NC Education Code · NC Policy Manual

NC 1501-11 Methods of Ensuring Services

Plain English summary

This regulation establishes the framework for interagency coordination to ensure FAPE for children with disabilities, defining financial responsibilities among public agencies, LEAs, and insurance programs. It requires the Governor and designees to maintain interagency agreements that prioritize noneducational public agency financial responsibility before LEA responsibility, and sets detailed rules for accessing public and private insurance to fund special education services. Key protections ensure parents cannot be required to enroll in public benefits programs, incur out-of-pocket costs, or have their insurance adversely affected as a condition of their child receiving FAPE.

Key requirements

  • The Governor and designees must ensure that an interagency agreement or other mechanism for interagency coordination is in effect between each noneducational public agency and the SEA.
  • The financial responsibility of each noneducational public agency, including the State Medicaid agency and other public insurers of children with disabilities, must precede the financial responsibility of the LEA.
  • The agreement or mechanism must include an identification of, or a method for defining, the financial responsibility of each agency for providing services to ensure FAPE.
  • The agreement or mechanism must include conditions, terms, and procedures under which an LEA must be reimbursed by other agencies.
  • The agreement or mechanism must include procedures for resolving interagency disputes under which LEAs may initiate proceedings to secure reimbursement from other agencies.
  • The agreement or mechanism must include policies and procedures for agencies to determine and identify the interagency coordination responsibilities of each agency to promote the coordination and timely and appropriate delivery of services.
  • If any public agency other than an educational agency is obligated under Federal or State law to provide or pay for services that are also considered special education or related services necessary for ensuring FAPE, the public agency must fulfill that obligation or responsibility, either directly or through contract or other arrangement.
  • A noneducational public agency may not disqualify an eligible service for Medicaid reimbursement because that service is provided in a school context.
  • If a public agency other than an educational agency fails to provide or pay for special education and related services, the LEA must provide or pay for these services to the child in a timely manner.
  • The LEA or State agency is authorized to claim reimbursement for the services from the noneducational public agency that failed to provide or pay for these services.
  • A public agency may use the Medicaid or other public benefits or insurance programs in which a child participates to provide or pay for services required under these Policies, except as provided in paragraph (d)(2).
  • The public agency may not require parents to sign up for or enroll in public benefits or insurance programs in order for their child to receive FAPE under Part B of the IDEA.
  • The public agency may not require parents to incur an out-of-pocket expense such as the payment of a deductible or co-pay amount incurred in filing a claim for services.
  • The public agency may not use a child's benefits under a public benefits or insurance program if that use would decrease available lifetime coverage or any other insured benefit.
  • The public agency may not use a child's benefits under a public benefits or insurance program if that use would result in the family paying for services that would otherwise be covered by the public benefits or insurance program and that are required for the child outside of the time the child is in school.
  • The public agency may not use a child's benefits under a public benefits or insurance program if that use would increase premiums or lead to the discontinuation of insurance.
  • The public agency may not use a child's benefits under a public benefits or insurance program if that use would risk loss of eligibility for home and community-based waivers, based on aggregate health-related expenditures.
  • Prior to accessing a child's or parent's public benefits or insurance for the first time, the public agency must obtain written parental consent that specifies the personally identifiable information that may be disclosed, the purpose of the disclosure, and the agency to which the disclosure may be made.
  • Prior to accessing a child's or parent's public benefits or insurance for the first time, and annually thereafter, the public agency must provide written notification to the child's parents that includes statements of parental consent provisions, no-cost provisions, rights to withdraw consent, and that withdrawal of consent does not relieve the public agency of its responsibility to ensure required services are provided at no cost.
  • With regard to services required to provide FAPE, a public agency may access a parent's private insurance proceeds only if the parent provides informed consent consistent with NC 1500-2.6.
  • Each time the public agency proposes to access the parent's private insurance proceeds, the agency must obtain parental consent and inform the parents that their refusal does not relieve the public agency of its responsibility to ensure that all required services are provided at no cost.
  • If a public agency is unable to obtain parental consent to use the parent's private insurance, or public benefits or insurance when the parent would incur a cost, the public agency may use its Part B funds to pay for the service.
  • Proceeds from public benefits or insurance or private insurance will not be treated as program income for reporting purposes (2 CFR 200.307).
  • If a public agency spends reimbursements from Federal funds for services under these Policies, those funds will not be considered State or local funds for purposes of the maintenance of effort provisions in NC 1501-12.6 and NC 1502-4.

Affected parties

  • Children with disabilities
  • Parents of children with disabilities
  • Local Education Agencies (LEAs)
  • State Education Agency (SEA)
  • Noneducational public agencies
  • State Medicaid agency
  • Other public insurers
  • Private insurers
  • Governor and designees
  • State agencies responsible for developing IEPs

Official source

https://www.dpi.nc.gov/documents/publications/catalog/ec144-policies-governing-services/open#page=39