Family Cost Participation Fee Policy

Child Development Services Policy DFC

The Maine Department of Education (DOE) and Child Development Services (CDS), as the Governor appointed local lead agency, is responsible for the development and implementation of the state’s early intervention system for infants and toddlers, birth through two, who have disabilities or developmental delays and their families.  The Maine DOE and CDS have established Family Cost Participation Fee Policies and Procedures in accordance with Part C of the Individuals with Disabilities Education Act (IDEA).  The CDS Case Manager for the family is responsible for the collection of information and verification of income.

FAMILY COST PARTICIPATION FEE POLICY
Early intervention services provided to eligible infants and toddlers and their families shall be financed through multiple funding sources.  Sources which may be available to finance individualized services, as appropriate, may include, but are not limited to, the following:

  • Title V of the Social Security Act
  • Title XIX of the Social Security Act
  • Head Start Act
  • Part C and Part B of the Individuals with Disabilities Act
  • Developmentally Disabled Assistance and Bill of Rights Act
  • MaineCare
  • Third party payers (Third party payers, such as health insurance companies, may be accessed by families to cover the costs of early intervention services.)
  • Long Term Care
  • Medical Day Care
  • Any medical program administered by the Secretary of the United States Department of Defense
  • State appropriation, Early Childhood Intervention Program
  • Cost participation by the family of an eligible child that receives direct early intervention services through the implementation of an Individualized Family Service Plan (IFSP)

CDS has established Family Cost Participation Fee procedures for charges and fees for early intervention services provided under an IFSP by CDS.

CDS may exempt or reduce a required Family Cost Participation Fee payment if:

  • An application to adjust income for extraordinary expenses that exceed 5% of the household income is submitted by the family and approved by  CDS; or
  • CDS receives payment from a family’s public or private health care insurance carrier.

A parent requested to provide family income information to determine a Family Cost Participation Fee payment amount shall exercise one of the following:

  • Provide required family income information to determine the Family Cost Participation Fee;
  • Decline to provide family income information and pay the full cost of appropriate early intervention IFSP services provided by CDS;
  • Decline / discontinue services with a Family Cost Participation Fee and receive the early intervention services provided at public expense, including service coordination, evaluation / assessment, IFSP development, IFSP periodic and annual review, and procedural safeguards; or
  • Terminate participation with Child Development Services.

The Family Cost Participation Fee options and, as appropriate, the family income information shall be reviewed by the CDS Case Manager as follows:

  • Annually (usually coinciding with the IFSP date);
  • Within thirty (30) days of a parent request to change income information, including an increase or reduction in income;
  • A parent request to change the Family Cost Participation Fee option as described in 1 to 4 above; or
  • As a result of a change in the CDS Family Cost Participation Fee Policies and Procedures.

The Family Cost Participation Fee payments received by CDS will be used to fund services provided by CDS.

DETERMINATION OF THE FAMILY COST PARTICIPATION FEE
Child Development Services Family Cost Participation Fee is a progressive co-payment per month of direct services provided in accordance with an IFSP.

Family Cost Participation Fee is based upon family size, CDS determined income and the federal poverty level guidelines.

Families must agree to provide required income documentation to determine family fee participation for services.

Families with an annual income at or above 300% of the federal poverty level will be required to participate in the costs of CDS services provided.

The family will be responsible for a family fee not to exceed the cost of services or a maximum of 5% of the family’s monthly CDS determined income.

The co-payment per month will be charged based on the month a service is rendered including services provided as make-up and/or compensation from prior months.

The Family Cost Participation Fee system is similar in structure to the federal income tax progression and, like the federal tax structure; a larger co-payment is assessed in a progressive manner as the family’s income increases.

CDS determined incomes at 300% of the federal poverty level will start with a _______ per month payment on the actual cost of service, with progressive co-payment increases based on income and family size.

A Family Cost Participation Fee with $500 income increments contains the family’s co-payment fee participation based on family size and CDS determined income.  The family’s actual fee will either be the family co-payment per month of service or the actual cost of the services, whichever is less.

The Family Cost Participation Fee Table (DFC-T) is available through the case manager or the CDS website at: www.maine.gov/doe/cds.

The monthly Family Cost Participation Fee established for the family will be the same regardless of:

  • Whether one or more children receive services; or
  • The number of early intervention providers from which services are received.

