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Public Act 098-0041
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SB0626 Enrolled | LRB098 04441 JWD 34469 b |
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AN ACT concerning regulation.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 5. The Illinois Insurance Code is amended by adding |
Section 367m as follows:
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(215 ILCS 5/367m new) |
Sec. 367m. Early intervention services. A policy of |
accident and health insurance that provides coverage for early |
intervention services must conform to the following criteria: |
(1) The use of private health insurance to pay for |
early intervention services under Part C of the federal |
Individuals with Disabilities Education Act may not count |
towards or result in a loss of benefits due to annual or |
lifetime insurance caps for an infant or toddler with a |
disability, the infant's or toddler's parent, or the |
infant's or toddler's family members who are covered under |
that health insurance policy. |
(2) The use of private health insurance to pay for |
early intervention services under Part C of the federal |
Individuals with Disabilities Education Act may not |
negatively affect the availability of health insurance to |
an infant or toddler with a disability, the infant's or |
toddler's parent, or the infant's or toddler's family |
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members who are covered under that health insurance policy, |
and health insurance coverage may not be discontinued for |
these individuals due to the use of the health insurance to |
pay for services under Part C of the federal Individuals |
with Disabilities Education Act. |
(3) The use of private health insurance to pay for |
early intervention services under Part C of the federal |
Individuals with Disabilities Education Act may not be the |
basis for increasing the health insurance premiums of an |
infant or toddler with a disability, the infant's or |
toddler's parent, or the infant's or toddler's family |
members covered under that health insurance policy. |
For the purposes of this Section, "early intervention |
services" has the same meaning as in the Early Intervention |
Services System Act.
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Section 10. The Early Intervention Services System Act is |
amended by changing Sections 3, 4, 5, 7, 9, 10, 11, 12, 13, |
13.5, 13.10, and 13.30 as follows:
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(325 ILCS 20/3) (from Ch. 23, par. 4153)
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Sec. 3. Definitions. As used in this Act:
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(a) "Eligible infants and toddlers" means infants and |
toddlers
under 36 months of age with any of the following |
conditions:
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(1) Developmental delays.
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(2) A physical or mental condition which typically |
results in
developmental delay.
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(3) Being at risk of having substantial developmental |
delays
based on informed clinical opinion judgment .
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(4) Either (A) having entered the program under any of
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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) social or |
emotional psycho-social , or (v) adaptive 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)
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having
been determined by the multidisciplinary |
individualized
family service plan
team to require the |
continuation of early intervention services in order to
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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
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progress, and may consist of only service coordination, |
evaluation, and
assessments.
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(b) "Developmental delay" means a delay in one or more of |
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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; social or emotional psycho-social ;
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or adaptive self-help skills . The term means a delay of 30% or |
more below the mean in
function in one or more of those areas.
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(c) "Physical or mental condition which typically results |
in developmental
delay" means:
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(1) a diagnosed medical disorder bearing a relatively |
well known
expectancy for developmental outcomes within |
varying ranges of developmental
disabilities; or
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(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
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developing a disability or delay based on a medical |
history.
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(d) "Informed clinical opinion 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.
