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PART C OF THE INDIVIDUALS WITH DISABILITIES EDUCATION ACT FINAL REGULATIONS NONREGULATORY GUIDANCE - PDF
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1 PART C OF THE INDIVIDUALS WITH DISABILITIES EDUCATION ACT FINAL REGULATIONS NONREGULATORY GUIDANCE NOVEMBER 2011
2 Table of Contents Page A 1: CHANGES IN EARLY INTERVENTION: A SUMMARY OF MAJOR REGULATORY CHANGES FOR PARENTS, EARLY INTERVENTION SERVICE PROVIDERS, AND STATE LEAD AGENCIES A 3: Family Engagement A 3: Child Find/Evaluations and Assessments/Eligibility/Initial IFSP A 6: IFSP Development, Implementation, and Review A 7: Transition (including Part C to Part B)/Exiting Part C A 10: Coordination with Head Start/Early Head Start, Early Education, and Child Care B 1: USE OF PUBLIC BENEFITS OR INSURANCE OR PRIVATE INSURANCE TO PAY FOR PART C SERVICES B 3: Federal Requirements for States to Coordinate Resources for Part C Services, Use Part C Funds as a Payor of Last Resort, and Ensure Methods to Ensure the Provision of, and Financial Responsibility for, Part C Services B 4: Federal Requirements for a State s System of Payments B 7: Treatment of Funds Received under Public Benefits or Insurance, Private Insurance, or Family Fees C 1: CHANGES IN EARLY INTERVENTION: A SUMMARY OF MAJOR REGULATORY CHANGES RELATED TO THE ADMINISTRATIVE RESPONSIBILITES OF STATE LEAD AGENCIES C 3: State Application and Assurances C 9: Federal and State Monitoring and Enforcement C 11: State Interagency Coordinating Council C 12: Procedural Safeguards
3 IDEA PART C FINAL REGULATIONS ISSUED SEPTEMBER 28, 2011 AND EFFECTIVE OCTOBER 28, 2011 CHANGES IN EARLY INTERVENTION: A SUMMARY OF MAJOR REGULATORY CHANGES FOR PARENTS, EARLY INTERVENTION SERVICE PROVIDERS, AND STATE LEAD AGENCIES NON-REGULATORY GUIDANCE November 2011 Office of Special Education Programs Office of Special Education and Rehabilitative Services U.S. Department of Education A - 1
4 PURPOSE OF THIS GUIDANCE This guidance provides parents, early intervention service (EIS) providers, State lead agencies, and other interested parties with detailed information about the some of the changes made to the Individuals with Disabilities Education Act (IDEA or Act) Part C Regulations in 34 CFR Part 303, as those regulations were published in the Federal Register on September 28, 2011 and made effective on October 28, 2011 (Final Regulations). The Final Regulations can be found at The Final Regulations reflect changes made to the IDEA, as amended by the Individuals with Disabilities Education Improvement Act of 2004, and make other necessary changes needed to implement the Early Intervention Program for Infants and Toddlers with Disabilities. This non-regulatory guidance focuses on the following topics where changes were made to regulatory requirements that directly affect infants and toddlers with disabilities and their families and local EIS providers and programs: (1) Family Engagement; (2) Child Find/Evaluations/Assessments/Eligibility/Initial IFSP (Individualized Family Service Plan); (3) IFSP Development, Implementation, and Review; (4) Transition (including Part C to Part B)/Exiting Part C; and (5) Coordination with Head Start/Early Head Start, Early Education, and Child Care programs. This non-regulatory guidance identifies some of the changes made to the Final Regulations in these areas and does not impose additional requirements beyond those required under the IDEA and the Final Regulations. The IDEA, its implementing regulations, and other important documents related to the IDEA and the regulations can be found at A - 2
5 I. Family Engagement The Final Regulations acknowledge the importance of parents and other family members in supporting a child s development. This section identifies the changes made to 34 CFR Part 303 by the Final Regulations as they directly affect the involvement of parents and families of infants and toddlers with disabilities. Section (d)(1)(ii) requires that the family of a toddler with a disability who is served under Part C be included in the development of the transition plan required under (d)(1)(ii) and (h). (See Section IV related to Transition.) Section clarifies that if the lead agency determines, after conducting an evaluation, that a child is not an infant or toddler with a disability, the lead agency must provide the parent with prior written notice, including information about the parent s right to dispute the eligibility determination through the IDEA Part C dispute resolution mechanisms. Section (d) requires the lead agency to provide parents with an initial notice when a child is referred to Part C that informs parents about their rights under the IDEA Part C confidentiality provisions and a summary of the record maintenance, destruction, retention, and storage policies with which participating agencies 1 must comply. Section (a) requires a participating agency to comply with a parent s request to inspect and review the early intervention records of his/her child in no more