POLICY

  1. Service coordinators are required to document the family's gross annual income and family size prior to implementation of initial and annual Individualized Family Service Plans (IFSPs), regardless of the following:
    1. Type of insurance coverage; or
    2. Types of Early Intervention (EI) services needed.
  2. Families that refuse to disclose financial information will not receive EI services and Assistive Technology (AT) devices subject to fees.
  3. One annualized fee is assessed per family, using a sliding fee schedule that adjusts for gross income and family size.
    1. If more than one child is enrolled, one child's IFSP will be designated as the fee account period for the entire family.
    2. Accumulated annual services provided to all family members will be reflected on the family's monthly fee invoice.
    3. The sliding fee schedule will be updated annually by DHS and distributed to the CFC's for use.
  4. Families are assessed monthly installments of fees, and receive monthly fee invoices showing fees accumulated since the beginning of the current fee period unless:
    1. Annual gross income is at or below 185% of the Federal Poverty Level; or
    2. EI eligible children are enrolled in All Kids or the WIC Program; or
    3. A fee exemption has been approved.
  5. NOTE: Letter b) above does not apply to children who are enrolled in All Kids Programs Level 2 and above. Children enrolled in All Kids Programs Level 2 and above may be assessed a family fee.
  6. Families may request an exemption from fees for the current IFSP period. A family fee exemption is not retroactive. A family may request exemption if:
    1. Out-of-pocket medical expenses during the past twelve months meets or exceeds 15% of their gross annual income; or
    2. Out-of-pocket losses during the past twelve months due to disaster such as fire, flood or tornado meets or exceeds 15% of their gross annual income.
  7. At the written request of the family, the annualized fee obligation may be adjusted prospectively at any point during the IFSP period upon proof of change in family income or family size that warrants a change in the fee amount.
  8. EI will not charge a family more than the annualized Family Fee per IFSP period. EI will charge the family the maximum annual Family Fee or the amount that the EI Central Billing Office (CBO) paid for direct services - whichever is less per IFSP period.
    1. Direct IFSP services and AT devices are subject to fees.
    2. Screening, evaluation and assessment (including medical diagnostic services); IFSP development (including review and modification); service coordination; and family training and support by parent liaisons, interpreters and deaf mentors are not subject to fees.
  9. Annual fees are divided in to level monthly installments in order to assist families in budgeting.
  10. Level monthly installments of the annual fee begin to accrue beginning with the entry of the first authorization for services subject to fees and ends only with the IFSP end or case closure.
  11. Fee maximums are prorated within an IFSP period only at the beginning month and end month of the fee period.
    1. Beginning month: Families are charged the first calendar month that an authorization for direct services subject to fees begins on or before the 15th of the month. Example: Authorization was entered on the 12th of the month.
    2. End month: Families are charged the final calendar month that an IFSP ends after the 15th of the month. Example: Child ages out on the 18th of the month the family will be charged the family fee for the month.
  12. Families are encouraged to pay level monthly installments if the total state payments for services subject to fees are expected to equal or exceed maximum fees assessed for the annual IFSP period.
  13. Families are responsible for paying at least the "minimum due" amount shown on their monthly invoice. (See Sample Family Invoice at the end of the Family Fee Determination Section)
    1. Minimum due amounts vary from month to month. Totals depend on payments made by the CBO to the provider. Payments are made by the CBO based upon the providers billing practices, which could be daily, weekly or other. NOTE: A provider has 90 days from the date of service or 90 days from the date of the last written correspondence from the insurance company to submit claims for payment to the CBO.
    2. Minimum due amounts remain zero until the CBO pays a provider for a service subject to fees.
  14. A family may have multiple IFSP accounts. Each account is based upon an individual IFSP period, making each account IFSP specific.
    1. Families can begin paying on a second IFSP account when there is still an open balance owed on a previous IFSP account, but all accounts are considered when determining delinquency.
    2. When making a payment, each payment is applied to a specific account that is based on the account number shown on the return stub. NOTE: The family must submit the return stub received with the monthly statement when submitting a payment in order to ensure that the payment is posted against the correct account. Otherwise the payment will be posted to the oldest IFSP account.
    3. Families will receive a monthly statement for each active IFSP account until each individual account is paid in full and has had no activity during the last 9 months. NOTE: If a family has multiple open accounts, the family will receive multiple monthly statements.
    4. Final reconciliation of an account that has been paid in full may be delayed up to nine (9) months to allow for providers to bill the insurance and/or CBO.
    5. Upon reconciliation of an account, any overpayments/credits will be applied to the family's current account if one or more children remain in the EI Services System. Overpayments/credits are refunded to the family if all their children have exited the EI system.
  15. DHS initiates collection procedures against families based on unpaid minimum due amounts.
    1. DHS will notify the family each month that their oldest minimum payment is thirty (30), sixty (60 or ninety (90) days past due.
    2. When the oldest minimum payment is ninety (90) days past due, the Service Coordinator will notify the family that the child is still eligible for services not subject to fees. But that all services subject to fees will be discontinued.
    3. When the oldest minimum payment is ninety (90) days past due, the Service Coordinator will notify the provider that services subject to fees will be discontinued.
    4. Monthly installments of the annual fee will continue to be applied to the account balance through the end of the IFSP or case closure.
    5. Minimum due amounts will be recalculated monthly based on accumulated CBO payments for annual services subject to fees. NOTE: A provider has 90 days from the date of service or 90 days from the date of the last written correspondence from the insurance company to submit claims for payment to the CBO.
  16. If a family does not agree with the findings of their financial assessment refer the family to the complaint process found in the State of Illinois: Infant/Toddler and Family Rights Under IDEA for the Early Intervention System.
  17. Any fee dispute must be submitted to DHS within 30 days of the family's initial receipt of their EI Family Fee Report, using the Request for Investigation of State Complaint form.
  18. If a family files a bankruptcy petition and list their EI account balances as a debtor, EI may not pursue pre-discharge debt. However, EI will pursue post-discharge debt.
  19. All other resources such as insurance and All Kids must be accessed prior to use of state and federal EI funds.

