Current through Reg. 49, No. 38; September 20, 2024
(a) The parent has the right to:
(1) receive certain early childhood
intervention services at no cost in accordance with
34 CFR §
303.521(b);
(2) refuse any early childhood intervention
services they do not wish to receive;
(3) receive information about any method the
contractor may use to verify the family's allowable deductions;
(4) receive information about the
contractor's process for determining their maximum charge before signing the
family cost share agreement;
(5)
not have their personally identifiable information released for billing
purposes without prior written consent; and
(6) not have their private insurance billed
without prior written consent.
(b) If the family has an inability to pay,
all IDEA Part C services are provided with no out-of-pocket charge to the
parent. The family's inability to pay for early childhood intervention services
will not result in the delay or denial of early childhood intervention services
to the child or the family.
(c) If
the parent disagrees with the contractor's determination of the family's
ability to pay, the calculated adjusted income, or the assigned maximum charge,
the parent can:
(1) request a review by the
contractor manager or program director;
(2) file an informal or formal complaint with
the contractor;
(3) contact the
HHSC Office of the Ombudsman for help resolving a problem or concern with the
contractor;
(4) file a formal
complaint with HHSC , in compliance with
34 CFR §
303.434;
(5) participate in mediation, in compliance
with 34 CFR §
303.431;
and
(6) participate in a due
process hearing, in compliance with
34 CFR §
303.436 or §
303.441,
whichever is applicable.
(d) The contractor must provide the parent a
copy of the ECI Family Cost Share publication before the contractor initially
bills the child's third-party payor to pay for early childhood intervention
services.
(e) The ECI Family Cost
Share publication:
(1) explains the family
cost share process;
(2) describes
the parent's procedural safeguards and related due process rights;
(3) notifies the parent that:
(A) parental consent must be obtained before
the contractor releases personally identifiable information to third-party
payors;
(B) if the parent does not
consent under
34
CFR §
303.520(a)(2),
the contractor must still make available those Part C services on the IFSP to
which the parent has consented;
(C)
the parent has the right to withdraw their consent at any time;
(D) the parent may incur potential costs for
co-pays as a result of using their public insurance and potential costs such as
co-pays, co-insurance, or deductibles as a result of using their private
insurance to pay for early childhood intervention services; and
(E) if the child has private insurance in
addition to Medicaid, the private insurance is the primary payor and must be
billed before filing a claim with Medicaid.
