1. (a) Provider program must provide any service on the IFSP at no cost to the parent.
2. (b) Part C funds may only be used as the payor of last resort when there are no other federal, state, local, or private resources available to pay for the early intervention service necessary to reach the goals and objectives on a current IFSP.
3. (c) Part C funds may be used to provide an urgently needed service on an interim (temporary) IFSP prior to CMDE for an urgently needed early intervention service for a maximum of forty-five (45) calendar days if public or private insurance denies payment for that service prior to evaluation and Rx for service. See 20 CAR § 1002-508, interim IFSP.

4. (d)

   1. (1) A parent cannot be required to obtain private insurance or enroll in Medicaid (including TEFRA) to receive early intervention services necessary to reach IFSP goals and objectives.

   2. (2)

      1. (A) A local provider program and, or, or both EI service provider must have parent consent on the state-approved form to submit a claim for payment for early intervention services through a child or parent's public or private insurance.
      2. (B) Prior to obtaining parent consent, a service provider must provide the parent the approved written notification regarding the use of the child or parent's public or private insurance and a statement of the no-cost protection provisions.

   3. (3)

      1. (A) When a parent's public or private insurance is used, the parent is responsible for any applicable public or private insurance premiums.
      2. (B)

5. (i) Any copayments and deductibles in connection with early intervention services that are not covered by public or private insurance or other funding may be paid with Part C funds.

   1. (ii) A parent may be reimbursed using Part C funds for any copayments and deductibles in connection with early intervention services they paid that are not covered by private insurance, Medicaid, or other funding.
   2. (4) Part C funds may be used to prevent a delay in providing early intervention services pending reimbursement from the insurer or other available funding source that has ultimate responsibility for payment.
6. (e) A local provider program and, or, or both EI service provider must accept the Medicaid payment for an early intervention service as payment in full regardless of amount.
7. (f) If a parent has granted parent consent to bill their Medicaid and private insurance, then the local provider program and, or, or both EI service provider must first bill and receive a denial from the private insurance before billing Medicaid for an early intervention service.

Codification Notes: “TEFRA” means the Tax Equity and Fiscal Responsibility Act, Pub. L. No. 97-248. "EI" means early intervention. "Rx" means prescription.