Approved: ______________

Required Procedure:
            Family Cost Participation Fee Procedure (DFC-R)

Required Forms:
            Family Cost Participation Fee Determination Form (DFC-F)
            Family Cost Participation Fee Table (DFC-T)

Child Development Services Policy DFC-R

Family Cost Participation Fee Procedure

FAMILY RESPONSIBILITIES IN DETERMINING THE FAMILY COST PARTICIPATION FEE
The family is responsible for the following:

Requesting assistance from their case manager to answer questions regarding the Family Cost Participation Fee policies / procedures and their family fee payment which they do not understand.

Providing timely financial information at least annually in order for a family fee to be determined by CDS including, but not limited to current federal and state filing documents, form W-2, and paystubs.

  • Providing tax information from the most recently federally required tax return year.
  • Families who have not filed taxes must provide copies of IRS approved extension unless not required to file as per IRS regulations in which case documentation must be provided.
  • If an extension was filed for the most current tax year, the IRS extension is valid until October 15th and families must submit their filed tax records or provide the case manager with another IRS approved extension by October 31st.
    • If the family fails to submit the updated information, the family will automatically be placed at full-fee effective November 1st.
    • The full fee status will remain until the updated documents are received by the case manager and revised CDS Family Cost Participation Fee Determination Form are completed and signed.

Families may opt to start services at full fee but must understand that a change will not be made retroactively.  The full fee status will not be changed until tax documentation are received and completed.

Families may choose to decline the start of services until their Family Cost Participation Fee is determined to avoid paying full cost.

Providing financial information prior to or at the initial IFSP meeting to ensure that CDS can provide the family with the family fee co-payment notice prior to the initiation of services.

A family’s failure to provide timely income information will result in the family paying for the full cost of services delivered until the date the Family Cost Participation Fee determination can be finalized.

Identifying any extraordinary expenses associated with the eligible child(ren) and/or other family members.

Informing their case manager and providing required documentation when there are changes in the family’s financial status or family size.

Participation in an annual review of the Family Cost Participation Fee options and, as appropriate, the family income information.

Providing written communication and supporting documentation for changes in income and family size in order to have the family fee recalculated with a new effective date.  The effective date will be at the discretion of the CDS when there is a failure to submit appropriate and timely documentation.

Case Manager Responsibilities
The CDS case manager is responsible for the following:

During the intake process, the case manager must explain the family’s rights and financial responsibilities within CDS including:

  • How extraordinary expenses related to the determination of family fee participation;
  • What functions or services must be provided at public expense; and
  • How IFSPs are developed without regard to a family’s ability to pay.

Once eligibility for the child has been determined, the case manager is responsible for explaining the CDS Family Cost Participation Fee policies and procedures, informing the family of documentation need and, as appropriate, collecting required income information from the family.

Informing and assisting the family as needed in completing a CDS Family Cost Participation Fee Determination Form (DFC-F).

Obtaining family income and family size information by obtaining the name and relationship of each family member.

Obtaining the date of birth (DOB) for each child family member.

Obtaining income verification documentation for each adult included in the family size, including verification of zero income.

Obtaining a parent signature on the Family Cost Participation Fee Determination Form.

For families identified as having one or more self-employed household members, case managers must assist the family in submitting appropriate self-employment income records to the CDS in accordance with the Income Determination for Any Family Household Member Filing a Federal Schedule E section below.

Maintaining the completed Family Cost Participation Fee Determination Form in the child’s file.

Annually, reviewing the Family Cost Participation Fee Policy and Procedures with parents and obtaining updated income information by competing new a Family Cost Participation Fee Determination Form.

The case manager must verify that families reviewed the income documents supplied by having families sign the Family Cost Participation Fee Determination Form verifying the accuracy of all information provided.

Within five (5) calendar days, the case manager must forward a copy of the completed Family Cost Participation Fee Determination Form to the CDS State IEU office for Family Cost Participation Fee determination.

Within thirty (30) days of a request from a family to review their family fee, the case manager must review the documentation of the family’s income, changes in income and/or assist with a Family Cost Participation Fee Determination Form.  Documentation of the review, including the completion of any necessary forms, and supporting documentation, must be maintained with the child’s file.

