Full Text of SB2852 93rd General Assembly
SB2852 93RD GENERAL ASSEMBLY
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93RD GENERAL ASSEMBLY
State of Illinois
2003 and 2004 SB2852
Introduced 2/6/2004, by Richard J. Winkel Jr. SYNOPSIS AS INTRODUCED: |
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325 ILCS 20/11 |
from Ch. 23, par. 4161 |
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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 | |
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A BILL FOR
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SB2852 |
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LRB093 15498 DRJ 41104 b |
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| AN ACT concerning children.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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| Section 5. The Early Intervention Services System Act is | 5 |
| amended by changing Section 11 as follows:
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| (325 ILCS 20/11) (from Ch. 23, par. 4161)
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| Sec. 11. Individualized Family Service Plans.
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| (a) Each eligible infant or toddler and that infant's or | 9 |
| toddler's family
shall receive:
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| (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
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| (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
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| 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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SB2852 |
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LRB093 15498 DRJ 41104 b |
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| 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.
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| (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.
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| (c) The evaluation and initial assessment and initial
Plan |
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LRB093 15498 DRJ 41104 b |
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| 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.
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| (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
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| other findings or sanctions against the parents. Parameters of | 14 |
| the Plan
shall be set forth in rules.
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| (e) The regional intake offices shall explain to each | 16 |
| family, orally and
in
writing, all of the following:
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| (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.
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| (2) That services will not be delayed due to any rules | 24 |
| or restrictions
under the family's insurance plan or | 25 |
| policy.
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| (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.
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| (4) That responsibility for co-payments or
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| co-insurance under a family's private insurance
plan or | 32 |
| policy will be transferred to the lead
agency's central | 33 |
| billing office.
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| (5) That families will be responsible
for payments of | 35 |
| family fees,
which will be based on a sliding scale
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| according to income, and that these fees
are payable to the |
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LRB093 15498 DRJ 41104 b |
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| central billing office,
and that if the family encounters a
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| 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.
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| (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
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| include all of the following information:
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| (1) The name, address, and telephone number of the | 12 |
| insurance
carrier.
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| (2) The contract number and policy number of the | 14 |
| insurance plan.
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| (3) The name, address, and social security number of | 16 |
| the primary
insured.
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| (4) The beginning date of the insurance benefit year.
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| (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.
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| (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.)
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| Section 99. Effective date. This Act takes effect upon | 25 |
| becoming law.
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