Thursday, August 11, 2011

Changes to First Steps Cost-participation: effective August 1

Family Voices Indiana wants to ensure its members are kept up-to-date on changes that impact families with children with special health care needs and/or disabilities. Emily McKinley, health information specialist for Family Voices Indiana, shares the following update to cost- participation. If families need assistance with First Steps, or other programs or resources, please contact Family Voices at 317 944 8982 or email info@fvindiana.org. We're happy to help!

The Indiana Family and Social Service Administration (FSSA) is making an effort to recoup the costs of its early intervention services and in accordance with HB1001, First Steps recently changed cost-participation policies. These policies may affect the delivery of services.

Families whose income does not exceed 250% of the federal poverty level will continue to receive services at no cost. Cost-participation for families with income above 250% ($55,875 for a family of four) will now be billed per 15 minute increments of service. Previously, billing was “per service,” which was typically delivered in one hour increments. According to the Division of Disability and Rehabilitative Services (DDRS), this change is to “encourage families to ‘think about’ the amount of time that is reasonable for their child.”

Despite the change in service increments, families whose income does not exceed 650% of the federal poverty level will not see an increase in the total co-pay for an hour of service. Those families with incomes at or above 651% FPL ($ 143,545.50 for a family of four) will see increases in the 60-minute service co-pay.

Monthly co-pay maximums increase for all cost-participation families to 200% the 2010 maximum. DDRS states that the increases reflect monthly maximums for 16 hours of service per month. According to DeeAnn Rowley, SPOE Supervisor, First Steps of Mid-North Indiana, families who are not required to pay a co-pay will “not be denied services because of their ability to pay.”

In all cases, First Steps will bill private insurance for the services provided, regardless of family cost-participation obligation. Insurance plans eligible for billing include all Non-ERISA, Public Employee and State University plans. When insurance covers the full cost of services, co-payments for those services will be waived. Services provided on or after August 1, 2011, are eligible for billing to insurance plans.

Services may be suspended in cases where families fall 60 days past due on their cost-participation share. In such cases, the Service Coordinator must work with the family to inform them of suspension, “their rights within the system and their ability to set up a payment plan.” Billing may be waived in the event that the family is able to show financial or personal hardship.

Families are encouraged to learn more about cost participation and insurance billing; contact your Service Coordinator or your local System Point of Entry (SPOE) to learn more. If you disagree with any determination made by First Steps with regard to the services provided to your family or cost- participation policies, you have the right to file a complaint, request mediation, or request a hearing. For more information call 1-800-441-STEP or contact:

Complaint Coordinator (for complaints) or Part C Coordinator (to request mediation or an impartial hearing)
First Steps Early Intervention Program,
402 W. Washington St.
Room W-386, MS-02

Indianapolis, IN 46204

To learn more about First Steps and to find your local early intervention system point of entry visit:

http://www.in.gov/fssa/ddrs/2633.htm

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