PROCEDURES

the list styles have changed due to the original list not being available in this format

  1. Explain to the family that income and family size will be used to determine any annual family fees and that only one fee will be assessed per family regardless of the number of children who are receiving EI services. Also explain that a fee exemption may be requested at any time if the family encounters medical expenses or losses due to disaster such as fire, flood or tornado in excess of 15% of their annual gross income and that a fee exemption is not retroactive.
    1. If the family refuses to document income, leave the fee record blank and develop an IFSP limited to services not subject to fees. Document in Cornerstone case notes the reason for leaving the fee record blank.
  2. Confirm that the family size and annual gross income reported on the most recent Screening Device for Determining Family Fees and Eligibility for All Kids & DSCC are still accurate. This screening is completed at intake and prior to each annual IFSP. If not accurate, complete the following steps:
    1. Re-screen. (See INTAKE Section of this manual)
    2. Complete needed referrals to DSCC, All Kids.
    3. Update Cornerstone regarding child's enrollment in All Kids (PA05), DSCC and other programs (PA35) and document activities in Cornerstone case notes.
  3. Obtain written documentation of the family's annual gross income for the child's Cornerstone and CFC permanent records. Income verification should follow the hierarchy of accuracy of the family's situation as listed below:
    1. For children enrolled with All Kids Plans below Premium Level 2 (excludes Premium Level 2 and above), a copy of the All Kids Recipient Identification Card may be obtained for income verification purposes; or
    2. For children who receive WIC services, a copy of WIC Identification Card may be obtained for income verification purposes; or
    3. For all other children, including children who have All Kids Level 2 and above, obtain a copy of the family's most recent Federal Income Tax Form 1040 if it accurately reflects current gross income; or
    4. If the family's most recent Federal Income Tax Form 1040 does not accurately reflect current gross income due to a circumstance such as a change in employment or an increase/decrease in pay, etc., obtain two consecutive pay stubs if the pay stubs accurately reflects current gross income;
      1. The family must provide two recent consecutive check stubs from each working parent (gross amount averaged and multiplied by number of pay periods per year.)
    5. If the four documentation types identified above do not apply due to no income, cash income, commissions, etc., obtain an itemized statement signed by the parent indicating the family's estimated annual income and any proof of that income.
  4. Enter financial information in Cornerstone and update the financial information for all grouped children, if applicable.
    1. Enter family size used for tax reporting purposes, plus any dependents added since filing.
      1. Use "1" for DCFS wards in foster care and children residing in private residential facilities where the facility has guardianship established (i.e. custodial, legal).
    2. Enter annual gross income.
      1. The Service Coordinator must enter $0 for DCFS wards in foster care and children residing in private residential facilities where the facility has guardianship established (i.e. custodial, legal).
      2. The Service Coordinator must enter an income amount for non-DCFS wards.
    3. Enter type of written income documentation obtained. Use All Kids Recipient Identification card for DCFS wards in foster care. NOTE: See Procedure 3.0 above for types of documentation that are required.
    4. If an annualized Family Fee greater than zero is assessed, enter name (last name and then first name) and social security number of financially responsible adult. If fee is zero, do not complete this step. NOTE: Families eligible for All Kids Level 2 and above are not automatically exempt from family fees and may be assessed a fee.
  5. If more than one child from a family is enrolled, group the children in Cornerstone. NOTE: Not all CFC offices are able to group children due to shared server issues. This issue is scheduled to be resolved in a future Cornerstone version. However, until that time, sibling accounts at shared server sites must be manually adjusted. (See Fee Credit Requests Procedure of Family Fee Determination Section.)
    1. If all children in the family have the same date of birth and are being enrolled at the same time, the Service Coordinator can select the group head at random.
    2. If the children have different dates of birth and are being enrolled at the same time, the Service Coordinator should select the oldest child as the group head.
    3. If the children being enrolled have different dates of birth and/or are being enrolled at different points in time, the Service Coordinator should always select the child who was enrolled first as the group head, regardless of age.
