PUT AWAY THE PANIC BUTTON!
IMPLEMENTING THE NEW
PART C FEDERAL
REGULATIONS IN VIRGINIA
Part 2June 27, 2012
Do you have these forms? If not, please print them before we start -
Family Cost Share Agreement, Temporary Family Cost Share
Agreement, Notice of Child and Family Rights and Safeguards
Including Facts About Family Cost Share, IFSP
http://www.infantva.org/pr-New-Forms-July1.htm#pm
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Code: 463-661-9330#
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What is Your Primary Role in Early Intervention?
A. Local System Manager or Program Administrator
B. Service Coordinator C. EI Service ProviderD. Family Member
What is Your Primary Role in Early Intervention?
A. Local System Manager or Program Administrator
B. Service Coordinator C. EI Service ProviderD. Family Member
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Overview/RemindersNew regulations released
September 2011Must begin implementing
July 1, 2012Virginia prioritizing parent
protectionsHave until June 30, 2013
to have “documents” in place
Regulatio
ns for EI
Program for
Infants and
Toddlers with
Disabilities
numbered 303
Road Map - Regulations
Subpart A-Purpose and Definitions of terms used in the ActSubpart B and C- What states need to have in place for their system of services and assure in order to receive funds (often called the state application)Subpart D- child find, evaluations and assessments and the IFSPSubpart E- Subpart E- Procedural SafeguardsProcedural SafeguardsSubpart F- Subpart F- Use of fundsUse of fundsSubpart G- State interagency coordinating councilSubpart H- State monitoring and enforcement
Procedural Safeguards
Access to RecordsInitial copy of record,
copies of IFSP and ED Form at no cost to family (303.400(c))
10-day timeline when parent requests to review records (303.409(c))
Expansion of what can be maintained in permanent record (303.416(b))
Scavenger Hunt
On what page of the revised Notice of Child and Family Rights and
Safeguards Including Facts About Family Cost Share document does
the information about records start?
a. 9b. 4c. 1
Notice and ConsentIf child not eligible, must be
given prior written notice including parents rights to dispute the eligibility determination (303.322)
Initial notice about confidentiality and records when a child is referred (303.404(d))
Procedures when parent refuses consent to release records (303.414(c))
Surrogate Parents(303.422)
30-day timeline for assigning
Surrogate cannot be a provider of any service to child or family member
Must consult with public agency assigned care of child
Judge may assign surrogate
Administrative Complaints
(303.434)• Must file within 1 year of
alleged violation• What must be included in
complaint has been expanded
• Must forward copy to the agency/provider at same time filed with state
• Can extend timeline for mediation
Due Process Hearing(303.436)
Available to any child referredCopy of transcript, written
copy of findings and decisions at no cost to parent
Either party can request extension
In Virginia: Procedural Safeguards
Revised Notice of Child and Family Rights and Safeguards
Revised Strengthening Partnerships
Minor revisions to some procedural safeguards forms
System of Payments
Blood Pressure Check
How high is your anxiety level as we start talking about system of payment (family cost share requirements)? My blood pressure is …
a.Sky high
b.Slightly above normal
c.Normal
d.Below normal … I feel faint!
Use of Public Insurance
(303.520(a))May not require parents to
enroll in public benefits or insurance program
Must meet consent requirementsChild does not have Medicaid yet
Child has MedicaidRelease of info for billing
Public
insuran
ce =
Medicai
d
No Cost Protections (303.520(a)(ii))Cannot decrease available lifetime
coverage or any other insured benefitCannot result in parents paying for
services that would otherwise be covered by the public benefits or insurance program
Cannot result in increase in premiums or discontinuation of public benefits or insurance
Cannot cause a loss of eligibility for home and community based waivers based on aggregated health related expenses
Use of Public Insurance (cont’d)
(303.520(a))Must provide written
notification to parentsConsent requirements
Categories of costsNo cost protection provisions
Scavenger HuntOn what page of the Notice of Child and
Family Rights and Safeguards Including Facts About Family Cost Share can you
find the information you need to explain to families about use of
Medicaid/FAMIS to pay for EI services?a. 14b. 16c. 13d. 15
Use of Private Insurance
(303.520(b))Must obtain written parental consent: At the initial IFSP At IFSP Review if services increase
Lack of consent cannot result in denial of services if family unable to pay
TRICARE
treated as
private
insurance
in Virginia
Use of Private Insurance (cont’d)
(303.520(b))Copy of policies to
parent when consent is sought
Any cost for use must be included policies
Scavenger HuntOn what page of the Notice of Child and
Family Rights and Safeguards Including Facts About Family Cost Share can you
find the information you need to explain to families about use of private
insurance to pay for EI services?a. 14b. 16c. 13d. 15
Written Policies (303.521)Payment system and
schedule of fessBasis and amount of the feesDefinition of the ability and
inability to pay and a process for determining
Assurance regarding services to be provided at no cost
Provision regarding failure to provide income information
Provision that permits the lead agency to use Part C funding to pay for some costs
Procedural Safeguards (303.521(e))
Written policies must include informing parents of dispute resolution options
Must provide copy of these policies when obtaining consent for services
In Virginia: Intake
Combined Rights document and Facts About Family Cost Share
Revised Facts About Family Cost ShareNotification requirementsNo cost protectionsCosts associated with
private insuranceWritten policies
In Virginia: Before Initial IFSP
Family Cost Share Agreement Form
-OR-Temporary Family
Cost Share Agreement Form
Release of information to bill
Family Cost Share Agreement Form
Family Cost Share Agreement Form
Family Cost Share Agreement Form
Release of Information
Give it a Try
Temporary Family Cost Share Agreement Form
Temporary Family Cost Share Agreement Form
Choose the Correct Form
• Prior to initial IFSP, family chooses not to provide income information and pay full fee
• Prior to initial IFSP, family cannot find tax return in their moving boxes but doesn’t want to delay services
• Temporary Family Cost Share Agreement Form
• Family Cost Share Agreement Form
In Virginia: IFSP Review
Notice of Rights and Safeguards Including Facts About Family Cost Share
Consent for private insurance if services increasingFrequency, length,
durationChange from group to
individual
IFSP - Page 9
When to Use Box on Page 9
1. Child is covered by private insurance
2. Family has consented to use of insurance
3. Services are increasing
In Virginia: Annual IFSP
Notice of Rights and Safeguards Including Facts About Family Cost Share
New Family Cost Share Agreement FormTemporary FCS Form, if needed
The Bottom Line
Already in Place• Consent for Medicaid• Consent for private
insurance at initial and annual
• Written policies• Procedural
safeguards for payment
• Consent to release information for billing
New• Consent for private
insurance when services increase (added to page 9 of IFSP)
• Notification requirements (added to Facts About Family Cost Share)
Blood Pressure Re-Check
Blood pressure
higher or lower
now?
Next Steps
Get electronic forms ready to go
Participate in July regional meetings
Share information with local staff and providers
Next
Steps:
QUESTIONS?