1. Early Intervention (EI) is Part C of the "Individuals With Disabilities Education Act" and is a developmental program serving children birth to three with developmental delays, disabilities and at-risk conditions. Services are authorized based upon functional outcomes that focus on child development and family training, education and support that address developmental needs rather than medical needs.
  2. Part C requires states to provide services in "Natural Environments". Under Section 303.18 of Part C, Natural Environments is defined as "settings that are natural or normal for the child's age peers who have no disabilities".
  3. Early Intervention is a fee-for-service system. In a fee-for-service system the service must be provided prior to billing for the service.
  4. All services are pre-authorized. Never provide services without an authorization in hand. Services provided without a pre-approved authorization are not guaranteed for payment. The exception to this rule is the Individualized Family Service Plan (IFSP) meeting. Providers will receive authorization for IFSP meetings based upon attendance. Providers must attend the entire IFSP meeting in order to receive authorization for payment. 
  5. Providers who attend IFSP meetings, whether in person or via a phone call, should always ask the Service Coordinator to give them a copy of the IFSP meeting authorization prior to leaving the meeting, or the IFSP meeting authorization number if the Service Coordinator is unable to print the authorization. Service Coordinators are required to have their laptop computers with them when facilitating an IFSP meeting. The IFSP meeting authorization number can be generated using the laptop.
  6. Providers can attend the IFSP meeting in person or be present via conference call. Providers must accept responsibility for phone charges for IFSP conference calls if done for their convenience. Providers are required to attend the entire IFSP meeting in order to receive authorization for payment, whether attending the meeting in person or participating via conference call.
  7. Evaluation and assessment services for the purpose of determining initial eligibility, participating in the development of an initial comprehensive IFSP, and adding new types of services to existing IFSPs must be provided by credentialed/enrolled evaluators only, or by an enrolled audiologist. Audiologists are not required to be credentialed.
  8. One person cannot provide evaluation, assessment or direct services as two disciplines to the same child/family. This would be considered a conflict of interest.
  9. A global evaluation is a general testing of the five developmental domains and is not domain specific. When determining eligibility a domain specific evaluation should always supercede the results of a general global evaluation.
  10. All initial and ongoing evaluation and assessments must be submitted to the Child and Family Connections Office (CFC) in the most current DHS Evaluation and Assessment Report Format within 14 calendar days of receipt of the request to perform the evaluation or assessment. Reports not submitted in the most current format will not be accepted by the CFC. (See ATTACHMENT 1: EARLY INTERVENTION SERVICE REPORT GUIDELINES/FORMAT).
  11. Early Intervention does not pay a provider to write reports other than those required by Early Intervention for initial IFSP development, annual IFSP review, the six-month review, transition, discharge or others that may be required by the Service Coordinator due to additional evaluation/assessment activity required by the IFSP.
  12. Providers who complete initial evaluations to determine eligibility must attend the entire IFSP meeting in order to receive payment for the initial evaluation. If the provider who completed the initial evaluation cannot attend, an equally qualified provider may attend on behalf of the provider who completed the evaluation.
  13. Recommendations for goals, outcomes, and strategies for services, with frequency, intensity, duration and location will be determined at the IFSP meeting in collaboration with the child's family and are based on the family's identified priorities and concerns and the PRINCIPLES OF EARLY INTERVENTION. It is inappropriate for providers to approach a child's family to discuss eligibility for EI services and/or recommendations for frequency, intensity or location of services prior to the IFSP meeting. Providers may discuss the results of evaluations and assessments only with families prior to the meeting. 
  14. Providers shall strive to determine the approach to service delivery for each child and family based upon the PRINCIPLES OF EARLY INTERVENTION found within this document.
  15. Prior to making any changes to an IFSP such as increasing/decreasing the frequency or intensity of services that were originally identified as a need on the IFSP or changing the location from an offsite location to an onsite location, an IFSP team meeting must be convened to discuss the recommendation and justification for the change. The service coordinator must facilitate the meeting and the parent(s) must be present. Please see ATTACHMENT 3: DEVELOPMENTAL JUSTIFICATION OF NEED GUIDELINES AND WORKSHEET to request changes to existing authorizations.
  16. If IFSP changes are requested within the first three months of an IFSP, the original IFSP team must reconvene and the direct service provider recommending the changes must be present to discuss the recommendation and the justification for the change. The service coordinator must facilitate the meeting and the parent(s) must be present.
