(325 ILCS 20/2) (from Ch. 23, par. 4152)
Sec. 2. Legislative Findings and Policy.
(a) The General Assembly finds that there is an urgent and substantial need to:
(1) enhance the development of all eligible infants |
| and toddlers in the State of Illinois in order to minimize developmental delay and maximize individual potential for adult independence; | |
(2) enhance the capacity of families to meet the |
| special needs of eligible infants and toddlers including the purchase of services when necessary; | |
(3) reduce educational costs by minimizing the need |
| for special education and related services when eligible infants and toddlers reach school age; | |
(4) enhance the independence, productivity and |
| integration with age‑appropriate peers of eligible children and their families; | |
(5) reduce social services costs and minimize the |
| need for institutionalization; and | |
(6) prevent secondary impairments and disabilities |
| by improving the health of infants and toddlers, thereby reducing health costs for the families and the State. | |
(b) The General Assembly therefore intends that the policy of this State shall be to:
(1) affirm the importance of the family in all areas |
| of the child's development and reinforce the role of the family as a participant in the decision making processes regarding their child; | |
(2) provide assistance and support to eligible |
| infants and toddlers and their families to address the individual concerns and decisions of each family; | |
(3) develop and implement, on a statewide basis, |
| locally based comprehensive, coordinated, interdisciplinary, interagency early intervention services for all eligible infants and toddlers; | |
(4) enhance the local communities' capacity to |
| provide an array of quality early intervention services; | |
(5) identify and coordinate all available resources |
| for early intervention within the State including those from federal, State, local and private sources; | |
(6) provide financial and technical assistance to |
| local communities for the purposes of coordinating early intervention services in local communities and enhancing the communities' capacity to provide individualized early intervention services to all eligible infants and toddlers in their homes or in community environments; and | |
(7) affirm that eligible infants and toddlers have a |
| right to receive early intervention services to the maximum extent appropriate, in natural environments in which infants and toddlers without disabilities would participate. | |
(c) The General Assembly further finds that early intervention services are cost‑effective and effectively serve the developmental needs of eligible infants and toddlers and their families. Therefore, the purpose of this Act is to provide a comprehensive, coordinated, interagency, interdisciplinary early intervention services system for eligible infants and toddlers and their families by enhancing the capacity to provide quality early intervention services, expanding and improving existing services, and facilitating coordination of payments for early intervention services from various public and private sources.
(Source: P.A. 91‑538, eff. 8‑13‑99.) |
(325 ILCS 20/3) (from Ch. 23, par. 4153)
Sec. 3. Definitions. As used in this Act:
(a) "Eligible infants and toddlers" means infants and toddlers under 36 months of age with any of the following conditions:
(1) Developmental delays.
(2) A physical or mental condition which typically |
| results in developmental delay. | |
(3) Being at risk of having substantial |
| developmental delays based on informed clinical judgment. | |
(4) Either (A) having entered the program under any |
| of the circumstances listed in paragraphs (1) through (3) of this subsection but no longer meeting the current eligibility criteria under those paragraphs, and continuing to have any measurable delay, or (B) not having attained a level of development in each area, including (i) cognitive, (ii) physical (including vision and hearing), (iii) language, speech, and communication, (iv) psycho‑social, or (v) self‑help skills, that is at least at the mean of the child's age equivalent peers; and, in addition to either item (A) or item (B), (C) having been determined by the multidisciplinary individualized family service plan team to require the continuation of early intervention services in order to support continuing developmental progress, pursuant to the child's needs and provided in an appropriate developmental manner. The type, frequency, and intensity of services shall differ from the initial individualized family services plan because of the child's developmental progress, and may consist of only service coordination, evaluation, and assessments. | |
(b) "Developmental delay" means a delay in one or more of the following areas of childhood development as measured by appropriate diagnostic instruments and standard procedures: cognitive; physical, including vision and hearing; language, speech and communication; psycho‑social; or self‑help skills. The term means a delay of 30% or more below the mean in function in one or more of those areas.
(c) "Physical or mental condition which typically results in developmental delay" means:
(1) a diagnosed medical disorder bearing a |
| relatively well known expectancy for developmental outcomes within varying ranges of developmental disabilities; or | |
(2) a history of prenatal, perinatal, neonatal or |
| early developmental events suggestive of biological insults to the developing central nervous system and which either singly or collectively increase the probability of developing a disability or delay based on a medical history. | |
(d) "Informed clinical judgment" means both clinical observations and parental participation to determine eligibility by a consensus of a multidisciplinary team of 2 or more members based on their professional experience and expertise.
