Chapter 12: Individualized Family Services Plan (IFSP) - REVISED - 02/2014

12.1 Interim IFSP Policy

• 12.1.1 An interim IFSP may be needed pursuant to IDEA regulations 34 CFR 303.310(c)(3) and 303.345 for children for whom the following has been determined:
  • If there are exceptional circumstances that make it impossible to complete the evaluation and assessment within 45 days and the Service Coordinator has documented those circumstances in the child's EI record (for example, the child or parent has been hospitalized); or
  • Obvious immediate needs were identified, even at the time of referral that would ensure the completion of evaluations/ assessments that will determine the child eligible for EI services (e.i. a physician recommends that a child with cerebral palsy begin receiving physical therapy for developmental issues as soon as possible). NOTE: In this case evaluations/assessments and eligibility determination must still occur and the initial IFSP must still be developed within the 45-day time line.
• 12.1.2 An interim IFSP may not be used to extend the 45-day time line unless 12.1.1 above applies.
• 12.1.3 A physician's prescription must be obtained prior to direct service provision, routed to the appropriate service provider and a copy maintained in the CFC permanent record for each of the following EI services/service providers:
  • Audiology and aural rehabilitation services provided by licensed Audiologists or licensed Speech-Language Pathologists;
  • Occupational therapy services provided by licensed Occupational Therapists;
  • Physical therapy services provided by licensed Physical Therapists; and
  • Speech-language therapy services provided by licensed Speech-Language Pathologists.

12.2 Interim IFSP Procedure

• 12.2.1 The Service Coordinator shall determine whether an interim IFSP is needed pursuant to Individuals with Disabilities Education Act regulations 34 CFR 303.310(c)(3) and 303.345. If so, document the reason(s) the interim IFSP is needed in case notes. NOTE: An interim IFSP is not to be used to extend the 45-day time line unless exceptional circumstances can be documented.
• 12.2.2 An interim IFSP can be implemented if there are exceptional circumstances that make it impossible to complete the evaluation and assessment within 45 days (i.e., child is ill). If exceptional circumstances have been determined:
  • Document the exceptional circumstances that made it impossible to complete the evaluation and assessment within the 45-day time frame;
  • Develop and implement an interim IFSP to the extent appropriate and consistent with §303.345(a) and (b).
• 12.2.3 An interim IFSP can be developed if obvious immediate needs were identified even at the time of referral. NOTE: In this case eligibility must still be determined and the initial IFSP must be developed within the 45-day time line.
  • Document that obvious immediate needs were identified even at the time of referral. NOTE: An interim IFSP is not to be used to extend the 45-day time line unless exceptional circumstances (see 12.1.1 above) can be documented; and
  • Develop an interim IFSP to the extent appropriate and consistent with §303.345(a) and (b).
• 12.2.4 Within §303.345(a) and (b), it states that an interim IFSP can be developed prior to evaluation and assessments if the following conditions are met:
  • Parental consent is obtained;
  • The interim IFSP includes the name of the Service Coordinator who will be responsible for implementation of the interim IFSP and coordination with other agencies and persons; and
  • The interim IFSP includes the EI services that have been determined to be needed immediately by the child and the child's family.
• 12.2.5 Communicate with the family to arrange for a meeting time and location.
• 12.2.6 Provide reasonable prior written notice to the family and other participants of this meeting.
• 12.2.7 Assist the family in determining their ability to participate in the cost of services that are subject to fees.
• 12.2.8 Enter the interim IFSP dates in Cornerstone and complete the IFSP form with the child's parent/guardian and with input from the IFSP team members who recommended immediate services for the child and family.
• 12.2.9 Work with family to ensure that prescriptions for direct services are obtained prior to service provision as necessary.
• 12.2.10 Ensure that the services being discussed are appropriate to the needs of the child and/or family.
• 12.2.11 Facilitate the selection of available providers as described in Provider Selection and as required by applicable private insurance requirements. (NOTE: Private insurance may not be used for evaluation/assessment activities).
• 12.2.12 Generate authorizations for appropriate EI services using the Service Authorization screen in Cornerstone.
• 12.2.13 Arrange for the interim IFSP to be implemented.
• 12.2.14 Request service reports at the end of the interim IFSP period and monitor provision of services.
• 12.2.15 Maintain the child's permanent and electronic record during the interim IFSP period.
• 12.2.16 Ensure that evaluations/assessments and Initial IFSP activities are completed within the 45-day time frame unless the above applies and the evaluations/assessments or Initial IFSP could not be completed due to exceptional circumstances within the required 45-day time frame outlined in 12.1.1 above.

12.3 Initial/Annual IFSP Development Policy

• 12.3.1 All IFSP meetings must be conducted as follows:
  • In settings and at times that are convenient for the family; and
  • In the native language of the family or other mode of communication used by the family unless it is clearly not feasible to do so.
  • With consent of the parent/guardian.
• 12.3.2 Meeting arrangements must be made with, and written prior notice provided to, the family and other participants early enough before the meeting date to ensure that they will be able to attend.
• 12.3.3 All IFSP meetings must include the following participants:
  • The parent or parents of the child;
  • Other family members, as requested by the parent, if feasible to do so;
  • An advocate or person outside of the family if the parent requests that the person participate;
  • The service coordinator responsible for implementing the IFSP;
  • The providers who completed the evaluations/assessments; and
  • As appropriate, providers who will be providing early intervention services to the child/family (annual IFSP review meeting).
• 12.3.4 At the meeting to develop the IFSP the Service Coordinator shall:
  • Coordinate and participate in the IFSP meeting;
  • Ensure that the meeting is conducted in the parent's native language or other mode of communication, unless it is clearly not feasible to do so, or that an interpreter is present to interpret what is discussed;
  • Seek a consensus by the multidisciplinary team regarding child outcomes. The IFSP team will measure each child's functioning as compared to same-age peers related to the following three outcomes:
  • positive social-emotional skills, including social relationships;
  • acquisition and use of knowledge of skills; and
  • use of appropriate behaviors to meet needs.
  • Seek a consensus by the multidisciplinary team regarding, functional outcomes, goals and objectives and an integrated plan to meet the outcomes ensuring appropriate services are agreed to that have scientifically-based research to help meet the goals and objectives;
  • If no consensus is reached, the Service Coordinator may establish a DHS-approved service plan (IFSP) that is consistent with DHS guidelines (EI policies/procedures) that will be reviewed by DHS designated experts (clinical technical assistance consultant(s) under contract by CFC offices);
  • Provide the parents with prior written notice of the DHS proposed service plan IFSP. The parents may seek mediation or a due process hearing officer regarding other requested services; and
  • Complete the Consent for Release of Information for Children With Identified Hearing Loss form and submit the form to the Illinois Department of Public Health (IDPH) Vision and Hearing Screening Program at the address identified on the form if the child meets any of the following criteria: 1) the child presented with an identified hearing loss during initial enrollment; 2) the child was referred from an IDPH Newborn Hearing Program with a confirmed hearing loss; 3) an identified hearing loss was confirmed after the initial IFSP meeting; or 4) the family of a child with an identified hearing loss chose not to accept EI services.
• 12.3.5 The IFSP is an important document. Those portions of the IFSP completed by hand must be legibly completed in ink.
• 12.3.6 The IFSP is a confidential document. Photocopies of the completed IFSP must be distributed to the family, providers and other individuals/agencies/physicians as soon as reasonably possible but no more than 15 business days after the completion of the IFSP meeting as directed by the parent's informed, signed consent on Section 7 of the IFSP (Implementation and Distribution Authorization). NOTE: AT and Transportation providers are not required to receive a copy of the IFSP.
• 12.3.7 The original signed IFSP is maintained in the child's permanent record housed at the CFC office.
• 12.3.8 All necessary services for each eligible child as agreed upon by the IFSP team, including the family, must be documented on the IFSP regardless of availability.
• 12.3.9 DHS shall not pay for services listed on the IFSP that DHS is not required to fund.
• 12.3.10 EI funding is the payor of last resort for IFSP services that DHS is required to fund.
• 12.3.11 A physician's prescription must be obtained prior to direct service provision, routed to the appropriate service provider and a copy maintained in the child's permanent record for each of the following EI services/service providers:
  • audiology and aural rehabilitation services provided by licensed Audiologists or licensed Speech-Language Pathologists;
  • occupational therapy services provided by licensed Occupational Therapists;
  • physical therapy services provided by licensed Physical Therapists;
  • speech-language therapy services provided by licensed Speech-Language Pathologists.
• 12.3.12 Decisions regarding services for each individual child are made by consensus of the IFSP team, including the parents. EI services should be based on a collaborative relationship between families and providers that emphasizes the family's role as central in EI activities. Frequency of developmental services should depend on the amount of time necessary for the family to incorporate new techniques into family routines and re-evaluation/assessment of the child's response to the developmental services.
• 12.3.13 The family is the primary interventionist and the primary foundation of their child's optimum development in all areas. In order for developmental services to be successful, it is essential for families to be involved in facilitating carryover to daily living activities. This means that the most important goal of the EI provider/family collaboration is to support the child's participation in the family and his/her functional/natural environment.
• 12.3.14 Intervention services should be considered as a means of achieving the functional outcomes that have been determined by the IFSP team. Specific strategies should be collaborative and interdisciplinary, avoiding unnecessary duplication of similar activities by multiple EI providers.
• 12.3.15 The inclusion of specific services in the intervention plan should never be based solely on the presence of a medical diagnosis or delay. Developmental services must be linked to specific developmental functional outcomes, regardless of the underlying cause of the developmental delay.
• 12.3.16 Acute rehabilitative therapy is not a developmentally based service, but is a medically based service that is provided by other resources outside the EI arena. Once the condition has become sub-acute or chronic, EI services to treat the developmental delay(s) can and should be provided by the EI Program.
• 12.3.17 Evaluations, eligibility determination and IFSP development may occur on the same day if the following criteria apply.
  • All required intake activity has been previously completed with the family, a review of existing records has occurred and the appropriate composition of the evaluation team has been determined. NOTE: See Chapter 8 -Intake and Chapter 9 - Eligibility Criteria, Evaluation and Assessment of this manual for steps that must be completed prior to the development of the IFSP.
  • The family has been contacted and has agreed to the completion of evaluations, eligibility determination and the development of the IFSP on the same day. NOTE: A minimum of two disciplines is required to complete evaluations to determine initial eligibility and to re-determine eligibility on an annual basis. Arena or team evaluations may be used. However, the evaluators should be carefully selected to ensure that each evaluator is addressing an identified area of concern. Use developmental information obtained through the Referral and Intake processes to help determine the most appropriate composition of an evaluation team for each child.
• 12.3.18 If a family agrees to allow evaluations, eligibility determination and IFSP development to occur on the same day, the Waiver of Written Prior Notice form must be completed on that day in the presence of the family and the following information must be documented in writing:
  • the evaluation team's determination regarding eligibility;
  • the reason for the team's decision;
  • the procedural safeguards available to the parent, including the right to refuse EI service; 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 does not have sufficient support to proceed, the Service Coordinator should 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.
  • Natural Environments - If it is determined that a specific service must be provided in a setting other than a natural environment, the IFSP team must complete the Natural Environments Worksheet to justify the decision to provide the service(s) in a non-natural environment.

