Consent to Bill

The IDEA safeguards for billing are summarized below and are the purpose of PIC’s Consent to Bill form.

Summary of § 303.520 – Policies on Public Benefits, Insurance, and Private Insurance for Part C Services

1. Use of Public Benefits or Insurance
   • A State may use a child’s or parent’s public benefits (e.g., Medicaid) for Part C services only after providing written notification and ensuring certain no-cost protections.
   • Parents cannot be required to enroll in public benefits as a condition for receiving services.
   • Parental consent is required if using public benefits would:
     • Reduce available coverage or benefits.
     • Result in out-of-pocket costs for parents.
     • Increase premiums or discontinue benefits.
     • Risk loss of eligibility for Medicaid waivers.
   • If a parent refuses consent, the State must still provide approved Part C services.
2. Use of Private Insurance
   • A State cannot use private insurance to pay for Part C services without parental consent unless a State law protects against:
     • Loss of benefits due to coverage caps.
     • Negative impact on insurance availability.
     • Increased insurance premiums.
   • Consent is needed when:
     • Private insurance is first used for a service.
     • There is an increase in service levels.
   • If parents may incur costs (e.g., co-pays, deductibles), these must be identified in State policies.
3. Inability to Pay
   • If a family cannot afford private insurance costs and does not consent to its use, services cannot be delayed or denied.
4. Use of Funds from Public or Private Insurance
   • Reimbursements from public or private insurance are not considered State or local funds.
   • Medicaid reimbursements are also not considered State or local funds.
5. Parent Payments Under a State's System
   • Payments made by parents under a State's system of payments are program income and must be used for early intervention services but are not counted as State or local funds.