POLICY

  1. Early Intervention (EI) covers authorized Assistive Technology (AT) devices and services directly related to the developmental needs of the child.
  2. EI is not responsible for paying for devices and services that are necessary to treat or control a medical condition or assist a parent or caregiver with his/her disability.
  3. EI is not responsible for paying for devices and services that are necessary or desirable for typically developing children.
  4. Assistive technology devices and services must be developmentally and age appropriate.
  5. Any AT requested for a child must be submitted to the Department for prior approval. Prior approval is required for the provision of all equipment/services. The prior approval process reviews developmental necessity, determines covered services, pricing requests, quantity and duplication.
  6. All AT evaluations and letters of developmental necessity must be completed by a credentialed/enrolled evaluator.
  7. The Department maintains the right to request the substitution of less expensive items of comparable function if a substitution is deemed appropriate.

PROCEDURE

  1. If the need for AT is identified outside of a formal IFSP meeting, the Service Coordinator must reconvene the IFSP team in order to discuss the need for AT services, existing resources that may be used to loan or purchase the AT equipment/device, and/or alternative, comparably effective adaptations.
    • 1.1 Upon notification of the possible need to add AT services as a new service to the IFSP, convene a meeting of the IFSP service team and the child's family.
    • 1.2 Ensure that the IFSP team, including the family, is aware of the Department's prior approval process for AT.
    • 1.3 If the team determines that there is a need for AT services, and the direct service provider is a credentialed/enrolled evaluator, request that the evaluator write a letter of developmental necessity to submit for AT prior approval purposes. The provider will bill this time as IFSP development time.
    • 1.4 If the direct service provider is not a credentialed/enrolled evaluator, generate an evaluation authorization to a credentialed/enrolled evaluator who will complete an AT evaluation, generate the evaluation report and develop the letter of developmental necessity to submit for prior approval purposes. The provider will bill this time based upon evaluation procedure codes identified on the authorization.
    • 1.5 Ensure that the AT need is appropriately related to one or more of the child's developmental outcomes and is documented in the IFSP.
  2. If the IFSP team determines that the need for assistive equipment can only be met via a purchase through the Department, the CFC AT coordinator or Service Coordinator submits the following:
    • 2.1 Assistive Technology Prior Approval Request Form, completed by the Service Coordinator in its entirety. Note: Items with attachments or accessories must be listed under one HCPCS code with the breakdown of cost, description of each attachment and/or accessory and the purpose of each attachment and/or accessory identified in the evaluation (letter of developmental necessity) and vendor information;
    • 2.2 IFSP sections: Cover page, Section 2 - Present Levels of Development and Section 3 - Child and Family Outcome(s) relating to AT only;
    • 2.3 Physician's order/script;
    • 2.4 Evaluation(s) reflecting the developmental need, the child's current functioning, identifying goals and objectives with the utilization of the recommended equipment/service and how it will be used;
    • 2.5 Picture and description of requested item including manufacturer pricing; and
    • 2.6 Copy of DSCC eligibility letter, if applicable.
  3. If the AT request is for a child 33 months of age or older, include with the AT request a letter of justification which includes the following information:
    • 3.1 Developmental benefit expected to be achieved prior to age 3 through the use of the requested equipment/device(s); and
    • 3.2 All steps taken to obtain the requested equipment/device(s) from resources available to the child after age 3 (i.e. Medicaid, private insurance, DSCC, Lekotek, Illinois Assistive Technology Project, local civic organizations, lending libraries).
  4. Completed requests must be mailed to the attention of the Assistive Technology Coordinator at 222 S. College, 2nd Floor, Springfield, IL 62704.
    • 4.1 Upon receipt of a completed AT request, the Department will review the request and fax a decision memo to the AT Coordinator or Service Coordinator who submitted the request.
    • 4.2 If upon review it is determined that the AT request is incomplete, the Service Coordinator will be notified by fax of missing or incomplete information and will have 10 business days to submit all necessary information to the Department. Failure to submit requested information may result in an automatic denial of the AT request.
  5. Upon receipt of the Department's decision memo, generate authorizations for approved equipment /devices.
    • 5.1. Generate authorizations for approved equipment/device(s) taking care to enter the authorization information exactly as it is written in the Department's decision memo. NOTE: It is important that the HCPCS code, quantity and amount be checked for accuracy prior to saving the authorization in the Cornerstone system. If the authorization information in the Department's decision memo is known to be or appears to be incorrect, contact the Department for clarification before the authorization is entered/saved.
  6. Notify the IFSP team of the Department's decision regarding the requested equipment/ devices and convene a meeting of the IFSP team, if necessary, to discuss denied requests or substituted equipment/devices. NOTE: do not enter authorizations for equipment/device(s) that are denied.
    • 6.1. If it is determined that the equipment/devices cannot be covered by the State's EI Program, work with the IFSP team and the vendor to assist the family in pursuing any and all other funding options (including recycled devices). Other funding options may include public or private insurance, the Division of Specialized Care for Children (DSCC), Lekotek, Illinois Assistive Technology Project, and/or local civic organizations. Funding sources may be combined to cover the cost of the equipment/device(s).
  7. Notify the family, reprint the IFSP and send the revised IFSP to all IFSP team members. NOTE: Only send the AT authorization and the Insurance Report to the supplying vendor.

Returns

  1. 8.0 If an item is received by the family and is determined by the therapist to not appropriately meet the child's needs, the item is to be returned immediately so that appropriate equipment can be obtained. Work with the family to determine how to return the equipment. If the vendor shipped the wrong equipment, it is the vendor's responsibility to pay for the return.
  2. 9.0 Upon notification from the therapist and/or family of the need to return one or more AT items, notify the family of their responsibility to return the item to the vendor in a timely manner.
  3. 10.0 If a replacement item is needed, the following information is required:
    • 10.1 A new Assistive Technology Prior Approval Request Form indicating the new equipment to be purchased;
    • 10.2 A letter of developmental necessity indicating why the original equipment was not appropriate and why a new request will better meet the needs of the child;
    • 10.3 If the new item is significantly different from the returned item, a new physician's order, picture and description of the new item, including manufacturer pricing and verification from the vendor of the return and funding status of the original item.
      • 10.3.1 If vendor has not yet billed for the original equipment, proceed with submission of request to DHS and cancel the original authorization.
      • 10.3.2 If vendor has billed the Insurance, CBO or other fund sources or has received payment for the original item, notify vendor of the need to return funds to the appropriate party(s) before a replacement item can be approved.
  4. Complete Procedure 3.0 above.
  5. Additional information regarding Assistive Technology services can be found in the document entitled Early Intervention Assistive Technology Guidelines.