12.4 Initial/Annual IFSP Development Procedure

• 12.4.1 The Service Coordinator must review existing records to identify whether additional information is needed to determine the child's current health status and medical history and, if so, complete the Consent for Release of Information form in order to acquire the additional information and to release that information to members of the IFSP team. A separate form containing an original parent signature must be completed to acquire and to release information for each entity that information will be acquired from or released to.
• 12.4.2 The Service Coordinator must review existing records and evaluation reports to identify whether additional information is needed to determine the child's functioning levels, unique strengths and needs and the services appropriate to meet those needs in the five developmental domains (cognitive development; physical development including vision and hearing; communication development; social-emotional development; and adaptive self-help skills) and, if so, arrange for additional evaluation/assessment activities, as described in Chapter 9-Eligibility Criteria, Evaluation and Assessment.
• 12.4.3 Within 45 days of referral the Service Coordinator must arrange for a meeting to be held at a time and place convenient for the family in order to develop the IFSP. Central locations may be used when scheduling IFSP meetings in order to maximize attendance and facilitate timeliness as long as the location is convenient to the family and the family has agreed to the time and place. This meeting must include the child's parent/guardian and other family members by parental request, the Service Coordinator, a person or persons directly involved in conducting the evaluation/ assessments, and others such as an advocate or person outside the family by parental request. Send a copy of the Sample Letter 18: Confirmation of IFSP Meeting to the family and all entities that will participate in the IFSP meeting. File a copy of the letter in the child's CFC permanent record.
• If a documented Family Exceptional Circumstance or the parent has not provided consent for the initial evaluation/assessment of the child despite documented, repeated attempts, the CFC must appropriate enter the code in Cornerstone when entering the IFSP begin date that is over 45-days from the referral.
• 12.4.4 Transportation services to evaluations and IFSP meetings may be authorized pre-IFSP. However, it is important to note that parents who require reimbursement for transporting their child using their private auto must enroll as a Transportation provider with the State.
• 12.4.5 Provide reasonable prior written notice to the family and other participants of this meeting.
  • Providers are required to attend the entire IFSP meeting in order to receive authorization for payment. If a person directly involved in conducting the evaluation/assessments cannot attend the meeting due to exceptional circumstances, make arrangements for the person to participate in the meeting by telephone conference call. Using a laptop computer authorize provider participation by selecting, either IFSP MEETING-OFFSITE if providers attend the IFSP in person or IFSP MEETING-ONSITE if due to extenuating circumstances, providers are not able to participate in person and must participate in the IFSP meeting by phone. NOTE: The CFC Program Manager must write a letter explaining the specific details of the extenuating circumstance they allowed for the provider. The provider must include the letter in their claim submission to the CBO.
• NOTE: EI Audiologists who perform evaluations for a child are not required to attend provided if the following two criteria are met. 1) The test results of the evaluation resulted in results within normal range in at least one or both ears and 2) the evaluation report is submitted within 14 days of the request to perform the evaluation.
  • Have the Audiologist sign the completed Individualized Family Service Plan Meeting Attendance Waiver for Audiologists form to be maintained in the record.
  • Do not provide an authorization prior to the meeting. The time allowed for billing on the authorization must equal the time that the provider was actually present at the entire meeting.
  • Providers will accept responsibility for phone charges for IFSP meeting conference calls.
  • If an evaluation completed prior to a child's referral to EI was used to assist in determining EI eligibility and the provider who completed the evaluation is enrolled in the EI Services System, the provider should be encouraged to attend the IFSP meeting. If the provider is not enrolled or if the enrolled provider is not available to attend the IFSP meeting, a credentialed evaluator of the same discipline should review the evaluation and attend the IFSP meeting.
• 12.4.6 The Service Coordinator will coordinate development of the IFSP as follows:
  • Coordinate and participate in the IFSP meeting;
  • Ensure that the IFSP meeting is conducted in the parent's native language or mode of communication unless it is clearly not feasible to do so or that an interpreter is present to interpret what is discussed;
• 12.4.7 Seek a consensus by the multidisciplinary team regarding child outcomes. The IFSP team will measure each child's functioning as compared to same-age peers related to the following three outcomes:
  • Positive social-emotional skills, including social relationships;
  • Acquisition and use of knowledge of skills; and
  • Use of appropriate behaviors to meet needs.
• 12.4.8 Discuss previously distributed evaluation and assessment reports/results;
• 12.4.9 Seek a consensus by the multidisciplinary team regarding functional outcomes, goals and objectives and an integrated plan to meet the outcomes, goals and objectives;
• 12.4.10 If it is determined that a specific service must be provided in a setting other than a natural environment, the IFSP team must complete the Natural Environments Worksheet at the meeting to justify the decision to provide the service(s) in a non-natural environment.
• 12.4.11 If no consensus can be reached by the IFSP team, the Service Coordinator will not complete a service plan prior to consultation with DHS designated experts in order to establish a DHS approved service plan, and shall then provide the parents with prior written notice regarding the proposed IFSP;
  • Complete the hard copy and electronic sections of the IFSP as indicated in the Individualized Family Service Plan (IFSP) Form Instruction document;
  • Using a laptop computer, generate IFSP meeting authorizations according to the parameters outlined in the procedure above and give the providers in attendance their authorization numbers;
  • Obtain the parent's informed, signed consent to implement services on Section 7 of the IFSP (Implementation and Distribution Authorization). Include the child's Primary Care Physician (PCP) in this section under the area that allows other individuals/agencies to receive a copy of the IFSP and any revisions made to the IFSP. It is important that the PCP be aware that the child was referred to EI, is provided information on the status of the referral and receives a copy of the IFSP if the child is deemed eligible or when a new IFSP is developed;
  • Complete the Consent for Release of Information for Children With Identified Hearing Loss form and submit the form to the Illinois Department of Public Health (IDPH) Vision and Hearing Screening Program at the address identified on the form if the child meets any of the following criteria: 1) the child presented with an identified hearing loss during initial enrollment; 2) the child was referred from an IDPH Newborn Hearing Program with a confirmed hearing loss; 3) an identified hearing loss was confirmed after the initial IFSP meeting; or 4) the family of a child with an identified hearing loss chose not to accept EI services.
  • Work with the family to ensure that prescriptions for services are obtained prior to direct service provision for EI services as required by EI, licensure and/or by insurance as necessary; and
  • Print the IFSP with approved EI service authorizations and distribute to the family, EI providers and any other entity identified on Section 7 of the IFSP (Implementation and Distribution Authorization) as soon as reasonably possible, but no more than 15 business days after the IFSP meeting. Include a copy of the Insurance Report to EI Service Providers and a copy of the Family Fee Report to the family. NOTE: A copy of the IFSP must be provided to every member of the IFSP team, with the exception of AT and Transportation providers. Send service authorization(s) and a copy of the Insurance Report to AT providers and service authorization(s) to Transportation providers.
• 12.4.12 If evaluations/assessments and the IFSP meeting were held on the same day, the Waiver of Written Prior Notice form must be completed in the presence of the family, documenting in writing the evaluation team's determination regarding eligibility, the reason for the team's decision, the procedural safeguards available to the parent, 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.

