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2012-2013 Answers to Questions about EA Procedures

 

NICU Stay and Eligibility in Procedures Manual
Jane Boley-Herr 6/12/13

Where in the procedures manual does it address the question of NICU stay and eligibility. If a child is full term and spent a day or two in the NICU due to maternal fever, observation, or other non critical reason does he qualify simply because he set foot in a NICU?

     
Meghan Wolfe 6/13/13

In Iowa a child who has been admitted to the NICU is not automatically eligible for Early ACCESS.

Eligibility is discussed in Section 8: Eligibility Determination of the Early ACCESS Procedural Manual.  Page 8-2 of the manual begins to discuss ways children qualify for Early ACCESS.  To qualify for Early ACCESS, infants and toddlers under the age of three years old are eligible to receive early intervention services coordinated by Early ACCESS when they meet one if two criteria:

1.  Based on Informed Clinical Opinion, the child has a known condition that has a high probability of resulting in later developmental delays if early intervention services are not provided.

OR

2.  The child has a 25% or more delay as measured by appropriate diagnostic instruments and procedures, and based on Informed Clinical Opinion in one or more areas of the following developmental areas: cognitive development, physical development including vision and hearing, communication development, social or emotional development, and adaptive development.

Page 8-4 of the Procedure Manual provides a list of  known conditions with a high probability of later delay, they include, but are not limited to the following:

*Genetic abnormalities including but not limited to: Down syndrome, Fragile X, cystic fibrosis, and dwarfism.

*Sensory impairments including but not limited to vision and hearing deficits.

*Inborn errors of metabolism including but not limited to phenylketonuria and hypothyroidism, galactosemia, sickle cell disease.

*Congenital central nervous disorders including but not limited to spina bifida, microcephaly.

*Other congenital or acquired conditions including but not limited to cleft palate, missing limbs, cerebral palsy, traumatic brain injury, seizure disorders, physical impairments from birth or accident.

*Venous blood lead level greater than or equal to 20 micrograms per deciliter.

*Behavioral or emotional conditions such as serious attachment disorders.

*Foster care (includes all children placed out of home by DHS).

*Conditions resulting from serious chronic conditions (>12 months duration expected), fetal drug or alcohol exposure, failure to thrive, Pervasive Developmental Disorder (PDD) and other autistic spectrum disorders, low birth weight or prematurity.

While this list isn't exhaustive, you can see that being admitted to the NICU is not listed as a condition with high probability for delay.  If you feel in conjunction with an evaluation, that based on your informed clinical opinion the child has a condition that has a high probability of resulting in later developmental delays if early intervention services are not provided, then you can use your clinical judgment and qualify this child based on his/her health and social situation.

 

RIOT
Rae Miller 05/09/13

1. Does EA require the use of multiple elements of RIOT be utilized in an evaluation for a child in order to implement an IFSP, to be considered a valid evaluation, or to be compliant in a file review? 

2. Are there parameters on who can use the “R” – review of records as part of RIOT (for example can a Service Coordinator who is a paraprofessional review records)? 

3. What is required for documentation of RIOT in the IFSP for a child's evaluation? Would each of the required evaluated domains need to have more than one of the RIOT methods utilized and documented in the IFSP?

     
Meghan Wolfe 05/10/13

Question 1. Does EA require the use of multiple elements of RIOT be utilized in an evaluation for a child in order to implement an IFSP, to be considered a valid evaluation, or to be compliant in a file review?

Answer 1. The following requirement is established in Iowa Rules 120.321(4).  Procedures to determine eligibility must include, “administering an evaluation instrument; taking the child’s history including interviewing the parent; identifying the child’s level of functioning in each of the developmental areas; gathering information from other sources such as family members, other caregivers, providers, social workers, and educators, to understand the full scope of the child’s strengths and needs; and reviewing medical, educational, or other records. See RIOT framework beginning on page 7-9.”  (EA manual page 7-8)

You will notice that administering an evaluation instrument (T), taking history via interviewing parents (I), and reviewing medical, educational, or other records (R), are required by Rules.  Observation of the child is not required however is part of the RIOT framework in order to gather as much information as possible in order to understand the child’s strengths and needs.

