OAR 581-015-2885
Preschool Children with Disabilities Covered by Public Insurance

(1)

Applicability: For purposes of OAR 581-015-2885 (Preschool Children with Disabilities Covered by Public Insurance), IDEA Part C requirements apply to children ages birth through two; IDEA Part B requirements apply to children ages three and above.

(2)

For purposes of this rule the term “public benefits” means public insurance including but not limited to Medicaid.

(3)

The contractor or subcontractor may use a child or family’s public benefits to provide or pay for early intervention, as permitted under the public insurance program and the requirements of this rule.

(4)

The contractor or subcontractor may not require a parent to sign up for, or enroll in, public benefits to receive early intervention services under Part C.

(5)

For a child under age three, the contractor or subcontractor:

(a)

Must obtain, prior to using public benefits, parent consent if the child or family is not enrolled in the public benefits program or if that use would:

(A)

Decrease available lifetime coverage or any other insured benefit;

(B)

Result in the family paying for services that would otherwise be covered by the public benefits;

(C)

Increase premiums or lead to the discontinuation of insurance; or

(D)

Risk loss of eligibility for home and community-based waivers, based on aggregate health-related expenditures.

(b)

Must provide, if the parent does not consent to use of their public benefits, the early intervention services on the IFSP for which the parent has provided consent.

(c)

Must provide written notification, prior to using public benefits, to the parents that includes:

(A)

A statement that parental consent must be obtained before the contractor or subcontractor discloses a child’s personally identifiable information to the State Medicaid Agency for billing purposes;

(B)

A statement of the no-cost protection provision in subsection (5)(a)–(b) that early intervention services on the IFSP must still be made available if the parent has consented to these services;

(C)

A statement that the parents have the right to withdraw their consent to disclose personally identifiable information to the public agency responsible for the administration of public benefits or insurance program (e.g., Medicaid) at any time; and

(D)

A statement of the general cost categories that the parent would incur as a result of participating in a public benefits program.

(d)

Must pay any costs incurred as a result of using public benefits for early intervention services, such as a deductible or copayment.

(e)

May use its Part C funds to pay fees and costs (e.g., the deductible or co-pay amounts) the parents otherwise would have to pay to use public benefits.

(f)

May use its Part C funds to pay for early intervention services;

(g)

Must notify EI parents that they may use any of the state’s dispute resolution procedures including, but not limited to, the state complaint system under OAR 581-015-2030 (Procedures for Complaints as Required by IDEA Regulations), and mediation, due process and related resolution sessions under 581-015-2865 (Mediation) through 581-015-2870 (Due Process Hearings) to contest the imposition of an insurance-related fee or cost, such as co-payments or deductibles, to provide early intervention services for a child who may have a disability.

(6)

For a child over age three, the ECSE program, contractor, or subcontractor may use the State’s Medicaid or other public benefits or insurance programs in which a child participates to provide or pay for special education and related services required under IDEA and permitted under the public benefits or insurance program, as specified in subsection (2) below.

(7)

With regard to services required to provide a free appropriate public education (FAPE) to a child with disabilities under IDEA, the ECSE program, contractor, or subcontractor

(a)

May not require parents to sign up for or enroll in public benefits or insurance programs in order for their child with disabilities to receive FAPE under the IDEA;

(b)

May not require parents to incur an out-of-pocket expense such as the payment of deductible or copay amount incurred in filing a claim for special education and related services, pursuant to IDEA, but may pay the cost that the parent otherwise would be required to pay; and

(c)

May not use the child’s benefits under a public insurance program if that use would:

(A)

Decrease available lifetime coverage or any other insured benefit;

(B)

Result in the family paying for services that would otherwise be covered by the public benefits or insurance program and that are required for the child outside of the time the child is in school;

(C)

Increase premiums or lead to the discontinuation of insurance; or

(D)

Risk loss of eligibility for home and community-based waivers, based on aggregate health-related expenditures; and

(d)

Must not use a child’s benefits under a public insurance program if that use would:

(A)

Decrease available lifetime coverage or any other insured benefit;

(B)

Result in the family paying for services that would otherwise be covered by the public benefits;

(C)

Increase premiums or lead to the discontinuation of insurance; or

(D)

Risk loss of eligibility for home and community-based waivers, based on aggregate health-related expenditures.

(8)

Prior to accessing a child’s or parent’s public benefits or insurance for the first time, and after providing notification to the child’s parents consistent with (5) below, the ECSE program, contractor, or subcontractor must obtain written, parental consent that: Meets the requirements of the Family Education Rights and Privacy Act (34 CFR part 99) and the parental consent provisions in IDEA (34 CFR §300.622) requiring that consent state:

(a)

the personally identifiable information that may be disclosed (e.g., records or information about the services that may be provided to a particular child);

(b)

the purpose of the disclosure (e.g., billing for services under the Individuals with Disabilities Education Act (IDEA);

(c)

the agency to which the disclosure may be made (e.g., the State’s public benefits or insurance program (e.g., Medicaid); and

(d)

Specifies that the parent understands and agrees that the public agency may access the parent’s or child’s public benefits or insurance to pay for services under IDEA.

