Chapter 9: Eligibility Criteria, Evaluation and Assessment - REVISED 02/2014

9.1 Eligibility Criteria in Illinois

Children residing in Illinois who are under the age of 3 years old and their families are eligible for EI services if a child has one of the following:

9.1.1 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 (including vision and hearing), 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 and Assessment Instruments list); or
- If a child is unable to be appropriately and accurately tested by the standardized measures available, informed clinical opinion of the qualified staff based upon multidisciplinary evaluation may be used to document the level of delay.
9.1.2 Physical or Mental 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 include 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.

9.1.3 At Risk Condition Through Informed Clinical Opinion
At risk of substantial developmental delay, based on informed clinical opinion means that there is a consensus of qualified staff based upon multidisciplinary evaluation and assessment that development of a Department-determined eligible level of delay is probable if EI services are not provided, because a child is experiencing either:
- A parent who has been medically diagnosed as having a mental illness or serious emotional disorder defined in the Diagnostic and Statistical Manual 5 (DSM 5); or
- Three or more of the following risk factors:
  1. Current alcohol or substance abuse by the primary caregiver;
  2. Caregiver who is currently less than 15 years of age;
  3. 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;
  4. Chronic illness of the primary caregiver;
  5. Alcohol or substance abuse by the mother during pregnancy with the child;
  6. Primary caregiver with a level of education equal to or less than the 10th grade, unless that that level is appropriate to the primary caregiver's age; or
  7. An indicated case of abuse or neglect regarding the child and the child has not been removed from the abuse or neglect circumstances.

9.2 Evaluation of Child

9.2.1 EI definitions for Evaluations
- Initial Evaluation - the procedures used by qualified personnel to determine the child's initial eligibility.
- Evaluation - the procedures used by qualified personnel to determine a child's initial and continuing eligibility.
9.2.2 Initial Evaluations to determine eligibility shall be completed by EI credentialed/enrolled Evaluators only. Evaluations to determine on-going eligibility shall be completed by EI credentialed/enrolled providers. A minimum of two or more separate disciplines are required to complete Initial Evaluations and Evaluations.
9.2.3 Evaluation services to evaluate the child shall include:

administration of the evaluation tool;
collection of the child's history (including interviewing the parent);
identification of the child's level of functioning in each of the five developmental areas;
gathering information from other sources such as family members, other care-givers, medical providers, social workers and educators, if necessary, to understand the full scope of the child's unique strengths and needs; and
reviewing medical, educational, and other records.

9.2.4 With consent, the Service Coordinator must obtain any existing medical records, educational records, i.e. Early Head Start, existing evaluations or therapy records, or other records for review. The Service Coordinator must review the existing records to determine if initial eligibility is met based on existing records in one of the following ways:

An already-determined level of functioning in one or more of the developmental areas exists which constitutes an EI developmental delay of 30% or greater (See Developmental Delay).

NOTE: For meeting eligibility based on these criteria, ensure the medical records and/or evaluations are current within the last six months.

A physical or mental condition exists that has a high probability of resulting in delay (See Medical Conditions Resulting in Developmental Delay).
At Risk eligibility should be determined based upon the appropriate records to establish the At Risk criteria. (See At Risk Condition Through Informed Clinical Opinion)

9.2.5 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.
9.2.6 If existing medical records, educational records, evaluation records or other records DO establish Initial Eligibility, Initial Evaluations are not required. However, the Service Coordinator must do the following:
- With consent, authorize credentialed/enrolled evaluators to perform multidisciplinary Initial Assessments of the child.
- With consent, share existing medical records and/or reports used to determine initial eligibility (including the Intake Social History/Summary Sheet), and the signed Consent for Release of Information, Parental Consent and Ability to Decline Services and Consent to Use Personally Identifiable Information (PII) & Bill Public Benefits with the Evaluators.
9.2.7 If existing medical records and/or evaluations DO NOT indicate eligibility, the Service Coordinator must do the following:
- With consent, authorize credentialed/enrolled evaluators to perform Initial Evaluations and Initial Assessments of the child.
- With consent, share existing medical records and/or reports, if relevant and the Intake Social History/Summary Sheet), and the signed Consent for Release of Information, Parental Consent and Ability to Decline Services and Consent to Use Personally Identifiable Information (PII) & Bill Public Benefits with the Evaluators.
9.2.8 Unless clearly not feasible to do so, evaluations must be conducted in the language normally used by the child.
9.2.9 Use developmental information obtained through the Referral and Intake processes to help determine the most appropriate composition of an evaluation team for each child.

