Effective Date: July 13, 1996 Connecticut Birth to Three System
Date Revised: July 1, 2011
Title: PAYMENTS TO PROGRAMS
Purpose: To provide financial support to programs providing Birth to Three services.
Overview
Contracted programs are paid monthly in arrears for children enrolled and for
evaluations performed by submitting a monthly invoice generated by the Connecticut
Birth to Three data system (SPIDER). Monthly billing invoices will be paid within 30
days of receipt. This is provided that all information submitted is correct and has been
entered into the data system and the program has also electronically signed off on their
monthly attendance at the time of submitting their invoice. For additional information
on entering the attendance information and completing the monthly invoice please see
the Connecticut Birth to Three Data System Manual at www.birth23.org.
Electronic Payments
Contracted programs may enroll with the state to receive their payment electronically
(Electronic Funds Transfer). To do so, the program may request an enrollment form
from the Office of the State Comptroller, or may go to the CT.gov website, Executive
division. Choose Comptroller, Office of the State Accounts Payable Division,
“participate in the EFT (ACH) Program”.
Payment for Units of Service
All invoices must be sent to the Connecticut Birth to Three Fiscal Office via email or
mailed to 460 Capitol Avenue, Hartford, CT 06106. All payments will be issued from
that office. Payment for eligible children receiving direct services is one unit for
enrollment between the first and fifteenth day of the month and one unit for enrollment
between the sixteenth and last day of the month, regardless of service frequency. The
exception is children who require more than 13 hours of service per month (see
Contract Supplement Funding section of this procedure). Payment for an eligibility
evaluation is equivalent to one unit regardless of when the evaluation is completed
and regardless of whether the child is eligible.
Contracted programs will be paid for each initial Individualized Family Service Plan
(IFSP) meeting at a rate established by the Department of Developmental Services
(DDS), as revised from time to time, and posted by July 1 of each year on the
Department’s website. Payment for an initial meeting will be made if the initial IFSP
meeting is held:
1. on a different day from the initial evaluation and
2. within 45 days of the call to Child Development Infoline or within 30 days of the
date the referral was sent to the Birth to Three Program, which ever is later, or
3. more than 45 days from the call to Infoline if the delay was at the family’s request,
entered as such into the data system, and documented in the child’s record. (This
could include families that call before moving from another state; children who are
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in the hospital or too ill to be evaluated; a family that wants to wait until after a visit
to the physician; or other reasons that are specific to the child or family), or
4. for children whose initial IFSP is delayed due to the completion of an assessment
to determine if the child meets the educational classification of autism.
An interim IFSP can be completed on the same day as the evaluation (See IFSP
Handbook or IFSP Procedure) but this will not be considered the initial IFSP for
payment purposes. If an interim IFSP is developed the initial IFSP still must meet the
above requirements in order for payment to be issued.
The program will enter an “I” code on the attendance to indicate an initial IFSP
meeting that meets these criteria. If the IFSP meeting does not meet the criteria, the
data system will not allow the “I” to remain on the attendance screen but the IFSP will
not be counted for payment on the invoice.
Attendance Codes and Payments
After the initial IFSP meeting is held, programs will receive payment for direct services
that begin on or after the date that the IFSP is signed by both the parent and the
physician or advanced practice registered nurse (APRN). The program must enter the
IFSP with the “MD signature” date into the data system in order to be able to enter the
first visit on the attendance screen. The first visit to provide direct services must
actually occur in order for payment to begin. A cancelled visit or a meeting is not
considered a “first visit to provide direct services”. Direct services do not include staff
time for preparation or program planning unless done with the parent and or child and
does not include visits made for the purpose of carrying out service coordination
activities when the service coordinator is not listed as a provider of services on the
IFSP.
When entering monthly attendance regarding visits to deliver direct services, the
program enters the following codes as indicated:
“X” - for services delivered in the home, or the surrounding neighborhood such as
library, playground, park, or grocery store;
“C” - for a regularly scheduled visit to child care or other community locations;
“O” - for office visits,
“H” - for visits to a child who is a hospital inpatient;
“M” - team, transition, PPT meeting or IFSP review meetings (“M” will only trigger
payment for supplemental services when “team meeting” is listed in the IFSP
service section VI)
“U” - if visit cancelled by family with less than 24-hours notice.