  17. Provisional EI services require prior approval from DHS.
  18. Early Intervention does not support specific approaches to services such as NDT, ABA, Hannon Program, infant massage therapy, etc. EI pays for services as outlined in this document only. If a provider is trained in a specific approach, and it is appropriate to incorporate that approach into direct service sessions, that is allowed. A specific approach should never be written into a child's IFSP. (Please see PRINCIPLES OF EARLY INTERVENTION found within this document on guidelines for service provision).
  19. All providers of EI services must obtain an EI credential and enroll with the Central Billing Office prior to provision of services. Exceptions to the credential requirement are deaf mentors, interpreters, audiologists, physicians, optometrists, ophthalmologists, and transportation providers. These disciplines are only required to enroll. Associate level providers must also obtain an EI credential prior to provision of services, but do not enroll with the Central Billing Office.
  20. Providers who bill and receive payment for services that are provided by a non-credentialed/ enrolled provider (if a credential is required) will be required to submit a refund for those services upon identification of this problem.
  21. Early Intervention does not pay for therapeutic services required due to, or as part of, a medical procedure, a medical intervention or an injury. Acute rehabilitative therapy and therapy required as part of a medical procedure, medical intervention or injury, is not developmentally based but is medically based. Once the condition has become chronic or sub-acute, services that address on-going developmental delay can be provided by EI.
  22. All providers of EI services are required under their Early Intervention Service Provider Agreement to have access to the Internet. Providers should access the EI website at www.dhs.state.il.us/ei and/or the other websites identified in the Introduction section of this document regularly for current information that may affect the provision of Early Intervention services or the billing and payment of those services (i.e., current Evaluation/Assessment format, changes to EI policy).
  23. Utilization of private insurance benefits is mandatory to the extent allowed by EI Program policy and/or the insurance plan/policy.
  24. Providers must verify insurance company coverage of benefits and comply with insurance company requirements, including network enrollment and documentation requests as outlined in DHS policy, unless insurance use has been exempted by DHS or the service is required to be provided at public expense. (See ATTACHMENT 9: EARLY INTERVENTION PUBLIC AND PRIVATE INSURANCE USE DETERMINATION GUIDELINES).
  25. Per federal and state law, services that are provided at public expense that are not to be billed to insurance include the following; 1) Evaluations, including Audiological evaluations and Medical Diagnostics; 2) Assessments; and 3) IFSP development. These services should only be billed to the CBO and never to the private insurance company of the family.
  26. In addition to the services identified in number 25 above, other services not billable to insurance include the following: 1) Parent Liaison; 2) Interpreter, Interpreter for the Deaf and Translator; 3) Deaf Mentor; 4) Developmental Therapy; and 5) Transportation. These services should be billed to the CBO.
  27. The CBO cannot generate/backdate an insurance waiver that would apply toward dates of service that have been previously provided to the child/family. Accepting waivers post service delivery is contrary to EI policy.
  28. Providers should never bill the family directly for any EI service, unless the insurance payment was paid to the family versus the provider and the provider has a copy of the signed "Child and Family Connections Insurance Affidavit, Assignment and Release Form" in hand. This form is signed by the family and the CFC is responsible for making a copy of the signed form available to all providers identified on a child's IFSP. (See ATTACHMENT 10: EARLY INTERVENTION BILLING GUIDELINES).
  29. Providers must accept the payment from the insurance company, as payment in full unless the payment received is less than the EI rate. If payment from EI is required, the provider must submit a claim for payment to the CBO and attach a copy of the insurance Explanation of Benefits (EOB) to the claim. The claim and EOB must be received by the CBO within 90 days of the original date of the insurance EOB. The provider may not balance bill the family to make up the difference between the combination of the insurance and EI payments and the provider's internal rate. (See ATTACHMENT 10: EARLY INTERVENTION BILLING GUIDELINES).
  30. Providers should bill for attendance at a child's Individualized Education Plan (IEP) meeting held prior to a child's third birthday using IFSP development procedure codes.
  31. All providers should review the definition of IFSP Development found in the DEFINITIONS section of this document. Do not bill for any type of service using IFSP development procedure codes unless that service is identified in this definition. A refund will be required for all dates of service for which a provider has billed for services not identified in this definition using IFSP development procedure codes.