12.5 Individualized Family Service Plan Implementation Policy

• 12.5.1 The parent has the right to accept or decline any or all services without jeopardy to other services. Refusals of services or referrals shall be documented in writing. 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 the IFSP development, including all policies and procedures outlined in Chapter 10 - Public and Private Insurance Use Determination and Chapter 11 - Family Participation Fees.
• 12.5.2 Providers shall render authorized services as indicated in the IFSP. They shall provide direct service reports to the Service Coordinator at least every six months and prior to each IFSP update/review or more often if the child's progress/lack of progress warrants.
• 12.5.3 All Evaluations and/or Assessments for the purpose of adding new types of services to existing IFSPs shall be provided only by credentialed/enrolled providers who hold current Evaluation/Assessment credentials. NOTE: See the Chapter 9-Eligibility Criteria, Evaluation and Assessment of this manual.
• 12.5.4 Prior to making any changes to an existing authorization the provider(s) who is requesting a change must submit the Developmental Justification of Need to Change Frequency, Intensity or Location of Authorized Services to the service coordinator; a multidisciplinary IFSP team meeting must be scheduled at a time and place that is convenient to the family for the purpose of reviewing the proposed change(s) and to come to an agreement that the change(s) is in the best interest of the child; and the parent must be given written prior notice of the meeting and the proposed change(s) a reasonable time before the meeting and the family must be provided the State of Illinois Infant/Toddler and Family Rights under IDEA for the Early Intervention System booklet. If the team, including the family, agrees to the requested changes and the family has private health insurance, the family must be provided a copy of the Notice of System of Payments and Fees sign a new Notice to Consent and Use Private Insurance form. See the Developmental Justification of Need to Change Frequency, Intensity or Location of Authorized Services Guidelines and Worksheet.
• 12.5.5 The Illinois EI Services System is not responsible for funding early intervention services that a parent privately seeks from providers not enrolled with the system, unless an enrolled provider cannot be made available to the family. If services must be accessed outside of the System due to no available enrolled providers, those services must be pre-approved by DHS and a provisional authorization must be requested. See Chapter 12.7 & 12.8 section of this manual for steps to implement a provisional authorization.

12.6 Individualized Family Service Plan Implementation Procedure

• 12.6.1 Upon receiving the parent's informed, signed consent to implement services on Section 7 of the IFSP (Implementation and Distribution Authorization) and the compliance of Chapter 10 - Public and Private Insurance Use Determination and Chapter 11 -Family Participation Fees are followed:
  • Arrange for implementation of the IFSP utilizing available enrolled providers. Every effort shall be made to refer families eligible for DSCC services to DSCC-enrolled providers.
  • Provide copies of the IFSP as soon as reasonably possible but no more than 15 business days after the IFSP meeting to each person that the parent has consented to receive a copy, including each enrolled provider who is providing EI services to the child who is the subject of that plan and other individuals/agencies/physicians for whom the parent has consented to receive a copy of the plan. Include a copy of the Insurance Report to EI Service Providers
  • For 1) Insurance plans that are not Employer Self-Funded AND 2) Consenting families with Employer Self-Funded plans, ensure all direct service providers have the following:
  • Front and back of family's insurance card;
  • Notice to Consent to Use Private Insurance/Healthcare Plan Benefits & Assignment of Rights;
  • Parental Consent and Ability to Decline Services;
  • Consent to Use Personally Identifying Information (PII and Bill Public Insurance)
  • Provide the Family Fee Report to the family.
  • NOTE: A copy of the IFSP must be provided to every member of the IFSP team, with the exception of AT and Transportation providers.
• 12.6.2 Assist the family in monitoring the implementation of the IFSP, assess the family's satisfaction with the services and/or supports that are being provided and verify the accuracy of demographic and financial information.
  • Communicate monthly with the family via a face-to-face meeting or phone call. If the family cannot be seen via a face-to-face meeting or reached by phone, written correspondence may be utilized. However, face-to-face meetings or phone calls are preferred modes of communication.
  • Always ask the family if insurance coverage has changed, are services being provided as authorized, etc.
  • Document the communication in case notes.
• 12.6.3 Prior to making any changes to existing authorizations in an IFSP, the CFC must:
  • Follow the Developmental Justification of Need to Change Frequency, Intensity or Location of Authorized Services Guidelines and Worksheet procedures.
  • Ensure the family is provided with a State of Illinois Infant/Toddler and Family Rights under IDEA for the Early Intervention System booklet.
  • If changes are agreed to by everyone and the family has private insurance, the family must also sign a new Notice to Consent to Use Private Insurance/Healthcare Plan Benefits & Assignment of Rights form as outlined in Chapter 10 - Public and Private Insurance Use Determination.
• 12.6.4 Update and maintain each child's permanent and electronic case record as needed after each monthly face-to-face meeting or phone call or at any time during the IFSP period that it is determined that information has changed.

12.7 Provider Selection & Provisional Authorization Process Policy

• 12.7.1 EI service providers are selected in collaboration with the family. The Service Coordinators shall never recommend a provider over another based on personal preference. Families shall be offered a choice as much as allowed with enrollment and insurance limitations.
• 12.7.2 The CFC shall utilize the provider selection flow (described below) for provider selection unless a CFC-specific plan of provider selection has been submitted and approved by the Bureau with written documentation maintained. Best practice would be for any provider to forward a "resume" to include in a booklet or electronic format to be presented to the parents. The choice of providers offered to the family may be limited for the following reasons:
  • Initial Evaluating Providers:
    • The CFC must consider the developmental needs of the child for determining any expertise or experience of one provider over another.
    • The CFC shall offer the family all available providers to perform initial evaluations/assessments. Best practice is to offer a listing of all available providers to allow 3 to 5 choices (if appropriate) and then contact the providers in the preference of the parent for openings to evaluate/assess the child.
    • No single provider may provide EI services to a single child as 2 discipline types.
  • Direct Service Providers: The CFC should follow a flow of selecting a provider based on the various limitations to create a comprehensive listing to share with the family. The following circumstances must be considered:
    • Private insurance policies or other payors (i.e., DSCC) may require the use of network providers, except as specified in Chapter 10 - Public and Private Insurance Use Determination of this manual;
    • The developmental needs of the child may lend to the expertise or experience of one provider over another;
    • The number of credentialed and enrolled EI service providers in the geographic region may be limited; and
    • No single provider may provide EI services to a single child as 2 discipline types.
• The final selection of the provider should be the families based on the individual circumstances of the child/family.
• The CFC should create and send authorizations prior to any service delivery. The authorization should be created using the rendering provider and the payee chosen. If a change in rendering providers is necessary, the SC must create a new authorization in the new rendering provider and payee. Agencies may send out, on an emergency basis only, an equally qualifying rendering provider meeting all the credentialed/enrollment processes of EI. If the temporary situation becomes permanent, the CFC must create new authorizations with the permanent replacement rendering provider within the same payee for proper data collection and monitoring purposes. The CFC must end all authorizations not used due to changes in rendering providers.
• 12.7.3 If an available credentialed/enrolled evaluator or direct service provider is not identified within seven business days, the CFC will proceed with the provisional authorization process.
• 12.7.4 The CFC and Local Interagency Council (LIC) will work collaboratively to identify and address gaps in service delivery.
• 12.7.5 The purpose of the provisional provider process is to provide services for children when no other credentialed and enrolled provider is available. If an enrolled provider is available, that provider must be utilized first. This process is not to allow providers to circumvent the background check and fingerprinting process and cannot be used with providers who allow their credential to lapse.
• 12.7.6 Provisional provider requests will not be backdated to the start date. The request is processed based on the date of receipt by DHS. The exception is the IFSP meeting. The IFSP meeting request must be received by DHS within two (2) weeks of the meeting.
• 12.7.7 Developmental Therapists not yet enrolled do not use the provisional approval process. Rule 500 states "An emergency waiver of educational requirements for developmental therapists may be applied for and must be accompanied by the recommendation of a regional intake entity manager documenting the need for developmental therapy services in the service area. A bachelor's degree or higher is required. If approved, the resulting temporary credential will be awarded for a maximum of 18 months. A training plan toward qualification for full credential status must be submitted with the emergency waiver application." NOTE: If exceptional circumstances occur; contact the Provisional Provider Coordinator to discuss the need for a DT to obtain a provisional approval.