Birth to Three Programs will not be paid for unit(s) of service when the only
attendance code for that half of the month is a “U”. While reporting a “U” on
attendance for the first visit does not begin payment for the program, it could still be
entered when this is a new service, because entering a “U” will inform the system that
the program attempted to deliver services in a timely manner (within 45 days of the
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IFSP meeting), but the family cancelled the appointment with less than 24 hours
notice or was not home. Please note that families will be billed if they received any
services during the month, including visits that were cancelled with less than 24-hours
notice and entered as a “U” on the attendance for that month.
For a newly enrolled child who enters the system and receives his first direct service
on or before the 15th of the month, the program will be paid for two units. For a newly
enrolled child that enters the system and receives her first direct service after the 15th
of the month, the program will be paid for one unit.
After services begin, payment will continue for any enrolled child who has a current
IFSP, unless the monthly attendance indicates only U or no service. The term
“service”, for this purpose, includes IFSP meetings, transition conferences, and
planning and placement team meetings (all of which should be indicated by an “M”
when completing the monthly attendance information). A program will not receive
payment for a month in which no direct services were delivered to a child. Payment
will resume if and when services are resumed for that child. A program can
discontinue a child with written prior notice to the family, if there are no expectations of
the family continuing services. For more information on exiting a child see the Exit
procedure.
For a child that exits before the 15th of the month, the program will be paid one unit if
direct services were provided. For a child that exits on or after the 15th of the month, the
program will be paid two units. For children exiting at or near their third birthday, the
program will calculate the last day of enrollment as the day before the child’s third
birthday. For a child exiting prior to age three, the last day of enrollment is the day that
services were discontinued, most likely the day after the last service was delivered or
the day that the parent notified the program.
For a child transferring to another program, the payment will be based on the date of
transfer. Transfers must coincide with the 1st or 16th of the month. If, by parent
request, the transfer occurs on a date other than the 1st or 16th, the receiving
program will bill for that service period (e.g. If the transfer occurs on the 1st through
the 15th of the month, the receiving program will bill for two units of enrollment. If the
transfer occurs on the 16th through the 31st of the month, the receiving program will
bill for one unit of enrollment). When a family is transferring, the sending and
receiving programs must look at the services that have been provided or will be
provided during that month and decide which program will get one or two units for the
month. This decision should be mutually agreed upon by the programs and should
not impact the family negatively such as an extended break in services to match the
transfer dates of the 1st of 16th. For the receiving program, payment will begin on the
day of the meeting to review/revise the IFSP, indicated by an “M” in the monthly
attendance. For more information on this topic see the procedure “Transfer of Child
from one Program to Another”.
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Payment for Providing Services “At No Cost” To the Family
If a family of an eligible child meets the criteria for the Family Cost Participation fee
(see Family Cost Participation Procedure) they may request to receive only those
services that are available at no cost. The family can expect to receive the following:
evaluation/assessment, development and review of the IFSP, all components of
service coordination (including transition planning and updating assessments), and
due process rights. When a family makes this decision, the program should
immediately update the data system to reflect this change, or the parent will be billed
for that month. As long as there is documentation that the service coordinator has had
contact with the family that month and that at least quarterly the contact is a face to
face meeting with the parent(s) at any location, the program will be paid a monthly rate
established annually by the Birth to Three System. When entering monthly
attendance, the program will enter an “S” on the day(s) that service coordination was
provided. No other coding will be permissible for payment. Whether the contact was
for service coordination, an IFSP meeting, updating an assessment, a transition
conference, or a Planning and Placement Team meeting, the correct coding is “S”. No
payment will be made if there is no actual voice contact with the family. Voice mail
messages and e-mail do not constitute “contact”.
Completing the Monthly Invoice
After programs verify that the data for their program is correct in the data system the
Connecticut Birth to Three System Monthly Direct Service Invoice (Form 2-1) will be
submitted to the Birth to Three Fiscal Office. Programs will use the Connecticut Birth
to Three data system to automatically fill in the number of children and units of service
in each category under “Billable Services”. This information when multiplied times the
program’s unit rate will calculate the gross amount due from the Connecticut Birth to
Three System.
