Current through Register Vol. 25-06, March 15, 2025
(1) A school district may use the medicaid or
other public benefits or insurance programs in which a student participates to
provide or pay for services required under Part B of the act, as permitted
under the public benefits or insurance program, except as provided under
subsection (2) of this section.
(2)
With regard to services required to provide FAPE to an eligible student, the
school district:
(a) May not require parents
to sign up for or enroll in public benefits or insurance programs in order for
their student to receive FAPE under Part B of the act;
(b) May not require parents to incur an
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 part, but may
pay the cost that the parents otherwise would be required to pay;
(c) May not use a student's benefits under a
public benefits or insurance program if that use would:
(i) Decrease available lifetime coverage or
any other insured benefit;
(ii)
Result in the family paying for services that would otherwise be covered by the
public benefits or insurance program and that are required for the student
outside of the time the student is in school;
(iii) Increase premiums or lead to the
discontinuation of benefits or insurance; or
(iv) Risk loss of eligibility for home and
community-based waivers, based on aggregate health-related expenditures;
and
(d) Prior to
accessing a student's or parent's public benefits or insurance for the first
time, and after providing notification to the student's parents consistent with
subsection (3) of this section, the school district must obtain written,
parental consent that:
(i) Meets the
requirements of 34 C.F.R.
Sec. 99.30 and WAC
392-172A-05225, which consent
must specify:
(A) The personally identifiable
information that may be disclosed, such as records or information about the
services that may be provided to a particular student;
(B) The purpose of the disclosure, such as
billing for services under the act; and
(C) The agency to which the disclosure may be
made such as the health care authority; and
(ii) Specifies that the parent understands
and agrees that the public agency may access the parent's or student's public
benefits or insurance to pay for services under the act.
(3) Prior to accessing a student's
or parent's public benefits or insurance for the first time, and annually
thereafter, the school district must provide written notification, consistent
with WAC 392-172A-05010(3)
to the student's parents, that includes:
(a) A statement of the parental consent
provisions in subsection (2)(d)(i) of this section;
(b) A statement of the "no cost" provisions
in subsection (2)(b) and (c) of this section;
(c) A statement that the parents have the
right under 34 C.F.R. Part 99 and WAC 392-172A-05225 to withdraw their consent
to disclosure of their child's personally identifiable information to the
agency responsible for the administration of the state's public benefits or
insurance program at any time; and
(d) A statement that the withdrawal of
consent or refusal to provide consent under 34 C.F.R. Part 99 and WAC
392-172A-05225 to disclose personally identifiable information to the agency
responsible for the administration of the state's public benefits or insurance
program does not relieve the school district of its responsibility to ensure
that all required services are provided at no cost to the parents.
(4) With regard to services
required to provide FAPE to an eligible student under this part, a school
district may access the parents' private insurance proceeds only if the parents
provide consent. Each time the public agency proposes to access the parents'
private insurance proceeds, the school district must:
(a) Obtain parental consent; and
(b) Inform the parents that their refusal to
permit the public agency to access their private insurance does not relieve the
school district of its responsibility to ensure that all required services are
provided at no cost to the parents.
(5)
(a) If
a school district is unable to obtain parental consent to use the parents'
private insurance, or public benefits or insurance when the parents would incur
a cost for a specified service required under this part, to ensure FAPE the
public agency may use its Part B funds to pay for the service.
(b) To avoid financial cost to parents who
otherwise would consent to use private insurance, or public benefits or
insurance if the parents would incur a cost, the school district may use its
Part B funds to pay the cost that the parents otherwise would have to pay to
use the parents' benefits or insurance such as deductible or co-pay
amounts.
(6) Proceeds
from public benefits or insurance or private insurance will not be treated as
program income for purposes of 34 C.F.R. 80.25.
(7) If a school district spends
reimbursements from federal funds such as medicaid, for services under this
part, those funds will not be considered state or local funds for purposes of
the maintenance of effort provisions.
(8) Nothing in this part 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 statute,
regulations or policy under Title XIX, or Title XXI of the Social Security Act,
42 U.S.C. Secs.
1396 through
1396v and
42 U.S.C. Secs.
1397aa through
1397jj, or any other public
benefits or insurance program.
Statutory Authority:
RCW
28A.155.090 and 34 C.F.R. Part 300 . WSR
13-20-034, 392-172A-07005, filed 9/24/13, effective 10/25/13. Statutory
Authority:
RCW
28A.155.090(7) and 42 U.S.C.
1400 et. seq. WSR 07-14-078, 392-172A-07005, filed 6/29/07, effective 7/30/07.
WSR 13-20-001, § 392-172A-07005, filed 9/18/2013, effective
10/19/2013