There is nothing in the web IFSP implementation process that checks to see how many of the RIOT fields are selected in each of the domains.  The term “valid evaluation” is not used in Iowa Rules or EA procedures. It is being interpreted in this response as meaning evaluation requirements meet Iowa Rules.  Therefore, a “valid” evaluation is one that meets the requirements of the Iowa Administrative Rules for Early ACCESS.   To be compliant in a self-assessment file review, the IFSP must indicate that all areas of development have been evaluated.

 

Question 2. Are there parameters on who can use the “R” – review of records as part of RIOT (for example can a Service Coordinator who is a paraprofessional review records)?

Answer: 2. Evaluations are required to be completed by “qualified personnel” which is defined in Iowa Rules (120.31) as “personnel who have met state-approved or state-recognized certification, licensing, registration, or other comparable requirements that apply to the areas in which the individuals are conducting evaluations or assessments or providing early intervention services.  In Iowa, we recognize service coordination as a profession with a state-approved certification (completion of service coordination modules).  Evaluations can be done by one person if that person is qualified in two professions.  This means, a service coordinator who wears “two-hats” can do all required evaluation components including the review of information on a child, (R) of RIOT.  If the SC doesn’t wear two hats, another professional must be included in the evaluation process.

 

Question 3. What is required for documentation of RIOT in the IFSP for a child's evaluation? Would each of the required evaluated domains need to have more than one of the RIOT methods utilized and documented in the IFSP?

Answer 3. Iowa Administrative Rule 120.321(4)”c”:  In conducting an evaluation, no single procedure may be used as the sole criterion for determining a child’s eligibility under this chapter.  Procedures must include: indentifying the child’s level of functioning in each of the developmental areas in subrule 120.21(1).

Iowa Administrative Rule 120.21(1) defines an infant or toddler with a disability and reads: the individual “is experiencing a developmental delay, which is a 25 percent delay as measured by appropriate diagnostic instruments and procedures, in one or more of the following areas: cognitive development, physical development including vision and hearing, communication development, social or emotional development, and adaptive development.

In the definition of an infant or toddler with a disability you will see that you must use an appropriate diagnostic tool (T in RIOT) in cognitive, physical, communication, social or emotional and adaptive developmental domains [120.21(1)].  The tool gives you the child’s level of functioning in each developmental domain required in 120.321(4)c.  Therefore, you must use the T in RIOT for all developmental domains.

Evaluators may or may not use R, I, or O in each of the child’s developmental areas.  For example, an evaluator may be reviewing records (R) which only address some of the developmental areas and would be recorded in the web IFSP accordingly.  An observation may occur where development in only some of the domains are witnessed and those would be recorded in the appropriate domains.  An interview with the parent could very well include information for all areas and would be entered under “I” in the web IFSP for all developmental areas.

 

 

Translated IFSP
Pamela Deluhery 4/22/13 Is it possible to translate a completed IFSP into Spanish in the web program or does it need to be retyped?
     
Cindy Weigel 4/22/13

The web IFSP program does not translate to other languages. The state has that on a list of things to do for future versions.

 

 

Definition of Parent in EA Procedures

Cindy Weigel 

Meghan Wolfe

4/5/13

In the EA Procedures Manual, 2010 version you will find the following information on page 7-1:

Parent definition.

Parent means:

  • A biological or adoptive parent of a child;
  • A foster parent, unless State law, regulations, or contractual obligations with a State of local entity prohibit a foster parent from acting as a parent [Note. The Departments of Education and Human Services are currently reviewing this issue to determine whether such a barrier exists.];
  • A guardian generally authorized to act as the child's parent, or authorized to make education decisions for the child (but not the State if the child is a ward of the State)
  • An individual acting in the place of a biological or adoptive parent (including a grandparent, stepparent, or other relative) with whom the child lives, or an individual who is legally responsible for the child's welfare; or
  • A surrogate parent who has been appointed. See blocks below for surrogate parent definition and procedures.