Ensuring that families are informed of their right to submit to CDS a request for administrative review of income and/or pursue procedural safeguards dispute resolution options.

Ensuring that IFSPs are developed without regard to the family’s ability to pay.

Submit timely updates and changes to family income and size to the CDS State IEU office.

CDS REGIONAL SITE RESPONSIBILITIES
The CDS regional site is responsible for the following:

Ensuring that the case manager accurately completes the Family Cost Participation Fee Determination Form, reviews and verifies supporting documentation, and maintains appropriate documents in the child’s file.

Ensuring that IFSPs, Family Cost Participation Fee Determination Forms are maintained, updated, and submitted to the CDS State IEU office in a timely manner.

Calculating the Family Cost Participation Fee for each family based on services provider.

Mailing the Explanation of Benefits (EOB) and Family Cost Participation Fee Statement (billing) to the family outlining the services provided and payment information.

Processing all revenue received through Family Cost Participation Fees.

Tracking and, as appropriate, providing notice of suspension for nonpayment of cost participation.

Ensuring that early intervention services are provided in accordance with the IFSP.

FAMILY INCOME AND FAMILY SIZE DETERMINATION
Individuals that contribute to the care and control of the child and living with the family must present, at a minimum, the following documents for verification:

  • The most recently filed state and federal income tax forms with all applicable attachments.
  • Current W-2’s and/or last 3 consecutive pay stubs.
  • Business Schedule E when self-employed; and
  • Documentation of child support received or paid, as appropriate.

Notes:

  • Under exceptional circumstances and with the approval of the CDS Regional Site Director, a notarized written statement from an employer regarding salary / wages may be accepted.
  • Estimates and/or projections of income are not allowable.
  • Previous end of year commissions and bonuses are included in the income determination.
  • Negative income and/or losses are not allowable and must not be included on the income verification form.
  • Case Managers must not make adjustments or deductions to family income with the exception of child support / alimony paid out of the household to another household.
  • All income documentation must be verified annually or within thirty (30) days after the family reports a change in income.
  • Child support received must be included as income.
  • Child support paid to a benefit a child that does not live with the parent may be deducted from income.  The child must not be reported in family size.
  • A parent is responsible for providing household income documentation if they have legal custody of the child even though they may or may not reside with the child.
  • Child and/or family benefits received from the Social Security Administration (SSA) are calculated into family income.
  • Children with special needs adoptions must show the following documentation:
    • Adoption assistance maintenance payments, special service subsidies and/or clothing allowances.
  • If a foster child is adopted by the family, the family size must be adjusted and income information must be included even if the adopted child maintains Medicaid coverage.
  • A family may request an administrative review by CDS if asked for special consideration of their financial status.  Families may also request mediation, a due process hearing, or resolution of an administrative complaint through the Part C procedures.  Additional information is referenced in the Administrative Review section of this document.
  • The number of family members (family size) to be considered in the eligibility determination is established by counting the dependent child, the child’s parent(s), the child’s siblings with whom the dependent child lives full-time and any adults identified as dependent when filing income taxes in accordance with Federal IRS regulations.  All natural, adoptive, or half-siblings who meet the definition of dependent child must be included in the family group.  The income rules require the consideration of the income of the dependent child, the dependent child’s siblings, and dependent child’s parents.
  • A child who resides in a foster home is considered a family of one and would not be considered for cost participation.
  • A change in family size must be reported to the case manager as soon as possible.

INCOME DETERMINATION FOR ANY FAMILY HOUSEHOLD MEMBER FILING A FEDERAL SCHEDULE E
For families that include self-employed household members:

  • On an interim basis, a Family Cost Participation Fee will be determined based on the family’s most recent state tax return pending a review of the family’s most current Federal 1040 (business) income tax return, statements, schedules, and forms including: 1120S, 1065, 8582, 4562, K-1, corresponding statements, and itemized “Cost of Goods Sold” and expenses.
  • If the family delays submitting the appropriate requested documentation, the interim Family Cost Participation Fee will expire 30 days from the date of the signed consent for early intervention services and the family will be billed full fee for services received from that date forward until the documentation is submitted.
  • Based on the CDS review of the family’s federal tax documentation, a revised Family Cost Participation Fee may be determined with a new effective date starting from the date of determination.  However, if CDS has determined that the family has provided information that misrepresents the family’s income, the effective date will be retroactively applied.

