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92_SB0461ham001
LRB9207772DJmbam03
1 AMENDMENT TO SENATE BILL 461
2 AMENDMENT NO. . Amend Senate Bill 461 by replacing
3 everything after the enacting clause with the following:
4 "Section 5. The Early Intervention Services System Act
5 is amended by changing Sections 3, 4, 5, 11, 13, and 15 and
6 adding Sections 13.5, 13.10, 13.15, 13.20, 13.25, 13.30,
7 13.32, and 13.50 as follows:
8 (325 ILCS 20/3) (from Ch. 23, par. 4153)
9 Sec. 3. Definitions. As used in this Act:
10 (a) "Eligible infants and toddlers" means infants and
11 toddlers under 36 months of age with any of the following
12 conditions:
13 (1) Developmental delays as defined by the
14 Department by rule.
15 (2) A physical or mental condition which typically
16 results in developmental delay.
17 (3) Being at risk of having substantial
18 developmental delays based on informed clinical judgment.
19 (4) Having entered the program under any of the
20 circumstances listed in paragraphs (1) through (3) of
21 this subsection, and continuing to have any measurable
22 delay; or not having attained a level of development in
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1 each area, including (i) cognitive, (ii) physical
2 (including vision and hearing), (iii) language, speech,
3 and communication, (iv) psycho-social, or (v) self-help
4 skills, that is at least at the mean of the child's age
5 equivalent peers; or having been determined by the
6 multidisciplinary individualized family service plan team
7 to continue to require or to be likely to benefit from
8 the continuation of early intervention services.
9 (b) "Developmental delay" means a delay in one or more
10 of the following areas of childhood development as measured
11 by appropriate diagnostic instruments and standard
12 procedures: cognitive; physical, including vision and
13 hearing; language, speech and communication; psycho-social;
14 or self-help skills.
15 (c) "Physical or mental condition which typically
16 results in developmental delay" means:
17 (1) a diagnosed medical disorder bearing a
18 relatively well known expectancy for developmental
19 outcomes within varying ranges of developmental
20 disabilities; or
21 (2) a history of prenatal, perinatal, neonatal or
22 early developmental events suggestive of biological
23 insults to the developing central nervous system and
24 which either singly or collectively increase the
25 probability of developing a disability or delay based on
26 a medical history.
27 (d) "Informed clinical judgment" means both clinical
28 observations and parental participation to determine
29 eligibility by a consensus of a multidisciplinary team of 2
30 or more members based on their professional experience and
31 expertise.
32 (e) "Early intervention services" means services which:
33 (1) are designed to meet the developmental needs of
34 each child eligible under this Act and the needs of his
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1 or her family;
2 (2) are selected in collaboration with the child's
3 family;
4 (3) are provided under public supervision;
5 (4) are provided at no cost except where a schedule
6 of sliding scale fees or other system of payments by
7 families has been adopted in accordance with State and
8 federal law;
9 (5) are designed to meet an infant's or toddler's
10 developmental needs in any of the following areas:
11 (A) physical development, including vision and
12 hearing,
13 (B) cognitive development,
14 (C) communication development,
15 (D) social or emotional development, or
16 (E) adaptive development;
17 (6) meet the standards of the State, including the
18 requirements of this Act;
19 (7) include one or more of the following:
20 (A) family training,
21 (B) social work services, including
22 counseling, and home visits,
23 (C) special instruction,
24 (D) speech, language pathology and audiology,
25 (E) occupational therapy,
26 (F) physical therapy,
27 (G) psychological services,
28 (H) service coordination services,
29 (I) medical services only for diagnostic or
30 evaluation purposes,
31 (J) early identification, screening, and
32 assessment services,
33 (K) health services specified by the lead
34 agency as necessary to enable the infant or toddler
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1 to benefit from the other early intervention
2 services,
3 (L) vision services,
4 (M) transportation, and
5 (N) assistive technology devices and services;
6 (8) are provided by qualified personnel, including
7 but not limited to:
8 (A) child development specialists or special
9 educators,
10 (B) speech and language pathologists and
11 audiologists,
12 (C) occupational therapists,
13 (D) physical therapists,
14 (E) social workers,
15 (F) nurses,
16 (G) nutritionists,
17 (H) optometrists,
18 (I) psychologists, and
19 (J) physicians;
20 (9) are provided in conformity with an
21 Individualized Family Service Plan;
22 (10) are provided throughout the year; and
23 (11) are provided in natural environments,
24 including the home and community settings in which
25 infants and toddlers without disabilities would
26 participate to the extent determined by the
27 multidisciplinary Individualized Family Service Plan.
28 (f) "Individualized Family Service Plan" or "Plan" means
29 a written plan for providing early intervention services to a
30 child eligible under this Act and the child's family, as set
31 forth in Section 11.
32 (g) "Local interagency agreement" means an agreement
33 entered into by local community and State and regional
34 agencies receiving early intervention funds directly from the
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1 State and made in accordance with State interagency
2 agreements providing for the delivery of early intervention
3 services within a local community area.
