Section 470 IAC 3.1-12-7 - Cost participation planAuthority: IC 12-13-2-3; IC 12-13-5-3
Affected: IC 12-17-15
Sec. 7.
(a) As used in this section, family of an eligible infant or toddler shall be composed of members who live in the same household as the eligible infant or toddler and include only the following members:(b) The division shall establish and implement cost participation plan procedures for charges and fees imposed by service providers for the individualized services specified in the following: (1)470 IAC 3.1-4-2(a)(2) through 470 IAC 3.1-4-2(a)(4).(2)470 IAC 3.1-4-2(a)(6) through 470 IAC 3.1-4-2(a)(10).(3)470 IAC 3.1-4-2(a)(12) through 470 IAC 3.1-4-2(a)(14).(4)470 IAC 3.1-4-2(a)(16).(c) The cost participation plan procedures for each eligible family shall be based upon the following: (1) The following schedule of costs: | Percentage of Federal Income Poverty Level | Copayment Per Treatment Up to Actual Cost of Treatment | Maximum Monthly Cost Share Per Family |
| At Least | But Not More Than |
| 0% | 250% | $0 | $0 |
| 251% | 350% | $3 | $24 |
| 351% | 450% | $6 | $48 |
| 451% | 550% | $15 | $120 |
| 551% | 650% | $25 | $200 |
| 651% | 750% | $50 | $400 |
| 751% | 850% | $75 | $600 |
| 851% | 1,000% | $100 | $800 |
| 1,001% | | $120 | $960 |
(2) The parent's ability to pay.(d) The division may waive or reduce a required copayment if out-of-pocket medical expenses and personal care needs expenses incurred, within the previous twelve (12) month period preceding the date of application, that relate to the health or medical needs of a family member reduce the level of income the parent has to a lower level found in the schedule of costs at subsection (c)(1).(e) A parent who fails to provide the financial information for the division to be able to determine the copayment amount shall pay the maximum level copayment found in the schedule of costs at subsection (c)(1).(f) The division may allow and accept voluntarily contributed payments that exceed the parent's required copayment amount.(g) The parent's cost participation amount shall be reviewed by the division for one (1) or both of the following:(2) Within thirty (30) days after the parent reports a reduction in income. (h) The SPOE shall notify the parent of the following:(1) The copayment amount per treatment and the maximum monthly cost share per family.(2) Any recalculated copayment amount per treatment and the maximum monthly cost share per family determined under subsection (g)(1) or (g)(2).(i) The parent may request reconsideration by the division of the copayment amount within fifteen (15) days from the date the notification of the copayment amount was received by the parent. The request for reconsideration shall: (2) be sent to the director of the division; and(3) state the specific reasons the copayment amount should be reconsidered.(j) The division shall establish and implement procedures to assure timely reimbursement of the copayment by parents for early intervention services required under this section.(k) The copayments that are received by the division under this cost participation plan must be used to fund the early intervention system.Division of Family Resources; 470 IAC 3.1-12-7; filed Feb 10, 2003, 3:22 p.m.: 26 IR 2320; filed Feb 16, 2006, 8:25 a.m.: 29 IR 2185; readopted filed Oct 24, 2007, 11:25 a.m.: 20071121-IR-470070448RFA; readopted filed Aug 23, 2013, 3:36 p.m.: 20130918-IR-470130306RFAReadopted filed 11/13/2019, 11:56 a.m.: 20191211-IR-470190490RFA