Notes:

  • CDS is responsible to review, verify and/or revise the family’s income determination.
  • Negative income and/or losses are not applied as a deduction against family income.
  • Depreciation, amortization, bad debts, dues, subscriptions, training, meals, entertainment, gifts and miscellaneous deductions are non-allowable deductions in determining the family fee.
  • CDS will provide the family with the outcome of a review and, as appropriate, a notice of a revised Family Cost Participation Fee.
  • The family must respond within ten (10) business days in one of the following ways or the full-fee option will be implemented and remain until the required documentation is received by CDS:
    • If in agreement with the revised family fee, the family must sign, date and return the Family Cost Participation Fee Determination Form; or
    • If the family disagrees with the income determination and wants to decline / discontinue services on the IFSP, a new Payment Option Form must be completed; or
    • If the family chooses to withdraw from participation in Child Development Services, the family must provide written notice to CDS.
  • The family may appeal their family fee in writing to CDS.
  • Families under appeal may opt to continue service but would be required to continue to make timely payments under the CDS family fee determination pending resolution of the appeal.

ADJUSTMENT(S) TO INCOME FOR EXTENUATING CIRCUMSTANCES / EXTRAORDINARY EXPENSES
Families may submit a written request to adjust income for extenuating circumstances to the CDS Regional Site Director.  The case manager is responsible for assisting the family with preparing and submitting the request.

  • Extenuating circumstances are defined as average monthly or yearly unreimbursed (out of pocket) expenses that are related specifically to the eligible child’s disability or an immediate family member with a disability or long term health issue.  Deductions might include specific purchases, expenses, modifications, and alterations that family members have made within the previous month or year to accommodate the extended / additional needs of the eligible child or family member.  Extenuating circumstances may include unexpected events that affect the family’s financial situation.
  • Extenuating circumstances cannot include out of pocket expenses for anticipated future services or any expenses for which other funding resources have been requested to assist in paying for the same products and services.  Extenuating circumstances must be supported by written documentation.
  • Extraordinary expenses do not include well visits, over the counter or alternative nutritional supplements, complementary or alternative treatment procedures.
  • Additional information on extraordinary expenses is provided under the Family Cost Participation Fee Determination Form process that requires review and approval by CDS.
  • If, at any time, a family experiences a significant change in expenses for medical or personal care needs, or has other extraordinary expenses, they may request a re-evaluation of their family fee.

UTILIZATION OF INSURANCE
Medicaid:
Families will be informed of and, as requested, assisted by the CDS Case Manager, benefits, including MaineCare (state children’s health insurance program), for which their child may be eligible.

Families who have adopted children that remain eligible for Medicaid may also be responsible for the Family Cost Participation Fee if the:

  • Family’s CDS determined household income is at or above 300% FPL;
  • Early Intervention Services received are not covered or reimbursed by Medicaid.

Private Insurance / Third-Party Coverage:
Families covered by a third-party (such as Anthem, commercial health insurance or governmental agencies) have the option, consistent with the terms of their third-party coverage, of accessing services through their insurance company to meet the needs identified on the Individualized Family Service Plan.  (see Parental Rights for Use of Third-party Payment)

ESTABLISHMENT OF A FAMILY COST PARTICIPATION FEE CO-PAYMENT AMOUNT
Child Development Services Monthly Family Cost Participation Fee Table (DFC-T) established under Federal Poverty Levels (FPL) by family size will be utilized in determining the family fee co-payment.  The determination takes into consideration:

  • The family’s income minus any CDS reviewed and approved allowable extraordinary expenses, and the family size.
  • Families under the 300% Federal Poverty Level are exempt for cost participation payment.
  • Incomes calculated at or above 300% have a Family Cost Participation Fee payment based on the income level and family size.
  • Families, who choose to decline or delay providing their financial information for the determination of the family fee payment amount and choose to receive early intervention services, will be billed the actual cost of direct early intervention services identified as needed in the IFSP.
  • Family fee payment amounts will be identified on the CDS Family Cost Participation Fee Determination Form.  No other written or verbal quotes will be valid.
  • Families may submit written documentation of extenuating circumstances.
  • Families who disagree with the family fee payment amount may:
    • Request an administrative review in writing; or
    • Request procedural safeguards dispute resolution options including mediation, a due process hearing, or administrative complaint.

