New York State Department of Health (NYSDOH) 

OFFICE OF SPECIAL EDUCATION PROGRAMS (OSEP)

FISCAL MONITORING INSTRUMENT (FMI):

FFY 2017

New York State Department of Health (NYSDOH) 

Please note the following abbreviations are used in the Fiscal Monitoring Instrument 

(FMI): 

EI – early intervention 

EIS provider – early intervention service provider 

FFY – Federal fiscal year 

IDEA – Individuals with Disabilities Education Act 

IFSP- indivualized family service plan 

LA – lead agency 

SoP –System of Payments 

Scope of Monitoring: 

OSEP’s IDEA Part C Fiscal Monitoring in 2017 examined implementation by the State lead 

agency (LA) of the State’s: 

(1) System of payments (SoP) as funding sources to pay for the provision of 

IDEA Part C early intervention (EI) services; and 

Regarding the State’s SoP, OSEP examined how the State LA ensures compliance with IDEA 

Part C if the State uses one or more of the following three sources of funding to pay for IDEA 

Part C services: 

(I) Private health insurance; 

(II) Public health insurance benefits; and 

(III) Family Fees. 

In conducting the monitoring, OSEP reviewed the State’s draft1 SoP policies and procedures 

and other related State-submitted documentation. OSEP also conducted virtual monitoring and 

telephone interviews with State LA staff on June 19, 2017 and June 23, 2017. 

 

1

 The State submitted its final SoP policy to OSEP on September 27, 2017. OSEP will respond to the 

State regarding its SoP policy submission under separate cover. 
New York State Department of Health (NYSDOH) 

IDEA Part C 

Summary of Monitoring Criteria 

Monitoring Area 1, IDEA Part C: System of Payments (SoP) 

Under IDEA Part C, a State may establish a SoP to fund early intervention services consistent with 34 CFR §§ 303.13(a)(3) and 

303.203(b). These systems can include cost participation fees (such as co-payments, premiums, or deductibles) required to be paid 

under Federal, State, local or private programs of insurance consistent with 34 CFR §§ 303.520 and 303.521. States must also 

demonstrate compliance with the requirements regarding the use of funds and payor of last resort provisions in 34 CFR § 303.510(a) 

and (b). The focus of this monitoring activity is to examine the State’s implementation of its SoP policies and procedures, where 

applicable. 

Description of State SoP: 

The New York State Early Intervention Program (EIP) is administered by the New York State Department of Health (NYSDOH) 

through its Bureau of Early Intervention.Under New York State Public Health Law (PHL), EI services must be provided at no cost to 

parents and no fees are charged to parents (including co-payments and deductibles). The State’s EI services are paid for using a 

combination of funds including: reimbursement from private and public insurance, local municipality revenue and State general 

revenue. Contracts are in place between the NYSDOH and each county in the State and New York City. Each county coodinates EI 

services at the local level. IDEA Part C funds are not used to pay for EI services in the State, but instead are used for administration 

at the State and county level. New York State Insurance Law provides protections regarding the use of private insurance to pay for 

the IDEA Part C services consistent with 34 CFR § 303.520(b)(2) for State regulated private insurance plans. When a family’s public 

insurance is accessed to pay for EIP services, New York’s Public Health Law and Insurance Law provide protections for families 

consistent with 34 CFR § 303.520(a)(2)(ii). 
New York State Department of Health (NYSDOH) 

Page 3 of 10

I. General Requirements: 

Criterion Number Description

Noncompliance 

identified? Applicable Requirements

Criterion 1.1 The State is implementing its SoP policies and 

procedures consistently with the payor of last resort 

requirements for the use of Part C funds, including 

ensuring that Part C funds are not used for services that 

would have been otherwise paid for from another public 

or private source. 

No 34 CFR §303.510(a) and 

(b).

Criterion 1.2 If families are charged out of pocket costs such as 

copayments, deductibles, or family fees, the State is 

implementing its SoP policies and procedures 

consistently with the State’s:

 definition of inability to pay/ability to pay;

 definition of income, family expenses, and 

extraordinary medical expenses; and

 process for determining ability or inability to pay.

No 34 CFR §303.521(a)(3)
New York State Department of Health (NYSDOH) 

Page 4 of 10

Criterion Number Description

Noncompliance 

identified? Applicable Requirements

Criterion 1.3 The State is implementing its SoP policies and 

procedures consistent with the requirement that fees will 

not be charged to parents for the following services that 

a child is entitled to receive at no cost including;

 child find, evaluations and assessments, service 

coordination services, administrative and 

coordinative activities related to procedural 

safeguards, and the development, review and 

evaluation of individualized family service plans 

(IFSPs) and interim IFSPs.

No 34 CFR §§303.521(a)(4)(i)

and 303.521(b)

Criterion 1.4 The State ensures that the inability of the parents of an 

infant or toddler with a disability to pay for services will 

not result in a delay or denial of Part C services.

No 34 CFR §303.521(a)(4)(ii)

Criterion 1.5 The State ensures that Part C services are not delayed 

or denied to parents or families determined unable to 

pay under the State’s definition of inability to pay.

No 34 CFR § 303.520(c)

Criterion 1.6 The State ensures that parents are provided with

documentation that identifies their procedural safeguard 

options with regard to any disputes for payment for Part 

C services under the State’s SoP.

No 34 CFR §303.521(e)

Finding: 

None. 
New York State Department of Health (NYSDOH) 

Page 5 of 10

II. Use of Private Insurance: 

A State may use private health insurance to pay for IDEA Part C services. If the State uses a parent’s private health insurance, it 

must either: 

(1) have legislation that includes certain protections; or 

(2) obtain prior written parental consent. In a State that has adopted legislation with protections, if a private insurance plan is not 

subject to the statutory protections, the State is still responsible for obtaining prior written parental consent. 

