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Full Text of SB0626  98th General Assembly

SB0626ham001 98TH GENERAL ASSEMBLY

Rep. Sara Feigenholtz

Filed: 5/9/2013

 

 


 

 


 
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1
AMENDMENT TO SENATE BILL 626

2    AMENDMENT NO. ______. Amend Senate Bill 626 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Illinois Insurance Code is amended by
5adding Section 367m as follows:
 
6    (215 ILCS 5/367m new)
7    Sec. 367m. Early intervention services. A policy of
8accident and health insurance that provides coverage for early
9intervention services must conform to the following criteria:
10        (1) The use of private health insurance to pay for
11    early intervention services under Part C of the federal
12    Individuals with Disabilities Education Act may not count
13    towards or result in a loss of benefits due to annual or
14    lifetime insurance caps for an infant or toddler with a
15    disability, the infant's or toddler's parent, or the
16    infant's or toddler's family members who are covered under

 

 

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1    that health insurance policy.
2        (2) The use of private health insurance to pay for
3    early intervention services under Part C of the federal
4    Individuals with Disabilities Education Act may not
5    negatively affect the availability of health insurance to
6    an infant or toddler with a disability, the infant's or
7    toddler's parent, or the infant's or toddler's family
8    members who are covered under that health insurance policy,
9    and health insurance coverage may not be discontinued for
10    these individuals due to the use of the health insurance to
11    pay for services under Part C of the federal Individuals
12    with Disabilities Education Act.
13        (3) The use of private health insurance to pay for
14    early intervention services under Part C of the federal
15    Individuals with Disabilities Education Act may not be the
16    basis for increasing the health insurance premiums of an
17    infant or toddler with a disability, the infant's or
18    toddler's parent, or the infant's or toddler's family
19    members covered under that health insurance policy.
20    For the purposes of this Section, "early intervention
21services" has the same meaning as in the Early Intervention
22Services System Act.
 
23    Section 10. The Early Intervention Services System Act is
24amended by changing Sections 3, 4, 5, 7, 9, 10, 11, 12, 13,
2513.5, 13.10, and 13.30 as follows:
 

 

 

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1    (325 ILCS 20/3)  (from Ch. 23, par. 4153)
2    Sec. 3. Definitions. As used in this Act:
3    (a) "Eligible infants and toddlers" means infants and
4toddlers under 36 months of age with any of the following
5conditions:
6        (1) Developmental delays.
7        (2) A physical or mental condition which typically
8    results in developmental delay.
9        (3) Being at risk of having substantial developmental
10    delays based on informed clinical opinion judgment.
11        (4) Either (A) having entered the program under any of
12    the circumstances listed in paragraphs (1) through (3) of
13    this subsection but no longer meeting the current
14    eligibility criteria under those paragraphs, and
15    continuing to have any measurable delay, or (B) not having
16    attained a level of development in each area, including (i)
17    cognitive, (ii) physical (including vision and hearing),
18    (iii) language, speech, and communication, (iv) social or
19    emotional psycho-social, or (v) adaptive self-help skills,
20    that is at least at the mean of the child's age equivalent
21    peers; and, in addition to either item (A) or item (B), (C)
22    having been determined by the multidisciplinary
23    individualized family service plan team to require the
24    continuation of early intervention services in order to
25    support continuing developmental progress, pursuant to the

 

 

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1    child's needs and provided in an appropriate developmental
2    manner. The type, frequency, and intensity of services
3    shall differ from the initial individualized family
4    services plan because of the child's developmental
5    progress, and may consist of only service coordination,
6    evaluation, and assessments.
7    (b) "Developmental delay" means a delay in one or more of
8the following areas of childhood development as measured by
9appropriate diagnostic instruments and standard procedures:
10cognitive; physical, including vision and hearing; language,
11speech and communication; social or emotional psycho-social;
12or adaptive self-help skills. The term means a delay of 30% or
13more below the mean in function in one or more of those areas.
14    (c) "Physical or mental condition which typically results
15in developmental delay" means:
16        (1) a diagnosed medical disorder bearing a relatively
17    well known expectancy for developmental outcomes within
18    varying ranges of developmental disabilities; or
19        (2) a history of prenatal, perinatal, neonatal or early
20    developmental events suggestive of biological insults to
21    the developing central nervous system and which either
22    singly or collectively increase the probability of
23    developing a disability or delay based on a medical
24    history.
25    (d) "Informed clinical opinion judgment" means both
26clinical observations and parental participation to determine

 

 

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1eligibility by a consensus of a multidisciplinary team of 2 or
2more members based on their professional experience and
3expertise.
4    (e) "Early intervention services" means services which:
5        (1) are designed to meet the developmental needs of
6    each child eligible under this Act and the needs of his or
7    her family;
8        (2) are selected in collaboration with the child's
9    family;
10        (3) are provided under public supervision;
11        (4) are provided at no cost except where a schedule of
12    sliding scale fees or other system of payments by families
13    has been adopted in accordance with State and federal law;
14        (5) are designed to meet an infant's or toddler's
15    developmental needs in any of the following areas:
16            (A) physical development, including vision and
17        hearing,
18            (B) cognitive development,
19            (C) communication development,
20            (D) social or emotional development, or
21            (E) adaptive development;
22        (6) meet the standards of the State, including the
23    requirements of this Act;
24        (7) include one or more of the following:
25            (A) family training,
26            (B) social work services, including counseling,