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(e) "Early intervention services" means services which:
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(1) are designed to meet the developmental needs of |
each child
eligible under this Act and the needs of his or |
her family;
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(2) are selected in collaboration with the child's |
family;
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(3) are provided under public supervision;
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(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;
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(5) are designed to meet an infant's or toddler's |
developmental needs in
any of the following areas:
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(A) physical development, including vision and |
hearing,
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(B) cognitive development,
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(C) communication development,
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(D) social or emotional development, or
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(E) adaptive development;
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(6) meet the standards of the State, including the |
requirements of this Act;
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(7) include one or more of the following:
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(A) family training,
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(B) social work services, including counseling, |
and home visits,
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(C) special instruction,
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(D) speech, language pathology and audiology,
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(E) occupational therapy,
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(F) physical therapy,
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(G) psychological services,
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(H) service coordination services,
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(I) medical services only for diagnostic or |
evaluation purposes,
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(J) early identification, screening, and |
assessment services,
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(K) health services specified by the lead agency as |
necessary to
enable the infant or toddler to benefit |
from the other early intervention
services,
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(L) vision services,
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(M) transportation, and
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(N) assistive technology devices and services , ;
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(O) nursing services, |
(P) nutrition services, and |
(Q) sign language and cued language services;
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(8) are provided by qualified personnel, including but |
not limited to:
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(A) child development specialists or special |
educators , including teachers of children with hearing |
impairments (including deafness) and teachers of |
children with vision impairments (including |
blindness) ,
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(B) speech and language pathologists and |
audiologists,
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(C) occupational therapists,
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(D) physical therapists,
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(E) social workers,
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(F) nurses,
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(G) dietitian nutritionists,
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(H) vision specialists, including ophthalmologists |
and optometrists,
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(I) psychologists, and
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(J) physicians;
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(9) are provided in conformity with an Individualized |
Family Service Plan;
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(10) are provided throughout the year; and
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(11) are provided in natural
environments, to the |
maximum extent appropriate, which may include the home and |
community settings, unless justification is provided |
consistent with federal regulations adopted under Sections |
1431 through 1444 of Title 20 of the United States Code.
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(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.
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(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.
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(h) "Council" means the Illinois Interagency Council on |
Early
Intervention established under Section 4.
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(i) "Lead agency" means the State agency
responsible for |
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administering this Act and
receiving and disbursing public |
funds received in accordance with State and
federal law and |
rules.
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(i-5) "Central billing office" means the central billing |
office created by
the lead agency under Section 13.
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(j) "Child find" means a service which identifies eligible |
infants and
toddlers.
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(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.
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(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.
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(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.
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(Source: P.A. 97-902, eff. 8-6-12.)
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(325 ILCS 20/4) (from Ch. 23, par. 4154)
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Sec. 4. Illinois Interagency Council on Early |
Intervention.
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(a) There is established the Illinois Interagency Council |
on Early
Intervention. The Council shall be composed of at |
least 20 but not more than
30 members. The members of the |
Council and the designated chairperson of the
Council shall be |
appointed by the Governor. The Council member representing the
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lead agency may not serve as chairperson of the Council. The |
Council shall be
composed of the following members:
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(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:
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(A) Department of Insurance; and
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(B) Department of Healthcare and Family Services.
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(2) Other members as follows:
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(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
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experience with, programs for infants and toddlers |
with disabilities. At
least one such member shall be a |
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parent of an infant or toddler with a
disability or a |
child with a disability aged 6 or younger;
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(B) At least 20% of the members of the Council |
shall be public or
private providers of early |
intervention services;
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(C) One member shall be a representative of the |
General Assembly;
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(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;
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(E) Two members shall be from advocacy |
organizations with expertise in improving health, |
development, and educational outcomes for infants and |
toddlers with disabilities; |
(F) One member shall be a Child and Family |
Connections manager from a rural district; |
(G) One member shall be a Child and Family |
Connections manager from an urban district; |
(H) One member shall be the co-chair of the |
Illinois Early Learning Council (or his or her |
designee); and |
(I) Members representing the following agencies or |
entities: the State Board of Education; the Department |
of Public Health; the Department of Children and Family |
Services; the University of Illinois Division of |
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Specialized Care for Children; the Illinois Council on |
Developmental Disabilities; Head Start or Early Head |
Start; and the Department of Human Services' Division |
of Mental Health. A member may represent one or more of |
the listed agencies or entities. |
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
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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
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appointed. No member shall be appointed to serve more than 2 |
consecutive
terms.
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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.
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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 |
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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.