(e) "Early intervention services" means services which:
(1) are designed to meet the developmental needs of |
| each child eligible under this Act and the needs of his or her family; | |
(2) are selected in collaboration with the child's |
|
(3) are provided under public supervision;
(4) are provided at no cost except where a schedule |
| of sliding scale fees or other system of payments by families has been adopted in accordance with State and federal law; | |
(5) are designed to meet an infant's or toddler's |
| developmental needs in any of the following areas: | |
(A) physical development, including vision and |
|
(B) cognitive development,
(C) communication development,
(D) social or emotional development, or
(E) adaptive development;
(6) meet the standards of the State, including the |
| requirements of this Act; | |
(7) include one or more of the following:
(A) family training,
(B) social work services, including counseling, |
|
(C) special instruction,
(D) speech, language pathology and audiology,
(E) occupational therapy,
(F) physical therapy,
(G) psychological services,
(H) service coordination services,
(I) medical services only for diagnostic or |
|
(J) early identification, screening, and |
|
(K) health services specified by the lead agency |
| as necessary to enable the infant or toddler to benefit from the other early intervention services, | |
(L) vision services,
(M) transportation, and
(N) assistive technology devices and services;
(8) are provided by qualified personnel, including |
|
(A) child development specialists or special |
|
(B) speech and language pathologists and |
|
(C) occupational therapists,
(D) physical therapists,
(E) social workers,
(F) nurses,
(G) nutritionists,
(H) optometrists,
(I) psychologists, and
(J) physicians;
(9) are provided in conformity with an |
| Individualized Family Service Plan; | |
(10) are provided throughout the year; and
(11) are provided in natural environments, including |
| the home and community settings in which infants and toddlers without disabilities would participate to the extent determined by the multidisciplinary Individualized Family Service Plan. | |
(f) "Individualized Family Service Plan" or "Plan" means a written plan for providing early intervention services to a child eligible under this Act and the child's family, as set forth in Section 11.
(g) "Local interagency agreement" means an agreement entered into by local community and State and regional agencies receiving early intervention funds directly from the State and made in accordance with State interagency agreements providing for the delivery of early intervention services within a local community area.
(h) "Council" means the Illinois Interagency Council on Early Intervention established under Section 4.
(i) "Lead agency" means the State agency responsible for administering this Act and receiving and disbursing public funds received in accordance with State and federal law and rules.
(i‑5) "Central billing office" means the central billing office created by the lead agency under Section 13.
(j) "Child find" means a service which identifies eligible infants and toddlers.
(k) "Regional intake entity" means the lead agency's designated entity responsible for implementation of the Early Intervention Services System within its designated geographic area.
(l) "Early intervention provider" means an individual who is qualified, as defined by the lead agency, to provide one or more types of early intervention services, and who has enrolled as a provider in the early intervention program.
(m) "Fully credentialed early intervention provider" means an individual who has met the standards in the State applicable to the relevant profession, and has met such other qualifications as the lead agency has determined are suitable for personnel providing early intervention services, including pediatric experience, education, and continuing education. The lead agency shall establish these qualifications by rule filed no later than 180 days after the effective date of this amendatory Act of the 92nd General Assembly.
(Source: P.A. 92‑307, 8‑9‑01; 93‑124, eff. 7‑10‑03.) |
(325 ILCS 20/4)
(from Ch. 23, par. 4154)
Sec. 4.
Illinois Interagency Council on Early Intervention.
(a) There is established the Illinois Interagency Council on Early Intervention. The Council shall be composed of at least 15 but not more than 25 members. The members of the Council and the designated chairperson of the Council shall be appointed by the Governor. The Council member representing the lead agency may not serve as chairperson of the Council. The Council shall be composed of the following members:
(1) The Secretary of Human Services (or his or her
| designee) and 2 additional representatives of the Department of Human Services designated by the Secretary, plus the Directors (or their designees) of the following State agencies involved in the provision of or payment for early intervention services to eligible infants and toddlers and their families: | |
(A) Illinois State Board of Education;
(B) (Blank);
(C) (Blank);
(D) Illinois Department of Children and Family |
|
(E) University of Illinois Division of |
| Specialized Care for Children; | |
(F) Illinois Department of Healthcare and Family |
|
(G) Illinois Department of Public Health;
(H) (Blank);
(I) Illinois Planning Council on Developmental |
|
(J) Illinois Department of Insurance.