 

 

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1        and home visits,
2            (C) special instruction,
3            (D) speech, language pathology and audiology,
4            (E) occupational therapy,
5            (F) physical therapy,
6            (G) psychological services,
7            (H) service coordination services,
8            (I) medical services only for diagnostic or
9        evaluation purposes,
10            (J) early identification, screening, and
11        assessment services,
12            (K) health services specified by the lead agency as
13        necessary to enable the infant or toddler to benefit
14        from the other early intervention services,
15            (L) vision services,
16            (M) transportation, and
17            (N) assistive technology devices and services, ;
18            (O) nursing services,
19            (P) nutrition services, and
20            (Q) sign language and cued language services;
21        (8) are provided by qualified personnel, including but
22    not limited to:
23            (A) child development specialists or special
24        educators, including teachers of children with hearing
25        impairments (including deafness) and teachers of
26        children with vision impairments (including

 

 

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1        blindness),
2            (B) speech and language pathologists and
3        audiologists,
4            (C) occupational therapists,
5            (D) physical therapists,
6            (E) social workers,
7            (F) nurses,
8            (G) dietitian nutritionists,
9            (H) vision specialists, including ophthalmologists
10        and optometrists,
11            (I) psychologists, and
12            (J) physicians;
13        (9) are provided in conformity with an Individualized
14    Family Service Plan;
15        (10) are provided throughout the year; and
16        (11) are provided in natural environments, to the
17    maximum extent appropriate, which may include the home and
18    community settings, unless justification is provided
19    consistent with federal regulations adopted under Sections
20    1431 through 1444 of Title 20 of the United States Code.
21    (f) "Individualized Family Service Plan" or "Plan" means a
22written plan for providing early intervention services to a
23child eligible under this Act and the child's family, as set
24forth in Section 11.
25    (g) "Local interagency agreement" means an agreement
26entered into by local community and State and regional agencies

 

 

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1receiving early intervention funds directly from the State and
2made in accordance with State interagency agreements providing
3for the delivery of early intervention services within a local
4community area.
5    (h) "Council" means the Illinois Interagency Council on
6Early Intervention established under Section 4.
7    (i) "Lead agency" means the State agency responsible for
8administering this Act and receiving and disbursing public
9funds received in accordance with State and federal law and
10rules.
11    (i-5) "Central billing office" means the central billing
12office created by the lead agency under Section 13.
13    (j) "Child find" means a service which identifies eligible
14infants and toddlers.
15    (k) "Regional intake entity" means the lead agency's
16designated entity responsible for implementation of the Early
17Intervention Services System within its designated geographic
18area.
19    (l) "Early intervention provider" means an individual who
20is qualified, as defined by the lead agency, to provide one or
21more types of early intervention services, and who has enrolled
22as a provider in the early intervention program.
23    (m) "Fully credentialed early intervention provider" means
24an individual who has met the standards in the State applicable
25to the relevant profession, and has met such other
26qualifications as the lead agency has determined are suitable

 

 

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1for personnel providing early intervention services, including
2pediatric experience, education, and continuing education. The
3lead agency shall establish these qualifications by rule filed
4no later than 180 days after the effective date of this
5amendatory Act of the 92nd General Assembly.
6(Source: P.A. 97-902, eff. 8-6-12.)
 
7    (325 ILCS 20/4)  (from Ch. 23, par. 4154)
8    Sec. 4. Illinois Interagency Council on Early
9Intervention.
10    (a) There is established the Illinois Interagency Council
11on Early Intervention. The Council shall be composed of at
12least 20 but not more than 30 members. The members of the
13Council and the designated chairperson of the Council shall be
14appointed by the Governor. The Council member representing the
15lead agency may not serve as chairperson of the Council. The
16Council shall be composed of the following members:
17        (1) The Secretary of Human Services (or his or her
18    designee) and 2 additional representatives of the
19    Department of Human Services designated by the Secretary,
20    plus the Directors (or their designees) of the following
21    State agencies involved in the provision of or payment for
22    early intervention services to eligible infants and
23    toddlers and their families:
24            (A) Department of Insurance; and
25            (B) Department of Healthcare and Family Services.

