POLICY

  1. All Early Intervention (EI) services shall be authorized prior to provision of services. The exception to this rule is the Individualized Family Service Plan (IFSP) meeting. Authorizations for IFSP meetings are to be generated at the end of each meeting and are based upon attendance. Providers must attend the entire IFSP meeting in order to receive authorization for payment. If the IFSP meeting occurs away from the CFC office, Service Coordinators are responsible for generating the IFSP meeting authorizations on their laptops and for giving each provider their authorization number at the end of each meeting.
  2. All evaluations completed for the purposes of determining initial eligibility and adding new types of services to existing IFSPs shall be provided only by credentialed/enrolled Evaluators. This includes evaluations to determine the need to add assistive technology services as a new service to an existing IFSP. Do not issue authorizations to the evaluator category except for the above circumstances.
  3. One provider shall not receive authorizations to provide services as two disciplines (two types of service) for the same child/family.
  4. In order to maximize all available resources, evaluations conducted by providers within or outside of the EI Services System prior to referral can and should be used to assist in eligibility determination and IFSP development if they are current (within the last six months) and contain all needed information. In order to consider an evaluation that was completed prior to the referral within the context of the whole child and family and make service recommendations accordingly, the enrolled provider who actually completed the evaluation should be invited to attend the IFSP meeting. If the provider is not an enrolled provider, or if the enrolled provider is not available to attend the IFSP meeting, either the Child and Family Connections (CFC) clinical technical assistance consultant or a credentialed/enrolled evaluator should review the evaluation and attend the IFSP meeting. NOTE: If information is received concerning HIV/AIDS, do not share this information with any other entity without a consent that is specific to HIV/AIDS that has been signed by the parent or guardian only. It is a violation of Pubic Health laws to share HIV/AIDS information without specific consent.
  5. Evaluation includes professional observation and interpretation of the quality of a child's performance of developmental tasks and how these are integrated into the daily routines of the family. This requires full family participation throughout the process to ensure that the therapists' observations are a meaningful reflection of the family's perspective.
  6. Physician's orders (prescriptions) are not required to complete initial evaluations to determine eligibility for services, but are required for direct service provision for physical therapy, occupational therapy, speech therapy, audiology, aural rehabilitation services provided by a speech therapist or audiologist and assistive technology.
  7. Evaluations of the following five developmental domains are required to determine the specific developmental areas that are in question and the need for any additional evaluations in those areas:
    • 7.1 Cognitive development;
    • 7.2 Physical development including vision and hearing;
    • 7.3 Language, speech and communication development;
    • 7.4 Social emotional development; and
    • 7.5 Adaptive self-help skills development.
  8. A minimum of two disciplines is required to complete evaluations to determine initial eligibility and to redetermine eligibility on an annual basis. Arena or team evaluations may be used. However, the evaluators should be carefully selected to ensure that each evaluator is addressing an identified area of concern. Use developmental information obtained through the Referral and Intake processes to help determine the most appropriate composition of an evaluation team for each child. NOTE: See Policy 11 and Procedure 6.0 for policy and procedure concerning arena evaluations.
  9. The evaluation process should begin with an exploration of the family's specific developmental concerns. The family's concerns coupled with the findings of the evaluations can then be used to develop family-centered functional outcomes and specific intervention strategies.
  10. All reports, including those for initial and annual evaluations and ongoing assessments must be provided to the Service Coordinator within 14 calendar days of the receipt of a request to perform an evaluation/assessment. Unless sufficient extenuating circumstances exist and are documented in a letter from the CFC manager, a provider must attend the initial IFSP meeting in order to be paid for an initial evaluation. Audiologists who have completed an evaluation prior to the initial IFSP meeting with test results that were obtained within the normal range may choose not to participate in the initial IFSP meeting. If the audiologist chooses not to participate, he/she must complete the Individualized Family Service Plan Meeting Attendance Waiver for Audiologists form and attach it to the audiological evaluation claim for the Central Billing Office (CBO) to process payment.
  11. Evaluations, eligibility determination and IFSP development may occur on the same day if the following criteria apply.
    1. All required intake activity and a review of existing records has been previously completed. NOTE: See Intake and Evaluation Authorizations sections for steps that must be completed.
    2. The family has been contacted and has agreed to the completion of evaluations, eligibility determination and the development of the IFSP on the same day.
    3. The activities have been scheduled on a date that is convenient to the family and the family has received prior written notice of that date and the activities that are to occur on that date.
    4. The most appropriate composition of the evaluation team has been determined using developmental information obtained through the Referral and Intake processes.
    5. The review of existing records and the completion of the evaluations have provided sufficient information regarding each developmental domain to ensure development of a comprehensive plan. NOTE: Refer to the Evaluation Authorizations and Initial and Annual Eligibility Determination Sub-sections.
    6. The Waiver of Written Prior Notice form has been completed in the presence of the family, documenting in writing the evaluation team's determination regarding eligibility, the reason for the team's decision, the procedural safeguards available to the family, including the right to refuse EI services, and the parent's consent to waive written notice of eligibility determination and written prior notice of the IFSP meeting. NOTE: Service Coordinators should carefully observe the family and ensure that they are adequately informed and emotionally prepared to proceed with the development of the IFSP. If the Service Coordinator feels that the parent(s) needs time to consider the evaluation findings or does not have sufficient support to proceed, the Service Coordinator must immediately stop the meeting and work with the family and providers to reconvene the team at a later date that is convenient to the family.