(2) Other members as follows:
(A) At least 20% of the members of the Council |
| shall be parents, including minority parents, of infants or toddlers with disabilities or children with disabilities aged 12 or younger, with knowledge of, or experience with, programs for infants and toddlers with disabilities. At least one such member shall be a parent of an infant or toddler with a disability or a child with a disability aged 6 or younger; | |
(B) At least 20% of the members of the Council |
| shall be public or private providers of early intervention services; | |
(C) One member shall be a representative of the |
|
(D) One member shall be involved in the |
| preparation of professional personnel to serve infants and toddlers similar to those eligible for services under this Act. | |
The Council shall meet at least quarterly and in such places as it deems necessary. Terms of the initial members appointed under paragraph (2) shall be determined by lot at the first Council meeting as follows: of the persons appointed under subparagraphs (A) and (B), one‑third shall serve one year terms, one‑third shall serve 2 year terms, and one‑third shall serve 3 year terms; and of the persons appointed under subparagraphs (C) and (D), one shall serve a 2 year term and one shall serve a 3 year term. Thereafter, successors appointed under paragraph (2) shall serve 3 year terms. Once appointed, members shall continue to serve until their successors are appointed. No member shall be appointed to serve more than 2 consecutive terms.
Council members shall serve without compensation but shall be reimbursed for reasonable costs incurred in the performance of their duties, including costs related to child care, and parents may be paid a stipend in accordance with applicable requirements.
The Council shall prepare and approve a budget using funds appropriated for the purpose to hire staff, and obtain the services of such professional, technical, and clerical personnel as may be necessary to carry out its functions under this Act. This funding support and staff shall be directed by the lead agency.
(b) The Council shall:
(1) advise and assist the lead agency in the |
| performance of its responsibilities including but not limited to the identification of sources of fiscal and other support services for early intervention programs, and the promotion of interagency agreements which assign financial responsibility to the appropriate agencies; | |
(2) advise and assist the lead agency in the |
| preparation of applications and amendments to applications; | |
(3) review and advise on relevant regulations and |
| standards proposed by the related State agencies; | |
(4) advise and assist the lead agency in the |
| development, implementation and evaluation of the comprehensive early intervention services system; and | |
(5) prepare and submit an annual report to the |
| Governor and to the General Assembly on the status of early intervention programs for eligible infants and toddlers and their families in Illinois. The annual report shall include (i) the estimated number of eligible infants and toddlers in this State, (ii) the number of eligible infants and toddlers who have received services under this Act and the cost of providing those services, (iii) the estimated cost of providing services under this Act to all eligible infants and toddlers in this State, and (iv) data and other information as is requested to be included by the Legislative Advisory Committee established under Section 13.50 of this Act. The report shall be posted by the lead agency on the early intervention website as required under paragraph (f) of Section 5 of this Act. | |
No member of the Council shall cast a vote on or participate substantially in any matter which would provide a direct financial benefit to that member or otherwise give the appearance of a conflict of interest under State law. All provisions and reporting requirements of the Illinois Governmental Ethics Act shall apply to Council members.
(Source: P.A. 95‑331, eff. 8‑21‑07.) |
(325 ILCS 20/5)
(from Ch. 23, par. 4155)
Sec. 5.
Lead Agency.
The Department of Human Services is designated the lead agency and shall provide leadership in establishing and implementing the coordinated, comprehensive, interagency and interdisciplinary system of early intervention services. The lead agency shall not have the sole responsibility for providing these services. Each participating State agency shall continue to coordinate those early intervention services relating to health, social service and education provided under this authority.