 

 

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1        (2) Other members as follows:
2            (A) At least 20% of the members of the Council
3        shall be parents, including minority parents, of
4        infants or toddlers with disabilities or children with
5        disabilities aged 12 or younger, with knowledge of, or
6        experience with, programs for infants and toddlers
7        with disabilities. At least one such member shall be a
8        parent of an infant or toddler with a disability or a
9        child with a disability aged 6 or younger;
10            (B) At least 20% of the members of the Council
11        shall be public or private providers of early
12        intervention services;
13            (C) One member shall be a representative of the
14        General Assembly;
15            (D) One member shall be involved in the preparation
16        of professional personnel to serve infants and
17        toddlers similar to those eligible for services under
18        this Act;
19            (E) Two members shall be from advocacy
20        organizations with expertise in improving health,
21        development, and educational outcomes for infants and
22        toddlers with disabilities;
23            (F) One member shall be a Child and Family
24        Connections manager from a rural district;
25            (G) One member shall be a Child and Family
26        Connections manager from an urban district;

 

 

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1            (H) One member shall be the co-chair of the
2        Illinois Early Learning Council (or his or her
3        designee); and
4            (I) Members representing the following agencies or
5        entities: the State Board of Education; the Department
6        of Public Health; the Department of Children and Family
7        Services; the University of Illinois Division of
8        Specialized Care for Children; the Illinois Council on
9        Developmental Disabilities; Head Start or Early Head
10        Start; and the Department of Human Services' Division
11        of Mental Health. A member may represent one or more of
12        the listed agencies or entities.
13    The Council shall meet at least quarterly and in such
14places as it deems necessary. Terms of the initial members
15appointed under paragraph (2) shall be determined by lot at the
16first Council meeting as follows: of the persons appointed
17under subparagraphs (A) and (B), one-third shall serve one year
18terms, one-third shall serve 2 year terms, and one-third shall
19serve 3 year terms; and of the persons appointed under
20subparagraphs (C) and (D), one shall serve a 2 year term and
21one shall serve a 3 year term. Thereafter, successors appointed
22under paragraph (2) shall serve 3 year terms. Once appointed,
23members shall continue to serve until their successors are
24appointed. No member shall be appointed to serve more than 2
25consecutive terms.
26    Council members shall serve without compensation but shall

 

 

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1be reimbursed for reasonable costs incurred in the performance
2of their duties, including costs related to child care, and
3parents may be paid a stipend in accordance with applicable
4requirements.
5    The Council shall prepare and approve a budget using funds
6appropriated for the purpose to hire staff, and obtain the
7services of such professional, technical, and clerical
8personnel as may be necessary to carry out its functions under
9this Act. This funding support and staff shall be directed by
10the lead agency.
11    (b) The Council shall:
12        (1) advise and assist the lead agency in the
13    performance of its responsibilities including but not
14    limited to the identification of sources of fiscal and
15    other support services for early intervention programs,
16    and the promotion of interagency agreements which assign
17    financial responsibility to the appropriate agencies;
18        (2) advise and assist the lead agency in the
19    preparation of applications and amendments to
20    applications;
21        (3) review and advise on relevant regulations and
22    standards proposed by the related State agencies;
23        (4) advise and assist the lead agency in the
24    development, implementation and evaluation of the
25    comprehensive early intervention services system; and
26        (4.5) coordinate and collaborate with State

 

 

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1    interagency early learning initiatives, as appropriate;
2    and
3        (5) prepare and submit an annual report to the Governor
4    and to the General Assembly on the status of early
5    intervention programs for eligible infants and toddlers
6    and their families in Illinois. The annual report shall
7    include (i) the estimated number of eligible infants and
8    toddlers in this State, (ii) the number of eligible infants
9    and toddlers who have received services under this Act and
10    the cost of providing those services, and (iii) the
11    estimated cost of providing services under this Act to all
12    eligible infants and toddlers in this State. , and (iv)
13    data and other information as is requested to be included
14    by the Legislative Advisory Committee established under
15    Section 13.50 of this Act. The report shall be posted by
16    the lead agency on the early intervention website as
17    required under paragraph (f) of Section 5 of this Act.
18    No member of the Council shall cast a vote on or
19participate substantially in any matter which would provide a
20direct financial benefit to that member or otherwise give the
21appearance of a conflict of interest under State law. All
22provisions and reporting requirements of the Illinois
23Governmental Ethics Act shall apply to Council members.
24(Source: P.A. 97-902, eff. 8-6-12.)
 
25    (325 ILCS 20/5)  (from Ch. 23, par. 4155)

 

 

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1    Sec. 5. Lead Agency. The Department of Human Services is
2designated the lead agency and shall provide leadership in
3establishing and implementing the coordinated, comprehensive,
4interagency and interdisciplinary system of early intervention
5services. The lead agency shall not have the sole
6responsibility for providing these services. Each
7participating State agency shall continue to coordinate those
8early intervention services relating to health, social service
9and education provided under this authority.
10    The lead agency is responsible for carrying out the
11following:
12        (a) The general administration, supervision, and
13    monitoring of programs and activities receiving assistance
14    under Section 673 of the Individuals with Disabilities
15    Education Act (20 United States Code 1473).
16        (b) The identification and coordination of all
17    available resources within the State from federal, State,
18    local and private sources.
19        (c) The development of procedures to ensure that
20    services are provided to eligible infants and toddlers and
21    their families in a timely manner pending the resolution of
22    any disputes among public agencies or service providers.
23        (d) The resolution of intra-agency and interagency
24    regulatory and procedural disputes.
25        (e) The development and implementation of formal
26    interagency agreements, and the entry into such

 

 