than 10 days after the parent makes the request. Section (c) requires a participating agency to provide, at no cost to the parent, a copy of each evaluation, assessment of the child, family assessment, and IFSP as soon as possible after each IFSP meeting. Section states the general rule that parental consent is required before a participating agency may disclose personally identifiable information under the IDEA Part C regulations and identifies (rather than incorporating by reference) the IDEA-specific and FERPA-related exceptions to this rule. II. Child Find/Evaluations and Assessments/Eligibility/Initial IFSP 1 Participating agency means any individual, agency, entity, or institution that collects, maintains, or uses personally identifiable information to implement the requirements in Part C of the Act and the Part C regulations with respect to a particular child. A participating agency includes the lead agency and EIS providers, but does not include primary referral sources, or those public agencies or private entities that act solely as funding sources for Part C services. A - 3
6 Section identifies the major components of the statewide comprehensive, coordinated, multidisciplinary interagency system by specifically distinguishing between pre-referral activities (public awareness and child find), referral, and post-referral IFSP activities (including screening; evaluations; assessments; and IFSP development, review, and implementation). This section identifies the changes made to 34 CFR Part 303 by the Final Regulations as they directly affect these major component areas. Child Find Section clarifies that the central directory of early intervention services in the State must be accessible to the general public (i.e., through the lead agency s Web site and other appropriate means) and include accurate, up-to-date information about early intervention services, professional and other groups that provide services to infants and toddlers with disabilities, and research and demonstration projects being conducted in the State relating to infants and toddlers with disabilities. Section (c) requires each lead agency to inform parents of toddlers served under Part C about preschool programs under section 619 of the Act as part of the transition requirements when a child exits the Part C program; that information must be provided not fewer than 90 days prior to the toddler s third birthday. Section (c) requires the State to ensure that the child find system is coordinated with specific agencies, including the following State agencies (in addition to those long-referenced in 34 CFR Part 303): the State agency responsible for administering the Child Abuse Prevention and Treatment Act (CAPTA), the State Early Hearing Detection and Intervention (EHDI) system, the Home Visiting program under Maternal and Child Health (MCH-Title V), Child Care programs, and the Children s Health Insurance Program (CHIP). Section (a)(2)(i) requires primary referral sources to refer a child to the Part C program as soon as possible but in no case more than seven days after identification. Section requires that, within 45 days after the lead agency or EIS provider receives a referral of a child, the screening (if applicable), initial evaluation, initial assessments (of the child and family), and the initial IFSP meeting for that child must be completed (45-day timeline). Screening Section adds new screening procedures and confirms that such screening procedures are not required under the Act; rather, using screening procedures is an option that a State may choose to include as a part of its comprehensive child find system. A - 4
7 Under (a)(1)(i), the State must provide the parent with prior written notice of its intent to screen the child to determine whether the child is suspected of having a disability and obtain parental consent before administering the screening. That notice must explain the parent s right to request an evaluation at any time during the screening process. Section (a)(1) requires the State to obtain parental consent prior to administering any screening procedures that the State elects to adopt under IDEA Part C. Section (a)(2) requires the State to provide notice of the screening results to the parent and, if the screening results indicate that the child is suspected of having a disability, the State must conduct an evaluation after obtaining parental consent. Evaluations and Assessments Section (b)(2) adds an exception to the 45-day timeline. If a parent has not provided consent to the initial screening, evaluation, or assessment of a child, despite documented, repeated attempts to obtain parental consent, the lead agency must complete the initial evaluation, assessments, and IFSP meeting as soon as possible after parental consent is obtained. Section (a)(2)(i) clarifies that the term initial evaluation refers to the evaluation of a child that is used to determine his or her initial eligibility for services under Part C of the Act. Section (a)(2)(iii) clarifies that the