048-8 Wyo. Code R. §§ 8-10 - Payment for Services

(a) In determining contract amounts pertaining to state general funds, regional Part C Program Providers shall calculate the number of children age birth through two (2) years of age who have a completed and signed IFSP on December 1st or the first business day thereafter. These numbers shall be used to calculate payments to service providers for the subsequent fiscal year.

(b) In determining contract amounts pertaining to federal funding, the Division shall multiply the total number of children age birth through two (2) receiving Part C Early Intervention Services on December 1st by the specified federal per child amount.

(c) Part C funds may only be used for early intervention services that an eligible infant or toddler needs but is not currently entitled to under any other federal, State, local, or private source. All Part C funds disseminated by formula are specified as payer of last resort. The regional Part C Program Provider is required to identify all available resources in their community and to use such resources prior to the use of Part C funds to develop or pay for direct services.

(i) The Regional Part C Program Provider may bill public and private insurance to pay for early intervention services if the parent provides informed consent. A parent's refusal to provide consent to access insurance shall not result in the denial of early intervention services to a child and their family. The consent to bill insurance must clearly state the parents:

(A) Agree to the Early Intervention Service Program's filing of an insurance claim to obtain reimbursement for specifically identified services;

(B) Acknowledge the information and records identified in the request for consent will be released to specifically identified persons or entities in connection with submitting the claim for reimbursement;

(C) Understand the parent is not required to consent to the filing of insurance claims and may refuse to do so at any time in the future; and

(D) Recognize that any refusal to permit the early intervention program to access their private insurance does not relieve the early intervention program of its obligation to provide all required services at no cost.

(ii) Families must be informed by the regional Part C Program Provider of possible consequences that may occur in accessing their private insurance, including but not limited to:

(A) A decrease in available lifetime benefit coverage or decrease in any other public benefit;

(B) Increase in premiums;

(C) Cancelation or non-renewal of coverage; and

(D) Decreased or inability to obtain alternate acceptable coverage.

(d) If a family's public or private insurance is accessed, the Regional Part C Program Provider may use Part C funding to pay for deductible and co-pays. Proceeds from public or private insurance are not treated as program income.

(e) The regional Part C Program Provider must provide the following without charge to the parent/caregiver:

(i) Implementing the child find requirements in 34 C.F.R. § 303.321;

(ii) Evaluation and assessment, as included in 34 C.F.R. § 303.321, and including the functions related to evaluation and assessment in § 303.12;

(iii) Service coordination, as included in 34 C.F.R. §§ 303.34 and 303.344(g); and

(iv) Administrative and coordinative activities related to the development, review, and evaluation of IFSPs in 34 C.F.R. §§ 303.340 through 303.346.

Notes

048-8 Wyo. Code R. §§ 8-10

Adopted, Eff. 2/8/2019.