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1 | | AN ACT concerning children.
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2 | | Be it enacted by the People of the State of Illinois,
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3 | | represented in the General Assembly:
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4 | | Section 5. The Early Intervention Services System Act is |
5 | | amended by changing Sections 3, 4, 5, 7, 9, 10, 11, 12, 13, |
6 | | 13.5, 13.10, 13.15, and 13.30 as follows:
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7 | | (325 ILCS 20/3) (from Ch. 23, par. 4153)
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8 | | Sec. 3. Definitions. As used in this Act:
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9 | | (a) "Eligible infants and toddlers" means infants and |
10 | | toddlers
under 36 months of age with any of the following |
11 | | conditions:
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12 | | (1) Developmental delays.
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13 | | (2) A physical or mental condition which typically |
14 | | results in
developmental delay.
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15 | | (3) Being at risk of having substantial developmental |
16 | | delays
based on informed clinical opinion judgment .
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17 | | (4) Either (A) having entered the program under any of
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18 | | the circumstances listed in paragraphs (1) through (3) of |
19 | | this
subsection
but no
longer meeting
the current |
20 | | eligibility criteria under those paragraphs,
and |
21 | | continuing to have any measurable delay, or (B) not
having |
22 | | attained a level of development in each area,
including
(i) |
23 | | cognitive, (ii) physical (including vision and hearing), |
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1 | | (iii)
language,
speech, and communication, (iv) social or |
2 | | emotional psycho-social , or (v) adaptive self-help
skills , |
3 | | that
is at least at the mean of the child's age equivalent |
4 | | peers;
and,
in addition to either item (A) or item (B), (C)
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5 | | having
been determined by the multidisciplinary |
6 | | individualized
family service plan
team to require the |
7 | | continuation of early intervention services in order to
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8 | | support
continuing
developmental progress, pursuant to the |
9 | | child's needs and provided in an
appropriate
developmental |
10 | | manner. The type, frequency, and intensity of services |
11 | | shall
differ from
the initial individualized family |
12 | | services plan because of the child's
developmental
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13 | | progress, and may consist of only service coordination, |
14 | | evaluation, and
assessments.
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15 | | (b) "Developmental delay" means a delay in one or more of |
16 | | the following
areas of childhood development as measured by |
17 | | appropriate diagnostic
instruments and standard procedures: |
18 | | cognitive; physical, including vision
and hearing; language, |
19 | | speech and communication; social or emotional psycho-social ;
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20 | | or adaptive self-help skills . The term means a delay of 30% or |
21 | | more below the mean in
function in one or more of those areas.
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22 | | (c) "Physical or mental condition which typically results |
23 | | in developmental
delay" means:
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24 | | (1) a diagnosed medical disorder bearing a relatively |
25 | | well known
expectancy for developmental outcomes within |
26 | | varying ranges of developmental
disabilities; or
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1 | | (2) a history of prenatal, perinatal, neonatal or early |
2 | | developmental
events suggestive of biological insults to |
3 | | the developing central nervous
system and which either |
4 | | singly or collectively increase the probability of
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5 | | developing a disability or delay based on a medical |
6 | | history.
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7 | | (d) "Informed clinical opinion judgment " means both |
8 | | clinical observations and
parental participation to determine |
9 | | eligibility by a consensus of a
multidisciplinary team of 2 or |
10 | | more members based on their professional
experience and |
11 | | expertise.
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12 | | (e) "Early intervention services" means services which:
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13 | | (1) are designed to meet the developmental needs of |
14 | | each child
eligible under this Act and the needs of his or |
15 | | her family;
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16 | | (2) are selected in collaboration with the child's |
17 | | family;
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18 | | (3) are provided under public supervision;
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19 | | (4) are provided at no cost except where a schedule of |
20 | | sliding scale
fees or other system of payments by families |
21 | | has been adopted in accordance
with State and federal law;
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22 | | (5) are designed to meet an infant's or toddler's |
23 | | developmental needs in
any of the following areas:
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24 | | (A) physical development, including vision and |
25 | | hearing,
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26 | | (B) cognitive development,
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1 | | (C) communication development,
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2 | | (D) social or emotional development, or
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3 | | (E) adaptive development;
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4 | | (6) meet the standards of the State, including the |
5 | | requirements of this Act;
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6 | | (7) include one or more of the following:
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7 | | (A) family training,
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8 | | (B) social work services, including counseling, |
9 | | and home visits,
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10 | | (C) special instruction,
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11 | | (D) speech, language pathology and audiology,
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12 | | (E) occupational therapy,
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13 | | (F) physical therapy,
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14 | | (G) psychological services,
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15 | | (H) service coordination services,
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16 | | (I) medical services only for diagnostic or |
17 | | evaluation purposes,
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18 | | (J) early identification, screening, and |
19 | | assessment services,
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20 | | (K) health services specified by the lead agency as |
21 | | necessary to
enable the infant or toddler to benefit |
22 | | from the other early intervention
services,
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23 | | (L) vision services,
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24 | | (M) transportation, and
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25 | | (N) assistive technology devices and services , ;
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26 | | (O) nursing services, |
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1 | | (P) nutrition services, and |
2 | | (Q) sign language and cued language services;
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3 | | (8) are provided by qualified personnel, including but |
4 | | not limited to:
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5 | | (A) child development specialists or special |
6 | | educators , including teachers of children with hearing |
7 | | impairments (including deafness) and teachers of |
8 | | children with vision impairments (including |
9 | | blindness) ,
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10 | | (B) speech and language pathologists and |
11 | | audiologists,
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12 | | (C) occupational therapists,
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13 | | (D) physical therapists,
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14 | | (E) social workers,
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15 | | (F) nurses,
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16 | | (G) dietitian nutritionists,
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17 | | (H) vision specialists, including ophthalmologists |
18 | | and optometrists,
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19 | | (I) psychologists, and
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20 | | (J) physicians;
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21 | | (9) are provided in conformity with an Individualized |
22 | | Family Service Plan;
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23 | | (10) are provided throughout the year; and
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24 | | (11) are provided in natural
environments, to the |
25 | | maximum extent appropriate, which may include the home and |
26 | | community settings, unless justification is provided |
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1 | | consistent with federal regulations adopted under Sections |
2 | | 1431 through 1444 of Title 20 of the United States Code.
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3 | | (f) "Individualized Family Service Plan" or "Plan" means a |
4 | | written plan for
providing early intervention services to a |
5 | | child eligible under this Act
and the child's family, as set |
6 | | forth in Section 11.
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7 | | (g) "Local interagency agreement" means an agreement |
8 | | entered into by
local community and State and regional agencies |
9 | | receiving early
intervention funds directly from the State and |
10 | | made in accordance with
State interagency agreements providing |
11 | | for the delivery of early
intervention services within a local |
12 | | community area.
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13 | | (h) "Council" means the Illinois Interagency Council on |
14 | | Early
Intervention established under Section 4.
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15 | | (i) "Lead agency" means the State agency
responsible for |
16 | | administering this Act and
receiving and disbursing public |
17 | | funds received in accordance with State and
federal law and |
18 | | rules.
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19 | | (i-5) "Central billing office" means the central billing |
20 | | office created by
the lead agency under Section 13.