term initial assessments refers to the assessment of the child and the family assessment that are conducted prior to the child s first IFSP meeting. The definition of multidisciplinary in requires the IFSP Team to include the parent and at least two individuals from separate disciplines or professions, and one of these individuals must be the service coordinator. Sections (a) and (a)(5) and (a)(6) clarify that when conducting evaluations and assessments, the native language for a child who is limited English proficient is the language of the child s parents but that it may be the language of the child, if determined developmentally appropriate by the qualified personnel conducting the evaluation and assessment. In the definition of native language in (a), the term limited English proficient (LEP) has the same meaning as in IDEA section 602(18), which crossreferences the same term in section 9101 of the Elementary and Secondary Education Act of 1965, as amended (ESEA). A - 5
8 Eligibility Section adds a definition for at-risk infant or toddler. An at-risk infant or toddler is a child less than three years of age who would be at risk of experiencing a substantial developmental delay if early intervention services were not provided to the child. A State may expand the definition to include a child who is at risk of experiencing developmental delays because of biological or environmental factors that can be identified. Section (a)(2) provides the following examples of infants or toddlers with disabilities who have a diagnosed physical or mental condition that has a high probability of resulting in developmental delays: chromosomal abnormalities; severe attachment disorders; disorders secondary to exposure to toxic substances, including fetal alcohol syndrome; genetic or congenital disorders; sensory impairments; inborn errors of metabolism; congenital infections; and disorders reflecting disturbance of the development of the nervous system. Section requires each State to provide a rigorous definition of developmental delay that will be used by the State in carrying out programs under Part C in order to appropriately identify infants and toddlers with disabilities who are in need of services under Part C. Section requires each State to include its definition of developmental delay in the State s IDEA Part C grant application. III. IFSP Development, Implementation, and Review This section identifies the changes made to 34 CFR Part 303 by the Final Regulations as they directly affect IFSP development, implementation, and review. Section defines qualified personnel as personnel who have met Stateapproved or State-recognized certification, licensing, registration, or other comparable requirements that apply to the areas in which the individuals are conducting evaluations or assessments or providing early intervention services. Section provides that scientifically based research has the meaning given the term in section 9101(37) of the ESEA. 2 2 The term scientifically based research under the ESEA (A) means research that involves the application of rigorous, systematic, and objective procedures to obtain reliable and valid knowledge relevant to education activities and programs; and A - 6
9 Section provides that service coordination (in addition to the other functions and duties that have been longstanding in 34 CFR Part 303) includes (a) conducting follow-up activities to determine that appropriate early intervention services are provided ( (b)(7)) and (b) coordinating funding sources for early intervention services required under Part C ( (b)(9)). Service coordinators are no longer required to coordinate funding for other services identified in the IFSP, but not required to be provided, under Part C. IV. Transition (including Part C to Part B)/Exiting Part C Transition services are those services that assist a toddler with a disability and his or her family to experience a smooth and effective transition from the early intervention program under Part C to the child s next program or other appropriate services, including services that may be identified for a child who is no longer eligible to receive Part C or Part B services. This section identifies the changes made to 34 CFR Part 303 by the Final Regulations as they directly affect the transition of children exiting the Part C program. Application Requirements: Intra-agency and Interagency Agreements and Opt- Out Policy Section (a)(3) requires that all lead agencies, including those in which the State educational agency (SEA) is the lead agency, to establish an interagency or an intra-agency agreement between the early intervention program under Part C of the Act and the preschool program under section 619 of Part B of the Act. (Previously, the State lead agency was only required to establish and submit an interagency agreement if it was not also the SEA responsible for administering the Part B preschool program under IDEA section 619.) Section (a)(3)(ii) requires that interagency and intra-agency agreements include