The lead agency is responsible for carrying out the following:
(a) The general administration, supervision, and
| monitoring of programs and activities receiving assistance under Section 673 of the Individuals with Disabilities Education Act (20 United States Code 1473). | |
(b) The identification and coordination of all |
| available resources within the State from federal, State, local and private sources. | |
(c) The development of procedures to ensure that |
| services are provided to eligible infants and toddlers and their families in a timely manner pending the resolution of any disputes among public agencies or service providers. | |
(d) The resolution of intra‑agency and interagency |
| regulatory and procedural disputes. | |
(e) The development and implementation of formal |
| interagency agreements, and the entry into such agreements, between the lead agency and (i) the Department of Healthcare and Family Services, (ii) the University of Illinois Division of Specialized Care for Children, and (iii) other relevant State agencies that: | |
(1) define the financial responsibility of each |
| agency for paying for early intervention services (consistent with existing State and federal law and rules, including the requirement that early intervention funds be used as the payor of last resort), a hierarchical order of payment as among the agencies for early intervention services that are covered under or may be paid by programs in other agencies, and procedures for direct billing, collecting reimbursements for payments made, and resolving service and payment disputes; and | |
(2) include all additional components necessary |
| to ensure meaningful cooperation and coordination. | |
Interagency agreements under this paragraph (e) must |
| be reviewed and revised to implement the purposes of this amendatory Act of the 92nd General Assembly no later than 60 days after the effective date of this amendatory Act of the 92nd General Assembly. | |
(f) The maintenance of an early intervention |
| website. Within 30 days after the effective date of this amendatory Act of the 92nd General Assembly, the lead agency shall post and keep posted on this website the following: (i) the current annual report required under subdivision (b)(5) of Section 4 of this Act, and the annual reports of the prior 3 years, (ii) the most recent Illinois application for funds prepared under Section 637 of the Individuals with Disabilities Education Act filed with the United States Department of Education, (iii) proposed modifications of the application prepared for public comment, (iv) notice of Council meetings, Council agendas, and minutes of its proceedings for at least the previous year, (v) proposed and final early intervention rules, (vi) requests for proposals, and (vii) all reports created for dissemination to the public that are related to the early intervention program, including reports prepared at the request of the Council, the General Assembly, and the Legislative Advisory Committee established under Section 13.50 of this Act. Each such document shall be posted on the website within 3 working days after the document's completion. | |
(Source: P.A. 95‑331, eff. 8‑21‑07.) |
(325 ILCS 20/6) (from Ch. 23, par. 4156)
Sec. 6. Local Structure and Interagency Councils. The lead agency, in conjunction with the Council and as defined by administrative rule, shall define local service areas and define the geographic boundaries of each so that all areas of the State are included in a local service area but no area of the State is included in more than one service area. In each local service area, the lead agency shall designate a regional entity responsible for the assessment of eligibility and services and a local interagency council responsible for coordination and design of child find and public awareness. The regional entity shall be responsible for staffing the local council, carrying out child find and public awareness activities, and providing advocacy for eligible families within the given geographic area. The regional entity is the prime contractor responsible to the lead agency for implementation of this Act.
The lead agency, in conjunction with the Council, shall create local interagency councils. Members of each local interagency council shall include, but not be limited to, the following: parents; representatives from coordination and advocacy service providers; local education agencies; other local public and private service providers; representatives from State agencies at the local level; and others deemed necessary by the local council.
Local interagency councils shall:
(a) assist in the development of collaborative |
| agreements between local service providers, diagnostic and other agencies providing additional services to the child and family; | |
(b) assist in conducting local needs assessments and |
|
(c) identify and resolve local access issues;
(d) conduct collaborative child find activities;
(e) coordinate public awareness initiatives;
(f) coordinate local planning and evaluation;
(g) assist in the recruitment of specialty personnel;
(h) develop plans for facilitating transition and |
| integration of eligible children and families into the community; | |
(i) facilitate conflict resolution at the local |
|
(j) report annually to the Council.
(Source: P.A. 91‑538, eff. 8‑13‑99.) |
(325 ILCS 20/7) (from Ch. 23, par. 4157)
Sec. 7. Essential Components of the Statewide Service System. As required by federal laws and regulations, a statewide system of coordinated, comprehensive, interagency and interdisciplinary programs shall be established and maintained. The framework of the statewide system shall be based on the components set forth in this Section. This framework shall be used for planning, implementation, coordination and evaluation of the statewide system of locally based early intervention services.
