Bill Text: IL SB0626 | 2013-2014 | 98th General Assembly | Amended
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Amends the Cable and Video Competition Law of 2007 in the Public Utilities Act. Makes a technical change in a Section concerning the short title of the Article.
Spectrum: Moderate Partisan Bill (Democrat 9-1)
Status: (Passed) 2013-06-28 - Public Act . . . . . . . . . 98-0041 [SB0626 Detail]
Download: Illinois-2013-SB0626-Amended.html
Bill Title: Amends the Cable and Video Competition Law of 2007 in the Public Utilities Act. Makes a technical change in a Section concerning the short title of the Article.
Spectrum: Moderate Partisan Bill (Democrat 9-1)
Status: (Passed) 2013-06-28 - Public Act . . . . . . . . . 98-0041 [SB0626 Detail]
Download: Illinois-2013-SB0626-Amended.html
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1 | AMENDMENT TO SENATE BILL 626
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2 | AMENDMENT NO. ______. Amend Senate Bill 626 by replacing | ||||||
3 | everything after the enacting clause with the following:
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4 | "Section 5. If and only if Senate Bill 2217 becomes law, | ||||||
5 | the Illinois Insurance Code is amended by adding Section 367m | ||||||
6 | as follows:
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7 | (215 ILCS 5/367m new) | ||||||
8 | Sec. 367m. Early intervention services. Parental consent | ||||||
9 | is not required for the use of private insurance for early | ||||||
10 | intervention services as defined in the Early Intervention | ||||||
11 | Services System Act that are provided in this State pursuant to | ||||||
12 | Part C of the federal Individuals with Disabilities Education | ||||||
13 | Act. A policy of accident and health insurance that provides | ||||||
14 | coverage for early intervention services must conform to the | ||||||
15 | following criteria: | ||||||
16 | (1) The use of private health insurance to pay for |
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1 | early intervention services under Part C of the federal | ||||||
2 | Individuals with Disabilities Education Act may not count | ||||||
3 | towards or result in a loss of benefits due to annual or | ||||||
4 | lifetime insurance caps for an infant or toddler with a | ||||||
5 | disability, the infant's or toddler's parent, or the | ||||||
6 | infant's or toddler's family members who are covered under | ||||||
7 | that health insurance policy. | ||||||
8 | (2) The use of private health insurance to pay for | ||||||
9 | early intervention services under Part C of the federal | ||||||
10 | Individuals with Disabilities Education Act may not | ||||||
11 | negatively affect the availability of health insurance to | ||||||
12 | an infant or toddler with a disability, the infant's or | ||||||
13 | toddler's parent, or the infant's or toddler's family | ||||||
14 | members who are covered under that health insurance policy, | ||||||
15 | and health insurance coverage may not be discontinued for | ||||||
16 | these individuals due to the use of the health insurance to | ||||||
17 | pay for services under Part C of the federal Individuals | ||||||
18 | with Disabilities Education Act. | ||||||
19 | (3) The use of private health insurance to pay for | ||||||
20 | early intervention services under Part C of the federal | ||||||
21 | Individuals with Disabilities Education Act may not be the | ||||||
22 | basis for increasing the health insurance premiums of an | ||||||
23 | infant or toddler with a disability, the infant's or | ||||||
24 | toddler's parent, or the infant's or toddler's family | ||||||
25 | members covered under that health insurance policy.
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1 | Section 10. If and only if Senate Bill 2217 becomes law, | ||||||
2 | the Early Intervention Services System Act is amended by | ||||||
3 | changing Sections 11, 13, 13.10, and 13.15 as follows:
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4 | (325 ILCS 20/11) (from Ch. 23, par. 4161)
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5 | Sec. 11. Individualized Family Service Plans.