4 (h) "Council" means the Illinois Interagency Council on
5 Early Intervention established under Section 4.
6 (i) "Lead agency" means the State agency responsible for
7 administering this Act and receiving and disbursing public
8 funds received in accordance with State and federal law and
9 rules.
10 (i-5) "Central billing office" means the central billing
11 office created by the lead agency under Section 13.
12 (j) "Child find" means a service which identifies
13 eligible infants and toddlers.
14 (Source: P.A. 90-158, eff. 1-1-98; 91-538, eff. 8-13-99.)
15 (325 ILCS 20/4) (from Ch. 23, par. 4154)
16 Sec. 4. Illinois Interagency Council on Early
17 Intervention.
18 (a) There is established the Illinois Interagency
19 Council on Early Intervention. The Council shall be composed
20 of at least 15 but not more than 25 members. The members of
21 the Council and the designated chairperson of the Council
22 shall be appointed by the Governor. The Council member
23 representing the lead agency may not serve as chairperson of
24 the Council. The Council shall be composed of the following
25 members:
26 (1) The Secretary of Human Services (or his or her
27 designee) and 2 additional representatives of the
28 Department of Human Services designated by the Secretary,
29 plus the Directors (or their designees) of the following
30 State agencies involved in the provision of or payment
31 for early intervention services to eligible infants and
32 toddlers and their families:
33 (A) Illinois State Board of Education;
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1 (B) (Blank);
2 (C) (Blank);
3 (D) Illinois Department of Children and Family
4 Services;
5 (E) University of Illinois Division of
6 Specialized Care for Children;
7 (F) Illinois Department of Public Aid;
8 (G) Illinois Department of Public Health;
9 (H) (Blank);
10 (I) Illinois Planning Council on Developmental
11 Disabilities; and
12 (J) Illinois Department of Insurance.
13 (2) Other members as follows:
14 (A) At least 20% of the members of the Council
15 shall be parents, including minority parents, of
16 infants or toddlers with disabilities or children
17 with disabilities aged 12 or younger, with knowledge
18 of, or experience with, programs for infants and
19 toddlers with disabilities. At least one such
20 member shall be a parent of an infant or toddler
21 with a disability or a child with a disability aged
22 6 or younger;
23 (B) At least 20% of the members of the Council
24 shall be public or private providers of early
25 intervention services;
26 (C) One member shall be a representative of
27 the General Assembly; and
28 (D) One member shall be involved in the
29 preparation of professional personnel to serve
30 infants and toddlers similar to those eligible for
31 services under this Act.
32 The Council shall meet at least quarterly and in such
33 places as it deems necessary. Terms of the initial members
34 appointed under paragraph (2) shall be determined by lot at
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1 the first Council meeting as follows: of the persons
2 appointed under subparagraphs (A) and (B), one-third shall
3 serve one year terms, one-third shall serve 2 year terms, and
4 one-third shall serve 3 year terms; and of the persons
5 appointed under subparagraphs (C) and (D), one shall serve a
6 2 year term and one shall serve a 3 year term. Thereafter,
7 successors appointed under paragraph (2) shall serve 3 year
8 terms. Once appointed, members shall continue to serve until
9 their successors are appointed. No member shall be appointed
10 to serve more than 2 consecutive terms.
11 Council members shall serve without compensation but
12 shall be reimbursed for reasonable costs incurred in the
13 performance of their duties, including costs related to child
14 care, and parents may be paid a stipend in accordance with
15 applicable requirements.
16 The Council shall prepare and approve a budget using
17 funds appropriated for the purpose to hire staff, and obtain
18 the services of such professional, technical, and clerical
19 personnel as may be necessary to carry out its functions
20 under this Act. This funding support and staff shall be
21 directed by the lead agency.