The statewide system shall include, at a minimum:
(a) a definition of the term "developmentally |
| delayed", in accordance with the definition in Section 3, that will be used in Illinois in carrying out programs under this Act; | |
(b) timetables for ensuring that appropriate early |
| intervention services will be available to all eligible infants and toddlers in this State after the effective date of this Act; | |
(c) a timely, comprehensive and interdisciplinary |
| evaluation of the functioning of each infant and toddler with suspected disabilities in this State and the concerns, priorities and resource needs of the families to appropriately assist in the development of the infant and toddler with disabilities; | |
(d) for each eligible infant and toddler, an |
| Individualized Family Service Plan, including case management services; | |
(e) a comprehensive child find system, consistent |
| with Part B of the Individuals with Disabilities Education Act (20 United States Code 1411 through 1420), which includes timelines and provides for participation by primary referral sources; | |
(f) a public awareness program focusing on early |
| identification of eligible infants and toddlers; | |
(g) a central directory which includes early |
| intervention services, resources, and experts available in this State and early intervention research and demonstration projects being conducted in this State; | |
(h) a comprehensive system of personnel development;
(i) a policy pertaining to the contracting or making |
| of other arrangements with public and private service providers to provide early intervention services in this State, consistent with the provisions of this Act, including the contents of the application used and the conditions of the contract or other arrangements; | |
(j) a procedure for securing timely reimbursement of |
|
(k) procedural safeguards with respect to programs |
|
(l) policies and procedures relating to the |
| establishment and maintenance of standards to ensure that personnel necessary to carry out this Act are appropriately and adequately prepared and trained; | |
(m) a system of evaluation of, and compliance with, |
|
(n) a system for compiling data on the numbers of |
| eligible infants and toddlers and their families in this State in need of appropriate early intervention services; the numbers served; the types of services provided; and other information required by the State or federal government; and | |
(o) a single line of responsibility in a lead agency |
| designated by the Governor to carry out its responsibilities as required by this Act. | |
In addition to these required components, linkages may be established within a local community area among the prenatal initiatives affording services to high risk pregnant women. Additional linkages among at risk programs and local literacy programs may also be established.
Within 60 days of the effective date of this Act, a five‑fiscal‑year implementation plan shall be submitted to the Governor by the lead agency with the concurrence of the Interagency Council on Early Intervention. The plan shall list specific activities to be accomplished each year, with cost estimates for each activity. No later than the second Monday in July of each year thereafter, the lead agency shall, with the concurrence of the Interagency Council, submit to the Governor's Office a report on accomplishments of the previous year and a revised list of activities for the remainder of the five‑fiscal‑year plan, with cost estimates for each. The Governor shall certify that specific activities in the plan for the previous year have been substantially completed before authorizing relevant State or local agencies to implement activities listed in the revised plan that depend substantially upon completion of one or more of the earlier activities.
(Source: P.A. 87‑680.) |
(325 ILCS 20/11) (from Ch. 23, par. 4161)
Sec. 11. Individualized Family Service Plans.
(a) Each eligible infant or toddler and that infant's or toddler's family shall receive:
(1) timely, comprehensive, multidisciplinary |
| assessment of the unique needs of each eligible infant and toddler, and assessment of the concerns and priorities of the families to appropriately assist them in meeting their needs and identify services to meet those needs; and | |
(2) a written Individualized Family Service Plan |
| developed by a multidisciplinary team which includes the parent or guardian. The individualized family service plan shall be based on the multidisciplinary team's assessment of the resources, priorities, and concerns of the family and its identification of the supports and services necessary to enhance the family's capacity to meet the developmental needs of the infant or toddler, and shall include the identification of services appropriate to meet those needs, including the frequency, intensity, and method of delivering services. During and as part of the initial development of the individualized family services plan, and any periodic reviews of the plan, the multidisciplinary team shall consult the lead agency's therapy guidelines and its designated experts, if any, to help determine appropriate services and the frequency and intensity of those services. All services in the individualized family services plan must be justified by the multidisciplinary assessment of the unique strengths and needs of the infant or toddler and must be appropriate to meet those needs. At the periodic reviews, the team shall determine whether modification or revision of the outcomes or services is necessary. | |
(b) The Individualized Family Service Plan shall be evaluated once a year and the family shall be provided a review of the Plan at 6 month intervals or more often where appropriate based on infant or toddler and family needs. The lead agency shall create a quality review process regarding Individualized Family Service Plan development and changes thereto, to monitor and help assure that resources are being used to provide appropriate early intervention services.
