Payor of Last Resort (POLR) Questions and Answers
We will be making changes to the POLR process to better streamline the process for families, early
intervention programs and early intervention providers once the early intervention transition is complete
between the Ohio Department of Health and the Department of Developmental Disabilities. In the
meantime, this communication is meant to clarify the current process and address some of the barriers
that have been identified.
Any questions about this communication can be directed to
[email protected] and will be incorporated into an updated FAQ document and re-distributed to the
field.
What is POLR?
POLR and EISOP have been used interchangeably in the past, but in the future, POLR will be identified as
part of what makes up Ohio’s System of Payment (SOP). POLR is used when no other funding source is
available to pay for an identified early intervention service that is needed to meet an outcome on the
Individualized Family Service Plan (IFSP). Other funding sources that should be reviewed with the family
include, Medicaid or private insurance and any local funds such as county boards of developmental
disabilities
Which EI Services will POLR pay for?
POLR will pay for EI services as defined in HMG rule 3701-8-01 which includes:
 Assistive technology device and services
 Audiology services
 Family training, counseling and home visits
 Health services
 Medical services (diagnostic or evaluation purposes to determine status and need for EI services)
 Nursing services
 Nutrition services
 Occupational therapy
 Physical therapy
 Psychological services
 Sign language and cued language services
 Social work services
 Special instruction
 Speech-language pathology
 Vision services
 Other early intervention services determined necessary by the IFSP team and consistent with the
definition of EI services in OAC 3701-8-01(U).
One component of many EI services is a discipline-specific evaluation. POLR will pay for this if the IFSP
team believes the service (including an evaluation) is needed.
POLR will not pay for Service Coordination, Transportation or Medical Services such as routine health
care, hospitalizations or prescriptions.
1
Last updated 5/12/16
What do I need to do before a POLR application is made?
Before POLR can be applied for, the child must be determined eligible for early intervention services, have
a need for early intervention services and have an IFSP developed in accordance with OAC 3701-8-07.1.
If a specific service is identified by the team as needed to meet an IFSP outcome, but is not available
through local, public or private funding sources, a POLR application may be made.
The identified service, the name of the provider (if known), and the team anticipated frequency, intensity
and duration will be entered in the “Services needed but not yet coordinated” part of Section VI of the
IFSP. For example, Physical Therapy, XYZ Care, anticipated 20 times in 180 days-for45 minutes per session,
May 1, 2016 to September 3, 2016, POLR funding pending.
If the service is an evaluation to determine the frequency and duration of an identified therapy, it is also
entered in the “Services needed but not yet coordinated” part of Section VI of the IFSP with the name of
the provider, the anticipated frequency of the evaluation and the duration of time that the evaluation will
take place. For example, PT Eval, XYZ Care, 1 time -90 minutes, May 1, 2016 to May 30, 2016, POLR
funding pending.
How do I apply for POLR?
All POLR forms that are needed for the application process are located on the Help Me grow website:
http://www.helpmegrow.ohio.gov/Early%20Intervention/Payor%20of%20Last%20Resort%20%20POLR.aspx
We acknowledge that most of the forms need to be updated, and they are under review.
The Service Coordinator will assist the family in gathering the following information:
 Application for POLR Participation
 Parental Consent
 Insurance form (optional)
 Services Not available
 Combined Application
 Recent Tax Form 1040
 Pay stubs/W2’s
 Complete IFSP
Once all of the above information is gathered, the Service Coordinator will either email the information
to: [email protected] or send it to the following physical address:
EI Payor of Last Resort
Ohio Department of Developmental Disabilities
30 East Broad Street, 12th Floor
Columbus, Ohio 43215
2
Last updated 5/12/16
What is the purpose of all these forms?

Application for POLR Participation – The application gives the demographic information for both
the family and the Service Coordinator and summarizes the service(s) being requested.

Parental Consent – The family is consenting and acknowledging their understanding of early
intervention services and Ohio’s SOP process.

Insurance form (optional) – This form is signed only if, after informed consent the family does not
consent to using their insurance (both private insurance and Medicaid) to pay for EI services. If
the family does consent to using their insurance, this form will not be signed and submitted, and
POLR will become their secondary payment source. Service Coordinators must explain this
process fully to families to ensure each families makes an informed decision. The EI Resource
Coordinator is available to work with Service Coordinators who have questions or who feel they
need additional information.

Services not available – Certification that the requested service is not available through local
funding sources such as the county board of disabilities. The service coordinator signs this form.

Combined Application, recent federal income tax form 1040 and pay stubs/W2s – This
information is needed to determine the family’s ability or inability to pay for early intervention
services.