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6 | (a) Each eligible infant or toddler and that infant's or | ||||||
7 | toddler's family
shall receive:
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8 | (1) timely, comprehensive, multidisciplinary | ||||||
9 | assessment of the unique
strengths and needs of each | ||||||
10 | eligible infant and toddler, and assessment of the concerns
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11 | and priorities of the families to appropriately assist them | ||||||
12 | in meeting
their needs and identify supports and services | ||||||
13 | to meet those needs; and
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14 | (2) a written Individualized Family Service Plan | ||||||
15 | developed by a
multidisciplinary team which includes the | ||||||
16 | parent or guardian. The
individualized family service plan | ||||||
17 | shall be based on the
multidisciplinary team's assessment | ||||||
18 | of the resources, priorities,
and concerns of the family | ||||||
19 | and its identification of the supports
and services | ||||||
20 | necessary to enhance the family's capacity to meet the
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21 | developmental needs of the infant or toddler, and shall | ||||||
22 | include the
identification of services appropriate to meet | ||||||
23 | those needs, including the
frequency, intensity, and | ||||||
24 | method of delivering services. During and as part of
the | ||||||
25 | initial development of the individualized family services |
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1 | plan, and any
periodic reviews of the plan, the | ||||||
2 | multidisciplinary team may seek consultation from the lead
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3 | agency's designated experts, if any, to help
determine | ||||||
4 | appropriate services and the frequency and intensity of | ||||||
5 | those
services. All services in the individualized family | ||||||
6 | services plan must be
justified by the multidisciplinary | ||||||
7 | assessment of the unique strengths and
needs of the infant | ||||||
8 | or toddler and must be appropriate to meet those needs.
At | ||||||
9 | the periodic reviews, the team shall determine whether | ||||||
10 | modification or
revision of the outcomes or services is | ||||||
11 | necessary.
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12 | (b) The Individualized Family Service Plan shall be | ||||||
13 | evaluated once a year
and the family shall be provided a review | ||||||
14 | of the Plan at 6 month intervals or
more often where | ||||||
15 | appropriate based on infant or toddler and family needs.
The | ||||||
16 | lead agency shall create a quality review process regarding | ||||||
17 | Individualized
Family Service Plan development and changes | ||||||
18 | thereto, to monitor
and help assure that resources are being | ||||||
19 | used to provide appropriate early
intervention services.
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20 | (c) The initial evaluation and initial assessment and | ||||||
21 | initial
Plan meeting must be held within 45 days after the | ||||||
22 | initial
contact with the early intervention services system. | ||||||
23 | The 45-day timeline does not apply for any period when the | ||||||
24 | child or parent is unavailable to complete the initial | ||||||
25 | evaluation, the initial assessments of the child and family, or | ||||||
26 | the initial Plan meeting, due to exceptional family |
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1 | circumstances that are documented in the child's early | ||||||
2 | intervention records, or when the parent has not provided | ||||||
3 | consent for the initial evaluation or the initial assessment of | ||||||
4 | the child despite documented, repeated attempts to obtain | ||||||
5 | parental consent. As soon as exceptional family circumstances | ||||||
6 | no longer exist or parental consent has been obtained, the | ||||||
7 | initial evaluation, the initial assessment, and the initial | ||||||
8 | Plan meeting must be completed as soon as possible. With | ||||||
9 | parental consent,
early intervention services may commence | ||||||
10 | before the completion of the
comprehensive assessment and | ||||||
11 | development of the Plan.
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12 | (d) Parents must be informed that early
intervention
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13 | services shall be provided to each eligible infant and toddler, | ||||||
14 | to the maximum extent appropriate, in the natural
environment, | ||||||
15 | which may include the home or other community settings. Parents
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16 | shall make
the final decision to accept or decline
early | ||||||
17 | intervention services. A decision to decline such services | ||||||
18 | shall
not be a basis for administrative determination of | ||||||
19 | parental fitness, or
other findings or sanctions against the | ||||||
20 | parents. Parameters of the Plan
shall be set forth in rules.
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21 | (e) The regional intake offices shall explain to each | ||||||
22 | family, orally and
in
writing, all of the following:
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23 | (1) That the early intervention program will pay for | ||||||
24 | all early
intervention services set forth in the | ||||||
25 | individualized family service plan that
are not
covered or | ||||||
26 | paid under the family's public or private insurance plan or |
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1 | policy
and not
eligible for payment through any other third | ||||||
2 | party payor.
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3 | (2) That services will not be delayed due to any rules | ||||||
4 | or restrictions
under the family's insurance plan or | ||||||
5 | policy.