The program is responsible for reporting their “Third Party Activity” for the month on
Lines J and K. The gross insurance receipts (100%), will be deducted from the gross
amount and reduces the amount that will be paid by the department. The program
completes the “Adjustments” section of the form by entering negotiated supplemental
costs on line L; and assistive technology devices on line M. Line N “Other” is for
entering any of the adjustments from previous months, repayment of insurance
receipts, excess costs (specialty evaluations or interpreters), funding for inclusive
community play groups or for providing training or technical assistance. These
adjustments are subtotaled on line “O” and added to the total due to the program.
Attendance Status Related to Payment
When entering a child’s monthly attendance into the data system, use the following
attendance statuses:
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Evaluation Only
When the only thing that happened in the month was an evaluation to determine
eligibility the contracted program will enter the child’s eligibility status in the data system
and use the attendance status “Evaluation Only”. The program will be paid 1 unit for
the evaluation regardless if the child is found eligible or not.
If the initial IFSP meeting is also held during this month the attendance status for this
child would still be “Evaluation Only”. If the initial IFSP meeting meets all the
requirements listed on page one of this procedure then the program indicates the date
of the meeting on the attendance grid with a code of “I” and the program will receive a
unit for the initial IFSP.
Programs will not receive payment for direct services until those services begin.
If directly after the initial evaluation a family of an eligible child decides to accept only
services provided at no cost, the attendance status “Evaluation Only” is selected. This
is true even if an IFSP meeting and a service coordination visit are also completed in
the same month.
New
The only time “New” is used as a child’s attendance status is in the month that the first
direct service is delivered. It is possible that the initial evaluation, the IFSP meeting,
and the first service were delivered in the same month. In this case, the child’s
attendance status would still be “New”.
Contracted programs are paid 1 or 2 units depending on whether the first date of
service was in the first or second half of the month. Here are several examples of how
the scenario and payment might go:
1. The initial evaluation and IFSP were provided as well as the first service in the first
half of the month, the child’s attendance status is “New” and the program would
receive 4 units of service for that month.
2. The evaluation and IFSP were provided in the first half of the month and the first
service delivered in the second half of the month, the child’s attendance status is
“New” and the program would receive 3 units of service for that month.
3. If prior to the first direct service being delivered a child’s attendance status is
“Service Coordination Only”, and then the family chooses to receive direct services,
the attendance status “New” is selected for the month in which the first direct service
is provided (after the IFSP has been revised and signed by the doctor). Programs
will be paid 2 units of service for that month and subsequent months.
Pending
This attendance status indicates that the child has not yet been evaluated for eligibility.
Programs will not receive payment until the evaluation is completed.
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NA
This attendance status indicates that, the child has been found eligible during a
previous month. It is used when only the initial IFSP meeting is held and no direct
services are provided or when no initial IFSP meeting is held during this month. The
eligibility information must indicate that the child is “eligible”.
Services Provided at No Cost
This attendance status is selected for the full month during which a family who meets
the criteria to pay a fee has decided to accept only those services provided at no cost.
These include: evaluation, assessment (initial and annual), IFSP development and
review, service coordination (including transition planning) and procedural safeguards.
The provider must also indicate that the child’s status is Services at No Cost on the
eligibility section of the data system and on the IFSP screen.
Programs must provide a face-to-face visit with one of the child’s parents at least one
time every 3 months in order to continue to receive payment. The location of the visit
can be any place that is mutually convenient. No payment will be made if there is no
actual voice contact with the family. Voice mail messages and e-mail do not constitute
“contact”.
Continued
The month following an attendance status of “New” and for all of the months that an
eligible child continues to be enrolled, their attendance status will be “Continued.”
Programs are paid for 2 units of service each month for each child that is “Continued”.
If a family decides to decline direct services that have already begun and elects only
services at no cost during the first or second half of a month, the attendance status
“Continued” is selected. Programs will be paid 2 units for that month as long as at least
one direct service was provided. The attendance status of “Services at no Cost” will
begin with the next month. In these instances the family will not be billed however, the
program must make sure to change the status as soon as requested by indicating
“Services at no Cost” on the eligibility section and “Switched to Services at no Cost
during the Month” on the attendance section of the data system or the family will be
billed for that month.
