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Early Intervention Program
Standards and Procedures for Evaluations, Evaluation
Reimbursement, and Eligibility Requirements and Determinations
Under the Early Intervention Program
New York State Department of Health
Bureau of Early Intervention
Standards and Procedures for Evaluations, Evaluation Reimbursement, and Eligibility
Requirements and Determination Under the EIP
New York State Department of Health
Early Intervention Program
Standards and Procedures for Evaluations, Evaluation Reimbursement, and Eligibility Requirements and Determinations Under the Early Intervention Program I. Referrals to the Early Intervention Program
Children Referred as “At-Risk for Disability”
Children Referred by the Child Protective System
Children Referred With a Confirmed or Suspected Disability
II. Multidisciplinary Evaluation Procedures
Purpose of the Multidisciplinary Evaluation
General Requirements for the Evaluation Process
A Special Note on Standardized Evaluation and Assessment Instruments
A Special Note on Informed Clinical Opinion
A Special Note on Parent Participation in the Multidisciplinary Evaluation Process...........11 Intake and Screening Procedures
Composition of the Evaluation Team
Required Components of the Multidisciplinary Evaluation
Voluntary Family Assessment
Use of Findings From Other Examinations
III. Evaluation Reports and Documentation Requirements
Informing Parents of Results
Role of the Multidisciplinary Evaluation Team in the IFSP Meeting
Children Found To Be Typically Developing and Who Are Not Eligible for the EIP..........22 IV. Reimbursement Mechanisms for Screening and Evaluation
V. Eligibility Criteria
Federal Eligibility Requirements
State Eligibility Requirements
Diagnosed Conditions With a High Probability of Resulting in Developmental Delay............26 Developmental Delay
Measuring Developmental Delay
Developmental Domains Used to Establish Eligibility for the EIP
New York State Definition of Developmental Delay
Determining Eligibility Based on Developmental Delay
VI. Monitoring Progress
VII. Procedures and Criteria for Ongoing Eligibility
Procedures for Ongoing Eligibility
Criteria for Ongoing Eligibility
VIII. Frequently Asked Questions
ii Standards and Procedures for Evaluations, Evaluation Reimbursement, and Eligibility Requirements and Determination Under the EIP Appendix A – Risk Factors Pertaining to Referrals of At-Risk Children
Appendix B – Personnel Qualified to Diagnose EIP Eligible Conditions
Appendix C – Recommendations for Preventive Pediatric Health Care
Appendix D – Evaluation Summary Forms
Appendix E – Clinical Clues Adapted From the NYS EIP Clinical Practice Guidelines..............58 Appendix F – Predictors of Continued Language Delay
Appendix G – Developmental Surveillance Recommendations for Children At Risk for Communication Delays
Appendix H – Components of an In-depth Speech-Language Evaluation
Appendix I – Milestones on Normal Feeding, Clinical Clues of a Possible Feeding Problem, and Components of an Oral Motor Assessment
SUBJECT: Standards and Procedures for Evaluations, Evaluation Reimbursement, and Eligibility Requirements and Determinations Under the Early Intervention Program The purpose of this guidance is to review procedures for referral to the Early Intervention Program (EIP); clarify requirements, procedures, and reimbursement for conducting multidisciplinary evaluations; and, clarify procedures and requirements for determining children’s eligibility and ongoing eligibility for the EIP. Consistent use of these requirements statewide is important to ensure that evaluations are appropriately performed, and eligibility is appropriately established and documented, for all children and families participating in the EIP.
This document reviews procedures for:
• referrals to the EIP;
• multidisciplinary evaluations and State regulations pertaining to the responsibilities of evaluators;
• evaluation reports and documentation requirements;
• use of EIP rates for payment of evaluators for performance of screenings and evaluations for children referred to and enrolled in the EIP;
• statutory and regulatory requirements for EIP eligibility;
• strategies for children found to be typically developing after evaluation;
• monitoring child and family progress; and,
• procedures and criteria to determine ongoing eligibility for the EIP.
Standards and Procedures for Evaluations, Evaluation Reimbursement, and Eligibility Requirements and Determination Under the EIP I. Referrals to the Early Intervention Program Section 2542 (1)(a) of the Public Health Law (PHL) requires Early Intervention Officials (EIOs) 1 to identify and locate children who are eligible for the Early Intervention Program and to provide for the identification, screening, and tracking of children at risk for developmental delay. 2 PHL and regulations further require the following primary referral sources to refer children suspected of having disabilities, or at risk of having disabilities, to the EIO of the municipality in which the child resides (unless the child has been referred or the parent objects to the referral). Primary referral sources include: all individuals who are qualified personnel; all approved evaluators, service coordinators, and providers of early intervention services; hospitals; child health care providers, including pediatricians; day care programs; local school districts; public health facilities; early childhood direction centers; local health units; local school districts; local social service districts; public health facilities; and operators of any clinic approved under Article 28 of the PHL, Articles 16 or 31 of the Mental Hygiene Law, and other such social service and health care agencies and providers specified in State regulation.
If a parent objects to a referral to the EIP by a primary referral source, the primary referral source is required to document the parent’s objection to the referral; provide the parent with the name and telephone number of the EIO in the child’s county of residence; and, make reasonable efforts within two months to follow up with the parent, if appropriate, to refer the child unless the parent objects. 3 Parents may also refer their child directly to the EIP if they have a concern about their child’s development, or when they agree with a concern raised by someone else about their child. For example, if a child’s primary health care provider is concerned about his or her development, the parent may directly refer the child to the EIP or ask the physician to refer the child.