specific IDEA Part B and C transition requirements. Section (e) permits the State to adopt an opt-out policy that requires EIS providers to inform parents of a toddler with a disability of the intended disclosure of (B) includes research that (i) employs systematic, empirical methods that draw on observation or experiment; (ii) involves rigorous data analyses that are adequate to test the stated hypotheses and justify the general conclusions drawn; (iii) relies on measurements or observational methods that provide reliable and valid data across evaluators and observers, across multiple measurements and observations, and across studies by the same or different investigators; (iv) is evaluated using experimental or quasi-experimental designs in which individuals, entities, programs, or activities are assigned to different conditions and with appropriate controls to evaluate the effects of the condition of interest, with a preference for random-assignment experiments, or other designs to the extent that those designs contain within-condition or across-condition controls; (v) ensures that experimental studies are presented in sufficient detail and clarity to allow for replication or, at a minimum, offer the opportunity to build systematically on their findings; and (vi) has been accepted by a peer-reviewed journal or approved by a panel of independent experts through a comparably rigorous, objective, and scientific review. (20 U.S.C. 7801) A - 7
10 personally identifiable information (child s name, child s date of birth, and parent contact information) to the SEA and the local educational agency (LEA) where the child resides and allows the parents a specified time period to object to the disclosure in writing. Transition Notification Section (b)(1)(i) requires LEA/SEA Notification: For children exiting Part C and potentially eligible for Part B services, the lead agency must notify, not fewer than 90 days before the toddler's third birthday, the SEA and the LEA for the area where the toddler resides that the toddler on his or her third birthday will reach the age of eligibility for services under Part B of the Act, as determined in accordance with State law. Sections (b)(1) and require that the LEA/SEA Notification include the child s name, date of birth, and parent contact information. Section (b)(1)(ii) clarifies that if the lead agency determines a child to be eligible for Part C early intervention services between 45 and 90 days prior to the toddler s third birthday, the lead agency must provide the LEA/SEA Notification as soon as possible after the toddler s eligibility determination. Section (b)(1)(iii) provides that if a child is referred to the lead agency fewer than 45 days before that toddler s third birthday, the lead agency is not required to conduct the initial evaluation, assessment, or IFSP meeting, and if that child may be eligible for preschool services or other services under Part B of the Act, the lead agency, with parental consent, required under , must refer the toddler to the SEA and appropriate LEA. Section (b)(2) requires the State to ensure that the LEA/SEA Notification is consistent with any opt-out policy that the State has adopted, which would permit a parent to object to disclosure of personally identifiable information. Transition Conference and Meeting Section (c) clarifies that, for a child exiting Part C, the transition conference must be held, with family approval, at least 90 days and not more than nine months prior to the toddler s third birthday for children potentially eligible for Part B services. Section (e) clarifies that a transition conference or meeting to develop the transition plan must meet the IFSP meeting requirements and that this conference and the IFSP meeting may be combined. A - 8
11 Transition Plan Section (d)(2) clarifies that the transition plan be included in the IFSP. Section (d)(2) requires that a transition plan be established in a child s IFSP not fewer than 90 days (and at the discretion of all parties, not more than 9 months) before a toddler s third birthday. Section (d)(3) requires the transition plan to include steps for the toddler with a disability and his or her family to exit from the Part C program ( (d)(3)(i)) and any transition services that the IFSP team identifies as needed by that toddler and his or her family ( (d)(3)(ii)). Section (h) clarifies that the steps included in the IFSP must support transition to one of the following: preschool services under Part B of the Act; early education, Head Start, Early Head Start, or child care programs; other appropriate services or, for children participating under a State s option in to provide early intervention services to children beyond age three, to preschool services, kindergarten, or elementary school. Serving Children Ages Three and Older Section allows each State to develop and implement a policy under which parents of children who are receiving early intervention services and who are eligible to receive services under section 619 of Part