Transfer In/Transfer Out
These attendance statuses indicate that the child entered or left one program for
another program. Payment for children receiving direct services will be based on
whether the child entered or left in the first or second half of the month. For the
receiving program, the day of the meeting to review/revise the IFSP which should be
indicated as “M” in the monthly attendance will trigger the payment for a unit of service
even if no direct service is provided during that half of the month.
Discontinued
This attendance status is only used if a child’s attendance status was “New” or
“Continued” in the previous month. Programs will be paid 1 or 2 units depending on
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whether the exit date was in the first or second half of the month. This attendance
status is not used if “Services Provided at No Cost” has been indicated in the data
system.
Services Provided at No Cost – Exited
This attendance status is used if a child’s attendance status was “Services Provided at
No Cost” and the child has now exited the Connecticut Birth to Three System during the
month. If the program provided and documented service coordination during the month
of exit, programs will be paid a flat amount per month (established annually by The
Connecticut Birth to Three System).
The following table shows the possible attendance status codes depending on
what transpires with the child each month:
April May June
What happened Eval only IFSP only 1st Service
Attendance Status Eval Only NA New
Units* 1 1 1 or 2
What happened Eval only nothing IFSP and 1st Service
Attendance Status Eval Only NA New
Units* 1 0 2 or 3
What happened Eval & IFSP only 1st Service Next Service
Attendance Status Eval Only New Cont
Units* 2 1 or 2 2
What happened Eval & IFSP only nothing 1st Service
Attendance Status Eval Only NA New
Units* 2 0 1 or 2
What happened Eval, IFSP and 1st Service nothing Next Service
Attendance Status New Cont Cont
Units* 2-4 0 2
Attendance Sign off and Correcting Attendance Errors
Once the attendance is completed in the data system the program must electronically
sign for the correct billing month, thus committing the information so that the invoice can
be generated and paid. Note that if an error is made in choosing the correct billing
month it will result in an error in the billing of the families. If there are additions or
changes to the attendance after this sign off and the program is working with BPS to
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submit insurance claims then they notify them directly and as soon as possible about
the change. For programs not working with BPS and for all others that will need to
update the data system with this information, please follow these directions:
Under 60 days (data is not locked)
If the change does not affect your invoice
1. Program - make changes in data system
If the change does affect your invoice
1. Program - Make changes in data system
2. Program - Print out corrected page
3. Program - Highlight attendance page changes
4. Program - Sign amended attendance sheet
5. Program - Write “Correction” on sheet
6. Program - Keep copy of attendance page changes for your records
7. Program - Submit corrected page with your next invoice. Enter the dollar amount
in line N of the invoice.
Over 60 days (data is locked in - you cannot make changes.)
If the change does not affect the invoice that was submitted
1. Program - Print attendance page
2. Program - Make changes, in ink, on attendance page
3. Program - Highlight attendance page changes
4. Program - Sign amended attendance sheet
5. Program - Write “Correction” on sheet
6. Program - Keep copy of attendance page changes for your records
7. Program - Send original attendance page to the Birth to Three fiscal office
If the change does affect the invoice that was submitted
In addition to the above, include a copy of the corrected attendance with your next
invoice and enter the dollar amount in Line N, of the invoice.
Contract Supplement Funding
The contract supplement funding process is designed to provide additional fiscal
resources to programs that provide intensive services to children in a manner that is
consistent with the Connecticut Birth to Three System’s procedures and guidelines.
Any decision made by the Connecticut Birth to Three System about supplemental
funding is not intended to compromise the integrity of the IFSP team.
Process to request a contract supplement
A program that wishes to request a contract supplement for a child needing more than
13 hours of direct service per month will fill out Form 2-7a, Contract Supplement
Request and send this along with a copy of Section VI of the IFSP to the Birth to
Three Fiscal office. Team meetings, family support groups, playgroups one-time
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consults, audiological evaluations and hours added to make up for missed visits are
not counted toward the threshold of 13 hours. If the child’s services provided by the
Birth to Three program already exceed 13 hours, the team meeting, family support
group or play group and these one-time services will be included for purposes of
reimbursement, as long as those services are included in the child’s IFSP. If a
Contract Supplement Request is in place and 13 hours of service have been provided
then hours added due to missed visits can be submitted in the invoice. Additional
hours being added for missed visits can be noted in the IFSP but should not be
entered into Section VI of the IFSP
The program must ensure that the most recent IFSP data has been entered into the
data system. The request is submitted to the Birth to Three Fiscal Office. Approval
for intensive hours does not have to be made in advance of the IFSP meeting, but the
request must be submitted prior to the submission of the invoice for the month in
which the intensive services are provided. Once the request is approved no additional
paperwork is needed unless requested.
