The Legal and Policy Implications of Third Party Reimbursement for Early Childhood Services

Abstract

Public Law 99–457, the Supreme Court decision in Bowen v. Massachusetts, budgetary needs, and the creation of entities such as TAMES (Trans Allied Medical Educational Services) haue combined to lead agencies seming young children with disabilities to obtain third-party reimbursement for services from Medicaid, private insurance, and other sources. At first glance, third-party payments are the perfect resource for these programs. But an examination of the legal and policy implications of increased third-party billing reveals serious drawbacks in the form of loss of confidentiality, burdens on the exercise of informed consent, hidden costs to parents, and financial and administrative difficulties.

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References

American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders, DSM-III-R. Washington, DC: Author.

Bowen v. Massachusetts, 108 S. Ct. 2722 (1988), affg 816 F.2d 796 (1st Cir. 1985).

Chester County Intermediate Unit v. Pennsylvania Blue Shield, 896 F.2d 808 (3d Cir. 1990).

Clune, W. , & Van Pelt, M. (1985). A political method of evaluating the Education of All Handicapped Children Act of 1975 and the several gaps of gap analysis. Law and Contemporary Problems, 48(1), 7–62.

Code of Federal Regulations, Title 34, §99.30(a) (1990).

Code of Federal Regulations, Title 34, §300.4 (1990).

Code of Federal Regulations, Title 34, §300301(b) (1990).

Code of Federal Regulations, Title 34, §300.562, 300.571-573(1990).

Code of Federal Regulations, Title 34, §303.1 (1990).

10.

Code of Federal Regulations, Title 34, §303.124 (1990).

11.

Code of Federal Regulations, Title 34, §303.520 (1990).

12.

Code of Federal Regulations, Title 34, §303.521 (1990).

13.

Code of Federal Regulations, Title 34, §303.522 (1990).

14.

Conway, 1986-87 Educ. Handicapped L. Rep (CRR) 211:438 (U.S. Dep't of Educ. 1987).

15.

Corpus Juris Secundum. (1952). Schools. 78, §106.

16.

Education of the Handicapped Act Amendments of 1986, 20 U.S.C. §§1471-1485 (1988).

17.

Fay v. South Colonie Central School District, 802 F.2d 21 (2d Cir. 1986).

18.

Federal Register, 45 Fed. Reg. 86390 (1980).

19.

Illinois Attorney General. (1989, May 15). Fact sheet: Comprehensive Health Insurance Plan Act. Disabled Persons Advisory Council in the Attorney General's Office, pp. 7–9.

20.

Illinois Revised Statutes chapter 102, §3 (1987).

21.

Sark, 1988-89 Educ. Handicapped L. Rep. (CRR) 213:203 (U.S. Dep't of Educ. 1988).

22.

Seals v. Loftis, 614 F. Supp. 302 (E.D. Tenn, 1985).

23.

Shook v. Gaston County Board of Education, 882 F.2d 119 (4th Cir. 1989), cert. denied, 58 U.S.L.W. 3528 (1990).

24.

Staff. (1990, January). EHA:B issues relevant to the preschool program. Early Childhood Repoter, pp. 12–13.

25.

United States Code, Title 42, § 1396d(b) (1988).

26.

Viadero, D. (1990, January 24). Schools' use of parents insurance for spec. ed. services stirs concerns. Education Week, pp 1, 13.

27.

Walbridge, 1982-83 Educ. Handicapped L.Rep (CRR) 211:292 (U.S. Dep't of Educ. 1982).

28.

Wing, K. (1984). North Carolina's Medicaid program: The effects of the Reagan-era budget reductions. North Carolina Central Law Journal, 14, 313–360.

29.

Yudof, M. (1984). Education for the Handicapped: Rowley in perspective. American Journal of Education, 92, 163–177.