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1    agreements, between the lead agency and (i) the Department
2    of Healthcare and Family Services, (ii) the University of
3    Illinois Division of Specialized Care for Children, and
4    (iii) other relevant State agencies that:
5            (1) define the financial responsibility of each
6        agency for paying for early intervention services
7        (consistent with existing State and federal law and
8        rules, including the requirement that early
9        intervention funds be used as the payor of last
10        resort), a hierarchical order of payment as among the
11        agencies for early intervention services that are
12        covered under or may be paid by programs in other
13        agencies, and procedures for direct billing,
14        collecting reimbursements for payments made, and
15        resolving service and payment disputes; and
16            (2) include all additional components necessary to
17        ensure meaningful cooperation and coordination.
18        Interagency agreements under this paragraph (e) must
19    be reviewed and revised to implement the purposes of this
20    amendatory Act of the 92nd General Assembly no later than
21    60 days after the effective date of this amendatory Act of
22    the 92nd General Assembly.
23        (f) The maintenance of an early intervention website.
24    Within 30 days after the effective date of this amendatory
25    Act of the 92nd General Assembly, the lead agency shall
26    post and keep posted on this website the following: (i) the

 

 

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1    current annual report required under subdivision (b)(5) of
2    Section 4 of this Act, and the annual reports of the prior
3    3 years, (ii) the most recent Illinois application for
4    funds prepared under Section 637 of the Individuals with
5    Disabilities Education Act filed with the United States
6    Department of Education, (iii) proposed modifications of
7    the application prepared for public comment, (iv) notice of
8    Council meetings, Council agendas, and minutes of its
9    proceedings for at least the previous year, (v) proposed
10    and final early intervention rules, (vi) requests for
11    proposals, and (vii) all reports created for dissemination
12    to the public that are related to the early intervention
13    program, including reports prepared at the request of the
14    Council, and the General Assembly, and the Legislative
15    Advisory Committee established under Section 13.50 of this
16    Act. Each such document shall be posted on the website
17    within 3 working days after the document's completion.
18        (g) Before adopting any new policy or procedure
19    (including any revisions to an existing policy or
20    procedure) needed to comply with Part C of the Individuals
21    with Disabilities Education Act, the lead agency must hold
22    public hearings on the new policy or procedure, provide
23    notice of the hearings at least 30 days before the hearings
24    are conducted to enable public participation, and provide
25    an opportunity for the general public, including
26    individuals with disabilities and parents of infants and

 

 

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1    toddlers with disabilities, early intervention providers,
2    and members of the Council to comment for at least 30 days
3    on the new policy or procedure needed to comply with Part C
4    of the Individuals with Disabilities Education Act and with
5    34 CFR Part 300 and Part 303.
6(Source: P.A. 95-331, eff. 8-21-07.)
 
7    (325 ILCS 20/7)  (from Ch. 23, par. 4157)
8    Sec. 7. Essential Components of the Statewide Service
9System. As required by federal laws and regulations, a
10statewide system of coordinated, comprehensive, interagency
11and interdisciplinary programs shall be established and
12maintained. The framework of the statewide system shall be
13based on the components set forth in this Section. This
14framework shall be used for planning, implementation,
15coordination and evaluation of the statewide system of locally
16based early intervention services.
17    The statewide system shall include, at a minimum:
18        (a) a definition of the term "developmentally
19    delayed", in accordance with the definition in Section 3,
20    that will be used in Illinois in carrying out programs
21    under this Act;
22        (b) timetables for ensuring that appropriate early
23    intervention services, based on scientifically based
24    research, to the extent practicable, will be available to
25    all eligible infants and toddlers in this State after the

 

 

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1    effective date of this Act;
2        (c) a timely, comprehensive, multidisciplinary and
3    interdisciplinary evaluation of the functioning of each
4    potentially eligible infant and toddler with suspected
5    disabilities in this State, unless the child meets the
6    definition of eligibility based upon his or her medical and
7    other records; for a child determined eligible, a
8    multidisciplinary assessment of the unique strengths and
9    needs of that infant or toddler and the identification of
10    services appropriate to meet those needs and a
11    family-directed assessment of the resources, priorities,
12    and concerns of the family and the identification of
13    supports and services necessary to enhance the family's
14    capacity to meet the developmental needs of that infant or
15    toddler the concerns, priorities and resource needs of the
16    families to appropriately assist in the development of the
17    infant and toddler with disabilities;
18        (d) for each eligible infant and toddler, an
19    Individualized Family Service Plan, including service
20    coordination (case management) services;
21        (e) a comprehensive child find system, consistent with
22    Part B of the Individuals with Disabilities Education Act
23    (20 United States Code 1411 through 1420 and as set forth
24    in 34 CFR 300.115), which includes timelines and provides
25    for participation by primary referral sources;
26        (f) a public awareness program focusing on early

 

 

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1    identification of eligible infants and toddlers;
2        (g) a central directory which includes public and
3    private early intervention services, resources, and
4    experts available in this State, professional and other
5    groups (including parent support groups and training and
6    information centers) that provide assistance to infants
7    and toddlers with disabilities who are eligible for early
8    intervention programs assisted under Part C of the
9    Individuals with Disabilities Education Act and their
10    families, and early intervention research and
11    demonstration projects being conducted in this State
12    relating to infants and toddlers with disabilities;
13        (h) a comprehensive system of personnel development;
14        (i) a policy pertaining to the contracting or making of
15    other arrangements with public and private service
16    providers to provide early intervention services in this
17    State, consistent with the provisions of this Act,
18    including the contents of the application used and the
19    conditions of the contract or other arrangements;
20        (j) a procedure for securing timely reimbursement of
21    funds;
22        (k) procedural safeguards with respect to programs
23    under this Act;
24        (l) policies and procedures relating to the
25    establishment and maintenance of standards to ensure that
26    personnel necessary to carry out this Act are appropriately

