- 9.1.1 All evaluations/assessments completed for the purpose of determining initial eligibility and for the purpose of adding new or additional services to existing IFSPs shall be completed by EI credentialed/enrolled Evaluators only. This includes the evaluation/assessment to determine the need to add assistive technology services as a new service to an existing IFSP.
- 9.1.2 A minimum of two disciplines are required to complete evaluations and/or assessments to determine initial eligibility, identify the child's unique strengths and needs, identify the EI services appropriate to meet those needs and to re-determine eligibility on an annual basis.
- 9.1.3 Arena or team evaluations and/or assessments may be used. However, the evaluators should be carefully selected to ensure that each evaluator is addressing an identified area of concern.
- 9.1.4 A multidisciplinary team consisting of two or more disciplines provided by two or more providers (has conducted evaluations/assessments and/or has reviewed existing medical records and/or evaluation information in all five developmental domains and agrees with the determination of the child's EI eligibility or ineligibility.
- 9.1.5 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 9.3.7 concerning arena evaluations.
- 9.1.6 EI Definitions for evaluation and assessment:
- Evaluation -the procedures used by qualified personnel to determine a child's initial and continuing eligibility.
- Initial evaluation - the evaluation to determine the child's initial eligibility.
- Evaluation services include:
- administration of an evaluation tool
- collection of child history (includes parent interview);
- identification of the child's level of functioning in each of the five developmental areas;
- gathering information from other sources such as family members or caregivers; and
- review of medical, educational, or other records.
- Assessment - the ongoing procedures used by qualified personnel to identify the child's unique strengths and needs and the EI services appropriate to meet those needs throughout the child's eligibility under EI.
- Initial assessment - the assessment of the child conducted prior to the child's first IFSP meeting.
- Assessment services include:
- review of results of the evaluation;
- personal observations of the child; and
- identification of the child's needs in each of the developmental areas:
- Cognitive development
- Physical development
- Communication development
- Social or Emotional development
- Adaptive development
- 9.1.7 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 Public Health laws to share HIV/AIDS information without specific consent.
- 9.1.8 All five developmental domains must be reviewed during evaluation for eligibility. Eligibility procedures must include a multidisciplinary process to determine the child's level of functioning in each domain and to determine the need for any additional specialized evaluations/assessments that may be needed prior to writing the initial IFSP.
- 9.1.9 All reports, including those for initial and annual evaluation/assessments must be provided to the Service Coordinator within 14 calendar days of the receipt of the request to perform the evaluation or assessment. In extenuating circumstances, if the report cannot be completed within those 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.
- 9.1.10 Unless sufficient extenuating circumstances exist and are documented in a letter from the CFC Manager, a provider must attend the full IFSP meeting in order to be paid for an assessment or evaluation/assessment. Providers who do not participate in the full IFSP meeting do not receive authorization for attendance at the meeting. If a provider does not show the extenuating circumstances letter, the assessment or evaluation/assessment claim will be denied by the CBO.
- 9.1.11 All reports, including initial evaluation/assessment reports must be provided in the parent(s)/guardian's native language and a copy of all reports must be provided to the parent(s)/guardian. A copy of each original (and each translated, if needed) report must be retained in the child's permanent record.
9.2 Eligibility Policy
Children residing in Illinois who are under the age of three years and their families are initially eligible for EI services if written evaluation/ assessment reports completed by a multidisciplinary team confirm that the child has a:
- Developmental Delay
"Developmental delay" means a DHS-determined eligible level of delay (30% or greater) exists in one or more of the following areas of childhood development: cognitive; physical; communication; social or emotional; or adaptive. The eligible level of delay must have been:
- Measured by DHS approved diagnostic instruments and standard procedures; (see the following Evaluation/Assessment Instruments list) or
- If a child is unable to be appropriately and accurately tested by the standardized measures available, informed clinical judgment of the qualified staff based upon multidisciplinary evaluation may be used to document the level of delay.
- Medical Conditions Resulting in Developmental Delay
A "Physical or mental condition which typically results in developmental delay" means a medical diagnosis or a physical or mental condition which typically results in developmental delay. The medical or mental condition must have been:
- Approved by DHS as an eligible condition; (see the Medical Conditions Resulting in a High Probability of Developmental Delay list at the end of this Chapter) or
- Confirmed by a qualified family physician, pediatrician or pediatric sub-specialist as being a condition with a relatively well-known expectancy for developmental outcomes/within varying ranges of developmental disabilities. Pediatric sub-specialists included are those such as pediatric neurologists, geneticists, pediatric orthopedic surgeons and pediatricians with special interest in disabilities. If a child exhibits a medical condition not approved by DHS as being an eligible condition, the qualified multidisciplinary team may use written verification by one of the physician categories identified above that the child's medical condition typically results in substantial developmental delay within the varying ranges of developmental disabilities.
