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92_SB0461enr SB461 Enrolled LRB9207772DJmb 1 AN ACT in relation to children. 2 Be it enacted by the People of the State of Illinois, 3 represented in the General Assembly: 4 Section 5. The Early Intervention Services System Act is 5 amended by changing Sections 3, 4, 5, 11, 13, and 15 and 6 adding Sections 13.5, 13.10, 13.15, 13.20, 13.25, 13.30, 7 13.32, and 13.50 as follows: 8 (325 ILCS 20/3) (from Ch. 23, par. 4153) 9 Sec. 3. Definitions. As used in this Act: 10 (a) "Eligible infants and toddlers" means infants and 11 toddlers under 36 months of age with any of the following 12 conditions: 13 (1) Developmental delays as defined by the 14 Department by rule. 15 (2) A physical or mental condition which typically 16 results in developmental delay. 17 (3) Being at risk of having substantial 18 developmental delays based on informed clinical judgment. 19 (4) Either (A) having entered the program under any 20 of the circumstances listed in paragraphs (1) through (3) 21 of this subsection but no longer meeting the current 22 eligibility criteria under those paragraphs, and 23 continuing to have any measurable delay, or (B) not 24 having attained a level of development in each area, 25 including (i) cognitive, (ii) physical (including vision 26 and hearing), (iii) language, speech, and communication, 27 (iv) psycho-social, or (v) self-help skills, that is at 28 least at the mean of the child's age equivalent peers; 29 and, in addition to either item (A) or item (B), (C) 30 having been determined by the multidisciplinary 31 individualized family service plan team to require the SB461 Enrolled -2- LRB9207772DJmb 1 continuation of early intervention services in order to 2 support continuing developmental progress, pursuant to 3 the child's needs and provided in an appropriate 4 developmental manner. The type, frequency, and intensity 5 of services shall differ from the initial individualized 6 family services plan because of the child's developmental 7 progress, and may consist of only service coordination, 8 evaluation, and assessments. 9 (b) "Developmental delay" means a delay in one or more 10 of the following areas of childhood development as measured 11 by appropriate diagnostic instruments and standard 12 procedures: cognitive; physical, including vision and 13 hearing; language, speech and communication; psycho-social; 14 or self-help skills. 15 (c) "Physical or mental condition which typically 16 results in developmental delay" means: 17 (1) a diagnosed medical disorder bearing a 18 relatively well known expectancy for developmental 19 outcomes within varying ranges of developmental 20 disabilities; or 21 (2) a history of prenatal, perinatal, neonatal or 22 early developmental events suggestive of biological 23 insults to the developing central nervous system and 24 which either singly or collectively increase the 25 probability of developing a disability or delay based on 26 a medical history. 27 (d) "Informed clinical judgment" means both clinical 28 observations and parental participation to determine 29 eligibility by a consensus of a multidisciplinary team of 2 30 or more members based on their professional experience and 31 expertise. 32 (e) "Early intervention services" means services which: 33 (1) are designed to meet the developmental needs of 34 each child eligible under this Act and the needs of his SB461 Enrolled -3- LRB9207772DJmb 1 or her family; 2 (2) are selected in collaboration with the child's 3 family; 4 (3) are provided under public supervision; 5 (4) are provided at no cost except where a schedule 6 of sliding scale fees or other system of payments by 7 families has been adopted in accordance with State and 8 federal law; 9 (5) are designed to meet an infant's or toddler's 10 developmental needs in any of the following areas: 11 (A) physical development, including vision and 12 hearing, 13 (B) cognitive development, 14 (C) communication development, 15 (D) social or emotional development, or 16 (E) adaptive development; 17 (6) meet the standards of the State, including the 18 requirements of this Act; 19 (7) include one or more of the following: 20 (A) family training, 21 (B) social work services, including 22 counseling, and home visits, 23 (C) special instruction, 24 (D) speech, language pathology and audiology, 25 (E) occupational therapy, 26 (F) physical therapy, 27 (G) psychological services, 28 (H) service coordination services, 29 (I) medical services only for diagnostic or 30 evaluation purposes, 31 (J) early identification, screening, and 32 assessment services, 33 (K) health services specified by the lead 34 agency as necessary to enable the infant or toddler SB461 Enrolled -4- LRB9207772DJmb 1 to benefit from the other early intervention 2 services, 3 (L) vision services, 4 (M) transportation, and 5 (N) assistive technology devices and services; 6 (8) are provided by qualified personnel, including 7 but not limited to: 8 (A) child development specialists or special 9 educators, 10 (B) speech and language pathologists and 11 audiologists, 12 (C) occupational therapists, 13 (D) physical therapists, 14 (E) social workers, 15 (F) nurses, 16 (G) nutritionists, 17 (H) optometrists, 18 (I) psychologists, and 19 (J) physicians; 20 (9) are provided in conformity with an 21 Individualized Family Service Plan; 22 (10) are provided throughout the year; and 23 (11) are provided in natural environments, 24 including the home and community settings in which 25 infants and toddlers without disabilities would 26 participate to the extent determined by the 27 multidisciplinary Individualized Family Service Plan. 28 (f) "Individualized Family Service Plan" or "Plan" means 29 a written plan for providing early intervention services to a 30 child eligible under this Act and the child's family, as set 31 forth in Section 11. 32 (g) "Local interagency agreement" means an agreement 33 entered into by local community and State and regional 34 agencies receiving early intervention funds directly from the SB461 Enrolled -5- LRB9207772DJmb 1 State and made in accordance with State interagency 2 agreements providing for the delivery of early intervention 3 services within a local community area. 4 (h) "Council" means the Illinois Interagency Council on 5 Early Intervention established under Section 4. 