 

 

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1    and adequately prepared and trained;
2        (m) a system of evaluation of, and compliance with,
3    program standards;
4        (n) a system for compiling data on the numbers of
5    eligible infants and toddlers and their families in this
6    State in need of appropriate early intervention services;
7    the numbers served; the types of services provided; and
8    other information required by the State or federal
9    government; and
10        (o) a single line of responsibility in a lead agency
11    designated by the Governor to carry out its
12    responsibilities as required by this Act.
13    In addition to these required components, linkages may be
14established within a local community area among the prenatal
15initiatives affording services to high risk pregnant women.
16Additional linkages among at risk programs and local literacy
17programs may also be established.
18    Within 60 days of the effective date of this Act, a
19five-fiscal-year implementation plan shall be submitted to the
20Governor by the lead agency with the concurrence of the
21Interagency Council on Early Intervention. The plan shall list
22specific activities to be accomplished each year, with cost
23estimates for each activity. No later than the second Monday in
24July of each year thereafter, the lead agency shall, with the
25concurrence of the Interagency Council, submit to the
26Governor's Office a report on accomplishments of the previous

 

 

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1year and a revised list of activities for the remainder of the
2five-fiscal-year plan, with cost estimates for each. The
3Governor shall certify that specific activities in the plan for
4the previous year have been substantially completed before
5authorizing relevant State or local agencies to implement
6activities listed in the revised plan that depend substantially
7upon completion of one or more of the earlier activities.
8(Source: P.A. 87-680.)
 
9    (325 ILCS 20/9)  (from Ch. 23, par. 4159)
10    Sec. 9. Role of Other State Entities. The Departments of
11Public Health, Human Services, Children and Family Services,
12and Healthcare and Family Services Public Aid; the University
13of Illinois Division of Specialized Care for Children; the
14State Board of Education; and any other State agency which
15directly or indirectly provides or administers early
16intervention services shall adopt compatible rules for the
17provision of services to eligible infants and toddlers and
18their families within one year of the effective date of this
19Act.
20    These agencies shall enter into and maintain formal
21interagency agreements to enable the State and local agencies
22serving eligible children and their families to establish
23working relationships that will increase the efficiency and
24effectiveness of their early intervention services. The
25agreement shall outline the administrative, program and

 

 

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1financial responsibilities of the relevant State agencies and
2shall implement a coordinated service delivery system through
3local interagency agreements.
4    There shall be created in the Office of the Governor an
5Early Childhood Intervention Ombudsman to assist families and
6local parties in ensuring that all State agencies serving
7eligible families do so in a comprehensive and collaborative
8manner.
9(Source: P.A. 89-507, eff. 7-1-97; 89-626, eff. 8-9-96.)
 
10    (325 ILCS 20/10)  (from Ch. 23, par. 4160)
11    Sec. 10. Standards. The Council and the lead agency, with
12assistance from parents and providers, shall develop and
13promulgate policies and procedures relating to the
14establishment and implementation of program and personnel
15standards to ensure that services provided are consistent with
16any State-approved or recognized certification, licensing,
17registration, or other comparable requirements which apply to
18the area of early intervention program service standards. Only
19State-approved public or private early intervention service
20providers shall be eligible to receive State and federal
21funding for early intervention services. All early childhood
22intervention staff shall hold the highest entry requirement
23necessary for that position.
24    To be a State-approved early intervention service
25provider, an individual (i) shall not have served or completed,

 

 

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1within the preceding 5 years, a sentence for conviction of any
2felony that the Department establishes by rule and (ii) shall
3not have been indicated as a perpetrator of child abuse or
4neglect, within the preceding 5 years, in an investigation by
5Illinois (pursuant to the Abused and Neglected Child Reporting
6Act) or another state. The Department is authorized to receive
7criminal background checks for such providers and persons
8applying to be such a provider and to receive child abuse and
9neglect reports regarding indicated perpetrators who are
10applying to provide or currently authorized to provide early
11intervention services in Illinois. Beginning January 1, 2004,
12every provider of State-approved early intervention services
13and every applicant to provide such services must authorize, in
14writing and in the form required by the Department, a State and
15FBI a criminal background check, as requested by the
16Department, and check of child abuse and neglect reports
17regarding the provider or applicant as a condition of
18authorization to provide early intervention services. The
19Department shall use the results of the checks only to
20determine State approval of the early intervention service
21provider and shall not re-release the information except as
22necessary to accomplish that purpose.
23(Source: P.A. 93-147, eff. 1-1-04.)
 
24    (325 ILCS 20/11)  (from Ch. 23, par. 4161)
25    Sec. 11. Individualized Family Service Plans.

