Iowa Admin. Code r. 281-120.521 - System of payments and fees
(1)
General. If a state
elects to adopt a system of payments in subrule 120.500(2), the state's system
of payments policies must be in writing and specify which functions or
services, if any, are subject to the system of payments (including any fees
charged to the family as a result of using one or more of the family 's public
insurance or benefits or private insurance), and include:
a. The payment system and schedule of sliding
or cost participation fees that may be charged to the parent for early
intervention services under this chapter;
b. The basis and amount of payments or
fees;
c. The state's definition of
ability to pay (including its definition of income and family expenses, such as
extraordinary medical expenses), its definition of inability to pay, and when
and how the state makes its determination of the ability or inability to
pay;
d. An assurance that:
(1) Fees will not be charged to parents for
the services that a child is otherwise entitled to receive at no cost
(including those services identified under this subrule and subrules 120.521(2)
and 120.521(3));
(2) The inability
of the parents of an infant or toddler with a disability to pay for services
will not result in a delay or denial of services under this chapter to the
child or the child's family such that, if the parent or family meets the
state's definition of inability to pay, the infant or toddler with a disability
must be provided all Part C services at no cost;
(3) Families will not be charged any more
than the actual cost of the Part C service (factoring in any amount received
from other sources for payment for that service); and
(4) Families with public insurance or
benefits or private insurance will not be charged disproportionately more than
families who do not have public insurance or benefits or private
insurance;
e. Provisions
stating that the failure to provide the requisite income information and
documentation may result in a charge of a fee on the fee schedule and specify
the fee to be charged; and
f.
Provisions that permit, but do not require, the department or other relevant
agency to use Part C or other funds to pay for costs such as the premiums,
deductibles, or copayments.
(2)
Functions not subject to
fees. The following are required functions that must be carried out at
public expense, and for which no fees may be charged to parents:
a. Implementing the child find requirements
in rules
281-120.301
( 34CFR303 ) through
281-120.303 (
34CFR303 ).
b. Evaluation and
assessment, in accordance with rule
281-120.320
( 34CFR303 ), and the functions related to evaluation and assessment in subrule
120.13(2).
c. Service coordination
services, as defined in subrule 120.13(2) and rule
281-120.33 ( 34CFR303
).
d. Administrative and
coordinative activities related to:
(1) The
development, review, and evaluation of IFSPs and interim IFSPs in accordance
with rules 281-120.342 ( 34CFR303 ) through 281-120.345 ( 34CFR303 );
and
(2) Implementation of the
procedural safeguards in Division VI of this chapter and the other components
of the statewide system of early intervention services in Division V of this
chapter and this division.
(3)
FAPE mandates or use of funds
under Part B of the Act to serve children under age three. If the
state has in effect a state law requiring the provision of FAPE for, or uses
Part B funds to serve, an infant or toddler with a disability under the age of
three (or any subset of infants and toddlers with disabilities under the age of
three), the state may not charge the parents of the infant or toddler with a
disability for any services (e.g., physical or occupational therapy) under this
chapter that are part of FAPE for that infant or toddler and the child's
family , and those FAPE services must meet the requirements of both Parts B and
C of the Act.
(4)
Family
fees.
a. Fees or costs collected
from a parent or the child's family to pay for early intervention services
under the state's system of payments are program income under
34 CFR 80.25. The
state may add this program income to its Part C grant funds, rather than
deducting the program income from the amount of the state's Part C grant. Any
fees collected must be used for the purposes of the grant under Part C of the
Act.
b. Fees collected under a
system of payments are considered neither state nor local funds under subrule
120.225(2).
(5)
Procedural safeguards.
a.
The state's system of payments must include written policies to inform parents
that a parent who wishes to contest the imposition of a fee, or the state's
determination of the parent's ability to pay, may do one of the following:
(1) Participate in mediation in accordance
with rule 281-120.431 ( 34CFR303 ).
(2) Request a due process hearing under rule
281-120.436 ( 34CFR303 ).
(3) File
a state complaint under rule 281-120.434 ( 34CFR303 ).
(4) Use any other procedure established by
the state for speedy resolution of financial claims, provided that such use
does not delay or deny the parent's procedural rights under this chapter,
including the right to pursue, in a timely manner, the redress options
described in this subrule.
b. The state must inform parents of these
procedural safeguard options by either:
(1)
Providing parents with a copy of the state's system of payments policies when
obtaining consent for provision of early intervention services under subrule
120.420(1); or
(2) Including this
information with the notice provided to parents under rule
281-120.421
( 34CFR303 ).
Notes
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