HJR 581

Joint Subcommittee Studying Early Intervention Services for Infants and Toddlers with Disabilities

November 24, 1997, Richmond
The joint subcommittee convened its annual meeting to receive an update on the implementation of Part H services for infants and toddlers with disabilities. Among the topics addressed at the meeting were the report of the Department of Mental Health, Mental Retardation and Substance Abuse Services (DMHMRSAS) and the Department of Medical Assistance Services (DMAS) concerning maximizing federal funding for Part H services, the adequacy of Part H providers in contracts entered into between DMAS and managed care organizations (MCOs), and the use of private insurance to cover Part H services.

Agencies' Report

At the request of the General Assembly, DMHMRSAS and DMAS prepared a joint report on maximizing federal Medicaid funds for early intervention services. The report states that many funding sources are available and utilized for infants and toddlers with disabilities, thus complicating the task of identifying the total sum of public dollars spent on any one child. The report highlights the need for a centralized data system across all participating state agencies that can be used to identify which funding sources are being used to cover Part H services.

Meanwhile, DMHMRSAS and DMAS are working collaboratively to collect, analyze and report data on infants and toddlers with disabilities who were Medicaid recipients and who were enrolled in Part H for fiscal year 1996-97. In addition, the report recommends the development of a work group to examine strategies for enhancing and integrating existing approaches for Medicaid coverage for Part H services.

Recommendations

The subcommittee made the following recommendations:

  • DMHMRSAS and DMAS should provide, no later than November 15, 1998, a report on the total state and federal funding sources being used to provide early intervention services for infants and toddlers with disabilities.

  • DMHMRSAS and DMAS should establish a work group consisting of two members of the joint subcommittee; representatives of the Local Interagency Coordinating Council, the Virginia Interagency Coordinating Council, Community Services Boards, the Department of Education, and the Department of Social Services; and family members. As part of its study, the work group should provide, no later than December 15, 1998, a report on how to better coordinate and implement Part H services. The report should address the extent to which the program can be modified to resolve administrative problems while delivering cost-effective and appropriate services to all who are in need of early intervention services for infants and toddlers with disabilities.

  • Any contract between DMAS and MCOs for early intervention services for infants and toddlers with disabilities should include sufficient Part H providers within the MCO network to ensure the early intervention population is served.

    Federal Regulations

    Federal Part H regulations require that states facilitate the coordination of payment for early intervention services from federal, state, local and private resources (including public and private insurance coverage). Proposed federal regulations for the re-authorization of the Individuals with Disabilities Education Act (IDEA), issued on October 22, 1997, specify that families cannot be required to use their private health insurance to pay for Part H services if any financial cost would be incurred.

    These regulations define financial cost as out-of-pocket expenses such as co-pays and deductibles, a decrease in lifetime cap or other benefits, an increase in premiums, and/or discontinuation of the policy. States could require families to use their private health insurance coverage to pay for Part H early intervention services if no financial cost would be incurred. The majority of insurance policies, however, would include a financial cost to a family. The proposed federal regulations do state that Part H funds may be used to pay the costs of co-pays and deductibles in situations where families refuse to use their insurance due to incurred financial costs. Therefore, the joint subcommittee recommended the following:

  • Encourage the Governor to seek broader access to private insurance coverage for early intervention services by filing a letter expressing the Commonwealth's concerns about the proposed federal regulations for the re-authorization of IDEA which specify that families cannot be required to use their private health insurance to pay for Part H services if any financial cost would be incurred.

  • Authorize the joint subcommittee Chair to express to the Secretary of the United States Department of Education the subcommittee's concerns about the proposed federal regulations.

  • Introduce legislation requiring the coverage of early intervention services for infants and toddlers with disabilities by private insurers and HMOs. The bill will state that the financial costs of co-pays and deductibles shall be paid with state, local and federal Part H dollars.
    The Honorable Mary T. Christian, Chair
    Legislative Services contact: Amy Marschean 
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    THE RECORD