HLS 13RS-406 ORIGINAL Page 1 of 23 CODING: Words in struck through type are deletions from existing law; words underscored are additions. Regular Session, 2013 HOUSE BILL NO. 375 BY REPRESENTATIVE HOFFMANN Prefiled pursuant to Article III, Section 2(A)(4)(b)(i) of the Constitution of Louisiana. EXCEP PERSON/DISABLED: Provides for the EarlySteps childhood disability intervention program and authorizes a fee schedule known as cost participation for services of the program AN ACT1 To amend and reenact R.S. 36:4(R), to enact Chapter 4-B of Title 28 of the Louisiana2 Revised Statutes of 1950, to be comprised of R.S. 28:461 through 470, and to repeal3 Part III of Chapter 8 of Title 17 of the Louisiana Revised Statutes of 1950, comprised4 of R.S. 17:1971 through 1979, relative to the early intervention program of this state5 for infants and toddlers with disabilities and their families; to establish the official6 name of such program; to provide for definitions; to provide for duties of the7 Department of Health and Hospitals relative to program administration; to provide8 requirements for a statewide system of services; to provide relative to payment for9 services; to allow for uses of funds for provision of certain services to eligible10 persons; to provide for authority to establish a statewide system of payments; to11 provide for authority to establish a schedule of fees for services provided to certain12 recipients; to create and provide for duties of the Louisiana State Interagency13 Coordinating Council for EarlySteps: Louisiana's Early Intervention Program for14 Infants and Toddlers with Disabilities and their Families; to authorize promulgation15 of rules by the Department of Health and Hospitals; to provide for continuation of16 effectiveness of certain administrative rules; and to provide for related matters.17 Be it enacted by the Legislature of Louisiana:18 HLS 13RS-406 ORIGINAL HB NO. 375 Page 2 of 23 CODING: Words in struck through type are deletions from existing law; words underscored are additions. Section 1. Chapter 4-B of Title 28 of the Louisiana Revised Statutes of 1950,1 comprised of R.S. 28:461 through 470, is hereby enacted to read as follows:2 CHAPTER 4-B. EARLYSTEPS: LOUISIANA'S EARLY INTERVENTION3 PROGRAM FOR INFANTS AND TODDLERS WITH DISABILITIES4 AND THEIR FAMILIES5 §461. Findings; policy6 A. The Louisiana Legislature hereby finds that there is an urgent and7 substantial need in this state for all of the following:8 (1) Enhancements in the development of infants and toddlers with9 disabilities in order to minimize their potential for developmental delay.10 (2) Greater recognition of the significant brain development that occurs11 during a child's first three years of life.12 (3) A reduction to the educational costs to our society, including costs borne13 by Louisiana's schools, through minimizing the need for special education and14 related services after infants and toddlers with disabilities reach school age.15 (4) Maximization of the potential for individuals with disabilities to live16 independently in the community.17 (5) Enhancement of families' capacity to meet the special needs of their18 infants and toddlers with disabilities.19 (6) Enhancement of the capacity of state and local agencies and service20 providers to identify, evaluate, and meet the needs of all children; particularly21 minority, low-income, inner-city, and rural children, and infants and toddlers in22 foster care.23 B. In consideration of the needs described in this Section, it is therefore the24 policy of Louisiana:25 (1) To develop and implement a statewide, comprehensive, coordinated,26 multidisciplinary interagency system that provides early intervention services for27 infants and toddlers with disabilities and their families.28 HLS 13RS-406 ORIGINAL HB NO. 375 Page 3 of 23 CODING: Words in struck through type are deletions from existing law; words underscored are additions. (2) To establish a state system of payments that provides for the collection,1 facilitation, and coordination of payment for early intervention services from federal,2 state, local, and private sources, including public and private insurance coverage and3 cost sharing with those families who qualify.4 (3) To enhance Louisiana's capacity to provide quality early intervention5 services and to expand and improve existing early intervention services currently6 being provided to infants and toddlers with disabilities and their families.7 (4) To encourage Louisiana to expand opportunities for children under three8 years of age who would be at risk of having substantial developmental delay if they9 did not receive early intervention services.10 §462. Definitions11 As used in this Chapter, the following terms shall have the meaning ascribed12 to them in this Section, unless the context clearly indicates otherwise:13 (1) "Cost participation" means fees or other charges through which families14 share in the cost for early intervention services provided pursuant to the provisions15 of this Chapter.16 (2) "Council" means the Louisiana State Interagency Coordinating Council17 for EarlySteps established pursuant to R.S. 28:470.18 (3) "Department" means the Department of Health and Hospitals.19 (4) "Early intervention services" means developmental services that:20 (a) Are provided under public supervision.21 (b) Are provided at no cost except where federal or state law provides for a22 system of payments by families, including but not limited to a schedule providing23 a sliding scale of fees as provided in R.S. 28:469.24 (c) Are designed to meet developmental needs of an infant or toddler with25 a disability, as identified by the individualized family service plan team, in any one26 of the following areas:27 (i) Physical development.28 (ii) Cognitive development.29 HLS 13RS-406 ORIGINAL HB NO. 375 Page 4 of 23 CODING: Words in struck through type are deletions from existing law; words underscored are additions. (iii) Communication development.1 (iv) Social or emotional development.2 (v) Adaptive development.3 (d) Meet the standards of the state of Louisiana.4 (e) Include but are not limited to:5 (i) Family training, counseling, and home visits.6 (ii) Special instruction.7 (iii) Speech-language pathology and audiology services and sign language8 and cued language services.9 (iv) Occupational therapy.10 (v) Physical therapy.11 (vi) Psychological services.12 (vii) Family service coordination services.13 (viii) Medical services only for diagnostic or evaluation purposes.14 (ix) Early identification, screening, and assessment services.15 (x) Health services necessary to enable the infant or toddler to benefit from16 other early intervention services.17 (xi) Social work services.18 (xii) Vision services.19 (xiii) Assistive technology devices and assistive technology services.20 (xiv) Transportation and related costs that are necessary to enable an infant21 or toddler and the infant's or toddler's family to receive early intervention services.22 (f) Are provided by qualified personnel, including:23 (i) Special educators.24 (ii) Speech-language pathologists and audiologists.25 (iii) Occupational therapists.26 (iv) Physical therapists.27 (v) Psychologists.28 (vi) Social workers.29 HLS 13RS-406 ORIGINAL HB NO. 375 Page 5 of 23 CODING: Words in struck through type are deletions from existing law; words underscored are additions. (vii) Nurses.1 (viii) Registered dieticians.2 (ix) Family therapists.3 (x) Vision specialists, including ophthalmologists and optometrists.4 (xi) Orientation and mobility specialists.5 (xii) Pediatricians and other physicians.6 (g) To the maximum extent appropriate, are provided in natural7 environments, including the home and community settings in which children without8 disabilities participate.9 (h) Are provided in conformity with an individualized family service plan10 adopted in accordance with the provisions of this Chapter.11 (5) "IDEA" means the federal Individuals with Disabilities Education Act.12 (6)(a) "Infant or toddler with a disability " means an individual under three13 years of age who needs early intervention services because of either of the following:14 (i) The individual is experiencing developmental delays, as measured by15 appropriate diagnostic instruments and procedures in the areas of cognitive16 development, physical development, communication development, social or17 emotional development, or adaptive development.18 (ii) The individual has a diagnosed physical or mental condition which has19 a high probability of resulting in developmental delay.20 (b) This definition may also include, at Louisiana's discretion, at-risk infants21 and toddlers as defined in Subparagraph (c) of this Paragraph.22 (c) "At-risk infant or toddler" means an individual under three years of age23 who would be at risk of experiencing a substantial developmental delay if early24 intervention services were not provided to the individual.25 (7) "Parent" means a person who meets the definition of such term in federal26 regulations relative to early intervention programs for infants and toddlers with27 disabilities and their families (34 CFR 303.27).28 HLS 13RS-406 ORIGINAL HB NO. 375 Page 6 of 23 CODING: Words in struck through type are deletions from existing law; words underscored are additions. §463. Goals1 A. Louisiana shall adopt a policy which incorporates all of the components2 of a statewide system as provided in this Chapter.3 B. The department shall include in its annual application for federal funds4 assurances that the statewide system provided for in this Chapter meets federal5 requirements for such a system and a description of services to be provided in6 accordance with the provisions of this Chapter.7 §464. Requirements for statewide system8 A statewide comprehensive, coordinated, multidisciplinary, interagency9 system to provide early intervention services for infants and toddlers with disabilities10 and their families shall include, at a minimum, the following components:11 (1) A definition of the term "developmental delay" that will be used by12 Louisiana in carrying out the provisions of this Chapter in order to appropriately13 identify infants and toddlers with disabilities who are in need of services provided14 for in this Chapter.15 (2) A state policy that is in effect and which ensures that appropriate early16 intervention services based on scientific research, to the extent practicable, are17 available to all infants and toddlers with disabilities and their families, including18 Indian infants and toddlers with disabilities and their families residing on a19 reservation geographically located in Louisiana, infants and toddlers with disabilities20 who are homeless and their families, and infants and toddlers with disabilities who21 are wards of the state.22 (3) A timely, comprehensive, multidisciplinary evaluation of the functioning23 of each infant and toddler with a disability in Louisiana and a family-directed24 identification of the needs of each family of such an infant or toddler to assist25 appropriately in the development of the infant or toddler.26 (4) For each infant and toddler with a disability in Louisiana, an27 individualized family service plan developed in accordance with applicable federal28 HLS 13RS-406 ORIGINAL HB NO. 375 Page 7 of 23 CODING: Words in struck through type are deletions from existing law; words underscored are additions. regulations, including family service coordination in accordance with such service1 plan.2 (5) A comprehensive child-find system, consistent with the federal3 requirements of IDEA-Part B, including a system for making referrals to service4 providers that includes timelines and provides for participation by primary referral5 sources and that ensures rigorous standards for appropriately identifying infants and6 toddlers with disabilities for services pursuant to this Chapter that will reduce the7 need for future services.8 (6) A public awareness program focusing on early identification of infants9 and toddlers with disabilities, including the preparation and dissemination by the10 department to all primary referral sources, especially hospitals and physicians, of11 information for parents, especially for parents with premature infants, or infants with12 other physical risk factors associated with learning or developmental complications,13 on the availability of early intervention services, and procedures for assisting such14 sources in disseminating such information to parents of infants and toddlers with15 disabilities.16 (7) A central directory that includes information on early intervention17 services, resources, and experts available in Louisiana and research and18 