PUT AWAY THE PANIC BUTTON! IMPLEMENTING THE NEW PART C FEDERAL REGULATIONS IN VIRGINIA Part 2 June...

PUT AWAY THE PANIC BUTTON!

IMPLEMENTING THE NEW

PART C FEDERAL

REGULATIONS IN VIRGINIA

Part 2June 27, 2012

Do you have these forms? If not, please print them before we start -

Family Cost Share Agreement, Temporary Family Cost Share

Agreement, Notice of Child and Family Rights and Safeguards

Including Facts About Family Cost Share, IFSP

http://www.infantva.org/pr-New-Forms-July1.htm#pm

Make sure you write down your questions!

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Code: 463-661-9330#

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What is Your Primary Role in Early Intervention?

A. Local System Manager or Program Administrator

B. Service Coordinator C. EI Service ProviderD. Family Member

What is Your Primary Role in Early Intervention?

A. Local System Manager or Program Administrator

B. Service Coordinator C. EI Service ProviderD. Family Member

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Overview/RemindersNew regulations released

September 2011Must begin implementing

July 1, 2012Virginia prioritizing parent

protectionsHave until June 30, 2013

to have “documents” in place

Regulatio

ns for EI

Program for

Infants and

Toddlers with

Disabilities

numbered 303

Road Map - Regulations

Subpart A-Purpose and Definitions of terms used in the ActSubpart B and C- What states need to have in place for their system of services and assure in order to receive funds (often called the state application)Subpart D- child find, evaluations and assessments and the IFSPSubpart E- Subpart E- Procedural SafeguardsProcedural SafeguardsSubpart F- Subpart F- Use of fundsUse of fundsSubpart G- State interagency coordinating councilSubpart H- State monitoring and enforcement

Procedural Safeguards

Access to RecordsInitial copy of record,

copies of IFSP and ED Form at no cost to family (303.400(c))

10-day timeline when parent requests to review records (303.409(c))

Expansion of what can be maintained in permanent record (303.416(b))

Scavenger Hunt

On what page of the revised Notice of Child and Family Rights and

Safeguards Including Facts About Family Cost Share document does

the information about records start?

a. 9b. 4c. 1

Notice and ConsentIf child not eligible, must be

given prior written notice including parents rights to dispute the eligibility determination (303.322)

Initial notice about confidentiality and records when a child is referred (303.404(d))

Procedures when parent refuses consent to release records (303.414(c))

Surrogate Parents(303.422)

30-day timeline for assigning

Surrogate cannot be a provider of any service to child or family member

Must consult with public agency assigned care of child

Judge may assign surrogate

Administrative Complaints

(303.434)• Must file within 1 year of

alleged violation• What must be included in

complaint has been expanded

• Must forward copy to the agency/provider at same time filed with state

• Can extend timeline for mediation

Due Process Hearing(303.436)

Available to any child referredCopy of transcript, written

copy of findings and decisions at no cost to parent

Either party can request extension

In Virginia: Procedural Safeguards

Revised Notice of Child and Family Rights and Safeguards

Revised Strengthening Partnerships

Minor revisions to some procedural safeguards forms

System of Payments

Blood Pressure Check

How high is your anxiety level as we start talking about system of payment (family cost share requirements)? My blood pressure is …

a.Sky high

b.Slightly above normal

c.Normal

d.Below normal … I feel faint!

Use of Public Insurance

(303.520(a))May not require parents to

enroll in public benefits or insurance program

Must meet consent requirementsChild does not have Medicaid yet

Child has MedicaidRelease of info for billing

Public

insuran

ce =

Medicai

d

No Cost Protections (303.520(a)(ii))Cannot decrease available lifetime

coverage or any other insured benefitCannot result in parents paying for

services that would otherwise be covered by the public benefits or insurance program

Cannot result in increase in premiums or discontinuation of public benefits or insurance

Cannot cause a loss of eligibility for home and community based waivers based on aggregated health related expenses

Use of Public Insurance (cont’d)

(303.520(a))Must provide written

notification to parentsConsent requirements

Categories of costsNo cost protection provisions

Scavenger HuntOn what page of the Notice of Child and

Family Rights and Safeguards Including Facts About Family Cost Share can you

find the information you need to explain to families about use of

Medicaid/FAMIS to pay for EI services?a. 14b. 16c. 13d. 15

Use of Private Insurance

(303.520(b))Must obtain written parental consent: At the initial IFSP At IFSP Review if services increase

Lack of consent cannot result in denial of services if family unable to pay

TRICARE

treated as

private

insurance

in Virginia

Use of Private Insurance (cont’d)

(303.520(b))Copy of policies to

parent when consent is sought

Any cost for use must be included policies

Scavenger HuntOn what page of the Notice of Child and

Family Rights and Safeguards Including Facts About Family Cost Share can you

find the information you need to explain to families about use of private

insurance to pay for EI services?a. 14b. 16c. 13d. 15

Written Policies (303.521)Payment system and

schedule of fessBasis and amount of the feesDefinition of the ability and

inability to pay and a process for determining

Assurance regarding services to be provided at no cost

Provision regarding failure to provide income information

Provision that permits the lead agency to use Part C funding to pay for some costs

Procedural Safeguards (303.521(e))

Written policies must include informing parents of dispute resolution options

Must provide copy of these policies when obtaining consent for services

In Virginia: Intake

Combined Rights document and Facts About Family Cost Share

Revised Facts About Family Cost ShareNotification requirementsNo cost protectionsCosts associated with

private insuranceWritten policies

In Virginia: Before Initial IFSP

Family Cost Share Agreement Form

-OR-Temporary Family

Cost Share Agreement Form

Release of information to bill

Family Cost Share Agreement Form

Family Cost Share Agreement Form

Family Cost Share Agreement Form

Release of Information

Give it a Try

Temporary Family Cost Share Agreement Form

Temporary Family Cost Share Agreement Form

Choose the Correct Form

• Prior to initial IFSP, family chooses not to provide income information and pay full fee

• Prior to initial IFSP, family cannot find tax return in their moving boxes but doesn’t want to delay services

• Temporary Family Cost Share Agreement Form

• Family Cost Share Agreement Form

In Virginia: IFSP Review

Notice of Rights and Safeguards Including Facts About Family Cost Share

Consent for private insurance if services increasingFrequency, length,

durationChange from group to

individual

IFSP - Page 9

When to Use Box on Page 9

1. Child is covered by private insurance

2. Family has consented to use of insurance

3. Services are increasing

In Virginia: Annual IFSP

Notice of Rights and Safeguards Including Facts About Family Cost Share

New Family Cost Share Agreement FormTemporary FCS Form, if needed

The Bottom Line

Already in Place• Consent for Medicaid• Consent for private

insurance at initial and annual

• Written policies• Procedural

safeguards for payment

• Consent to release information for billing

New• Consent for private

insurance when services increase (added to page 9 of IFSP)

• Notification requirements (added to Facts About Family Cost Share)

Blood Pressure Re-Check

Blood pressure

higher or lower

now?

Next Steps

Get electronic forms ready to go

Participate in July regional meetings

Share information with local staff and providers

Next

Steps:

QUESTIONS?