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(b) The Council shall:
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(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;
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(2) advise and assist the lead agency in the |
preparation of applications
and amendments to |
applications;
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(3) review and advise on relevant regulations and |
standards proposed by
the related State agencies;
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(4) advise and assist the lead agency in the |
development,
implementation and evaluation of the |
comprehensive early intervention services
system; and
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(4.5) coordinate and collaborate with State |
interagency early learning initiatives, as appropriate; |
and
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(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 |
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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, and (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.
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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.
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(Source: P.A. 97-902, eff. 8-6-12.)
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(325 ILCS 20/5) (from Ch. 23, par. 4155)
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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
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services. The lead agency shall not have the sole |
responsibility for
providing these services. Each |
participating State agency shall continue
to coordinate those |
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early intervention services relating to health, social
service |
and education provided under this authority.
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The lead agency is responsible for carrying out the |
following:
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(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).
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(b) The identification and coordination of all |
available resources within
the State from federal, State, |
local and private sources.
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(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.
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(d) The resolution of intra-agency and interagency |
regulatory and
procedural disputes.
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(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:
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(1) define the financial responsibility of each |
agency for paying
for early intervention services |
(consistent with existing State and federal
law and |
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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
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(2) include all additional components necessary to |
ensure meaningful
cooperation and coordination.
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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.
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(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 |
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Council meetings, Council agendas, and minutes of its
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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
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program, including reports prepared at the request of the |
Council, and 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.
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(g) Before adopting any new policy or procedure |
(including any revisions to an existing policy or |
procedure) needed to comply with Part C of the Individuals |
with Disabilities Education Act, the lead agency must hold |
public hearings on the new policy or procedure, provide |
notice of the hearings at least 30 days before the hearings |
are conducted to enable public participation, and provide |
an opportunity for the general public, including |
individuals with disabilities and parents of infants and |
toddlers with disabilities, early intervention providers, |
and members of the Council to comment for at least 30 days |
on the new policy or procedure needed to comply with Part C |
of the Individuals with Disabilities Education Act and with |
34 CFR Part 300 and Part 303. |
(Source: P.A. 95-331, eff. 8-21-07.)
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(325 ILCS 20/7) (from Ch. 23, par. 4157)
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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.
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The statewide system shall include, at a minimum:
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(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;
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(b) timetables for ensuring that appropriate early |
intervention services , based on scientifically based |
research, to the extent practicable,
will be available to |
all eligible infants and toddlers in this State after
the |
effective date of this Act;
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(c) a timely, comprehensive , multidisciplinary and |
interdisciplinary evaluation of the
functioning of each |
potentially eligible infant and toddler with suspected |
disabilities in this
State , unless the child meets the |
definition of eligibility based upon his or her medical and |
other records; for a child determined eligible, a |
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multidisciplinary assessment of the unique strengths and |
needs of that infant or toddler and the identification of |
services appropriate to meet those needs and a |
family-directed assessment of the resources, priorities, |
and concerns of the family and the identification of |
supports and services necessary to enhance the family's |
capacity to meet the developmental needs of that infant or |
toddler the concerns, priorities and resource needs of the |
families to
appropriately assist in the development of the |
infant and toddler with
disabilities ;
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(d) for each eligible infant and toddler, an |
Individualized Family
Service Plan, including service |
coordination ( case management ) services;
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(e) a comprehensive child find system, consistent with |
Part B of the
Individuals with Disabilities Education Act |
(20 United States Code 1411
through 1420 and as set forth |
in 34 CFR 300.115 ), which includes timelines and
provides |
for participation by primary referral sources;
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(f) a public awareness program focusing on early |
identification of
eligible infants and toddlers;
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(g) a central directory which includes public and |
private early intervention
services, resources, and |
experts available in this State , professional and other |
groups (including parent support groups and training and |
information centers) that provide assistance to infants |
and toddlers with disabilities who are eligible for early |
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intervention programs assisted under Part C of the |
Individuals with Disabilities Education Act and their |
families, and early
intervention research and |
demonstration projects being conducted in this State |
relating to infants and toddlers with disabilities ;
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(h) a comprehensive system of personnel development;
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(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;
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(j) a procedure for securing timely reimbursement of |
funds;
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(k) procedural safeguards with respect to programs |
under this Act;
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(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;
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(m) a system of evaluation of, and compliance with, |
program standards;
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(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 |
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other information required by the State or federal |
government; and
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(o) a single line of responsibility in a lead agency |
designated by the
Governor to carry out its |
responsibilities as required by this Act.