demonstration projects being conducted in Louisiana.19 (8)(a) A comprehensive system of personnel development, including the20 training of paraprofessionals and the training of primary referral sources with respect21 to the basic components of early intervention services available in Louisiana, that22 shall include:23 (i) Implementing innovative strategies and activities for the recruitment and24 retention of early education service providers.25 (ii) Promoting the preparation of early intervention providers who are fully26 and appropriately qualified to provide early intervention services.27 HLS 13RS-406 ORIGINAL HB NO. 375 Page 8 of 23 CODING: Words in struck through type are deletions from existing law; words underscored are additions. (iii) Training personnel to coordinate transition services for infants and1 toddlers served pursuant to this Chapter from an early intervention program provided2 for in this Chapter to preschool or other appropriate services.3 (b) The comprehensive system of personnel development may include:4 (i) Training personnel to work in rural and inner-city areas.5 (ii) Training personnel in the emotional and social development of young6 children.7 (9) Policies and procedures relating to the establishment and maintenance8 of qualifications to ensure that personnel necessary to carry out the provisions of this9 Chapter are appropriately and adequately prepared and trained, including the10 establishment and maintenance of qualifications that are consistent with any11 state-approved or recognized certification, licensing, registration, or other12 comparable requirements that apply to the area in which such personnel are13 providing early intervention services. Nothing in this Chapter, including this14 Paragraph, shall be construed to prohibit the use of paraprofessionals and assistants15 who are appropriately trained and supervised in accordance with Louisiana law,16 regulations, or written policy to assist in the provision of early intervention services17 to infants and toddlers with disabilities pursuant to the provisions of this Chapter.18 (10) A single line of responsibility in the department for carrying out the19 following functions:20 (a) General administration and supervision of programs and activities21 receiving assistance pursuant to this Chapter, and the monitoring of programs and22 activities used by Louisiana to carry out the provisions of this Chapter, whether or23 not such programs or activities are receiving assistance made available by this24 Chapter, to ensure compliance with this Chapter.25 (b) Identification, coordination, and collection of all available resources26 within Louisiana from federal, state, local, and private sources, including those of27 the system of payments established pursuant to the provisions of R.S. 28:969.28 (c) Assignment of financial responsibility to the appropriate agencies.29 HLS 13RS-406 ORIGINAL HB NO. 375 Page 9 of 23 CODING: Words in struck through type are deletions from existing law; words underscored are additions. (d) Development of procedures to ensure that services are provided to infants1 and toddlers with disabilities and their families in a timely manner pending the2 resolution of any disputes among public agencies or service providers.3 (e) Resolution of intra-agency and interagency disputes.4 (f) Entry into formal interagency agreements which conform with all5 applicable provisions of Louisiana law that provide the following:6 (i) Definitions of the financial responsibility of each agency for paying for7 early intervention services.8 (ii) Procedures for resolving disputes.9 (iii) Any additional component necessary to ensure meaningful cooperation10 and coordination.11 (11) A policy pertaining to the contracting or making of other arrangements12 with service providers to provide early intervention services in Louisiana, consistent13 with the provisions of this Chapter, including the contents of the application used and14 the conditions of the contract or other arrangements.15 (12) A procedure for securing timely reimbursement of funds.16 (13) Procedural safeguards with respect to programs.17 (14) A system for compiling data in accordance with information and18 reporting requirements of the United States Secretary of Education.19 (15) A state interagency coordinating council that meets the requirements of20 R.S. 28:470.21 (16) Policies and procedures to ensure all of the following:22 (a) To the maximum extent appropriate, early intervention services are23 provided in natural environments.24 (b) The provision of early intervention services for any infant or toddler with25 a disability occurs in a setting other than a natural environment that is most26 appropriate, as determined by the parent and the individualized family service plan27 team, only when early intervention cannot be achieved satisfactorily for the infant28 or toddler in a natural environment.29 HLS 13RS-406 ORIGINAL HB NO. 375 Page 10 of 23 CODING: Words in struck through type are deletions from existing law; words underscored are additions. §465. Individualized family service plan1 A. Assessment and program development shall provide, at a minimum, for2 each infant and toddler with disabilities and the infant's or toddler's family to receive:3 (1) A multidisciplinary assessment of the unique strengths and needs of the4 infant or toddler and the identification of services appropriate to meet such needs.5 (2) A family-directed assessment of the resources, priorities, and concerns6 of the family and the identification of the supports and services necessary to enhance7 the family's capacity to meet the developmental needs of the infant or toddler.8 (3) A written individualized family service plan developed by a9 multidisciplinary team, including the parents, as required by Subsection D of this10 Section, including a description of the appropriate transition services for the infant11 or toddler.12 B. The individualized family service plan shall be evaluated annually, and13 the family shall be provided a review of the plan at six-month intervals or more often14 as appropriate based on the infant or toddler and family needs.15 C. The individualized family service plan shall be developed within a16 reasonable time after the assessment required by Paragraph (A)(1) of this Section is17 completed. With the parent's