(c) The evaluation and initial assessment and initial Plan meeting must be held within 45 days after the initial contact with the early intervention services system. With parental consent, early intervention services may commence before the completion of the comprehensive assessment and development of the Plan.
(d) Parents must be informed that, at their discretion, early intervention services shall be provided to each eligible infant and toddler in the natural environment, which may include the home or other community settings. Parents shall make the final decision to accept or decline early intervention services. A decision to decline such services shall not be a basis for administrative determination of parental fitness, or other findings or sanctions against the parents. Parameters of the Plan shall be set forth in rules.
(e) The regional intake offices shall explain to each family, orally and in writing, all of the following:
(1) That the early intervention program will pay for |
| all early intervention services set forth in the individualized family service plan that are not covered or paid under the family's public or private insurance plan or policy and not eligible for payment through any other third party payor. | |
(2) That services will not be delayed due to any |
| rules or restrictions under the family's insurance plan or policy. | |
(3) That the family may request, with appropriate |
| documentation supporting the request, a determination of an exemption from private insurance use under Section 13.25. | |
(4) That responsibility for co‑payments or |
| co‑insurance under a family's private insurance plan or policy will be transferred to the lead agency's central billing office. | |
(5) That families will be responsible for payments |
| of family fees, which will be based on a sliding scale according to income, and that these fees are payable to the central billing office, and that if the family encounters a catastrophic circumstance, as defined under subsection (f) of Section 13 of this Act, making it unable to pay the fees, the lead agency may, upon proof of inability to pay, waive the fees. | |
(f) The individualized family service plan must state whether the family has private insurance coverage and, if the family has such coverage, must have attached to it a copy of the family's insurance identification card or otherwise include all of the following information:
(1) The name, address, and telephone number of the |
|
(2) The contract number and policy number of the |
|
(3) The name, address, and social security number of |
|
(4) The beginning date of the insurance benefit year.
(g) A copy of the individualized family service plan must be provided to each enrolled provider who is providing early intervention services to the child who is the subject of that plan.
(Source: P.A. 91‑538, eff. 8‑13‑99; 92‑10, eff. 6‑11‑01; 92‑307, eff. 8‑9‑01; 92‑651, eff. 7‑11‑02.) |
(325 ILCS 20/12) (from Ch. 23, par. 4162)
Sec. 12. Procedural Safeguards. The lead agency shall adopt procedural safeguards that meet federal requirements and ensure effective implementation of the safeguards for families by each public agency involved in the provision of early intervention services under this Act.
The procedural safeguards shall provide, at a minimum, the following:
(a) The timely administrative resolution of |
| complaints by parents as defined by administrative rule. | |
(b) The right to confidentiality of personally |
| identifiable information. | |
(c) The opportunity for parents and a guardian to |
| examine and receive copies of records relating to assessment, screening, eligibility determinations, and the development and implementation of the Individualized Family Service Plan. | |
(d) Procedures to protect the rights of the eligible |
| infant or toddler whenever the parents or guardians of the child are not known or unavailable or the child is a ward of the State, including the assignment of an individual (who shall not be an employee of the State agency or local agency providing services) to act as a surrogate for the parents or guardian. | |
(e) Timely written prior notice to the parents or |
| guardian of the eligible infant or toddler whenever the State agency or public or private service provider proposes to initiate or change or refuses to initiate or change the identification, evaluation, placement, or the provision of appropriate early intervention services to the eligible infant or toddler. | |
(f) Written prior notice to fully inform the parents |
| or guardians, in their primary language, in a comprehensible manner, of these procedural safeguards. | |
(g) During the pendency of any proceedings or action |
| involving a complaint, unless the State agency and the parents or guardian otherwise agree, the child shall continue to receive the appropriate early intervention services currently being provided, or in the case of an application for initial services, the child shall receive the services not in dispute. | |
(Source: P.A. 91‑538, eff. 8‑13‑99.) |
(325 ILCS 20/13) (from Ch. 23, par. 4163)
Sec. 13. Funding and Fiscal Responsibility.
(a) The lead agency and every other participating State agency may receive and expend funds appropriated by the General Assembly to implement the early intervention services system as required by this Act.
(b) The lead agency and each participating State agency shall identify and report on an annual basis to the Council the State agency funds utilized for the provision of early intervention services to eligible infants and toddlers.