B of the Act can choose for these children to continue receiving early intervention services under Part C of the Act. At the State s option, early intervention services could be available to these children beyond age three until they enter, or are eligible under State law to enter, kindergarten. Section (b)(1), requires parents whose child is receiving services beyond age three under to be provided an annual notice of procedural safeguards. Section (b)(3) clarifies that parents whose child is receiving services under Part C past the age of three retain the right, at any time, to opt-out of these early intervention services and, instead, to obtain a free appropriate public education (FAPE) under Part B of the Act for their child. Section (b)(4) clarifies that the lead agency must continue to provide all early intervention services identified in the IFSP under (and consented to by the parent under (e)) beyond age three until that toddler s initial eligibility determination under Part B of the Act is made under 34 CFR Section (b)(5) requires the lead agency to obtain informed consent from A - 9
12 the parent of any child with a disability for the continuation of early intervention services for that child. Consent must be obtained before the child reaches three years of age, where practicable. In a State that elects to offer Part C services to children ages three and older, (f) and (b)(6) clarify when and what transition requirements in apply to toddlers with disabilities at age three and to children receiving services under as they transition to preschool, kindergarten, or elementary school. V. Coordination with Head Start/Early Head Start, Early Education, and Child Care The U.S. Department of Education is committed to helping States transform early learning programs and services into integrated early learning systems that focus on improving the health (including physical), social, emotional, communication, adaptive, and cognitive outcomes of children through collaborative efforts with participating agencies. Section (a) requires each State application for IDEA Part C funds to include a description of the State s efforts to promote collaboration among Head Start, Early Head Start, early education, and child care programs, and services under Part C. Section (b) requires all State lead agencies to participate on the Head Start State Advisory Council on Early Childhood Education and Care established under the Head Start Act. Section (c) permits the State Interagency Coordinating Council to coordinate and collaborate with the State Advisory Council on Early Childhood Education and Care for children, as described in section 642B(b)(1)(A)(i) of the Head Start Act, 42 U.S.C. 9837b(b)(1)(A)(i), if applicable, and other State interagency early learning initiatives, as appropriate. A - 10
13 IDEA PART C FINAL REGULATIONS PUBLISHED SEPTEMBER 28, 2011 AND EFFECTIVE OCTOBER 28, 2011 USE OF PUBLIC BENEFITS OR INSURANCE OR PRIVATE INSURANCE TO PAY FOR PART C SERVICES NON-REGULATORY GUIDANCE November 2011 Office of Special Education Programs Office of Special Education and Rehabilitative Services U.S. Department of Education B - 1
14 PURPOSE OF THIS GUIDANCE This guidance provides parents, early intervention service (EIS) providers, State lead agencies, and other interested parties with detailed information about some of the changes made to the Individuals with Disabilities Education Act (IDEA or Act) Part C Regulations in 34 CFR Part 303, as those regulations were published in the Federal Register on September 28, 2011, and made effective on October 28, 2011, (Final Regulations). The Final Regulations can be found at The Final Regulations reflect changes made to the IDEA, as amended by the Individuals with Disabilities Education Improvement Act of 2004, and make other necessary changes needed to implement the Early Intervention Program for Infants and Toddlers with Disabilities. This non-regulatory guidance focuses on State responsibilities and parents rights regarding the use of different funding sources to pay for Part C services, including public benefits or insurance, private insurance, and family fees, if the State elects to use such funding sources. It includes information regarding parental consent and notification requirements prior to a State s use of a child s or parent s public or private insurance, the State option to implement a system of payments for Part C services, and State requirements to have in place methods (such as a State statute or regulation or interagency agreement or other appropriate written methods) to ensure the timely provision of, and payment for, Part C services. This non-regulatory guidance describes the regulatory changes reflected in the Final Regulations and does not impose additional requirements beyond those required under the IDEA and the Final Regulations. The IDEA, its implementing regulations, and other important documents related to the IDEA and the regulations can be found at B - 2
