Instructions for Early Intervention Funding Policies and Extraordinary Expense Requests

Extraordinary Expenses funding may be accessed to reimburse an agency for services and products that are provided to children with low-incidence/high cost services. Typically, these are children with partial or complete hearing loss or a diagnosis in the autism spectrum. However, other extraordinary expenses and out of the ordinary requests may be made.

All goods and services for which the agency requests Extraordinary Expenses funding must be pre-approved by KCDDD. When following the Extraordinary Expenses Funding Policy and Request Form Instructions, the agency shall meet all relevant requirements in the agency’s contract with KCDDD.

All goods and services for which the agency requests Extraordinary Expenses funding must be identified on the child's Individual Family Service Plan and the basis for determining each need must be included in the Individual Family Service Plan or otherwise documented in the child’s file. The agency is also required to explain why routine services available within the context of the current early intervention system will not meet the child’s needs.

For the agency to be reimbursed with Extraordinary Expenses funding, the child must receive all services, hearing aids and/or other items before turning three years old. The one exception to this is the one year service and maintenance agreement for hearing aids covered under the flat fee, which may be in place under the hearing aid purchase agreement. For additional information, please see the Hearing Aid/FM System Policy (pdf).

The Extraordinary Expenses Funding Request Form (excel spreadsheet) is available online or  you may also request a copy from Theary Oeun at 206-263-9048.

A copy of the goods or service invoice is required with the reimbursement request for any durable goods, or for services purchased outside the early intervention system, such as those provided via a non-contracted provider. See the Hearing Aid/FM System Policy (pdf) for more detailed information on billing requirements for Hearing Aids and related items.

To request reimbursement for pre-approved Extraordinary Expenses, use the “EE Invoice” worksheet in your Part C excel billing file. Print out a copy of the worksheet, sign it, and either mail or fax it into the KCDDD office with your regular monthly billing to KCDDD.

Funding requests that extend beyond the current contract period are not guaranteed. Reimbursement is contingent on availability of funding during the next contract year.

Once the funding request has been approved by KCDDD and the term of service indicated by the agency, the agency shall make all reasonable efforts to bill KCDDD in a timely fashion. For reimbursement requests received after a contract period reimbursement deadline, KCDDD is freed from any obligation to reimburse.

Extraordinary Expenses Funding Request Form Instructions

If you are requesting reimbursement for Hearing Aids and related items, see the Hearing Aid/FM System Funding Policy (pdf) before filling out the Extraordinary Expenses Funding Request Form.

One goal of the Funding Request Form and the pre-approval process is to create an adequate record of what services and items were funded with federal dollars through the Extraordinary Expenses Funding Policy of KCDDD. Another is to ensure adequate justification of the need for additional funding. Keep these goals in mind and provide full and accurate information in your funding request.

Instructions for filling out the “Description” section:

In the space provided, write a summary statement in which you identify the child’s diagnosis and treatment plan and the additional services or items prescribed in the child’s treatment plan for which you are requesting additional funding. If not self explanatory, briefly describe why routine services available within the context of the system will not meet the child’s needs.

Do not simply list the child’s entire treatment plan. Be sure to indicate those additional services and items that are above and beyond what would be typically provided to a child.

The description should be written in lay terms and should flow logically from the IFSP. The request must be substantiated by attaching the documents listed in the following section.

Additional Documents Required:

Copies of the following documents must be submitted with the funding request form:

• The IFSP
• The full report or narrative from each professional or medical evaluations(s) and/or recommendations that document the need for the service/item, including the brand/model of hearing aid
• A payer of last resort worksheet documenting other sources of funding attempted, and results of such efforts including reasons for denial of funding
• Documentation of the expected results of the service/item to be provided

See the Hearing Aid/FM System Funding Policy (pdf) for more information on documentation required when requesting Extraordinary Expenses funding for Hearing Aids and related items.

Instructions for filling out the “Funding Request Grid” section:

In the “Funding Request Grid”, list all items or services and the amount of funding being requested for each. Enter data in all the applicable columns so that your subtotals and total are correct. The “Other” section is for listing items and services that are not related to hearing aids or to an Autism Spectrum Disorder diagnosis.

Enter all items and services to be delivered in a single contract period on a single row. Do not enter items or services to be delivered in two contract periods on the same row. For example, if the child will receive services from January through December, the services to be delivered from January through September should be listed on one row and from October through December on the next row. For hearing aides, the agency shall enter the best estimate of the month the hearing aid will be delivered to the child and enter it as the service period on the Funding Request Grid. Similarly, the agency shall make a best estimate of the months in which earmolds will be required by the child and enter these months as the service period for the earmolds.

Accurate estimates for hearing aid and earmold delivery will help to ensure adequate allocation of Extraordinary Expenses funds in the agency contract with KCDDD and to minimize denial of requests for reimbursement because of missed contract period reimbursement deadlines.

If you are using an electronic copy of the Funding Request Form, you will enter data in the following columns: “Calendar Year”, “Service Months From” and Service Months To”, “# of hearing aids”, “single unit cost per hearing aid”, “# of earmolds”, “Flat fee”, “cost per month”, “# of months”, and “description”. All the columns where you will enter data are formatted to have blue text in them. The following columns contain formulas or static values and you will not need to enter data in them: “A.S.D Services”, “subtotal”, “cost per earmold”, “total”.

If you are filling out a paper copy of the funding request form, enter data in the appropriate columns and calculate subtotals and totals accordingly.

Earmolds are reimbursed at not more than $45 per earmold. No more than three pairs of earmolds over a twelve month period per child will be approved. If a child will require three sets of earmolds over a twelve month period, reimbursement for all three pairs of earmolds may be requested at one time. Each earmold will be entered individually on the “Funding Request Grid”. For example, for two pairs of earmolds, you will enter “4” in the “# of earmolds” column. The flat fee will always be $500, or less, if the actual costs are lower.

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