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6 | (3) That the family may request, with appropriate | ||||||
7 | documentation
supporting the request, a
determination of | ||||||
8 | an exemption from private insurance use under
Section | ||||||
9 | 13.25.
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10 | (4) That responsibility for co-payments or
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11 | co-insurance under a family's private insurance
plan or | ||||||
12 | policy will be transferred to the lead
agency's central | ||||||
13 | billing office.
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14 | (5) That families will be responsible
for payments of | ||||||
15 | family fees,
which will be based on a sliding scale
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16 | according to the State's definition of ability to pay which | ||||||
17 | is comparing household size and income to the sliding scale | ||||||
18 | and considering out-of-pocket medical or disaster | ||||||
19 | expenses, and that these fees
are payable to the central | ||||||
20 | billing office. Families who fail to provide income | ||||||
21 | information shall be charged the maximum amount on the | ||||||
22 | sliding scale.
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23 | (f) The individualized family service plan must state | ||||||
24 | whether the family
has private insurance coverage and, if the | ||||||
25 | family has such coverage and parental consent has been | ||||||
26 | obtained, must
have attached to it a copy of the family's |
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1 | insurance identification card or
otherwise
include all of the | ||||||
2 | following information:
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3 | (1) The name, address, and telephone number of the | ||||||
4 | insurance
carrier.
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5 | (2) The contract number and policy number of the | ||||||
6 | insurance plan.
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7 | (3) The name, address, and social security number of | ||||||
8 | the primary
insured.
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9 | (4) The beginning date of the insurance benefit year.
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10 | (g) A copy of the individualized family service plan must | ||||||
11 | be provided to
each enrolled provider who is providing early | ||||||
12 | intervention services to the
child
who is the subject of that | ||||||
13 | plan.
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14 | (h) Children receiving services under this Act shall | ||||||
15 | receive a smooth and effective transition by their third | ||||||
16 | birthday consistent with federal regulations adopted pursuant | ||||||
17 | to Sections 1431 through 1444 of Title 20 of the United States | ||||||
18 | Code. | ||||||
19 | (Source: P.A. 97-902, eff. 8-6-12; 09800SB2217eng.)
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20 | (325 ILCS 20/13) (from Ch. 23, par. 4163)
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21 | Sec. 13. Funding and Fiscal Responsibility.
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22 | (a) The lead agency and every
other participating State | ||||||
23 | agency may receive and expend funds appropriated
by the General | ||||||
24 | Assembly to implement the early intervention services system
as | ||||||
25 | required by this Act.
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1 | (b) The lead agency and each participating State agency | ||||||
2 | shall identify
and report on an annual basis to the Council the | ||||||
3 | State agency funds utilized
for the provision of early | ||||||
4 | intervention services to eligible infants and
toddlers.
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5 | (c) Funds provided under Section 633 of the Individuals | ||||||
6 | with
Disabilities Education Act (20 United States Code 1433) | ||||||
7 | and State funds
designated or appropriated for early | ||||||
8 | intervention services or programs
may not be used to satisfy a
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9 | financial commitment for services which would have been paid | ||||||
10 | for from
another public or private source but for the enactment | ||||||
11 | of this Act, except
whenever considered necessary to prevent | ||||||
12 | delay in receiving appropriate early
intervention services by | ||||||
13 | the eligible infant or toddler or family in a
timely manner. | ||||||
14 | "Public or private source" includes public and private
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15 | insurance coverage.
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16 | Funds provided under Section 633 of the Individuals with
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17 | Disabilities Education Act
and State funds designated or | ||||||
18 | appropriated for early intervention services or
programs
may be | ||||||
19 | used by the lead agency to pay the
provider of services (A) | ||||||
20 | pending reimbursement from the appropriate State
agency
or (B) | ||||||
21 | if (i) the claim for payment is denied in whole or in part by a | ||||||
22 | public
or private source, or would be denied under the written | ||||||
23 | terms of the public
program or plan or private plan, or (ii) | ||||||
24 | use of private insurance for the
service has been exempted | ||||||
25 | under Section 13.25 , or (iii) parental consent has not been | ||||||
26 | obtained for the use of private insurance . Payment under item |
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1 | (B)(i) may
be made based on a pre-determination telephone | ||||||
2 | inquiry supported by written
documentation of the denial | ||||||
3 | supplied thereafter by the insurance carrier.
