CCS/HCS/SCS/SB 500 - Under this act, a lead state agency designated by the governor will maintain a statewide birth to age three system of early intervention services through the first steps program. The statewide system shall include a comprehensive public awareness program to ensure eligible children are identified and evaluated for eligibility (Section 160.900). A State Interagency Coordinating Council will be established to assist the lead agency in implementing the program (Section 160.905).
The structure for the delivery of the Part C early intervention system services will be on a regional basis, with the regions to be determined by the lead agency through a bidding process. The bidding process must establish criteria for allowing regions to implement models that will serve the unique needs of their community. The process shall also encourage agreements between bidding organizations and other state and local governmental entities providing similar services to infants and toddlers, including the department of mental health's division of mental retardation and developmental disability centers and with established quality early intervention providers in the region (Section 160.910).
Each regional office shall include in their proposal assurances and documentation of their plan to provide for those functions specifically identified under state and federal regulations, ensure provider oversight, include family oriented, transdisciplinary and coaching approaches as necessary, utilize multiple funding sources, and implement a system to re-utilize and oversee assistive technology services (Section 160.915).
The lead agency shall not use general revenue funds appropriated for the administration of the Part C early intervention system to satisfy a financial commitment for services that should have been paid from another public or private source (Section 160.920.1). Federal funds available under the federal program shall be used whenever necessary to prevent the delay of early intervention services to the eligible child or family. When funds are used to reimburse the service provider to prevent a delay of services, the funds shall be recovered from the public or private service that has ultimate responsibility for payment (Section 160.920.1).
The lead agency in the first instance and where applicable, will seek payment from all third party payers prior to claiming payment from the state program (Section 160.920.5).
The lead agency shall also pay required deductibles, copayments, or other out-of-pocket expenses for an eligible child directly to the provider. (Section 160.920.6).
A schedule of monthly cost participation fees for services per qualifying family will be established by the lead agency for services per family regardless of the number of children participating or the amount of services provided. These fees shall not include services to be provided to the family at no cost as established by the IDEA (Section 160.920.7).
Fees shall be based on a sliding scale to become effective October 1, 2005, and will take into account the following elements:
- adjusted gross income, family size, financial hardship, and Medicaid eligibility with the fee implementation beginning at two hundred percent of the federal poverty guidelines;
- a minimum monthly fee amount of five dollars to the maximum of one hundred dollars;
- an increased fee schedule for parents who have insurance and elect not to use the insurance;
- the effect of procedures for notifying regional offices if a family is not paying the cost participation and suspension of services; and
- the effect of procedures for determining waivers for the cost participation based on significant financial hardship or medicaid eligibility (Section 160.920.7).
The lead agency shall provide regional offices with the necessary financial data to assist regional offices in monitoring their expenditures and the cost of direct services (Section 160.910).
Nothing in this act will permit any other state agency that provides medically related services to reduce medical assistance to eligible children (Section 160.920).
All amounts generated by family cost participation, including insurance and Medicaid reimbursements, will be deposited to the Part C early intervention system fund created in Section 160.925 (Section 160.920).
In addition, current law expresses that school districts may coordinate with public, private, and private not-for-profit agencies for the delivery of efficient early childhood special education (Section 162.700). This act changes the aforementioned "may" to "shall".
This act requires school districts providing early childhood special education to give consideration to the value of continuing services with Part C providers for the remainder of a school year when developing an individualized education program for a student who has received services pursuant to Part C of the federal Individuals with Disabilities Education Act and reaches the age of three years during a regular school year. Further, the act removes language from the section which specifies that preference shall be given to the continuation of services with the student's private provider unless the cost exceeds the average per student cost of early childhood education in the district (Section 162.700).
The department of social services shall recognize the Part C early intervention system as an eligible program and shall pay all claims for reimbursement for Medicaid-eligible children to the Part C early intervention system. For those eligible children having other private insurance, the department of social services shall seek reimbursement as appropriate from the lead agency for payments made to the Part C early intervention system for covered benefits provided by health benefit plans under section 376.1218 (Section 208.144).
This act also provides that each health carrier that offers or issues health benefit plans, other than Medicaid health benefit plans, which are issued or renewed in this state on or after January 1, 2006, shall provide coverage for early intervention services for children in the Part C IDEA system. Early intervention services include medically necessary speech and language therapy, occupational therapy, physical therapy, and assistive technology devices for children from birth to age three who are identified by the Part C IDEA system as eligible for services. Such coverage shall be limited to three thousand dollars per covered child per policy per calendar year, with a maximum of nine thousand dollars per child (Section 376.1218).
In the event that the provisions of section 376.1218.1 do not apply to a health carrier because of preemption by a federal law, or the provisions are found to be unconstitutional, then the lead agency shall be responsible for payment and provision of any benefit required under section 376.1218 (Section 376.1218.3).
A health benefit plan shall be billed at the applicable Medicaid rate at the time the covered benefit is delivered, and the health benefit plan shall pay the Part C early intervention system at such rate for benefits covered by this act(Section 376.1218.5).
The health care service required by this section shall not be subject to any greater deductible, copayment, or coinsurance than other similar health care services provided by the health benefit plan (Section 376.1218.6).
Payments made during a calendar year by a health carrier subject to the provisions of this act to the Part C early intervention system for services provided to children covered by the Part C system shall not exceed one-half of one percent of the direct written premium for health benefit plans as reported to the department of insurance on the health carrier's most recently filed annual financial statement. (Section 376.1218.7(1)).
Instead of reimbursing claims, a carrier may directly pay the Part C early intervention system by January 31 of the calendar year an amount equal to one-half of one percent of the direct written premium for health benefit plans as reported to the department of insurance on the health carrier's most recently filed annual financial statement, or five hundred thousand dollars, whichever is less. The payment shall constitute full and complete satisfaction of the carrier's obligation for the calendar year (Section 376.1218.7(2)).
This act shall not apply to supplemental insurance policies, including a life care contract, specified disease policies, hospital policy providing a fixed daily benefit only, Medicare supplement policy, hospitalization-surgical care policy, long-term care policy, or short-term major medical policies of six months or less duration (Section 376.1218.8).
Except for health carriers or health benefit plans making direct payments in complete satisfaction of the carrier's obligation for the calendar year, under section 376.1218.7(2), the Department of Insurance shall collect data related to the number of children receiving private insurance coverage under section 376.1218 and the total amount of moneys paid on behalf of such children by private health insurance carriers or health benefit plans. The department shall report to the General Assembly regarding the department's findings no later than January 30, 2007, and annually thereafter (Section 376.1218.9)
The provisions of the Part C early intervention system shall sunset in two years, unless reauthorized by an act of the general assembly (Section 1).