Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part IX - Developmental Disabilities Services › Chapter 3 - Infant Intervention Services › Section IX-334 - System of Payments

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				department shall have the authority to establish a statewide system of payments
				in accordance with  34 CFR part 303.
B. In implementing the system of payments:
1. the department establishes a schedule of
				monthly cost participation for early intervention services per qualifying
				family. Cost participation sh all be based on a sliding scale;
2. application of the familys cost share
				using the sliding scale will include the familys adjusted gross income, family
				size, financial hardship, extraordinary expenses associated with the eligible
				child, and Medicaid eligibility;
a.
				extraordinary expenses may include but are not limited to unreimbursed medical
				expenses, equipment, home modifications, or other costs associated with the
				child with a disability;
b.
				extraordinary expenses must have been incurred during the calendar year that
				the familys cost share for individualized family services plan (IFSP) services
				is applied;
c. the family will be
				required to produce invoices, receipts, or other documents which establish the
				costs and payment for these expenses;
d. the family may request a reassessment of
				their costs based on extraordinary expenses at any time if there are
				significant changes affecting the determination of the cost participation
				amount. The request will be in writing and submitted to the service
				coordinator;
e. the request for
				reassessment will be considered by the designated EarlySteps office for a
				determination of the familys request. The family and the service coordinator
				will receive the departments written response;
3. the sliding scale shall utilize the most
				recent federal poverty guidelines issued in the
Federal
				Register
by the United States Department of Health and Human Services
				as the basis for determining the income threshold based on family size for
				eligibility for cost participation;
4. the department shall not assess any fee or
				other charge through the cost participation schedule upon a family which has an
				annual income of less than 300 percent of the federal poverty level;
5. the department shall not assess fees or
				other charges through the cost participation schedule which totals more than 3
				percent of the monthly income level for a family of
four, according to the federal poverty guideline schedule
				  which will be updated annually;
6. once the familys income has been verified
				with the required documentation and the IFSP services have been determined by
				the IFSP team, the following will occur:
a.
				the system point of entry office will issue the cost participation statement to
				notify the family of their assessed costs which will be reviewed with the
				family and a copy provided;
b.
				following the submission of service claims by the childs provider, the Central
				Finance Office (CFO) will mail a monthly explanation of payment statement (EOP)
				to the family for payment. The EOP will include a notice of the familys right
				for reconsideration of their financial status and their right to apply for
				exemption from cost participation due to financial hardship;
c. families will remit reimbursement to the
				CFO at the address provided in the EOP;
7. when a family is not complying with the
				cost participation requirements and procedures for suspending services, the
				following will occur related to the status of the childs services;
a. a notice will be issued to the family, to
				the service coordinator and to the designated EarlySteps office;
b. the CFO will notify the department when
				the family is in arrears for a duration of three months at which time the
				service coordinator will discuss the familys options with the family and assist
				the department with its determination of the status of the childs IFSP
				services;
c. if the family provides
				its consent, a copy of the notice that the family is in arrears with payment
				for three months will be sent to the representative and senator in whose
				district the family resides;
d. the
				department will make a written determination regarding the status of the childs
				IFSP services following review of information provided by the service
				coordinator and the family. Families will be offered the option to continue to
				receive services available at no cost if they choose according to the no-cost
				provisions which follow;
e. the
				department shall not limit early intervention services for a child in any month
				if the cost for the services in that month exceeds the maximum contribution
				from the childs family.