22 (b) The Council shall:
23 (1) advise and assist the lead agency in the
24 performance of its responsibilities including but not
25 limited to the identification of sources of fiscal and
26 other support services for early intervention programs,
27 and the promotion of interagency agreements which assign
28 financial responsibility to the appropriate agencies;
29 (2) advise and assist the lead agency in the
30 preparation of applications and amendments to
31 applications;
32 (3) review and advise on relevant regulations and
33 standards proposed by the related State agencies;
34 (4) advise and assist the lead agency in the
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1 development, implementation and evaluation of the
2 comprehensive early intervention services system; and
3 (5) prepare and submit an annual report to the
4 Governor and to the General Assembly on the status of
5 early intervention programs for eligible infants and
6 toddlers and their families in Illinois. The report shall
7 be provided to the Governor and to the General Assembly,
8 and shall be posted on the lead agency's early
9 intervention website along with the annual report of each
10 of the previous 3 years. The annual report shall
11 include, in addition to each element required to be
12 provided by the Secretary of the U.S. Department of
13 Education, the following: (i) the estimated number of
14 eligible infants and toddlers in this State, and the
15 basis and assumptions underlying that estimate; (ii) the
16 number of children, by month and region, on waiting lists
17 for a completed individualized family service plan for
18 more than 45 days, and the number of children, by month
19 and by region, on waiting lists for any of the early
20 intervention services required under the plan; (iii) the
21 number of eligible infants and toddlers who have
22 received early intervention services each month and in
23 total during the year, in each region, broken down by age
24 in 12-month increments (for example, birth-to-one), by
25 the basis of program eligibility (diagnosed physical or
26 mental condition which typically results in developmental
27 delay, developmental delay in 10% increments, and at-risk
28 of developmental delay), by race, by income (below 135%
29 of the federal poverty line, at least 135% but not more
30 than 185% of the federal poverty line, more than 185% but
31 not more than 200% of the federal poverty line, and more
32 than 200% of the federal poverty line), by health
33 insurance status and type of insurance (none, private, or
34 Medicaid/KidCare); (iv) the expenditures made per
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1 individualized family service plan by region; (v) the
2 number of individualized family service plan expenditures
3 in $1000 increments, by region and by month; (vi) the
4 federal funds recovered for early intervention services
5 under Medicaid and KidCare by type of early intervention
6 service, by month and by region; (vii) the amount of
7 early intervention expenditures offset by private
8 insurance billings, by type of early intervention
9 service, by month, and by region; (viii) the number of
10 early intervention children also enrolled in the Division
11 of Specialized Care for Children's (DSCC) Title V
12 maternal and child health services program, and the
13 amount of early intervention expenditures offset by DSCC
14 billings, by type of early intervention service, by
15 month, and by region; (ix) the amount of family fees
16 collected, by month and by region; and (x) program
17 outcome data that shows the level of developmental delay
18 upon program entry and upon program exit, the number of
19 children transitioning to Part B services, and the number
20 of children who reach age equivalence (plus or minus 10%)
21 in one or more areas of development. The report shall
22 also include a summary of the monthly managers' reports
23 submitted by each of the regional intake entities. The
24 annual report shall include (i) the estimated number of
25 eligible infants and toddlers in this State, (ii) the
26 number of eligible infants and toddlers who have received
27 services under this Act and the cost of providing those
28 services, and (iii) the estimated cost of providing
29 services under this Act to all eligible infants and
30 toddlers in this State.
31 No member of the Council shall cast a vote on or
32 participate substantially in any matter which would provide a
33 direct financial benefit to that member or otherwise give the
34 appearance of a conflict of interest under State law. All
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1 provisions and reporting requirements of the Illinois
2 Governmental Ethics Act shall apply to Council members.
3 (Source: P.A. 91-357; eff. 7-29-99.)
4 (325 ILCS 20/5) (from Ch. 23, par. 4155)
5 Sec. 5. Lead Agency. The Department of Human Services
6 is designated the lead agency and shall provide leadership in
7 establishing and implementing the coordinated, comprehensive,
8 interagency and interdisciplinary system of early
9 intervention services. The lead agency shall not have the
10 sole responsibility for providing these services. Each
11 participating State agency shall continue to coordinate those
12 early intervention services relating to health, social
13 service and education provided under this authority.
14 The lead agency is responsible for carrying out:
15 (a) the general administration, supervision, and
16 monitoring of programs and activities receiving
17 assistance under Section 673 of the Individuals with
18 Disabilities Education Act (20 United States Code 1473);
19 (b) the identification and coordination of all
20 available resources within the State from federal, State,
21 local and private sources;
22 (c) the development of procedures to ensure that
23 services are provided to eligible infants and toddlers
24 and their families in a timely manner pending the
25 resolution of any disputes among public agencies or
26 service providers;
27 (d) the resolution of intra-agency and interagency
28 regulatory and procedural disputes; and
29 (e) the development and implementation of formal
30 interagency agreements between the lead agency and (i)
31 the Department of Public Aid, (ii) the University of
32 Illinois Division of Specialized Care for Children, and
33 (iii) other relevant State agencies that:
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1 (1) define the financial responsibility of
2 each agency for paying for early intervention
3 services (consistent with existing State and federal
4 law and rules, including the requirement that early
5 intervention funds be used as the payor of last
6 resort), a hierarchical order of payment as among
7 the agencies for early intervention services that
8 are covered under or may be paid by programs in
9 other agencies, and procedures for direct billing,
10 collecting reimbursements for payments made, and
11 resolving service and payment disputes; and
12 (2) include all additional components
13 necessary to ensure meaningful cooperation and
14 coordination; and.
15 (3) are reviewed and revised to implement the
16 purposes of this amendatory Act of the 92nd General
17 Assembly and signed by the relevant agency directors
18 no later than 60 days after the effective date of
19 this amendatory Act of the 92nd General Assembly.
20 (Source: P.A. 90-158, eff. 1-1-98.)