6 (i) "Lead agency" means the State agency responsible for 7 administering this Act and receiving and disbursing public 8 funds received in accordance with State and federal law and 9 rules. 10 (i-5) "Central billing office" means the central billing 11 office created by the lead agency under Section 13. 12 (j) "Child find" means a service which identifies 13 eligible infants and toddlers. 14 (k) "Regional intake entity" means the lead agency's 15 designated entity responsible for implementation of the Early 16 Intervention Services System within its designated geographic 17 area. 18 (l) "Early intervention provider" means an individual 19 who is qualified, as defined by the lead agency, to provide 20 one or more types of early intervention services, and who has 21 enrolled as a provider in the early intervention program. 22 (m) "Fully credentialed early intervention provider" 23 means an individual who has met the standards in the State 24 applicable to the relevant profession, and has met such other 25 qualifications as the lead agency has determined are suitable 26 for personnel providing early intervention services, 27 including pediatric experience, education, and continuing 28 education. The lead agency shall establish these 29 qualifications by rule filed no later than 180 days after the 30 effective date of this amendatory Act of the 92nd General 31 Assembly. 32 (Source: P.A. 90-158, eff. 1-1-98; 91-538, eff. 8-13-99.) 33 (325 ILCS 20/4) (from Ch. 23, par. 4154) SB461 Enrolled -6- LRB9207772DJmb 1 Sec. 4. Illinois Interagency Council on Early 2 Intervention. 3 (a) There is established the Illinois Interagency 4 Council on Early Intervention. The Council shall be composed 5 of at least 15 but not more than 25 members. The members of 6 the Council and the designated chairperson of the Council 7 shall be appointed by the Governor. The Council member 8 representing the lead agency may not serve as chairperson of 9 the Council. The Council shall be composed of the following 10 members: 11 (1) The Secretary of Human Services (or his or her 12 designee) and 2 additional representatives of the 13 Department of Human Services designated by the Secretary, 14 plus the Directors (or their designees) of the following 15 State agencies involved in the provision of or payment 16 for early intervention services to eligible infants and 17 toddlers and their families: 18 (A) Illinois State Board of Education; 19 (B) (Blank); 20 (C) (Blank); 21 (D) Illinois Department of Children and Family 22 Services; 23 (E) University of Illinois Division of 24 Specialized Care for Children; 25 (F) Illinois Department of Public Aid; 26 (G) Illinois Department of Public Health; 27 (H) (Blank); 28 (I) Illinois Planning Council on Developmental 29 Disabilities; and 30 (J) Illinois Department of Insurance. 31 (2) Other members as follows: 32 (A) At least 20% of the members of the Council 33 shall be parents, including minority parents, of 34 infants or toddlers with disabilities or children SB461 Enrolled -7- LRB9207772DJmb 1 with disabilities aged 12 or younger, with knowledge 2 of, or experience with, programs for infants and 3 toddlers with disabilities. At least one such 4 member shall be a parent of an infant or toddler 5 with a disability or a child with a disability aged 6 6 or younger; 7 (B) At least 20% of the members of the Council 8 shall be public or private providers of early 9 intervention services; 10 (C) One member shall be a representative of 11 the General Assembly; and 12 (D) One member shall be involved in the 13 preparation of professional personnel to serve 14 infants and toddlers similar to those eligible for 15 services under this Act. 16 The Council shall meet at least quarterly and in such 17 places as it deems necessary. Terms of the initial members 18 appointed under paragraph (2) shall be determined by lot at 19 the first Council meeting as follows: of the persons 20 appointed under subparagraphs (A) and (B), one-third shall 21 serve one year terms, one-third shall serve 2 year terms, and 22 one-third shall serve 3 year terms; and of the persons 23 appointed under subparagraphs (C) and (D), one shall serve a 24 2 year term and one shall serve a 3 year term. Thereafter, 25 successors appointed under paragraph (2) shall serve 3 year 26 terms. Once appointed, members shall continue to serve until 27 their successors are appointed. No member shall be appointed 28 to serve more than 2 consecutive terms. 29 Council members shall serve without compensation but 30 shall be reimbursed for reasonable costs incurred in the 31 performance of their duties, including costs related to child 32 care, and parents may be paid a stipend in accordance with 33 applicable requirements. 34 The Council shall prepare and approve a budget using SB461 Enrolled -8- LRB9207772DJmb 1 funds appropriated for the purpose to hire staff, and obtain 2 the services of such professional, technical, and clerical 3 personnel as may be necessary to carry out its functions 4 under this Act. This funding support and staff shall be 5 directed by the lead agency. 6 (b) The Council shall: 7 (1) advise and assist the lead agency in the 8 performance of its responsibilities including but not 9 limited to the identification of sources of fiscal and 10 other support services for early intervention programs, 11 and the promotion of interagency agreements which assign 12 financial responsibility to the appropriate agencies; 13 (2) advise and assist the lead agency in the 14 preparation of applications and amendments to 15 applications; 16 (3) review and advise on relevant regulations and 17 standards proposed by the related State agencies; 18 (4) advise and assist the lead agency in the 19 development, implementation and evaluation of the 20 comprehensive early intervention services system; and 21 (5) prepare and submit an annual report to the 22 Governor and to the General Assembly on the status of 23 early intervention programs for eligible infants and 24 toddlers and their families in Illinois. The