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21 | | (j) "Child find" means a service which identifies eligible |
22 | | infants and
toddlers.
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23 | | (k) "Regional intake entity" means the lead agency's |
24 | | designated entity
responsible for implementation of the Early |
25 | | Intervention Services System within
its designated geographic |
26 | | area.
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1 | | (l) "Early intervention provider" means an individual who |
2 | | is qualified, as
defined by the lead agency, to provide one or |
3 | | more types of early intervention
services, and who has enrolled |
4 | | as a provider in the early intervention program.
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5 | | (m) "Fully credentialed early intervention provider" means |
6 | | an individual who
has met the standards in the State applicable |
7 | | to the relevant
profession, and has met such other |
8 | | qualifications as the lead agency has
determined are suitable |
9 | | for personnel providing early intervention services,
including |
10 | | pediatric experience, education, and continuing education. The |
11 | | lead
agency shall establish these qualifications by rule filed |
12 | | no later than 180
days
after the effective date of this |
13 | | amendatory Act of the 92nd General Assembly.
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14 | | (Source: P.A. 97-902, eff. 8-6-12.)
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15 | | (325 ILCS 20/4) (from Ch. 23, par. 4154)
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16 | | Sec. 4. Illinois Interagency Council on Early |
17 | | Intervention.
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18 | | (a) There is established the Illinois Interagency Council |
19 | | on Early
Intervention. The Council shall be composed of at |
20 | | least 20 but not more than
30 members. The members of the |
21 | | Council and the designated chairperson of the
Council shall be |
22 | | appointed by the Governor. The Council member representing the
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23 | | lead agency may not serve as chairperson of the Council. The |
24 | | Council shall be
composed of the following members:
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25 | | (1) The Secretary of Human Services (or his or her |
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1 | | designee) and 2
additional representatives of the |
2 | | Department of Human Services designated by
the Secretary, |
3 | | plus the Directors (or their designees) of the following |
4 | | State
agencies involved in the provision of or payment for |
5 | | early intervention
services to eligible infants and |
6 | | toddlers and their families:
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7 | | (A) Department of Insurance; and
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8 | | (B) Department of Healthcare and Family Services.
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9 | | (2) Other members as follows:
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10 | | (A) At least 20% of the members of the Council |
11 | | shall be parents,
including minority parents, of |
12 | | infants or toddlers with disabilities or
children with |
13 | | disabilities aged 12 or younger, with knowledge of, or
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14 | | experience with, programs for infants and toddlers |
15 | | with disabilities. At
least one such member shall be a |
16 | | parent of an infant or toddler with a
disability or a |
17 | | child with a disability aged 6 or younger;
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18 | | (B) At least 20% of the members of the Council |
19 | | shall be public or
private providers of early |
20 | | intervention services;
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21 | | (C) One member shall be a representative of the |
22 | | General Assembly;
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23 | | (D) One member shall be involved in the preparation |
24 | | of professional
personnel to serve infants and |
25 | | toddlers similar to those eligible for services
under |
26 | | this Act;
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1 | | (E) Two members shall be from advocacy |
2 | | organizations with expertise in improving health, |
3 | | development, and educational outcomes for infants and |
4 | | toddlers with disabilities; |
5 | | (F) One member shall be a Child and Family |
6 | | Connections manager from a rural district; |
7 | | (G) One member shall be a Child and Family |
8 | | Connections manager from an urban district; |
9 | | (H) One member shall be the co-chair of the |
10 | | Illinois Early Learning Council (or his or her |
11 | | designee); and |
12 | | (I) Members representing the following agencies or |
13 | | entities: the State Board of Education; the Department |
14 | | of Public Health; the Department of Children and Family |
15 | | Services; the University of Illinois Division of |
16 | | Specialized Care for Children; the Illinois Council on |
17 | | Developmental Disabilities; Head Start or Early Head |
18 | | Start; and the Department of Human Services' Division |
19 | | of Mental Health. A member may represent one or more of |
20 | | the listed agencies or entities. |
21 | | The Council shall meet at least quarterly and in such |
22 | | places as it deems
necessary. Terms of the initial members |
23 | | appointed under paragraph (2) shall be
determined by lot at the |
24 | | first Council meeting as follows: of the persons
appointed |
25 | | under subparagraphs (A) and (B), one-third shall serve one year
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26 | | terms, one-third shall serve 2 year terms, and one-third shall |
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1 | | serve 3 year
terms; and of the persons appointed under |
2 | | subparagraphs (C) and (D), one
shall serve a 2 year term and |
3 | | one shall serve a 3 year term. Thereafter,
successors appointed |
4 | | under paragraph (2) shall serve 3 year terms. Once
appointed, |
5 | | members shall continue to serve until their successors are
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6 | | appointed. No member shall be appointed to serve more than 2 |
7 | | consecutive
terms.
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8 | | Council members shall serve without compensation but shall |
9 | | be reimbursed
for reasonable costs incurred in the performance |
10 | | of their duties, including
costs related to child care, and |
11 | | parents may be paid a stipend in accordance
with applicable |
12 | | requirements.
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13 | | The Council shall prepare and approve a budget using funds |
14 | | appropriated
for the purpose to hire staff, and obtain the |
15 | | services of such
professional, technical, and clerical |
16 | | personnel as may be necessary to
carry out its functions under |
17 | | this Act. This funding support and staff
shall be directed by |
18 | | the lead agency.
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19 | | (b) The Council shall:
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20 | | (1) advise and assist the lead agency in the |
21 | | performance of its
responsibilities including but not |
22 | | limited to the identification of sources
of fiscal and |
23 | | other support services for early intervention programs, |
24 | | and
the promotion of interagency agreements which assign |
25 | | financial
responsibility to the appropriate agencies;
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26 | | (2) advise and assist the lead agency in the |
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1 | | preparation of applications
and amendments to |
2 | | applications;
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3 | | (3) review and advise on relevant regulations and |
4 | | standards proposed by
the related State agencies;
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5 | | (4) advise and assist the lead agency in the |
6 | | development,
implementation and evaluation of the |
7 | | comprehensive early intervention services
system; and
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8 | | (4.5) coordinate and collaborate with State |
9 | | interagency early learning initiatives, as appropriate; |
10 | | and
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11 | | (5) prepare and submit an annual report to the Governor |
12 | | and to the
General Assembly on the status of early |
13 | | intervention programs for eligible
infants and toddlers |
14 | | and their families in Illinois.
The annual report shall |
15 | | include (i) the estimated number of eligible infants
and |
16 | | toddlers in this State, (ii) the number of eligible infants |
17 | | and toddlers
who have received services under this Act and |
18 | | the cost of providing those
services, and (iii) the |
19 | | estimated cost of providing services under this Act
to
all |
20 | | eligible infants and toddlers in this State . , and (iv) |
21 | | data and other
information as is requested to be included |
22 | | by the
Legislative Advisory Committee established under |
23 | | Section 13.50 of this Act.
The report shall be posted by |
24 | | the lead agency on the early intervention website
as |
25 | | required under paragraph (f) of Section 5 of this Act.