(c) Funds provided under Section 633 of the Individuals with Disabilities Education Act (20 United States Code 1433) and State funds designated or appropriated for early intervention services or programs may not be used to satisfy a financial commitment for services which would have been paid for from another public or private source but for the enactment of this Act, except whenever considered necessary to prevent delay in receiving appropriate early intervention services by the eligible infant or toddler or family in a timely manner. "Public or private source" includes public and private insurance coverage.
Funds provided under Section 633 of the Individuals with Disabilities Education Act and State funds designated or appropriated for early intervention services or programs may be used by the lead agency to pay the provider of services (A) pending reimbursement from the appropriate State agency or (B) if (i) the claim for payment is denied in whole or in part by a public or private source, or would be denied under the written terms of the public program or plan or private plan, or (ii) use of private insurance for the service has been exempted under Section 13.25. Payment under item (B)(i) may be made based on a pre‑determination telephone inquiry supported by written documentation of the denial supplied thereafter by the insurance carrier.
(d) Nothing in this Act shall be construed to permit the State to reduce medical or other assistance available or to alter eligibility under Title V and Title XIX of the Social Security Act relating to the Maternal Child Health Program and Medicaid for eligible infants and toddlers in this State.
(e) The lead agency shall create a central billing office to receive and dispense all relevant State and federal resources, as well as local government or independent resources available, for early intervention services. This office shall assure that maximum federal resources are utilized and that providers receive funds with minimal duplications or interagency reporting and with consolidated audit procedures.
(f) The lead agency shall, by rule, create a system of payments by families, including a schedule of fees. No fees, however, may be charged for: implementing child find, evaluation and assessment, service coordination, administrative and coordination activities related to the development, review, and evaluation of Individualized Family Service Plans, or the implementation of procedural safeguards and other administrative components of the statewide early intervention system.
The system of payments, called family fees, shall be structured on a sliding scale based on family income. The family's coverage or lack of coverage under a public or private insurance plan or policy shall not be a factor in determining the amount of the family fees.
Each family's fee obligation shall be established annually, and shall be paid by families to the central billing office in installments. At the written request of the family, the fee obligation shall be adjusted prospectively at any point during the year upon proof of a change in family income or family size. The inability of the parents of an eligible child to pay family fees due to catastrophic circumstances or extraordinary expenses shall not result in the denial of services to the child or the child's family. A family must document its extraordinary expenses or other catastrophic circumstances by showing one of the following: (i) out‑of‑pocket medical expenses in excess of 15% of gross income; (ii) a fire, flood, or other disaster causing a direct out‑of‑pocket loss in excess of 15% of gross income; or (iii) other catastrophic circumstances causing out‑of‑pocket losses in excess of 15% of gross income. The family must present proof of loss to its service coordinator, who shall document it, and the lead agency shall determine whether the fees shall be reduced, forgiven, or suspended within 10 business days after the family's request.
(g) To ensure that early intervention funds are used as the payor of last resort for early intervention services, the lead agency shall determine at the point of early intervention intake, and again at any periodic review of eligibility thereafter or upon a change in family circumstances, whether the family is eligible for or enrolled in any program for which payment is made directly or through public or private insurance for any or all of the early intervention services made available under this Act. The lead agency shall establish procedures to ensure that payments are made either directly from these public and private sources instead of from State or federal early intervention funds, or as reimbursement for payments previously made from State or federal early intervention funds.
(Source: P.A. 91‑538, eff. 8‑13‑99; 92‑10, eff. 6‑11‑01; 92‑307, eff. 8‑9‑01; 92‑651, eff. 7‑11‑02.) |
(325 ILCS 20/13.20)
Sec. 13.20. Families with insurance coverage.
(a) Families of children with insurance coverage, whether public or private, shall incur no greater or less direct out‑of‑pocket expenses for early intervention services than families who are not insured.
(b) Managed care plans.