21 (325 ILCS 20/11) (from Ch. 23, par. 4161)
22 Sec. 11. Individualized Family Service Plans.
23 (a) Each eligible infant or toddler and that infant's or
24 toddler's family shall receive:
25 (1) (a) timely, comprehensive, multidisciplinary
26 assessment of the unique needs of each eligible infant
27 and toddler, and assessment of the concerns and
28 priorities of the families to appropriately assist them
29 in meeting their needs and identify services to meet
30 those needs; and
31 (2) (b) a written Individualized Family Service
32 Plan developed by a multidisciplinary team which includes
33 the parent or guardian. The individualized family service
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1 plan shall be developed and periodically reviewed with
2 the guidance of best practice standards or service
3 guidelines, and may be reviewed during the course of
4 development or thereafter by experts in the relevant
5 disciplines, but such standards, guidelines, and reviews
6 shall not be binding on the multidisciplinary team that
7 includes the parent of the child and develops the
8 individualized family services plan. The lead agency may
9 establish review panels to guide the individualized
10 family services plan development and implementation
11 process. To give the greatest attention to those plans
12 that fall outside the mean, these panels shall focus
13 their reviews on plans that call for services that are
14 among the highest 15% in cost in the region or State, and
15 those that call for services that are among the lowest
16 15% in cost in the region or State.
17 (b) The Individualized Family Service Plan shall be
18 evaluated once a year and the family shall be provided a
19 review of the Plan at 6 month intervals or more often where
20 appropriate based on infant or toddler and family needs.
21 (c) The evaluation and initial assessment and initial
22 Plan meeting must be held within 45 days after the initial
23 contact with the early intervention services system. With
24 parental consent, early intervention services may commence
25 before the completion of the comprehensive assessment and
26 development of the Plan.
27 (d) Parents must be informed that, at their discretion,
28 early intervention services shall be provided to each
29 eligible infant and toddler in the natural environment, which
30 may include the home or other community settings. Parents
31 shall make the final decision to accept or decline early
32 intervention services. A decision to decline such services
33 shall not be a basis for administrative determination of
34 parental fitness, or other findings or sanctions against the
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1 parents. Parameters of the Plan shall be set forth in rules.
2 (e) The regional intake offices shall explain to each
3 family, orally and in writing, all of the following:
4 (1) That the early intervention program will pay
5 for all early intervention services set forth in the
6 individualized family service plan that are not covered
7 or paid under the family's public or private insurance
8 plan or policy and not eligible for payment through any
9 other third party payor.
10 (2) That services will not be delayed due to any
11 rules or restrictions under the family's insurance plan
12 or policy.
13 (3) That the family may request, with appropriate
14 documentation supporting the request, at the regional
15 intake entity, a determination of an exemption from
16 private insurance use under Section 13.25.
17 (4) That responsibility for co-payments or
18 co-insurance under a family's private insurance plan or
19 policy will be transferred to the lead agency's central
20 billing office.
21 (5) That families will be responsible for quarterly
22 payments of family fees, which will be based on a sliding
23 scale according to income, and that these fees are
24 payable to the central billing office, and that if the
25 family encounters a catastrophic circumstance making it
26 unable to pay the fees, the lead agency may, upon proof
27 of inability to pay, waive the fees.
28 (f) The individualized family service plan must state
29 whether the family has private insurance coverage and, if the
30 family has such coverage, must have attached to it a copy of
31 the family's insurance identification card or otherwise
32 include all of the following information:
33 (1) The name, address, and telephone number of the
34 insurance carrier.
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1 (2) The contract number and policy number of the
2 insurance plan.
3 (3) The name, address, and social security number
4 of the primary insured.
5 (4) The beginning date of the insurance benefit
6 year.
7 (g) A copy of the individualized family service plan
8 must be provided to each enrolled provider who is providing
9 early intervention services to the child who is the subject
10 of that plan.
11 (Source: P.A. 91-538, eff. 8-13-99.)
12 (325 ILCS 20/13) (from Ch. 23, par. 4163)
13 Sec. 13. Funding and Fiscal Responsibility.
14 (a) The lead agency and every other participating State
15 agency may receive and expend funds appropriated by the
16 General Assembly to implement the early intervention services
17 system as required by this Act.
18 (b) The lead agency and each participating State agency
19 shall identify and report on an annual basis to the Council
20 the State agency funds utilized for the provision of early
21 intervention services to eligible infants and toddlers.
22 (c) Funds provided under Section 633 of the Individuals
23 with Disabilities Education Act (20 United States Code 1433)
24 and State funds designated or appropriated for early
25 intervention services or programs may not be used to satisfy
26 a financial commitment for services which would have been
27 paid for from another public or private source but for the
28 enactment of this Act, except whenever considered necessary
29 to prevent delay in receiving appropriate early intervention
30 services by the eligible infant or toddler or family in a
31 timely manner. Funds provided under Section 633 of the
32 Individuals with Disabilities Education Act and State funds
33 designated or appropriated for early intervention services or
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1 programs may be used by the lead agency to pay the provider
2 of services (A) pending reimbursement from the appropriate
3 State agency or (B) if (i) the claim for payment is denied in
4 whole or in part by a public or private source, or would be
5 denied under the terms of the public program or plan or
6 private plan, or (ii) use of private insurance for the
7 service has been exempted under Section 13.25.
8 (d) Nothing in this Act shall be construed to permit the
9 State to reduce medical or other assistance available or to
10 alter eligibility under Title V and Title XIX of the Social
11 Security Act relating to the Maternal Child Health Program
12 and Medicaid for eligible infants and toddlers in this State.