Note. This definition aligns with Part B's definition (20 U.S.C. 1439(a)(5).

I've attached the guiding document about who can sign for Early ACCESS services. (Click here to view "Decision Tree for Unobtainable Parent Signature for IDEA Part C".)

This section of the EA Procedures Manual is under revision due to rule changes.  Until the revisions are finished, the 2010 version of this manual section is still in effect.  The revised Section 7 will be the new 2013 Section 20.  It should be done in May and will be posted at www.iowaideainfo.org as well as emailed to the liaisons.

     
Teresa Hobbs 4/3/13 Does the EA Procedures include definitions of parent and who can sign forms? (Information is available in Part B manual but could not find in EA manual). 

 

New Amendment to FERPA Questions
Cindy Weigel on behalf of regional liaisons 3/25/13 New amendment to FERPA questions: Can DHS now request records
for all kids referred and eligible for EA? (Already in the EA system.) (So,
retroactive to all kids and also during referral process.) Did you find out
about DHS contracted partners? (Ex: Families First)
     

Cindy Weigel

Chris Rubino

3/25/13

ANSWERS ARE TYPED BELOW AFTER EACH QUESTION.

Can DHS now request records for all kids referred and eligible for EA?  Yes (Already in the EA system.) Yes (So, retroactive to all kids and also during referral process.)  Yes

Did you find out about DHS contracted partners? (Ex: Families First)  What Thomas said was "private providers are covered by the Uninterrupted Scholars Act only if they have right to have access to the child's case plan.". I then asked around at DHS and was told that the Family Safety Risk and Permanency Workers (FSRP)already have a copy of the DHS caseplan (which means that yes, they could access education files) BUT there should not be much reason for them to need any info from Education.  My suggestion is that if asked from anyone other than DHS itself, the EA worker should first check with the DHS worker on the case.

 

Steps to Close Intake When Parent Does Not Give Consent
Cindy Weigel on behalf of regional liaisons 3/25/13 1. Child is referred to Early ACCESS and is entered in the web
IFSP system. 2. Service coordinator calls mom to schedule and appointment and she changes her mind and informs service coordinator that she does not want a home visit. 3. Steps to close  intake are not clear when parent does not agree for consent to screen. There are steps to decline eval. So should we follow the same steps when they decline screen and eval? Steps are on page 4-7 of the procedures manual.
     
Megan Wolfe 3/25/13

You will follow the same steps when parents decline screening as you do when they decline an evaluation.

The case closure options have been revised in web IFSP to now say "parent declines screening/consent for eval" in the notes section on intake page, enter phone call date and summary of contacts. Also provide a PWN.

 

Definition for "Timely Pre-Referral Screening"
Teresa Hobbs 3/20/13 Is there a definition for "timely pre-referral screening?"
     

Cindy Weigel

Megan Wolfe

3/20/13 When reviewing results from pre-referral screenings, use professional judgment when determining if the screening information is still relevant based on how much time has passed between the screening and referral, what was screened (just speech versus many developmental domains), changes in the child's condition or life event (child has experienced a health trauma between pre-referral screening and referral to EA), etc.  There is no set timeline that suggests that a pre-referral screening data should not be used.  However, when working with very young children, the longer the period of time between a pre-referral screening and a referral to EA, the more you will need to reflect on all that has happened during that period of time.

 

Audiologist on the IFSP Team (Clarification)
Megan Wolfe on behalf of regional liaisons 2/22/13 Needing clarification on the answer to Linda Boshart's question dated 1/21/13 on the Iowa IDEA FAQs. If the area of concern has nothing to do with hearing, the audiologist can still be the second evaluator. Is that correct?
     