- At risk condition through informed clinical judgment
"At risk of substantial developmental delay, according to informed clinical judgment" means the multidisciplinary team confirms that development of a DHS determined eligible level of delay (30% or greater) is probable if EI services are not provided because the child is experiencing either:
- A parent who has been medically diagnosed as having a severe mental disorder as set forth under axis I and axis II of the Diagnostic and Statistical Manual (DSM) IV or a developmental disability; or
- Three or more of the following risk factors:
- Current alcohol or substance abuse by the primary caregiver;
- Primary caregiver who is currently less than 15 years of age;
- Current homelessness of the child. Homelessness is defined as children who lack a fixed, regular and adequate nighttime residence, in conformity with the McKinney Vento Homeless Assistance Act;
- Chronic illness of the primary caregiver;
- Alcohol or substance abuse by the mother during pregnancy with the child;
- Primary caregiver with a level of education equal to or less than the 10th grade, unless that level is appropriate to the primary caregiver's age; or
- An indicated case of abuse or neglect regarding the child and the child has not been removed from the abuse or neglect circumstances.
9.3 Eligibility Procedures
- 9.3.1 With Consent, the Service Coordinator must obtain any existing medical records including existing evaluations or other records for review.
- 9.3.2 The Service Coordinator must review the existing records to determine:
- A physical or mental condition exists which typically results in developmental delay;
- An already-determined level of functioning in one or more of the developmental areas exists which constitutes an Early Intervention developmental delay of 30% or greater; or
- An at-risk condition exists meeting the eligibility criteria of at-risk condition(s).
- For meeting Developmental Delay eligibility, ensure the medical records and/or evaluations are current (within the last six months).
- 9.3.3 If existing medical records and/or evaluations do indicate eligibility, then, based on the concerns of the child/family, the Service Coordinator must ensure that the following steps occur:
- Authorize credentialed/enrolled evaluators to perform multidisciplinary assessments. Existing medical records and/or reports/records (including the Intake Social History/Summary Sheet) must be shared with the evaluator.
- Ensure the assessment process:
- occurs prior to the initial IFSP meeting;
- fully addresses all five developmental domains;
- includes reports written in the required EI report format; and
- includes the timely return of the reports.
- has the evaluators attend the IFSP meeting.
- 9.3.4 If existing medical records and/or evaluations do not indicate eligibility, then, based on the concerns of the child/family, the following steps should occur:
- With consent, authorize credentialed/enrolled evaluators to perform multidisciplinary evaluations/assessments to determine initial eligibility. Existing medical records and/or reports/records must be shared with the evaluator if relevant. The Intake Social History/Summary Sheet must be shared as well.
- Ensure the multidisciplinary team is created based on the concerns of the family.
- Ensure the evaluation/assessment process:
- occurs prior to the initial IFSP meeting;
- fully addresses the five developmental domains;
- determines eligibility;
- includes reports written in the required EI report format;
- includes the timely return of the reports; and
- has the evaluators attend the IFSP meeting.
- 9.3.5 Ensure all reports are submitted in the required EI report format. This includes reports submitted for a medical diagnostic evaluation. Reports that are not fully completed or reports that have added components such as recommendations for frequency, intensity, length and duration should be returned to the provider with the request to immediately correct and resubmit the report. Recommendations for frequency, intensity, length and duration of services are made at the IFSP meeting and must be based upon the functional outcomes developed by the IFSP team as a whole.
- 9.3.6 Physician's orders (prescriptions) are not required to complete initial assessments or evaluations/assessments 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.
- 9.3.7 Evaluations/assessments, eligibility determination and IFSP development may occur on the same day only if the following criteria apply:
- All required intake activities and a review of existing records has been previously completed as required in the Intake and Eligibility chapters of this manual;
- The family has been contacted and has agreed to the completion of assessments, evaluation/assessments, eligibility determination and the development of the IFSP on the same day;
- 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. NOTE: Service Coordinators must always include activities that will occur on the agreed to date in the letter of prior notice to the family;
- The most appropriate composition of the evaluation team has been determined using developmental information obtained through the Referral and Intake processes;
- The review of existing records and the completion of the assessments or evaluations/assessments have provided sufficient information regarding each developmental domain to ensure development of a comprehensive plan if the child is determined eligible;
- 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;
- Including the reason for the team's decision; and
- 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 lack 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.
9.4 Evaluation/Assessment Authorization Procedure
- 9.4.1 All EI services shall be authorized prior to provision of services. The only exception to this rule is the Individualized Family Service Plan (IFSP) meeting. Assessment and evaluation/assessment authorizations must be generated and provided to the Evaluator timely and prior to service provision.
- Use the Cornerstone system to generate authorizations for needed assessments or evaluations/assessments 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.
- Authorize appropriate time based on the activities of assessment or evaluation/assessment processes. Remind providers to only bill time used if an authorization is written for time in excess of the actual time needed to perform the steps of assessment or evaluation/assessment.
- Utilize only credentialed/enrolled Evaluators to complete initial assessment or evaluations/assessments to determine initial eligibility or to determine the need to add new services to an existing IFSP.