12.8 Provider Selection & Provisional Authorization Process Procedure

• 12.8.1 The CFC shall follow the following provider selection flow:
  • Based on private insurance policy and procedure outlined in Chapter 10 - Public and Private Insurance Use Determination, if the Benefits Verification for insurance process is completed and a single provider results - If available, authorize that provider. If not available - follow the waiver process. Work with the family once the waiver is received to choose a provider. The Service Coordinator shall offer the family a choice of enrolled service providers available to provide EI services as outlined in the IFSP.
  • If no insurance benefits verification limits choice, the Service Coordinator shall offer the family a choice of enrolled service providers available to provide EI services as outlined in the IFSP.
  • If the family does not have private insurance or is allowed, by policy and procedure outlined in Chapter 10 to decline the use of their insurance, the Service Coordinator shall offer the family a choice of enrolled service providers available to provide EI services as outlined in the IFSP.
  • No Provider may provide services to a single child as 2 or more disciplines types. This is a conflict of interest. The CFC must authorize any service type accordingly to individual providers if using a single Payee entity. The Payee entity must not allow the same provider to serve the child as two disciplines, even under Equally Qualifying status.
• 12.8.2 Provisional Provider Process for Evaluations
  • If no enrolled provider can be identified for an IFSP service, immediately contact your CFC Manager for assistance.
    • For initial evaluations to determine eligibility for EI services or to add a new service to an existing IFSP, if an available EI enrolled evaluator is not identified within seven business days, the CFC shall locate an enrolled direct service provider and shall request a DHS provisional provider service authorization for the evaluation.
  • Once the enrolled direct service provider is located, submit a completed Provisional Provider Authorization Request form to the Bureau. Follow the instructions on the form in their entirety.
  • The CFC will receive a Memorandum from the Bureau indicating the status of the request. Once the approval Memorandum is received, the CFC must follow the instructions on the approval Memorandum.
• 12.8.3 Provisional Provider Process for Direct Services
  • For direct service provision, if an available EI enrolled direct service provider is not identified within seven (7) business days; the CFC shall first determine if a current Provisional Provider is available. If no current Provisional Provider is available, the CFC shall locate an available qualified provider who is not enrolled, and begin the Provision Provider process.
  • The CFC shall:
    • Inform the family of the Provisional Provider availability and, if the family agrees, the CFC must obtain the parent's consent on the CFC Provisional Provider Consent form.
    • If the located provider is an enrolled Provisional Provider available to begin services, the CFC shall submit the completed Provisional Provider Authorization Request form to the Bureau.
    • If the located provider is not enrolled as a Provisional Provider yet, the CFC shall:

• 12.8.4 Submitting the Provisional Provider Request Form:
  • To submit the request, the CFC shall:
    • Complete the form entirely and submit:
    • The completed current W-9 form from the provider. NOTE: You can access the current W-9 form at: www.irs.gov.
    • A copy of the license, certification or credential, if applicable (if not enrolled in the CBO);
    • The completed packet may be faxed to the Provisional Provider Coordinator at 217/524-6248 or mailed to:
      • Provisional Provider Coordinator
        DHS - Bureau of Early Intervention
        823 East Monroe
        Springfield, IL 62701
• 12.8.5 Submitting the Provisional Provider Authorization Request form:
  • To submit the request, the CFC shall:
  • Complete the form entirely,
  • Submit a copy of the signed Parental Consent and Ability to Decline Services (only needed for Evaluation and/or Assessments)
  • Submit a copy of the Provisional Provider Parental Consent Form
  • For direct services, submit a copy of:
    1. IFSP Cover Page
    2. Applicable IFSP Functional Outcome page(s), and
    3. Parent/guardian signature implementation page.
  • The completed packet may be faxed to the Provisional Provider Coordinator at 217/524-6248 or mailed to:
    • Provisional Provider Coordinator
      DHS - Bureau of Early Intervention
      823 East Monroe
      Springfield, IL 62701
  • Allow a minimum of five business days to process the provisional request.
  • Do not start services until the Provisional Provider Approval Memorandum is received. Same day or next day request are not guaranteed and services may need to be rescheduled if they are planned prior to receipt of the approval memorandum.
• 12.8.6 If the Provisional Provider fails to complete the credential and/or enrollment process, the CFC will be notified by Provider Connections and the Bureau that any/all authorizations shall be ended.
• 12.8.7 Provide verbal and written notification to the non-enrolled provider who fails to enroll indicating the following:
  • The date on which the provisional authorization will be discontinued and why.
  • Payment for all subsequent service(s) past that date with the non-enrolled provider will be the family's responsibility if the family chooses to continue with that non-enrolled provider.
• 12.8.8 On the date an available enrolled provider is offered to the family or the provisional provider becomes enrolled, the Service Coordinator shall notify the DHS Provisional Provider Coordinator to discontinue the provisional authorization and the Service Coordinator shall enter services authorizations for the enrolled/credentialed provider.
  • For families who transfer to an enrolled provider and for provisional providers who enroll, complete the authorization process on Cornerstone and fax a copy of the authorization to the provider and to the Provisional Provider Coordinator at 217/524-6248. File a copy of the authorization in the child's CFC permanent record.
• 12.8.9 Provide verbal and written notification to families who decline to transfer to an enrolled provider indicating the following:
  • The date on which the provisional authorization will be discontinued and why;
  • Payment for all subsequent service with the non-enrolled provider will be the family's responsibility; and
  • EI funds will continue for IFSP services the family receives from enrolled providers.
• 12.8.10 Update the child's CFC permanent record and Cornerstone electronic case record.

12.9 Required Six Month Review Policy

• 12.9.1 The Individualized Family Service Plan (IFSP) shall be reviewed at least every six months or more frequently if conditions warrant or upon reasonable request of the child's parent. NOTE: The six-month review is required by Part C of the Individuals with Disabilities Act.
• 12.9.2 The review may be carried out by a meeting or teleconference and must include, at a minimum, the parent or parents of the child and the Service Coordinator.
• 12.9.3 EI service providers shall conduct authorized assessments using a DHS approved instrument as indicated on the IFSP as an ongoing process throughout the period of the child's eligibility and shall provide assessment reports to the Service Coordinator prior to IFSP updates/reviews. NOTE: The required report that is due at the six month review may be a summary of the provider's record notes if it is determined that there is not a need to administer a formal assessment tool at this time.
• 12.9.4 The purpose of the review is to determine a) the degree to which progress toward achieving the outcomes is being made; and b) whether modification or revision of the outcomes, services or supports is necessary.
• 12.9.5 If changes to the IFSP are recommended, the full IFSP team must be convened and a consensus reached regarding the recommended changes before they may be implemented. If no consensus is reached, the Service Coordinator will not complete a service plan prior to consultation with DHS designated experts in order to establish a DHS approved service plan, and shall then provide the parents with prior written notice regarding the proposed IFSP.