13 (e) The lead agency shall create a central billing
14 office to receive and dispense all relevant State and federal
15 resources, as well as local government or independent
16 resources available, for early intervention services. This
17 office shall assure that maximum federal resources are
18 utilized and that providers receive funds with minimal
19 duplications or interagency reporting and with consolidated
20 audit procedures.
21 (f) The lead agency shall, by rule, may also create a
22 system of payments by families, including a schedule of fees.
23 No fees, however, may be charged for: implementing child
24 find, evaluation and assessment, service coordination,
25 administrative and coordination activities related to the
26 development, review, and evaluation of Individualized Family
27 Service Plans, or the implementation of procedural safeguards
28 and other administrative components of the statewide early
29 intervention system.
30 The system of payments, called family fees, shall be
31 structured on a sliding scale based on family income. The
32 family's coverage or lack of coverage under a public or
33 private insurance plan or policy shall not be a factor in
34 determining the amount of the family fees.
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1 Each family's fee obligation shall be established
2 annually, and shall be paid by families to the central
3 billing office in quarterly installments. At the written
4 request of the family, the fee obligation shall be adjusted
5 at any point during the year upon proof of a change in family
6 income. The inability of the parents of an eligible child to
7 pay family fees due to catastrophic or extraordinary
8 circumstances, as established by rule, shall not result in
9 the denial of services to the child or the child's family.
10 The rules adopted under this paragraph shall establish
11 procedures that ensure that families with documented
12 extraordinary expenses or other catastrophic circumstances
13 are given an opportunity to demonstrate that the family fees
14 should be reduced or forgiven.
15 (g) To ensure that early intervention funds are used as
16 the payor of last resort for early intervention services, the
17 lead agency shall determine at the point of early
18 intervention intake, and again at any periodic review of
19 eligibility thereafter or upon a change in family
20 circumstances, whether the family is eligible for or enrolled
21 in any program for which payment is made directly or through
22 public or private insurance for any or all of the early
23 intervention services made available under this Act. The lead
24 agency shall establish procedures to ensure that payments are
25 made either directly from these public and private sources
26 instead of from State or federal early intervention funds, or
27 as reimbursement for payments previously made from State or
28 federal early intervention funds.
29 (Source: P.A. 91-538, eff. 8-13-99.)
30 (325 ILCS 20/13.5 new)
31 Sec. 13.5. Other programs.
32 (a) When an application or a review of eligibility for
33 early intervention services is made, and at any eligibility
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1 redetermination thereafter, the family shall be asked if it
2 is currently enrolled in Medicaid, KidCare, or the Title V
3 program administered by the University of Illinois Division
4 of Specialized Care for Children. If the family is enrolled
5 in any of these programs, that information shall be put on
6 the individualized family service plan and entered into the
7 computerized case management system, and shall require that
8 the individualized family services plan of a child who has
9 been found eligible for services through the Division of
10 Specialized Care for Children state that the child is
11 enrolled in that program. For those programs in which the
12 family is not enrolled, a preliminary eligibility screen
13 shall be conducted simultaneously for (i) medical assistance
14 (Medicaid) under Article V of the Illinois Public Aid Code,
15 (ii) children's health insurance program (KidCare) benefits
16 under the Children's Health Insurance Program Act, and (iii)
17 Title V maternal and child health services provided through
18 the Division of Specialized Care for Children of the
19 University of Illinois. A child enrolled in an early
20 intervention program shall automatically be enrolled in any
21 of these other programs for which the child is also eligible.
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)
25 through (iii) of subsection (a), the lead agency shall
26 develop and use, within 60 days after the effective date of
27 this amendatory Act of the 92nd General Assembly, with the
28 cooperation of the Department of Public Aid and the Division
29 of Specialized Care for Children of the University of
30 Illinois, a single application form that provides sufficient
31 information for the early intervention regional intake
32 entities or other agencies to establish eligibility for those
33 other programs and shall, in cooperation with the Illinois
34 Department of Public Aid and the Division of Specialized Care
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1 for Children, train the regional intake entities on using the
2 screening device.
3 (c) When a child is determined eligible for and
4 enrolled in the early intervention program and has been
5 found to at least meet the threshold income eligibility
6 requirements for Medicaid or KidCare, the regional intake
7 entity shall complete a KidCare/Medicaid application with the
8 family and forward it to the Illinois Department of Public
9 Aid's KidCare Unit for a determination of eligibility.
10 (d) With the cooperation of the Department of Public
11 Aid, the lead agency shall establish procedures that ensure
12 the timely and maximum allowable recovery of payments for all
13 early intervention services and allowable administrative
14 costs under Article V of the Illinois Public Aid Code and the
15 Children's Health Insurance Program Act and shall include
16 those procedures in the interagency agreement required under
17 subsection (e) of Section 5 of this Act.
18 (e) For the purpose of determining eligibility for
19 benefits and making referrals for final eligibility
20 determinations for medical assistance under Article V of the
21 Illinois Public Aid Code, the lead agency and the Department
22 of Public Aid shall treat the regional intake entities as
23 "qualified entities" within the meaning of 42 U.S.C.
24 1396r-1a.