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26 | | No member of the Council shall cast a vote on or |
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1 | | participate substantially
in any matter which would provide a |
2 | | direct financial benefit to that member
or otherwise give the |
3 | | appearance of a conflict of interest under State law.
All |
4 | | provisions and reporting requirements of the Illinois |
5 | | Governmental Ethics
Act shall apply to Council members.
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6 | | (Source: P.A. 97-902, eff. 8-6-12.)
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7 | | (325 ILCS 20/5) (from Ch. 23, par. 4155)
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8 | | Sec. 5. Lead Agency. The Department of Human Services is |
9 | | designated the
lead agency and shall
provide leadership in |
10 | | establishing and implementing the coordinated,
comprehensive, |
11 | | interagency and interdisciplinary system of early intervention
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12 | | services. The lead agency shall not have the sole |
13 | | responsibility for
providing these services. Each |
14 | | participating State agency shall continue
to coordinate those |
15 | | early intervention services relating to health, social
service |
16 | | and education provided under this authority.
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17 | | The lead agency is responsible for carrying out the |
18 | | following:
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19 | | (a) The general administration, supervision, and |
20 | | monitoring of programs
and activities receiving assistance |
21 | | under Section 673 of the Individuals
with Disabilities |
22 | | Education Act (20 United States Code 1473).
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23 | | (b) The identification and coordination of all |
24 | | available resources within
the State from federal, State, |
25 | | local and private sources.
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1 | | (c) The development of procedures to ensure that |
2 | | services are provided to
eligible infants and toddlers and |
3 | | their families in a timely manner pending
the resolution of |
4 | | any disputes among public agencies or service
providers.
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5 | | (d) The resolution of intra-agency and interagency |
6 | | regulatory and
procedural disputes.
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7 | | (e) The development and implementation of formal |
8 | | interagency agreements,
and the entry into such |
9 | | agreements, between the lead agency and (i) the
Department |
10 | | of Healthcare and Family Services, (ii) the University of |
11 | | Illinois Division of
Specialized Care for Children, and |
12 | | (iii) other relevant State agencies that:
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13 | | (1) define the financial responsibility of each |
14 | | agency for paying
for early intervention services |
15 | | (consistent with existing State and federal
law and |
16 | | rules, including the requirement that early |
17 | | intervention funds
be used as the payor of last |
18 | | resort), a hierarchical order of payment as
among the |
19 | | agencies for
early intervention services that are |
20 | | covered under or may
be paid by programs in other |
21 | | agencies,
and procedures for direct billing, |
22 | | collecting reimbursements for payments
made, and |
23 | | resolving service and payment disputes; and
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24 | | (2) include all additional components necessary to |
25 | | ensure meaningful
cooperation and coordination.
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26 | | Interagency agreements under this paragraph (e) must |
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1 | | be reviewed and
revised to implement the purposes of this |
2 | | amendatory Act of the 92nd General
Assembly no later than |
3 | | 60 days after the effective date of this amendatory Act
of |
4 | | the 92nd General Assembly.
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5 | | (f) The maintenance of an early intervention website. |
6 | | Within 30 days
after the effective date of this amendatory |
7 | | Act of the 92nd General Assembly,
the lead agency shall |
8 | | post and keep posted on this website the following: (i)
the |
9 | | current annual report required under subdivision (b)(5) of |
10 | | Section 4 of
this Act, and the annual reports of the prior |
11 | | 3 years, (ii) the most recent
Illinois application for |
12 | | funds prepared under Section 637 of the Individuals
with |
13 | | Disabilities Education Act filed with the United States |
14 | | Department of
Education, (iii) proposed modifications of |
15 | | the application prepared for public
comment, (iv) notice of |
16 | | Council meetings, Council agendas, and minutes of its
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17 | | proceedings for at least the previous year, (v) proposed |
18 | | and final early
intervention rules, (vi) requests for |
19 | | proposals, and (vii) all reports created
for dissemination |
20 | | to the public that are related to the early intervention
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21 | | program, including reports prepared at the request of the |
22 | | Council, and the General
Assembly , and the Legislative |
23 | | Advisory Committee established under Section
13.50 of this |
24 | | Act . Each such document shall be posted on the website |
25 | | within 3
working days after the document's completion.
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26 | | (g) Before adopting any new policy or procedure |
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1 | | (including any revisions to an existing policy or |
2 | | procedure) needed to comply with Part C of the Individuals |
3 | | with Disabilities Education Act, the lead agency must hold |
4 | | public hearings on the new policy or procedure, provide |
5 | | notice of the hearings at least 30 days before the hearings |
6 | | are conducted to enable public participation, and provide |
7 | | an opportunity for the general public, including |
8 | | individuals with disabilities and parents of infants and |
9 | | toddlers with disabilities, early intervention providers, |
10 | | and members of the Council to comment for at least 30 days |
11 | | on the new policy or procedure needed to comply with Part C |
12 | | of the Individuals with Disabilities Education Act and with |
13 | | 34 CFR Part 300 and Part 303. |
14 | | (Source: P.A. 95-331, eff. 8-21-07.)
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15 | | (325 ILCS 20/7) (from Ch. 23, par. 4157)
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16 | | Sec. 7. Essential Components of the Statewide Service |
17 | | System. As
required by federal laws and regulations, a |
18 | | statewide system of
coordinated, comprehensive, interagency |
19 | | and interdisciplinary programs shall
be established and |
20 | | maintained. The framework of the statewide system shall
be |
21 | | based on the components set forth in this Section. This |
22 | | framework shall
be used for planning, implementation, |
23 | | coordination and evaluation of the
statewide system of locally |
24 | | based early intervention services.