(1) Use of managed care network providers. When a |
| family's insurance coverage is through a managed care arrangement with a network of providers that includes one or more types of early intervention specialists who provide the services set forth in the family's individualized family service plan, the regional intake entity shall require the family to use those network providers, but only to the extent that: | |
(A) the network provider is immediately |
| available to receive the referral and to begin providing services to the child; | |
(B) the network provider is enrolled as a |
| provider in the Illinois early intervention system and fully credentialed under the current policy or rule of the lead agency; | |
(C) the network provider can provide the |
| services to the child in the manner required in the individualized service plan; | |
(D) the family would not have to travel more |
| than an additional 15 miles or an additional 30 minutes to the network provider than it would have to travel to a non‑network provider who is available to provide the same service; and | |
(E) the family's managed care plan does not |
| allow for billing (even at a reduced rate or reduced percentage of the claim) for early intervention services provided by non‑network providers. | |
(2) Transfers from non‑network to network providers. |
| If a child has been receiving services from a non‑network provider and the regional intake entity determines, at the time of enrollment in the early intervention program or at any point thereafter, that the family is enrolled in a managed care plan, the regional intake entity shall require the family to transfer to a network provider within 45 days after that determination, but within no more than 60 days after the effective date of this amendatory Act of the 92nd General Assembly, if: | |
(A) all the requirements of subdivision (b)(1) |
| of this Section have been met; and | |
(B) the child is less than 26 months of age.
(3) Waivers. The lead agency may fully or partially |
| waive the network enrollment requirements of subdivision (b)(1) of this Section and the transfer requirements of subdivision (b)(2) of this Section as to a particular region, or narrower geographic area, if it finds that the managed care plans in that area are not allowing further enrollment of early intervention providers and it finds that referrals or transfers to network providers could cause an overall shortage of early intervention providers in that region of the State or could cause delays in families securing the early intervention services set forth in individualized family services plans. | |
(4) The lead agency, in conjunction with any |
| entities with which it may have contracted for the training and credentialing of providers, the local interagency council for early intervention, the regional intake entity, and the enrolled providers in each region who wish to participate, shall cooperate in developing a matrix and action plan that (A) identifies both (i) which early intervention providers and which fully credentialed early intervention providers are members of the managed care plans that are used in the region by families with children in the early intervention program, and (ii) which early intervention services, with what restrictions, if any, are covered under those plans, (B) identifies which credentialed specialists are members of which managed care plans in the region, and (C) identifies the various managed care plans to early intervention providers, encourages their enrollment in the area plans, and provides them with information on how to enroll. These matrices shall be complete no later than 7 months after the effective date of this amendatory Act of the 92nd General Assembly, and shall be provided to the Early Intervention Legislative Advisory Committee at that time. The lead agency shall work with networks that may have closed enrollment to additional providers to encourage their admission of early intervention providers, and shall report to the Early Intervention Legislative Advisory Committee on the initial results of these efforts no later than February 1, 2002. | |
(Source: P.A. 92‑307, eff. 8‑9‑01.) |
(325 ILCS 20/13.30)
Sec. 13.30. System of personnel development. The lead agency shall provide training to early intervention providers and may enter into contracts to meet this requirement. If such contracts are let, they shall be bid under a public request for proposals that shall be posted on the lead agency's early intervention website for no less than 30 days. This training shall include, at minimum, the following types of instruction:
(a) Courses in birth‑to‑3 evaluation and treatment of children with developmental disabilities and delays (1) that are taught by fully credentialed early intervention providers or educators with substantial experience in evaluation and treatment of children from birth to age 3 with developmental disabilities and delays, (2) that cover these topics within each of the disciplines of audiology, occupational therapy, physical therapy, speech and language pathology, and developmental therapy, including the social‑emotional domain of development, (3) that are held no less than twice per year, (4) that offer no fewer than 20 contact hours per year of course work, (5) that are held in no fewer than 5 separate locales throughout the State, and (6) that give enrollment priority to early intervention providers who do not meet the experience, education, or continuing education requirements necessary to be fully credentialed early intervention providers; and
(b) Courses held no less than twice per year for no fewer than 4 hours each in no fewer than 5 separate locales throughout the State each on the following topics:
(1) Practice and procedures of private insurance |
|
(2) The role of the regional intake entities; |
| service coordination; program eligibility determinations; family fees; Medicaid, KidCare, and Division of Specialized Care applications, referrals, and coordination with Early Intervention; and procedural safeguards. | |
(3) Introduction to the early intervention program, |
| including provider enrollment and credentialing, overview of Early Intervention program policies and regulations, and billing requirements. | |
(4) Evaluation and assessment of birth‑to‑3 |
| children; individualized family service plan development, monitoring, and review; best practices; service guidelines; and quality assurance. | |
(Source: P.A. 92‑307, eff. 8‑9‑01.) |