annual 25 report shall include (i) the estimated number of eligible 26 infants and toddlers in this State, (ii) the number of 27 eligible infants and toddlers who have received services 28 under this Act and the cost of providing those services, 29and(iii) the estimated cost of providing services under 30 this Act to all eligible infants and toddlers in this 31 State, and (iv) data and other information as is 32 requested to be included by the Legislative Advisory 33 Committee established under Section 13.50 of this Act. 34 The report shall be posted by the lead agency on the SB461 Enrolled -9- LRB9207772DJmb 1 early intervention website as required under paragraph 2 (f) of Section 5 of this Act. 3 No member of the Council shall cast a vote on or 4 participate substantially in any matter which would provide a 5 direct financial benefit to that member or otherwise give the 6 appearance of a conflict of interest under State law. All 7 provisions and reporting requirements of the Illinois 8 Governmental Ethics Act shall apply to Council members. 9 (Source: P.A. 91-357; eff. 7-29-99.) 10 (325 ILCS 20/5) (from Ch. 23, par. 4155) 11 Sec. 5. Lead Agency. The Department of Human Services 12 is designated the lead agency and shall provide leadership in 13 establishing and implementing the coordinated, comprehensive, 14 interagency and interdisciplinary system of early 15 intervention services. The lead agency shall not have the 16 sole responsibility for providing these services. Each 17 participating State agency shall continue to coordinate those 18 early intervention services relating to health, social 19 service and education provided under this authority. 20 The lead agency is responsible for carrying out the 21 following: 22 (a) The general administration, supervision, and 23 monitoring of programs and activities receiving 24 assistance under Section 673 of the Individuals with 25 Disabilities Education Act (20 United States Code 1473).;26 (b) The identification and coordination of all 27 available resources within the State from federal, State, 28 local and private sources.;29 (c) The development of procedures to ensure that 30 services are provided to eligible infants and toddlers 31 and their families in a timely manner pending the 32 resolution of any disputes among public agencies or 33 service providers.;SB461 Enrolled -10- LRB9207772DJmb 1 (d) The resolution of intra-agency and interagency 2 regulatory and procedural disputes.; and3 (e) The development and implementation of formal 4 interagency agreements, and the entry into such 5 agreements, between the lead agency and (i) the 6 Department of Public Aid, (ii) the University of Illinois 7 Division of Specialized Care for Children, and (iii) 8 other relevant State agencies that: 9 (1) define the financial responsibility of 10 each agency for paying for early intervention 11 services (consistent with existing State and federal 12 law and rules, including the requirement that early 13 intervention funds be used as the payor of last 14 resort), a hierarchical order of payment as among 15 the agencies for early intervention services that 16 are covered under or may be paid by programs in 17 other agencies, and procedures for direct billing, 18 collecting reimbursements for payments made, and 19 resolving service and payment disputes; and 20 (2) include all additional components 21 necessary to ensure meaningful cooperation and 22 coordination. 23 Interagency agreements under this paragraph (e) must 24 be reviewed and revised to implement the purposes of this 25 amendatory Act of the 92nd General Assembly no later than 26 60 days after the effective date of this amendatory Act 27 of the 92nd General Assembly. 28 (f) The maintenance of an early intervention 29 website. Within 30 days after the effective date of 30 this amendatory Act of the 92nd General Assembly, the 31 lead agency shall post and keep posted on this website 32 the following: (i) the current annual report required 33 under subdivision (b)(5) of Section 4 of this Act, and 34 the annual reports of the prior 3 years, (ii) the most SB461 Enrolled -11- LRB9207772DJmb 1 recent Illinois application for funds prepared under 2 Section 637 of the Individuals with Disabilities 3 Education Act filed with the United States Department of 4 Education, (iii) proposed modifications of the 5 application prepared for public comment, (iv) notice of 6 Council meetings, Council agendas, and minutes of its 7 proceedings for at least the previous year, (v) proposed 8 and final early intervention rules, (vi) requests for 9 proposals, and (vii) all reports created for 10 dissemination to the public that are related to the early 11 intervention program, including reports prepared at the 12 request of the Council, the General Assembly, and the 13 Legislative Advisory Committee established under Section 14 13.50 of this Act. Each such document shall be posted on 15 the website within 3 working days after the document's 16 completion. 17 (Source: P.A. 90-158, eff. 1-1-98.) 18 (325 ILCS 20/11) (from Ch. 23, par. 4161) 19 Sec. 11. Individualized Family Service Plans. 20 (a) Each eligible infant or toddler and that infant's or 21 toddler's family shall receive: 22 (1)(a)timely, comprehensive, multidisciplinary 23 assessment of the unique needs of each eligible infant 24 and toddler, and assessment of the concerns and 25 priorities of the families to appropriately assist them 26 in meeting their needs and identify services to meet 27 those needs; and 28 (2)(b)a written Individualized Family Service 29 Plan developed by a multidisciplinary team which includes 30 the parent or guardian. The individualized family service 31 plan shall be based on the multidisciplinary team's 32 assessment of the resources, priorities, and concerns of 33 the family and its identification of the supports and SB461 Enrolled -12- LRB9207772DJmb 1 services necessary to enhance the family's capacity to 2 meet the developmental needs of the infant or toddler, 3 and shall include the identification of services 4 appropriate to meet those needs, including the frequency, 5 intensity, and method of delivering services. During and 6 as part of the initial development of the individualized 7 family services plan, and any periodic reviews of the 8 plan, the multidisciplinary team shall consult the lead 9 agency's therapy guidelines and its designated experts, 10 if any, to help determine appropriate services and the 11 frequency and intensity of those services. All services 12 in the individualized family services plan must be 13 justified by the multidisciplinary assessment of the 14 unique strengths and needs of the infant or toddler and 15 must be appropriate to meet those needs. At the periodic 16 reviews, the team shall determine whether modification or 17 revision of the outcomes or services is necessary. 