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25 | | The statewide system shall include, at a minimum:
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1 | | (a) a definition of the term "developmentally |
2 | | delayed", in accordance
with the definition in Section 3, |
3 | | that will be used in Illinois in carrying
out programs |
4 | | under this Act;
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5 | | (b) timetables for ensuring that appropriate early |
6 | | intervention services , based on scientifically based |
7 | | research, to the extent practicable,
will be available to |
8 | | all eligible infants and toddlers in this State after
the |
9 | | effective date of this Act;
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10 | | (c) a timely, comprehensive , multidisciplinary and |
11 | | interdisciplinary evaluation of the
functioning of each |
12 | | potentially eligible infant and toddler with suspected |
13 | | disabilities in this
State , unless the child meets the |
14 | | definition of eligibility based upon his or her medical and |
15 | | other records; for a child determined eligible, a |
16 | | multidisciplinary assessment of the unique strengths and |
17 | | needs of that infant or toddler and the identification of |
18 | | services appropriate to meet those needs and a |
19 | | family-directed assessment of the resources, priorities, |
20 | | and concerns of the family and the identification of |
21 | | supports and services necessary to enhance the family's |
22 | | capacity to meet the developmental needs of that infant or |
23 | | toddler the concerns, priorities and resource needs of the |
24 | | families to
appropriately assist in the development of the |
25 | | infant and toddler with
disabilities ;
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26 | | (d) for each eligible infant and toddler, an |
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1 | | Individualized Family
Service Plan, including service |
2 | | coordination ( case management ) services;
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3 | | (e) a comprehensive child find system, consistent with |
4 | | Part B of the
Individuals with Disabilities Education Act |
5 | | (20 United States Code 1411
through 1420 and as set forth |
6 | | in 34 CFR 300.115 ), which includes timelines and
provides |
7 | | for participation by primary referral sources;
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8 | | (f) a public awareness program focusing on early |
9 | | identification of
eligible infants and toddlers;
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10 | | (g) a central directory which includes public and |
11 | | private early intervention
services, resources, and |
12 | | experts available in this State , professional and other |
13 | | groups (including parent support groups and training and |
14 | | information centers) that provide assistance to infants |
15 | | and toddlers with disabilities who are eligible for early |
16 | | intervention programs assisted under Part C of the |
17 | | Individuals with Disabilities Education Act and their |
18 | | families, and early
intervention research and |
19 | | demonstration projects being conducted in this State |
20 | | relating to infants and toddlers with disabilities ;
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21 | | (h) a comprehensive system of personnel development;
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22 | | (i) a policy pertaining to the contracting or making of |
23 | | other
arrangements with public and private service |
24 | | providers to provide early
intervention services in this |
25 | | State, consistent with the provisions of this
Act, |
26 | | including the contents of the application used and the |
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1 | | conditions of
the contract or other arrangements;
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2 | | (j) a procedure for securing timely reimbursement of |
3 | | funds;
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4 | | (k) procedural safeguards with respect to programs |
5 | | under this Act;
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6 | | (l) policies and procedures relating to the |
7 | | establishment and
maintenance of standards to ensure that |
8 | | personnel necessary to carry out
this Act are appropriately |
9 | | and adequately prepared and trained;
|
10 | | (m) a system of evaluation of, and compliance with, |
11 | | program standards;
|
12 | | (n) a system for compiling data on the numbers of |
13 | | eligible infants
and toddlers and their families in this |
14 | | State in need of appropriate early
intervention services; |
15 | | the numbers served; the types of services provided;
and |
16 | | other information required by the State or federal |
17 | | government; and
|
18 | | (o) a single line of responsibility in a lead agency |
19 | | designated by the
Governor to carry out its |
20 | | responsibilities as required by this Act.
|
21 | | In addition to these required components, linkages may be |
22 | | established
within a local community area among the prenatal |
23 | | initiatives affording
services to high risk pregnant women. |
24 | | Additional linkages among at risk
programs and local literacy |
25 | | programs may also be established.
|
26 | | Within 60 days of the effective date of this Act, a |
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1 | | five-fiscal-year
implementation plan shall be submitted to the |
2 | | Governor by the lead agency
with the concurrence of the |
3 | | Interagency Council on Early Intervention. The
plan shall list |
4 | | specific activities to be accomplished each year, with cost
|
5 | | estimates for each activity. No later than the second Monday in |
6 | | July of
each year thereafter, the lead agency shall, with the |
7 | | concurrence of the
Interagency Council, submit to the |
8 | | Governor's Office a report on
accomplishments of the previous |
9 | | year and a revised list of activities for
the remainder of the |
10 | | five-fiscal-year plan, with cost estimates for each.
The |
11 | | Governor shall certify that specific activities in the plan for |
12 | | the
previous year have been substantially completed before |
13 | | authorizing relevant
State or local agencies to implement |
14 | | activities listed in the revised plan
that depend substantially |
15 | | upon completion of one or more of the earlier
activities.
|
16 | | (Source: P.A. 87-680.)
|
17 | | (325 ILCS 20/9) (from Ch. 23, par. 4159)
|
18 | | Sec. 9. Role of Other State Entities. The Departments of |
19 | | Public
Health, Human Services, Children and Family
Services , |
20 | | and Healthcare and Family Services Public Aid ; the University |
21 | | of Illinois Division of Specialized
Care for Children; the |
22 | | State Board of Education;
and any other State agency which |
23 | | directly or
indirectly provides or administers early |
24 | | intervention services shall adopt
compatible rules for the |
25 | | provision of services to eligible infants and
toddlers and |
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|
1 | | their families within one year of the effective date of this |
2 | | Act.
|
3 | | These agencies shall enter into and maintain formal |
4 | | interagency
agreements to enable the State and local agencies |
5 | | serving eligible children
and their families to establish |
6 | | working relationships that will increase
the efficiency and |
7 | | effectiveness of their early intervention services. The
|
8 | | agreement shall outline the administrative, program and |
9 | | financial
responsibilities of the relevant State agencies and |
10 | | shall implement a
coordinated service delivery system through |
11 | | local interagency agreements.
|
12 | | There shall be created in the Office of the Governor an |
13 | | Early Childhood
Intervention Ombudsman to assist families and |
14 | | local parties in ensuring
that all State agencies serving |
15 | | eligible families do so in a comprehensive
and collaborative |
16 | | manner.
|
17 | | (Source: P.A. 89-507, eff. 7-1-97; 89-626, eff. 8-9-96.)
|
18 | | (325 ILCS 20/10) (from Ch. 23, par. 4160)
|
19 | | Sec. 10. Standards. The Council and the lead agency, with |
20 | | assistance
from parents and providers, shall develop and |
21 | | promulgate policies and
procedures relating to the |
22 | | establishment and implementation of program and
personnel |
23 | | standards to ensure that services provided are consistent with
|
24 | | any State-approved or recognized certification, licensing, |
25 | | registration, or
other comparable requirements which apply to |
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1 | | the area of early intervention
program service standards. Only |
2 | | State-approved public or private early
intervention service |
3 | | providers shall be eligible to receive State and
federal |
4 | | funding for early intervention services. All early childhood
|
5 | | intervention staff shall hold the highest entry requirement |
6 | | necessary for that
position.
|
7 | | To be a State-approved early intervention service |
8 | | provider, an individual
(i) shall
not have served or completed, |
9 | | within the preceding 5 years, a sentence for
conviction of any |
10 | | felony that the Department establishes by rule and (ii) shall
|
11 | | not have been indicated as a perpetrator of child abuse or |
12 | | neglect, within the
preceding 5 years, in an investigation by |
13 | | Illinois (pursuant to the Abused and
Neglected Child Reporting |
14 | | Act) or another state. The Department is authorized
to receive |
15 | | criminal background checks for such providers and persons |
16 | | applying
to be such a provider and to receive child abuse and |
17 | | neglect reports regarding
indicated perpetrators who are |
18 | | applying to provide or currently authorized to
provide early |
19 | | intervention services in Illinois. Beginning January 1, 2004,
|
20 | | every provider of State-approved early intervention services |
21 | | and every
applicant to provide
such services must authorize, in |
22 | | writing and in the form required by the
Department, a State and |
23 | | FBI a criminal background check , as requested by the |
24 | | Department, and check of child abuse and neglect
reports |
25 | | regarding the provider or applicant as a condition of |
26 | | authorization to
provide early intervention services. The |
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1 | | Department shall use the results of
the checks only to |
2 | | determine State approval of the early intervention service
|
3 | | provider and shall not re-release the information except as |
4 | | necessary to
accomplish that purpose.
|
5 | | (Source: P.A. 93-147, eff. 1-1-04.)
