Virginia Administrative Code
Title 8 - EDUCATION
Agency 20 - STATE BOARD OF EDUCATION
Chapter 81 - REGULATIONS GOVERNING SPECIAL EDUCATION PROGRAMS FOR CHILDREN WITH DISABILITIES IN VIRGINIA
Part IV - Funding
Section 8VAC20-81-300 - Use of public and private insurance
Universal Citation: 8 VA Admin Code 20-81-300
Current through Register Vol. 40, No. 16, March 25, 2024
A. Children with disabilities who are covered by public benefits or insurance. ( 34 CFR 300.154(d) )
1. A local educational agency may use
Medicaid or other public benefits or insurance programs in which a child
participates to provide or pay for services required under this chapter and as
permitted under the public benefits or insurance program except as provided in
subdivision 2 of this subsection.
2. With regard to services required to
provide a free appropriate public education to an eligible child with a
disability, a local educational agency:
a.
Shall provide notice to the parent(s) that the local educational agency:
(1) May not require the parent(s) to sign up
for or enroll in public benefits or insurance programs in order for their child
to receive a free appropriate public education;
(2) May not require the parent(s) to incur
any out-of-pocket expense, such as the payment of a deductible or co-pay amount
incurred in filing a claim for services provided pursuant to this section, but
in accordance with subsection C of this section may pay the cost that the
parent(s) otherwise would be required to pay; and
(3) May not use a child's benefits under a
public benefits or insurance program if that use would:
(a) Decrease available lifetime coverage or
any other insured benefit;
(b)
Result in the family's paying for services that would otherwise be covered by
the public benefits or insurance program and that are required for the child
outside of the time the child is in school;
(c) Increase premiums or lead to the
discontinuation of benefits insurance; or
(d) Risk loss of eligibility for home and
community-based waivers, based on aggregate health-related
expenditures.
b. Shall obtain informed parental consent
each time that access to public benefits or insurance is sought, including
parental consent to release educational information to the public benefits of
insurance program for billing purposes in accordance with the provisions of the
Management of the Student's Scholastic Record in the Public Schools of Virginia
(8VAC20-150); and
c. Shall provide
notice to the parent(s) that refusal to allow access to their public benefits
or insurance does not relieve the local educational agency of its
responsibility to ensure that all required services are provided at no cost to
the parent(s).
B. Children with disabilities who are covered by private insurance. ( 34 CFR 300.154(e) )
1. With regard to services required to
provide a free appropriate public education to an eligible child under this
chapter, a local educational agency may access a parent's private insurance
proceeds only if the parent provides informed consent.
2. Each time the local educational agency
proposes to access a parent's private insurance proceeds, it shall:
a. Obtain informed parental consent,
including parental consent to release educational information to the private
insurance program for billing purposes in accordance with the provisions of the
Management of the Student's Scholastic Record in the Public Schools of Virginia
(8VAC20-150); and
b. Inform the
parent(s) that the refusal to permit the local educational agency to access
their private insurance does not relieve the local educational agency of its
responsibility to ensure that all required services are provided at no cost to
the parent(s).
C. Use of Part B funds. ( 34 CFR 300.154(f) )
1. If a local educational agency is unable to
obtain parental consent to use the parent's private insurance, or public
benefits or insurance when the parent(s) would incur a cost for a specified
service required under this chapter to ensure a free appropriate public
education, the local educational agency may use its Part B funds under the Act
to pay for the service.
2. To avoid
financial cost to a parent who otherwise would consent to use private
insurance, or public benefits or insurance if the parent would incur a cost,
the local educational agency may use its Part B funds to pay the costs the
parent otherwise would have to pay to use the parent's benefits or insurance
(e.g., deductible or co-pay amounts).
D. Proceeds from public or private insurance. ( 34 CFR 80.25 and 34 CFR 300.154(g) )
1. Proceeds from public benefits or insurance
or private insurance is not treated as program income for purposes of the
Education Department General Administrative Regulations.
2. If a local educational agency spends
reimbursements from federal funds (e.g., Medicaid) for services under this
chapter, those funds are not considered state or local funds for purposes of
the maintenance of effort provisions.
E. Nothing in this chapter should be construed to alter the requirements imposed on a state Medicaid agency or any other agency administering a public benefits or insurance program by federal law, regulations, or policy under Title XIX or Title XXI of the Social Security Act, or any other public benefits or insurance program. ( 34 CFR 300.154(h) )
Statutory Authority
§§ 22.1-16 and 22.1-214 of the Code of Virginia; 20 USC § 1400 et seq.; 34 CFR Part 300.
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