 

 

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

 

 

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

 

 

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

 

 

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1        (3) That the family may request, with appropriate
2    documentation supporting the request, a determination of
3    an exemption from private insurance use under Section
4    13.25.
5        (4) That responsibility for co-payments or
6    co-insurance under a family's private insurance plan or
7    policy will be transferred to the lead agency's central
8    billing office.
9        (5) That families will be responsible for payments of
10    family fees, which will be based on a sliding scale
11    according to the State's definition of ability to pay which
12    is comparing household size and income to the sliding scale
13    and considering out-of-pocket medical or disaster
14    expenses, and that these fees are payable to the central
15    billing office, and that if the family encounters a
16    catastrophic circumstance, as defined under subsection (f)
17    of Section 13 of this Act, making it unable to pay the
18    fees, the lead agency may, upon proof of inability to pay,
19    waive the fees. Families who fail to provide income
20    information shall be charged the maximum amount on the
21    sliding scale.
22    (f) The individualized family service plan must state
23whether the family has private insurance coverage and, if the
24family has such coverage, must have attached to it a copy of
25the family's insurance identification card or otherwise
26include all of the following information:

 

 

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1        (1) The name, address, and telephone number of the
2    insurance carrier.
3        (2) The contract number and policy number of the
4    insurance plan.
5        (3) The name, address, and social security number of
6    the primary insured.
7        (4) The beginning date of the insurance benefit year.
8    (g) A copy of the individualized family service plan must
9be provided to each enrolled provider who is providing early
10intervention services to the child who is the subject of that
11plan.
12    (h) Children receiving services under this Act shall
13receive a smooth and effective transition by their third
14birthday consistent with federal regulations adopted pursuant
15to Sections 1431 through 1444 of Title 20 of the United States
16Code.
17(Source: P.A. 97-902, eff. 8-6-12.)
 
18    (325 ILCS 20/12)  (from Ch. 23, par. 4162)
19    Sec. 12. Procedural Safeguards. The lead agency shall adopt
20procedural safeguards that meet federal requirements and
21ensure effective implementation of the safeguards for families
22by each public agency involved in the provision of early
23intervention services under this Act.
24    The procedural safeguards shall provide, at a minimum, the
25following:

 

 

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1        (a) The timely administrative resolution of State
2    complaints, due process hearings, and mediations by
3    parents as defined by administrative rule.
4        (b) The right to confidentiality of personally
5    identifiable information.
6        (c) The opportunity for parents and a guardian to
7    examine and receive copies of records relating to
8    evaluations and assessments assessment, screening,
9    eligibility determinations, and the development and
10    implementation of the Individualized Family Service Plan
11    provision of early intervention services, individual
12    complaints involving the child, or any part of the child's
13    early intervention record.
14        (d) Procedures to protect the rights of the eligible
15    infant or toddler whenever the parents or guardians of the
16    child are not known or unavailable or the child is a ward
17    of the State, including the assignment of an individual
18    (who shall not be an employee of the State agency or local
19    agency providing services) to act as a surrogate for the
20    parents or guardian. The regional intake entity must make
21    reasonable efforts to ensure the assignment of a surrogate
22    parent not more than 30 days after a public agency
23    determines that the child needs a surrogate parent.
24        (e) Timely written prior notice to the parents or
25    guardian of the eligible infant or toddler whenever the
26    State agency or public or private service provider proposes

 

 

09800SB0626ham001- 30 -LRB098 04441 KTG 45693 a

1    to initiate or change or refuses to initiate or change the
2    identification, evaluation, placement, or the provision of
3    appropriate early intervention services to the eligible
4    infant or toddler.
5        (f) Written prior notice to fully inform the parents or
6    guardians, in their native primary language or mode of
7    communication used by the parent, unless clearly not
8    feasible to do so, in a comprehensible manner, of these
9    procedural safeguards.
10        (g) During the pendency of any proceedings or action
11    involving a complaint, unless the State agency and the
12    parents or guardian otherwise agree, the child shall
13    continue to receive the appropriate early intervention
14    services currently being provided, or in the case of an
15    application for initial services, the child shall receive
16    the services not in dispute.
17(Source: P.A. 91-538, eff. 8-13-99.)
 
18    (325 ILCS 20/13)  (from Ch. 23, par. 4163)
19    Sec. 13. Funding and Fiscal Responsibility.
20    (a) The lead agency and every other participating State
21agency may receive and expend funds appropriated by the General
22Assembly to implement the early intervention services system as
23required by this Act.
24    (b) The lead agency and each participating State agency
25shall identify and report on an annual basis to the Council the

 

 

09800SB0626ham001- 31 -LRB098 04441 KTG 45693 a

1State agency funds utilized for the provision of early
2intervention services to eligible infants and toddlers.
3    (c) Funds provided under Section 633 of the Individuals
4with Disabilities Education Act (20 United States Code 1433)
5and State funds designated or appropriated for early
6intervention services or programs may not be used to satisfy a
7financial commitment for services which would have been paid
8for from another public or private source but for the enactment
9of this Act, except whenever considered necessary to prevent
10delay in receiving appropriate early intervention services by
11the eligible infant or toddler or family in a timely manner.
12"Public or private source" includes public and private
13insurance coverage.
14    Funds provided under Section 633 of the Individuals with
15Disabilities Education Act and State funds designated or
16appropriated for early intervention services or programs may be
17used by the lead agency to pay the provider of services (A)
18pending reimbursement from the appropriate State agency or (B)
19if (i) the claim for payment is denied in whole or in part by a
20public or private source, or would be denied under the written
21terms of the public program or plan or private plan, or (ii)
22use of private insurance for the service has been exempted
23under Section 13.25. Payment under item (B)(i) may be made
24based on a pre-determination telephone inquiry supported by
25written documentation of the denial supplied thereafter by the
26insurance carrier.