Cindy Weigel

Megan Wolfe

2/22/13

Evaluators are from any of the 10 domains that we evaluate (adaptive, cognitive, communication, physical-gross motor, physical-fine motor, social/emotional, health, hearing, nutrition, vision) as long as they are qualified personnel in the area they are evaluating. An audiologist who evaluates a child's hearing is considered one of the evaluators as long as they are qualified personnel to complete the evaluation. A physician or other medical personnel who evaluates a child's health status is considered one of the evaluators if they are qualified personnel. The documentation of the evaluation must be submitted and entered into the evaluation portion of the IFSP.

It is important to note that the people involved in the evaluation must be invited to participate as part of the IFSP team for an initial and annual IFSP meeting. It is the responsibility of the AEA or signatory agency to make that invitation as well as provide opportunities for participating in alternative ways (see manual pages 12-4 and 15-4).

 

Can the Disability of a Child be Changed?
Mary Jo Nordheim 2/18/13 If an IFSP child started with the disability of TD, and the service coordinator now feels this should be HP, can this be changed? If so, the web IFSP will not allow it to be changed.
     

Cindy Weigel

Megan Wolfe

2/18/13 Once a child is determined eligible, you cannot change the eligibility code for that child. The eligibility determination at time of initial IFSP meeting is the code used throughout the child's time in Early ACCESS. If this code was selected in error, you will have to work with your web IFSP administrator

 

DHS Access to Information Without Parent Signature
Cindy Weigel on behalf of regional liaison 2/12/13 Child is in Foster Care Home, rights have not been terminated. EA is working with both Foster Parents and Bio Parents. Bio Parent does not want DHS on Exchange of Information. Can DHS now get information from EA team with out parent signature?
     
Cindy Weigel 2/12/13 Yes, because of FERPA amendment. A DHS worker who has the right to examine the child's case permanency plan has the right to information without parent consent, and even over parent objection.

 

Post-Referral Screening and Part C Procedures
Cindy Weigel on behalf of regional liaison 2/10/13 There are a handful of kids who I have already gone out to visit and completed a screening which has resulted in moving towards the evaluation which we haven't completed yet. For a few of the kids I had not yet opened a meeting, and now it doesn't allow you to start a meeting until you complete the PR screening form. However, the post referral screening form consent was not completed because it didn't exist until yesterday.
     

Cindy Weigel

Meghan Wolfe

2/10/13

Prior to 1/29/2013, all children referred to Early ACCESS were eligible for a full evaluation.  Post-referral screening was not part of the authorized Part C procedures.  Therefore, in the web IFSP, only post-referral screenings completed on 1/29/2013 and beyond are considered when completing the P-R Screening tab.  Answer "yes" to the post-referral screening question only when providers conducted screening on or after 1/29/2013.  Get the appropriate consents and record documentation related to that post-referral screening.  From 1/29/2013 forward, post-referral screening applies to screening activities that occur on that date or after.

In order to have access to the meeting tab, parental rights, post-referral screening and consent for evaluation fields need to be completed.  After they are filled in, the Meeting tab will appear.

 

First Delivery Date for Audiology Services Provided Quarterly
Jackie Humphrey 1/30/13 I am adding audiology services to an IFSP. The audiologist saw the
child prior to the IFSP meeting and will not see the child again until 2 months after the IFSP meeting as she is seeing the child quarterly. How do we handle the first delivery date? What reason should be used if the audiologist logs her note after the 30 day timeline?
     

Cindy Weigel

Meghan Wolfe

2/7/13 All early intervention services are required to be provided within 30 days of consent for service.  If the time between consent for services and the delivery of the first service is beyond 30 days due to agreed upon monitoring or retesting in the case of hearing, use the delay code of "OT" and describe that service is only provided 4x year and more than 30 days between the initial evaluation and the follow-up screening of hearing is recommended in order to get best results.  In other words, use this code and explain why it was not appropriate to meet with the child/family within the 30 day timeline.