- Provide a copy of the signed Consent for Release of Information, Parental Consent and Ability to Decline Services and Consent to Collect and Store Personally Identifiable Information (PII), Intake/Social History Summary Sheet to each member of the evaluation team. These documents give permission for release, review and discussion of assessment reports.
- 9.4.2 Monitor the status of assessment or evaluation/assessment activities in order to ensure completion in a timely manner.
- If needed, generate a transportation authorization to an enrolled transportation provider to transport the family to evaluation locations if necessary
- If a transportation provider is not available, if necessary, request a DHS Provisional service authorization using the Provisional Provider Authorization Request form for reimbursement of family transportation expenses to evaluation locations. Provisional service authorizations must be approved prior to service delivery. See Chapter 12, sections 12.7 and 12.8 for Provisional Provider policies and procedures.
- 9.4.3 Ensure the evaluation team attends the 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.
- 9.4.4 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.
9.5 Discontinuation of Services - Family Choice
If a family removes a child from services prior to reaching age three years and the child is later referred again, the child must meet eligibility criteria in effect at the time of the subsequent referral in order to be re-enrolled. NOTE: Service Coordinators must complete all steps required to complete an initial IFSP when re-enrolling a child that was previously removed from the program, beginning with the Intake process.
9.6 Exception to 45-Day Timeline Due to Family Unavailability
If the child or parent is unavailable to complete the initial evaluation, the initial assessments of the child and family or the initial IFSP meeting due to exceptional family circumstances that are documented in the child's EI records, or the parent has not provided consent for the initial evaluation/assessment of the child despite documented repeated attempts by the Service Coordinator, the 45-day timeline does not apply for this period.
Eligibility must be re-determined at the end of each annual IFSP period using DHS-determined eligibility criteria in effect at the time of the annual evaluation/assessment period. NOTE: Refer to Chapter 12.11 and 12.12 for the required annual review policy and procedure.
Children who do not meet current eligibility criteria upon re-determination will continue to be eligible only if they:
- Exhibit any measurable delay or have not attained a level of development in one or more developmental areas that is at least the mean of the child's age equivalent peers; and
- Have been determined by the multidisciplinary IFSP team to require the continuation of EI services in order to support continuing developmental progress.
When eligibility for EI services is reviewed at any time thereafter, Service Coordinators shall determine a family's enrollment status in AllKids. If the child is not enrolled in AllKids, and the child may be eligible, with parent consent complete an All Kids Application and make a referral to DSCC, if indicated.
9.8 Children Found Eligible for EI Services
If the child is eligible for EI complete the following steps:
- 9.8.1 Enter Cornerstone eligibility determination information. NOTE: Refer to the Cornerstone Reference Manual for instructions.
- 9.8.2 Send Sample Letter 17: Eligible - No Further Assessment Needed to provide written notice of the child's eligibility. With parental consent, see Chapter 8 - Intake, provide a copy to the referral source.
- 9.8.3 Coordinate and authorize any additional evaluations/assessments needed for the development of the IFSP. Utilize only credentialed/ enrolled evaluators to complete initial evaluations/assessments.
- 9.8.4 Contact the family to discuss eligibility.
- 9.8.5 If the family has not already provided this information, inform the family that written proof of income and insurance will be requested at the time of IFSP development, including proof of All Kids enrollment if applicable. Follow policy and procedures outlined in Chapter 10 - Public and Private Insurance Use Determination and Chapter 11 - Family Fees chapters.
9.9 Children Found Not Eligible for EI Services
If the child is NOT eligible for EI the Service Coordinator shall complete the following activities:
- 9.9.1 Contact the family in order to provide verbal notification of ineligibility for EI.
- 9.9.2 Provide written notification of ineligibility determination to the family by sending Sample Letter 14: Ineligible - Initial Eligibility Determination indicating EI ineligibility and right to dispute the determination. (Refer to Chapter 6 - Disputes). With receipt of a signed Consent to Release Information form (see Chapter 8 - Intake), copy the referral source at initial eligibility determination.
- 9.9.3 Provide ten (10) days notice before discontinuing services if the child was found ineligible through annual re-evaluation. Send Sample Letter 15: Ineligible - Annual Eligibility Determination.
- 9.9.4 Discuss other community resources and refer to those resources, as appropriate.
- 9.9.5 Document the child's ineligibility for EI in Cornerstone case notes.
- 9.9.6 Edit the child's level of delay on the EI Program Data screen, if necessary.
- 9.9.7 Complete case closure. (Refer to Chapter 14 - Transfer and Case Closure).
A list of a non- exclusive list can be found at Approved Assessment Instruments (http://www.dhs.state.il.us/page.aspx?item=54205).
A list of Medical Conditions Resulting in High Probability of Developmental Delay and DSCC Screening Information can be found at:(http://www.dhs.state.il.us/page.aspx?item=31244)