(9)

Prior to accessing a child’s or parent’s public benefits or insurance for the first time, and annually thereafter, the District or ECSE program must provide prior written notification, consistent with requirements of OAR 581-015-2310 (Prior Written Notice)(4) and (5), to the child’s parents, that includes:

(a)

A statement of the parental consent provisions in paragraphs (4)(a)(A) and (B) above;

(b)

A statement of the “no cost” provisions in paragraphs (2)(a) through (c) above.

(c)

A statement that the parents have the right under the Family Education Rights and Privacy Act (FERPA) and IDEA, Part B, and OAR 581-0152005 to withdraw their consent to disclosure of their child’s personally identifiable information to the agency responsible for the administration of the State’s public benefits or insurance program (e.g., Medicaid) at any time; and

(d)

A statement that the withdrawal of consent or refusal to provide consent, pursuant to FERPA and IDEA, to disclose personally identifiable information to the agency responsible for the administration of the State’s public benefits or insurance program (e.g., Medicaid) does not relieve the public agency of its responsibility to ensure that all required services are provided at no cost to the parents.

(10)

Use of IDEA Part B funds.

(a)

If the ECSE program, contractor, or subcontractor is unable to obtain parental consent to use the parents’ public benefits or insurance when the parents would incur a cost for a specified service required to ensure a free appropriate public education, the district or ECSE program may use its Part B funds to pay for the service.

(b)

To avoid financial cost to parents who would otherwise consent to use public benefits or insurance, the ECSE program, contractor, or subcontractor may use its Part B funds to pay the cost the parents otherwise would have to pay to use the public insurance (e.g., the deductible or co-pay amounts).

(c)

Proceeds from public benefits or insurance will not be treated as program income for purposes of 34 CFR 80.25.

(d)

If the ECSE program, contractor, or subcontractor spends reimbursements from federal funds (e.g., Medicaid) for special education and related services, those funds will not be considered “state or local” funds for purposes of the maintenance of effort provisions pursuant to IDEA If a contractor or subcontractor spends reimbursements from federal funds (e.g., Medicaid) for early intervention, those funds will not be considered “state or local” funds for purposes of the maintenance of effort provisions.

(11)

Construction. Nothing in this rule should be construed to alter the requirements imposed on a state Medicaid agency, or any other agency administering a public benefits or insurance program by federal statute, regulations or policy under title XIX, or title XXI of the Social Security Act, 42 U.S.C. 1396 through 1396v and 42 U.S.C. 1397 aa through 1397jj, or any other insurance program.

Source: Rule 581-015-2885 — Preschool Children with Disabilities Covered by Public Insurance, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=581-015-2885.