consent, early intervention services may commence18 prior to the completion of the assessment.19 D. The individualized family service plan shall be in writing and contain all20 of the following:21 (1) A statement of the infant's or toddler's present level of physical22 development, cognitive development, communication development, social or23 emotional development, and adaptive development, based on objective criteria.24 (2) A statement of the family's resources, priorities, and concerns relating to25 enhancing the development of the family's infant or toddler with a disability.26 (3) A statement of the measurable results or outcomes expected to be27 achieved for the infant and toddler and the family, including preliteracy and language28 skills, as developmentally appropriate for the child, and the criteria, procedures, and29 HLS 13RS-406 ORIGINAL HB NO. 375 Page 11 of 23 CODING: Words in struck through type are deletions from existing law; words underscored are additions. timelines used to determine the degree to which progress toward achieving the1 results or outcomes is being made and whether modifications or revisions of the2 results or outcomes or services are necessary.3 (4) A statement of specific early intervention services based on4 peer-reviewed research, to the extent practicable, necessary to meet the unique needs5 of the infant or toddler and the family, including the frequency, intensity, and the6 method of delivering services.7 (5) A statement of the natural environments in which early intervention8 services shall appropriately be provided, including a justification of the extent, if9 any, to which the services will not be provided in a natural environment.10 (6) The projected dates for initiation of services and the anticipated length,11 duration, and frequency of the services.12 (7) The identification of the family service coordinator from the profession13 most immediately relevant to the infant's or toddler's or family's needs or who is14 otherwise qualified to carry out all applicable responsibilities pursuant to the15 provisions of this Chapter who will be responsible for the implementation of the plan16 and coordination with other agencies and persons, including transition services.17 (8) The steps to be taken to support the transition of the toddler with a18 disability to preschool or other appropriate services, including the following steps:19 (a) Notify the local educational agency for the area in which such a child20 resides that the child will shortly reach the age of eligibility for preschool services21 pursuant to IDEA-Part B federal regulations as determined in accordance with22 Louisiana law.23 (b) In the case of a child who may be eligible for such preschool services,24 with the approval of the family of the child, convene a conference among the family25 service coordinator, the family, and the local educational agency at least ninety days26 but no more than six months before the child is eligible for the preschool services,27 to discuss any such services that the child may receive.28 HLS 13RS-406 ORIGINAL HB NO. 375 Page 12 of 23 CODING: Words in struck through type are deletions from existing law; words underscored are additions. (c) In the case of a child who may not be eligible for such preschool services,1 with the approval of the family, make reasonable efforts to convene a conference2 among the family service coordinator, the family, and providers of other appropriate3 services for children who are not eligible for preschool service pursuant to4 IDEA-Part B federal regulations to discuss the appropriate services that the child5 may receive.6 E. The contents of the individualized family service plan shall be fully7 explained to the parents and informed written consent from the parents shall be8 obtained prior to the provision of early intervention services described in such plan.9 If the parents do not provide consent with respect to a particular early intervention10 service, then only the early intervention services to which consent is obtained shall11 be provided.12 §466. Uses of funds13 In addition to utilizing funds provided pursuant to the provisions of this14 Chapter to implement and maintain the statewide system, Louisiana may use such15 funds for the following purposes:16 (1) For direct early intervention services for infants and toddlers with17 disabilities and their families as provided in this Chapter that are not otherwise18 funded through public or private sources.19 (2) To expand and improve upon services for infants and toddlers and their20 families as provided in this Chapter that are otherwise available.21 (3) To strengthen the statewide system by initiating, expanding, or22 improving collaborative efforts related to at-risk infants and toddlers, including23 establishing linkages with appropriate public or private community-based24 organizations, services, and personnel for the purposes of:25 (a) Identifying and evaluating at-risk infants and toddlers.26 (b) Making referrals of the infants and toddlers identified and evaluated27 pursuant to the provisions of Subparagraph (a) of this Paragraph.28 HLS 13RS-406 ORIGINAL HB NO. 375 Page 13 of 23 CODING: Words in struck through type are deletions from existing law; words underscored are additions. (c) Conducting periodic follow-up on each such referral to determine if the1 status of the infant or toddler involved has changed with respect to the eligibility of2 the infant or toddler for services pursuant to this Chapter.3 §467. Procedural safeguards4 The procedural safeguards which shall be included in a statewide system5 shall provide, at a minimum, the following:6 (1) The timely administrative resolution of complaints by parents. Any party7 aggrieved by the findings and decision regarding an administrative complaint shall8 have the right to bring a civil action with respect to the complaint in any state court9 of competent jurisdiction or in a district court of the United States without regard to10 the amount in controversy. In any action brought pursuant to the provisions of this11 Paragraph, the court shall receive the records of the administrative proceedings, shall12 hear additional evidence at the request of a party, and, basing its decision on the13 preponderance of the evidence, shall grant such relief as the court determines is14 appropriate.15 (2) The