 

Reliability of Some of the Pre-Referral Screening        
Cindy Weigel on behalf of regional liaison 1/29/13 Concern from some service coordinators has risen over the reliability of some of the pre-referral screening that comes in where they feel a post-referral screening would be more appropriate than a full eval. How do we deal with this?
     

Cindy Weigel

Megan Wolfe

1/29/13

When a pre-referral screening has been completed, the service coordinator should request, with parent permission, the results of that screening.  If the screening tool used by another organization or agency is known to be a reliable screening instrument, then the information should be used and not dismissed by Early ACCESS personnel from either the AEAs or the signatory agencies (see manual page 5-1for criteria for selection of screening tools).

If a service coordinator is unfamiliar with a screener then she/he should seek out the information needed to determine if the screening tool does in fact provide the information you expect and need.  If in doubt, your service coordinators need to know who within your agency they can go to get support around understanding particular screening tools.

If your service coordinator has concerns about the agency or organization doing the screening and not the tool in particular, the EA Regional Liaison or other EA staff person should be contacting the referral source and supporting each other to meet the needs of the Early ACCESS system. If referral sources need support in pre-referral screening, there should be a discussion at state leadership meetings to address this need.

Keep in mind that a post-referral screening should be used as outlined in the procedures manual, section 5 and as illustrated in the flowchart on page 7-7.  Remember, it is very important to realize that every child MUST be offered a full evaluation.  Iowa Rules do not state that every child must receive a post-referral screening.  In fact, that would be inappropriate and not a good use of Part C resources.

 

Hospital Report as the Second Discipline at the Initial Evaluation
Gale Randall 1/28/13 Can a hospital report be used as the second discipline at the initial evaluation to make it multidisciplinary?
     

Cindy Weigel

Megan Wolfe

1/28/13

Evaluators are from any of the 10 domains that we evaluate (adaptive, cognitive, communication, physical-gross motor, physical-fine motor, social/emotional, health, hearing, nutrition, vision). Just as the audiologist who evaluates a child's hearing is considered one of the evaluators, a physician who evaluates a child's health status is considered one of the evaluators.  The documentation of the evaluation must be submitted and entered into the evaluation portion of the IFSP.

It is important to note that the people involved in the evaluation must be invited to participate at part of the IFSP team for an initial and annual IFSP meeting.  It is the responsibility of the AEA or signatory agency to make that invitation as well as provide opportunities for participating in alternative ways (see manual pages 12-4 and 15-4).

 

First Service within 30 days for Audiology Services
Gale Randall 1/28/13 First service within 30 days: This is not logical for audiology services if the child has normal hearing or a medically significant loss. I test the child within the 45 day window and if I want to monitor them at 6 month intervals, I need to retest within the first 30 days? Even if I made a medical referral this is usually too soon to see results.
     

Cindy Weigel

Megan Wolfe

1/28/13 All early intervention services are required to be provided within 30 days of consent for service.  If the time between consent for services and the delivery of the first service is beyond 30 days due to agreed upon monitoring or retesting in the case of hearing, use the delay code of "OT" and describe that service is only provided 2x year and more than 30 days between the initial evaluation and the follow-up screening of hearing is recommended in order to get best results.  In other words, use this code and explain why it was not appropriate to meet with the child/family within the 30 day timeline.

 

Annual IFSP meeting
Cindy Weigel on behalf of regional liaison 1/28/13 How early can you hold an annual IFSP meeting? (How far ahead of your annual date?)
     
Cindy Weigel 1/28/13 The annual IFSP meeting must be held no more than 365 days after the initial or previous annual IFSP meeting. There are no allowable exceptions to this timeline. The SC must send out the written meeting notification to all participants early enough to ensure their attendance. It is important to plan ahead and schedule the annual IFSP meeting in ample time to ensure compliance with this requirement. It is acceptable to hold the meeting up to a month prior to the due date.