  32. It is very rare that a provider would use exactly 15 minutes (one unit) of IFSP Development time for each date that a direct service occurs. This type of billing for IFSP Development time is a "red flag" to the EI Bureau staff and monitoring staff who complete file reviews.
  33. All providers should review the definition of documentation found in the DEFINITIONS section of this document. Daily documentation is required to support the billing and payment of all EI services, including IFSP development time. In an audit or a compliance review documentation will be reviewed. A refund will be required for all dates of service for which a provider cannot produce supporting documentation. For EI documentation means daily record notes that summarize each date of service. A weekly or monthly note which is one note to cover multiple dates of service, or a checklist that does not include a summary of services provided, is not considered acceptable documentation.
  34. Documentation must justify time for all services billed to and paid by the CBO, including IFSP development time.
  35. In a monitoring review or audit it is the entity who submits claims and receives payments (payee) for each date of service and each procedure code billed to and paid by the CBO who is responsible for providing documentation for review. Failure to provide documentation may result in a refund. Therefore, it would be to the advantage of the payee to require all employees' and/or contracted employee's to submit documentation to support billing and payment prior to submitting claims to the CBO for payment. (See definition of documentation found in the DEFINITIONS section of this document).
  36. Time in/time out sheets are not considered documentation, but are viewed as additional support to documentation, especially if the parent or care giver has signed this sheet.
  37. All providers are required to maintain documentation for a period of at least six years from a child's completion of EI services and permit access to those records by the entities identified in the definition of documentation found in the DEFINITIONS section of this document.
  38. Never ask a parent or care giver to sign blank case notes or time in/time out sheets for future dates of service. This is not an acceptable practice and could result in a refund and/or the loss of a providers EI credential, CBO enrollment and notification of inappropriate practice to the Illinois Department of Financial and Professional Regulation.
  39. Never submit a claim to the CBO for services that were not provided. This is considered an illegal practice and could result in the loss of a providers EI credential, CBO enrollment and notification of inappropriate practice to the Illinois Department of Financial and Professional Regulation
  40. Every time the CBO makes payment to a provider, the provider receives a Claim Summary and the parent receives an EOB. The Parent EOB notifies the family of all dates of service billed and paid to each of their providers. Families are asked to review their EOBs and to call the CBO Call Center if a provider has been paid for a date of service that their child did not receive. EI Bureau staff investigates each of these complaints. If it is determined that the provider billed for a date of service that was not actually provided or that there is no documentation to support the payment of the service, the provider will be required to submit a refund to the CBO.
  41. If a provider bills for one hour of therapy, the provider must have actually delivered that therapy. For EI, rounding up of time for billing purposes is not allowed.
  42. Once a provider accepts an authorization, the provider commits to provision of services based upon a frequency, intensity and duration that have been identified as a need on a child's IFSP.
  43. All providers are required to give a 30-day prior written notice to the child's Service Coordinator and the child's family prior to terminating services for an eligible child (see 89 Illinois Administrative Code, Part 500.115(f)).
  44. All providers must accept evaluations and assessments that have been completed prior to the initial IFSP meeting or prior to referral when beginning direct services. Early Intervention will not pay for the direct service provider to duplicate evaluations and assessments completed prior to referral unless the evaluations/assessments are more than six months old.
  45. The purpose of Bilingual interpreters/translators is to interpret services necessary during the rendering of other Early Intervention services in order for the direct service provider to be able to communicate with the child and family and to provide written translation of Early Intervention documents in the child/family's native language. If the interpreter is authorized to interpret service sessions for a provider/family, the interpreter may assist that provider in scheduling service appointments for that family. A provider should never ask an interpreter to call a child's family for any purpose other than to schedule or cancel an appointment. The responsibility of the interpreter is to simply interpret the words of the provider to the family and to interpret the family's response back to the provider. It is not the responsibility of the interpreter to discuss the provision of services with the family when not in the presence of the provider.
  46. Approved Assistive Technology equipment must be delivered to the child/family as soon as possible after the vendor receives authorization.
  47. All providers of Assistive Technology services are required to provide the equipment to the child/family prior to submitting a claim for services to insurance or to the CBO.
  48. Make up sessions are allowed if the missed session is rescheduled within seven (7) days of the missed session. All providers should review the definition of Make Up Sessions found in the DEFINITIONS section of this document.