18 (b) The Individualized Family Service Plan shall be 19 evaluated once a year and the family shall be provided a 20 review of the Plan at 6 month intervals or more often where 21 appropriate based on infant or toddler and family needs. 22 (c) The evaluation and initial assessment and initial 23 Plan meeting must be held within 45 days after the initial 24 contact with the early intervention services system. With 25 parental consent, early intervention services may commence 26 before the completion of the comprehensive assessment and 27 development of the Plan. 28 (d) Parents must be informed that, at their discretion, 29 early intervention services shall be provided to each 30 eligible infant and toddler in the natural environment, which 31 may include the home or other community settings. Parents 32 shall make the final decision to accept or decline early 33 intervention services. A decision to decline such services 34 shall not be a basis for administrative determination of SB461 Enrolled -13- LRB9207772DJmb 1 parental fitness, or other findings or sanctions against the 2 parents. Parameters of the Plan shall be set forth in rules. 3 (e) The regional intake offices shall explain to each 4 family, orally and in writing, all of the following: 5 (1) That the early intervention program will pay 6 for all early intervention services set forth in the 7 individualized family service plan that are not covered 8 or paid under the family's public or private insurance 9 plan or policy and not eligible for payment through any 10 other third party payor. 11 (2) That services will not be delayed due to any 12 rules or restrictions under the family's insurance plan 13 or policy. 14 (3) That the family may request, with appropriate 15 documentation supporting the request, a determination of 16 an exemption from private insurance use under Section 17 13.25. 18 (4) That responsibility for co-payments or 19 co-insurance under a family's private insurance plan or 20 policy will be transferred to the lead agency's central 21 billing office. 22 (5) That families will be responsible for payments 23 of family fees, which will be based on a sliding scale 24 according to income, and that these fees are payable to 25 the central billing office, and that if the family 26 encounters a catastrophic circumstance, as defined under 27 subsection (f) of Section 13 of this Act, making it 28 unable to pay the fees, the lead agency may, upon proof 29 of inability to pay, waive the fees. 30 (f) The individualized family service plan must state 31 whether the family has private insurance coverage and, if the 32 family has such coverage, must have attached to it a copy of 33 the family's insurance identification card or otherwise 34 include all of the following information: SB461 Enrolled -14- LRB9207772DJmb 1 (1) The name, address, and telephone number of the 2 insurance carrier. 3 (2) The contract number and policy number of the 4 insurance plan. 5 (3) The name, address, and social security number 6 of the primary insured. 7 (4) The beginning date of the insurance benefit 8 year. 9 (g) A copy of the individualized family service plan 10 must be provided to each enrolled provider who is providing 11 early intervention services to the child who is the subject 12 of that plan. 13 (Source: P.A. 91-538, eff. 8-13-99.) 14 (325 ILCS 20/13) (from Ch. 23, par. 4163) 15 Sec. 13. Funding and Fiscal Responsibility. 16 (a) The lead agency and every other participating State 17 agency may receive and expend funds appropriated by the 18 General Assembly to implement the early intervention services 19 system as required by this Act. 20 (b) The lead agency and each participating State agency 21 shall identify and report on an annual basis to the Council 22 the State agency funds utilized for the provision of early 23 intervention services to eligible infants and toddlers. 24 (c) Funds provided under Section 633 of the Individuals 25 with Disabilities Education Act (20 United States Code 1433) 26 and State funds designated or appropriated for early 27 intervention services or programs may not be used to satisfy 28 a financial commitment for services which would have been 29 paid for from another public or private source but for the 30 enactment of this Act, except whenever considered necessary 31 to prevent delay in receiving appropriate early intervention 32 services by the eligible infant or toddler or family in a 33 timely manner. Funds provided under Section 633 of the SB461 Enrolled -15- LRB9207772DJmb 1 Individuals with Disabilities Education Act and State funds 2 designated or appropriated for early intervention services or 3 programs may be used by the lead agency to pay the provider 4 of services (A) pending reimbursement from the appropriate 5 State agency or (B) if (i) the claim for payment is denied in 6 whole or in part by a public or private source, or would be 7 denied under the written terms of the public program or plan 8 or private plan, or (ii) use of private insurance for the 9 service has been exempted under Section 13.25. Payment under 10 item (B)(i) may be made based on a pre-determination 11 telephone inquiry supported by written documentation of the 12 denial supplied thereafter by the insurance carrier. 13 (d) Nothing in this Act shall be construed to permit the 14 State to reduce medical or other assistance available or to 15 alter eligibility under Title V and Title XIX of the Social 16 Security Act relating to the Maternal Child Health Program 17 and Medicaid for eligible infants and toddlers in this State. 