right to confidentiality of personally identifiable information,16 including the right of parents to written notice of and written consent to the exchange17 of such information among agencies consistent with applicable provisions of federal18 and state law.19 (3) The right of the parents to determine whether they, their infant or toddler,20 or other family members will accept or decline any early intervention service21 provided for in this Chapter in accordance with state law without jeopardizing other22 early intervention services provided for in this Chapter.23 (4) The opportunity for parents to examine records relating to assessment,24 screening, eligibility determinations, and the development and implementation of the25 individualized family service plan.26 (5) Procedures to protect the rights of the infant or toddler whenever the27 parents of the infant or toddler are not known or cannot be found or the infant or28 toddler is a ward of the state, including the assignment of an individual, who shall29 HLS 13RS-406 ORIGINAL HB NO. 375 Page 14 of 23 CODING: Words in struck through type are deletions from existing law; words underscored are additions. not be an employee of the department or any other state agency; and who shall not1 be any person, or any employee of a person, providing early intervention services to2 the infant or toddler or any family member of the infant or toddler to act as a3 surrogate for the parents.4 (6) Written prior notice to the parents of the infant or toddler with a5 disability whenever the state agency or service provider proposes to initiate or6 change or refuses to initiate or change the identification, evaluation, or placement of7 the infant or toddler with a disability, or the provision of appropriate early8 intervention services to the infant or toddler.9 (7) Procedures designed to ensure that the notice required by Paragraph (6)10 of this Section fully informs the parents, in the parents' native language, unless it is11 not feasible to do so, of all procedures available pursuant to this Section.12 (8) The right of parents to use mediation in accordance with Section 615 of13 IDEA.14 (9) During the pendency of any proceeding or action involving a complaint15 by the parents of an infant or toddler with a disability, unless the department and the16 parents otherwise agree, the infant or toddler shall continue to receive the appropriate17 early intervention services currently being provided, or if applying for initial18 services, shall receive the services not in dispute.19 §468. Payor of last resort; nonsubstitution; reduction of other benefits20 A. Funds provided pursuant to this Chapter may not be used to satisfy a21 financial commitment for services that would have been paid for from another public22 or private source, including any medical program administered by the Secretary of23 Defense, but for the enactment of this Chapter; except that whenever considered24 necessary to prevent a delay in the receipt of appropriate early intervention services25 by the infant or toddler or family in a timely fashion, funds provided pursuant to this26 Chapter may be used to pay the provider of services pending reimbursement from27 the agency that has ultimate responsibility for the payment.28 HLS 13RS-406 ORIGINAL HB NO. 375 Page 15 of 23 CODING: Words in struck through type are deletions from existing law; words underscored are additions. B. Nothing in this Chapter shall be construed to permit Louisiana to reduce1 medical or other assistance available or to alter eligibility pursuant to Title V of the2 Social Security Act, relating to maternal and child health, or Title XIX of the Social3 Security Act, relating to Medicaid for infants or toddlers with disabilities, within the4 state of Louisiana.5 §469. System of payments; authority of the Department of Health and Hospitals;6 cost participation schedule7 A. The department is hereby authorized to establish a statewide system of8 payments in accordance with the provisions of 34 CFR Part 303.9 B.(1) In implementing the system of payments, the department shall10 promulgate rules for the reimbursement of services from all third-party payers, both11 private and public.12 (2) In the first instance and where applicable, the department or its designee13 shall seek payment from all third-party payers prior to claiming payment from the14 IDEA-Part C early intervention system of this state for services rendered to eligible15 children.16 (3) The department or its designee may pay directly to a provider any17 required deductible, copayment, coinsurance, or other out-of-pocket expense for a18 child who is eligible for services from the IDEA-Part C early intervention system of19 this state.20 C.(1)(a) The department shall promulgate rules in accordance with the21 Administrative Procedure Act that establish a schedule of monthly cost participation22 for early intervention services per qualifying family. Cost participation shall be23 based on a sliding scale and shall consider elements including but not limited to24 adjusted gross income, family size, financial hardship, extraordinary expenses25 associated with the child, and Medicaid eligibility.26 (b) Parents who have public or private insurance and elect not to assign such27 right of recovery or indemnification to the department or choose not to release28 financial information shall be assessed the cost for each early intervention service29 HLS 13RS-406 ORIGINAL HB NO. 375 Page 16 of 23 CODING: Words in struck through type are deletions from existing law; words underscored are additions. listed on the individualized family service plan according to the most current service1 rate schedule and cost participation schedule promulgated by the department.2 (c) The cost participation schedule promulgated by the department shall3 provide all of the following:4 (i) Procedures by which a service provider may notify the department that5 a family is not complying with the cost participation requirements and procedures6 for suspending services.7 (ii) A statement of assurance that fees are not charged for services which a8 child is otherwise entitled to receive at no cost to parents, including child find9 activities, evaluation and assessment for eligibility and individualized family service10 planning, service coordination, administrative and coordinative activities