12.10 Required Six-Month Review Procedure

• 12.10.1 Request direct service reports from providers prior to the six month review meeting and review the reports to determine whether changes to existing services are being recommended. If changes to existing services are being recommended, ensure that the provider who is recommending the changes has included the Developmental Justification of Need to Change Frequency, Intensity or Location of Authorized Services Worksheet with their six-month report.
• 12.10.2 Communicate with the family to determine who should participate in the review meeting, apart from the parent(s), and the Service Coordinator and providers of existing EI services and to discuss a time and place to hold the meeting that is convenient to the family.
• 12.10.3 Provide reasonable prior written notice to the family and other participants of this meeting.
• 12.10.4 Obtain input from the family and all EI service providers regarding any progress made (or lack thereof) toward achieving the identified functional outcomes since the beginning of the IFSP period.
  • Review each functional outcome and related service/support with the family and all EI service providers in order to determine whether the services, as provided, are facilitating the achievement of the identified outcomes.
• 12.10.5 If changes are recommended to the frequency, intensity, duration or place of service of one or more EI services, review the recommendation with the family and all EI service providers in order to determine whether the recommended service change is consistent with the resources and priorities of the family, is considerate of the other services/supports being provided and is likely to achieve the intended result.
• 12.10.6 If changes are requested within the first three months of an IFSP the original IFSP team must reconvene with the provider recommending the changes in attendance. The team must agree that a change from the team's original recommendation(s) is needed and is in the best interest of the child.
• 12.10.7 If changes are requested more than three (3) months after the development of an IFSP, the child's current multidisciplinary service team must participate in the IFSP review meeting. The multidisciplinary service team must agree that a change from the team's original recommendation(s) is needed and is in the best interest of the child.
• 12.10.8 If a provider submitted a Developmental Justification of Need to Change Frequency, Intensity or Location of Authorized Services Worksheet with their six month report and it was accepted as a completed document by the Service Coordinator, share the Worksheet with the all members of the multidisciplinary team prior to the IFSP meeting.
• 12.10.9 If changes are requested by a provider at the IFSP meeting, complete the Developmental Justification of Need to Change Frequency, Intensity or Location of Authorized Services Worksheet, it is the responsibility of the multidisciplinary team to complete the Worksheet at the IFSP meeting.
• 12.10.10 Upon review, complete IFSP revisions as needed. NOTE: Refer to the Individualized Family Service Plan form instructions document.
• 12.10.11 Using Section 3 of the IFSP, document any progress made (or lack thereof) toward achieving the identified outcome.
• 12.10.12 Provide the family with written prior notice of any modifications or revisions, which would change the placement of the child or the provision of appropriate EI services, using Sample Letter 12: Discontinuation of One or More Services form letter.
• 12.10.13 Once the IFSP has been updated, print, copy and distribute the document in its entirety to the family, the EI service providers listed in the IFSP and anyone else the family has consented to receive a copy. ALWAYS distribute changes in service authorizations in this manner, taking special care to ensure that affected providers have been adequately notified of changes to their service authorizations.

12.11 Required Annual Review Policy

• 12.11.1 At least once a year the Service Coordinator shall arrange for an annual IFSP meeting to re-determine eligibility and revise the IFSP for the child and the child's family.
• 12.11.2 The results of any current evaluations and ongoing evaluations of the child and family must be used in determining what services are needed and shall be provided.
• 12.11.3 At least annually, a financial assessment shall be completed with the family in order to re-determine their ability to participate financially in their child's intervention, and update private insurance information.
• 12.11.4 Potential eligibility for All Kids and DSCC services must be determined prior to each annual IFSP using the Screening Device for Determining Family Fees and Eligibility for All Kids and DSCC.
• 12.11.5 Children who do not meet current EI 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 (Consult with developmental pediatrician consultation contractor for help in making this determination.); AND
  • Have been determined by the multidisciplinary IFSP team to require the continuation of EI services, provided in an appropriate developmental manner to meet the child's needs, in order to support continuing developmental progress.
• 12.11.6 Explain procedural safeguards, rights and privacy practices and provide the family with a copy of the State of Illinois Infant, Toddler and Family Rights booklet, the Parent Handbook.
• 12.11.7 The type, frequency and intensity of services will differ from the initial IFSP based on the child's developmental progress and may consist of only service coordination, evaluation and assessments and IFSP development.

12.12 Required Annual Review Procedure

• 12.12.1 One to two months prior to the annual IFSP meeting, conduct the annual eligibility re-determination and subsequent steps appropriate for child's eligibility status. NOTE: Refer to Chapter 9-Eligibility Criteria, Evaluation and Assessment
• 12.12.2 Authorize assessments necessary to establish continuing EI eligibility and annual IFSP development within the current IFSP.
  • If the process to establish the IFSP date/time cannot take place within the established IFSP period due to exceptional family circumstances such as illness, conflict of schedule, etc,the IFSP may be extended for up to a maximum of three additional months. Follow all Cornerstone procedures and inform all IFSP team members of the extension and intended IFSP date/time. NOTE: Watch authorizations carefully for ALL authorized services that the IFSP date will impact.
• 12.12.3 Complete financial assessments for family fee determination and private insurance use.
• 12.12.4 Prior to each annual IFSP, complete the Screening Device to determine potential eligibility for All Kids and DSCC services. If indicated, complete and submit an All Kids application with family consent and/or make a referral to DSCC. As part of the referral to DSCC and with proper authorization (documented with the Consent for Release of Information form), send to the DSCC local office a copy of the completed Screening Device and the following Cornerstone screens/reports: Participant Enrollment Information, Assessment History, and Insurance. File the completed, signed screening form in the child's file.
• 12.12.5 If the child remains eligible and family consents to continued services, complete eligibility determination procedures as indicated in Chapter 9-Eligibility Criteria, Evaluation and Assessment.
• 12.12.6 Explain procedural safeguards, rights and privacy practices and provide the family with a copy of the State of Illinois Infant, Toddler and Family Rights booklet, the Parent Handbook.
• 12.12.7 Complete new annual IFSP. Refer to Chapter 12 - Individualized Family Service Plan (IFSP) - 12.3 & 12.4 - Initial/Annual IFSP Development
• 12.12.8 If ineligible or family does not consent to continue services, follow case closure procedures. NOTE: Refer to Chapter 14-Transfer and Case Closure.

12.13 Eyeglasses Authorizations Policy

• 12.13.1 Eyeglasses for eligible children are purchased through the Illinois Department of Corrections (IDOC).
• 12.13.2 Optometric examination services and dispensing fees must be authorized prior to service provision.

12.14 Eyeglasses Authorizations Procedure

• 12.14.1 Facilitate the selection of available vision providers to conduct the optometric examination.
• 12.14.2 Generate an authorization for the optometric examination AND an authorization for the dispensing fee using the SV07 screen. NOTE: Every optometric examination authorization must be accompanied by a Dispensing Fee Authorization, regardless of whether or not eyeglasses are prescribed.
• 12.14.3 If it is determined that the child needs eyeglasses, the provider will submit a IDOC order form that includes the prescription information to the CBO along with their claim for the optometric examination and the dispensing fee. The CBO will generate the specific authorization(s) and send it to IDOC with the order form.
• 12.14.4 The IDOC will make the eyeglasses and send them to the provider. The provider will dispense the eyeglasses to the child. NOTE: A claim against the dispensing fee authorization will not be honored by the CBO unless the claim is accompanied by an IDOC order form requesting eyeglasses for the child. For additional information regarding eyeglasses for children enrolled in the EI Program, refer to the "Procedure to Order Eyeglasses" section of the Early Intervention Service Descriptions, Billing Codes and Rates - Provider Handbook.

12.15 AT Policy

• The definition of AT includes both AT devices and AT services. An AT device is any durable item, piece of equipment or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain or improve the functional capabilities of children with disabilities.
• 12.15.1 An AT service means any service that directly assists a child with a disability in the selection, acquisition or use of an AT device. The term includes:
  • The evaluation of the needs of the child with a disability, including a functional evaluation of the child in the child's natural environment;
  • Purchasing, leasing or otherwise providing for the acquisition of AT devices by children with disabilities;
  • Selecting, designing, fitting, customizing, adapting, applying, retaining, repairing or replacing AT devices;
  • Coordinating and using other therapies, interventions or services with AT devices such as those associated with existing education and rehabilitation plans and programs;
  • Training or technical assistance for a child with a disability or, if appropriate, that child's family; and
  • Training or technical assistance for professionals who provide services to children with disabilities through the EI program.
• 12.15.2 All children with disabilities who are eligible for EI services must be provided with AT, if appropriate, as part of an IFSP. AT devices should be considered if interventions are required to aid in the development tasks such as interaction with the environment, communication and cognition. These AT devices and services are authorized, however, only when they directly relate to the developmental needs of the infants and toddlers.
• 12.15.3 Inclusion of AT in the IFSP occurs on an individual basis based on the child's needs, the family's concerns and intervention priorities and goals. AT devices/services must be included in the IFSP as agreed upon by the parent and other team members.
• 12.15.4 AT devices and services must be developmentally and age appropriate.
• 12.15.5 Each CFC office will designate one CFC AT Coordinator. This individual will be the contact person at the CFC for the EI Program AT Coordinator.
• 12.15.6 Any AT requested for a child must be submitted to DHS for prior approval with two exceptions (see Chapter 12, under 12.16.3 for exceptions).
  • 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.
• 12.15.7 All Assistive Technology Developmental Evaluation/Letter of Necessity forms must be completed by a credentialed/enrolled evaluator.
• 12.15.8 DHS maintains an Ad Hoc AT Advisory Committee to review devices considered for DHS funding. This committee will provide consultation and support for DHS when considering new, questionable or unfamiliar items and will provide guidance on therapeutic appropriateness.
• 12.15.9 DHS maintains the right to request the substitution of less expensive items of comparable function if a substitution is deemed appropriate.
• 12.15.10 Eyeglasses are not processed under AT devices. (Refer to Chapter 12, under 12.13 and 12.14).