18 (e) The lead agency shall create a central billing 19 office to receive and dispense all relevant State and federal 20 resources, as well as local government or independent 21 resources available, for early intervention services. This 22 office shall assure that maximum federal resources are 23 utilized and that providers receive funds with minimal 24 duplications or interagency reporting and with consolidated 25 audit procedures. 26 (f) The lead agency shall, by rule,may alsocreate a 27 system of payments by families, including a schedule of fees. 28 No fees, however, may be charged for: implementing child 29 find, evaluation and assessment, service coordination, 30 administrative and coordination activities related to the 31 development, review, and evaluation of Individualized Family 32 Service Plans, or the implementation of procedural safeguards 33 and other administrative components of the statewide early 34 intervention system. SB461 Enrolled -16- LRB9207772DJmb 1 The system of payments, called family fees, shall be 2 structured on a sliding scale based on family income. The 3 family's coverage or lack of coverage under a public or 4 private insurance plan or policy shall not be a factor in 5 determining the amount of the family fees. 6 Each family's fee obligation shall be established 7 annually, and shall be paid by families to the central 8 billing office in installments. At the written request of the 9 family, the fee obligation shall be adjusted prospectively at 10 any point during the year upon proof of a change in family 11 income or family size. The inability of the parents of an 12 eligible child to pay family fees due to catastrophic 13 circumstances or extraordinary expenses shall not result in 14 the denial of services to the child or the child's family. A 15 family must document its extraordinary expenses or other 16 catastrophic circumstances by showing one of the following: 17 (i) out-of-pocket medical expenses in excess of 15% of gross 18 income; (ii) a fire, flood, or other disaster causing a 19 direct out-of-pocket loss in excess of 15% of gross income; 20 or (iii) other catastrophic circumstances causing 21 out-of-pocket losses in excess of 15% of gross income. The 22 family must present proof of loss to its service coordinator, 23 who shall document it, and the lead agency shall determine 24 whether the fees shall be reduced, forgiven, or suspended 25 within 10 business days after the family's request. 26 (g) To ensure that early intervention funds are used as 27 the payor of last resort for early intervention services, the 28 lead agency shall determine at the point of early 29 intervention intake, and again at any periodic review of 30 eligibility thereafter or upon a change in family 31 circumstances, whether the family is eligible for or enrolled 32 in any program for which payment is made directly or through 33 public or private insurance for any or all of the early 34 intervention services made available under this Act. The lead SB461 Enrolled -17- LRB9207772DJmb 1 agency shall establish procedures to ensure that payments are 2 made either directly from these public and private sources 3 instead of from State or federal early intervention funds, or 4 as reimbursement for payments previously made from State or 5 federal early intervention funds. 6 (Source: P.A. 91-538, eff. 8-13-99.) 7 (325 ILCS 20/13.5 new) 8 Sec. 13.5. Other programs. 9 (a) When an application or a review of eligibility for 10 early intervention services is made, and at any eligibility 11 redetermination thereafter, the family shall be asked if it 12 is currently enrolled in Medicaid, KidCare, or the Title V 13 program administered by the University of Illinois Division 14 of Specialized Care for Children. If the family is enrolled 15 in any of these programs, that information shall be put on 16 the individualized family service plan and entered into the 17 computerized case management system, and shall require that 18 the individualized family services plan of a child who has 19 been found eligible for services through the Division of 20 Specialized Care for Children state that the child is 21 enrolled in that program. For those programs in which the 22 family is not enrolled, a preliminary eligibility screen 23 shall be conducted simultaneously for (i) medical assistance 24 (Medicaid) under Article V of the Illinois Public Aid Code, 25 (ii) children's health insurance program (KidCare) benefits 26 under the Children's Health Insurance Program Act, and (iii) 27 Title V maternal and child health services provided through 28 the Division of Specialized Care for Children of the 29 University of Illinois. 30 (b) For purposes of determining family fees under 31 subsection (f) of Section 13 and determining eligibility for 32 the other programs and services specified in items (i) 33 through (iii) of subsection (a), the lead agency shall SB461 Enrolled -18- LRB9207772DJmb 1 develop and use, within 60 days after the effective date of 2 this amendatory Act of the 92nd General Assembly, with the 3 cooperation of the Department of Public Aid and the Division 4 of Specialized Care for Children of the University of 5 Illinois, a screening device that provides sufficient 6 information for the early intervention regional intake 7 entities or other agencies to establish eligibility for those 8 other programs and shall, in cooperation with the Illinois 9 Department of Public Aid and the Division of Specialized Care 10 for Children, train the regional intake entities on using the 11 screening device. 12 (c) When a child is determined eligible for and 13 enrolled in the early intervention program and has been 14 found to at least meet the threshold income eligibility 15 requirements for Medicaid or KidCare, the regional intake 16 entity shall complete a KidCare/Medicaid application with the 17 family and forward it to the Illinois Department of Public 18 Aid's KidCare Unit for a determination of eligibility. 