|
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
strengths and needs of each |
12 | | eligible infant and toddler, and assessment of the concerns
|
13 | | and priorities of the families to appropriately assist them |
14 | | in meeting
their needs and identify supports and services |
15 | | to meet those needs; and
|
16 | | (2) a written Individualized Family Service Plan |
17 | | developed by a
multidisciplinary team which includes the |
18 | | parent or guardian. The
individualized family service plan |
19 | | shall be based on the
multidisciplinary team's assessment |
20 | | of the resources, priorities,
and concerns of the family |
21 | | and its identification of the supports
and services |
22 | | necessary to enhance the family's capacity to meet the
|
23 | | developmental needs of the infant or toddler, and shall |
24 | | include the
identification of services appropriate to meet |
25 | | those needs, including the
frequency, intensity, and |
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1 | | method of delivering services. During and as part of
the |
2 | | initial development of the individualized family services |
3 | | plan, and any
periodic reviews of the plan, the |
4 | | multidisciplinary team may seek consultation from shall |
5 | | consult the lead
agency's therapy guidelines and its |
6 | | designated experts, if any, to help
determine appropriate |
7 | | services and the frequency and intensity of those
services. |
8 | | All services in the individualized family services plan |
9 | | must be
justified by the multidisciplinary assessment of |
10 | | the unique strengths and
needs of the infant or toddler and |
11 | | must be appropriate to meet those needs.
At the periodic |
12 | | reviews, the team shall determine whether modification or
|
13 | | revision of the outcomes or services is necessary.
|
14 | | (b) The Individualized Family Service Plan shall be |
15 | | evaluated once a year
and the family shall be provided a review |
16 | | of the Plan at 6 month intervals or
more often where |
17 | | appropriate based on infant or toddler and family needs.
The |
18 | | lead agency shall create a quality review process regarding |
19 | | Individualized
Family Service Plan development and changes |
20 | | thereto, to monitor
and help assure that resources are being |
21 | | used to provide appropriate early
intervention services.
|
22 | | (c) The initial evaluation and initial assessment and |
23 | | initial
Plan meeting must be held within 45 days after the |
24 | | initial
contact with the early intervention services system. |
25 | | The 45-day timeline does not apply for any period when the |
26 | | child or parent is unavailable to complete the initial |
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1 | | evaluation, the initial assessments of the child and family, or |
2 | | the initial Plan meeting, due to exceptional family |
3 | | circumstances that are documented in the child's early |
4 | | intervention records, or when the parent has not provided |
5 | | consent for the initial evaluation or the initial assessment of |
6 | | the child despite documented, repeated attempts to obtain |
7 | | parental consent. As soon as exceptional family circumstances |
8 | | no longer exist or parental consent has been obtained, the |
9 | | initial evaluation, the initial assessment, and the initial |
10 | | Plan meeting must be completed as soon as possible. With |
11 | | parental consent,
early intervention services may commence |
12 | | before the completion of the
comprehensive assessment and |
13 | | development of the Plan.
|
14 | | (d) Parents must be informed that , at their discretion, |
15 | | early
intervention
services shall be provided to each eligible |
16 | | infant and toddler , to the maximum extent appropriate, in the |
17 | | natural
environment, which may include the home or other |
18 | | community settings. Parents
shall make
the final decision to |
19 | | accept or decline
early intervention services. A decision to |
20 | | decline such services shall
not be a basis for administrative |
21 | | determination of parental fitness, or
other findings or |
22 | | sanctions against the parents. Parameters of the Plan
shall be |
23 | | set forth in rules.
|
24 | | (e) The regional intake offices shall explain to each |
25 | | family, orally and
in
writing, all of the following:
|
26 | | (1) That the early intervention program will pay for |
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1 | | all early
intervention services set forth in the |
2 | | individualized family service plan that
are not
covered or |
3 | | paid under the family's public or private insurance plan or |
4 | | policy
and not
eligible for payment through any other third |
5 | | party payor.
|
6 | | (2) That services will not be delayed due to any rules |
7 | | or restrictions
under the family's insurance plan or |
8 | | policy.
|
9 | | (3) That the family may request, with appropriate |
10 | | documentation
supporting the request, a
determination of |
11 | | an exemption from private insurance use under
Section |
12 | | 13.25.
|
13 | | (4) That responsibility for co-payments or
|
14 | | co-insurance under a family's private insurance
plan or |
15 | | policy will be transferred to the lead
agency's central |
16 | | billing office.
|
17 | | (5) That families will be responsible
for payments of |
18 | | family fees,
which will be based on a sliding scale
|
19 | | according to the State's definition of ability to pay which |
20 | | is comparing household size and income to the sliding scale |
21 | | and considering out-of-pocket medical or disaster |
22 | | expenses , and that these fees
are payable to the central |
23 | | billing office ,
and that if the family encounters a
|
24 | | catastrophic circumstance, as defined under subsection (f) |
25 | | of Section 13 of
this Act, making it unable
to pay the |
26 | | fees, the lead agency may, upon
proof of inability to pay, |
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1 | | waive the fees . Families who fail to provide income |
2 | | information shall be charged the maximum amount on the |
3 | | sliding scale.
|
4 | | (f) The individualized family service plan must state |
5 | | whether the family
has private insurance coverage and, if the |
6 | | family has such coverage and parental consent has been |
7 | | obtained , must
have attached to it a copy of the family's |
8 | | insurance identification card or
otherwise
include all of the |
9 | | following information:
|
10 | | (1) The name, address, and telephone number of the |
11 | | insurance
carrier.
|
12 | | (2) The contract number and policy number of the |
13 | | insurance plan.
|
14 | | (3) The name, address, and social security number of |
15 | | the primary
insured.
|
16 | | (4) The beginning date of the insurance benefit year.
|
17 | | (g) A copy of the individualized family service plan must |
18 | | be provided to
each enrolled provider who is providing early |
19 | | intervention services to the
child
who is the subject of that |
20 | | plan.
|
21 | | (h) Children receiving services under this Act shall |
22 | | receive a smooth and effective transition by their third |
23 | | birthday consistent with federal regulations adopted pursuant |
24 | | to Sections 1431 through 1444 of Title 20 of the United States |
25 | | Code. |
26 | | (Source: P.A. 97-902, eff. 8-6-12.)
|
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1 | | (325 ILCS 20/12) (from Ch. 23, par. 4162)
|
2 | | Sec. 12. Procedural Safeguards. The lead agency shall adopt |
3 | | procedural safeguards that meet federal
requirements and |
4 | | ensure effective implementation of the safeguards
for families
|
5 | | by each
public agency involved in the provision of early |
6 | | intervention
services under this Act.
|
7 | | The procedural safeguards shall provide, at a minimum, the |
8 | | following:
|
9 | | (a) The timely administrative resolution of
State |
10 | | complaints , due process hearings, and mediations by |
11 | | parents as defined by administrative rule.
|
12 | | (b) The right to confidentiality of personally |
13 | | identifiable information.
|
14 | | (c) The opportunity for parents and a guardian to |
15 | | examine and receive
copies of records relating to |
16 | | evaluations and assessments assessment , screening, |
17 | | eligibility
determinations, and the development and |
18 | | implementation of the
Individualized Family Service Plan |
19 | | provision of early intervention services, individual |
20 | | complaints involving the child, or any part of the child's |
21 | | early intervention record .
