FIRST REGULAR SESSION
SENATE BILL NO. 500
93RD GENERAL ASSEMBLY
INTRODUCED BY SENATORS GIBBONS, KLINDT AND CLEMENS.
Read 1st time March 1, 2005, and ordered printed.
TERRY L. SPIELER, Secretary.
1821S.02I
AN ACT
To amend chapters 160, 208, and 376, RSMo, by adding thereto seven new sections relating to family cost participation in the Missouri first steps program, with an emergency clause.
Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Chapters 160, 208, and 376, RSMo, are amended by adding thereto seven new sections, to be known as sections 160.900, 160.905, 160.910, 160.915, 160.920, 208.144, and 376.1218, to read as follows:
160.900. 1. Subject to appropriations, the state of Missouri shall participate in the federal Infant and Toddler Program, Part C of the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. Section 1431, et seq., and provide early intervention services to infants and toddlers determined eligible under state regulations.
2. The department of elementary and secondary education shall be responsible for the administration and implementation of Part C of IDEA through a regional first steps system and shall promulgate rules implementing the requirements of Part C of IDEA consistent with federal regulations, 34 C.F.R. 303, et seq.
3. Any rule or portion of a rule, as that term is defined in section 536.010, RSMo, that is created under the authority delegated in sections 160.900 to 160.920 shall become effective only if it complies with and is subject to all of the provisions of chapter 536, RSMo, and, if applicable, section 536.028, RSMo. Sections 160.900 to 160.920 and chapter 536, RSMo, are nonseverable and if any of the powers vested with the general assembly pursuant to chapter 536, RSMo, to review, to delay the effective date, or to disapprove and annul a rule are subsequently held unconstitutional, then the grant of rulemaking authority and any rule proposed or adopted after July 1, 2005, shall be invalid and void.
160.905. 1. The department of elementary and secondary education shall maintain a statewide birth to age three system of early intervention services under Part C of the Individuals with Disabilities Education Act, 20 U.S.C. Section 1431, et seq., for eligible children and families of such children which shall be administered through the regional first steps system.
2. The statewide system shall compile data on the number of eligible children in the state in need of early intervention services, the number of eligible children and their families served, the types of services provided, and other information as deemed necessary by the department.
3. The statewide system shall include a comprehensive child-find system and public awareness program to ensure that eligible children are identified, located, referred to the system, and evaluated for eligibility.
4. The department shall monitor system expenditures for administrative services and first steps regional offices to ensure maximum utilization of state funds for all children determined to be eligible for early intervention services.
160.910. 1. In the bidding cycle for the first steps system undertaken after July 1, 2005, the structure for delivery of services shall be placed on a regional basis. Regions shall include counties to be determined by the department of elementary and secondary education. The first steps regional center shall conduct the intake process, evaluations and assessments, service coordination, development of an individualized family service plan, and oversight of the service providers. An agency shall bid upon a contract to manage the regional allotment for the region as designated by the department.
2. Any agency that bids for a regional center contract shall provide assurances that:
(1) First steps program services shall be provided, either directly or through contract, to eligible children in its region with the funding it receives;
(2) The child's individualized family service plan shall include measurements on the family's outcomes toward implementing the child's developmental goals; and
(3) Transdisciplinary and coaching approaches will be the focus of the individualized family service plan.
The department may require other assurances that it deems necessary.
3. The department shall give priority in the bidding process to agencies that include two or more of the following elements in their proposal:
(1) An agreement with the mental retardation and developmental disability regional center of the department of mental health determining its coordination;
(2) An agreement with the local Senate Bill 40 boards to serve first steps eligible children in their counties; or
(3) An assurance that an agency has a funding source to contribute in addition to state funding to provide services to children in its regional area.
4. The department may develop a rule creating a process for review of stewardship of funds before accepting a rebid from an agency that has held a regional center contract.
160.915. 1. No funds appropriated to the department of elementary and secondary education for the implementation and administration of sections 160.900 to 160.920 shall be used to satisfy a financial commitment for services that should have been paid from another public or private source. Federal funds available under Part C of the Individuals with Disabilities Education Act, 20 U.S.C. Section 1431, et seq., may 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 the provision of services, the funds shall be recovered from the public or private source that has ultimate responsibility for the payment.
2. Nothing in this section shall be construed to permit any other state agency providing medically related services to reduce medical assistance to eligible children.
3. Payments for the provision of direct early intervention services to children and families who meet the state's eligibility criteria shall be paid in the manner prescribed by the department. Where applicable, the first steps system shall seek reimbursement from all third-party payers, both private and public.
4. The department shall promulgate rules that provide for family cost participation in early intervention services for eligible children, and such rules shall consider:
(1) A process to access private and public insurance; and
(2) Sliding scale of fees for participation relative to the financial resources of the parents or legal guardians of eligible children that contemplates the following elements, to become effective October 1, 2005:
(a) A basis in adjusted gross income and family size, with the lowest fee level tied to the Medicaid eligibility threshold, so that no fee is charged for a family whose income qualifies for Medicaid;
(b) A monthly fee for participation rather than per service;
(c) A minimum fee of five dollars and a maximum fee of one hundred dollars, with the department retaining the right to revise the fee schedule no earlier than the third year after its implementation.