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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.
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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
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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.
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(Source: P.A. 87-680.)
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(325 ILCS 20/9) (from Ch. 23, par. 4159)
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Sec. 9. Role of Other State Entities. The Departments of |
Public
Health, Human Services, Children and Family
Services , |
and Healthcare and Family Services Public Aid ; the University |
of Illinois Division of Specialized
Care for Children; the |
State Board of Education;
and any other State agency which |
directly or
indirectly provides or administers early |
intervention services shall adopt
compatible rules for the |
provision of services to eligible infants and
toddlers and |
their families within one year of the effective date of this |
Act.
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These agencies shall enter into and maintain formal |
interagency
agreements to enable the State and local agencies |
serving eligible children
and their families to establish |
working relationships that will increase
the efficiency and |
effectiveness of their early intervention services. The
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agreement shall outline the administrative, program and |
financial
responsibilities of the relevant State agencies and |
shall implement a
coordinated service delivery system through |
local interagency agreements.
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There shall be created in the Office of the Governor an |
Early Childhood
Intervention Ombudsman to assist families and |
local parties in ensuring
that all State agencies serving |
eligible families do so in a comprehensive
and collaborative |
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manner.
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(Source: P.A. 89-507, eff. 7-1-97; 89-626, eff. 8-9-96.)
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(325 ILCS 20/10) (from Ch. 23, par. 4160)
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Sec. 10. Standards. The Council and the lead agency, with |
assistance
from parents and providers, shall develop and |
promulgate policies and
procedures relating to the |
establishment and implementation of program and
personnel |
standards to ensure that services provided are consistent with
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any State-approved or recognized certification, licensing, |
registration, or
other comparable requirements which apply to |
the area of early intervention
program service standards. Only |
State-approved public or private early
intervention service |
providers shall be eligible to receive State and
federal |
funding for early intervention services. All early childhood
|
intervention staff shall hold the highest entry requirement |
necessary for that
position.
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To be a State-approved early intervention service |
provider, an individual
(i) shall
not have served or completed, |
within the preceding 5 years, a sentence for
conviction of any |
felony that the Department establishes by rule and (ii) shall
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not have been indicated as a perpetrator of child abuse or |
neglect, within the
preceding 5 years, in an investigation by |
Illinois (pursuant to the Abused and
Neglected Child Reporting |
Act) or another state. The Department is authorized
to receive |
criminal background checks for such providers and persons |
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applying
to be such a provider and to receive child abuse and |
neglect reports regarding
indicated perpetrators who are |
applying to provide or currently authorized to
provide early |
intervention services in Illinois. Beginning January 1, 2004,
|
every provider of State-approved early intervention services |
and every
applicant to provide
such services must authorize, in |
writing and in the form required by the
Department, a State and |
FBI a criminal background check , as requested by the |
Department, and check of child abuse and neglect
reports |
regarding the provider or applicant as a condition of |
authorization to
provide early intervention services. The |
Department shall use the results of
the checks only to |
determine State approval of the early intervention service
|
provider and shall not re-release the information except as |
necessary to
accomplish that purpose.
|
(Source: P.A. 93-147, eff. 1-1-04.)