19 (d) With the cooperation of the Department of Public 20 Aid, the lead agency shall establish procedures that ensure 21 the timely and maximum allowable recovery of payments for all 22 early intervention services and allowable administrative 23 costs under Article V of the Illinois Public Aid Code and the 24 Children's Health Insurance Program Act and shall include 25 those procedures in the interagency agreement required under 26 subsection (e) of Section 5 of this Act. 27 (e) For purposes of making referrals for final 28 determinations of eligibility for KidCare benefits under the 29 Children's Health Insurance Program Act and for medical 30 assistance under Article V of the Illinois Public Aid Code, 31 the lead agency shall require each early intervention 32 regional intake entity to enroll as a "KidCare agent" in 33 order for the entity to complete the KidCare application as 34 authorized under Section 22 of the Children's Health SB461 Enrolled -19- LRB9207772DJmb 1 Insurance Program Act. 2 (f) For purposes of early intervention services that may 3 be provided by the Division of Specialized Care for Children 4 of the University of Illinois (DSCC), the lead agency shall 5 establish procedures whereby the early intervention regional 6 intake entities may determine whether children enrolled in 7 the early intervention program may also be eligible for those 8 services, and shall develop, within 60 days after the 9 effective date of this amendatory Act of the 92nd General 10 Assembly, (i) the inter-agency agreement required under 11 subsection (e) of Section 5 of this Act, establishing that 12 early intervention funds are to be used as the payor of last 13 resort when services required under an individualized family 14 services plan may be provided to an eligible child through 15 the DSCC, and (ii) training guidelines for the regional 16 intake entities and providers that explain eligibility and 17 billing procedures for services through DSCC. 18 (g) The lead agency shall require that an individual 19 applying for or renewing enrollment as a provider of services 20 in the early intervention program state whether or not he or 21 she is also enrolled as a DSCC provider. This information 22 shall be noted next to the name of the provider on the 23 computerized roster of Illinois early intervention providers, 24 and regional intake entities shall make every effort to refer 25 families eligible for DSCC services to these providers. 26 (325 ILCS 20/13.10 new) 27 Sec. 13.10. Private health insurance; assignment. The 28 lead agency shall determine, at the point of new applications 29 for early intervention services, and for all children 30 enrolled in the early intervention program, at the regional 31 intake offices, whether the child is insured under a private 32 health insurance plan or policy. An application for early 33 intervention services shall serve as a right to assignment of SB461 Enrolled -20- LRB9207772DJmb 1 the right of recovery against a private health insurance plan 2 or policy for any covered early intervention services that 3 may be billed to the family's insurance carrier and that are 4 provided to a child covered under the plan or policy. 5 (325 ILCS 20/13.15 new) 6 Sec. 13.15. Billing of insurance carrier. 7 (a) Subject to the restrictions against private 8 insurance use on the basis of material risk of loss of 9 coverage, as determined under Section 13.25, each enrolled 10 provider who is providing a family with early intervention 11 services shall bill the child's insurance carrier for each 12 unit of early intervention service for which coverage may be 13 available. The lead agency may exempt from the requirement of 14 this paragraph any early intervention service that it has 15 deemed not to be covered by insurance plans. When the service 16 is not exempted, providers who receive a denial of payment on 17 the basis that the service is not covered under any 18 circumstance under the plan are not required to bill that 19 carrier for that service again until the following insurance 20 benefit year. That explanation of benefits denying the claim, 21 once submitted to the central billing office, shall be 22 sufficient to meet the requirements of this paragraph as to 23 subsequent services billed under the same billing code 24 provided to that child during that insurance benefit year. 25 Any time limit on a provider's filing of a claim for payment 26 with the central billing office that is imposed through a 27 policy, procedure, or rule of the lead agency shall be 28 suspended until the provider receives an explanation of 29 benefits or other final determination of the claim it files 30 with the child's insurance carrier. 31 (b) In all instances when an insurance carrier has been 32 billed for early intervention services, whether paid in full, 33 paid in part, or denied by the carrier, the provider must SB461 Enrolled -21- LRB9207772DJmb 1 provide the central billing office, within 90 days after 2 receipt, with a copy of the explanation of benefits form and 3 other information in the manner prescribed by the lead 4 agency. 5 (c) When the insurance carrier has denied the claim or 6 paid an amount for the early intervention service billed that 7 is less that the current State rate for early intervention 8 services, the provider shall submit the explanation of 9 benefits with a claim for payment, and the lead agency shall 10 pay the provider the difference between the sum actually paid 11 by the insurance carrier for each unit of service provided 12 under the individualized family service plan and the current 13 State rate for early intervention services. The State shall 14 also pay the family's co-payment or co-insurance under its 15 plan, but only to the extent that those payments plus the 16 balance of the claim do not exceed the current State rate for 17 early intervention services. The provider may under no 18 circumstances bill the family for the difference between its 19 charge for services and that which has been paid by the 20 insurance carrier or by the State. 21 (325 ILCS 20/13.20 new) 22 Sec. 13.20. Families with insurance coverage. 23 (a) Families of children with insurance coverage, 24 whether public or private, shall incur no greater or less 25 direct out-of-pocket expenses for early intervention services 26 than families who are not insured. 