9.3 Assessment of Child and Family

9.3.1 EI definitions for Assessments
- Initial Assessment - the assessment of the child and family conducted prior to the child's first IFSP meeting.
- 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, which includes the assessment of the child and the child's family.
9.3.2 Initial Assessments of the child shall be completed by EI credentialed/enrolled Evaluators only. Assessments of the child and family to determine on-going services shall be completed by EI credentialed/enrolled providers. A minimum of two or more separate disciplines are required to complete Initial Assessments and Assessments.
Assessments of the child shall include:

a review of the results of the evaluations;
personal observations of the child;
identification of the child's needs in each of the developmental areas (cognitive development, physical development, communication development, social or emotion development and adaptive development).
If medical records determined eligibility, the assessment of the child shall also include the review of those records.

Unless clearly not feasible to do so, assessments of the child must be conducted in the language normally used by the child.
9.3.3 The family directed assessment shall be completed by Service Coordinators. See Section 8.1.8 for details. Family directed assessment includes an assessment of the resources, priorities, and concerns of the family and the identification the supports and services necessary to enhance the family's capacity to meet the developmental needs of that infant or toddler.
The family-directed assessment must:

be voluntary on the part of each family member participating in the assessment;
be based on information obtained through an assessment tool and also through an interview with those family members who elect to participate in the assessment; and
include the family's description of its resources, priorities, and concerns related to enhancing the child's development.

Unless clearly not feasible to do so, assessments of the family must be conducted in the native language of the family members being assessed.

9.4 Prior to the IFSP Team Meeting

9.4.1 The Service Coordinator is responsible to ensure the following occurs with respect to the Initial Evaluation (if needed), the Initial Assessment of the child and the family directed assessment:

occur prior to the initial IFSP meeting;
fully address the five developmental domains; and
includes the timely return of the reports.

9.4.2 Physician's orders (prescriptions) are not required to complete initial evaluations or initial assessments, 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.
9.4.3 The Service Coordinator shall be responsible for arranging any additional evaluations or assessments that may be needed prior to writing the initial IFSP.

9.5 Reports

9.5.1 All reports, including those for Initial Evaluation, Evaluation, Initial Assessment, and Assessment must be provided to the Service Coordinator within 14 calendar days of the receipt of the request to perform the service. 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.
9.5.2 The Initial Evaluation, Evaluation, Initial Assessment and Assessment reports must be provided in the parent(s)/guardian(s) in their native language. A copy of each original (and each translated, if needed) report must be retained in the child's permanent record.
9.5.3 Service Coordinators shall ensure all reports are submitted in required EI report formats. 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.
9.5.4 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.

9.6 IFSP Team Meeting

9.6.1 The IFSP Team Meeting must occur within 45 days of the referral unless an exception applies. 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 time line does not apply for this period.
9.6.2 The initial evaluation, the initial assessments (of the child and family), and the initial IFSP meeting should be completed as soon as possible after the documented exceptional family circumstances no longer exist or parental consent is obtained for the initial evaluation and the initial assessment of the child. An interim IFSP should be developed, to the extent appropriate.

9.7 Arena or Team Evaluations

9.7.1 Arena or team evaluations and/or assessments may be used. Initial Evaluations, Initial 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 the Initial Evaluations, Initial 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. Documentation must include:
  1. the evaluation team's determination regarding eligibility;
  2. including the reason for the team's decision; and
  3. 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.

9.8 Authorization for IFSP Meeting

The Service Coordinator shall 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. 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.

9.9 Attendance of IFSP Meeting

Providers must attend the entire IFSP meeting in order to receive authorization for payment. 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 the Initial Evaluation, Evaluation, Initial Assessment and 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 provider claim will be denied by the CBO.
- 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 CBO to process payment.

9.10 Required IFSP Meeting

If the child is eligible for EI, an IFSP meeting must be held. See Chapter 12 for additional information.

9.11 IFSP Meetings for Ineligible Children

If the child is NOT eligible, DO NOT have an IFSP meeting. The initial evaluating/assessing providers should submit claims for the evaluations/assessments completed. IFSP meeting (IM) authorizations are NOT required for billing the evaluation/assessment since no IFSP meeting will be held due to a child being found not eligible.

The EI Service Coordinator shall complete the following activities:

Contact the family in order to provide verbal notification of ineligibility for EI.
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.
Discuss other community resources and refer to those resources, as appropriate.
Document the child's ineligibility for EI in Cornerstone case notes.
Complete case closure. (Refer to Chapter 14 - Transfer and Case Closure).

9.12 Continuing Eligibility

9.12.1 Eligibility must be re-determined at the end of each annual IFSP period using the same steps as used when completing the Initial Evaluation and Initial Assessment.
NOTE: Refer to Chapter 12.11 and 12.12 for the required annual review policy and procedure.
9.12.2 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.
- If the child is no longer eligible:
  - Contact the family in order to provide verbal notification of ineligibility for EI.
  - 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.
  - Discuss other community resources and refer to those resources, as appropriate.
  - Document the child's ineligibility for EI in Cornerstone case notes.
  - Edit the child's level of delay on the EI Program Data screen, if necessary.
  - Complete case closure. (Refer to Chapter 14 - Transfer and Case Closure).
9.12.3 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.