  6. Print and give the family a copy of the Cornerstone EI Family Fee Report and explain the report to the family. File a copy in the CFC permanent record. Request that the family inform their Service Coordinator immediately upon any changes to the following information that may require an update to Cornerstone:
    1. Family size;
    2. Annual gross income;
    3. All Kids or other insurance status;
    4. WIC status.
  • NOTE: Immediately update Cornerstone upon receipt of any change to the above information.
  1. Additional Family Fee Reports may be necessary if authorizations for services are subject to fees and they are not entered into the Cornerstone system immediately for any reason. When changes in Cornerstone necessitate a change in the annual Family Fee that was determined from initial contact with the family, Cornerstone will indicate the need to re-print the Family Fee report and the Service Coordinator will supply a corrected copy to the family and file a copy in the CFC permanent record.

Fee Exemption Requests

  1. If the Service Coordinator becomes aware of the need for an exemption or if a family with fees requests exemption from fees any time during the IFSP period, assist the family to complete a Family Participation Fee Exemption Request form. Explain to the family that an exemption is not retroactive.
    1. Verify that gross income, family size, All Kids and WIC status that was reported by the family is correct for the current year. If necessary, update Cornerstone and reprint the Cornerstone EI Family Fee Report. Send a copy of the Updated Family Fee Report to the family and file a copy of the report in the CFC permanent record.
    2. If the family still has a fee after any financial information updates and it appears that the family may qualify for a fee exemption, give the family a copy of the Family Participation Fee Exemption Request form.
    3. Explain that exemptions may be requested if out-of-pocket extraordinary medical expenses or losses due to disaster such as fire, flood or tornado during the 12 months prior to the signature date on the fee exemption request form have met or exceeded 15% of their annual gross income. Expenses for the entire family are considered, not just the participating child/children.
      1. Medical expenses deductible for income tax purposes will be accepted as medical expenses for fee exemption request purposes. Families should contact their tax consultant if they have questions about deductible medical expenses.
    4. Collect and review the following required documentation with the family:
      1. REQUIRED: Completed Family Participation Fee Exemption Request form; and
      2. REQUIRED: Copy of Cornerstone EI Family Fee Report (printed from Cornerstone) showing current gross income, family size, type of documentation and fee amount; and
      3. REQUIRED: Itemized verification of medical or disaster related payments during previous 12 months and/or bills currently owed that will not be covered by insurance (list largest items first and stop when bottom line totals more than 15% of their annual gross income); and
      4. REQUIRED: Copies of a family's paid receipts and/or unpaid invoices showing the portion that will not be covered by insurance for each payment or a bill for payment shown on an itemized list. NOTE: Utilizing the source of the bill for printouts (pharmacy printout or insurance printout) showing expense's is acceptable.
      5. OPTIONAL: Other documentation that the family believes may be necessary to prove they should receive exemption from fees, including a statement of why they feel it should be considered.
    5. Obtain the completed fee exemption request form from family and verify that all necessary documentation is attached. Service Coordinator and Program Manager signatures are required to certify completeness.
    6. Completed packet may be faxed to the Family Fee Coordinator at 217/524- 6248 or mailed to the DHS Bureau of Early Intervention at 222 S. College, 2nd Floor, Springfield, IL 62704.
      1. Update Cornerstone (PA 25) proof of income field to indicate "Pending Exempt" immediately after submitting the packet to DHS. Cornerstone will begin the Exemption (if approved) based on the date that the "Pending Exempt" status was entered into Cornerstone. Do not use this code until the exemption request has been sent to DHS.
      2. Reprint the updated Cornerstone EI Family Fee Report showing no fee due to pending exempt status. Give a copy to the family and file a copy in the CFC permanent record.
    7. Update the Cornerstone (PA 25) proof of income field upon receipt of the DHS decision of exemption.
      1. Reprint the updated Cornerstone EI Family Fee Report showing the final exemption status.
        1. If approved, update the (PA 25) proof of income field to indicate "Exempt".
        2. If denied, update the (PA25) proof of income field to indicate the appropriate current proof of income used for the family.
        3. Give a copy to the family and file a copy in the CFC permanent record.