PROCEDURE

  • 1.0 Obtain a signed Consent for Release of Information form from the family to obtain existing medical and developmental records and evaluation reports to assist with the evaluation process. Evaluations must have been completed within six months of their use in eligibility determination and/or plan development. Medical and/or developmental records that are not likely to impact eligibility determination and/or intervention planning need not be obtained.
  • 2.0 Review developmental information obtained through the Referral and Intake processes to help determine the most appropriate composition of an evaluation team for the child.
  • 3.0 Use the Cornerstone system to generate authorizations for needed evaluations that will be provided through the EI Services System. Refer to the Cornerstone Reference Manual for specific information concerning Cornerstone information/reports to include in the referral packet to send to the provider.
    • 3.1 Utilize only credentialed/enrolled Evaluators to complete initial evaluations to determine initial eligibility or to determine the need to add new services to an existing IFSP.
    • 3.2 Provide copy of signed Child and Family Connections Informed Consent Documentation of Receipt of Rights and Notice of Privacy Practices, (which gives permission for release, review and discussion of evaluation reports) to each member of the evaluation team.
  • 4.0 Monitor the status of evaluation activities in order to ensure completion in a timely manner.
    • 4.1 Request a DHS Provisional service authorization using the Provisional Provider Authorization Request form for reimbursement of family transportation expenses to evaluation locations if necessary. Provisional service authorizations must be approved prior to service delivery.
  • 5.0 Collect any additional information needed for eligibility determination.
  • 6.0 If the family has agreed to the completion or evaluations, eligibility determination and the development of the IFSP on the same day, ensure that the following has occurred.
    • 6.1 A review of developmental information obtained through the Referral and Intake processes has been previously completed and the most appropriate composition of an evaluation team for the child has been determined;
    • 6.2 The activities (evaluations, eligibility determination, IFSP meeting) have been scheduled on a date that is convenient to the family;
    • 6.3 The family received written prior notice of that date and the activities that will occur on that date; and
    • 6.4 The Waiver of Written Prior Notice is completed on the date that the activities occur.
  • 7.0 Obtain evaluation reports from providers within fourteen (14) calendar days of the begin date of the authorization to perform the evaluation.
    • 7.1 In extenuating circumstances, if the report cannot be completed within 14 calendar days, the CFC Manager may determine if a 5-day extension is necessary. If the manager approves an extension, adjust the authorization to reflect the extension.
  • 8.0 Ensure that all evaluation reports have been translated into the parent(s)/guardian's native language and provide a copy of all reports to the parent(s)/guardian. Retain a copy of each original and each translated report in the child's permanent record.
  • 9.0 Provide a copy of all evaluation reports to each member of the evaluation team. NOTE: If information is received concerning HIV/AIDS, do not share this information with any other entity without a consent that is specific to HIV/AIDS that has been signed by the parent or guardian only. It is a violation of Pubic Health laws to share HIV/AIDS information without specific consent.
  • 10.0 Ensure that a multidisciplinary team consisting of two or more disciplines (one person cannot act as two disciplines for the same child) has conducted evaluations and/or has reviewed existing evaluation information in all five developmental domains and agrees with the child's EI eligibility or ineligibility determination.