Or. Admin. R. 581-015-2890 - Preschool Children with Disabilities Covered by Private Insurance

(1) With regard to services required to provide FAPE to a preschool child or EI services to a child under the age of three, a contractor or subcontractor may access a parent's private insurance proceeds only if the parent provides informed consent consistent with this rule and applicable federal requirements related to confidentiality of personally identifiable information.

(2) For a child under the age of three, when the contractor or subcontractor proposes to access the parent's private insurance to pay for the initial provision of early intervention services, it must:

(a) Obtain parent consent in accordance with this rule; and whenever personally identifiable information is released due to an increase in frequency, length, duration, or intensity in the provision of services on the child's IFSP.

(b) Inform the parents of any of the State's payment policies and identify potential costs that the parent may incur when their private insurance is used to pay for services.

(c) Not permit use of private insurance to:

(A) Count towards or result in a loss of benefits due to the annual or lifetime insurance coverage caps, to the parent, or the child's family members who are covered by the policy;

(B) Negatively affect the availability of insurance to the child, the parent, or the child's family members who are covered under the insurance policy, and insurance coverage may not be discontinued for these individuals due to the use of the insurance to pay for services; or

(C) Be the basis for increasing insurance premiums of the child, the parent, or the child's family members covered under the insurance policy.

(3) For a child under the age of three, the contractor or subcontractor:

(a) Must not require parents to pay out-of-pocket expenses (e.g., co-payments, premiums, or deductibles), even if the parent has given consent for the use of private insurance.

(b) May use its Part C funds to pay the cost the parents otherwise would have to pay to use public benefits (e.g., the deductible or co-pay amounts);

(c) May use its Part C funds to pay for early intervention services;

(d) Must notify parents that they may use any of the state's dispute resolution procedures including, but not limited to, the state complaint system under OAR 581-015-2030; mediation, due process, and related resolution sessions under 581-015-2865 through 581-015-2870, to contest the imposition of an insurance related fee or cost, such as co-payments or deductibles, to provide early intervention services.

(4) For a child above the age of three, the contractor or subcontractor must obtain consent each time it proposes to access the parents' private insurance.

(a) If a public agency is unable to obtain parental consent to use the parent's private insurance, to ensure the provision of FAPE, the public agency may use its Part B funds to pay for the service.

(b) To avoid financial cost to parents who otherwise would consent to use private insurance, if the parent would incur a cost, the public agency may use its Part B funds to pay the cost the parents otherwise would have to pay to use the parent's insurance (e.g., the deductible or co-pay amounts).

(5) For all preschool children, the contractor or subcontractor must inform the parents that their refusal to permit the public agency to access their private insurance does not relieve the public agency of its responsibility to ensure that all required services are provided at no cost to the parents.

(6) Proceeds from private insurance will not be treated as program income.

Notes

Or. Admin. R. 581-015-2890

ODE 2-2003, f. & cert. ef. 3-10-03; Renumbered from 581-015-1052, ODE 10-2007, f. & cert. ef. 4-25-07; ODE 14-2012, f. 3-30-12, cert. ef. 4-2-12; ODE 30-2012, f. 11-7-12, cert. ef. 11-9-12

Stat. Auth.: ORS 343.475

Stats. Implemented: ORS 343.475, 343.495, 34 CFR 300.154, 303.520(b)