Monthly Fee Invoices and Statements

(See Sample Family Invoice at the end of the Family Fee Determination Section)

  1. Each IFSP account has its own "Account #" and related invoices. Families may receive invoices on IFSP accounts for up to nine months, until final reconciliation occurs on the account.
    1. Invoices are mailed during the first week of the month and cover the previous month. For example, February's invoice will reflect Family Fee monthly installment and CBO activity during the month of January.
    2. Invoices are sent to the Financially Responsible Adult as identified on the Secondary Address screen in Cornerstone.
  2. After being grouped in Cornerstone, all siblings who have IFSPs are listed as "Eligible Children" on family's invoice. Families with fees receive one invoice for each current IFSP account, regardless of number of enrolled children.
  3. Level monthly installments of the annual fee are shown on invoices as "Current Charges". Families are encouraged to pay "Current Charges" each month if they expect annual CBO payments for services subject to fees to equal or exceed their maximum annual fee.
    1. During each fee period the accumulated total of CBO payments for services subject to fees for all EI members is indicated in "Total CBO Services Paid to Date" line of invoice.
    2. The billing system verifies monthly that a family is not asked to pay more in annual fees than the CBO has paid out for annual services subject to fees. The "Minimum Payment" is the portion of "Account Balance" that families must pay by the "Payment Due Date".
    3. An account is based upon an IFSP period. A family may have multiple accounts. If a family has multiple accounts payments are applied to the account number shown on the return stub used when making a payment.
    4. Payments are applied to the oldest balance (oldest month) owed for the IFSP account # shown on the family's return stub that is submitted with the payment.
    5. Families with invoice questions should call the CBO Call Center at 800/634-8540.

Fee Credit Requests

  1. If the family was billed in error, the Service Coordinator must document and verify the cause of the error and request a fee credit by faxing DHS Bureau of EI a completed Early Intervention Fee Credit Request form and a copy of the Family Fee Report indicating the monthly family fee installment amount to correct past months billed.
    1. If necessary, update Cornerstone and reprint Family Fee Report, giving copy to family and maintaining one for record.

Delinquency Reports

(See Sample Delinquency Report and Letter at the end of the Family Fee Determination Section)