27 (b) Managed care plans. 28 (1) Use of managed care network providers. When a 29 family's insurance coverage is through a managed care 30 arrangement with a network of providers that includes 31 one or more types of early intervention specialists who 32 provide the services set forth in the family's 33 individualized family service plan, the regional intake SB461 Enrolled -22- LRB9207772DJmb 1 entity shall require the family to use those network 2 providers, but only to the extent that: 3 (A) the network provider is immediately 4 available to receive the referral and to begin 5 providing services to the child; 6 (B) the network provider is enrolled as a 7 provider in the Illinois early intervention system 8 and fully credentialed under the current policy or 9 rule of the lead agency; 10 (C) the network provider can provide the 11 services to the child in the manner required in the 12 individualized service plan; 13 (D) the family would not have to travel more 14 than an additional 15 miles or an additional 30 15 minutes to the network provider than it would have 16 to travel to a non-network provider who is available 17 to provide the same service; and 18 (E) the family's managed care plan does not 19 allow for billing (even at a reduced rate or reduced 20 percentage of the claim) for early intervention 21 services provided by non-network providers. 22 (2) Transfers from non-network to network 23 providers. If a child has been receiving services from a 24 non-network provider and the regional intake entity 25 determines, at the time of enrollment in the early 26 intervention program or at any point thereafter, that the 27 family is enrolled in a managed care plan, the regional 28 intake entity shall require the family to transfer to a 29 network provider within 45 days after that determination, 30 but within no more than 60 days after the effective date 31 of this amendatory Act of the 92nd General Assembly, if: 32 (A) all the requirements of subdivision (b)(1) 33 of this Section have been met; and 34 (B) the child is less than 26 months of age. SB461 Enrolled -23- LRB9207772DJmb 1 (3) Waivers. The lead agency may fully or 2 partially waive the network enrollment requirements of 3 subdivision (b)(1) of this Section and the transfer 4 requirements of subdivision (b)(2) of this Section as to 5 a particular region, or narrower geographic area, if it 6 finds that the managed care plans in that area are not 7 allowing further enrollment of early intervention 8 providers and it finds that referrals or transfers to 9 network providers could cause an overall shortage of 10 early intervention providers in that region of the State 11 or could cause delays in families securing the early 12 intervention services set forth in individualized family 13 services plans. 14 (4) The lead agency, in conjunction with any 15 entities with which it may have contracted for the 16 training and credentialing of providers, the local 17 interagency council for early intervention, the regional 18 intake entity, and the enrolled providers in each region 19 who wish to participate, shall cooperate in developing a 20 matrix and action plan that (A) identifies both (i) which 21 early intervention providers and which fully credentialed 22 early intervention providers are members of the managed 23 care plans that are used in the region by families with 24 children in the early intervention program, and (ii) 25 which early intervention services, with what 26 restrictions, if any, are covered under those plans, (B) 27 identifies which credentialed specialists are members of 28 which managed care plans in the region, and (C) 29 identifies the various managed care plans to early 30 intervention providers, encourages their enrollment in 31 the area plans, and provides them with information on how 32 to enroll. These matrices shall be complete no later than 33 7 months after the effective date of this amendatory Act 34 of the 92nd General Assembly, and shall be provided to SB461 Enrolled -24- LRB9207772DJmb 1 the Early Intervention Legislative Advisory Committee at 2 that time. The lead agency shall work with networks that 3 may have closed enrollment to additional providers to 4 encourage their admission of early intervention 5 providers, and shall report to the Early Intervention 6 Legislative Advisory Committee on the initial results of 7 these efforts no later than February 1, 2002. 8 (325 ILCS 20/13.25 new) 9 Sec. 13.25. Private insurance; exemption. 10 (a) The lead agency shall establish procedures for a 11 family, whose child is eligible to receive early intervention 12 services, to apply for an exemption restricting the use of 13 its private insurance plan or policy based on material risk 14 of loss of coverage as authorized under subsection (c) of 15 this Section. 16 (b) The lead agency shall make a final determination on 17 a request for an exemption within 10 business days after its 18 receipt of a written request for an exemption at the regional 19 intake entity. During that 10 days, no claims may be filed 20 against the insurance plan or policy. If the exemption is 21 granted, it shall be noted on the individualized family 22 service plan, and the family and the providers serving the 23 family shall be notified in writing of the exemption. 