Current through March 25, 2025
A. The Rhode Island
Early Intervention system of payments includes a combination of state and
federal funds and the use of public and private insurance. Early Intervention
is a state-required benefit for all insurance plans issued in Rhode Island. RI
General Laws §§27-18-64, 27-20-50, and 27-41-68 require private and
public insurers based in Rhode Island and providing coverage for dependent
children to cover the cost of Early Intervention services. Plans may not
include deductibles, co-pays, or co-insurance. Rhode Island residents may have
employer-sponsored health benefit plans or "self- insured" plans that are
exempt from Rhode Island State law but these plans must follow federal law.
These plans and other out-of-state plans may provide "essential benefits",
including "rehabilitative and habilitative services and devices" depending on
the plan design, which may cover early intervention services. Any Early
Intervention service not covered by health insurance or health benefit plans
exempt from Rhode Island State law including deductibles, co-pays or
co-insurance is funded through the use of public and Part C funds.
B. The Rhode Island Early Intervention system
of payments does not include any family fees, co-payments or deductibles.
Therefore, there is no family payment system; no sliding or cost participation
fees; no basis for determining fees; and no definitions regarding ability and
inability to pay.
C. The Rhode
Island Early Intervention system will ensure that parents are not charged any
out-of-pocket costs for any Part C services. Fees will not be charged for the
services that a child is otherwise entitled to receive at no cost to the
parents including:
1. Implementation of the
child find requirements;
2.
Evaluation and assessment;
4.
Administrative and coordinative activities related to:
a. The development, review, and evaluation of
IFSPs;
b. The implementation of
procedural safeguards;
c. All Early
Intervention services authorized on the IFSP, including any co-payments or
deductibles related to these services.
D. The Rhode Island Early Intervention system
does not charge any fees to parents, copayments or deductibles, therefore:
1. The inability of the parents to pay for
services will not result in the delay or denial of services to the child or the
child's family;
2. Families will
not be charged any more than the actual cost of an Early Intervention
service;
3. Parents with public
insurance or benefits or private insurance will not be charged
disproportionately more than those who do not; and
4. No fees will be charged to parents for
failure to provide income information.
E. Parents are only responsible for the cost
of their health insurance premiums.
F. No service a child is entitled to receive
will be delayed or denied due to disputes between agencies regarding financial
or other responsibilities.
G. All
Part C services on the IFSP are available to the child and family whether or
not consent to use insurance or Medicaid is required or provided.
H. Payor of Last Resort
1. Part C funds may be used for activities or
expenses that are reasonable and necessary for implementing the Rhode Island
Early Intervention system including direct Part C services for children and
families and the cost of co-pays and deductibles. Part C funds will be used as
the payor of last resort and cannot be used to satisfy a financial commitment
for services that would otherwise have been paid for from another public or
private source. However, if necessary to prevent a delay in the timely
provision of appropriate Part C services to an infant/toddler or the family,
funds may be used to pay the provider of services for services and functions
authorized under Part C pending reimbursement from the insurance provider that
has ultimate responsibility for the payment.
I. The Use of Private Insurance to Pay for
Part C Services
1. Consent for the use of
private insurance is not required because the Part C required specific
protections are provided by Rhode Island state statutes governing insurance in
Rhode Island. Parents who have insurance plans exempt from RI law are also
afforded the required specific protections under Federal law.
a. Required Protection C.F.R.
§303.520(b) 2(i)
(1) The use of private
health insurance to pay for Part C services cannot count towards or result in a
loss of benefits due to the annual or lifetime health insurance coverage caps
for the infant or toddler with a disability, the parent or the child's family
members who are covered under that health policy.
b. Required Protection C.F.R.
§303.520(b) 2(ii)
(1) The use of private
health insurance to pay for Part C services cannot negatively affect the
availability of health insurance to the infant or toddler with a disability,
the parent, or the child's family members who are covered under that health
policy and health insurance may not be discontinued for these individuals due
to the use of the health insurance to pay for Part C
services.
c. Required
Protection C.F.R. §303.520(b) 2(iii)
(1)
The use of private health insurance to pay for Part C services cannot be the
basis for increasing the health insurance premiums of the infant and toddler
with a disability, the parent, or the child's family members covered under that
health insurance policy.
J. Notification prior to the initial use of
the parent's private insurance is required as well as consent to release
personally identifiable information for billing purposes. Consent to release
personally identifiable information can be revoked at any time without the risk
of losing Early Intervention services.
K. The Use of Public Benefits or Public
Insurance to Pay for Part C Services - Medicaid/RIte Care:
1. The use of public benefits or public
insurance is allowed to pay for Part C services, however the following
provisions must be followed:
a. Parents are
not required to sign up or enroll in a public benefits or public insurance
program as a condition for their child to receive Part C services.
b. Parental notification must be provided
prior to using public benefits or public insurance of a child or parent if that
child or parent is enrolled in a public benefits or public insurance program.
Parental notification must include the following:
(1) A statement that in Rhode Island when
using public insurance, parents have no out-of-pocket costs except for
insurance premiums. Co-pays, co-insurance and deductibles are not charged to
parents.
(2) Consent for disclosure
of personally identifiable information to bill public insurance is not required
because EOHHS administers both Part C and Medicaid.
(3) A statement that parents, who have both
private insurance and public insurance, state Medicaid regulations require the
use of private insurance as the primary insurance.
(4) In Rhode Island, consent is not required
to bill private insurance because of specific protections provided in state
statute and federal law. However, notification prior to the initial use of the
parent's private insurance is required as well as consent to release personally
identifiable information for billing purposes. (For parents with public
insurance, consent to release personally identifiable information was provided
upon enrollment in Medicaid). Consent to release personally identifiable
information can be revoked at any time without the risk of losing Early
Intervention services.
L. If an infant or toddler or parent is
enrolled in a public benefits or public insurance program, written parental
consent is not required because the use of these benefits to pay for Part C
services does not:
1. Decrease available
lifetime coverage or any other insured benefit for the child or parent;
or
2. Result in the child's parents
paying for services that would otherwise be covered by public benefits or
insurance; or
3. Result in any
increase in premiums or cancellation of public benefits or insurance for the
child or parent; or
4. Risk the
loss of eligibility for the child or the child's parents for home and
community-based waivers based on total health-related costs.
5. Prior to the initial use of private or
public insurance, the EI provider must provide families with the following:
a. Procedural safeguards including the right
to participate in mediation; request a due process hearing; or file a state
complaint;
b. Written notice
related to the use of private insurance and Medicaid.
