93RD GENERAL ASSEMBLY
State of Illinois
2003 and 2004
HB5100

 

Introduced 02/05/04, by Elizabeth Coulson

 

SYNOPSIS AS INTRODUCED:
 
325 ILCS 20/11   from Ch. 23, par. 4161

    Amends the Early Intervention Services System Act. With respect to an individualized family service plan, provides that if the lead agency develops therapy guidelines that reflect current best practices for serving eligible children, those guidelines may not cap the frequency or intensity, or restrict the method of delivering, the services determined by the multidisciplinary team. Provides that the lead agency may not use designated experts to directly or indirectly impose such caps. Makes other changes. Effective immediately.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

HB5100 LRB093 15497 DRJ 41103 b

1     AN ACT concerning 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 Section 11 as follows:
 
6     (325 ILCS 20/11)  (from Ch. 23, par. 4161)
7     Sec. 11. Individualized Family Service Plans.
8     (a) Each eligible infant or toddler and that infant's or
9 toddler's family shall receive:
10         (1) timely, comprehensive, multidisciplinary
11     assessment of the unique needs of each eligible infant and
12     toddler, and assessment of the concerns and priorities of
13     the families to appropriately assist them in meeting their
14     needs and identify services to meet those needs; and
15         (2) a written Individualized Family Service Plan
16     developed by a multidisciplinary team which includes the
17     parent or guardian. The individualized family service plan
18     shall be based on the multidisciplinary team's assessment
19     of the resources, priorities, and concerns of the family
20     and its identification of the supports and services
21     necessary to enhance the family's capacity to meet the
22     developmental needs of the infant or toddler, and shall
23     include the identification of services appropriate to meet
24     those needs, including the frequency, intensity, and
25     method of delivering services. If the lead agency develops
26     therapy guidelines that reflect current best practices for
27     serving eligible children, those therapy guidelines may
28     not directly or indirectly cap the frequency or intensity,
29     or restrict the method of delivering, the services
30     determined by the multidisciplinary team. Such prohibited
31     direct or indirect caps on services include, but are not
32     limited to: (i) requiring that the individualized service

 

 

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1     plan be consistent with any therapy guidelines even if the
2     multidisciplinary team cannot reach a consensus; (ii)
3     requiring that multidisciplinary team members adhere to or
4     operate within the framework of any therapy guidelines;
5     (iii) preventing authorizations for services when the
6     multidisciplinary team has recommended services that are
7     different in frequency or intensity, or different in both
8     frequency and intensity, than those provided for in any
9     therapy guidelines; or (iv) allowing exceptions to the
10     service guidelines only if appropriate clinical
11     justification is submitted to the lead agency. The lead
12     agency also may not utilize designated experts to directly
13     or indirectly cap the frequency or intensity, or restrict
14     the method of delivering, the services determined by the
15     multidisciplinary team. During and as part of the initial
16     development of the individualized family services plan,
17     and any periodic reviews of the plan, the multidisciplinary
18     team shall consult the lead agency's therapy guidelines and
19     its designated experts, if any, to help determine
20     appropriate services and the frequency and intensity of
21     those services. All services in the individualized family
22     services plan must be justified by the multidisciplinary
23     assessment of the unique strengths and needs of the infant
24     or toddler and must be appropriate to meet those needs. At
25     the periodic reviews, the team shall determine whether
26     modification or revision of the outcomes or services is
27     necessary.
28     (b) The Individualized Family Service Plan shall be
29 evaluated once a year and the family shall be provided a review
30 of the Plan at 6 month intervals or more often where
31 appropriate based on infant or toddler and family needs. The
32 lead agency shall create a quality review process regarding
33 Individualized Family Service Plan development and changes
34 thereto, to monitor and help assure that resources are being
35 used to provide appropriate early intervention services.
36     (c) The evaluation and initial assessment and initial Plan

 

 

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1 meeting must be held within 45 days after the initial contact
2 with the early intervention services system. With parental
3 consent, early intervention services may commence before the
4 completion of the comprehensive assessment and development of
5 the Plan.
6     (d) Parents must be informed that, at their discretion,
7 early intervention services shall be provided to each eligible
8 infant and toddler in the natural environment, which may
9 include the home or other community settings. Parents shall
10 make the final decision to accept or decline early intervention
11 services. A decision to decline such services shall not be a
12 basis for administrative determination of parental fitness, or
13 other findings or sanctions against the parents. Parameters of
14 the Plan shall be set forth in rules.
15     (e) The regional intake offices shall explain to each
16 family, orally and in writing, all of the following:
17         (1) That the early intervention program will pay for
18     all early intervention services set forth in the
19     individualized family service plan that are not covered or
20     paid under the family's public or private insurance plan or
21     policy and not eligible for payment through any other third
22     party payor.
23         (2) That services will not be delayed due to any rules
24     or restrictions under the family's insurance plan or
25     policy.
26         (3) That the family may request, with appropriate
27     documentation supporting the request, a determination of
28     an exemption from private insurance use under Section
29     13.25.
30         (4) That responsibility for co-payments or
31     co-insurance under a family's private insurance plan or
32     policy will be transferred to the lead agency's central
33     billing office.
34         (5) That families will be responsible for payments of
35     family fees, which will be based on a sliding scale
36     according to income, and that these fees are payable to the

 

 

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1     central billing office, and that if the family encounters a
2     catastrophic circumstance, as defined under subsection (f)
3     of Section 13 of this Act, making it unable to pay the
4     fees, the lead agency may, upon proof of inability to pay,
5     waive the fees.
6     (f) The individualized family service plan must state
7 whether the family has private insurance coverage and, if the
8 family has such coverage, must have attached to it a copy of
9 the family's insurance identification card or otherwise
10 include all of the following information:
11         (1) The name, address, and telephone number of the
12     insurance carrier.
13         (2) The contract number and policy number of the
14     insurance plan.
15         (3) The name, address, and social security number of
16     the primary insured.
17         (4) The beginning date of the insurance benefit year.
18     (g) A copy of the individualized family service plan must
19 be provided to each enrolled provider who is providing early
20 intervention services to the child who is the subject of that
21 plan.
22 (Source: P.A. 91-538, eff. 8-13-99; 92-10, eff. 6-11-01;
23 92-307, eff. 8-9-01; 92-651, eff. 7-11-02.)
 
24     Section 99. Effective date. This Act takes effect upon
25 becoming law.