25 (f) For purposes of making referrals for final
26 determinations of eligibility for KidCare benefits under the
27 Children's Health Insurance Program Act and for medical
28 assistance under Article V of the Illinois Public Aid Code,
29 the lead agency and the Department of Public Aid shall enroll
30 each early intervention regional intake entity as a "KidCare
31 agent" in order for the entity to complete the KidCare
32 application as authorized under Section 22 of the Children's
33 Health Insurance Program Act.
34 (g) For purposes of early intervention services that may
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1 be provided under Title V of the Social Security Act, the
2 lead agency, in conjunction with the Division of Specialized
3 Care for Children (DSCC) of the University of Illinois, shall
4 establish procedures whereby the early intervention regional
5 intake entities may determine whether children enrolled in
6 the early intervention program may also be eligible for those
7 services, and shall develop, within 60 days after the
8 effective date of this amendatory Act of the 92nd General
9 Assembly, (i) the inter-agency agreement required under
10 subsection (e) of Section 5 of this Act, establishing that
11 early intervention funds are to be used as the payor of last
12 resort when services required under an individualized family
13 services plan may be provided to an eligible child through
14 the DSCC, and (ii) training guidelines for the regional
15 intake entities and providers that explain eligibility for
16 care through DSCC, and its billing procedures. Within 24
17 months after the effective date of this amendatory Act of the
18 92nd General Assembly, to maintain enrollment as a fully
19 credentialed specialist under this Act, an individual must
20 meet the requirements of DSCC for enrollment within his or
21 her discipline, if DSCC accepts the enrollment of such
22 providers within that discipline, and shall bill DSCC for all
23 early intervention services that are payable under that
24 program that are provided to children who are found eligible
25 under that program. The lead agency shall require that an
26 individual applying for or renewing enrollment as providers
27 of services in the early intervention program state whether
28 or not he or she is also enrolled as a DSCC provider. This
29 information shall be noted next to the name of the provider
30 on the computerized roster of Illinois early intervention
31 providers, and regional intake entities shall make every
32 effort to refer families eligible for DSCC services to these
33 providers.
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1 (325 ILCS 20/13.10 new)
2 Sec. 13.10. Private health insurance; assignment. No
3 later than 60 days after the effective date of this
4 amendatory Act of the 92nd General Assembly, the lead agency
5 shall determine, at the point of new applications for early
6 intervention services, and for all children enrolled in the
7 early intervention program, at the regional intake offices,
8 whether the child is insured under a private health insurance
9 plan or policy. An application for early intervention
10 services shall serve as a right to assignment of the right of
11 recovery against a private health insurance plan or policy
12 for any covered early intervention services that are not
13 required to be provided at State expense and that are
14 provided to a child covered under the plan or policy.
15 (325 ILCS 20/13.15 new)
16 Sec. 13.15. Billing of insurance carrier.
17 (a) Subject to the restrictions against private
18 insurance use on the basis of material risk of loss of
19 coverage, as determined under Section 13.25, each enrolled
20 provider who is providing a family with early intervention
21 services shall bill the child's insurance carrier for each
22 unit of early intervention service that is not required to be
23 provided at public expense under Section 13 of this Act and
24 for which coverage may be available. The lead agency may
25 exempt from the requirement of this paragraph any early
26 intervention service that it has deemed not to be covered by
27 insurance plans in Illinois. When the service is not
28 exempted, providers who receive a denial of payment on the
29 basis that the service is not covered under any circumstance
30 under the plan are not required to bill that carrier for that
31 service again until the following insurance benefit year.
32 That explanation of benefits denying the claim, once
33 submitted to the central billing office, shall be sufficient
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1 to meet the requirements of this paragraph as to subsequent
2 services billed under the same billing code provided to that
3 child during that insurance benefit year. Any time limit on a
4 provider's filing of a claim for payment with the central
5 billing office that is imposed through a policy, procedure,
6 or rule of the lead agency shall be suspended until the
7 provider receives an explanation of benefits or other final
8 determination of the claim it files with the child's
9 insurance carrier.
10 (b) In all instances when an insurance carrier has been
11 billed for early intervention services, whether paid in full,
12 paid in part, or denied by the carrier, the provider must
13 provide the central billing office, within 90 days after
14 receipt, with a copy of the explanation of benefits form and
15 other information in the manner prescribed by the lead
16 agency.
17 (c) When the insurance carrier has denied the claim or
18 paid an amount for the early intervention service billed that
19 is less that the current State rate for early intervention
20 services, the provider shall submit the explanation of
21 benefits with a claim for payment, and the lead agency shall
22 pay the provider the difference between the sum actually paid
23 by the insurance carrier for each unit of service provided
24 under the individualized family service plan and the current
25 State rate for early intervention services. The State shall
26 also pay the family's co-payment or co-insurance under its
27 plan, but only to the extent that those payments plus the
28 balance of the claim do not exceed the current State rate for
29 early intervention services. The provider may under no
30 circumstances bill the family for the difference between its
31 charge for services and that which has been paid by the
32 insurance carrier or by the State.
33 (325 ILCS 20/13.20 new)
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1 Sec. 13.20. Families with insurance coverage; payment for
2 services.