 

 

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1    (d) Nothing in this Act shall be construed to permit the
2State to reduce medical or other assistance available or to
3alter eligibility under Title V and Title XIX of the Social
4Security Act relating to the Maternal Child Health Program and
5Medicaid for eligible infants and toddlers in this State.
6    (e) The lead agency shall create a central billing office
7to receive and dispense all relevant State and federal
8resources, as well as local government or independent resources
9available, for early intervention services. This office shall
10assure that maximum federal resources are utilized and that
11providers receive funds with minimal duplications or
12interagency reporting and with consolidated audit procedures.
13    (f) The lead agency shall, by rule, create a system of
14payments by families, including a schedule of fees. No fees,
15however, may be charged for: implementing child find,
16evaluation and assessment, service coordination,
17administrative and coordination activities related to the
18development, review, and evaluation of Individualized Family
19Service Plans, or the implementation of procedural safeguards
20and other administrative components of the statewide early
21intervention system.
22    The system of payments, called family fees, shall be
23structured on a sliding scale based on the family's ability to
24pay family income. The family's coverage or lack of coverage
25under a public or private insurance plan or policy shall not be
26a factor in determining the amount of the family fees.

 

 

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

 

 

09800SB0626ham001- 34 -LRB098 04441 KTG 45693 a

1payment is made directly or through public or private insurance
2for any or all of the early intervention services made
3available under this Act. The lead agency shall establish
4procedures to ensure that payments are made either directly
5from these public and private sources instead of from State or
6federal early intervention funds, or as reimbursement for
7payments previously made from State or federal early
8intervention funds.
9(Source: P.A. 91-538, eff. 8-13-99; 92-10, eff. 6-11-01;
1092-307, eff. 8-9-01; 92-651, eff. 7-11-02.)
 
11    (325 ILCS 20/13.5)
12    Sec. 13.5. Other programs.
13    (a) When an application or a review of eligibility for
14early intervention services is made, and at any eligibility
15redetermination thereafter, the family shall be asked if it is
16currently enrolled in any federally funded, Department of
17Healthcare and Family Services administered, medical programs
18Medicaid, KidCare, or the Title V program administered by the
19University of Illinois Division of Specialized Care for
20Children. If the family is enrolled in any of these programs,
21that information shall be put on the individualized family
22service plan and entered into the computerized case management
23system, and shall require that the individualized family
24services plan of a child who has been found eligible for
25services through the Division of Specialized Care for Children

 

 

09800SB0626ham001- 35 -LRB098 04441 KTG 45693 a

1state that the child is enrolled in that program. For those
2programs in which the family is not enrolled, a preliminary
3eligibility screen shall be conducted simultaneously for (i)
4medical assistance (Medicaid) under Article V of the Illinois
5Public Aid Code, (ii) children's health insurance program (any
6federally funded, Department of Healthcare and Family Services
7administered, medical programs KidCare) benefits under the
8Children's Health Insurance Program Act, and (iii) Title V
9maternal and child health services provided through the
10Division of Specialized Care for Children of the University of
11Illinois.
12    (b) For purposes of determining family fees under
13subsection (f) of Section 13 and determining eligibility for
14the other programs and services specified in items (i) through
15(iii) of subsection (a), the lead agency shall develop and use,
16within 60 days after the effective date of this amendatory Act
17of the 92nd General Assembly, with the cooperation of the
18Department of Public Aid (now Healthcare and Family Services)
19and the Division of Specialized Care for Children of the
20University of Illinois, a screening device that provides
21sufficient information for the early intervention regional
22intake entities or other agencies to establish eligibility for
23those other programs and shall, in cooperation with the
24Illinois Department of Public Aid (now Healthcare and Family
25Services) and the Division of Specialized Care for Children,
26train the regional intake entities on using the screening

 

 

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1device.
2    (c) When a child is determined eligible for and enrolled in
3the early intervention program and has been found to at least
4meet the threshold income eligibility requirements for any
5federally funded, Department of Healthcare and Family Services
6administered, medical programs Medicaid or KidCare, the
7regional intake entity shall complete an application for any
8federally funded, Department of Healthcare and Family Services
9administered, medical programs a KidCare/Medicaid application
10with the family and forward it to the Department of Healthcare
11and Family Services' KidCare Unit for a determination of
12eligibility. A parent shall not be required to enroll in any
13federally funded, Department of Healthcare and Family Services
14administered, medical programs as a condition of receiving
15services provided pursuant to Part C of the Individuals with
16Disabilities Education Act.
17    (d) With the cooperation of the Department of Healthcare
18and Family Services, the lead agency shall establish procedures
19that ensure the timely and maximum allowable recovery of
20payments for all early intervention services and allowable
21administrative costs under Article V of the Illinois Public Aid
22Code and the Children's Health Insurance Program Act and shall
23include those procedures in the interagency agreement required
24under subsection (e) of Section 5 of this Act.
25    (e) For purposes of making referrals for final
26determinations of eligibility for any federally funded,

