Any assistive technology requested for a child must be submitted to DHS for prior approval and is required for the provision of all equipment/services with the exception of replacement hearing aid earmolds (see 4.a. below). The prior approval process reviews requests to look for developmental necessity, equipment/services as described in the section addressing "limitations," pricing requests, quantity and duplication.

Requests are processed through the DHS Bureau of Early Intervention for prior approval consideration. Requests must be submitted by mail to:

Illinois Department of Human Services
Bureau of Early Intervention - Assistive Technology
222 South College, 2nd Floor
Springfield, IL 62704

Procedure

  1. The therapist identifies an AT need through evaluation or ongoing assessment, contacts the service coordinator to schedule an IFSP meeting and brings the information to the IFSP team for consideration.
  2. If the IFSP team agrees with a need, an outcome page relating to the AT need is completed by the service coordinator.
  3. The service coordinator compiles all the necessary documentation:
    1. Assistive Technology Prior Approval Request Form (pdf), completed by the service coordinator in its entirety. Note: Items with attachments or accessories should 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 and vendor information. (Example - Corner chair with tray should be listed as one item under HCPCS code A9900, Tristander with various support attachments listed as one item under HCPCS code E1399);
    2. IFSP sections: Cover page, Section 2 - Present Levels of Development and Section 3 - Child and Family Outcome(s) relating to AT only (outcome must be within the previous six month time frame);
    3. Physician's order (script must be within the previous six month time frame);
    4. A separate letter of developmental necessity from a credentialed evaluator is required. The letter must be dated within the recent six-month time frame and include information on the child's developmental need and current functioning level. Goals and objectives must be identified in the most current IFSP with regards to the utilization of the recommended equipment/service. NOTE: Do not include AT justification in the initial evaluations or assessments. A recommendation to complete an evaluation to determine the need for AT must be made by the IFSP team prior to the development of a letter of developmental necessity;
    5. Picture and description of item including manufacturer pricing;
    6. Copy of DSCC eligibility letter, if applicable.
  4. The request including all necessary information listed above is mailed to the assistive technology coordinator at DHS for review.
    1. All AT must be pre-approved with the exception of replacement hearing aid earmolds and hearing aid batteries (batteries limited to 16 every 60 days). A letter of necessity and physician order/script must be in the child's record and no more than one year old. Earmolds are approved as needed but no more than two per authorization at the current HFS approved price.
    2. Once a request has been received, it will be reviewed by the AT coordinator for the above information within 21 business days of the date of receipt.
    3. If missing or additional information is required, a memo of notification identifying what information is needed will be faxed to the child's service coordinator or the CFC AT coordinator. The service coordinator will have 10 working days to provide the AT coordinator with the information for processing. If information is not received by this time, request will be denied due to lack of information.
  5. Once all pertinent information is received to the satisfaction of the AT coordinator, request will be reviewed and recommendation made within 10 working days of receipt of pertinent information. Notification of request status will be sent by fax to the child's service coordinator at this time.
  6. The service coordinator enters an authorization(s) for any approved items indicated in the DHS notification.
    1. The information for the authorization must be entered exactly as written in the DHS notification, noting HCPCS code, quantity and amount, and must be checked for accuracy prior to saving the authorization in the Cornerstone system.
    2. 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.
  7. If the AT request is denied, no authorization is entered.
    1. The service coordinator must inform the family and service providers of the denial.
    2. The service coordinator and vendor should assist the family in pursuing any and all other funding options (including recycled devices). Typically, parents and providers look at private insurance, Medicaid, Division of Specialized Care for Children (DSCC), Lekotek, Illinois Assistive Technology Project, local civic organizations, and parent contributions. Actual funding may include a combination of fund sources.
  8. The service coordinator notifies the family, reprints the IFSP and sends the revised IFSP to all team members, sending only the approved authorization to the supplying vendor.

Any requests received without the above information may experience delays in processing. As with any other EI service, AT services must be related to one or more outcomes in the IFSP. Early Intervention does maintain the right to request the substitution of a less expensive item of comparable function if a substitution is deemed appropriate. Note: Requests for children 2 years, 9 months and older may be denied as equipment requested during this time would not allow the child to achieve substantial benefit while in the EI program.

Typically, insurance, Medicaid, and DSCC funds pay for equipment and devices that fall under the category of "Durable Medical Equipment." This includes equipment such as daily living aids, standers, positioning systems, wheelchairs, prosthetics/orthotics, augmentative communication devices and hearing aids. Seldom does it include learning tools like switch-operated toys, assistive play equipment, and computer equipment.

Change in HCPCS Codes

At times, especially with orthotic requests, the vendor will quote the orthotics based on the therapist's letter of developmental necessity. When the vendor sees the child, it may be necessary to change the HCPCS code(s) originally requested. If this situation occurs:

  1. Complete a new AT request form with the new information. Write "code change" at the top of the page.
  2. Obtain a new vendor quote and manufacturer's pricing information (not required for orthotics).
  3. Obtain a new physician script if the script states specific items that are no longer applicable.

Fax the above information to the attention of the AT Coordinator.

Change of Vendor

In the event that a vendor must be changed to deliver an approved AT request:

  1. Complete a new AT request form with the new information. Write "change of vendor" at the top of the page.
  2. Obtain a new vendor quote and manufacturer's pricing information from the new vendor as they may quote a different price.

Fax the above information to the attention of the AT Coordinator.

Returns

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 so that appropriate equipment can be obtained.

  1. The therapist contacts the service coordinator about equipment return.
  2. Equipment in question is returned to the vendor by the family.
  3. If a replacement item is needed, the service coordinator obtains the following information:
    1. Revised Assistive Technology Prior Approval Request Form (pdf) indicating new equipment and a comment about equipment returned
    2. Letter of developmental necessity indicating why original equipment was not appropriate and why new request will better meet the needs of the child,
    3. If new item is significantly different from item returned, a new physician's order (when applicable) should be obtained,
    4. Picture and description of new item including manufacturer pricing,
    5. Verification from the vendor of return and funding status of the original item.
      1. If vendor has not yet billed for the original equipment, process with submission of request to DHS.
      2. If vendor has billed the Insurance, CBO or other fund sources or has received payment for the original item, the vendor will need to return funds to the appropriate party(ies) before a replacement item can be approved.
      3. EI will approve payment of a "restocking fee" if the company the vendor obtained the equipment from has a written policy.
  4. Proceed with above procedure for obtaining AT step number 4.