581‑015‑2000
Definitions 581‑015‑2005
Criteria for Approving School District Special Education Programs 581‑015‑2010
Census and Data Reporting 581‑015‑2015
Compliance Monitoring 581‑015‑2020
Recovery of Funds for Misclassified Children 581‑015‑2025
Advanced Payment to School Districts for Special Education Programs 581‑015‑2030
Procedures for Complaints as Required by IDEA Regulations 581‑015‑2035
Minimum Standards for Sign Language Interpreters Serving Students in Public Schools 581‑015‑2040
Free Appropriate Public Education (FAPE) and Age Ranges 581‑015‑2045
Age Limitations and Exceptions to FAPE 581‑015‑2050
Graduation 581‑015‑2055
Assistive Technology 581‑015‑2060
Accessible Materials 581‑015‑2065
Extended School Year Services 581‑015‑2070
Nonacademic Services 581‑015‑2075
Charter Schools 581‑015‑2080
Child Find 581‑015‑2085
Child Find for Children Attending Private Schools 581‑015‑2090
Consent 581‑015‑2095
Exceptions to Consent 581‑015‑2100
Responsibility for Evaluation and Eligibility Determination 581‑015‑2105
Evaluation and Reevaluation Requirements 581‑015‑2110
General Evaluation and Reevaluation Procedures 581‑015‑2115
Evaluation Planning 581‑015‑2120
Determination of Eligibility 581‑015‑2125
Interpretation of Evaluation Data 581‑015‑2127
Developmental Delay 581‑015‑2130
Autism Spectrum Disorder 581‑015‑2135
Communication Disorder 581‑015‑2140
Deafblindness 581‑015‑2145
Emotional Disturbance Eligibility Criteria 581‑015‑2150
Deaf or Hard of Hearing 581‑015‑2155
Intellectual disability 581‑015‑2160
Orthopedic Impairment 581‑015‑2165
Other Health Impairment 581‑015‑2170
Specific Learning Disability 581‑015‑2175
Traumatic Brain Injury 581‑015‑2180
Visual Impairment 581‑015‑2181
Functional Behavioral Assessments 581‑015‑2190
Parent Participation – General 581‑015‑2195
Additional Parent Participation Requirements for IEP and Placement Meetings 581‑015‑2200
Content of IEP 581‑015‑2205
IEP Team Considerations and Special Factors 581‑015‑2210
IEP Team 581‑015‑2215
Oregon Standard IEP 581‑015‑2220
When IEPs Must Be In Effect 581‑015‑2225
Review and Revision of IEPs 581‑015‑2230
Transfer Students 581‑015‑2235
School District and Participating Agency Responsibilities for Transition Services 581‑015‑2240
Requirement for Least Restrictive Environment 581‑015‑2245
Alternative Placements and Supplementary Aids and Services 581‑015‑2250
Placement of the Child 581‑015‑2255
Nonacademic Settings 581‑015‑2260
Rights of Children with Disabilities in Private Schools Placed or Referred by Public Agencies 581‑015‑2265
Obligations of Public Agencies that Contract with Approved Private Schools 581‑015‑2270
Standards for Approval of Private Schools for School-age Children 581‑015‑2275
Standards for Approval of Private Preschools 581‑015‑2280
Process for Approval of Private School or Preschool as a Contractor with Public Agencies 581‑015‑2285
Suspension, Revocation or Refusal to Renew Approval 581‑015‑2290
Appeal of Denial, Suspension, Revocation or Refusal to Renew Approval 581‑015‑2295
Out-of-State Placements for Special Education 581‑015‑2300
Access to Student Education Records 581‑015‑2305
Independent Educational Evaluation 581‑015‑2310
Prior Written Notice 581‑015‑2315
Notice of Procedural Safeguards 581‑015‑2320
Surrogate Parents 581‑015‑2325
Transfer of Procedural Rights at Age of Majority 581‑015‑2330
Notice of Transfer of Rights at Majority 581‑015‑2335
Mediation 581‑015‑2340
Procedural Rules for Due Process Hearings 581‑015‑2345
Hearing Request and Response 581‑015‑2350
Sufficiency of Hearing Request 581‑015‑2355
Resolution Process 581‑015‑2360
Pre-Hearing Conference, Notice of Hearing and Hearing Rights 581‑015‑2365
Criteria for Administrative Law Judge 581‑015‑2370
Conduct of Hearing 581‑015‑2375
Decision of Administrative Law Judge 581‑015‑2380
Informal Disposition 581‑015‑2383
Failure to Appear at a Hearing 581‑015‑2385
Hearing Costs 581‑015‑2390
Definitions for Hearings Under Section 504 of the Rehabilitation Act 581‑015‑2395
Procedures for a Hearing under Section 504 of the Rehabilitation Act of 1973 581‑015‑2400
Definitions 581‑015‑2405
Disciplinary Removals for Up to 10 School Days for Children with Disabilities 581‑015‑2410
Additional Disciplinary Removals of Up to 10 School Days Each (No Pattern) 581‑015‑2415
Disciplinary Removals of More than 10 School Days (Pattern or Consecutive) 581‑015‑2420
Manifestation Determination 581‑015‑2425
Removal to an Interim Alternative Educational Setting by School District 581‑015‑2430
Removal to an Interim Alternative Educational Setting by Administrative Law Judge (Injurious Behavior) 581‑015‑2435
Requirements of an Interim Alternative Educational Setting 581‑015‑2440
Protections for Children Not Yet Eligible for Special Education 581‑015‑2445
Expedited Due Process Hearings 581‑015‑2450