 

Initial IFSP Meeting with Only Two People Present
Gale Randall 1/28/13 If we are holding an Initial IFSP meeting and the third person on the IFSP team is unable to attend. Is it ok to go ahead with the meeting with only the two people present and have the SC review the results of the person not present?
     

Cindy Weigel

Megan Wolfe

1/28/13

Members of the IFSP team can participate via alternative methods if they cannot participate in person.  Alternative methods of meeting participation for an initial IFSP meeting (manual page 12-4) and annual (manual page 15-4) provide information on how meeting participants can be involved other than face-to-face.

In the example below it sounds as though the third person is participating via written report/record which is considered "making the pertinent records available at the meeting" as listed in the procedures manual.  Therefore that person should be recorded as participating in the meeting on the Meeting tab in the IFSP- method of participation would be written report/record.

 

Add Information to the Pre-Referral Screening
Cindy Weigel on behalf of regional liaison 1/28/13 If a parent calls in a referral, indicates an agency conducted a screening, but she doesn't know what it is and date it happened, do we complete the pre-referral screening tab as if one did not occur in order to move forward with the referral? Is is possible to add information to the tab "after the fact"?
     

Cindy Weigel

Megan Wolfe

1/28/13

Once P-R Screening is completed I wouldn't recommend going back and adding information after that fact. I would complete the tab with the information you have at the time you complete the intake.

In the example you used, I would indicate that yes pre-referral screening was completed but you won't be able to fill out name of tool (which is fine) you can only document what you know. I would move onto offering parents full evaluation and ask parents to sign an exchange of information for agency that did screening to obtain info, as having that info might help you decide who will participate in evaluation.

 

Entering Logs for OTs and PTs
Cindy Weigel on behalf of regional liaison 1/28/13 PTs and OTs continue to have questions about entering their logs into the web environment vs. uploading them because their signature is required to maintain their license. What makes it acceptable for practitioners to enter their service logs directly into the web environment? Are folks using an electronic signature? Is pressing "submit" considered your signature? Is there anything that says PTs and OTs can't or should not continue to upload their logs?
     
Cindy Weigel 1/28/13 OT and PT providers can continue uploading their notes.  However, they need to go into the web IFSP and make an entry that says see the attached associated files for visit so that the date, etc. is captured in the log notes.

 

Billing Private Insurance for OT/PT Services
Gale Randall 1/28/13 Should the AEAs be billing private insurances for OT/PT services and how does this affect # of visits per year? This question comes from the changes in the Medicaid form.
     
Cindy Weigel 1/28/13 In Iowa, billing private insurance for any Part C early intervention service is not allowed.  Only Medicaid is allowed to bill private insurance as part of Iowa's Medicaid program.  All families who have Medicaid have already consented to having their private insurance billed (if they have private insurance) when they apply for Medicaid.  Early ACCESS only asks the families to consent to billing private insurance through Medicaid.  The EA consent to bill private insurance is a confirmation that the family has already given that same consent to Medicaid.  However, if the family has Medicaid and has changed their mind and does not consent to bill private insurance, then agencies cannot bill Medicaid since Medicaid will bill that families private insurance.  That is what the family agreed to when applying for Medicaid.  At no time can the agencies bill the private insurance for Part C early intervention services.

 

Service Coordination Only Service
Gale Randall 1/28/13 Should we be exiting kiddos who the SC is the only service in the
home? Who do we bring in for another service for meetings when the child does not need any other service?
     

Cindy Weigel

Megan Wolfe

1/28/13

If a child/family qualified for Early ACCESS and service coordination is the single service being provided, you would only exit the child/family for the same reasons any child would be exited (manual page 19-1):

(1) Completion of IFSP prior to reaching age 3 (maximum age). Child who has not reached age 3, has completed his/her IFSP, and no longer requires services under IDEA, Part C (Code PMA). Note:  PMA would be an inappropriate code to use for a child age 2 years, 9 months and older because of the transition activities or services (of either pathway) that are required at least 3 months prior to child's third birthday.

