Navigating Ohios System of Payments POLRdodd ohio gov

Navigating Ohio’s System of Payments POLR@dodd. ohio. gov

O b j e c t i v e s Understand how Early Intervention services are funded in Ohio Become familiar with terms used in Ohio’s System of Payments Know what services are provided at no cost to families Understand the System of Payments rule Understand the System of Payments process and the Service Coordinator’s role

Mandated Responsibilities of Service Coordination under IDEA, Part C § 303. 34 (b)(9) Coordinating the funding sources for services required under this part

IFSP process not changing Helpful new forms and brochure for families SOP conversation flows from other conversations

IFSP Process System of Payments Process Answers the question Which service(s) are needed to meet the outcome(s)? How will needed services be funded?

What is the “IFSP Year? ” 5123: 2 -10 -01 (B) (11) A. One of the Chinese zodiac signs START B. A system for organizing your calendar C. The first year the IFSP was used in Early Intervention D. None of the above END The period, not to extend beyond the child’s 3 rd birthday, beginning on the day signatures are secured on an initial or annual IFSP and ending the day immediately prior to the day signatures are secured on a subsequent annual IFSP. 5123: 2 -10 -01 (B) (11)

What is a “unit? ” 5123: 2 -10 -01 (B) (17) Sixty minutes of early intervention services OR One hundred dollars expended for an assistive technology device

What are Extraordinary Medical Expenses? Hospital Stays 5123: 2 -10 -01 (B) (8) Physician Visits Dental Care Vision Care Prescribed medications, supplies, therapies Health insurance premiums, co-pays, deductibles Modifications to make home accessible for any member of the family residing in the home with the child

5123: 2 -10 -01 (C) (1) Which services are provided at no cost to eligible children and their families? Child Find Evaluation and Assessment Service Coordination Activities related to IFSP Development ! W E N Implementation of Procedural Safeguards Fifty-five (55) Units of Services

Which funding sources need to be examined? County Boards Parent Cost Participation (after first 55 units) Private Insurance The Department (DODD) Public Insurance 5123: 2 -10 -01 C (2)

When is inability to pay determined? Initially (within the first 45 calendar days), and Within 45 calendar days of each annual IFSP review The Service Coordinator will: • Explain the SOP rule, • Provide a copy of the SOP brochure, • Determine inability to pay for EI services. 5123: 2 -10 -01 (D)

How are parents determined to be unable to pay for their EI services? Determined by SC 5123: 2 -10 -01 (D) (2) WIC Medicaid Income less than or Determined equal to threshold for by SC Ohio Children’s insurance Program (CHIP) (206% Federal Poverty Level) Determined by DODD EMEs (after first IFSP)

5123: 2 -10 -01 (D) (3) What happens if a parent chooses not to share financial information? If a parent does not wish to disclose financial information requested by the Service Coordinator, they will be determined able to pay and will be responsible for payment for EI services over 55 units.

Who pays for the first 55 units of services? County Board? OR Private insurance (when DODD pays co-pays and deductibles)? OR Public Insurance? If none available or denied The Departmen t (POLR) 5123: 2 -10 -01 (C)

What if more than 55 units are needed? Parent able to pay unable to pay Parent pays for services POLR (or other public source) pays for services 5123: 2 -10 -01 (C)(4)

Using Private Insurance Service Coordinator must: Explain rule Provide System of Payments brochure Obtain consent (form 1701) initially and with any increase in services 5123: 2 -10 -01 (F)

Using Private Insurance The EI System will: Pay co-payments and deductibles for the first 55 units of EI services per IFSP year (DODD) NOT pay insurance premiums( DODD) Inform the parent of potential costs (SC)

Using Public Insurance The Service Coordinator will: Obtain initial, one-time consent for disclosure of PII Make available the EI services for which the parent has given consent Provide written notification to the parent prior to using public insurance via the System of Payments brochure 5123: 2 -10 -01 (G)

Using Public Insurance The EI System will: Share information about public insurance programs Not require a child/parent to enroll in public insurance program in order to receive services Not enroll the child/parent in public insurance programs

Procedura l Safeguard Mediation s State Complaint Procedures Due Process Hearing 5123: 2 -10 -01 (H)

System of Payments Process SC Collects financial informatio n and determine s if parent is unable to pay Screening, Evaluation, Assessme nt IFSP Complete d Services identified to meet outcomes If services not provided by CBDD, SC helps parent make POLR application SC monitors units; when 55 units almost exhausted, facilitates IFSP review and redetermines if parent is unable to pay POLR application as needed 45 Days

System of Payments Process SC Collects financial informatio n and determine s if parent is unable to pay Screening, Evaluation, Assessme nt If services not provided by CBDD, SC helps parent make POLR application IFSP Complete d Services identified to meet outcomes IFSP and SOP processes intersect SC monitors units; when 55 units almost exhausted, facilitates IFSP review and redetermines if parent is unable to pay POLR application as needed

What happens if a family is re-referred OR transfers from another county?

Ability to Pay Determination Form (EI 1701)

Ability to Pay Determination Form (EI 1701)

Ability to Pay Determination Form (EI 1701)

Payment for Early Intervention Services (EI 1702)

EME Worksheet (EI 1703)

EME Worksheet (EI 1704)

Early Intervention Services System of Payments Rule 5123: 2 -10 -01 Section Topic A Purpose B Definitions C Provisions D Determination of a parent’s ability to pay for early intervention services E Parent cost participation F Using the private insurance of a child or parent to pay for early intervention services G Using the public insurance of a child or parent to pay for early intervention services H Procedural safeguards

Questions? POLR@dodd. ohio. gov http: //ohioearlyintervention. org/

Thank you!