Missouri Senate

House Committee Substitute

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 agency 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 funds appropriated for the implementation and 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).

ADRIANE CROUSE