(2) Eligible for Part B, exiting Part C.  Child served in Part C who exited Part C and was determined to be eligible for Part B.  Part B eligibility refers to a child who has been determined according to State and Federal criteria to have a disability that requires special education and related services (Code EFB).

(3) Not eligible for Part B, exited with referrals to other programs OR
Suspected of having disability, parent declines consideration for Part B, exited with referrals to other programs (Code EOP).

(4) Not Eligible for Part B, exited with no referrals OR Child suspected of having a disability, parents declined consideration for Part B eligibility determination, exited with no referrals (Code ENR)

(5) Part B eligibility not determined (Code BND).

(6) Moved out of State, known to be continuing IFSP services (Code CMK).

(7) Moved out of State, not known to be continuing IFSP services (Code CMN).

(8) Services declined by parent (Code SDP).

(9) Deceased (Code DEC).

(10) Unknown/Attempts to contact unsuccessful (Code UNK).

Regarding your question about who to bring in for the meetings, required participants for the initial and annual meetings are found on manual pages
12-4 and 15-4.  Required participants for a periodic review could be the parent(s) and service coordinator only if there are no specific areas of concern and no changes to the IFSP are needed.  Manual page 14-3 describes required participants for a periodic review.

When considering who could be part of the IFSP team, we recommend always asking the parents/family if they have anyone they would like invite. Consider inviting the child's primary care provider, daycare provider, or any other agencies or programs involved with the child.

 

Guidance Document Explaining Medicaid Second Signature Private Insurance Issue
Cindy Weigel on behalf of regional liaison 1/28/13 Staff are wondering if it is possible to develop a "brochure" or simple (family friendly language) guidance/explanation document that explains the Medicaid second signature private insurance issue?
     
Cindy Weigel 1/28/13 Jim Donoghue is working on a FAQ that should be helpful.  Once I see what that looks like perhaps it can even be simplified and put in a brochure.  I will let the EA leadership group know when it is ready.

 

Involvement of 3rd Person on IFSP Team
Gale Randall 1/28/13 What is the minimal involvement for the 3rd person on an IFSP team, do they have to be part of an outcome?
     

Cindy Weigel

Megan Wolfe

1/28/13

At a minimum, members of the IFSP team must participate via an alternative method if they cannot participate in person.  Alternative methods of meeting participation for an initial IFSP meeting (manual page 12-4) and annual (manual page 15-4) provide information on how meeting participants can be involved other than face-to-face:

INITIAL MTG:
If any of the required participants are unable to attend a meeting, arrangements must be made for the person's involvement through other means, including one of the following [120.343(1)(b)]:
   ♦   Participating in a telephone conference call.
  ♦   Having a knowledgeable authorized representative attend the meeting.
  ♦   Making pertinent records available at the meeting.

ANNUAL MTG:
For the participation of a professional who has been directly involved in conducting evaluations, assessments, or medical diagnoses and who is unable to attend the IFSP meeting, arrangements must be made for the person's involvement through other means including [120.343(1)"b"]:
  ♦   Participating in a telephone conference call.
  ♦   Having a knowledgeable authorized representative attend the meeting.
  ♦   Making pertinent records available at the meeting

There is no requirement for team members to be part of an outcome for the child or family.

 

Copy of Screening Tool Results
Gale Randall 1/28/13 With the new post referral screening requirements should intake personnel be requesting a copy of the screening tool results from the referral source?  Wouldn't an exchange of information be needed?  This could really mess with the 45 day referral timeline.
     

Cindy Weigel

Megan Wolfe

1/28/13

Intake personnel should request a copy of the screening tool results from the referral source.  See procedures manual page 3-4.

Yes, an exchange of information is more than likely needed by the referral source to send Early ACCESS the results.  If the referral source obtain consent to make a referral to Early ACCESS, perhaps the referral source has an exchange signed.  Intake personnel should always ask the referral source for a copy of the screening tool results and ask if they have permission to release the results of the screening tool.