Definitions 581‑015‑2455
Provision of services for Private School Children with Disabilities 581‑015‑2460
Services Plan 581‑015‑2465
Documentation Requirements 581‑015‑2470
Expenditures for Parentally-Placed Private School Children 581‑015‑2475
Private School Child Count 581‑015‑2480
Consultation with Representatives of Private School Children with Disabilities 581‑015‑2483
Written Affirmation 581‑015‑2485
Complaint by Private School Official 581‑015‑2490
Complaints and Due Process Hearings for Private School Children 581‑015‑2495
Funds and Property Not to Benefit Private Schools 581‑015‑2500
Use of Personnel 581‑015‑2505
Separate Classes Prohibited 581‑015‑2510
Property, Equipment, and Supplies 581‑015‑2515
Reimbursement for Private Placement 581‑015‑2530
Children with Disabilities under IDEA Enrolled in Public Benefits or Insurance 581‑015‑2535
Children with Disabilities Covered by Private Insurance 581‑015‑2540
Definitions for Regional Programs 581‑015‑2545
Administration of Regional Programs 581‑015‑2550
Eligibility for Regional Services 581‑015‑2555
Referral for Regional Services 581‑015‑2560
Individualized Educational Program/Individualized Family Service Plan 581‑015‑2565
Regional Program Services 581‑015‑2570
Definitions and Purposes of Long-Term Care and Treatment (LTCT) Programs 581‑015‑2571
Long-Term Care and Treatment (LTCT) Education Program Eligibility and Approval 581‑015‑2572
Long-Term Care and Treatment (LTCT) Education Program Funding Formula 581‑015‑2573
Due Process Hearings for Long-Term Care and Treatment (LTCT) Education Programs 581‑015‑2574
Resident District Obligations for Students in Long-Term Care and Treatment (LTCT) Education Programs 581‑015‑2575
School Programs in Private Hospitals 581‑015‑2580
School Programs in State-Operated Hospitals 581‑015‑2585
Youth (Juvenile) Corrections Education and Juvenile Detention Education Programs 581‑015‑2590
Required Days of Instruction 581‑015‑2595
Education Programs for Children at Residential Youth Care Centers 581‑015‑2600
Incarcerated Youth 581‑015‑2605
Plans to Serve Students in Local or Regional Correctional Facilities 581‑015‑2610
Standards for Home, Hospital, Institutional or Other Regularly Scheduled Instruction 581‑015‑2700
Definitions — EI/ECSE Program 581‑015‑2705
Establishment of Service Areas 581‑015‑2710
Selection of Contractor 581‑015‑2712
Availability of Early Intervention Services 581‑015‑2713
Central Directory 581‑015‑2715
Role of Local Interagency Coordinating Council (LICC) 581‑015‑2720
Census and Data Reporting – EI/ECSE Program 581‑015‑2725
Compliance Monitoring – EI/ECSE Program 581‑015‑2730
Parent Consent for EI 581‑015‑2735
Parent Consent for ECSE 581‑015‑2740
Exceptions to Parental Consent — EI/ECSE Program 581‑015‑2745
Prior Written Notice and Notice of Procedural Safeguards — EI/ECSE Program 581‑015‑2750
Parent Participation — General — EI/ECSE Program 581‑015‑2755
Additional Parental Participation Requirements for IFSP and Placement Meetings — EI/ECSE Program 581‑015‑2760
Surrogate Parents — EI/ECSE 581‑015‑2765
Independent Education Evaluation — ECSE 581‑015‑2770
Confidentiality of Records for Preschool Children with Disabilities 581‑015‑2774
Referral Procedures and Early Intervention Screening 581‑015‑2775
EI Evaluation 581‑015‑2780
EI Eligibility 581‑015‑2785
Provision of EI Services Before an Evaluation and Assessment Are Completed 581‑015‑2786
Dispute Resolution Within and Between Public Agencies — Early Intervention (EI) Services 581‑015‑2790
ECSE Evaluation 581‑015‑2795
ECSE Eligibility 581‑015‑2800
Termination of Eligibility — EI/ECSE 581‑015‑2805
EI and ECSE Transition 581‑015‑2810
IFSP Meeting Procedures and Timelines 581‑015‑2815
IFSP Content 581‑015‑2820
IFSP Team Consideration and Special Factors 581‑015‑2825
Participants for IFSP Team Meetings and Reviews 581‑015‑2830
Implementation of the IFSP 581‑015‑2835
Natural Environments in EI 581‑015‑2840
Service Coordination 581‑015‑2845
Placement and Least Restrictive Environment in ECSE 581‑015‑2850
Free Appropriate Public Education (FAPE) for ECSE 581‑015‑2855
Extended Year Services for ECSE 581‑015‑2860
Assistive Technology for ECSE 581‑015‑2863
Procedures for EI/ECSE Complaints 581‑015‑2865
Mediation 581‑015‑2870
Due Process Hearings 581‑015‑2875
Discipline of Children with Disabilities for ECSE 581‑015‑2880
Private Placement — ECSE 581‑015‑2885
Preschool Children with Disabilities Covered by Public Insurance 581‑015‑2890
Preschool Children with Disabilities Covered by Private Insurance 581‑015‑2895
Health and Safety 581‑015‑2900
Personnel Standards 581‑015‑2905
Authorization of Early Childhood Specialist 581‑015‑2910
Authorization of Early Childhood Supervisor 581‑015‑2930
Employment-Related Transition Services
Last Updated

Jun. 8, 2021

Rule 581-015-2885’s source at or​.us