3 (a) Families of children with insurance coverage,
4 whether public or private, shall incur no greater or less
5 direct out-of-pocket expenses for early intervention services
6 than families who are not insured.
7 (b) Deductibles. When the deductible on a family's
8 insurance plan or policy has not yet been met in full under
9 the terms of the plan or policy, the provider must first bill
10 the insurance carrier. If the provider reimbursement is
11 reduced in whole or in part by the remaining amount of a
12 deductible, the provider shall then bill the lead agency's
13 central billing office. The provider shall be paid the
14 difference for the services up to the amount payable under
15 the State's early intervention fee-for-service rates and
16 shall in no case bill the family for the services not paid
17 for under the plan or policy.
18 (c) Co-payments and co-insurance. Financial
19 responsibility for private insurance co-payments or
20 co-insurance payments required by a family's insurance
21 carrier on claims paid for early intervention services is
22 transferred in full to the lead agency. The lead agency shall
23 pay the provider the sum that would otherwise be payable
24 directly by the family under its insurance plan or policy and
25 the sum payable under subsection (c) of Section 13.15, unless
26 the provider already has been paid a sum by the carrier for
27 the early intervention service provided that is equal to or
28 in excess of the State rate for that service. The provider
29 may not bill the family for co-payments or co-insurance
30 payments, whether paid by the lead agency under this
31 subsection or not.
32 (d) Managed care plans.
33 (1) Families receiving services from an
34 out-of-network provider on the effective date of this
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1 amendatory act of the 92nd General Assembly shall have 45
2 days to transfer to an available credentialed specialist
3 who is enrolled in the family's network, unless the plan
4 or policy allows for payment of services provided by
5 out-of-network provider. When a family's insurance
6 coverage is through a managed care arrangement with a
7 network of providers that includes one or more
8 credentialed specialists who provide services prescribed
9 under its individualized family service plan, the family
10 shall use the network providers for each early
11 intervention service for which there is an available
12 credentialed specialist, unless (1) the child is over 26
13 months old and has already established a relationship
14 with a non-network provider before the effective date of
15 this amendatory Act of the 92nd General Assembly, or (2)
16 the family would have to travel more than 15 miles or
17 more than 30 minutes to the network provider within the
18 family's managed care network of providers.
19 (2) The lead agency, in conjunction with any
20 entities with which it may have contracted for the
21 training and credentialing of providers, the local
22 interagency council for early intervention, the regional
23 intake entity, and the enrolled providers in each region
24 who wish to participate, shall cooperate in developing a
25 matrix and action plan that (1) identifies which managed
26 care plans are used in its region by families with
27 children in the early intervention program, and which
28 early intervention services, with what restrictions, if
29 any, are covered under those plans, (2) identifies which
30 credentialed specialists are members of which managed
31 care plans in the region, and (3) identifies the various
32 managed care plans to credentialed specialists,
33 encourages their enrollment in the area plans, and
34 provides them with information on how to enroll. These
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1 matrices shall be complete no later than 7 months after
2 the effective date of this amendatory Act of the 92nd
3 General Assembly, and shall be provided to the Early
4 Intervention Legislative Advisory Committee at that time.
5 The lead agency shall work with networks that may have
6 closed enrollment to additional providers to encourage
7 their admission of early intervention credentialed
8 specialists, and shall report to the Early Intervention
9 Legislative Advisory Committee on the initial results of
10 these efforts no later than February 1, 2002.
11 (325 ILCS 20/13.25 new)
12 Sec. 13.25. Private insurance; exemption.
13 (a) No later than 60 days after the effective date of
14 this amendatory Act of the 92nd General Assembly, the lead
15 agency shall adopt rules to establish procedures by which a
16 family whose child is eligible to receive early intervention
17 services may apply for an exemption restricting the use of
18 its private insurance plan or policy based on material risk
19 of loss of coverage.
20 (b) The lead agency shall rule on a claim for an
21 exemption within 10 days after its receipt of a written
22 request for an exemption at the regional intake entity.
23 During that 10 days, no claims may be filed against the
24 insurance plan or policy. If the exemption is granted, it
25 shall be noted on the individualized family service plan, and
26 the family and the providers serving the family shall be
27 notified in writing of the exemption.
28 (c) An exemption may be granted if the family submits
29 documentation with its request for an exemption that
30 establishes that either (i) the insurance plan or policy
31 covering the child is an individually purchased plan or
32 policy and has been purchased by a self-employed head of the
33 household who is not eligible for a group medical insurance
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1 plan, is a member of a group plan with less than 15 employee
2 members, or has a policy with a lifetime cap on one or more
3 types of early intervention services that could be exhausted
4 during the period covered by the individualized family
5 service plan or (ii) such other circumstances exist relative
6 to the plan or policy and its use for early intervention
7 services that there is a material risk of loss of coverage,
8 as the lead agency may establish by rule, and that (iii) the
9 family's income and financial circumstances make it
10 materially unacceptable to absorb the established risk of
11 higher premiums, amended coverage, or policy restrictions or
12 changes.