|
22 | | (d) Procedures to protect the rights of the eligible |
23 | | infant or toddler
whenever the parents or guardians of the |
24 | | child are not known or unavailable
or the child is a ward |
25 | | of the State, including the assignment of an
individual |
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1 | | (who shall not be an employee of the State agency or local
|
2 | | agency providing services) to act as a surrogate for the |
3 | | parents or guardian. The regional intake entity must make |
4 | | reasonable efforts to ensure the assignment of a surrogate |
5 | | parent not more than 30 days after a public agency |
6 | | determines that the child needs a surrogate parent.
|
7 | | (e) Timely written prior notice to the parents or |
8 | | guardian of the
eligible infant or toddler whenever the |
9 | | State agency or public or private
service provider proposes |
10 | | to initiate or change or refuses to initiate or
change the |
11 | | identification, evaluation, placement, or the provision of
|
12 | | appropriate early intervention services to the eligible |
13 | | infant or toddler.
|
14 | | (f) Written prior notice to fully inform the parents or |
15 | | guardians, in
their native primary language or mode of |
16 | | communication used by the parent, unless clearly not |
17 | | feasible to do so , in a comprehensible manner, of these |
18 | | procedural
safeguards.
|
19 | | (g) During the pendency of any proceedings or action |
20 | | involving a
complaint, unless the State agency and the |
21 | | parents or guardian otherwise
agree, the child shall |
22 | | continue to receive the appropriate early
intervention |
23 | | services currently being provided, or in the case of an
|
24 | | application for initial services, the child shall receive |
25 | | the services not in
dispute.
|
26 | | (Source: P.A. 91-538, eff. 8-13-99.)
|
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1 | | (325 ILCS 20/13) (from Ch. 23, par. 4163)
|
2 | | Sec. 13. Funding and Fiscal Responsibility.
|
3 | | (a) The lead agency and every
other participating State |
4 | | agency may receive and expend funds appropriated
by the General |
5 | | Assembly to implement the early intervention services system
as |
6 | | required by this Act.
|
7 | | (b) The lead agency and each participating State agency |
8 | | shall identify
and report on an annual basis to the Council the |
9 | | State agency funds utilized
for the provision of early |
10 | | intervention services to eligible infants and
toddlers.
|
11 | | (c) Funds provided under Section 633 of the Individuals |
12 | | with
Disabilities Education Act (20 United States Code 1433) |
13 | | and State funds
designated or appropriated for early |
14 | | intervention services or programs
may not be used to satisfy a
|
15 | | financial commitment for services which would have been paid |
16 | | for from
another public or private source but for the enactment |
17 | | of this Act, except
whenever considered necessary to prevent |
18 | | delay in receiving appropriate early
intervention services by |
19 | | the eligible infant or toddler or family in a
timely manner. |
20 | | "Public or private source" includes public and private
|
21 | | insurance coverage.
|
22 | | Funds provided under Section 633 of the Individuals with
|
23 | | Disabilities Education Act
and State funds designated or |
24 | | appropriated for early intervention services or
programs
may be |
25 | | used by the lead agency to pay the
provider of services (A) |
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1 | | pending reimbursement from the appropriate State
agency
or (B) |
2 | | if (i) the claim for payment is denied in whole or in part by a |
3 | | public
or private source, or would be denied under the written |
4 | | terms of the public
program or plan or private plan, or (ii) |
5 | | use of private insurance for the
service has been exempted |
6 | | under Section 13.25 , or (iii) parental consent has not been |
7 | | obtained for the use of private insurance . Payment under item |
8 | | (B)(i) may
be made based on a pre-determination telephone |
9 | | inquiry supported by written
documentation of the denial |
10 | | supplied thereafter by the insurance carrier.
|
11 | | (d) Nothing in this Act shall be construed to permit the |
12 | | State to reduce
medical or other assistance available or to |
13 | | alter eligibility under Title V
and Title XIX of the Social |
14 | | Security Act relating to the Maternal Child
Health Program and |
15 | | Medicaid for eligible infants and toddlers in this State.
|
16 | | (e) The lead agency shall create a central billing office |
17 | | to receive and
dispense all relevant State and federal |
18 | | resources, as well as local
government or independent resources |
19 | | available, for early intervention
services. This office shall |
20 | | assure that maximum federal resources are
utilized and that |
21 | | providers receive funds with minimal duplications or
|
22 | | interagency reporting and with consolidated audit procedures.
|
23 | | (f) The lead agency shall, by rule, create a system of
|
24 | | payments by families, including
a schedule of fees. No fees, |
25 | | however, may be charged for: implementing
child find,
|
26 | | evaluation and assessment, service coordination, |
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1 | | administrative and
coordination activities related to the |
2 | | development, review, and evaluation of
Individualized Family |
3 | | Service Plans, or the implementation of procedural
safeguards |
4 | | and other administrative components of the statewide early
|
5 | | intervention system.
|
6 | | The system of payments, called family fees, shall be
|
7 | | structured on a sliding
scale based on the family's ability to |
8 | | pay family income . The family's coverage
or lack
of coverage |
9 | | under a public or private insurance plan or
policy
shall not be |
10 | | a factor in determining the amount of the
family fees.
|
11 | | Each family's fee obligation shall be
established |
12 | | annually, and shall be paid by
families to
the central billing |
13 | | office in
installments. At the written request of the family, |
14 | | the fee obligation shall be
adjusted prospectively at any point |
15 | | during the year upon proof of a change in
family income or |
16 | | family size. The inability of the parents
of an eligible child |
17 | | to pay family fees due to catastrophic
circumstances or |
18 | | extraordinary expenses shall not result in
the denial of |
19 | | services to the child or the child's family.
A family must |
20 | | document its extraordinary expenses or other catastrophic
|
21 | | circumstances
by showing one of the following: (i) |
22 | | out-of-pocket medical expenses in excess
of 15% of gross |
23 | | income; (ii) a fire, flood, or other disaster causing a direct
|
24 | | out-of-pocket loss in excess of 15% of gross income; or (iii) |
25 | | other
catastrophic
circumstances causing out-of-pocket losses |
26 | | in excess of 15% of gross income.