 

 

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1Department of Healthcare and Family Services administered,
2medical programs KidCare benefits under the Children's Health
3Insurance Program Act and for medical assistance under Article
4V of the Illinois Public Aid Code, the lead agency shall
5require each early intervention regional intake entity to
6enroll as an application agent a "KidCare agent" in order for
7the entity to complete the any federally funded, Department of
8Healthcare and Family Services administered, medical programs
9KidCare application as authorized under Section 22 of the
10Children's Health Insurance Program Act.
11    (f) For purposes of early intervention services that may be
12provided by the Division of Specialized Care for Children of
13the University of Illinois (DSCC), the lead agency shall
14establish procedures whereby the early intervention regional
15intake entities may determine whether children enrolled in the
16early intervention program may also be eligible for those
17services, and shall develop, within 60 days after the effective
18date of this amendatory Act of the 92nd General Assembly, (i)
19the inter-agency agreement required under subsection (e) of
20Section 5 of this Act, establishing that early intervention
21funds are to be used as the payor of last resort when services
22required under an individualized family services plan may be
23provided to an eligible child through the DSCC, and (ii)
24training guidelines for the regional intake entities and
25providers that explain eligibility and billing procedures for
26services through DSCC.

 

 

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1    (g) The lead agency shall require that an individual
2applying for or renewing enrollment as a provider of services
3in the early intervention program state whether or not he or
4she is also enrolled as a DSCC provider. This information shall
5be noted next to the name of the provider on the computerized
6roster of Illinois early intervention providers, and regional
7intake entities shall make every effort to refer families
8eligible for DSCC services to these providers.
9(Source: P.A. 95-331, eff. 8-21-07.)
 
10    (325 ILCS 20/13.10)
11    Sec. 13.10. Private health insurance; assignment. The lead
12agency shall determine, at the point of new applications for
13early intervention services, and for all children enrolled in
14the early intervention program, at the regional intake offices,
15whether the child is insured under a private health insurance
16plan or policy. An application for early intervention services
17shall serve as a right to assignment of the right of recovery
18against a private health insurance plan or policy for any
19covered early intervention services that may be billed to the
20family's insurance carrier and that are provided to a child
21covered under the plan or policy.
22(Source: P.A. 92-307, eff. 8-9-01.)
 
23    (325 ILCS 20/13.30)
24    Sec. 13.30. System of personnel development. The lead

 

 

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1agency shall provide training to early intervention providers
2and may enter into contracts to meet this requirement. If such
3contracts are let, they shall be bid under a public request for
4proposals that shall be posted on the lead agency's early
5intervention website for no less than 30 days. This training
6shall include, at minimum, the following types of instruction:
7    (a) Courses in birth-to-3 evaluation and treatment of
8children with developmental disabilities and delays (1) that
9are taught by fully credentialed early intervention providers
10or educators with substantial experience in evaluation and
11treatment of children from birth to age 3 with developmental
12disabilities and delays, (2) that cover these topics within
13each of the disciplines of audiology, occupational therapy,
14physical therapy, speech and language pathology, and
15developmental therapy, including the social-emotional domain
16of development, (3) that are held no less than twice per year,
17(4) that offer no fewer than 20 contact hours per year of
18course work, (5) that are held in no fewer than 5 separate
19locales throughout the State, and (6) that give enrollment
20priority to early intervention providers who do not meet the
21experience, education, or continuing education requirements
22necessary to be fully credentialed early intervention
23providers; and
24    (b) Courses held no less than twice per year for no fewer
25than 4 hours each in no fewer than 5 separate locales
26throughout the State each on the following topics:

 

 

09800SB0626ham001- 40 -LRB098 04441 KTG 45693 a

1        (1) Practice and procedures of private insurance
2    billing.
3        (2) The role of the regional intake entities; service
4    coordination; program eligibility determinations; family
5    fees; any federally funded, Department of Healthcare and
6    Family Services administered, medical programs Medicaid,
7    KidCare, and Division of Specialized Care applications,
8    referrals, and coordination with Early Intervention; and
9    procedural safeguards.
10        (3) Introduction to the early intervention program,
11    including provider enrollment and credentialing, overview
12    of Early Intervention program policies and regulations,
13    and billing requirements.
14        (4) Evaluation and assessment of birth-to-3 children;
15    individualized family service plan development,
16    monitoring, and review; best practices; service
17    guidelines; and quality assurance.
18(Source: P.A. 92-307, eff. 8-9-01.)
 
19    (325 ILCS 20/13.50 rep.)
20    Section 15. The Early Intervention Services System Act is
21amended by repealing Section 13.50.
 
22    Section 99. Effective date. This Act takes effect upon
23becoming law.".