ASSESSMENT OF MONTHLY FAMILY COST PARTICIPATION FEE

  • Monthly Family Cost Participation Fee is based on delivery of services that are authorized for the eligible child and family in the IFSP.
  • Family fees may not be charged for early intervention functions or services required to be provided at public expense to eligible children and their families by federal or state regulation.  The functions and services that must be provided at public expense are:
    • Child Find;
    • Evaluation and Assessment;
    • Development of an Individualized Family Service Plan;
    • Service Coordination (Case Management); and
    • Procedural Safeguards and Due Process.
  • A Family Cost Participation Fee will be applied to the following services:
    • Assistive Technology Services and Devices
    • Audiology Services
    • Family Training and Counseling
    • Health Services
    • Medical Services (for the purposes of diagnosis or evaluation only)
    • Nursing Services
    • Nutrition Services
    • Occupational Therapy
    • Physical Therapy
    • Psychological Services
    • Social Work Services
    • Special Instruction
    • Speech and Language Therapy
    • Transportation Services
    • Vision Services

SOURCE OF PAYMENT

  • The family may meet their financial fee obligations in the following ways:
    • Payment of the family fee determined and billed by CDS, plus any applicable costs associated with assistive technology devices.
    • Full fee payment by the family for actual costs of services.
  • Families may select their preferred method of payment once the monthly Family Cost Participation Fee amount has been determined and the family is fully informed of the rights within CDS.  The family will indicate the method of payment on the CDS Family Cost Participation Fee Payment Option Form.
  • Federal and state regulations require that any and all other resources be utilized toward the cost of services.  Part C funds must not be used to replace other sources of payment, including other governmental agencies.  Part C funds are to be used as a payer of last resort.

BILLING PROCESS
The Accounts Receivable Specialist at the CDS State IEU office is responsible for notifying the parents of the monthly Family Cost Participation Fee amount due and for collecting all revenue.

FAILURE TO PAY PROCEDURE
The following timeline will be implemented for payment of services:

  • A family will have thirty (30) days from the date of issuance of the Family Cost Participation Fee Statement to pay their family fee payment.
  • Each month, the Family Cost Participation Fee Statement will provide the total amount due including past due amounts.  If payment was made after the generation of the current month’s billing statement, the receipt of payment may not be included on the statement.
  • Families with statements that include 60 day past due balances will receive an “approaching suspension” notice of non-payment stating that if payment is not received in fourteen (14) calendar days, services will be suspended.  The notice will include a date of suspension and current balance due to avoid suspension.
  • If payment is received after the suspension date, a new billing cycle will have begun and the prior Minimum Payment Required may not be sufficient to reinstate services.
  • Should a family access direct services on a current IFSP on or after the date of suspension, the family shall be held solely responsible for the entire cost of such services.
  • Families will not be entitled to make-ups for any misses services as a result of suspension for nonpayment of the family fee.
  • CDS State IEU staff will inform the Case Manager and Early Intervention Provider agencies that the transmittal of final notice was mailed to the family.
  • The family may contact their Case Manager to discuss the reason(s) for non-payment and, as appropriate, discuss the need to review, and revise the IFSP and/or Family Cost Participation Fee Income Verification.
  • If early intervention services are suspended due to the failure to pay their outstanding family fee, the family will continue to be entitled to receive the functions and services required to be provided at public expense, including case management.
  • If unpaid family fee balances remain ninety (90) days after the date the family exits CDS, the family may be included in a debtor file transferred to a private collection company for further collection efforts.

 

CANCELLATION OF SCHEDULED EARLY INTERVENTION SERVICES

In addition to sharing in the cost of services, families have a responsibility to be available for scheduled services.  Each member of the team must be respected and valued for the time dedicated in serving the child and family.

Family Responsibilities:

  • If a family cannot be available for a scheduled service, they must provide the early intervention provider with at least a 24-hour notice of cancellation unless prevented by an emergency.
  • If the family provides less than a 24-hour notice of cancellation of a scheduled service or, with the exception of an emergency situation, fails to be available for a scheduled service, the family will be liable for their family co-payment for that service.
  • The family should contact the early intervention provider and confirm their availability for the next scheduled service or identify a need to review the current IFSP.