12.16 AT Procedure

• 12.16.1 AT should only be considered as a strategy with a formal IFSP meeting. The Service Coordinator must convene the IFSP team in order to discuss adding AT services as a strategy to a functional IFSP outcome, explore existing resources that may be used to loan or purchase the AT equipment/device, and/or discuss alternative, comparably effective adaptations.
  • Ensure that the IFSP team, including the family, is aware of the DHS's prior approval process for AT.
  • Obtain a completed Assistive Technology Developmental Evaluation/Letter of Necessity form from a credentialed, enrolled evaluator. The provider must submit for the AT prior-approval process. The provider will bill the form preparation time as IFSP developmental time. Never accept an Assistive Technology Developmental Evaluation/Letter of Necessity form prior to the IFSP team determination of the need for the requested item(s).
  • Ensure that the AT strategy is appropriately related to one or more of the child's functional developmental outcomes and is documented in the IFSP.
• 12.16.2 At a minimum, the IFSP should have the following information regarding the AT item the team agreed upon:
  • The functional outcome(s) that will be achieved for the child and family, including the way in which the AT device is expected to increase, maintain or enhance a child's functional capabilities;
  • A description of the specific AT device(s) needed by the child;
  • the projected dates for acquisition of the device, and;
  • the method of acquisition;
  • the methods and strategies for the use of the AT device to increase, maintain or improve the child's functional capabilities, the individuals (including parents, other caregivers and family members and other qualified personnel) who will be assisting the child in using the device and the settings in which the device is to be used;
  • The qualified personnel who will be providing the AT services and the frequency, intensity and method of delivery recommended.
• 12.16.3 If the IFSP team determines that the AT device can only be met via a purchase through DHS, the CFC AT coordinator is responsible for the activities to request the AT. Any AT requested for a child must be submitted to DHS for prior approval. Prior approval and is required for the provision of all equipment/services with the exception of replacement hearing aid ear molds and 16 batteries every 60 days. The prior approval process reviews all requests to look for developmental necessity, equipment/services as described in the section addressing "limitations," pricing requests, quantity and duplication.
  • For replacement hear aid molds and batteries not through prior approval:
    • Contact the DHS AT Coordinator for current HCPCS codes and pricing.
    • A letter of developmental necessity from the audiologist must be on file in the child's record to order this equipment without prior approval.
• 12.16.4 If the IFSP team determines that the AT device is appropriate, the CFC At Coordinator submits the following:
  • Assistive Technology Prior Approval Request form, completed in its entirety. Do not send the AT request form to the provider to complete. 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 Assistive Technology Developmental Evaluation/Letter of Necessity and vendor information (Example - Corner chair with tray should be listed as one item under HCPCS code A9900, Tri-stander with various support attachments listed as one item under HCPCS code E0641);
  • IFSP sections needed:
  1. Cover page,
  2. Section 2 - Present Levels of Development
  3. Section 3 - Child and Family Functional Outcome(s) relating to AT only (the functional outcomes must be within the previous six-month timeframe),
     • A dated Physician's order/prescription (must be dated within the previous six months. NOTE: A physician signed Assistive Technology Developmental Evaluation/Letter of Necessity, with the physician's name printed for legibility, can serve as the prescription.
     • A dated, completed Assistive Technology Developmental Evaluation/Letter of Necessity. The evaluator must complete Section 5 - Category 2 Additional justification if requested Category 2 AT. This evaluation must be dated within the last six months 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 as services must be determined at the IFSP meeting. 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.
  4. Information from the vendor:
     • • Dated, itemized quote on letterhead
       • Picture and description of requested item(s)
       • Acquisition manufacturer pricing to follow SMART Act requirements;
     • If requested item has existing HCPCS code and pricing within the HFS system, that price will be used.
     • If requested item has existing HCPCS code but is hand-priced for HFS, price quote must show all primary and secondary discounts (that cost plus 50% will be approved) OR if the vendor does not have primary or secondary discounts, the vendor must submit manufacturer's pricing (catalog page, price sheet, etc.) from three different sources for the item (that price plus 25% of the most reasonable retail pricing will be approved).
     • If requested item is not listed as DME through HFS or vendor cannot provide true acquisition pricing showing primary and secondary discounts, the vendor must submit manufacturer's pricing (catalog page, price sheet, etc.) from three sources for the item (that price plus 25% of the most reasonable retail pricing will be approved).
  1. If applicable, copy of DSCC eligibility letter.
     • In addition the items listed above, requests for hearing technology such as aids or bone anchored hearing aid (baha) processors must also include:
  2. the Consent for Release of Information for Children with Identified Hearing Loss form, and
  3. if the child is not All Kids eligible, the Family Fee report, including family size.
• 12.16.5 If the AT request is for a child 32 months of age or older, include with the AT request, a letter of justification for an exception which includes the following information:
  • Developmental benefit expected to be achieved prior to age 3 through the use of the requested equipment/device(s); and
  • Steps taken to obtain the requested equipment/device(s) from resources available to the child after age 3 (i.e. private insurance, DSCC, Lekotek, Illinois AT Project, local civic organizations, lending libraries, etc.).
• 12.16.6 Requests are processed through the DHS EI Bureau for prior approval consideration. Requests must be submitted by mail to:
  • Assistive Technology Coordinator
    DHS - Bureau of Early Intervention
    823 East Monroe
    Springfield, IL 62701
• 12.16.7 Upon receipt of a completed AT request, DHS will review the request and fax a decision memo to the CFC AT Coordinator submitting the request.
• 12.16.8 If, upon review, it is determined that the AT request is incomplete, the CFC AT Coordinator will be notified by fax of missing or incomplete information and will have 14 business days to submit all necessary information to DHS. Failure to submit requested information may result in an automatic denial of the AT request.
• 12.16.9 Upon receipt of the DHS decision memo:
  • Generate authorizations for approved equipment/devices for a minimum of three months or up to a scheduled IFSP meeting. NOTE: All authorizations end the day before an IFSP meeting date. This may impact an authorization that has been generated and the equipment not yet received by the family and billing for the date of service by the vendor.
  • Generate authorizations for approved equipment/device(s) taking care to enter the authorization information exactly as it is written in DHS'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 DHS decision memo is known to be or appears to be incorrect, contact the DHS AT Coordinator for clarification before the authorization is entered/saved.
  • Notify the IFSP team of DHS'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.
  • 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
• 12.16.10 If it is determined that the equipment/devices cannot be funded by DHS, the CFC AT Coordinator will receive a denial from DHS. The CFC should 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, DSCC, Lekotek, Illinois AT Project, and/or local civic organizations. Funding sources may be combined to cover the cost of the equipment/device(s). NOTE: Do not enter authorizations for equipment/device(s) that are denied.
• 12.16.11 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 functional outcomes in the IFSP. EI 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, 8 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.
• 12.16.12 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, gait trainers and walker, prosthetics/orthotics, augmentative communication devices and hearing aids. Seldom does it include learning tools like switch-operated toys, assistive play equipment, sensory items and weighted or pressure vests.

12.17 AT Returns

• 12.17.1 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 (within 30 days) 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.
• 12.17.2 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 (within 30 days).
• 12.17.3 If a replacement item is needed, the following information is required:
  • A new AT Prior Approval Request form indicating the new equipment to be purchased;
  • 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;
  • 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.
  • If vendor has not yet billed for the original equipment, proceed with submission of the request to DHS and cancel the original authorization.
  • 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.
• 12.17.4 EI will approve payment of a "restocking fee" if the company the vendor obtained the equipment from has a written policy.
• 12.17.5 Proceed with the procedures for obtaining AT.

12.18 AT Devices

• 12.18.1 AT devices range from low technology to high technology items. Low technology devices are devices that rely on mechanical principles and can be purchased or made using simple hand tools and easy to find materials, such as homemade or modified items already used in the home. High technology devices include sophisticated equipment and may involve electronics.
• 12.18.2 Consideration of the types of AT devices and services available through this system is continually monitored. Determination of what equipment and services falls within these guidelines will be updated periodically as these considerations are reviewed. Eligible devices and services refer to items and services for which payment can be made. A written recommendation (order), signed and dated by the child's physician (often a prescription form) is required for all items requested or the physician can sign and date the letter of developmental necessity. Print the name of the physician under the signature for legibility.
• 12.18.3 EI deals only with AT that is directly relevant to the developmental needs of the child and specifically excludes devices and services that are necessary to treat or control a medical condition or assist a parent or caregiver with a disability. Equipment/devices must be developmentally and age appropriate to be considered eligible for EI funding.
• 12.18.4 The following sections address those items currently eligible for EI funding and those items that are not considered eligible under the definition of AT.

