Sec. 303.520 (a)

(a) Use of public benefits or public insurance to pay for part C services.

(1) A State may not use the public benefits or insurance of a child or parent to pay for part C services unless the State provides written notification, consistent with §303.520(a)(3), to the child’s parents, and the State meets the no-cost protections identified in paragraph (a)(2) of this section.
(2) With regard to using the public benefits or insurance of a child or parent to pay for part C services, the State—
(i) May not require a parent to sign up for or enroll in public benefits or insurance programs as a condition of receiving part C services and must obtain consent prior to using the public benefits or insurance of a child or parent if that child or parent is not already enrolled in such a program;
(ii) Must obtain consent, consistent with §§303.7 and 303.420(a)(4), to use a child’s or parent’s public benefits or insurance to pay for part C services if that use would—
(A) Decrease available lifetime coverage or any other insured benefit for that child or parent under that program;
(B) Result in the child’s parents paying for services that would otherwise be covered by the public benefits or insurance program;
(C) Result in any increase in premiums or discontinuation of public benefits or insurance for that child or that child’s parents; or
(D) Risk loss of eligibility for the child or that child’s parents for home and community-based waivers based on aggregate health-related expenditures.
(iii) If the parent does not provide consent under paragraphs (a)(2)(i) or (a)(2)(ii) of this section, the State must still make available those part C services on the IFSP to which the parent has provided consent.
(3) Prior to using a child’s or parent’s public benefits or insurance to pay for part C services, the State must provide written notification to the child’s parents. The notification must include—
(i) A statement that parental consent must be obtained under §303.414, if that provision applies, before the State lead agency or EIS provider discloses, for billing purposes, a child’s personally identifiable information to the State public agency responsible for the administration of the State’s public benefits or insurance program (e.g., Medicaid);
(ii) A statement of the no-cost protection provisions in §303.520(a)(2) and that if the parent does not provide the consent under §303.520(a)(2), the State lead agency must still make available those part C services on the IFSP for which the parent has provided consent;
(iii) A statement that the parents have the right under §303.414, if that provision applies, to withdraw their consent to disclosure of personally identifiable information to the State public agency responsible for the administration of the State’s public benefits or insurance program (e.g., Medicaid) at any time; and
(iv) A statement of the general categories of costs that the parent would incur as a result of participating in a public benefits or insurance program (such as co-payments or deductibles, or the required use of private insurance as the primary insurance).
(4) If a State requires a parent to pay any costs that the parent would incur as a result of the State’s using a child’s or parent’s public benefits or insurance to pay for part C services (such as co-payments or deductibles, or the required use of private insurance as the primary insurance), those costs must be identified in the State’s system of payments policies under §303.521 and included in the notification provided to the parent under paragraph (a)(3) of this section; otherwise, the State cannot charge those costs to the parent.
Severe Discrepancy
idea_regulations-template-default single single-idea_regulations postid-59475 with-font-selector group-blog elementor-default elementor-kit-82278 Sec.303.520(a) Sec.303.520(a) Sec 303520 (a) Sec 303 520 (a) Sec. 303.520 a Sec.303.520a Sec. 303.520 a Sec.303.520a Sec.--303.520-a Sec. 303.520 a Sec.--303.520-a Sec.303.520a

Last modified on May 3, 2017