15 The Department has revised the Part C regulations regarding the use of public benefits or insurance (e.g., Medicaid) and private insurance to pay for Part C services. IDEA sections 635(a)(10)(A) and 640 require States to use Federal IDEA Part C funds as a payor of last resort and to identify and coordinate all available funding resources to pay for Part C services. Additionally, IDEA section 632(4)(B) requires Part C services to be provided at no cost unless a State has adopted a system of payments for Part C services, which system can include use of public benefits or insurance or private insurance or costs to parents for some services (e.g., speech, physical, or occupational therapy). 1 A system of payments is the State s written policy regarding the costs parents and children may incur for receipt of Part C services and may include use of public or private insurance or a sliding fee scale. The Part C regulations provide the following important protections for parents of infants and toddlers with disabilities when States use public benefits or insurance or private insurance to pay for Part C services. I. Federal Requirements for States to Coordinate Resources for Part C Services, Use Part C Funds as a Payor of Last Resort, and Ensure Methods to Ensure the Provision of, and Financial Responsibility for, Part C Services Section (b) requires each State lead agency to identify and coordinate all available resources to pay for early intervention services, including Federal, State, local, and private sources. Section requires the State to provide a certification with its application that its methods under and contracts with EIS providers are current as of the date of submission of the application and reflect the applicable requirements in Subpart F of the Part C regulations (which include use of funds, payor of last resort, and system of payments requirements). Section sets forth the permissive uses of Federal IDEA Part C funds by lead agencies. Section requires Federal IDEA Part C funds to be used as a payor of last resort. Section requires the State to have methods in place that define the financial and service responsibility of each State-level agency that provides or pays for Part C services. Section (a)(2) and (b) requires that the State s methods be embodied in a State statute or regulation or interagency agreement or other appropriate written method that is submitted with the State s IDEA Part C grant application and approved by the Secretary of the U.S. Department of Education. 1 Section (b) lists those required functions of the lead agency, which the lead agency must make available and for which fees may not be charged. These required functions are child find, evaluation and assessment, service coordination, the development and review of the IFSP, and implementation of the procedural safeguards. B - 3
16 Section requires that the State s methods must include: Procedures for the timely resolution of any interagency or intragency disputes related to the payment for Part C services ( (c)). A method to ensure that Part C services are not delayed or denied to an eligible child or family because of disputes between agencies ( (d)). II. Federal Requirements for a State s System of Payments Section (a)(3) defines early intervention services under IDEA Part C as services provided at no cost, unless, the State has implemented policies establishing a system of payments by families in accordance with and , including a schedule of sliding fees. Section permits a State to develop policies that may result in a cost to the family to participate in the State s Part C system. A State may include a range of funding sources to pay for Part C services including: the child s or parent s public benefits or insurance the child s or parent s private insurance co-payments deductibles direct payment such as through a sliding fee scale or a cost participation schedule. Sections and clarify the requirements for a State s system of payments policies (i.e., using sources such as public benefits or insurance or private insurance, and family fees) to pay for Part C services. Under (a), the State s system of payments policies must be in writing and specify which functions or services are subject to the system of payments. Section (c) provides that if the State has a State law requiring the provision of a free appropriate public education (FAPE) for, or uses Part B funds to serve, an infant or toddler with a disability under the age of three (or any subset of infants and toddlers with disabilities under the age of three), the State may not charge the parents of the infant or toddler with a disability for any Part C services that constitute FAPE for that infant or toddler and the child s family, and those FAPE services must meet the requirements of both Parts B and C of the IDEA. A. Use of Family Fees or Cost Participation to Pay for IDEA Part C Services Under (a) the State s system of payments for family fee policies must also include: The payment system and schedule of sliding or cost participation fees (co-payments or deductibles) that may be charged to the parent for Part C services. The base and amount of payments or fees. B - 4