Early Intervention Provider Responsibilities:

  • Early Intervention (EI) providers must provide families with an annual calendar that identifies agency closings including, but not limited to, holidays and in-service trainings.
  • EI providers are to establish procedures for confirming scheduled or cancelled services with families.
  • If an EI provider cannot be available for a scheduled service, they must provide the family with at least a 24-hour notice of cancellation, unless prevented by an emergency, and make a reasonable attempt to re-schedule the service.  Exception:  When a service falls on a holiday; agency closing including a scheduled in-service; or is cancelled due to extreme weather conditions that make it dangerous to travel, notice is not required and attempts to reschedule are at the discretion of the EI provider.
  • If the family fails to be present when the EI provider arrives for a scheduled service, the provider will record the service as a “no show” and document reasonable attempts to contact the family prior to the next scheduled service to identify the reason for the “no show” and confirm the next scheduled service.
  • If the EI provider is unsuccessful in contacting the family regarding a scheduled service after several attempts, the provider will not be deployed to render scheduled services unless contact has been made with the family within 24-hours of scheduled services.
  • The family’s case manager will be:
    • Apprised of the difficulties experienced in rendering the service to the child or family;
    • Given notice of the contact requirements that shall be employed prior to the provider’s dispatch; and
    • Provided a list of attempts made to reach the family.
  • The case manager shall attempt to reach the family to schedule an IFSP review.  If after three attempts the case manager has been unsuccessful in scheduling an IFSP review with the family, the case manager along with the EI provider(s) designated to provide scheduled services shall meet to determine whether changes should be made in the child’s IFSP.  Throughout the entire process, any and all contact with the family will include a statement that the family is always entitled to invoke their right to procedural safeguards.
  • Prior to resuming a scheduled service, the EI provider will contact the family to confirm the next scheduled service.

Case Manager Responsibilities:

  • The case manager will inform the family of the policy and procedures for canceling scheduled services.
  • Follow-up with the family when notified by the EI provider that a family was a “no show” for a scheduled service and reasonable attempts to contact the family were unsuccessful.
  • Documentation of attempts to contact the family including, but not limited to telephone, letters, e-mails or home visits.
  • If contact with the family is established, the case manager will identify the reason(s) for the “no show” and determine any need to review the IFSP or family fee with the family.
  • If the case manager is unsuccessful in contacting the family, the case manager and EI provider(s) may convene an IFSP meeting to explore the reasons for “no shows”, including service delivery, location, etc.  If a meeting is convened, the case manager shall provide Advance Written Notice to the parents a reasonable time prior to the IFSP meeting and document attempts to contact the family about the meeting and its purpose.  If services are revised at the IFSP meeting, a family must receive Written Notice of the action that is being proposed or refused, the reason for taking the action, all procedural safeguards that are available to the family, and the State complaint procedures.

ADMINISTRATIVE REVIEW
The family must be informed of their rights and procedures for accessing dispute resolution options under CDS.  The following procedures are available to assist families in resolving concerns and disputes:

  • Families are encouraged to first contact their case manager to request, as appropriate, an IFSP meeting to review and consider an IFSP changes or address concerns about services.
  • The parent may submit to CDS for review of the Family Cost Participation Fee to the address below.  This should be submitted within fifteen (15) days from the date the notification of the Family Cost Participation Fee was received by the parent.  The request for administrative review should be a written statement that includes the specific reason the Family Cost Participation Fee amount should be reconsidered.
  • Families that disagree with any action or decision related to the family fee payment may:
    • Submit a request for CDS administrative review to:

Child Development Services State IEU
attn: Cindy Brown, State Director
146 State House Station
Augusta, Maine  04333

 

Submit a request for Mediation, a Due Process Hearing, or administrative complaint through the Part C procedures to:

Maine Department of Education
attn: Susan Parks, Due Process Consultant
23 State House Station
Augusta, Maine  04333

 

Approved: _______________

Required Policy:
            Family Cost Participation Fee Policy

Required Forms:
            Family Cost Participation Fee Determination Form (DFC-F)
            Family Cost Participation Fee Table (DFC-T)