12.19 Eligible AT Services

• 12.19.1 As the term AT covers so many different types of devices, it is often useful to divide the devices into functional categories. The following are examples of the types of AT devices that may be provided to eligible children and their families under this program. The AT available to young children is changing and expanding at a rapid pace, and it should be noted that this list is not an exhaustive list of AT devices, but is intended to provide guidance. There may be other items not listed that would appropriately meet the needs of children in this program.
• 12.19.2 Available AT include:
  • Aids for Daily Living. Self-help aids are designed for use in activities such as bathing, eating, dressing, and personal hygiene. Ex.: Bath chairs, adaptive utensils.
  • Assistive Listening. Assistive listening devices to help with auditory processing. Ex.: hearing aids.
  • Assistive Toys and Switches. Because "play" is the work of infants and toddlers, assistive devices such as switch-operated toys serve a vital role in the development of young children with disabilities. Playing with switch-operated toys helps build important cause and effect and choice-making skills that prepare a child for communication aids and computer use. Ex.: Single-use switches, switch battery adapters, switch adapted toy items.
  • Augmentative Communication. Augmentative communication devices are devices that should be used across all the natural settings so that the child learns how to communicate with a variety of different people in different circumstances. The inclusion of a variety of different augmentative communication strategies is particularly important for young children and may include a program that uses signing, device, gestures, and communication pictures and boards. Ex.: Symbol systems, picture or object communication boards, electronic communication devices, and communication enhancement software.
  • Computer Access. There are a wide variety of technologies that provide access to the computer. Once an access method has been determined, then decisions can be made about input devices and selection techniques. Input devices can include switches, touch windows, head pointers, etc. In some cases, access to keyboards can be improved by simple modifications such as slant boards, keyguards or keyboard overlays. Output devices include any adaptation that may be needed to access the screen display. Computer technology can help very young children acquire important developmental skills and work toward their individual goals. A variety of software programs have been developed for this population. These programs help infants and toddlers learn and practice cause and effect, early choice making, and build fine motor and visual motor skills.
  • Mobility. Mobility devices include braces, certain types of orthotics, self-propelled walkers and crawling assist devices.
  • Positioning. Proper positioning is important so that a child can interact effectively in their environment and to aid in promotion of the child's physical development. Proper positioning is typically achieved by using padding, structured chairs, straps, supports, or restraints to hold the child's body in a stable and comfortable position. Also considered is a child's position in relation to family or peers. Often, it is necessary to design positioning systems for a variety of setting so the child can participate in multiple activities in their natural environment. Ex.: Standers, walkers, floor sitters, trays, side-lyers, straps, rolls, weighted vests and garments, etc.
  • Visual aids. General methods for assisting with vision needs include increasing contrast, enlarging images, and making use of tactile and auditory materials. Devices that assist with vision may include optical or electronic magnifying devices, low vision aids such as hand-held or spectacle mounted magnifiers, and vision stimulation devices such as light boxes.
  • Repair and Maintenance. Repair, alteration and maintenance of necessary equipment. The provider is responsible for the fulfillment of all warranty service and warranty repair.
• 12.19.3 It is important to realize that within each of these categories, there is a continuum of device choices from simple to complex that should be considered when trying to find the AT to use with a particular child for different tasks and in different settings.
• 12.19.4 When an infant or toddler's needs are being assessed for the possible use of AT, there are usually a number of options that can and should be explored. The selection of devices should always start with simpler, low or mid tech tools to meet the child's needs. If a low-tech device, such as a laminated picture for making a choice, meets the child's needs, then that should be the device provided. Different devices from across the continuum should also be carefully matched to the different environments in which the devices will be used, appreciating that while a device may be useful in one setting, it may not be appropriate or effective in other settings.
• 12.19.5 When choosing a device, it is important to note that trials with a variety of different devices can actually help determine the child's needs, preferences and learning styles.

12.20 Limitations to AT

• 12.20.1 EI reserves the right to limit items of the same or similar nature such as switches, adapted switch toys, adapted cups, adapted utensils and tableware, computer software, therapy balls, rolls, bolsters, wedges, sensory items, swings, etc.
• 12.20.2 Certain equipment/services are not covered in the scope of AT and payment will not be made for their provision. The following are examples of devices or services that are NOT considered AT under this program.
  • Equipment/services that are prescribed by a physician, primarily medical in nature and not directly related to a child's developmental needs. Examples include but are not limited to helmets, oxygen, feeding pumps, heart monitors, apnea monitors, intravenous supplies, electrical stimulation units, beds, etc.;
  • Devices requested for children 2 years, 8 months of age and over, as equipment requested during this time would not be available long enough to achieve identified outcomes. Request must be received for review prior to 2 years, 8 months;
  • Equipment/services for which developmental necessity is not clearly established;
  • Equipment/services covered by another agency;
  • Equipment/services where prior approval (when applicable) has not been obtained;
  • Typical equipment, materials, and supplies related to infants and toddlers utilized by all children and which require no special adaptation. Examples include clothing, diapers, cribs, high chairs, car seats, infant swings, typical baby/toddler bottles, cups, utensils, dishes, infant monitors, etc. Toys that are not adapted, used by all children and are not specifically designed to increase, maintain, or improve the functional capabilities of children with disabilities include such examples as building blocks, dolls, puzzles, balls, ball pits, tents, tunnels and other common play materials;
  • Standard equipment used by service providers in the provision of EI services (regardless of service delivery setting), such as therapy mats, tables, desks, etc;
  • Seating and mobility devices such as car seats, strollers, wheelchairs or any part thereof;
  • Equipment/services which are considered duplicative in nature, generally promoting the same goal and/or objective with current or previously approved equipment/services;
  • Equipment/service if a less expensive item or service is available and appropriate to meet the child's need;
  • Extended warranties;
  • FM systems;
  • Power equipment for positioning chair, gait trainers, etc.;
  • Beds of any type and related accessories;
  • Helmets;
  • Replacement equipment if original item has not been returned to vendor or if payment for equipment has not been returned to the CBO by the supplying vendor;
  • Set-up charges; and
  • Sales tax, shipping and handling charges.

12.21 AT Evaluation

12.21.1 AT evaluations can be requested when there is reason to believe that a child may benefit from the use of AT. The AT evaluation is to be completed by a credentialed evaluator as in most situations the AT request is for a new AT item or service. The need for AT devices/ services may be identified:

• • As part of the initial multidisciplinary evaluation, where the credentialed evaluator determines a need that can be addressed when eligibility is determined;
  • As part of a supplemental evaluation included in the child's IFSP based on an anticipated or emerging need and as agreed upon by the team;
  • Through the ongoing assessment process conducted by the child's provider(s) if they are a credentialed evaluator. NOTE: Reimbursement for evaluations is done through the evaluation code for the specific provider type.
• 12.21.2 AT evaluations differ somewhat from "typical" evaluations conducted as part of eligibility or review of a child's needs and strengths. There are virtually no standardized tests to "find out" what kind of technology a child needs to use. Instead, a good AT evaluation looks at the results of all recent evaluations, along with the current IFSP goals and objectives. The evaluator should talk with the child's parents, interview people who work with the child, and interact directly with the child and the devices. The environment should be carefully examined, especially when the device has to work in a variety of settings.
• 12.21.3 The actual evaluation process consists of considerable observation coupled with trials with a full range or continuum of possible devices from low to high technology. Data is gathered from these trials about the effectiveness of various technologies to meet the child's needs. Information is collected concerning the child's ability and accuracy when using various technologies, including the positioning and settings that work best. The child's and family's feelings about the actual devices tried should be considered, as even very young children can show what they like and dislike by how they interact with different devices.
• 12.21.4 As the number of devices and the complexity of those technologies have grown exponentially in the past few years, many people who work extensively in this area have found the need to specialize in different areas of AT. Typically, these people have expertise in areas like assistive computer technology, augmentative communication, mobility and positioning and so forth. Other AT experts specialize in age or disability-specific technologies, such as visual and hearing impairment devices.

