Sec. 17a-248g. Birth-to-three funding. Fees for services. Insurance coverage. Regulations. Authority of advanced practice registered nurse to order services.
Sec. 17a-248g. Birth-to-three funding. Fees for services. Insurance coverage.
Regulations. Authority of advanced practice registered nurse to order services. (a)
Subject to the provisions of this section, funds appropriated to the lead agency for purposes of section 17a-248, sections 17a-248b to 17a-248f, inclusive, this section and
sections 38a-490a and 38a-516a shall not be used to satisfy a financial commitment for
services that would have been paid from another public or private source but for the
enactment of said sections, except for federal funds available pursuant to Part H of the
Individuals with Disabilities Education Act, 20 USC 1471 et seq., except that whenever
considered necessary to prevent the delay in the receipt of appropriate early intervention
services by the eligible child or family in a timely fashion, funds provided under said
sections may be used to pay the service provider pending reimbursement from the public
or private source that has ultimate responsibility for the payment.
(b) Nothing in section 17a-248, sections 17a-248b to 17a-248f, inclusive, this section and sections 38a-490a and 38a-516a shall be construed to permit the Department
of Social Services or any other state agency to reduce medical assistance pursuant to
this chapter or other assistance or services available to eligible children. Notwithstanding
any provision of the general statutes, costs incurred for early intervention services that
otherwise qualify as medical assistance that are furnished to an eligible child who is
also eligible for benefits pursuant to this chapter shall be considered medical assistance
for purposes of payments to providers and state reimbursement to the extent that federal
financial participation is available for such services.
(c) Providers of early intervention services shall, in the first instance and where
applicable, seek payment from all third-party payers prior to claiming payment from
the birth-to-three system for services rendered to eligible children, provided, for the
purpose of seeking payment from the Medicaid program or from other third-party payers
as agreed upon by the provider, the obligation to seek payment shall not apply to a
payment from a third-party payer who is not prohibited from applying such payment,
and who will apply such payment, to an annual or lifetime limit specified in the third-party payer's policy or contract.
(d) The commissioner, in consultation with the Office of Policy and Management
and the Insurance Commissioner, shall adopt regulations, pursuant to chapter 54, providing public reimbursement for deductibles and copayments imposed under an insurance
policy or health benefit plan to the extent that such deductibles and copayments are
applicable to early intervention services.
(e) The commissioner shall establish a schedule of fees based on a sliding scale for
early intervention services. The schedule of fees shall consider the cost of such services
relative to the financial resources of the parents or legal guardians of eligible children.
Fees may be charged to any such parent or guardian, regardless of income, and shall be
charged to any such parent or guardian with a gross annual family income of forty-five
thousand dollars or more, except that no fee may be charged to the parent or guardian
of a child who is eligible for Medicaid. The Department of Developmental Services
may assign its right to collect fees to a designee or provider participating in the early
intervention program and providing services to a recipient in order to assist the provider
in obtaining payment for such services. The commissioner may implement procedures
for the collection of the schedule of fees while in the process of adopting or amending
such criteria in regulation, provided the commissioner prints notice of intention to adopt
or amend the regulations in the Connecticut Law Journal within twenty days of implementing the policy. Such collection procedures and schedule of fees shall be valid until
the time the final regulations or amendments are effective.
(f) The commissioner shall develop and implement procedures to hold a recipient
harmless for the impact of pursuit of payment for early intervention services against
lifetime insurance limits.
(g) Notwithstanding any provision of title 38a relating to the permissible exclusion
of payments for services under governmental programs, no such exclusion shall apply
with respect to payments made pursuant to section 17a-248, sections 17a-248b to 17a-248f, inclusive, this section and sections 38a-490a and 38a-516a. Except as provided
in this subsection, nothing in this section shall increase or enhance coverages provided
for within an insurance contract subject to the provisions of section 10-94f, subsection
(a) of section 10-94g, subsection (a) of section 17a-219b, subsection (a) of section 17a-219c, sections 17a-248, 17a-248b to 17a-248f, inclusive, this section, and sections 38a-490a and 38a-516a.
(h) Notwithstanding any provision of the general statutes or the regulations of Connecticut state agencies, the signature on an individualized family service plan of an
advanced practice registered nurse, working within said nurse's scope of practice in
collaboration with a physician licensed to practice medicine in this state, in accordance
with section 20-87a, and performing or directly supervising the primary care services
for children enrolled in the birth-to-three program, shall be deemed sufficient to order
all such services included in the individualized family service plan and shall be deemed
sufficient by the Department of Social Services to substantiate a claim for federal financial participation.
(P.A. 96-185, S. 5, 16; P.A. 00-27, S. 5, 24; P.A. 02-89, S. 26; June 30 Sp. Sess. P.A. 03-3, S. 9; P.A. 04-54, S. 2; P.A.
07-73, S. 2(a).)
History: P.A. 96-185 effective July 1, 1996; P.A. 00-27 made technical changes, effective May 1, 2000; P.A. 02-89
amended Subsec. (g) to delete reference to Sec. 19a-1c, reflecting the repeal of said section by the same public act; June
30 Sp. Sess. P.A. 03-3 amended Subsec. (e) by requiring fees to be charged to parents or guardians earning $45,000 or
more and by making technical changes, effective August 20, 2003; P.A. 04-54 added Subsec. (h) re signature of advanced
practice registered nurse deemed sufficient to order services included in individualized family service plan, effective May
4, 2004; pursuant to P.A. 07-73 "Department of Mental Retardation" was changed editorially by the Revisors to "Department of Developmental Services", effective October 1, 2007.