160.920. Funding limitations--third-party payers--schedule of fees for family cost participation--collection of fees.
Funding limitations--third-party payers--schedule of fees for familycost participation--collection of fees.
160.920. 1. No funds appropriated to the lead agency for theimplementation and administration of sections 160.900 to 160.925 shall beused to satisfy a financial commitment for services that should have beenpaid from another public or private source. Federal funds available underPart C of the IDEA, 20 U.S.C. Section 1431, et seq., shall be used whenevernecessary to prevent the delay of early intervention services to theeligible child or family. When funds are used to reimburse the serviceprovider to prevent a delay of the provision of services, the funds shallbe recovered from the public or private source that has ultimateresponsibility for the payment.
2. Nothing in this section shall be construed to permit any otherstate agency providing medically related services to reduce medicalassistance to eligible children.
3. Payments for the provision of direct early intervention servicesto children and families shall be paid in the manner prescribed by the leadagency.
4. The lead agency shall promulgate rules for the reimbursement ofservices from all third-party payers, both private and public.
5. The lead agency or its designee shall, in the first instance andwhere applicable, seek payment from all third-party payers prior toclaiming payment from the state Part C early intervention system forservices rendered to eligible children.
6. The lead agency or its designee may pay required deductibles,co-payments, coinsurance or other out-of-pocket expenses for a Part C earlyintervention program eligible child directly to a provider.
7. The lead agency shall promulgate rules that establish a scheduleof monthly cost participation fees for early intervention services perqualifying family regardless of the number of children participating or theamount of services provided. Such fees shall not include services to beprovided to the family at no cost as established in Part C of IDEA, 20U.S.C. Section 1431, et seq. Fees shall be based on a sliding scale tobecome effective October 1, 2005, that contemplates the following elements:
(1) Adjusted gross income, family size, financial hardship andMedicaid eligibility with the fee implementation beginning at two hundredpercent of the federal poverty guidelines;
(2) A minimum fee amount of five dollars to the maximum amount of onehundred dollars monthly, with the lead agency retaining the right to revisethe fee schedule no earlier than the third year after the family costparticipation effective date;
(3) An increased fee schedule for parents who have insurance andelect not to assign such right of recovery or indemnification to the leadagency;
(4) Procedures for notifying the regional office that a family is notcomplying with the cost participation fee and procedures for suspendingservices.
8. All amounts generated by family cost participation, insurancereimbursements, and Medicaid reimbursement shall be deposited to the fundcreated in section 160.925.
9. The lead agency may assign the collection of early interventionparticipation fees, payments, and public or private insurance to adesignee, contractor, provider, third-party agent, or designatedclearinghouse participating in the Part C early intervention system. Suchfees, payments, or insurance amounts shall be paid to the department, itsdesignee, contractor, provider, third-party agent, or designatedclearinghouse in a timely manner. Notice of collection procedures,schedule of fees or payments, and guidelines for inability to pay shall bemade available to parents of eligible children.
10. Notwithstanding the provisions of section 23.253, RSMo, to thecontrary, the provisions of this section shall not sunset.
(L. 2005 S.B. 500, A.L. 2007 S.B. 112)