  1. DHS sends written notice to the family if they fall behind in minimum payments. Service Coordinators should be prepared to update financial data and recalculate fees if income, family size or All Kids/WIC status has changed. The Service Coordinator should assist a family to complete a Family Participation Fee Exemption Request form if the family is experiencing medical expenses or losses due to natural disaster that meets or exceeds 15% of their gross income.
    1. When DHS sends a notice to the family regarding minimum due payments that are one month (30 days) past due, follow-up with the family.
    2. When DHS sends a notice to the family regarding minimum due payments that two months (60 days) past due, follow up with the family.
    3. When DHS sends a notice to the family regarding minimum due payments that are three months (90 days) past due:
      1. Notify the provider that services subject to fees will be discontinued and the date that they will be discontinued.
      2. Notify the family that services subject to fees will be discontinued and the date that they will be discontinued, but that the child is still eligible for services not subject to fees.
      3. Adjust the end date of authorizations for services subject to fees to end on a date at least two weeks after the notices have been sent to the family and providers. NOTE: The exception is for AT devices. Do not discontinue any authorizations for AT devices that have been previously entered into Cornerstone.
      4. Immediately upon completion of adjusting the end dates of the authorizations, print the revised IFSP and send a copy to the family and other IFSP team members with the Discontinuation of One or More Services form letter #30.F20 Sample 6. File a copy of the IFSP and the form letter in the CFC permanent record.
      5. Do not enter any new authorizations for newly approved AT devices.
      6. Notify the DHS Bureau of EI to suspend processing of AT requests not yet approved for authorization
  2. Upon contact from the family indicating payment has been made and requesting reinstatement of services subject to fees, contact the CBO Call Center at 800/634-8540 to verify receipt of payment. Check back, if necessary, to allow for mail delivery and CBO processing.
    1. Upon verification of receipt of payment, initiate the IFSP review/update process to identify services that are subject to fees that should be re-authorized.

Bankruptcy

  1. If a family states that they have filed for bankruptcy, but continue to receive invoices from the CBO, obtain a current Chapter 13 Petition, Chapter 13 Discharge, Chapter 7 Petition, Chapter 7 Discharge, or a notice/motion/document for bankruptcy from the U.S. Bankruptcy Courts, an attorney or the Financially Responsible Adult. The petition or discharge must list EI account balances as a debtor. Forward a copy of the notice to the EI Family Fee Coordinator by fax at 217/524-6248 or by mail it to the DHS Bureau of Early Intervention at 222 S. College, 2nd Fl., Springfield, IL 62704
    1. CBO automatically receives a copy from the Bankruptcy Court and adjusts the invoice notice and amounts only if EI is as a debtor on the petition or discharge
  2. The Service Coordinator should modify the family fee information in Cornerstone only if a change in the family's income or size necessitates a modification. NOTE: EI may not pursue pre-discharge debt. However, EI will pursue post-discharge debt. Therefore, families retain responsibility for the portion of their fee not recorded in bankruptcy petition and for the portion that accrues after their bankruptcy has been discharged.

Sample Family Invoice (pdf)

Sample Delinquency Report to CFC
CHILD/ADULT/ADDRESS EI# IFSP 0 TO 30 31 TO 60 TOTAL
TESTCASE, CARTER
c/o JOHN TESTCASE
37 N. WASHINGTON
LAGRANGE, IL 60525		 270081 11/15/06-03/24/07 10.00 10.00 20.00

[Carter's family would receive a one month past due letter from DHS because $10.00 of their minimum payment was 30 days past due.]

Sample Delinquency Letter Sent by DHS to Families with Past Due Accounts

According to our records, your Early Intervention family fee minimum payment is past due, as follows.

Past Due Accounts

1-31 Days

31-60 Days

61-90 Days

Over 90 Days

Total

If you have recently mailed payment in full, please disregard this notice. Please contact your Child and Family Connections Service Coordinator to report changes in income, family size, All Kids status or WIC status, as these changes may affect your family fee amount. Additionally, your Service Coordinator can assist you in requesting exemption from family fees if extraordinary medical expenses or natural disasters (such as fire, flood or tornado) have caused out-of-pocket expenses during the past twelve months that meets or exceeds 15% of your annual gross income.

PLEASE NOTE: The Department of Human Services will instruct your Service Coordinator to discontinue authorizations for Early Intervention services subject to fees, including assistive technology devices, if some or all of your minimum payment becomes over 90 days past due. In addition, we will initiate collection proceedings against you at that time.

Thank you for your prompt attention to this matter. Payments should be mailed as soon as possible to the address shown on your monthly family fee invoice and/or statement of previous account. You may contact the Central Billing Office Help Desk at (800) 634-8540 if you have questions about your invoice.

Sincerely,

_________________, Chief

Bureau of Early Intervention