HB5100 93RD GENERAL ASSEMBLY

LRB093 15497 DRJ 41103 b

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.

FISCAL NOTE ACT MAY APPLY

A BILL FOR

AN ACT concerning children.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 5. The Early Intervention Services System Act is amended by changing Section 11 as follows:

(325 ILCS 20/11) (from Ch. 23, par. 4161)

Sec. 11. Individualized Family Service Plans.

(a) Each eligible infant or toddler and that infant's or toddler's family shall receive:

(1) timely, comprehensive, multidisciplinary assessment of the unique needs of each eligible infant and toddler, and assessment of the concerns and priorities of the families to appropriately assist them in meeting their needs and identify services to meet those needs; and

(2) a written Individualized Family Service Plan developed by a multidisciplinary team which includes the parent or guardian. The individualized family service plan shall be based on the multidisciplinary team's assessment of the resources, priorities, and concerns of the family and its identification of the supports and services necessary to enhance the family's capacity to meet the developmental needs of the infant or toddler, and shall include the identification of services appropriate to meet those needs, including the frequency, intensity, and method of delivering services. If the lead agency develops therapy guidelines that reflect current best practices for serving eligible children, those therapy guidelines may not directly or indirectly cap the frequency or intensity, or restrict the method of delivering, the services determined by the multidisciplinary team. Such prohibited direct or indirect caps on services include, but are not limited to: (i) requiring that the individualized service plan be consistent with any therapy guidelines even if the multidisciplinary team cannot reach a consensus; (ii) requiring that multidisciplinary team members adhere to or operate within the framework of any therapy guidelines; (iii) preventing authorizations for services when the multidisciplinary team has recommended services that are different in frequency or intensity, or different in both frequency and intensity, than those provided for in any therapy guidelines; or (iv) allowing exceptions to the service guidelines only if appropriate clinical justification is submitted to the lead agency. The lead agency also may not utilize designated experts to directly or indirectly cap the frequency or intensity, or restrict the method of delivering, the services determined by the multidisciplinary team. During and as part of the initial development of the individualized family services plan, and any periodic reviews of the plan, the multidisciplinary team shall consult the lead agency's therapy guidelines and its designated experts, if any, to help determine appropriate services and the frequency and intensity of those services. All services in the individualized family services plan must be justified by the multidisciplinary assessment of the unique strengths and needs of the infant or toddler and must be appropriate to meet those needs. At the periodic reviews, the team shall determine whether modification or revision of the outcomes or services is necessary.

(b) The Individualized Family Service Plan shall be evaluated once a year and the family shall be provided a review of the Plan at 6 month intervals or more often where appropriate based on infant or toddler and family needs. The lead agency shall create a quality review process regarding Individualized Family Service Plan development and changes thereto, to monitor and help assure that resources are being used to provide appropriate early intervention services.

(c) The evaluation and initial assessment and initial Plan meeting must be held within 45 days after the initial contact with the early intervention services system. With parental consent, early intervention services may commence before the completion of the comprehensive assessment and development of the Plan.

(d) Parents must be informed that, at their discretion, early intervention services shall be provided to each eligible infant and toddler in the natural environment, which may include the home or other community settings. Parents shall make the final decision to accept or decline early intervention services. A decision to decline such services shall not be a basis for administrative determination of parental fitness, or other findings or sanctions against the parents. Parameters of the Plan shall be set forth in rules.

(e) The regional intake offices shall explain to each family, orally and in writing, all of the following:

(1) That the early intervention program will pay for all early intervention services set forth in the individualized family service plan that are not covered or paid under the family's public or private insurance plan or policy and not eligible for payment through any other third party payor.

(2) That services will not be delayed due to any rules or restrictions under the family's insurance plan or policy.

(3) That the family may request, with appropriate documentation supporting the request, a determination of an exemption from private insurance use under Section 13.25.

(4) That responsibility for co-payments or co-insurance under a family's private insurance plan or policy will be transferred to the lead agency's central billing office.

(5) That families will be responsible for payments of family fees, which will be based on a sliding scale according to income, and that these fees are payable to the central billing office, and that if the family encounters a catastrophic circumstance, as defined under subsection (f) of Section 13 of this Act, making it unable to pay the fees, the lead agency may, upon proof of inability to pay, waive the fees.

(f) The individualized family service plan must state whether the family has private insurance coverage and, if the family has such coverage, must have attached to it a copy of the family's insurance identification card or otherwise include all of the following information:

(1) The name, address, and telephone number of the 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.

(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.)

Section 99. Effective date. This Act takes effect upon becoming law.