The monthly reconciliation of the provider’s invoice relies on the current approved
Contract Supplement Request Form 2-7a matching the child’s current IFSP in the data
system. Therefore the program must send the Birth to Three Fiscal Office a revised
Contract Supplement Request using Form 2-7a whenever the services on the IFSP
change and at least annually. The program should indicate on the form that this is a
revised request and either the reason why services have been increase or the new
time period for the request.
The program must ensure that the IFSP in the data system is current. Additional
information (e.g. recent reports, additional IFSP pages, meeting notes, etc.) may be
requested.
The process for approving a contract supplement request will include (1) check for
accuracy of dates and total hours listed on the form and (2) their agreement with the
data system (3) ensure that the reason for the intensive service hours is properly
documented on Form 2-7a and are in keeping with the Connecticut Birth to Three
System’s procedures and service guidelines.
If approved, Form 2-7a will be signed and returned to the program. Regardless of the
response to the Contract Supplement Request, the Birth to Three Program is
responsible for delivering all services listed on an IFSP. Only the IFSP team can
determine appropriate services for the child and family.
Contract Supplements without Prior Authorization
A contract supplement request is filed for children who have IFSPs indicating that they
will regularly be receiving more than 13 hours of direct service per month. Occasionally
children with IFSPs showing regular weekly visits that add up to 13 hours or less per
month (e.g. 3 one hour visits per week equals 12 hours per month in most months) will
receive more than 13 hours in a calendar month due to additional days in that month. In
these rare occasions the program can submit the additional hours on Form 2-7c without
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having submitted a Contract Supplement Request (Form 2-7a) by checking the NO box
on the line indicating “Supplement Request Submitted” on Form 2-7c and entering the
reason in the comment section on the form. This only applies to direct services and
does not include team meetings, family support groups, play groups or hours added to
make up for missed services in previous months.
Determining the amount of the contract supplement
As long as the child and family have actually received more than 13 hours during the
month, the cost of the first 13 hours of services per month will be part of the usual
monthly rate for comprehensive services.
Example of determining the amount of supplement:
A child needs 20 hours of direct service during the month,
- The contracted program will apply for approval through the Birth to Three
Fiscal Office,
- Once approved, the following calculation will determine the payment:
20 hours of direct service received during the month
(must be more than 13 hours of service)
Less (13) hours of monthly service
7 hours for supplemental payments
In instances where group services, (i.e. where more than one eligible child or family is
served at the same time) are being provided, these hours will be calculated at 1 hour of
group equals ¼ hour of hourly service rate. This does not include services to families
with multiple children. In such cases the IFSP and the invoice should reflect the hours
that each child is receiving. For example if a teacher is seeing a family with triplets 12
hours a week combined then these hours are split amongst the three children and this
does not count as contract supplement hours.
Separate hourly rates are issued each fiscal year for Professional, Early Intervention
Associate and Early Intervention Assistant.
Programs will be reimbursed at the Professional rate for persons listed in the
personnel standards as able to perform evaluations and/or assessments. This
category includes staff that are Early Intervention Specialists.
Programs will be reimbursed at the Early Intervention Associate rate for persons who
meet those requirements specified in the personnel standards (this includes certified
occupational therapy assistants, physical therapy assistants and Board Certified
Associate Behavior Analysts).
Programs will be reimbursed at the Early Intervention Assistant rate for persons
meeting those requirements as specified in the personnel standards.
If there is a mix of professional, early intervention associate, and early intervention
assistant, those first 13 hours will include the first 13 hours of professional services. If
the child is receiving less than 13 hours per month of professional services, all
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professional services will be covered, then early intervention associate, then early
intervention assistant services, in that order, totaling 13 hours per month.
