| (a) The family monthly maximum payment is the total
amount of money collected from a family in one month, including family
fees, co-pays, co-insurance, and deductibles. The assigned family
monthly maximum payment does not increase if the family has more than
one child receiving IFSP services.
(b) The contractor may not charge a family a co-pay
or any co-insurance, deductibles or family fees for children in receipt
of Medicaid.
(c) The contractor determines the family's assigned
family monthly maximum payment based on the family's placement on
the DARS ECI sliding fee scale. Placement on the sliding fee scale
is based on family size and annual adjusted income. The sliding fee
scale is based on the formula in the figure in this subsection. The
sliding fee scale must be provided to the parent and additional copies
can be obtained from DARS.
Attached Graphic
(d) Family size is calculated by adding: the child,
the number of parents living in the home, and the number of the parent's
other dependents.
(e) The annual adjusted income is calculated by subtracting
allowable deductions from the annual gross income.
(f) The contractor calculates the allowable deductions
amount using:
(1) the actual amounts that were paid over the previous
12 months and are expected to continue during the IFSP period; and
(2) projections for new expenses expected to occur
during the IFSP period.
(g) Allowable deductions are limited to the following
family expenses that are not reimbursed by other sources:
(1) medical or dental expenses that meet the requirements
in subsection (h) of this section;
(2) childcare and respite expenses;
(3) costs and fees associated with the adoption of
a child; and
(4) court-ordered child support payments for children
who were not counted as family members or dependents in calculating
the adjusted income and family monthly maximum payment.
(h) Allowable deductions for medical and dental expenses
are costs to primarily alleviate or prevent a physical or mental defect
or illness. Allowable deductions for medical and dental expenses are
limited to the cost of:
(1) diagnosis, cure, alleviation, treatment, or prevention
of disease;
(2) treatment of any affected body part or function;
(3) legal medical services delivered by physicians,
surgeons, dentists, and other medical practitioners;
(4) medication, medical supplies, and diagnostic devices;
(5) premiums paid for insurance that covers the expenses
of medical or dental care;
(6) transportation to receive medical or dental care;
and
(7) medical or dental debt that is being paid on an
established payment plan.
(i) In situations where there is shared physical custody
or shared legal or financial responsibility for a child, the adjusted
income(s) of the parent who financially supports the child will be
considered unless conditions warrant otherwise.
(j) The parent must sign a family cost share agreement
acknowledging the family monthly maximum payment. The contractor must
not provide IFSP services subject to a family cost share amount until
the parent signs a family cost share agreement.
|
| Source Note: The provisions of this §108.1413 adopted to be effective September 1, 2011, 36 TexReg 5408; amended to be effective July 1, 2012, 37 TexReg 4621; amended to be effective December 31, 2012, 37 TexReg 9786 |
