or enroll in Medicaid as a condition of receiving FCESS.

(k) An FCESS program shall not delay or deny the provision of any services in the child's IFSP if a parent does not enroll in Medicaid.

(l) The FCESS program shall maintain up to date insurance coverage information for each child.

#9594, eff 11-11-09 (from He-M 510.11); ss by #10325, eff 4-26-13 (from He-M 510.15)

Disclaimer: These regulations may not be the most recent version. New Hampshire may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.