|
(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
strengths and 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 supports and 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 may seek consultation from 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 initial evaluation and initial assessment and |
initial
Plan meeting must be held within 45 days after the |
initial
contact with the early intervention services system. |
The 45-day timeline does not apply for any period when the |
child or parent is unavailable to complete the initial |
evaluation, the initial assessments of the child and family, or |
the initial Plan meeting, due to exceptional family |
circumstances that are documented in the child's early |
intervention records, or when the parent has not provided |
consent for the initial evaluation or the initial assessment of |
the child despite documented, repeated attempts to obtain |
parental consent. As soon as exceptional family circumstances |
no longer exist or parental consent has been obtained, the |
initial evaluation, the initial assessment, and the initial |
Plan meeting must be completed as soon as possible. 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 , to the maximum extent appropriate, 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 the State's definition of ability to pay which |
is comparing household size and income to the sliding scale |
and considering out-of-pocket medical or disaster |
expenses , 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 . Families who fail to provide income |
information shall be charged the maximum amount on the |
sliding scale.
|
(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 |
insurance
carrier.
|
(2) The contract number and policy number of the |
insurance plan.
|
(3) The name, address, and social security number of |
the primary
insured.
|
(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.
|
(h) Children receiving services under this Act shall |
receive a smooth and effective transition by their third |
birthday consistent with federal regulations adopted pursuant |
to Sections 1431 through 1444 of Title 20 of the United States |
Code. |
(Source: P.A. 97-902, eff. 8-6-12.)
|
(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
State |
complaints , due process hearings, and mediations 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 |
|
evaluations and assessments assessment , screening, |
eligibility
determinations, and the development and |
implementation of the
Individualized Family Service Plan |
provision of early intervention services, individual |
complaints involving the child, or any part of the child's |
early intervention record .
|
(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. The regional intake entity must make |
reasonable efforts to ensure the assignment of a surrogate |
parent not more than 30 days after a public agency |
determines that the child needs a surrogate parent.
|
(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 native primary language or mode of |
communication used by the parent, unless clearly not |
|
feasible to do so , 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 the family's ability to |
pay 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 20/13.5)
|
Sec. 13.5. Other programs.
|
(a) When an application or a review of
eligibility for |
early
intervention services is made, and at any
eligibility |
redetermination
thereafter, the family shall be asked if it
is |
currently enrolled in
any federally funded, Department of |
Healthcare and Family Services administered, medical programs |
Medicaid, KidCare , or the Title V program
administered by the |
University of Illinois
Division of
Specialized Care for |
Children. If the
family is enrolled in any of these
programs, |
that information shall be put on
the individualized family |
service
plan and entered into the computerized case
management |
system, and shall
require that the individualized family
|
services plan of a child who has been
found eligible for |
services through the
Division of Specialized Care for
Children |
state that the child is enrolled
in that program. For those
|
programs in which the family is not
enrolled, a preliminary |
eligibility
screen shall be
conducted simultaneously
for (i) |
medical assistance
(Medicaid) under
Article V of the Illinois |
Public Aid Code, (ii)
children's
health insurance program ( any |
federally funded, Department of Healthcare and Family Services |
administered, medical programs KidCare ) benefits
under the
|
|
Children's Health Insurance Program Act, and (iii)
Title V
|
maternal and child health services provided
through the
|
Division of Specialized Care for Children of the
University
of |
Illinois.
|
(b) For purposes of determining family fees
under
|
subsection (f) of Section 13 and determining
eligibility for
|
the other programs and services specified in
items (i)
through |
(iii) of subsection (a), the lead agency
shall
develop and use, |
within 60 days after the effective
date of
this amendatory Act |
of the 92nd General Assembly,
with the
cooperation of the |
Department of Public Aid (now Healthcare and Family Services)
|
and the
Division
of Specialized Care for Children of the
|
University of
Illinois, a screening device that provides
|
sufficient
information for the early intervention regional
|
intake
entities or other agencies to establish eligibility for
|
those
other programs
and shall, in cooperation with the |
Illinois
Department of Public Aid (now Healthcare and Family |
Services) and the Division
of Specialized Care for Children, |
train the
regional intake entities
on using the screening |
device.