Criterion Number Description

Noncompliance 

identified?

Applicable 

Requirements

Criterion 1.7

For States that do not 

have a 

statute/legislation that 

includes applicable 

protections related to 

accessing private 

insurance, OSEP 

examined how the LA 

is consistently 

implementing the 

consent requirements 

for use of private 

insurance.

The State is ensuring that prior written parental consent 

for the use of private insurance is obtained:

 When the LA and/or its early intervention service 

(EIS) providers, seek to use private insurance to 

pay for the intital provision of an EI service in 

the IFSP;

 Each time consent for services is required due to 

an increase in frequency, length, duration, or 

intensity in the provision of services in the 

child’s IFSP; and

 When the use of private insurance is a 

prerequisite for the use of public benefits or 

insurance.

No 34 CFR §§ 

303.520(b)(1)(i),

303.520(b)(1)(i)(A), 

303.520(b)(1)(i)(B) and 

303.420(a)(3).
New York State Department of Health (NYSDOH) 

Page 6 of 10

Criterion Number Description

Noncompliance 

identified?

Applicable 

Requirements

Criterion 1.7.1

For States whose 

approved SoP included 

a State 

statute/legislation that 

included the applicable 

protections related to 

accessing private 

insurance to pay for EI 

services.

The State has in place legislation to ensure that the 

following protections are in place regarding the use of 

private health insurance:

 The lead agency’s use of private health 

insurance to pay for EI services does not 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 insurance policy;

 The lead agency’s use of private health 

insurance to pay for EI services does not 

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 

insurance policy, and that health insurance 

coverage is not discontinued due to the use of 

the insurance to pay for EI services; and

 The lead agency’s use of private health 

insurance to pay for EI services is not used as a 

basis for increasing the health insurance 

premiums of the infant or toddler with a 

disability, the parent, or the child’s family 

members covered under that health insurance 

policy.

No 34 CFR § 303.520(b)(2)
New York State Department of Health (NYSDOH) 

Page 7 of 10

Criterion Number Description

Noncompliance 

identified?

Applicable 

Requirements

Criterion 1.7.2

For all States 

regarding the use of 

private insurance, 

regardless if the State 

has statute/legislation 

including applicable 

protections.

The State is ensuring that parents are provided a copy 

of the State’s SoP policies either:

 When parental consent is required for the use of 

private insurance, including when the State 

seeks to use the parent’s private insurance to 

pay for the intital provision of an early 

intervention service on an IFSP, and each time 

consent is required due to an increase in the 

provision of services; or

 If a State has a statute that includes certain 

protections, when the State initially uses 

benefits under a child or parent’s private 

insurance policy to pay for EI services.

§303.520(b)(1)(iii)

Finding: 

None. 
New York State Department of Health (NYSDOH) 

Page 8 of 10

III. Use of Public Benefits or Public Health Insurance: 

A State may use public health benefits or public insurance to pay for IDEA Part C services. If the State uses such public benefits or 

insurance, it must: 

(1) obtain prior written parental consent for the use of public benefits or insurance if the child or parent is not already enrolled in 

the program, or if the use of public insurance or benefits would result in certain specified costs; and 

(2) provide written notification to parents prior to using a child’s or parent’s public benefits or insurance, regardless of whether or 

not parental consent is required. 

Criterion Number Description

Noncompliance 

identified?

Applicable 

Requirements

Criterion 1.8 The State ensures compliance with the requirement that

parents cannot be required to sign up for public benefits 

or insurance as a condition of receiving IDEA Part C EI 

services.

No 34 CFR § 303.520(a)(2)(i)

Criterion 1.8.1 The State ensures compliance with the requirement that 

consent must be obtained prior to using a child or 

parent’s public benefits or insurance when that child or 

parent is not already enrolled in the public benefits or 

insurance.

No 34 CFR § 303.520(a)(2)(i)
New York State Department of Health (NYSDOH) 

Page 9 of 10

Criterion Number Description

Noncompliance 

identified?

Applicable 

Requirements

Criterion 1.8.2 The State ensures compliance with consent 

requirements when the use of public insurance or 

benefits to pay for Part C services would result in 

specified costs such as: 

 A decrease in the available lifetime coverage or 

any other insured benefit for that child or parent 

under that program; 

 The child’s parents paying for services that would 

otherwise be covered by the public benefits or 

insurance program;

 Any increase in premiums or discontinuation of 

public benefits or insurance for that child or that 

child’s parents; or risk of loss of eligibility for the 

child or that child’s parents; or

 Loss of eligibility for the child or that child’s 

parents for home and community-based waivers 

based on aggregate health-related 

expenditures). 

No 34 CFR § 

303.520(a)(2)(ii).
New York State Department of Health (NYSDOH) 

Page 10 of 10

Criterion Number Description

Noncompliance 

identified?

Applicable 

Requirements

Criterion 1.8.3 The State ensures that, prior to using a child’s or 

parent’s public insurance to pay for EI services, parents 

are provided with written notification that includes:

 The requirement that parental consent must be 

obtained (where applicable) before the State lead 

agency or EIS provider discloses a child’s 

personally identifiable information (PII) to the 

State public agency responsible for the 

administration of the State’s public benefits or 

insurance program for billing purposes;

 Information about IDEA Part C public 

benefits/insurance no-cost protection provisions;

 Information about the parent’s right to withdraw 

consent for sharing PII (where such consent is 

required); and

 Categories of costs that parents might incur as a 

result of participatating in a public benefits or 

insurance program.

34 CFR §303.520(a)(3) 

and 34 CFR §303.414

Finding: 

None.