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1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. If and only if Senate Bill 2217 becomes law, the
5Illinois Insurance Code is amended by adding Section 367m as
6follows:
 
7    (215 ILCS 5/367m new)
8    Sec. 367m. Early intervention services. Parental consent
9is not required for the use of private insurance for early
10intervention services as defined in the Early Intervention
11Services System Act that are provided in this State pursuant to
12Part C of the federal Individuals with Disabilities Education
13Act. A policy of accident and health insurance that provides
14coverage for early intervention services must conform to the
15following criteria:
16        (1) The use of private health insurance to pay for
17    early intervention services under Part C of the federal
18    Individuals with Disabilities Education Act may not count
19    towards or result in a loss of benefits due to annual or
20    lifetime insurance caps for an infant or toddler with a
21    disability, the infant's or toddler's parent, or the
22    infant's or toddler's family members who are covered under
23    that health insurance policy.

 

 

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1        (2) The use of private health insurance to pay for
2    early intervention services under Part C of the federal
3    Individuals with Disabilities Education Act may not
4    negatively affect the availability of health insurance to
5    an infant or toddler with a disability, the infant's or
6    toddler's parent, or the infant's or toddler's family
7    members who are covered under that health insurance policy,
8    and health insurance coverage may not be discontinued for
9    these individuals due to the use of the health insurance to
10    pay for services under Part C of the federal Individuals
11    with Disabilities Education Act.
12        (3) The use of private health insurance to pay for
13    early intervention services under Part C of the federal
14    Individuals with Disabilities Education Act may not be the
15    basis for increasing the health insurance premiums of an
16    infant or toddler with a disability, the infant's or
17    toddler's parent, or the infant's or toddler's family
18    members covered under that health insurance policy.
 
19    Section 10. If and only if Senate Bill 2217 becomes law,
20the Early Intervention Services System Act is amended by
21changing Sections 11, 13, 13.10, and 13.15 as follows:
 
22    (325 ILCS 20/11)  (from Ch. 23, par. 4161)
23    Sec. 11. Individualized Family Service Plans.
24    (a) Each eligible infant or toddler and that infant's or

 

 

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1toddler's family shall receive:
2        (1) timely, comprehensive, multidisciplinary
3    assessment of the unique strengths and needs of each
4    eligible infant and toddler, and assessment of the concerns
5    and priorities of the families to appropriately assist them
6    in meeting their needs and identify supports and services
7    to meet those needs; and
8        (2) a written Individualized Family Service Plan
9    developed by a multidisciplinary team which includes the
10    parent or guardian. The individualized family service plan
11    shall be based on the multidisciplinary team's assessment
12    of the resources, priorities, and concerns of the family
13    and its identification of the supports and services
14    necessary to enhance the family's capacity to meet the
15    developmental needs of the infant or toddler, and shall
16    include the identification of services appropriate to meet
17    those needs, including the frequency, intensity, and
18    method of delivering services. During and as part of the
19    initial development of the individualized family services
20    plan, and any periodic reviews of the plan, the
21    multidisciplinary team may seek consultation from the lead
22    agency's designated experts, if any, to help determine
23    appropriate services and the frequency and intensity of
24    those services. All services in the individualized family
25    services plan must be justified by the multidisciplinary
26    assessment of the unique strengths and needs of the infant

 

 

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1    or toddler and must be appropriate to meet those needs. At
2    the periodic reviews, the team shall determine whether
3    modification or revision of the outcomes or services is
4    necessary.
5    (b) The Individualized Family Service Plan shall be
6evaluated once a year and the family shall be provided a review
7of the Plan at 6 month intervals or more often where
8appropriate based on infant or toddler and family needs. The
9lead agency shall create a quality review process regarding
10Individualized Family Service Plan development and changes
11thereto, to monitor and help assure that resources are being
12used to provide appropriate early intervention services.
13    (c) The initial evaluation and initial assessment and
14initial Plan meeting must be held within 45 days after the
15initial contact with the early intervention services system.
16The 45-day timeline does not apply for any period when the
17child or parent is unavailable to complete the initial
18evaluation, the initial assessments of the child and family, or
19the initial Plan meeting, due to exceptional family
20circumstances that are documented in the child's early
21intervention records, or when the parent has not provided
22consent for the initial evaluation or the initial assessment of
23the child despite documented, repeated attempts to obtain
24parental consent. As soon as exceptional family circumstances
25no longer exist or parental consent has been obtained, the
26initial evaluation, the initial assessment, and the initial

 

 