The family must present proof |
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1 | | of loss to its service coordinator, who shall
document it, and |
2 | | the lead agency shall determine
whether the fees shall be |
3 | | reduced, forgiven, or suspended within 10 business
days after
|
4 | | the family's request.
|
5 | | (g) To ensure that early intervention funds are used as the |
6 | | payor of last
resort for early intervention services, the lead |
7 | | agency shall determine at the
point of early intervention |
8 | | intake, and again at any periodic review of
eligibility |
9 | | thereafter or upon a change in family circumstances, whether |
10 | | the
family is eligible for or enrolled in any program for which |
11 | | payment is made
directly or through public or private insurance |
12 | | for any or all of the early
intervention services made |
13 | | available under this Act. The lead agency shall
establish |
14 | | procedures to ensure that payments are made either directly |
15 | | from
these public and private sources , when parental consent |
16 | | has been obtained, instead of from State or federal early
|
17 | | intervention funds, or as reimbursement for payments |
18 | | previously made from State
or federal early intervention funds.
|
19 | | (Source: P.A. 91-538, eff. 8-13-99; 92-10, eff. 6-11-01; |
20 | | 92-307, eff. 8-9-01;
92-651, eff. 7-11-02.)
|
21 | | (325 ILCS 20/13.5)
|
22 | | Sec. 13.5. Other programs.
|
23 | | (a) When an application or a review of
eligibility for |
24 | | early
intervention services is made, and at any
eligibility |
25 | | redetermination
thereafter, the family shall be asked if it
is |
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1 | | currently enrolled in
any federally funded, Department of |
2 | | Healthcare and Family Services administered, medical programs |
3 | | Medicaid, KidCare , or the Title V program
administered by the |
4 | | University of Illinois
Division of
Specialized Care for |
5 | | Children. If the
family is enrolled in any of these
programs, |
6 | | that information shall be put on
the individualized family |
7 | | service
plan and entered into the computerized case
management |
8 | | system, and shall
require that the individualized family
|
9 | | services plan of a child who has been
found eligible for |
10 | | services through the
Division of Specialized Care for
Children |
11 | | state that the child is enrolled
in that program. For those
|
12 | | programs in which the family is not
enrolled, a preliminary |
13 | | eligibility
screen shall be
conducted simultaneously
for (i) |
14 | | medical assistance
(Medicaid) under
Article V of the Illinois |
15 | | Public Aid Code, (ii)
children's
health insurance program ( any |
16 | | federally funded, Department of Healthcare and Family Services |
17 | | administered, medical programs KidCare ) benefits
under the
|
18 | | Children's Health Insurance Program Act, and (iii)
Title V
|
19 | | maternal and child health services provided
through the
|
20 | | Division of Specialized Care for Children of the
University
of |
21 | | Illinois.
|
22 | | (b) For purposes of determining family fees
under
|
23 | | subsection (f) of Section 13 and determining
eligibility for
|
24 | | the other programs and services specified in
items (i)
through |
25 | | (iii) of subsection (a), the lead agency
shall
develop and use, |
26 | | within 60 days after the effective
date of
this amendatory Act |
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1 | | of the 92nd General Assembly,
with the
cooperation of the |
2 | | Department of Public Aid (now Healthcare and Family Services)
|
3 | | and the
Division
of Specialized Care for Children of the
|
4 | | University of
Illinois, a screening device that provides
|
5 | | sufficient
information for the early intervention regional
|
6 | | intake
entities or other agencies to establish eligibility for
|
7 | | those
other programs
and shall, in cooperation with the |
8 | | Illinois
Department of Public Aid (now Healthcare and Family |
9 | | Services) and the Division
of Specialized Care for Children, |
10 | | train the
regional intake entities
on using the screening |
11 | | device.
|
12 | | (c) When a child is
determined eligible for and enrolled
in |
13 | | the early intervention
program and has been found to at least |
14 | | meet
the threshold income
eligibility requirements for any |
15 | | federally funded, Department of Healthcare and Family Services |
16 | | administered, medical programs Medicaid or
KidCare , the |
17 | | regional intake entity
shall complete an application for any |
18 | | federally funded, Department of Healthcare and Family Services |
19 | | administered, medical programs a KidCare/Medicaid
application |
20 | | with the family and forward it
to the
Department of Healthcare |
21 | | and Family Services ' KidCare
Unit for a determination of
|
22 | | eligibility. A parent shall not be required to enroll in any |
23 | | federally funded, Department of Healthcare and Family Services |
24 | | administered, medical programs as a condition of receiving |
25 | | services provided pursuant to Part C of the Individuals with |
26 | | Disabilities Education Act.
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1 | | (d) With the cooperation of the Department of Healthcare |
2 | | and Family Services, the lead agency shall establish procedures |
3 | | that
ensure
the timely and maximum allowable recovery of |
4 | | payments
for all
early intervention services and allowable
|
5 | | administrative
costs under Article V of the Illinois Public Aid
|
6 | | Code and the
Children's Health Insurance Program Act and shall |
7 | | include
those procedures in the interagency agreement required |
8 | | under subsection (e) of
Section 5 of this Act.
|
9 | | (e) For purposes of making referrals for final
|
10 | | determinations of eligibility for any federally funded, |
11 | | Department of Healthcare and Family Services administered, |
12 | | medical programs KidCare benefits
under the Children's Health |
13 | | Insurance Program Act and for medical assistance
under Article |
14 | | V of the Illinois Public Aid Code,
the lead agency shall |
15 | | require each early intervention regional intake entity to
|
16 | | enroll as an application agent a "KidCare agent" in order for |
17 | | the entity to complete the any federally funded, Department of |
18 | | Healthcare and Family Services administered, medical programs |
19 | | KidCare
application as authorized under Section 22 of the |
20 | | Children's Health Insurance
Program Act.
|
21 | | (f) For purposes of early intervention services that may be |
22 | | provided
by the Division of Specialized Care for Children of |
23 | | the University of Illinois
(DSCC), the lead agency shall |
24 | | establish procedures whereby the early
intervention regional
|
25 | | intake entities may determine whether children enrolled in the |
26 | | early
intervention program may also be eligible for those |
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1 | | services, and shall
develop, within 60 days after the effective |
2 | | date of this amendatory Act of the
92nd General Assembly, (i) |
3 | | the inter-agency agreement required under subsection
(e) of |
4 | | Section 5 of this Act, establishing that early intervention |
5 | | funds are to
be used as the payor of last resort when services |
6 | | required under an
individualized family services plan may be |
7 | | provided to an eligible child
through the DSCC, and (ii) |
8 | | training
guidelines for the regional intake entities
and |
9 | | providers that explain eligibility and billing procedures for
|
10 | | services through DSCC.
|
11 | | (g) The lead agency shall require that an
individual |
12 | | applying for or renewing
enrollment as a provider of services |
13 | | in the
early intervention program state whether or
not he or |
14 | | she is also enrolled as a DSCC
provider. This information shall |
15 | | be noted
next to the name of the provider on the
computerized |
16 | | roster of Illinois early
intervention providers, and regional |
17 | | intake
entities shall make every effort to refer
families |
18 | | eligible for DSCC services to
these providers.
|
19 | | (Source: P.A. 95-331, eff. 8-21-07.)
|
20 | | (325 ILCS 20/13.10)
|
21 | | Sec. 13.10.
