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Insurance Tool Kit for Service Coordinators Revised, New Child Insurance Information Form, and New Parent Notice Regarding Insurance

New York State Department of Health
Bureau of Early Intervention Electronic Mailing List

Insurance Tool Kit for Service Coordinators Revised, New Child Insurance Information Form, and New Parent Notice Regarding Insurance


Dear Colleague:

The Bureau of Early Intervention (BEI) is pleased to announce that the Insurance Tool Kit for Service Coordinators has been revised to implement new procedures for collection of insurance coverage information for children in the Early Intervention Program (EIP).  These new procedures being implemented ensure insurance information is obtained for all children in the program.  In addition, these new procedures are consistent with federal regulations issued in 2011, which requires that parents be notified prior to the use of public or private insurance for payment of early intervention services.  

This tool kit includes the following changes:

  • New Child Insurance Information form
  • New Child Insurance Information Form Instructions
  • New Parent Notice Regarding Insurance
  • Updates to the Service Coordinator Insurance Responsibilities sections to include the use of the new form and notice
  • Removal of the Parent Declination of Insurance form
  • Removal of the Parent Letter Regarding Regulated Insurance
  • Removal of the Parent Letter Regarding Non-Regulated Insurance
  • Removal of the List of New York State Regulated Insurers
  • Removal of the List of Non-Regulated Insurance Plans

Child Insurance Information form:

  • This form must be provided to parents by the service coordinator, and filled out by the child’s parent(s)
  • Service Coordinators will assist families as needed
  • This form includes an attestation that parents will complete and sign if their child currently does not have insurance coverage (if applicable)
  • Information on completing this form is included in the Child Insurance Information Form Instructions

Parent Notice Regarding Insurance:  This notice explains the use of insurance in the Early Intervention Program (EIP). Service Coordinators are responsible for providing this notice and reviewing the information with parents.  Consistent with federal requirements, this notice must be provided to the parent prior to using a child’s or parent’s public benefits or private insurance to pay for early intervention services (34 CFR Section 303.520(a)(2)(D)(3). The Parent Notice Regarding Insurance has replaced the Parent Letter Regarding Regulated Insurance and Parent Letter Regarding Non-Regulated Insurance

This notice includes:

  • Information for children who have Medicaid and private insurance coverage
  • Collection of insurance and social security numbers
  • Use of New York State regulated insurance and protections that exist
  • Use of insurance policies not regulated by New York State•         Written consent requirements for billing non-regulated insurance- clarification that parent written parent consent must be obtained to bill non-regulated insurance at every 6 month IFSP meeting and whenever there is an increase in the provision of services in the IFSP (eg. frequency, duration, or intensity).
  • Subrogation
  • Due process information

Service coordinators must review this revised tool kit and begin utilizing the guidance and the standardized templates immediately. This tool kit replaces older versions. Please ensure that you are using the current version. Revised May 2017 is noted on the bottom of each page for your reference

BEI will conduct a webinar in the near future to review the new forms, Parent Notice and other revisions made to the Tool Kit.  Registration information for this webinar will be sent in a separate email announcement. 

Additionally, in-person training on the Insurance Tool Kit for Service Coordinators will be offered through the BEI’s contract with Just Kids Early Childhood Learning Center.  To attend the in-person training, please access eilearningnetwork.com to register for Advanced Service Coordination: Working with Families (Insurance).  

Please share this information with colleagues involved in the EIP.

We hope that you find the information contained in the tool kit helpful. If you have any additional questions, please send them via e-mail to beipub@health.ny.gov.

Article ID: 355, Created On: 5/26/2017, Modified: 5/26/2017

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