5. Families with incomes meeting the eligibility criteria for Medicaid participation shall be deemed unable to pay the established fees for early intervention services. To determine whether a family is subject to a fee, the family shall provide information sufficient to determine adjusted gross income, substantially equivalent to the information needed to establish eligibility for Medicaid. Early intervention services will be provided at no cost to such families. All amounts generated by family cost participation, including but not limited to fees, copayments, and insurance reimbursements, shall be deposited to the first steps fund created in section 160.920.
6. The department shall ensure that the following services are provided at no cost to the family:
(1) Identifying the child;
(2) Evaluation and assessment;
(3) Service coordination; and
(4) Development of an individualized family service program.
7. The department may assign the collection of early intervention participation fees, payments, and public or private insurance to a designee, contractor, provider, third-party agent, or designated clearinghouse participating in the early intervention system. Such fees, payments, or insurance amounts shall be paid to the department, its designee, contractor, provider, third-party agent, or designated clearinghouse in a timely manner. Notice of collection procedures, schedule of fees or payments, and guidelines for inability to pay shall be made available to parents of eligible children. The department may require a release form that substantiates the parents' permission to seek insurance reimbursement.
160.920. 1. There is hereby created in the state treasury the "First Steps Fund". Moneys deposited in the fund shall be considered state funds under article IV, section 15 of the Missouri Constitution. The state treasurer shall be custodian of the fund and shall disburse moneys from the fund in accordance with sections 30.170 and 30.180, RSMo. Upon appropriation, money in the fund shall be used solely for the purpose of funding the first steps system established in sections 160.900 to 160.920.
2. Notwithstanding the provisions of section 33.080, RSMo, to the contrary, any moneys remaining in the fund at the end of the biennium shall not revert to the credit of the general revenue fund.
3. The state treasurer shall invest moneys in the fund in the same manner as other funds are invested. Any interest and moneys earned on such investments shall be credited to the fund.
208.144. The department of social services shall recognize the first steps system established under sections 160.900 to 160.920, RSMo, as an eligible program and shall pay all claims for reimbursement for Medicaid-eligible children to the first steps system. For those eligible children having other private insurance, the department of social services shall seek insurance reimbursement as appropriate.
376.1218. 1. Each health carrier or health benefit plan, as defined in section 376.1350, that offers or issues health benefit plans which are delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2006, shall provide coverage to reimburse the Missouri first steps system for the early intervention services described in subsection 2 of this section that are delivered by early intervention specialists for children from birth to age three identified by the Missouri first steps system as eligible for services under Part C of the Individuals with Disabilities Education Act 20 U.S.C. 1431, et seq. Such coverage shall be limited to three thousand dollars for each covered child per policy per calendar year, with a maximum of nine thousand dollars per child.
2. For purposes of this section, "early intervention services" means speech and language therapy, occupational therapy, physical therapy, and assistive technology services and devices for children from birth to age three who are identified by the Missouri first steps system as eligible for services under Part C of the Individuals with Disabilities Education Act 20 U.S.C. Section 1431, et seq., and which are designed to help that individual attain or retain the capability to function age-appropriately within his or her environment. Early intervention services shall include services under an active individualized family service plan that enhance functional ability without effecting a cure. Early intervention services, as defined in this section, may continue through the time period indicated in section 160.905, RSMo, or any period of compensatory services required by Part C of the Individuals with Disabilities Education Act, which may extend beyond age three. An individualized family service plan is a written plan for providing early intervention services to an eligible child and the child's family that is adopted in accordance with 20 U.S.C. Section 1436. Early intervention services shall be deemed medically necessary. The first steps system, on behalf of its contracted regional first steps centers and providers, shall be considered the rendering provider of services for purposes of this section.
3. No payment made for specified early intervention services shall be applied by the insurer against any maximum lifetime aggregate or annual limits specified in the policy or health benefit plan. Prescribed insurance benefits shall reimburse the Missouri first steps system administered by the department of elementary and secondary education, or its designee, for payments made by the system for the early intervention services as prescribed by the individualized family service plan, upon submission of the individualized family service plan and first steps explanation of benefits to the insurance carrier by the department or its designee. Prescribed insurance benefits shall be reimbursed at the current Medicaid reimbursement rate for each specified eligible service under subsection 2 of this section.
4. The health care service required by this section shall not be subject to any greater deductible or copayment than other similar health care services provided by the health benefit plan.
5. A health carrier or health benefit plan subject to the provisions of this section shall also provide reimbursement to the department of social services for claims filed on behalf of eligible children under the Missouri first steps system who are insureds of a health benefit plan under this section.
6. This section shall not apply to a supplemental insurance policy, including a life care contract, specified disease policy, hospital policy providing a fixed daily benefit only, Medicare supplement policy, long-term care policy, or short-term major medical policies of six months or less duration.
Section B. Because immediate action is necessary to ensure the continuation of early intervention services to infants and toddlers with disabilities section A of this act is deemed necessary for the immediate preservation of the public health, welfare, peace, and safety, and is hereby declared to be an emergency act within the meaning of the constitution, and section A of this act shall be in full force and effect on July 1, 2005, or upon its passage and approval, whichever later occurs.