Connecticut General Statutes/Title 17a/Chapter 319b/Section 17a-248g

CGS § 17a-248g. Birth-to-three funding. Fees for services prohibited. Insurance coverage. General administrative payments.

(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 C of the Individuals with Disabilities Education Act, 20 USC 1431 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 not charge a fee for early intervention services to the parents or legal guardians of eligible children.

(f) With respect to early intervention services rendered prior to June 16, 2021, the commissioner shall develop and implement procedures to hold a recipient harmless for the impact of pursuit of payment for such 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, sections 17a-248, 17a-248b to 17a-248f, inclusive, this section, and sections 38a-490a and 38a-516a.

(h) For the fiscal year ending June 30, 2023, and each fiscal year thereafter, the commissioner shall make a general administrative payment to providers in the amount of two hundred dollars for each child with an individualized family service plan on the first day of the billing month and whose plan accounts for less than nine hours of service during such billing month, provided at least one service is provided by such provider during such billing month.

Short History

(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); Sept. Sp. Sess. P.A. 09-3, S. 44; P.A. 10-93, S. 6; June Sp. Sess. P.A. 15-5, S. 260; P.A. 19-121, S. 12; P.A. 21-46, S. 24; P.A. 22-81, S. 12; 22-140, S. 5; P.A. 23-101, S. 3.)

Long History

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; Sept. Sp. Sess. P.A. 09-3 amended Subsec. (e) by authorizing commissioner to periodically revise fee schedule, giving consideration to financial resources of the state and the parents and legal guardians of eligible children, and by providing that on and after October 6, 2009, such fees shall be 60% greater than the fees charged on date prior to October 6, 2009, and fees shall be charged for all services including those provided in the first 2 months that a child is enrolled in the program, effective October 6, 2009; P.A. 10-93 amended Subsec. (a) by substituting “Part C” for “Part H” and substituting “20 USC 1431” for “20 USC 1471” and amended Subsec. (e) by defining “parent”; June Sp. Sess. P.A. 15-5 amended Subsec. (e) by replacing “Department of Developmental Services” with “lead agency”, “prints” with “posts” and “in the Connecticut Law Journal” with “on the eRegulations System, established pursuant to section 4-173b”, effective July 1, 2015; P.A. 19-121 deleted Subsec. (h) re signature of advanced practice registered nurse deemed sufficient to order services included in individualized family service plan, effective July 1, 2019; P.A. 21-46 amended Subsec. (e) by replacing provisions requiring commissioner to establish and charge fees to parents and guardians for early intervention services with provision prohibiting commissioner from charging such fees, and amended Subsec. (f) by specifying that procedures developed and implemented by commissioner to hold recipients of early intervention services harmless from pursuit of payment for such services shall apply to such services rendered prior to June 16, 2021, effective June 16, 2021; P.A. 22-81 added Subsec. (h) re general administrative payments, effective July 1, 2022; P.A. 22-140 amended Subsec. (g) by deleting references to Secs. 17a-219b(a) and 17a-219c(a); P.A. 23-101 amended Subsec. (h) by replacing “June 30, 2024” with “each fiscal year thereafter” and making a conforming change, effective July 1, 2023.

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