24 (c) An exemption may be granted on the basis of material 25 risk of loss of coverage only if the family submits 26 documentation with its request for an exemption that 27 establishes (i) that the insurance plan or policy covering 28 the child is an individually purchased plan or policy and has 29 been purchased by a head of a household that is not eligible 30 for a group medical insurance plan, (ii) that the policy or 31 plan has a lifetime cap that applies to one or more specific 32 types of early intervention services specified in the 33 family's individualized family service plan, and that SB461 Enrolled -25- LRB9207772DJmb 1 coverage could be exhausted during the period covered by the 2 individualized family service plan, or (iii) proof of another 3 risk that the lead agency, in its discretion, may have 4 additionally established and defined as a ground for 5 exemption by rule. 6 (d) An exemption under this Section based on material 7 risk of loss of coverage may apply to all early intervention 8 services and all plans or policies insuring the child, may be 9 limited to one or more plans or policies, or may be limited 10 to one or more types of early intervention services in the 11 child's individualized family services plan. 12 (325 ILCS 20/13.30 new) 13 Sec. 13.30. System of personnel development. The lead 14 agency shall provide training to early intervention providers 15 and may enter into contracts to meet this requirement. If 16 such contracts are let, they shall be bid under a public 17 request for proposals that shall be posted on the lead 18 agency's early intervention website for no less than 30 days. 19 This training shall include, at minimum, the following types 20 of instruction: 21 (a) Courses in birth-to-3 evaluation and treatment of 22 children with developmental disabilities and delays (1) that 23 are taught by fully credentialed early intervention providers 24 or educators with substantial experience in evaluation and 25 treatment of children from birth to age 3 with developmental 26 disabilities and delays, (2) that cover these topics within 27 each of the disciplines of audiology, occupational therapy, 28 physical therapy, speech and language pathology, and 29 developmental therapy, including the social-emotional domain 30 of development, (3) that are held no less than twice per 31 year, (4) that offer no fewer than 20 contact hours per year 32 of course work, (5) that are held in no fewer than 5 separate 33 locales throughout the State, and (6) that give enrollment SB461 Enrolled -26- LRB9207772DJmb 1 priority to early intervention providers who do not meet the 2 experience, education, or continuing education requirements 3 necessary to be fully credentialed early intervention 4 providers; and 5 (b) Courses held no less than twice per year for no 6 fewer than 4 hours each in no fewer than 5 separate locales 7 throughout the State each on the following topics: 8 (1) Practice and procedures of private insurance 9 billing. 10 (2) The role of the regional intake entities; 11 service coordination; program eligibility determinations; 12 family fees; Medicaid, KidCare, and Division of 13 Specialized Care applications, referrals, and 14 coordination with Early Intervention; and procedural 15 safeguards. 16 (3) Introduction to the early intervention program, 17 including provider enrollment and credentialing, overview 18 of Early Intervention program policies and regulations, 19 and billing requirements. 20 (4) Evaluation and assessment of birth-to-3 21 children; individualized family service plan development, 22 monitoring, and review; best practices; service 23 guidelines; and quality assurance. 24 (325 ILCS 20/13.32 new) 25 Sec. 13.32. Contracting. The lead agency may enter into 26 contracts for some or all of its responsibilities under this 27 Act, including but not limited to, credentialing and 28 enrolling providers; training under Section 13.30; 29 maintaining a central billing office; data collection and 30 analysis; establishing and maintaining a computerized case 31 management system accessible to local referral offices and 32 providers; creating and maintaining a system for provider 33 credentialing and enrollment; creating and maintaining the SB461 Enrolled -27- LRB9207772DJmb 1 central directory required under subsection (g) of Section 7 2 of this Act; and program operations. If contracted, the 3 contract shall be subject to a public request for proposals 4 as described in the Illinois Procurement Code, 5 notwithstanding any exemptions or alternative processes that 6 may be allowed for such a contract under that Code, and, in 7 addition to the posting requirements under that Code, shall 8 be posted on the early intervention website maintained by the 9 lead agency during the entire bid period. Any of these listed 10 responsibilities currently under contract or grant that have 11 not met these requirements shall be subject to public bid 12 under this request for proposal process no later than July 1, 13 2002 or the date of termination of any contract in place. 14 (325 ILCS 20/13.50 new) 15 Sec. 13.50. Early Intervention Legislative Advisory 16 Committee. No later than 60 days after the effective date of 17 this amendatory Act of 92nd General Assembly, there shall be 18 convened the Early Intervention Legislative Advisory 19 Committee. The majority and minority leaders of the General 20 Assembly shall each appoint 2 members to the Committee. The 21 Committee's term is for a period of 2 years, and the 22 Committee shall publicly convene no less than 4 times per 23 year. The Committee's responsibilities shall include, but not 24 be limited to, providing guidance to the lead agency 25 regarding programmatic and fiscal management and 26 accountability, provider development and accountability, 27 contracting, and program outcome measures. During the life 28 of the Committee, on a quarterly basis, or more often as the 29 Committee may request, the lead agency shall provide to the 30 Committee, and simultaneously to the public, through postings 31 on the lead agency's early intervention website, quarterly 32 reports containing monthly data and other early intervention 33 program information that the Committee requests. The first SB461 Enrolled -28- LRB9207772DJmb 1 data report must be supplied no later than September 21, 2 2001, and must include the previous 2 quarters of data. 3 (325 ILCS 20/15) (from Ch. 23, par. 4165) 4 Sec. 15. The Auditor General of the State shall conduct 5 a follow-upanevaluation of the system established under 6 this Act, in order to evaluate the effectiveness of the 7 system in providing services that enhance the capacities of 8 families throughout Illinois to meet the special needs of 9 their eligible infants and toddlers, and provide a report of 10 the evaluation to the Governor and the General Assembly no 11 later than April 30, 20021993. Upon receipt by the lead 12 agency, this report shall be posted on the early intervention 13 website. 14 (Source: P.A. 87-680.) 15 Section 99. Effective date. This Act takes effect upon 16 becoming law.