On Form 2-7a, a program may request reimbursement for a team meeting for up to 4
hours per month (or 24 hours within any six month period), with a parent present, for
each person listed on the IFSP. The team meeting must be included in section VI of
the IFSP if the program plans to bill for the meeting. The purposes for regular team
meetings include reviewing data collection and data, reviewing child progress, ensuring
that all team members are consistent in their approach which may include some
additional training for team members, reviewing and revising strategies or materials as
needed, discussing any new information brought up by any team member, including
the parent. It may also include meeting with the LEA for purposes of transition during a
transition conference or a PPT meeting.
The team meeting must be listed on the IFSP and must occur at least quarterly, if
team meetings are to qualify for reimbursement.
Team meeting hours are outside of contact hours for purposes of determining the
child and family’s contact hours and for reaching the threshold of more than 13
hours for contract supplement payment.
Team meetings need to be documented in progress notes with signatures.
It is recommended that this time also be used to review the IFSP.
These team meetings should be documented with an “M” in the monthly attendance
for each discipline attending.
Contract Supplement Payments
Contract supplement payments will be made based on actual monthly service data in
hours as reported on Form 2-7c, Contracted Provider Supplemental Service Form.
The request must be calculated using the Form 2-7c Excel spreadsheet. Handwritten
forms will not be accepted. The actual contract supplement amount due for the month
should be calculated by the program and reflected in the Adjustments section, Line L
of the monthly billing invoice, (Form 2-1) and submitted along with Form 2-7c (or Form
2-7d or both, if appropriate). The Fiscal Office will compare the total hours listed on
the IFSP screen as it appears in the data system. The Fiscal Office will not compare
the hours provided by each specific discipline against the IFSP. If the number of
hours billed for professional, EI Associate or EI Assistant is greater than the number of
those hours that appear in the data system, then the program should enter a short
note in the comment section on Form 2-7c indicating the reason for the variance.
Services listed on the IFSP service grid that are provided by an outside contractor or
program and are not directly paid for by the program cannot be submitted as hours
eligible for supplemental payment. Examples include services provided by the
Connecticut Board of Education and Services for the Blind (BESB) or audiologicals
that are paid for in full by a third party.
When a child’s intensive services begin after the 15th of the month or their services will
be reduced or terminated on or before the 15th of the month, the contract supplement
payment should be prorated if the amount of direct services delivered is more than 6.5
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hours. In this case, the program will be reimbursed using the same formula for hours
over 6.5 instead of 13 hours.
When a program needs to make up for missed hours of direct service time:
the invoice submitted shows more hours for the month than were authorized (because the
program was making up hours from a previous month), then indicate by a note on Form 2-
7c or Form 2-7d that X hours in this month were compensatory from _________ (list the
month(s)).
the invoice submitted shows more professional hours than were authorized because a
professional was substituting for an EI associate or assistant. Programs will be paid at the
professional rate if they enter the reason in the comment box on Form 2-7c or Form 2-7d
that X hours of professional time were substituting for an EI associate or assistant. If,
however, a paraprofessional is substituting for a professional, the paraprofessional rates
would apply.
If such a substitution is made, the program must enter a note in the comments box on
Form 2-7c or Form 2-7d that X hours of professional time were substituting for an EI
associate or assistant or COTA or PT Aide.
Assistive Technology
The Birth to Three System reimburses programs for the full cost of any assistive
technology device costing over $250 that is not covered by third party payers. An
assistive technology device is any item, piece of equipment or product system that is
used to maintain or improve the functional capabilities of a child with disabilities.