9.13 Discontinuation of Services - Family Choice

9.13.1 If a family removes a child from services prior to reaching the age of 3 years old 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.

Approved Evaluation/Assessment Instruments - (Not an exclusive list)

Below are approved evaluation/assessment instruments by developmental area.

Note: Approved Discipline(s): All Evaluation/Assessment Tools must be used by a professional with training and credentials and meet the requirements specified by the particular test instrument.

Global

Assessment Evaluation & Programming System (AEPS)
Alpen-Boll Developmental Profile II
Batelle Developmental Inventory
Carolina Curriculum for Infants and Toddlers
Child Developmental Inventory (CDI)
Early Learning Accomplishment Profile (ELAP)
Infant Development Inventory (IDI)
INSITE (for visually impaired)
Hawaii Early Learning Profile (HELP)
Infant Toddler Developmental Profile (IDA)
Mullen Scales of Early Learning (MSEL)
Reynell-Zinkin Scales: Developmental Scales for Young Handicapped Children
Transdiscplinary Play Based Assessment (TPBA)

Cognitive

Bayley Scales of Infant Development-Mental
Functional Emotional Assessment Scales (FEAS)
Infant Toddler Sensory Profile
Pediatric Evaluation of Disability Inventory (PEDI)
Test of Sensory Functioning in Infants
Vineland Adaptive Behavior Scales (VABS)

Motor

Alberta Infant Motor Scale
Bayley Scales of Infant Development- Motor
Erhardt Developmental Test of Prehension
Gross Motor Functional Measures (must be used in combination with a tool that provides age equivalents or % delay)
Peabody Developmental/ Motor Test 2
Test of Infant Motor Performance (TIMP)
TIME: Miller

Adaptive

Early Coping Inventory
Functional Emotional Assessment Scales (FEAS)
Functional Independence Measures (WEE FIMS)
Infant Toddler Sensory Profile
Pediatric Evaluation of Disability Inventory (PEDI)
Test of Sensory Functioning in Infants
Vineland Adaptive Behavior Scales

Communication

Callier-Azusa Scale
Communication & Symbolic Behavior Scales (CSBS) (must use all 3 portions: Infant Toddler Checklist, Caregiver Questionnaire, & Behavioral Sample)
Early Language Milestone Scales (ELM-2)
MacArthur Communicative Developmental Inventory
Non-Speech Test
Pre-School Language Scale (PLS 3 or 4)
Receptive Expressive Emergent Language Scale (REEL)
Reynell Developmental Language Scales-American Version
Rosetti Infant Toddler Language Scale
Sequenced Inventory of Communication Development (SICD)
SKI-HI Learning Development Scales (Hearing Impaired 0-3)

Articulation

(must be used in combination with one of the approved communication tools for evaluation & assessment)

Assessment of Phonological Processes-R (English & Spanish)
Goldman-Fristoe Test of Articulation
Hodson Phonological Screening
Paden Phonological Screening
Spanish Articulation Measure (SPAM)

Social Emotional

Achenbach Child Behavior Checklist
Carey Temperment Scales (must be used with tool that provides age equivalents or % delay)
Early Coping Inventory
Functional Emotional Assessment Scale (FEAS)
Infant-Toddler Social and Emotional Assessment (ITSEA)
Temperament & Atypical Behavior Scale (TABS)
Vineland Social Emotional Early Childhood Scale

Hearing

Conditioned Play Audiometry (CPA)
Otoacoustic Emissions (OAE)
Speech Awareness Thresholds (SAT)
Speech Discrimination Test
Visual Reinforcement Audiometry (VRA)

Vision

Erhardt Developmental Test of Vision
The Oregon Project Global Assessment Tool (assessment only)

Other

* Autism Diagnostic Observation Scale (assessment)

NOTE: Providers may use tools that are not identified on this list if the tool meets all of the following criteria:

The tool is listed in the Mental Measurement Yearbook Series;
The tool is nationally distributed;
The tool is age appropriate;
The tool has been formally validated;
The tool is individually administered; and
The tool has been approved for use by the Illinois Department of Healthcare and Family Services (HFS).

It is the responsibility of the provider to present proof of the above criteria to the DHS EI Program for HFS review and approval. The Mental Measurement Yearbook Series can be found at the Early Childhood Intervention Clearinghouse, many local libraries and by visiting the website at www.Buros.org. There is a cost to access some of the materials found on this website.
Children with undiagnosed medical conditions or who may require further medical evaluation may be referred for a medical diagnostic evaluation. If you have any questions regarding these eligible medical conditions or medical diagnostic services, please contact your developmental pediatrician consultation contractor.