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4 | (d) Nothing in this Act shall be construed to permit the | ||||||
5 | State to reduce
medical or other assistance available or to | ||||||
6 | alter eligibility under Title V
and Title XIX of the Social | ||||||
7 | Security Act relating to the Maternal Child
Health Program and | ||||||
8 | Medicaid for eligible infants and toddlers in this State.
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9 | (e) The lead agency shall create a central billing office | ||||||
10 | to receive and
dispense all relevant State and federal | ||||||
11 | resources, as well as local
government or independent resources | ||||||
12 | available, for early intervention
services. This office shall | ||||||
13 | assure that maximum federal resources are
utilized and that | ||||||
14 | providers receive funds with minimal duplications or
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15 | interagency reporting and with consolidated audit procedures.
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16 | (f) The lead agency shall, by rule, create a system of
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17 | payments by families, including
a schedule of fees. No fees, | ||||||
18 | however, may be charged for: implementing
child find,
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19 | evaluation and assessment, service coordination, | ||||||
20 | administrative and
coordination activities related to the | ||||||
21 | development, review, and evaluation of
Individualized Family | ||||||
22 | Service Plans, or the implementation of procedural
safeguards | ||||||
23 | and other administrative components of the statewide early
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24 | intervention system.
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25 | The system of payments, called family fees, shall be
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26 | structured on a sliding
scale based on the family's ability to |
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1 | pay. The family's coverage
or lack
of coverage under a public | ||||||
2 | or private insurance plan or
policy
shall not be a factor in | ||||||
3 | determining the amount of the
family fees.
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4 | Each family's fee obligation shall be
established | ||||||
5 | annually, and shall be paid by
families to
the central billing | ||||||
6 | office in
installments. At the written request of the family, | ||||||
7 | the fee obligation shall be
adjusted prospectively at any point | ||||||
8 | during the year upon proof of a change in
family income or | ||||||
9 | family size. The inability of the parents
of an eligible child | ||||||
10 | to pay family fees due to catastrophic
circumstances or | ||||||
11 | extraordinary expenses shall not result in
the denial of | ||||||
12 | services to the child or the child's family.
A family must | ||||||
13 | document its extraordinary expenses or other catastrophic
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14 | circumstances
by showing one of the following: (i) | ||||||
15 | out-of-pocket medical expenses in excess
of 15% of gross | ||||||
16 | income; (ii) a fire, flood, or other disaster causing a direct
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17 | out-of-pocket loss in excess of 15% of gross income; or (iii) | ||||||
18 | other
catastrophic
circumstances causing out-of-pocket losses | ||||||
19 | in excess of 15% of gross income.
The family must present proof | ||||||
20 | of loss to its service coordinator, who shall
document it, and | ||||||
21 | the lead agency shall determine
whether the fees shall be | ||||||
22 | reduced, forgiven, or suspended within 10 business
days after
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23 | the family's request.
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24 | (g) To ensure that early intervention funds are used as the | ||||||
25 | payor of last
resort for early intervention services, the lead | ||||||
26 | agency shall determine at the
point of early intervention |
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1 | intake, and again at any periodic review of
eligibility | ||||||
2 | thereafter or upon a change in family circumstances, whether | ||||||
3 | the
family is eligible for or enrolled in any program for which | ||||||
4 | payment is made
directly or through public or private insurance | ||||||
5 | for any or all of the early
intervention services made | ||||||
6 | available under this Act. The lead agency shall
establish | ||||||
7 | procedures to ensure that payments are made either directly | ||||||
8 | from
these public and private sources , when parental consent | ||||||
9 | has been obtained, instead of from State or federal early
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10 | intervention funds, or as reimbursement for payments | ||||||
11 | previously made from State
or federal early intervention funds.
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12 | (Source: P.A. 91-538, eff. 8-13-99; 92-10, eff. 6-11-01; | ||||||
13 | 92-307, eff. 8-9-01; 92-651, eff. 7-11-02; 09800SB2217.)
