9/28/2010 Agenda • Difficult conversations How to Talk to Families about Financial Issues • Why is talking about financial issues so difficult? • Be informed – Value of ECI – Components of FCS – Insurance Primer Tips for Difficult Conversations Don’t procrastinate Tips for Difficult Conversations • Don’t dwell on the “worst –case scenarios” • But, if the worst did happen, how bad could it be? 1 9/28/2010 Tips for Difficult Conversations Tips for Difficult Conversations Identify why the subject is difficult for you Prepare the family for the conversation Culture and Money • Your feelings/views of money started with your family of origin • Important to understand your feelings/beliefs about money so you don’t impose them on families • Important to understand why families may have certain views of money Why is talking about money taboo? Americans value: Privacy Boundaries – Could be similar or different than yours 2 9/28/2010 Why is talking about money taboo? Increase Your Knowledge • Do you know? “We relate our salary or our income to our place in the world,” Why ECI? • ECI provides valuable service • ECI is worth paying for • ECI Message Texas Early Childhood Intervention (ECI) programs serve families with children birth to 36 months with developmental delays or disabilities. ECI provides family support and specialized services to strengthen the family’s ability to access resources and improve their child’s development through daily activities. – Value of ECI Services – The “why” and “how” of Family Cost Share System – The “why” of collecting income information – The “how” of insurance relationship to FCS Scenario At the initial meeting, a family asks you what the difference is between ECI and the home health agency down the street. The family is trying to weigh the pros and cons of the potential financial obligation to ECI (FCS) and the financial obligation (copays, deductibles) to the home health agency. Use the ECI Message to help you with your answer 3 9/28/2010 Family Cost Share 303.521 CHAPTER III--OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION PART 303--EARLY INTERVENTION PROGRAM FOR INFANTS AND TODDLERS WITH DISABILITIES A State may establish, consistent with § 303.12(a)(3)(iv), a system of payments for early intervention services, including a schedule of sliding fees. Family Rights Related to FCS Parents must be informed of these rights before collection of income or third party payer information or the imposition of fees • Certain ECI services are at no cost to the parent • Parents can refuse any service they do not wish to receive • Parents can ask for and receive a review or reconsideration at any time of the current FCS (fees) or amount due or past due • Parents must receive information about any method the program may use to verify the family’s income and allowable expenses • Family Cost Share • Families share in the cost of services – Sliding Scale Fee – Public or Private Insurance • Family Cost Share Fee does not apply to*: Screening, evaluation and assessment Case Management Translation Development of the IFSP Procedural Safeguard activities Respite Child Find Children in the conservatorship of the State Children with auditory or visual impairments who qualify for school district services *means no cost to families – – – – – – – – – Family Cost Share – Monthly Fee • FCS fee is NOT fee for service • FCS determined by: • family size • adjusted income Sliding Scale Fees The parent must be informed of the program’s procedure for reviewing the FCS amount before they are asked to sign the financial agreement 4 9/28/2010 Allowable Expenses 1. 2. 3. 4. 5. Medical or dental expenses Payment for medical or dental debt Childcare or respite expenses Adoption fees Court ordered child support payments Family Cost Share Amount Calculating Family Cost Share Amount • Calculate adjusted income Gross income – Allowable expenses = Adjusted income • Review Sliding Fee Scale Fee Range = $0 - $150 Sliding Scale Fees Why do we collect income information and family size for all families? • FCS = O – Families participating in identified public benefit programs – Families with adjusted incomes below 250% of the Federal Poverty Level – Family already paying FCS for child enrolled in ECI – Children who qualify for school district services for auditory or visual impairments (no attestation form required) – Children in the conservatorship of the State (no attestation form required) Poll 5 9/28/2010 3rd Party Payers • Programs seek consent to bill IFSP services to private insurance and TRICARE • Programs collect information for Public Insurance (no consent needed) • Programs do not need consent to bill for private insurance if child has Medicaid and private insurance Insurance Primer Insurance Primer – Type of Plans • EPO • PP0 • HMO • Health Savings Account +/- Catastrophic Policy Services not covered by insurance • Copay • Coinsurance – Maximum out of pocket • Deductible If none of the IFSP services are paid by 3rd party, family pays Family Cost Share Amount – In Network – Out of Network 6 9/28/2010 Extraordinary Circumstances Waiver of fees is due to extraordinary expenses or loss of income that adversely affect the parent’s ability to pay for basic living expenses The family may not tell you when they need a waiver Approach the family with respect Offer Review if you noticed circumstances have changed, but don’t ASSUME. Extraordinary Circumstances Families can request a review at anytime – Sign a new Attestation Form and Family Cost Share Agreement for permanent income loss or increase in expenses – Use “Review Attestation” and Financial Agreement for a temporary income loss or increase in expenses Family Cost Share Review • Review at the complete periodic reviews (at least every six months) – Attestation form (family size, income, expenses) – FCS amount – Public or Private Insurance • Change requires new form and new signature • Family can request review at any time due to Extraordinary Circumstances Nonpayment of Fees • The parent has 30 days from the billing date to pay the Family Cost Share amount • Program must determine if nonpayment of fees is due to extraordinary circumstances • Programs must notify parents that – services that are subject to an FCS will be suspended after 90 days of nonpayment – Program cannot guarantee that services will be reinstated on the same schedule or with the same provider • Services that aren’t subject to the FCS will be provided during suspension of services – Excludes Respite vouchers 7 9/28/2010 Documentation and Record Keeping • FERPA applies to financial records • Financial agreement, financial records related to income, expenses, and payment history must be kept separate from the child’s other educational records. – Do not forward to a school district or other non ECI service providers at any time unless requested by the family. – Do transfer to other Texas ECI programs Scenario 1. A family who was participating consistently in services starts “no showing” some services. You look at the pattern of “no shows” and discover that they participate for all services during the months that they are scheduled to receive Speech (covered by insurance) and “no show” the services subject to a FCS during the month that they don’t receive speech? What would you do? 2. Your program’s Billing Specialist reports that the Fabray family’s services will be suspended next month due to nonpayment. She have been offered a Extraordinary Circumstances review. You have offered this review, but they have refused. What would you do next? 3. The Cullen family lives next door to the Stackhouse family. Both families are enrolled in ECI. You are the Service Coordinator for both families. Mr. Cullen calls you one day and is very angry because Mrs. Stackhouse reported that she is getting ECI services for free and he has a FCS. What would you do? 4. After this training, and examining your cultural values surrounding money, you still feel uncomfortable talking about financial issues with families. What can you do? One last tip! • Communicate! – With families about information needed to enroll in ECI – With families about their financial obligations for ECI services – Service Coordinators and Billing Specialists communicate about family’s 3rd party coverage – Service Coordinators communicate with Billing Specialist about planned and delivered IFSP services – Billing Specialists communicate with Service Coordinators about family’s non payment and suspension of services Summary • Examine your own values about money and financial obligations • Knowledge is the key • Communicate, communicate, communicate • Seek Support when needed] – Billing Specialist – Supervisor or Program Director 8