2004 -- H 8669 SUBSTITUTE A

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LC03683/SUB A/2

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STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2004

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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

     Referred To: House Corporations

It is enacted by the General Assembly as follows:

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

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

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read as follows:

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

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

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

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

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

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

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

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

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

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consistent with the intent of this chapter:

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

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identification and efficient referral of all developmentally disabled infants;

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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regulations.

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

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

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

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

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

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

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

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

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continuity of early intervention services among these departments.

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     (c) Within six (6) months after the effective date of this act where prescribed outcomes

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

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

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

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

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education and the interagency coordinating council and shall include any recommendations

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regarding modifications of the reimbursement mechanisms of this act.

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

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

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

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interagency coordinating council and shall include any recommendations regarding modifications

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

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

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intervention system.

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

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

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

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

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

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

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determining appropriations or other systemic changes.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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1471 et seq.).

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

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

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

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

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established by the Department of Human Services.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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1471 et seq.).

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

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

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

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

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established by the Department of Human Services.

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     SECTION 4. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service

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

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     27-20-49. Coverage for early intervention services. -- (a) Every individual or group

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

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

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

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

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

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

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

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

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

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

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

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

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1471 et seq.).

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

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

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

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

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established by the Department of Human Services.

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     SECTION 5. Chapter 27-41 of the General Laws entitled "Health Maintenance

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

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     27-41-66. Coverage for early intervention services. -- (a) Every individual or group

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

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

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

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

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

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

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

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

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

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

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

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

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1471 et seq.).

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

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

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

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

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established by the Department of Human Services.

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     SECTION 6. This act shall take effect as of July 1, 2004.

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LC03683/SUB A/2

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N A C T

RELATING TO HEALTH INSURANCE - - EARLY INTERVENTION SERVICES

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     This act would provide that individual or group hospital or medical expense insurance

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policies or contracts providing coverage for dependent children include coverage of early

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intervention services and would provide for a transition process for early intervention for

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developmentally disabled infants.

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     This act would take effect on July 1, 2004.

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LC03683/SUB A/2

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