Section 500.85  Individualized Family Service Plan Implementation

a)         Upon receiving informed written consent from the child's parent to implement the IFSP, the Service Coordinator shall:

1)         Arrange for implementation of the IFSP utilizing available enrolled providers.  Every effort shall be made to refer families eligible for DSCC services to DSCC-enrolled providers;

2)         Provide copies of the IFSP to each person the parent has consented to receive a copy, including each enrolled provider who is providing EI services to the child who is the subject of that plan;

3)         Request direct service reports and monitor provision of services; and

4)         Update and maintain the child's permanent and electronic record with the regional intake entity during the IFSP period.

b)         The parent has the right to accept or decline any or all services without jeopardy to other services under this Part as set forth in Section 500.155(c).  Refusals of services or referrals shall be documented in writing.

c)         Providers shall render authorized services as indicated in the IFSP.  They shall provide direct service reports to the Service Coordinator at least every six months and prior to each IFSP update/review or more often if the child's progress/lack of progress warrants.

d)         The Illinois EI Services System is not responsible for funding EI services the parent seeks from providers not enrolled with the system unless an enrolled provider cannot be made available to the family.  Services outside the System in such situations must be pre-approved by the Department.

e)         With the parent's informed consent to use private insurance and when a family's insurance coverage is through a managed care arrangement with a network of providers that includes one or more types of EI Specialists who provide the services set forth in the family's IFSP, the family shall use those network providers, but only to the extent that:

1)         the network provider is immediately available to  receive the referral and to begin providing services to the child;

2)         the  network  provider is enrolled as a provider in the Illinois EI system and fully credentialed under the current policy or rule of the Department;

3)         the network provider can provide the services to the child in the manner required in the IFSP;

4)         the family would not have to travel more than an  additional 15 miles or an additional 30 minutes to the network provider than it would have to travel to a non-network provider who is available to provide the same service; and

5)         the family's managed care plan does not allow for billing (even at a reduced rate or reduced  percentage of the claim) for EI services provided by non-network providers.   

f)         If the parent has provided informed consent to use private insurance and a child has been receiving services from a non-network provider and the regional intake entity determines, at the time of enrollment in the EI Program or at any point thereafter, that the family is enrolled in a managed care plan, the family shall transfer to a network provider within 45 days after that determination if all the requirements of subsection (e) have been met.

g)           If an exemption to use of insurance is granted, it shall be noted on the IFSP, and the family and the providers serving the family shall be notified in writing of the exemption.

(Source:  Amended at 38 Ill. Reg. 11086, effective May 12, 2014)