17 The State s definition of ability to pay and its definition of inability to pay, and how the State makes the determination of the ability or inability to pay. The State s procedural safeguard rights for children and families under the State s system of payments. Provisions stating that failure to provide the requisite income information may result in a charge of a fee as indicated on the fee schedule and specifying the fee to be charged. Provisions that permit, but do not require, the lead agency to use Federal IDEA Part C funds or other funds to pay for out-of-pocket costs such as premiums, deductibles, or copayments. Under (a)(4), the State must provide assurances that: Families will not be charged for the cost of those required functions specified in (b), including service coordination, child find, evaluations and assessments, Individualized Family Service Plan (IFSP) development, and implementation of procedural safeguards. The inability to pay for services will not result in a delay or denial of Part C services. If the parent or family meets the State s definition of inability to pay, all Part C services must be provided at no cost to the child or parent. Families will not be charged an amount that exceeds the actual cost of providing a particular Part C service. Families with public benefits or insurance or private insurance will not be charged disproportionately more than families who do not have public insurance or benefits or private insurance. B. Use of Public Benefits or Insurance to Pay for IDEA Part C Services Under (a)(2)(ii), the State may not require parents to sign up for or enroll in a public benefits or insurance program as a condition for their child to receive Part C services and the State must obtain parental consent prior to using the public benefits or insurance of a child or parent if that child or parent is not already enrolled in a public benefits or insurance program. Section (a)(2)(ii) requires the State to obtain parental consent to use a child s or parent s public benefits or insurance if the child or parent is already enrolled in such a program and use of such benefits or insurance to pay for Part C services would: Decrease available lifetime coverage or any other insured benefit for the child or parent. Result in the child s parents paying for services that would otherwise have been paid for by the public benefits or insurance program. Result in any increase in premiums or cancellation of public benefits or insurance for the child or parents. Risk the loss of eligibility for the child or the child s parents for home and community-based waivers based on total health-related costs. Section (a)(2)(iii) also provides that if the parent does not provide consent for the use of the child s or parent s public benefits or insurance when such consent is required B - 5
18 (i.e., the child or parent is already enrolled and one of the no-cost protections cited above applies or if the child or parent is not enrolled in such a program), the State lead agency must still make all Part C services on the IFSP available to the child and family, subject to any State s system of payments, if applicable. When the State uses a child s or parent s public benefits or insurance to pay for Part C services (regardless of whether consent is required), the State must provide a notification to the parent, which must include: A statement that parental consent is required under (if applicable) before the Part C lead agency or EIS provider discloses, for billing purposes, a child s personally identifiable information to the State agency responsible for administering the State s public benefits or insurance program ( (a)(3)(i)). Note that parental consent is not required under , when the State lead agency is the same agency that administers the public benefits or insurance program unless the State lead agency chooses to require parental consent even if the State lead agency is the Medicaid or public benefits or insurance agency. A statement that parents have the right to withdraw their consent to disclosure of personally identifiable information to the State agency responsible for administration of the State s public benefits or insurance program at any time ( (a)(3)(iii)). A statement of the general categories of costs to parents for participating in the public benefits or insurance program (such as co-payments or deductibles or the required use of private insurance as the primary insurance) ( (a)(3)(iv)). If the general costs are not identified in the notification, the State cannot charge those costs to the parent ( (a)(4)). C. Use of Private Insurance to Pay for IDEA Part C Services Section (b)(1) clarifies that parental consent is required for the use of a parent s private insurance to pay for Part C services unless the exception in (b)(2) applies. Section (b)(1) provides that parental consent must be obtained when the lead agency or EIS provider seeks to use the