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1Plan meeting must be completed as soon as possible. With
2parental consent, early intervention services may commence
3before the completion of the comprehensive assessment and
4development of the Plan.
5    (d) Parents must be informed that early intervention
6services shall be provided to each eligible infant and toddler,
7to the maximum extent appropriate, in the natural environment,
8which may include the home or other community settings. Parents
9shall make the final decision to accept or decline early
10intervention services. A decision to decline such services
11shall not be a basis for administrative determination of
12parental fitness, or other findings or sanctions against the
13parents. Parameters of the Plan shall be set forth in rules.
14    (e) The regional intake offices shall explain to each
15family, orally and in writing, all of the following:
16        (1) That the early intervention program will pay for
17    all early intervention services set forth in the
18    individualized family service plan that are not covered or
19    paid under the family's public or private insurance plan or
20    policy and not eligible for payment through any other third
21    party payor.
22        (2) That services will not be delayed due to any rules
23    or restrictions under the family's insurance plan or
24    policy.
25        (3) That the family may request, with appropriate
26    documentation supporting the request, a determination of

 

 

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1    an exemption from private insurance use under Section
2    13.25.
3        (4) That responsibility for co-payments or
4    co-insurance under a family's private insurance plan or
5    policy will be transferred to the lead agency's central
6    billing office.
7        (5) That families will be responsible for payments of
8    family fees, which will be based on a sliding scale
9    according to the State's definition of ability to pay which
10    is comparing household size and income to the sliding scale
11    and considering out-of-pocket medical or disaster
12    expenses, and that these fees are payable to the central
13    billing office. Families who fail to provide income
14    information shall be charged the maximum amount on the
15    sliding scale.
16    (f) The individualized family service plan must state
17whether the family has private insurance coverage and, if the
18family has such coverage and parental consent has been
19obtained, must have attached to it a copy of the family's
20insurance identification card or otherwise include all of the
21following information:
22        (1) The name, address, and telephone number of the
23    insurance carrier.
24        (2) The contract number and policy number of the
25    insurance plan.
26        (3) The name, address, and social security number of

 

 

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1    the primary insured.
2        (4) The beginning date of the insurance benefit year.
3    (g) A copy of the individualized family service plan must
4be provided to each enrolled provider who is providing early
5intervention services to the child who is the subject of that
6plan.
7    (h) Children receiving services under this Act shall
8receive a smooth and effective transition by their third
9birthday consistent with federal regulations adopted pursuant
10to Sections 1431 through 1444 of Title 20 of the United States
11Code.
12(Source: P.A. 97-902, eff. 8-6-12; 09800SB2217eng.)
 
13    (325 ILCS 20/13)  (from Ch. 23, par. 4163)
14    Sec. 13. Funding and Fiscal Responsibility.
15    (a) The lead agency and every other participating State
16agency may receive and expend funds appropriated by the General
17Assembly to implement the early intervention services system as
18required by this Act.
19    (b) The lead agency and each participating State agency
20shall identify and report on an annual basis to the Council the
21State agency funds utilized for the provision of early
22intervention services to eligible infants and toddlers.
23    (c) Funds provided under Section 633 of the Individuals
24with Disabilities Education Act (20 United States Code 1433)
25and State funds designated or appropriated for early

 

 

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1intervention services or programs may not be used to satisfy a
2financial commitment for services which would have been paid
3for from another public or private source but for the enactment
4of this Act, except whenever considered necessary to prevent
5delay in receiving appropriate early intervention services by
6the eligible infant or toddler or family in a timely manner.
7"Public or private source" includes public and private
8insurance coverage.
9    Funds provided under Section 633 of the Individuals with
10Disabilities Education Act and State funds designated or
11appropriated for early intervention services or programs may be
12used by the lead agency to pay the provider of services (A)
13pending reimbursement from the appropriate State agency or (B)
14if (i) the claim for payment is denied in whole or in part by a
15public or private source, or would be denied under the written
16terms of the public program or plan or private plan, or (ii)
17use of private insurance for the service has been exempted
18under Section 13.25, or (iii) parental consent has not been
19obtained for the use of private insurance. Payment under item
20(B)(i) may be made based on a pre-determination telephone
21inquiry supported by written documentation of the denial
22supplied thereafter by the insurance carrier.
23    (d) Nothing in this Act shall be construed to permit the
24State to reduce medical or other assistance available or to
25alter eligibility under Title V and Title XIX of the Social
26Security Act relating to the Maternal Child Health Program and

 

 

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1Medicaid for eligible infants and toddlers in this State.
2    (e) The lead agency shall create a central billing office
3to receive and dispense all relevant State and federal
4resources, as well as local government or independent resources
5available, for early intervention services. This office shall
6assure that maximum federal resources are utilized and that
7providers receive funds with minimal duplications or
8interagency reporting and with consolidated audit procedures.
9    (f) The lead agency shall, by rule, create a system of
10payments by families, including a schedule of fees. No fees,
11however, may be charged for: implementing child find,
12evaluation and assessment, service coordination,
13administrative and coordination activities related to the
14development, review, and evaluation of Individualized Family
15Service Plans, or the implementation of procedural safeguards
16and other administrative components of the statewide early
17intervention system.
18    The system of payments, called family fees, shall be
19structured on a sliding scale based on the family's ability to
20pay. The family's coverage or lack of coverage under a public
21or private insurance plan or policy shall not be a factor in
22determining the amount of the family fees.
23    Each family's fee obligation shall be established
24annually, and shall be paid by families to the central billing
25office in installments. At the written request of the family,
26the fee obligation shall be adjusted prospectively at any point