Devices needed for daily life, devices that are considered medical in nature, or
devices that are life-sustaining are not considered assistive technology for purposes of
Birth to Three. The assistive technology device must be identified in the IFSP. For
those items in which the program is seeking full or partial reimbursement from the
Birth to Three System, requests are made to the Birth to Three Fiscal Office using
Form 3-11, Assistive Technology Device Request. Once a request is approved the
program will purchase the item and submit for third party reimbursement. Any balance
not paid by third party payers will be reimbursed to the program. However, if Medicaid
pays for a device as durable medical equipment, the vendor and the Birth to Three
program must accept that amount as payment in full and the program cannot bill the
Birth to Three System for any balance. The program will indicate the balance on Line
M of the monthly invoice. Documentation of third party payments and proof of
payment (e.g. copy of check showing cancellation or a zero balance bill from vendor)
must be submitted with the invoice for reimbursement. Seeking third party payment
for assistive technology devices is required if the parent has commercial health
insurance or Medicaid. It is not required if the parent has no health insurance or a
plan that is not required to follow CT state mandates (this includes ERISA plans and
companies that do not sell health insurance in CT) and has not given Birth to Three
the permission to bill. For families covered by Medicaid, reimbursement (or direct
payment by the Medicaid Managed Care Organization) should be sought if it will cover
the entire amount of the device.
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If a program has an outstanding bill due to lack of response from insurance then they
can submit the paid invoice for reimbursement if they can show documentation that
they have submitted the bill to the insurance company two times and documented that
they have made two attempts (e.g. phone calls or emails) to get a response, without
any success. If any third party payment is received at a later time then this amount
should be shown as an adjustment on the program’s invoice.
Birth to Three will accept requests for reimbursement of modifications to previously-
approved devices even if the modification is less than $250. The program should
submit a copy of the original approval along with the request for a modification costing
less than $250.
It is estimated that it will take approximately 8.5 hours to dispense hearing aids. The
Birth to Three System will pay a one-time dispensing fee of up to $850 (8.5 X $100.)
When documentation is included with the monthly invoice, this onetime fee will be paid
to the child’s early intervention program for their services or for any contracted
audiologist. For additional information regarding assistive technology, see the Assistive
Technology procedure.
Adjustments: Other
The “Other” category on the monthly billing invoice (Line N) is for other costs or other
credits that are not part of the above categories. The amount billed or credited must
be accompanied by documentation. Possible payments listed here include: Excess
Costs (including one-time specialty evaluations and ongoing costs of interpreters for
languages other than Spanish), repayment of insurance receipts, Funding for Inclusive
Community Play Groups, Payment to Programs for providing Training and Technical
Assistance to other Programs, and Repayment of Cash Advance or adjustments from
errors in a prior month.
Excess Costs
The following types of excess costs may be reimbursed, in part by the Birth to Three
System with prior approval. To receive payment the program must call the Director or
Assistant Director of the Connecticut Birth to Three System to receive prior
authorization verbally and then written authorization will be sent to the program and
copied to the Birth to Three Fiscal Office. Services included in excess cost requests
cannot also be included in supplemental rate requests and reimbursement.
One-time specialty evaluations
With prior written authorization from the Director or Assistant Director of the Connecticut
Birth to Three System, programs may be reimbursed 75% of the total cost less any third
party reimbursement for any specialty evaluation costing in excess of $400.
To obtain prior written payment authorization for a specialty evaluation the following
information must be sent:
child’s name
program’s name
cost
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purpose of evaluation,
IFSP outcome pages or Section VI showing it as a service,
person(s) or agency performing the evaluation
After written approval from the Director or Assistant Director of the Connecticut Birth to
Three System is received, the evaluation is completed, and third party reimbursement
has been received or denied, the program must submit a copy of the invoice along with
documentation of third party reimbursements and proof of payment of the vendor (e.g.
copy of check showing cancellation or a zero balance bill from vendor) with the invoice
for reimbursement. The amount owed is to be entered in the monthly invoice online in
the Adjustments section, Line N “Other”.
Specialty evaluations could include:
assistive tech evaluation
medical diagnoses if necessary for program planning
For example, if an evaluation were to cost $2,000 and insurance paid $800, then the
program would receive 75% of $1,200, or $900.
The evaluation must be performed by another agency, an individual who is not a sub-
contractor, or who is, at least, not a sub-contractor for anything other than specialty
evaluations.