Children Referred as “At-Risk for Disability” It is important to differentiate the responsibilities of municipalities for children referred to the EIO as at risk for disability and children referred with a suspected or confirmed disability (either a developmental delay or diagnosed condition with a high probability of resulting in developmental delay). In New York State, children at-risk for disability are not eligible for the Early Intervention Program. However, any child who meets risk criteria established in EIP regulations (see Section 10 NYCRR §69-4.3 (f) – see Appendix A) must be referred to the Early Intervention Program for developmental surveillance (screening and tracking). The purpose of developmental surveillance is to identify potential delays or disabilities, as early as possible, in children who are typically developing but are at high risk for developmental problems due to medical/biological neonatal or medical/biological post-neonatal and early childhood risk factors.
Developmental surveillance has been described by the American Academy of Pediatrics as a “flexible, continuous process whereby knowledgeable professionals perform skilled observations of children during the provision of health care.” The components of developmental surveillance include eliciting and attending to parental concerns, developmental history, making accurate and Throughout this document, the term “EIO” will be used to reference both Early Intervention Officials and their designees.
PHL §2542(1)(a)(c) 10 NYCRR §69-4.3(a)(3) Standards and Procedures for Evaluations, Evaluation Reimbursement, and Eligibility Requirements and Determination Under the EIP informative observations of children, and sharing opinions and concerns with other professionals. 4 Developmental surveillance, which may include developmental screening (a brief assessment procedure to identify children who should receive more intensive diagnosis or assessment), for these children is generally accomplished through their primary health care providers. When families cannot be engaged with a primary health care provider, municipalities may directly provide developmental screening (for example, by using the Ages and Stages Questionnaire or other appropriate developmental screening tools).
Children Referred by the Child Protective System A new provision of the Federal Child Abuse Prevention and Treatment Act (CAPTA)5 requires state child protection agencies to establish “provisions and procedures for referral of a child under three years of age, who are involved in substantiated child abuse or neglect, to early intervention services funded under Part C of the Individuals with Disabilities Education Act.” In the 2004 reauthorization of the Individuals with Disabilities Education Act (IDEA), a new provision was added to Part C that requires states to provide “a description of State policies and procedures that require the referral for early intervention services …of a child under the age of three who (A) is involved in a substantiated case of child abuse or neglect; or, (B) is identified as affected by illegal substance abuse, or withdrawal symptoms resulting from prenatal exposure.”6 As part of its reauthorization of IDEA, Congress clarified that the intent of this provision is not to require state early intervention programs to provide a multidisciplinary evaluation for all children referred to Part C as the result of being the subject of a substantiated case of child abuse or neglect or affected by illegal substance abuse. Rather, the intent of these provisions is to ensure that these children are screened, either by a designated primary referral source or Part C provider to determine whether a referral for an evaluation for early intervention services under Part C is warranted.7 State PHL and EIP regulations 8 require EIOs, as part of their role in the child find system, to coordinate the efforts made by other agencies and community programs that serve infants and toddlers to identify, locate, and track children, and identify, track, and screen at-risk children, using available resources and resources allocated by the Department for this purpose. Under the new provisions of IDEA and CAPTA, municipalities are required to ensure that children involved in substantiated cases of child abuse and neglect and those affected by illegal substance abuse are included in child find efforts. Early Intervention Program regulations at 10 NYCRR §69-4.3(a) require primary referral sources to refer children at risk of having a disability to the EIO based on medical/biological risk criteria identified at 10 NYCRR §69-4.3(f), including maternal prenatal alcohol abuse, maternal prenatal abuse of illicit substances, and prenatal exposure to therapeutic drugs with known potential developmental implications (such as psychotropic, anticonvulsant, or antineoplastic medications). EIP regulations further specify that American Academy of Pediatrics: Developmental Surveillance and Screening of Infants and Young Children. Committee on Children with Disabilities. Pediatrics, Vol 108, No. 1, July, 2001, pp 192-195.
42 U.S.C. 5106a(b)(xxi) H.R. 1350, Sec. 637(a)(6) Conference Report on H.R. 1350, pg 126 PHL §2542(1) and 10 NYCRR §69-4.2 (a)(2)(3) Standards and Procedures for Evaluations, Evaluation Reimbursement, and Eligibility Requirements and Determination Under the EIP the following risk criteria may be considered by a primary referral source in the decision to make a referral: no prenatal care; parental developmental disability or diagnosed serious and persistent mental illness; parental substance abuse, including alcohol or illicit drug abuse; no well child care by six months of age or significant delay in immunizations; and/or, other risk criteria as identified by the primary referral source. 9 In accordance with new IDEA and CAPTA requirements, and existing PHL and regulations governing the EIP, children involved in substantiated cases of child abuse and neglect, and those affected by illegal substance abuse or withdrawal symptoms resulting from prenatal exposure should be considered at-risk for developmental delay and included in local child find efforts (unless a child also has a developmental delay or diagnosis that makes him or her potentially eligible for the EIP). This means that EIOs are responsible for collaborating with all available resources in the community to ensure that these children are identified, screened, and tracked, so that a referral to the EIP for a multidisciplinary evaluation can be made if a developmental delay or disability is suspected. Municipalities should provide direct developmental screening for those children for whom no other resources are available to provide screening and tracking services, using Early Intervention Administration funds allocated to municipalities to administer the EIP.10 Municipalities should already have child find procedures in place to work with hospitals and health care providers to ensure that children affected by illegal substance abuse are referred to the EIP for screening and tracking purposes.
EIOs and local EIP program staff should work with their local departments of social services and local early intervention coordinating councils to collaborate on the development of local procedures to ensure appropriate referrals of children in the child protective system to the EIP.