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Improving Systems, Practices, and Outcomes

Use of Private Insurance for Early Intervention Services

Under 34 CFR §303.520(3)(b), a state may use the private insurance of a parent to pay for services under this part only if the parent provides consent to do so in accordance with 34 CFR §303.7 (parental consent), 34 CFR §303.420(a)(3) (consent prior to provision of services), and 34 CFR §303.420(a)(4) (use of private insurance).

Under 34 CFR §303.521(c), if a State has in effect a State law requiring the provision of a Free Appropriate Public Education (FAPE) to children with disabilities from birth, the State may not charge parents for any services (for example, physical or occupational therapy) that are part of FAPE for that infant or toddler and family.

State Policies

Colorado

Requires coverage of Part C services by public medical assistance and private health insurance up to $6,067, including case management costs, per calendar or policy year.

Connecticut

Requires coverage of Part C services up to $6,400 per child per year and an aggregate benefit of $19,200 per child over the total three-year period. Group insurance policies have an exemption to the expense limit for children with autism spectrum disorder, who have a maximum benefit available through early intervention providers of $50,000 per child per year and an aggregate benefit of $150,000 per child over the total three-year period. These costs are exempt from:

  1. being applied against or result in a loss of benefits due to any maximum lifetime or annual limits specified in the policy;
  2. adversely affecting the availability of health insurance to the child, the child's parent or the child's family members insured under any such policy; or
  3. being a reason to rescind or cancel such policy.

Indiana

Requires insurers to reimburse early intervention services if they are otherwise covered under a policy and exempts these payments from counting against any lifetime caps.

Massachusetts

Dependent coverage for newborn infants and adoptive children; inclusion in policies of accident and sickness insuranc

Rhode Island

Requires coverage of Part C services up to $5,000 annually per dependent child and exempts these costs from counting against any lifetime cap in a family's policy.

Virginia

Requires coverage of Part C services up to $5,000 annually and exempt these costs from counting against any lifetime caps in a family's policy. The state also applies these provisions in a separate act to the insurance program for state employees.