§ 28:469 — System of payments; authority of the Louisiana Department of Health; cost

§469. System of payments; authority of the Louisiana Department of Health; cost
participation schedule
A. The department is hereby authorized to establish a statewide system of payments
in accordance with the provisions of 34 CFR Part 303.
B.(1) In implementing the system of payments, the department shall promulgate rules
for the reimbursement of services from all third-party payers, both private and public.
(2) The department or its designee shall seek payment from all third-party payers
prior to claiming payment from the IDEA-Part C early intervention system of this state for
services rendered to eligible children.
(3) The department or its designee may pay directly to a provider any required
deductible, copayment, coinsurance, or other out-of-pocket expense for a child who is
eligible for services from the IDEA-Part C early intervention system of this state.
C.(1)(a) The department shall promulgate rules in accordance with the
Administrative Procedure Act that establish a schedule of monthly cost participation for early
intervention services per qualifying family. Cost participation shall be based on a sliding
scale and shall consider elements including but not limited to adjusted gross income, family
size, financial hardship, extraordinary expenses associated with the child, and Medicaid
eligibility. The department shall be subject to all of the following limitations and
requirements relative to the cost participation schedule:
(i) The department shall utilize the most recent federal poverty guidelines published
in the Federal Register by the United States Department of Health and Human Services,
referred to hereafter in this Subsection as the "federal poverty guidelines", as the basis for
determining the income threshold based on family size for eligibility for cost participation.
(ii) The department shall not assess any fee or other charge through the cost
participation schedule upon a family which has an annual income of less than three hundred
percent of the applicable federal poverty guideline.
(iii) In any month, the department shall not assess fees or other charges through the
cost participation schedule which total more than three percent of the monthly income level
for a family of four, according to the federal poverty guideline schedule.
(iv) The department shall not assess a fee or other charge through the cost
participation schedule for any service provided for in Item (c)(ii) of this Paragraph.
(b) Parents who have public or private insurance and elect not to assign such right
of recovery or indemnification to the department or choose not to release financial
information shall be assessed the cost for each early intervention service listed on the
individualized family service plan according to the most current service rate schedule and
cost participation schedule promulgated by the department.
(c) The cost participation schedule promulgated by the department shall provide all
of the following:
(i) Procedures by which a service provider may notify the department that a family
is not complying with the cost participation requirements and procedures for suspending
services.
(ii) A statement of assurance that fees are not charged for services which a child is
otherwise entitled to receive at no cost to parents, including child-find activities, evaluation
and assessment for eligibility and individualized family service planning, service
coordination, administrative and coordinative activities related to development review,
evaluation of individualized family service plans, and implementation of procedural
safeguards and other components of the statewide system provided for in R.S. 28:464.
(2)(a) The department shall provide prior notification in writing to families for use
of public or private insurance according to the requirements of 34 CFR 303.414. Such
notification shall include a statement of the general categories of costs that the parent would
incur and a statement of the process for resolution of a dispute regarding decisions related
to use of public or private insurance, failure to pay for services or the state's determination
of a family's ability to pay.
(b) The department shall ensure that the procedures utilized to resolve such disputes
will not delay or deny the parents' rights or the child's ability to access timely services.
(3) The aggregate contributions made by the parent shall not exceed the aggregate
cost of the early intervention services received by the child and family, inclusive of any
amount received from other sources of payment for a service.
(4)(a) At least annually, or at any time the department determines is warranted, the
department shall conduct a reassessment of the parents' financial status. A parent may
request such reassessment at any time when significant changes in financial circumstances
may affect the calculation of the cost participation amount.
(b) The department shall not make any administrative decision regarding suspension
or termination of services for a family prior to the family having been in arrears, with respect
to fees or other charges assessed pursuant to cost participation, for a duration of three
months.
(c) On at least a monthly basis, the department shall send to any family in arrears,
with respect to fees or other charges assessed pursuant to cost participation, notice of the
family's right for reconsideration of their financial status and the family's right to apply for
exemption from cost participation due to financial hardship. A copy of the notice shall be
sent to the representative and senator in whose district the family resides.
(5) The department shall not limit early intervention services for a child in any month
if the cost of such services in that month exceeds the maximum monthly contribution from
the child's family as provided in Item (1)(a)(iii) of this Subsection.

Legislative History

Acts 2013, No. 417, §1, eff. June 21, 2013; Acts 2018, No. 206, §1.