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14 | (325 ILCS 20/13.10)
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15 | Sec. 13.10.
Private health insurance;
assignment. The lead | ||||||
16 | agency
shall determine, at the point of new applications
for | ||||||
17 | early
intervention services, and for all children enrolled
in | ||||||
18 | the early
intervention program, at the regional intake offices,
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19 | whether
the child is insured under a private health insurance
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20 | plan or
policy. Parental consent must be obtained when the lead | ||||||
21 | agency or enrolled provider who is providing a family with | ||||||
22 | early intervention services seeks to use the child or parent's | ||||||
23 | private insurance or benefits to pay for the initial provision | ||||||
24 | of early intervention services in the Individualized Family | ||||||
25 | Services Plan and anytime that an increase in frequency, |
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1 | length, duration, or intensity is made to existing services in | ||||||
2 | the child's Individualized Family Services Plan.
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3 | (Source: P.A. 92-307, eff. 8-9-01; 09800SB2217.)
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4 | (325 ILCS 20/13.15)
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5 | Sec. 13.15. Billing of insurance carrier.
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6 | (a) Subject to the restrictions against
private
insurance | ||||||
7 | use on the basis of material risk of
loss of
coverage, as | ||||||
8 | determined under Section 13.25, each
enrolled
provider who is | ||||||
9 | providing a family with early
intervention
services shall bill | ||||||
10 | the child's insurance carrier for
each
unit
of early | ||||||
11 | intervention service for
which coverage may be
available and | ||||||
12 | parental consent has been obtained . The lead agency may exempt | ||||||
13 | from the
requirement of this paragraph any early intervention | ||||||
14 | service
that it has deemed not to be covered by insurance | ||||||
15 | plans.
When the service is not exempted, providers who
receive | ||||||
16 | a denial of payment on the basis that the service is
not | ||||||
17 | covered under any circumstance under the plan are not
required | ||||||
18 | to bill that carrier for that service again until the following
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19 | insurance benefit year. That
explanation of benefits denying | ||||||
20 | the claim, once submitted to
the central billing office, shall | ||||||
21 | be sufficient to meet the
requirements of this paragraph as to | ||||||
22 | subsequent services billed under the same
billing code provided | ||||||
23 | to that child during that insurance benefit year. Any
time | ||||||
24 | limit on a
provider's filing of a claim for payment with the | ||||||
25 | central
billing office that is
imposed through a
policy, |
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1 | procedure, or rule of the lead agency shall be
suspended
until | ||||||
2 | the provider receives an explanation of
benefits or
other final | ||||||
3 | determination of the claim it files
with the
child's insurance | ||||||
4 | carrier.
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5 | (b) In all instances when an insurance carrier has
been | ||||||
6 | billed for early intervention services, whether paid in
full, | ||||||
7 | paid in part, or denied by the carrier, the provider must
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8 | provide the central billing office, within 90 days after | ||||||
9 | receipt, with a copy
of the explanation
of benefits form and | ||||||
10 | other information in the manner prescribed by the lead
agency.
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11 | (c) When the insurance carrier has denied the
claim or paid | ||||||
12 | an amount for the early intervention service
billed that is | ||||||
13 | less than the current State rate for early
intervention | ||||||
14 | services, the provider shall submit the
explanation of benefits | ||||||
15 | with a claim for payment, and the lead
agency shall pay the | ||||||
16 | provider the difference between the sum
actually paid by the | ||||||
17 | insurance carrier for each unit of service
provided under the | ||||||
18 | individualized family service plan and
the current State rate | ||||||
19 | for early intervention services.
The State shall also pay the | ||||||
20 | family's co-payment or co-insurance under its
plan, but only to | ||||||
21 | the extent that those
payments plus the balance of the claim do | ||||||
22 | not exceed the
current State rate for early intervention | ||||||
23 | services. The
provider may under no circumstances bill the | ||||||
24 | family for the
difference between its charge for services and | ||||||
25 | that which
has been paid by the insurance carrier or by the | ||||||
26 | State.
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1 | (Source: P.A. 97-813, eff. 7-13-12; 09800SB2217.)
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2 | Section 99. Effective date. This Act takes effect upon | ||||||
3 | becoming law.".
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