12.22 Components of an AT Evaluation

• 12.22.1 The four principles to consider when evaluating the potential for AT solutions should include:
  • Use of the multidisciplinary team.
  • Family members are a crucial member of the team
  • Focus on function - "What is it that the child needs to do that he/she currently cannot do?"
  • Strive for simplicity.
• 12.22.2 Team members should have a basic understanding of the kinds of AT that exists and how it can be used to help a child achieve more independence and control of his/her environment. The team assessing AT needs should address the following:
  • Current developmental needs and functioning of the child. Consideration should be given to the recommendation of the most appropriate device for the child's current development. Because technology devices and the needs of a child and family change, devices should be used to enhance the child's current development and functioning, addressing immediate needs and the appropriateness of the equipment in attaining outcomes that address the development and functioning of the child.
  • Cognitive and emotional resources. This should include assessing the child's ability to understand language, respond to prompts and trials, ability to make choices and the ability for social interaction. The child's response to stimuli and reinforcers, distractibility and attention span need also be considered.
  • Health and development. Statements regarding child's current health status, vision, hearing, and motor status should be included.
  • Needs of the child and family. Consideration should be given to devices that can fit easily into the family's lifestyle and will have the optimum functional and developmental impact on the child.
  • Equipment and device options. Consideration should be given to whether outcomes can be accomplished through the creative use of existing resources (e.g. household items, toys, etc. currently available in the home), loan programs or low-technology devices and other less intrusive option, prior to progressing to high technology equipment.
  • Use of equipment. Consideration should be given to devices that are needed to help achieve a specific functional outcome and are not therapeutically "nice to have." Equipment should be used to achieve a functional goal that will improve a child's development. Utilization of current equipment in the home should be documented as well.
  • Proper recommendation for the device. Consideration should be given to using a team which includes the parent, Service Coordinator, other EI service providers and the AT specialist to ensure a common understanding of the recommendation for a particular device or characteristic of the type of AT device.
  • Use of loan equipment. Checking out equipment from available local lending libraries or accessing local Lekotek programs is strongly recommended to ensure the appropriateness of the device prior to purchase. The Illinois AT Project (IATP) can answer questions regarding specific AT needs and a comprehensive directory available to assist in locating equipment and funding. IATP can be reached at 800-852-5110 or on the web at www.iltech.org. If equipment is needed for short-term use, utilizing equipment in this manner rather than purchase is strongly recommended.
• 12.22.3 The AT evaluation report should include information listed above and any other pertinent information regarding the reasons for evaluation, background of the child, observations of the child in the natural environment(s), observations of the child using currently available technologies, and observations of the child using a variety of possible AT options.
• 12.22.4 If the report recommends AT, it should include a full range of options or minimum specifications for equipment and a detailed justification if one device is recommended over all other choices. Equipment choices should consider current equipment, as well as high and low-tech options. Funding options must also be included as well as information about vendors and possible repair and maintenance providers.

12.23 Other Considerations with AT

• 12.23.1 There are a number of questions that the IFSP team including the family should answer when deciding about the inclusion of AT in a child's IFSP based on the conclusions included in the evaluation report.
  • What are the parent's goals for their child? Is any AT necessary to meet the parent's current goals?
  • What are the skills, needs, and likes of the child?
  • What problem will the AT device solve?
  • Will the proposed solution enable the child to function more independently and/or more successfully?
  • What is the ability of the child to independently and successfully learn and use the device?
  • Are there implications for the child's health status (e.g. effects of required positioning on respiratory or cardiac status)?
  • What are the limitations of the device?
  • Are there a number of equal device options for consideration?
  • Why is this technology more appropriate than other low-tech or no-tech alternatives?
  • How flexible is the device? Can it grow with the child's needs and abilities?
  • Is there a way a currently available piece of technology can be modified to meet the need?
  • How useful will the technology be with the other devices the child currently uses?
  • Does the family (or child) like or have other feelings about the device?
  • Are the size and weight of the device important issues?
  • If the device is carried between home and other settings, what precautions need to be made?
  • Have all the functional environments of the child's use been considered? What are the child's home and family activities?
  • Is the device safe and/or sturdy?
  • Is the technology current enough to provide service and part options for the immediate future? How easy is it to obtain repairs?
  • Has the device been on the market long enough to establish itself and for problems to have been worked out?
  • Has there been or is there a possibility for an adequate trial period?
  • Is the device available?
  • What is the expected lifetime and duration of use for the device?
  • Can the device be used for a number of different tasks?
• 12.23.2 Parents play a vital role in the choice, implementation, and use of AT. They should be involved with choosing, adapting, routine maintenance, training, and on-going assessment associated with the child's use of the devices. They are also vital in sharing their dreams and visions for their family and the child so that the team can better determine what kind of technologies would best suit their child.

12.24 AT and the IFSP

• 12.24.1 All children with disabilities who are eligible for EI services must be provided with AT, if appropriate, as part of the Individualized Family Service Plan (IFSP). AT devices should be considered if interventions are required to aid in the developmental tasks such as interaction with the environment, communication, and cognition. These AT devices and services are required, however, only when they relate to the developmental needs of infants and toddlers and their families.
• 12.24.2 Inclusion of AT in the IFSP must occur on an individual basis and must be based on the child's needs, the family's concerns and intervention priorities and goals. AT devices/services must be included in the IFSP as agreed upon by the parent and other team members. At minimum, the IFSP should have the following information:
  • The functional outcomes that will be achieved for the child and family, including the way in which the AT device is expected to increase, maintain, or enhance a child's functional capabilities.
  • A description of the specific AT device(s) needed by the child, the projected dates for acquisition of the device, and the method of acquisition.
  • The methods and strategies for use of the AT device to increase, maintain, or improve the child's functional capabilities, the individuals (including parents, other caregivers and family members, and qualified personnel) who will be assisting the child in using the device, and the settings in which the device is to be used.
  • The qualified personnel who will be providing the AT services and the frequency, intensity and method of delivery recommended.

12.25 Funding

12.25.1 EI will pay for AT items at rates matching the Illinois Department of Healthcare and Family Services (HFS) rate structure. See 12.17.4. All rates submitted are subject to the approval of the DHS AT coordinator.

12.26 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 actually sees the child, it may be necessary to change the HCPCS code(s) originally requested. If this situation occurs:

12.27 Relationship To Other Programs

• 12.27.1  Many of the eligible children in this program are also eligible for, or participating in other programs, such as DSCC or HFS (Illinois Department Healthcare and Family Services)/All Kids. The EI Services System is payor of last resort and should be utilized when these funding sources are exhausted.
• 12.27.2  HFS/All Kids and EI

• 12.27.3  DSCC and EI

• 12.27.4  If a device is not eligible for EI funding, child's AT Coordinator will be notified by fax after initial review is made.

12.28 Implementation Of AT

• 12.28.1  There are several things to consider when the use of AT is to be implemented. The best device in the world will not work if the child does not use it. One reason for this is that it may be the wrong technology for the child. The device might be one of many other assistive items for the child and may be overwhelming for the family. The family may not have the physical space in their home to accommodate the utilization of the specific technology. Another reason is that parents or other caregivers may not be adequately trained on how to use the technology. Parents who understand how a device works and believe that it plays an important role in their child's development will provide more and better opportunities for the child to learn about and use the devices. Parents' preferences and feelings about particular devices often determine whether implementation and use of devices will be successful.
• 12.28.2  In many cases, successful choice and use of a device often requires an extended "trial period" with the device via rental, lease, or loan programs giving the child an adequate chance to learn and use the technology and then evaluate its usefulness. In situations where a variety of different technologies, both low and high tech, serve the same needs, the child should also be provided, when appropriate, with reasonable access to several of these technologies for a trial period to make decisions about when and where to use each device. While it would be helpful if AT companies would allow free trial periods of offer loaners at no cost, this may not occur. Some companies do, however, allow for equipment rental or have return policies.

12.29 AT Provider Responsibilities

• 12.29.1  For consideration to be given by DHS to pay for AT equipment/services, the provider (vendor) must be enrolled in the EI Services System under the provider type of AT. Eligible providers are those who supply and/or service durable medical equipment, orthotics, hearing aids, and developmental and other equipment to assist activities of daily living. Manufacturers of items may be enrolled if distribution of equipment is directly to eligible EI children. Vendors are responsible to ensure approved equipment is received by the family in a timely manner, prior to billing insurance and/or the CBO. EI will not replace lost or stolen items upon delivery. Vendor should ensure safe delivery of items. Delivery to therapist office locations or CFC offices and signature verification of receipt should be considered.

12.30 AT References

• Illinois Department of Public Aid (2000) Information Notice, 8/31/00
• Connecticut State Department of Education and the Connecticut Birth to Three Systems. (1999). Guidelines for AT
• South Carolina Department of Health and Environmental Control (2000). Babynet Service Guidelines: Assistive Technology