Private health insurance;
assignment. The lead |
22 | | agency
shall determine, at the point of new applications
for |
23 | | early
intervention services, and for all children enrolled
in |
24 | | the early
intervention program, at the regional intake offices,
|
25 | | whether
the child is insured under a private health insurance
|
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1 | | plan or
policy. Parental consent must be obtained when the lead |
2 | | agency or enrolled provider who is providing a family with |
3 | | early intervention services seeks to use the child's or |
4 | | parent's private insurance or benefits to pay for the initial |
5 | | provision of early intervention services in the Individualized |
6 | | Family Services Plan and anytime that an increase in frequency, |
7 | | length, duration, or intensity is made to existing services in |
8 | | the child's Individualized Family Services Plan. An |
9 | | application for early intervention
services shall
serve as a |
10 | | right to assignment of the right of
recovery against a
private |
11 | | health insurance plan or policy for any covered
early |
12 | | intervention services that may be billed to the family's |
13 | | insurance
carrier and that are provided to a child
covered |
14 | | under the plan or policy.
|
15 | | (Source: P.A. 92-307, eff. 8-9-01.)
|
16 | | (325 ILCS 20/13.15)
|
17 | | Sec. 13.15. Billing of insurance carrier.
|
18 | | (a) Subject to the restrictions against
private
insurance |
19 | | use on the basis of material risk of
loss of
coverage, as |
20 | | determined under Section 13.25, each
enrolled
provider who is |
21 | | providing a family with early
intervention
services shall bill |
22 | | the child's insurance carrier for
each
unit
of early |
23 | | intervention service for
which coverage may be
available and |
24 | | parental consent has been obtained . The lead agency may exempt |
25 | | from the
requirement of this paragraph any early intervention |
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1 | | service
that it has deemed not to be covered by insurance |
2 | | plans.
When the service is not exempted, providers who
receive |
3 | | a denial of payment on the basis that the service is
not |
4 | | covered under any circumstance under the plan are not
required |
5 | | to bill that carrier for that service again until the following
|
6 | | insurance benefit year. That
explanation of benefits denying |
7 | | the claim, once submitted to
the central billing office, shall |
8 | | be sufficient to meet the
requirements of this paragraph as to |
9 | | subsequent services billed under the same
billing code provided |
10 | | to that child during that insurance benefit year. Any
time |
11 | | limit on a
provider's filing of a claim for payment with the |
12 | | central
billing office that is
imposed through a
policy, |
13 | | procedure, or rule of the lead agency shall be
suspended
until |
14 | | the provider receives an explanation of
benefits or
other final |
15 | | determination of the claim it files
with the
child's insurance |
16 | | carrier.
|
17 | | (b) In all instances when an insurance carrier has
been |
18 | | billed for early intervention services, whether paid in
full, |
19 | | paid in part, or denied by the carrier, the provider must
|
20 | | provide the central billing office, within 90 days after |
21 | | receipt, with a copy
of the explanation
of benefits form and |
22 | | other information in the manner prescribed by the lead
agency.
|
23 | | (c) When the insurance carrier has denied the
claim or paid |
24 | | an amount for the early intervention service
billed that is |
25 | | less than the current State rate for early
intervention |
26 | | services, the provider shall submit the
explanation of benefits |
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1 | | with a claim for payment, and the lead
agency shall pay the |
2 | | provider the difference between the sum
actually paid by the |
3 | | insurance carrier for each unit of service
provided under the |
4 | | individualized family service plan and
the current State rate |
5 | | for early intervention services.
The State shall also pay the |
6 | | family's co-payment or co-insurance under its
plan, but only to |
7 | | the extent that those
payments plus the balance of the claim do |
8 | | not exceed the
current State rate for early intervention |
9 | | services. The
provider may under no circumstances bill the |
10 | | family for the
difference between its charge for services and |
11 | | that which
has been paid by the insurance carrier or by the |
12 | | State.
|
13 | | (Source: P.A. 97-813, eff. 7-13-12.)
|
14 | | (325 ILCS 20/13.30)
|
15 | | Sec. 13.30. System of personnel development. The lead |
16 | | agency shall provide training to early intervention providers |
17 | | and may
enter into contracts to meet this requirement. If such |
18 | | contracts are let, they
shall be bid under a public request for
|
19 | | proposals that shall be posted on the lead agency's early |
20 | | intervention website
for
no less than 30 days. This training |
21 | | shall include, at
minimum, the following types of instruction:
|
22 | | (a) Courses
in birth-to-3 evaluation and treatment of |
23 | | children with
developmental disabilities and delays
(1) that |
24 | | are taught by fully credentialed early intervention providers |
25 | | or
educators with
substantial experience in evaluation and |
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1 | | treatment of
children from birth to age 3 with developmental
|
2 | | disabilities and delays, (2) that cover these topics within |
3 | | each of
the disciplines of audiology, occupational therapy,
|
4 | | physical therapy, speech and language pathology, and
|
5 | | developmental therapy, including the social-emotional domain |
6 | | of development,
(3) that are held no less than
twice per year, |
7 | | (4) that offer no fewer than 20 contact
hours per year of |
8 | | course work, (5) that are held in no
fewer than 5 separate |
9 | | locales throughout the State, and
(6) that give enrollment
|
10 | | priority to early intervention providers who do not meet
the
|
11 | | experience, education, or continuing education requirements
|
12 | | necessary to be fully credentialed early intervention |
13 | | providers; and
|
14 | | (b) Courses held no less than twice per year for
no fewer |
15 | | than 4 hours each in no fewer than 5 separate
locales |
16 | | throughout the State each on the following topics:
|
17 | | (1) Practice and procedures of private
insurance |
18 | | billing.
|
19 | | (2) The role of the regional intake entities;
service |
20 | | coordination; program eligibility determinations;
family |
21 | | fees; any federally funded, Department of Healthcare and |
22 | | Family Services administered, medical programs Medicaid, |
23 | | KidCare , and Division of Specialized
Care applications, |
24 | | referrals, and coordination with Early
Intervention; and |
25 | | procedural safeguards.
|
26 | | (3) Introduction to the early intervention
program, |
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1 | | including provider enrollment and credentialing,
overview |
2 | | of Early Intervention program policies and
regulations, |
3 | | and billing requirements.
|
4 | | (4) Evaluation and assessment of birth-to-3
children; |
5 | | individualized family service plan
development, |
6 | | monitoring, and review; best practices; service
|
7 | | guidelines; and quality assurance.
|
8 | | (Source: P.A. 92-307, eff. 8-9-01.)
|
9 | | (325 ILCS 20/13.50 rep.) |
10 | | Section 10. The Early Intervention Services System Act is |
11 | | amended by repealing Section 13.50.
|
12 | | Section 99. Effective date. This Act takes effect upon |
13 | | becoming law.
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| 1 | |
INDEX
| 2 | |
Statutes amended in order of appearance
| | 3 | | 325 ILCS 20/3 | from Ch. 23, par. 4153 | | 4 | | 325 ILCS 20/4 | from Ch. 23, par. 4154 | | 5 | | 325 ILCS 20/5 | from Ch. 23, par. 4155 | | 6 | | 325 ILCS 20/7 | from Ch. 23, par. 4157 | | 7 | | 325 ILCS 20/9 | from Ch. 23, par. 4159 | | 8 | | 325 ILCS 20/10 | from Ch. 23, par. 4160 | | 9 | | 325 ILCS 20/11 | from Ch. 23, par. 4161 | | 10 | | 325 ILCS 20/12 | from Ch. 23, par. 4162 | | 11 | | 325 ILCS 20/13 | from Ch. 23, par. 4163 | | 12 | | 325 ILCS 20/13.5 | | | 13 | | 325 ILCS 20/13.10 | | | 14 | | 325 ILCS 20/13.15 | | | 15 | | 325 ILCS 20/13.30 | | | 16 | | 325 ILCS 20/13.50 rep. | |
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