Complete IFSP – The IFSP will be reviewed for the following:
o
o
o
o
A statement about the child’s present levels of development
A statement about the family’s resources, priorities, and concerns related to enhancing their
child’s development
A statement of functional outcomes expected to be achieved for the child and family and
criteria, strategies and the timelines used to determine the degree of progress toward
outcomes identified on the IFSP
The specific EI services as defined in OAC 3701-8-01 necessary to meet the unique needs of
the child and family to achieve outcomes on the IFSP including:
 Length, duration, frequency, intensity, service type and method of delivering
the EI Service
 A statement that each of EI service will be provided in the natural
environment of the child and their family or justification as to why the service
will not be provided in the natural environment
 Location of each service
 Payment arrangements
 A description of the steps the Service Coordinator or family will take to assist
the parents in securing all services which are identified to achieve outcomes,
but are not currently being provided
 Projected start date for the initiation of each EI service and the anticipated
duration of each service
 The name of the Service Coordinator responsible for ensuring the
implementation of EI services identified on the IFSP
3
Last updated 5/12/16
What happens after the POLR Application is received?
After the POLR application is received and reviewed, the family’s financial information is used to
determine the ability or inability to pay.
The process of determining the family’s ability or inability to pay is a complicated algorithm and detailed
in full at OAC 3701-8-08.1. Simply put, the family’s adjusted income (after several deductions are made)
is compared to 185% of the Federal Poverty Level (FPL) income guide for the number of household
members.
If the adjusted income is at or below 185% of FPL, the family is determined to have an inability to pay, and
a Letter of Approval (LOA) is created and sent to the family and Service Coordinator with the approved
service(s) and units.
If the adjusted income is above the income level, the family is determined to have the ability to pay. When
a family is determined to have an ability to pay, the difference between their adjusted income level and
the income level of 185% of FPL, is the family’s cost share, or spend down amount. A Denial of Services
letter is sent to the family with a copy of the financial worksheet that details the deductions, adjusted
amount and the cost share. The service coordinator will receive a copy of the denial letter.
How does a family spend down their share?
If the family is determined to have a cost share, the family will receive a Denial of Services letter and a
cost share packet for completion. A family can document out of pocket medical expenses for the entire
family for the previous 12 months leading up to the POLR application through the upcoming 12 months
after the date of the POLR application. Examples of acceptable expenses are hospital bills, prescription
medications, dental bills and doctor office co-pays. These expenses are documented on the cost share
expense form and submitted with receipts of medical expenses of $100.00 or more to
[email protected] or sent to the following physical address:
EI Payor of Last Resort
Ohio Department of Developmental Disabilities
30 East Broad Street, 12th Floor
Columbus, Ohio 43215
After a review of the documentation for verification, a LOA will be created and the POLR application will
be approved. The date of the approval and the start of the services will depend on when the family
reaches their cost share. If the date is prior to the POLR application, services can be covered with the date
that is on the IFSP. If the date the family reaches their share is after the POLR application date, services
can start with the POLR approval date.
The family’s LOA will state the start and end dates of the approved services.
4
Last updated 5/12/16
When do I move the services to the grid on the IFSP?
Once the Service Coordinator receives the LOA or denial letter a periodic review will need to be scheduled
to update the IFSP.
How do I change/renew a POLR service?
The Service Coordinator needs to submit the Request for additional Early Intervention Services Application
and the updated IFSP if any changes need to be made to a POLR paid service. This includes an increase,
decrease or termination in frequency and duration, or a request for additional payment with a six month
review.
It is the responsibility of the Service Coordinator to submit the application and IFSP if any changes are
requested outside the normal periodic review.
The Service Coordinator will receive a renewal notice at least 30 days prior to the expiration of the POLR
services. If the renewal is 12 months after the initial POLR application, the family must submit the financial
parts of the application for the annual determination of the family’s ability/inability to pay for EI services.
What if I do not have any POLR providers in my county?
POLR providers are not bound by county lines. All contracted POLR providers are listed on the Help Me
Grow website:
http://www.helpmegrow.ohio.gov/~/media/HelpMeGrow/ASSETS/Files/Professionals%20Gallery/HMG
%20Early%20Intervention/EI%20System%20of%20Payment/New%20EISOP%20forms/WEBSITE%20USE
%20%20Payor%20of%20Last%20Resort%20POLR%20Providers%20%202016.pdf
It is the responsibility of the service coordinator to identify all potential providers who are able to offer
the early intervention service identified by the team to meet the family’s outcome. This provider can be
across county lines.
Any provider is able to apply to be a POLR provider as long as the provider is willing to be part of Ohio’s
early intervention process. The provider application and process is available on the Help Me Grow
website:
http://www.helpmegrow.ohio.gov/Early%20Intervention/Payor%20of%20Last%20Resort%20%20POLR.aspx
5
Last updated 5/12/16