 

 

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1during the year upon proof of a change in family income or
2family size. The inability of the parents of an eligible child
3to pay family fees due to catastrophic circumstances or
4extraordinary expenses shall not result in the denial of
5services to the child or the child's family. A family must
6document its extraordinary expenses or other catastrophic
7circumstances by showing one of the following: (i)
8out-of-pocket medical expenses in excess of 15% of gross
9income; (ii) a fire, flood, or other disaster causing a direct
10out-of-pocket loss in excess of 15% of gross income; or (iii)
11other catastrophic circumstances causing out-of-pocket losses
12in excess of 15% of gross income. The family must present proof
13of loss to its service coordinator, who shall document it, and
14the lead agency shall determine whether the fees shall be
15reduced, forgiven, or suspended within 10 business days after
16the family's request.
17    (g) To ensure that early intervention funds are used as the
18payor of last resort for early intervention services, the lead
19agency shall determine at the point of early intervention
20intake, and again at any periodic review of eligibility
21thereafter or upon a change in family circumstances, whether
22the family is eligible for or enrolled in any program for which
23payment is made directly or through public or private insurance
24for any or all of the early intervention services made
25available under this Act. The lead agency shall establish
26procedures to ensure that payments are made either directly

 

 

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1from these public and private sources, when parental consent
2has been obtained, instead of from State or federal early
3intervention funds, or as reimbursement for payments
4previously made from State or federal early intervention funds.
5(Source: P.A. 91-538, eff. 8-13-99; 92-10, eff. 6-11-01;
692-307, eff. 8-9-01; 92-651, eff. 7-11-02; 09800SB2217.)
 
7    (325 ILCS 20/13.10)
8    Sec. 13.10. Private health insurance; assignment. The lead
9agency shall determine, at the point of new applications for
10early intervention services, and for all children enrolled in
11the early intervention program, at the regional intake offices,
12whether the child is insured under a private health insurance
13plan or policy. Parental consent must be obtained when the lead
14agency or enrolled provider who is providing a family with
15early intervention services seeks to use the child or parent's
16private insurance or benefits to pay for the initial provision
17of early intervention services in the Individualized Family
18Services Plan and anytime that an increase in frequency,
19length, duration, or intensity is made to existing services in
20the child's Individualized Family Services Plan.
21(Source: P.A. 92-307, eff. 8-9-01; 09800SB2217.)
 
22    (325 ILCS 20/13.15)
23    Sec. 13.15. Billing of insurance carrier.
24    (a) Subject to the restrictions against private insurance

 

 

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1use on the basis of material risk of loss of coverage, as
2determined under Section 13.25, each enrolled provider who is
3providing a family with early intervention services shall bill
4the child's insurance carrier for each unit of early
5intervention service for which coverage may be available and
6parental consent has been obtained. The lead agency may exempt
7from the requirement of this paragraph any early intervention
8service that it has deemed not to be covered by insurance
9plans. When the service is not exempted, providers who receive
10a denial of payment on the basis that the service is not
11covered under any circumstance under the plan are not required
12to bill that carrier for that service again until the following
13insurance benefit year. That explanation of benefits denying
14the claim, once submitted to the central billing office, shall
15be sufficient to meet the requirements of this paragraph as to
16subsequent services billed under the same billing code provided
17to that child during that insurance benefit year. Any time
18limit on a provider's filing of a claim for payment with the
19central billing office that is imposed through a policy,
20procedure, or rule of the lead agency shall be suspended until
21the provider receives an explanation of benefits or other final
22determination of the claim it files with the child's insurance
23carrier.
24    (b) In all instances when an insurance carrier has been
25billed for early intervention services, whether paid in full,
26paid in part, or denied by the carrier, the provider must

 

 

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1provide the central billing office, within 90 days after
2receipt, with a copy of the explanation of benefits form and
3other information in the manner prescribed by the lead agency.
4    (c) When the insurance carrier has denied the claim or paid
5an amount for the early intervention service billed that is
6less than the current State rate for early intervention
7services, the provider shall submit the explanation of benefits
8with a claim for payment, and the lead agency shall pay the
9provider the difference between the sum actually paid by the
10insurance carrier for each unit of service provided under the
11individualized family service plan and the current State rate
12for early intervention services. The State shall also pay the
13family's co-payment or co-insurance under its plan, but only to
14the extent that those payments plus the balance of the claim do
15not exceed the current State rate for early intervention
16services. The provider may under no circumstances bill the
17family for the difference between its charge for services and
18that which has been paid by the insurance carrier or by the
19State.
20(Source: P.A. 97-813, eff. 7-13-12; 09800SB2217.)
 
21    Section 99. Effective date. This Act takes effect upon
22becoming law.