related to11 development review, evaluation of individualized family service plans, and12 implementation of procedural safeguards and other components of the statewide13 system provided for in R.S. 28:464.14 (2)(a) The department shall provide prior notification in writing to families15 for use of public or private insurance according to the requirements of 42 CFR16 303.414. Such notification shall include a statement of the general categories of17 costs that the parent would incur and a statement of the process for resolution of a18 dispute regarding decisions related to use of public or private insurance, failure to19 pay for services or the state's determination of a family's ability to pay.20 (b) The department shall ensure that the procedures utilized to resolve such21 disputes will not delay or deny the parents' rights or the child's ability to access22 timely services.23 (3) The aggregate contributions made by the parent shall not exceed the24 aggregate cost of the early intervention services received by the child and family,25 inclusive of any amount received from other sources of payment for a service.26 (4) At least annually, or at any time the department determines is warranted,27 the lead agency shall conduct a reassessment of the parents' financial status. A28 HLS 13RS-406 ORIGINAL HB NO. 375 Page 17 of 23 CODING: Words in struck through type are deletions from existing law; words underscored are additions. parent may request such reassessment at any time when significant changes in1 financial circumstances may affect the calculation of the cost participation amount.2 §470. Louisiana State Interagency Coordinating Council for EarlySteps: Louisiana's3 Early Intervention Program for Infants and Toddlers with Disabilities and4 Their Families5 A. The Louisiana State Interagency Coordinating Council for EarlySteps:6 Louisiana's Early Intervention Program for Infants and Toddlers with Disabilities7 and Their Families is hereby created. All council members shall be appointed by the8 governor who shall also appoint the chairperson. No member of the council who is9 a representative of the department may serve as the chairperson of the council. At10 least twenty percent of the members shall be parents of infants or toddlers with11 disabilities or children with disabilities age twelve or younger, with knowledge of12 or experience with programs for infants and toddlers with disabilities; and at least13 twenty percent of the members shall be public or private providers of early14 intervention services.15 B. The council shall be comprised of the following members:16 (1) At least one member shall be a parent of either of the following:17 (a) An infant or toddler with disabilities.18 (b) A child with disabilities age six or younger.19 (2) At least one member shall be an elected member of the Louisiana20 Legislature.21 (3) At least one member shall be involved in personnel preparation.22 (4) Members in the number of one each from each state agency involved in23 the provision of or payment for early intervention services to infants and toddlers24 with disabilities and their families, including Medicaid, and such members shall have25 sufficient authority to engage in policy planning and implementation on behalf of26 their respective agencies.27 (5) At least one member shall be from the office of the Louisiana28 Department of Education which is responsible for preschool services to children with29 HLS 13RS-406 ORIGINAL HB NO. 375 Page 18 of 23 CODING: Words in struck through type are deletions from existing law; words underscored are additions. disabilities and who shall have sufficient authority to engage in policy planning and1 implementation on behalf of such agency.2 (6) At least one member shall be from the Louisiana Department of3 Insurance.4 (7) At least one member shall be from a Head Start agency or program.5 (8) At least one member shall be from the Louisiana Department of Children6 and Family Services.7 (9) At least one member designated by the Louisiana Department of8 Education who is responsible for coordination of the education of homeless children9 and youth.10 (10) One member from the Department of Children and Family Services who11 is responsible for foster care.12 (11) One member from the Department of Health and Hospitals, office of13 behavioral health.14 (12) Any other members duly appointed by the governor.15 C. The council shall meet at least quarterly and in such places as it deems16 necessary. The meetings shall be publicly announced and to the extent appropriate,17 open, and accessible to the general public.18 D.(1) Subject to the approval of the governor, the council may prepare and19 approve a budget using funds provided pursuant to the provisions of this Chapter to20 conduct hearings and forums; to reimburse members of the council for reasonable21 and necessary expenses, including child care for parent representatives, for attending22 council meetings and performing council duties; and to pay compensation to a23 member of the council if the member is not employed or must forfeit wages from24 other employment when performing official council business.25 (2) The council shall use funds provided pursuant to this Chapter to hire an26 executive director who shall be responsible to and report directly to the council and27 the governor or his designee to carry out its functions pursuant to this Chapter. The28 executive director shall be hired as an unclassified employee of the office of the29 HLS 13RS-406 ORIGINAL HB NO. 375 Page 19 of 23 CODING: Words in struck through type are deletions from existing law; words underscored are additions. governor. The cost of maintaining the functions of the executive director and council1 shall be specified by an interagency agreement between the department and the2 office of the governor. The council may also use funds provided pursuant to this3 Chapter to obtain the services of other such professional, technical, and clerical4 personnel as may be necessary to carry out its functions as provided in this Chapter.5 E. The council shall have the following duties:6 (1) To advise and assist the department in the performance of responsibilities7 established pursuant to this Chapter, particularly the identification of sources of8 fiscal and other support for services for early intervention programs, assignment