13 (d) An exemption under this Section based on material
14 risk of loss of coverage may apply to all early intervention
15 services and all plans or policies insuring the child, may be
16 limited to one or more plans or policies, or may be limited
17 to one or more types of early intervention services in the
18 child's individualized family services plan.
19 (325 ILCS 20/13.30 new)
20 Sec. 13.30. System of personnel development. The lead
21 agency shall contract, under a public request for proposals
22 that shall be open and posted on its early intervention
23 website for no less than 30 days, with one or more entity to
24 provide training to credentialed early intervention
25 specialists. This training shall include, at minimum, the
26 following types of instruction:
27 (a) Courses in birth-to-3 evaluation and treatment of
28 children with developmental disabilities and delays (1) that
29 are taught by fully credentialed specialists with substantial
30 experience in evaluation in treatment of children from birth
31 to age 3 with developmental disabilities and delays, and who
32 are approved, as appropriate to the discipline, by the
33 Department of Professional Regulation to provide continuing
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1 education to that discipline, (2) that cover these topics
2 within each of the disciplines of audiology, occupational
3 therapy, physical therapy, speech and language pathology, and
4 developmental therapy, (3) that are held no less than twice
5 per year, (4) that offer no fewer than 20 contact hours per
6 year of course work, (5) that are held in no fewer than 5
7 separate locales throughout the State, and (6) that give
8 enrollment priority to those provisionally enrolled associate
9 specialists who do not meet the experience, education, or
10 continuing education requirements necessary to be fully
11 credentialed early intervention specialists; and
12 (b) Courses held no less than twice per year for no
13 fewer than 4 hours each in no fewer than 5 separate locales
14 throughout the State each on the following topics:
15 (1) Practice and procedures of private insurance
16 billing.
17 (2) The role of the regional intake entities;
18 service coordination; program eligibility determinations;
19 family fees; Medicaid, KidCare, and Division of
20 Specialized Care applications, referrals, and
21 coordination with Early Intervention; and procedural
22 safeguards.
23 (3) Introduction to the early intervention program,
24 including provider enrollment and credentialing, overview
25 of Early Intervention program policies and regulations,
26 and billing requirements.
27 (4) Evaluation and assessment of birth-to-3
28 children; individualized family service plan development,
29 monitoring, and review; best practices; service
30 guidelines; and quality assurance.
31 (325 ILCS 20/13.32 new)
32 Sec. 13.32. Contracting. The lead agency may enter into
33 contracts for some or all of its responsibilities under this
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1 Act, including but not limited to, credentialing and
2 enrolling providers; training under Section 13.30;
3 maintaining a central billing office; data collection and
4 analysis; establishing and maintaining a computerized case
5 management system accessible to local referral offices and
6 providers; creating and maintaining a system for provider
7 credentialing and enrollment; creating and maintaining the
8 central directory required under subsection (g) of Section 7
9 of this Act; and program operations. These contracts are
10 subject to the Illinois Procurement Code, shall be subject to
11 public bid under requests for proposals under that Code, and,
12 in addition to the posting requirements under that Code,
13 shall be posted on the early intervention website maintained
14 by the lead agency during the entire bid period. In setting
15 points for evaluating bids, while the lead agency may
16 establish points for general experience doing the work that
17 the request for proposals specifies, the lead agency may not
18 directly or indirectly credit points to a bidder for having
19 previously performed any of these responsibilities under
20 previous contracts or grants with the lead agency. Any of
21 these listed responsibilities currently under contract or
22 grant that have not met these requirements shall be subject
23 to public bid under this request for proposal process within
24 180 days after the effective date of this amendatory Act of
25 the 92nd General Assembly.
26 (325 ILCS 20/13.50 new)
27 Sec. 13.50. Early Intervention Legislative Advisory
28 Committee. No later than 60 days after the effective date of
29 this amendatory Act of 92nd General Assembly, there shall be
30 convened the Early Intervention Legislative Advisory
31 Committee. The majority and minority leaders of the General
32 Assembly shall each appoint 2 members to the Committee. The
33 Committee's term is for a period of 2 years, and the
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1 Committee shall publicly convene no less than 4 times per
2 year. The Committee's responsibilities shall include, but not
3 be limited to, providing guidance to the lead agency
4 regarding programmatic and fiscal management and
5 accountability, provider development and accountability,
6 contracting, and program outcome measures. On a quarterly
7 basis, or more often as the Committee may request, the lead
8 agency shall provide to the General Assembly and the public,
9 through postings on its website, monthly reports containing
10 the data required in the annual report under subdivision
11 (b)(5) of Section 4 of this Act.
12 (325 ILCS 20/15) (from Ch. 23, par. 4165)
13 Sec. 15. The Auditor General of the State shall conduct
14 a follow-up an evaluation of the system established under
15 this Act, in order to evaluate the effectiveness of the
16 system in providing services that enhance the capacities of
17 families throughout Illinois to meet the special needs of
18 their eligible infants and toddlers, and provide a report of
19 the evaluation to the Governor and the General Assembly no
20 later than April 30, 2002 1993. Upon receipt by the lead
21 agency, this report shall be posted on the early intervention
22 website.
23 (Source: P.A. 87-680.)".