|
(c) When a child is
determined eligible for and enrolled
in |
the early intervention
program and has been found to at least |
meet
the threshold income
eligibility requirements for any |
federally funded, Department of Healthcare and Family Services |
administered, medical programs Medicaid or
KidCare , the |
regional intake entity
shall complete an application for any |
|
federally funded, Department of Healthcare and Family Services |
administered, medical programs a KidCare/Medicaid
application |
with the family and forward it
to the
Department of Healthcare |
and Family Services ' KidCare
Unit for a determination of
|
eligibility. A parent shall not be required to enroll in any |
federally funded, Department of Healthcare and Family Services |
administered, medical programs as a condition of receiving |
services provided pursuant to Part C of the Individuals with |
Disabilities Education Act.
|
(d) With the cooperation of the Department of Healthcare |
and Family Services, the lead agency shall establish procedures |
that
ensure
the timely and maximum allowable recovery of |
payments
for all
early intervention services and allowable
|
administrative
costs under Article V of the Illinois Public Aid
|
Code and the
Children's Health Insurance Program Act and shall |
include
those procedures in the interagency agreement required |
under subsection (e) of
Section 5 of this Act.
|
(e) For purposes of making referrals for final
|
determinations of eligibility for any federally funded, |
Department of Healthcare and Family Services administered, |
medical programs KidCare benefits
under the Children's Health |
Insurance Program Act and for medical assistance
under Article |
V of the Illinois Public Aid Code,
the lead agency shall |
require each early intervention regional intake entity to
|
enroll as an application agent a "KidCare agent" in order for |
the entity to complete the any federally funded, Department of |
|
Healthcare and Family Services administered, medical programs |
KidCare
application as authorized under Section 22 of the |
Children's Health Insurance
Program Act.
|
(f) For purposes of early intervention services that may be |
provided
by the Division of Specialized Care for Children of |
the University of Illinois
(DSCC), the lead agency shall |
establish procedures whereby the early
intervention regional
|
intake entities may determine whether children enrolled in the |
early
intervention program may also be eligible for those |
services, and shall
develop, within 60 days after the effective |
date of this amendatory Act of the
92nd General Assembly, (i) |
the inter-agency agreement required under subsection
(e) of |
Section 5 of this Act, establishing that early intervention |
funds are to
be used as the payor of last resort when services |
required under an
individualized family services plan may be |
provided to an eligible child
through the DSCC, and (ii) |
training
guidelines for the regional intake entities
and |
providers that explain eligibility and billing procedures for
|
services through DSCC.
|
(g) The lead agency shall require that an
individual |
applying for or renewing
enrollment as a provider of services |
in the
early intervention program state whether or
not he or |
she is also enrolled as a DSCC
provider. This information shall |
be noted
next to the name of the provider on the
computerized |
roster of Illinois early
intervention providers, and regional |
intake
entities shall make every effort to refer
families |
|
eligible for DSCC services to
these providers.
|
(Source: P.A. 95-331, eff. 8-21-07.)
|
(325 ILCS 20/13.10)
|
Sec. 13.10.
Private health insurance;
assignment. The lead |
agency
shall determine, at the point of new applications
for |
early
intervention services, and for all children enrolled
in |
the early
intervention program, at the regional intake offices,
|
whether
the child is insured under a private health insurance
|
plan or
policy. An application for early intervention
services |
shall
serve as a right to assignment of the right of
recovery |
against a
private health insurance plan or policy for any |
covered
early intervention services that may be billed to the |
family's insurance
carrier and that are provided to a child
|
covered under the plan or policy.
|
(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 |
billing.
|
(2) The role of the regional intake entities;
service |
coordination; program eligibility determinations;
family |
fees; any federally funded, Department of Healthcare and |
Family Services administered, medical programs 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.)
|
(325 ILCS 20/13.50 rep.) |
Section 15. The Early Intervention Services System Act is |
amended by repealing Section 13.50.
|