Section 500.130  Family Fee/Insurance

a)         A statewide sliding fee schedule shall be established by the Department annually for direct EI services and assistive technology devices set forth in Section 500.55, except for those services that are required to be provided at no cost to families. (See Appendix A.)

b)         Each family's fee obligation shall be established annually.  Family fees will be billed and collected in installments through the centralized billing system.  Families shall not be required to pay more in annual fees than the cost of EI services and assistive technology devices received during the year and paid by the EI system.  At the written request of the family, the fee obligation shall be adjusted prospectively at any point during the year upon proof of change in family income or family size.

c)         Parents shall have their private insurance billed for services and devices.

d)         Recipients of medical assistance under Article V of the Illinois Public Aid Code or the Children's Health Insurance Program Act and WIC Program recipients shall not be charged an EI fee.  Parents of children eligible for Medicaid shall enroll their children with Medicaid so Medicaid funds can be accessed for EI services and devices.

e)         No one shall be denied services based on inability to pay.

f)          Families with insurance coverage, whether public or private, shall incur no greater or less direct out-of-pocket expenses for EI services than families who are not insured.

g)         Exemptions:

1)         A family may request exemption from the fee due to documentation of catastrophic circumstances or extraordinary expense, by showing either:

A)        out-of-pocket medical expense in excess of 15% of gross income; or

B)        a disaster such as fire, flood, or tornado causing direct out-of-pocket loss in excess of 15% of gross income.

2)         A family may request exemption from insurance use upon documentation showing a material risk of losing coverage because:

A)        the insurance plan/policy covering the child is an individually purchased policy/plan purchased by a head of household who is not eligible for group medical insurance; or

B)        the insurance plan/policy has a lifetime cap that applies to one or more specific types of early intervention services specified in the IFSP that coverage could be exhausted during the period covered by the service plan.  The exemption will only apply to the early intervention service and/or plan or policy for which there is a showing of material risk of loss of coverage.

3)         Regional intake entities shall submit requests for exemptions to the Department on the day that they are received, and the Department or its designee shall decide within 10 business days whether to grant the exemption and notify the family.

h)         A parent wishing to contest his/her family fee assessment may request mediation or an administrative resolution under Section 500.145 or 500.140. Such request shall be made as soon as possible but at least within 30 days after notice of the fee assessment.

(Source:  Amended at 32 Ill. Reg. 2161, effective January 23, 2008)