Iowa Administrative Code › Agency 281 - Education Department › Title XVIII - Early Childhood › Chapter 120 - Early Access Integrated System of Early Intervention Services › Rule 281-120.520 - Policies Related to Use of Public Benefits or Insurance or Private Insurance to Pay for Early Access Services

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Use of
				public benefits or public insurance to pay for Early ACCESS services.
a. The state may not use the public benefits
				or insurance of a child or parent to pay for Part C services unless the state
				provides written notification, consistent with paragraph
				120.521(1)
"c,"
to the child's parents, and the state meets the
				no-cost protections identified in paragraph 120.520(1)
"b."
b. With regard to the state's
				using the public benefits or insurance of a child or parent to pay for Part C
				services, the state:
(1) May not require a
				parent to sign up for or enroll in public benefits or insurance programs as a
				condition of receiving Part C services and must obtain consent prior to using
				the public benefits or insurance of a child or parent if that child or parent
				is not already enrolled in such a program;
(2) Must obtain consent, consistent with rule
				281-120.7 ( 34CFR303) and
				subrule 120.420(1), to use a child's or parent's public benefits or insurance
				to pay for Part C services if that use would:
1. Decrease available lifetime coverage or
				any other insured benefit for that child or parent under that
				program;
2. Result in the child's
				parents paying for services that would otherwise be covered by the public
				benefits or insurance program;
3.
				Result in any increase in premiums or discontinuation of public benefits or
				insurance for that child or that child's parents; or
4. Risk loss of eligibility for the child or
				that child's parents for home- and community-based waivers based on aggregate
				health-related expenditures.
(3) If the parent does not provide consent
				under paragraph 120.520(1)
"b,"
the state must still make
				available those Part C services on the IFSP to which the parent has provided
				consent.
c. Prior to the
				state's using a child's or parent's public benefits or insurance to pay for
				Part C services, the state must provide written notification to the child's
				parents. The notification must include:
(1) A
				statement that parental consent must be obtained under rule
				281-120.414 ( 34CFR303), if
				that rule applies, before the department or EIS provider discloses, for billing
				purposes, a child's personally identifiable information to the department of
				health and human services, the state public agency responsible for the
				administration of the state's public benefits or insurance program (e.g.,
				Medicaid);
(2) A statement of the
				no-cost protection provisions in subrule 120.520(1) and that if the parent does
				not provide the consent under that subrule, the agency must still make
				available those Part C services on the IFSP for which the parent has provided
				consent;
(3) A statement that the
				parents have the right under rule 281-120.414( 34CFR303), if that rule
				applies, to withdraw their consent to disclosure of personally identifiable
				information to the department of health and human services, the state public
				agency responsible for the administration of the state's public benefits or
				insurance program (e.g., Medicaid) at any time; and
(4) A statement of the general categories of
				costs that the parent would incur as a result of participating in a public
				benefits or insurance program (such as copayments or deductibles, or the
				required use of private insurance as the primary
				insurance).
d. If a state
				requires a parent to pay any costs that the parent would incur as a result of
				the state's using a child's or parent's public benefits or insurance to pay for
				Part C services (such as copayments or deductibles, or the required use of
				private insurance as the primary insurance), those costs must be identified in
				the state's system of payments policies under rule
				281-120.521 ( 34CFR303) and
				included in the notification provided to the parent under paragraph
				120.520(1)
"c"
; otherwise, the state cannot charge those costs
				to the parent.