of9 financial responsibility to the appropriate agency, and the promotion of interagency10 agreements.11 (2) To advise and assist the department in the preparation of applications and12 amendments thereto.13 (3) To advise and assist the department relative to the transition of toddlers14 with disabilities to preschool and other appropriate services.15 (4) To prepare and submit an annual report to the governor and to the United16 States Secretary of Education on the status of early intervention programs for infants17 and toddlers with disabilities and their families operated within the state.18 (5) The council may advise appropriate agencies in the state with respect to19 the integration of services for infants and toddlers with disabilities and at-risk infants20 and toddlers and their families, regardless of whether at-risk infants and toddlers are21 eligible for early intervention services in the state.22 F. No member of the council shall cast a vote on any matter which would23 provide direct financial benefit to that member or otherwise give the appearance of24 a conflict of interest.25 Section 2. R.S. 36:4(R) is hereby amended and reenacted to read as follows:26 §4. Structure of executive branch of state government27 * * *28 HLS 13RS-406 ORIGINAL HB NO. 375 Page 20 of 23 CODING: Words in struck through type are deletions from existing law; words underscored are additions. R. The Louisiana State Interagency Coordinating Council for Child Net:1 EarlySteps: Louisiana's Early Intervention Program for Infants and Toddlers with2 Special Needs Disabilities and Their Families (R.S. 17:1979 R.S. 28:470) is placed3 within the office of the governor and shall exercise and perform its powers, duties,4 functions, and responsibilities in the manner provided for agencies transferred under5 the provisions of R.S. 36:802, except that it shall have any other powers, duties,6 functions, and responsibilities specifically provided in R.S. 17:1979 R.S. 28:470.7 * * *8 Section 3. Part III of Chapter 8 of Title 17 of the Louisiana Revised Statutes of 1950,9 comprised of R.S. 17:1971 through 1979, is hereby repealed in its entirety.10 Section 4. All administrative rules relative to ChildNet: Louisiana's Early11 Intervention Program for Infants and Toddlers with Special Needs and Their Families duly12 promulgated by the Department of Education shall remain effective and shall be deemed to13 have been promulgated by the Department of Health and Hospitals until such time as those14 rules may be revised and repromulgated to provide for the EarlySteps program in accordance15 with the provisions of this Act.16 Section 5. This Act shall become effective upon signature by the governor or, if not17 signed by the governor, upon expiration of the time for bills to become law without signature18 by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If19 vetoed by the governor and subsequently approved by the legislature, this Act shall become20 effective on the day following such approval.21 DIGEST The digest printed below was prepared by House Legislative Services. It constitutes no part of the legislative instrument. The keyword, one-liner, abstract, and digest do not constitute part of the law or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)] Hoffmann HB No. 375 Abstract: Provides for the EarlySteps childhood disability intervention program and the La. State Interagency Coordinating Council for EarlySteps. Authorizes a fee schedule known as cost participation for services of the program. Proposed law deletes present law in Title 17 of the La. Revised Statutes of 1950 (R.S. 17:1971-1979), relative to ChildNet: La.'s Early Intervention Program for Infants and Toddlers with Special Needs and their Families. HLS 13RS-406 ORIGINAL HB NO. 375 Page 21 of 23 CODING: Words in struck through type are deletions from existing law; words underscored are additions. Proposed law recreates and revises certain provisions of present law relative to the ChildNet Program; changes the program name to "EarlySteps: La.'s Early Intervention Program for Infants and Toddlers with Disabilities and their Families"; and locates provisions relative to the EarlySteps Program in Title 28 of the La. Revised Statutes of 1950. Proposed law provides legislative findings relative to infants and toddlers with disabilities and their families, and defines terms used in proposed law. Proposed law provides for policies, goals, and requirements of a statewide comprehensive, coordinated, multidisciplinary, interagency system to provide early intervention services for infants and toddlers with disabilities and their families. Further provides for procedural safeguards which shall be included in such statewide system. Proposed law provides for requirements of individualized family service plans for infants, toddlers, and families who receive services through the EarlySteps program. Proposed law authorizes the use of funds for the following purposes: (1)Implementing and maintaining the statewide system providing early intervention services. (2)Providing direct early intervention services for infants and toddlers with disabilities and their families as provided in proposed law that are not otherwise funded through public or private sources. (3)Expanding and improving services for infants and toddlers and their families as provided in proposed law that are otherwise available. (4)Strengthening the statewide system by initiating, expanding, or improving collaborative efforts related to at-risk infants and toddlers, including establishing linkages with appropriate public or private community-based organizations, services, and personnel. Proposed law stipulates that funds provided to implement provisions of proposed law may not be used to satisfy a financial commitment for services that would have been paid for from another public or private source, including any medical program administered by the U.S. Secretary of Defense, but for the enactment of proposed law; except that whenever considered necessary to prevent a delay in the receipt of appropriate early intervention services by the infant or toddler or family in a timely fashion, funds provided pursuant to the provisions of proposed law may be used to pay the provider of services pending reimbursement from the agency that has ultimate responsibility for the payment. Proposed