Chapter 04-598

2004 -- H 8669 SUBSTITUTE A

Enacted 08/05/04

A N A C T

RELATING TO HEALTH INSURANCE - - EARLY INTERVENTION SERVICES

Introduced By: Representatives Naughton, Slater, Giannini, Handy, and E Coderre

Date Introduced: June 17, 2004

It is enacted by the General Assembly as follows:

SECTION 1. Section 23-13-22 of the General Laws in Chapter 23-13 entitled "Maternal

and Child Health Services for Children with Special Health Care Needs" is hereby amended to

read as follows:

23-13-22. Early intervention program for developmentally disabled infants. -- (a)

The director of the department of ~~health~~ human services shall ensure that all developmentally

disabled infants from birth to three (3) years of age shall be enrolled in the early intervention

program. Regulations governing the delivery of services under this program, including eligibility

criteria, shall be promulgated by the department of ~~health~~ human services, with the advice of the

interagency coordinating council; provided, however, that all regulations promulgated by the

department of ~~mental health, retardation, and hospitals~~ health shall remain in full force and effect

until the time they are replaced by regulations promulgated by the department of ~~health~~ human

services. The regulations shall stipulate, at a minimum, the following provisions that are

consistent with the intent of this chapter:

(1) The director shall develop and maintain a procedure for the earliest possible

identification and efficient referral of all developmentally disabled infants;

(2) The director shall ensure that every infant identified and referred to this program is

enrolled as soon as possible after birth; and further, that for infants placed on a waiting list for

facility based group programming, an early intervention program shall be made available within a

thirty (30) day period from the time a need is identified in the individual program plan;

(3) Unless parents refuse the service, the home visiting component of the program shall

commence as soon as the infant has been identified as having a possible developmental disability;

(4) Any parent(s) who is/are dissatisfied with decisions or termination of service or with

practices and procedures of a particular agency or the department of ~~health~~ human services shall

notify the director of the department of ~~health~~ human services in writing within thirty (30)

calendar days and the complaint shall be reviewed in accordance with department of health policy

and procedures, as amended, and the Administrative Procedures Act, chapter 35 of title 42.

(5) An early intervention program for purposes of this section shall mean a

comprehensive array of educational, developmental, health, and social services provided on a

calendar year basis to eligible infants, children, and their families as specified in program

regulations.

(b) Within ninety (90) days after the effective date of this act, an evaluation plan

describing outcome measures that document the program’s successes and shortcomings from the

previous fiscal year shall be submitted to the speaker of the house of representatives, the president

of the senate and the house oversight committee and the governor and the interagency

coordinating council. Development of the plan shall be made in consultation with the entities with

expertise in this area and the interagency coordinating council. The plan shall include a

memorandum of understanding between the department of health, department of human services

and the department of elementary and secondary education that demonstrates coordination and

continuity of early intervention services among these departments.

documented in the evaluation plan have not been accomplished the responsible agencies shall

submit written explanations for the shortfalls, together with their proposed remedies. The report

shall also include evaluation of the progress of the coordination efforts between the department of

health and the department of human services and the department of elementary and secondary

education and the interagency coordinating council and shall include any recommendations

regarding modifications of the reimbursement mechanisms of this act.

(d) Within twelve (12) months after the effective date of this article a final report shall

include the progress of the coordination efforts between the department of health and the

department of human services and department of elementary and secondary education,

interagency coordinating council and shall include any recommendations regarding modifications

to the comprehensive array of educational, developmental, health and social services provided on

a calendar year basis to eligible infants, children and their families as specified in an early

intervention system.

(e) All reports or documents required to be produced pursuant to 20 U.S.C. sec. 1471 et

seq. shall be submitted to the speaker of the house, president of the senate and the chairpersons of

the appropriate house of representatives and senate oversight committees and the governor and

the interagency coordinating council. Adherence to such plans and reporting requirements, and

budgets and the timely achievement of goals contained therein shall be considered by the

oversight committees of the house of representatives and senate, among other relevant factors, in

determining appropriations or other systemic changes.

SECTION 2. Chapter 27-18 of the General Laws entitled "Accident and Sickness

Insurance Policies" is hereby amended by adding thereto the following section:

27-18-63. Coverage for early intervention services. -- (a) Every individual or group

hospital or medical expense insurance policy or contract providing coverage for dependent

children, delivered or renewed in this state on or after the effective date of this act, shall include

coverage of early intervention services which coverage shall take effect no later than January 1,

2005. Such coverage shall be limited to a benefit of five thousand dollars ($5,000) per dependent

child per policy or calendar year and shall not be subject to deductibles and coinsurance factors.

Any amount paid by an insurer under this section for a dependent child shall not be applied to any

annual or lifetime maximum benefit contained in the policy or contract. For the purpose of this

section, "early intervention services" means, but is not limited to, speech and language therapy,

occupational therapy, physical therapy, evaluation, case management, nutrition, service plan

development and review, nursing services, and assistive technology services and devices for

dependents from birth to age three (3) who are certified by the department of human services as

eligible for services under part C of the individuals with disabilities education act (20 U.S.C. sec.

1471 et seq.).

(b) Subject to the annual limits provided in this section, insurers shall reimburse certified

early intervention providers, who are designated as such by the Department of Human Services,

for early intervention services as defined in this section at rates of reimbursement equal to or

greater than the prevailing integrated state/Medicaid rate for early intervention services as

established by the Department of Human Services.

SECTION 3. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service

Corporations" is hereby amended by adding thereto the following section:

27-19-54. Coverage for early intervention services. -- (a) Every individual or group