Ongoing costs of interpreters for languages other than Spanish (including ASL)
To bill for interpreters, the program must contact the Director or Assistant Director of the
Connecticut Birth to Three System to receive prior authorization. Programs will be
reimbursed monthly for 75% of the cost for interpretation services (for languages other
than Spanish) for that portion of the fee that exceeds $250 per month, per family. When
authorizing such service, the Connecticut Birth to Three System will take into
consideration the prevailing rate in the current state contracts for interpretation. Most
Birth to Three programs can access Connecticut State contracts and use the rates
quoted there. For more information see the “Procurement” section of the CT State
Dept. of Administrative Services at www.ct.gov. The interpreting must be performed by
another agency, an individual who is not a sub-contractor, or who is, at least, not a sub-
contractor for anything other than interpreting.
To receive payment, the program must submit the invoice for the interpreting service
along with documentation of third party reimbursements and proof of payment to the
vendor (e.g. copy of check showing cancellation or a zero balance bill from vendor). The
amount to be paid is to be entered on the Monthly Direct Service Invoice in the
Adjustments section, line N “Other”.
The following information must be sent to the Fiscal Office along with the monthly
invoice:
child’s name and case #
specific language being interpreted
agency/person being used for interpretation services
hourly rate
Payments page 15
For example, if the program needed to pay $100 per hour for interpretation and that
resulted in a monthly bill of $400; the Birth to Three System would pay the program
$112.50 (75% of the $150 that exceeded the $250 limit.)
Funding for Inclusive Community Play Groups
Programs will be reimbursed for any cost incurred that helps an eligible child participate
in an inclusive community play group. This may include fees to register for a program
or transportation to the program. The maximum amount of the reimbursement will be
based on program size (the same designations used for Focused Monitoring for the
start of the fiscal year will be used for requests that occur within that fiscal year) as
follows:
Small: Up to $500 per fiscal year per program
Medium: Up to $1,000 per fiscal year per program
Large: Up to $1,500 per fiscal year per program
The amount to be paid is to be entered on the Monthly Direct Service Invoice in the
Adjustments section, line N “Other”. Documentation of the payment must be included
with the monthly invoice when requesting reimbursement such as a zero balance
invoice from the vendor or a copy of a cancelled check.
Payment to Programs for providing Training or Technical Assistance or Both
to other Birth to Three Programs
Per Connecticut Purchase of Service Agreement with Birth to Three programs the Department
of Developmental Services may, at its discretion and at an amount determined by the
Department for each occasion, reimburse the program for allowing the staff to provide training
or technical assistance to other programs for the purpose of enhancing the quality of Birth to
Three services. The fiscal office will be notified in writing of such arrangements prior to the
training or technical assistance, including the expectations of the program/staff and the
payment amount. Programs will enter this amount on their monthly invoice along with evidence
that the activities have been completed and approved by Connecticut Birth to Three staff.
Repayment of Cash Advance
When a program is notified of contract cancellation, termination for cause or non-
renewal, repayment of the cash advance will be deducted from subsequent monthly
payments. In the event that there is no future payment the entire cash advance will be
due to the Department within 30 days of cancellation, termination for cause or
nonrenewal of the contract.
Payments to Autism- specific Programs
Autism-specific programs will be paid for the autism assessment (one unit) if the child is
referred from a general Birth to Three program. If the child is referred directly from
Child Development Infoline, payment will be one unit for the initial evaluation including
the autism assessment component. The attendance code for the assessment is
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indicated by an “A” entered on the “Eval Only” line in the data system. Only autism-
specific programs may use this code.
Autism-specific and general programs will be paid for an initial IFSP that is held later
than 45 calendar days from the referral if the reason it was late was due to an autism
assessment.
All autism-specific programs must submit a Contract Supplement Request Form 2-7a
along with section VI of the IFSP for children receiving more than 80 hours of direct
service per month in order to submit an invoice for payment of these hours. Hours for
team meetings will not be counted toward the 80 hours (see the Contract Supplement
Funding section of this procedure for more information). For those children for whom a
Contract Supplement Request Form 2-7a has been submitted and approved the autism-
specific program must submit a new Form 2-7a whenever services change or at least
annually.
________________________
References:
Form 2-7a, Contract Supplement Request
Form 2-7c, Contracted Provider Supplemental Invoice
Form 2-7d, Contracted Provider Pro-rated Supplemental Invoice
Assistive Technology Procedure
Form 3-11 Assistive Technology Device Request
Family Cost Participation Procedure
34 CFR Section 303.526
17a-248e (e) of the C.G.S.
Data System Manual