law provides that nothing in proposed law shall be construed to permit La. to reduce medical or other assistance available or to alter eligibility pursuant to Title V of the Social Security Act relating to maternal and child health, or Title XIX of the Social Security Act relating to Medicaid for infants or toddlers with disabilities, within the state of La. Proposed law authorizes DHH to establish a statewide system of payments for services provided pursuant to proposed law which comports with federal regulations relative to early intervention programs for infants and toddlers with disabilities and their families (34 CFR Part 303). Further provides that in implementing such system of payments, DHH: (1)Shall promulgate rules for the reimbursement of services from all third-party payers, both private and public. (2)Shall, in the first instance and where applicable, seek payment from all third-party payers prior to claiming payment from the early intervention system for services rendered to eligible children. HLS 13RS-406 ORIGINAL HB NO. 375 Page 22 of 23 CODING: Words in struck through type are deletions from existing law; words underscored are additions. (3)May pay directly to a provider any required deductible, copayment, coinsurance, or other out-of-pocket expense for a child who is eligible for services from the early intervention system. (4)Shall promulgate rules that establish a schedule of monthly cost participation for early intervention services per qualifying family. Proposed law defines "cost participation" as fees or other charges through which families share in the cost for services provided pursuant to proposed law. Proposed law authorizes DHH to establish procedures by which a service provider may notify the department that a family is not complying with the cost participation requirements and procedures for suspending services. Proposed law requires DHH to include in the cost participation schedule a statement of assurance that fees are not charged for services which a child is otherwise entitled to receive at no cost to parents, including child find activities, evaluation and assessment for eligibility and individualized family service planning, service coordination, administrative and coordinative activities related to development review, evaluation of individualized family service plans, and implementation of procedural safeguards and other components of the statewide system provided for in proposed law. Proposed law requires DHH to provide prior notification in writing to families relative to use of public or private insurance according to requirements provided in federal regulations. Also requires DHH to ensure that procedures utilized to resolve disputes related to use of insurance to cover services will not delay or deny the parents' rights or the child's ability to access timely services. Proposed law provides that the aggregate contributions made by the parent for services provided pursuant to proposed law shall not exceed the aggregate cost of the services, inclusive of any amount received from other sources of payment for a service. Proposed law provides that at least annually, or at any time the department determines is warranted, the lead agency shall conduct a reassessment of the parents' financial status. Provides that a parent may request such reassessment at any time when significant changes in financial circumstances may affect the calculation of the cost participation amount. Proposed law creates and provides for the membership of the La. State Interagency Coordinating Council for EarlySteps: La.'s Early Intervention Program for Infants and Toddlers with Disabilities and Their Families, referred to hereafter as "the council". Proposed law provides that subject to the approval of the governor, the council may use funds provided pursuant to the provisions of proposed law for the following purposes: (1)To conduct hearings and forums. (2)To reimburse members of the council for reasonable and necessary expenses for attending council meetings and performing council duties. (3)To pay compensation to a member of the council if the member is not employed or must forfeit wages from other employmen t when performing official council business. (4)To obtain the services of professional, technical, and clerical personnel as may be necessary to carry out its functions as provided in proposed law. Proposed law requires that the council hire an executive director who shall be an unclassified employee of the office of the governor. HLS 13RS-406 ORIGINAL HB NO. 375 Page 23 of 23 CODING: Words in struck through type are deletions from existing law; words underscored are additions. Proposed law provides that the council shall have the following duties: (1)To advise and assist DHH in the performance of the responsibilities established pursuant to the provisions of proposed law. (2)To advise and assist DHH in the preparation of applications and amendments thereto. (3)To advise and assist the department regarding the transition of toddlers with disabilities to preschool and other appropriate services. (4)To prepare and submit an annual report to the governor and to the U.S. Secretary of Education on the status of early intervention programs for infants and toddlers with disabilities and their families operating in La. Proposed law provides that the council may advise appropriate agencies in the state with respect to the integration of services for infants and toddlers with disabilities and at-risk infants and toddlers and their families, regardless of whether at-risk infants and toddlers are eligible for early intervention services in the state. Proposed law stipulates that no member of the council shall cast a vote on any matter which would provide direct financial benefit to that member or otherwise give the appearance of a conflict of interest. Proposed law provides that all administrative rules relative to the ChildNet program promulgated by the Dept. of Education shall remain effective and shall be deemed to have been promulgated by DHH until such time as those rules may be revised and repromulgated to provide for the EarlySteps program in accordance with the provisions of proposed law. Effective upon signature of governor or lapse of time for gubernatorial action. (Amends R.S. 36:4(R); Adds R.S. 28:461-470; Repeals R.S. 17:1971-1979)