parent s private insurance or benefits to pay for the initial provision of an early intervention service in the IFSP; and each time consent for services is required under (a)(3) due to an increase (in frequency, length, duration, or intensity) in the provision of services in the child s IFSP. Section (b)(2) clarifies that parental consent is not required when a State has enacted a State statute regarding private health insurance coverage for Part C services that expressly provides that the use of private health insurance to pay for Part C services: Cannot count towards or result in a loss of benefits due to the annual or lifetime health insurance coverage caps for the child, the parent, or the child s family members who are covered under that health insurance policy; B - 6
19 Cannot negatively affect the availability of health insurance to the child with a disability, the parent, or the child s family members who are covered under that health insurance policy; and health insurance coverage may not be discontinued for these individuals due to the use of private health insurance to pay for Part C services; and Cannot be the basis for increasing the health insurance premiums of the child with a disability, the parent, or the child s family members covered under that health insurance policy. Under (b)(1)(ii), if a State requires a parent to use private insurance to pay for Part C services and that use results in a cost to the parent (such as co-payments, deductibles), those general types of costs must be included in the State s system of payments or the State may not charge those costs to parents. Under (b)(1)(iii), the State must provide a copy to the parent of its system of payment policies that identify the potential costs that the parents may incur as a result of the use of their private insurance to pay for Part C services. D. Procedural Safeguards Section (e)(1) provides that a State s system of payments must include written policies to inform parents that a parent who wishes to contest the imposition of a fee, or the State s determination of the parent s ability to pay, may do one or more of the following: Participate in mediation in accordance with Request a due process hearing under or , whichever is applicable File a State complaint under Use any other procedure established by the State for the speedy resolution of financial claims, provided that such use does not delay or deny the parent s procedural rights, including the right to pursue, in a timely manner, the options described above. Section (e)(2) provides that a State must inform parents of these procedural safeguard options by either: Providing parents with a copy of the State s system of payments policies when obtaining consent for provision of early intervention services under (a)(3); or Including this information with the notice provided to parents under III. Treatment of Funds Received under Public Benefits or Insurance, Private Insurance, or Family Fees A. Treatment of Funds for Purposes of Program Income B - 7
20 Public Benefits or Insurance or Private Insurance: Section (d)(1) provides that proceeds or funds from public benefits or insurance or from private insurance are not treated as program income for purposes of 34 CFR Family Fees: Sections (e) and (d)(1) provide that funds or fees or costs collected from a parent or the child s family or received by the State from a parent or family member under the State s system of payments established under are considered program income under 34 CFR These funds--(1) are not deducted from the total allowable costs charged under Part C of the IDEA (as set forth in 34 CFR 80.25(g)(1)); and (2) must be used for the State s Part C early intervention services program, consistent with 34 CFR 80.25(g)(2). B. Treatment of Funds for Purposes of IDEA Part C Maintenance of Effort/Nonsupplanting Requirements Federal Funds: Section (d)(2) provides that if the State receives reimbursements from Federal funds (e.g., Medicaid reimbursements attributable directly to Federal funds) for Part C services, those funds are considered neither State nor local funds for maintenance of effort (MOE) purposes under (b). Private Insurance: Section (d)(3) provides that if the State spends funds from private insurance for services, those funds are considered neither State nor local funds for MOE purposes under Section (b)(3) provides that if a State has enacted a State statute that meets the requirements in (b)(2), regarding the use of private health insurance coverage to pay for early intervention services under Part C of the IDEA, the State may reestablish a new baseline of State and local expenditures under (b) in the next Federal fiscal year following the effective date of the statute. Family Fees: Sections (e) and (d)(2) provide that funds received by the State from a parent or family member under the State s system of payments established under are considered program income under 34 CFR These funds are considered neither State nor local funds for MOE purposes under (b). B - 8