If the referral source does not have permission to release the results then Early ACCESS should move onto a full evaluation as it appears that screening was already done (reason for referral) and rescreening would be duplicative.

 

Transition to New System
Shari Huecksteadt 1/25/13 What happens to current initial IFSP plans that have been started but the meeting is not held until after January 29th? Will providers have to go back and fill in information on additional tabs?
     

Cindy Weigel

Megan Wolfe

1/25/13 If the IFSP in the "old" system (prior to 1/29) has not reached the stage of providing parental rights and getting consent for evaluation, the system will not know if a post-referral screening or full evaluation is being done or not when we rollover all children to the new IFSP on 1/29.  If providers have not provided parental rights and secured consent for evaluation, they will have to complete the information on the P-R Screening tab.  If, before 1/29, the provider has entered the parental rights and consent for evaluation date and signature information than the information entered before 1/29 will fill in on the post-referral screening section so there should be nothing for providers to go back and fill in on the P-R Screening tab.

 

Initial Submitted But Not Implemented
Shari Huecksteadt 1/25/13 What if an initial has been submitted but not yet implemented?
     

Cindy Weigel

Megan Wolfe

1/25/13 If an initial IFSP has been submitted and not implemented, all information should automatically transfer into the new IFSP.  Information from the old system should automatically find the right fields to fill in on the new IFSP.  There should not be any work to go back and do.

 

Transition to New System
Shari Huecksteadt 1/25/13 What is the latest time a service coordinator can submit a new plan? If an initial is done on Monday the 28th, submitted and implemented that evening, does that give the system enough time to implement before the roll over?
     

Cindy Weigel

Megan Wolfe

1/25/13 IFSPs that are submitted on 1/28 will be implemented during an overnight process that night.  Therefore, they should show up as implemented in the system on 1/29/2013.

 

Team Membership
Gina Greene 1/24/13 After the Initial meeting, can the team consist of the parent(s) and the service coordinator?
     

Cindy Weigel

Megan Wolfe

1/24/13 Yes.  If the only service is service coordination, then the team is the parent(s) and the service coordinator.  If a concern comes up and a periodic review is needed, include people appropriate to address concern.

 

Team Membership
Gina Greene 1/24/13 At the periodic review, can the team consist of the parent(s) and the service coordinator, if the only service the family receives is service coordination?
     

Cindy Weigel

Megan Wolfe

1/24/13

If there are no concerns at the periodic review, which can be held by a meeting or other means that is acceptable to the parents and other participants, the periodic review participants can include the parent(s) and the service coordinator (Procedural Manual, page: 14-3).

If conditions warrant, provisions must be made for participation of the following:
 * persons involved in conducting the evaluation and assessments,
 * persons who will be providing services to the child as appropriate.

 

Eligibility
Gina Greene 1/24/13 At referral, parent states that the child has XXX syndrome. Records are requested from Physician/Hospital by the Service Coordinator to confirm eligibility. Service coordinator has not received records yet. Based on parent report, can we make child eligible under "known condition" and move to assessment?
     

Cindy Weigel

Megan Wolfe

1/24/13 Providers can move to assessment, with the understanding you must have the documentation to review before you can determine eligibility.

 

Outcomes
Gina Greene 1/24/13 Can an "other service" (OE and OH) have a separate outcome?
     

Cindy Weigel

Megan Wolfe

1/24/13 If the  "other service" is listed on the Early Intervention Service page, then that service should be contributing to the achievement of an existing outcome(s).  If the "other service" is not supporting achievement of outcome(s) and  wants to write a separate outcome for their service they can do so.  However, ask yourself is it necessary for them to be in Early Intervention system as  service?  Or should they not be listed on the Family Information page as another service/agency involved with the child.

 

Parent Consent for Billing Private Insurance
Jackie Muller 1/24/13 Can parents consent to billing Medicaid and not to bill private insurance? Does the parent need to sign even if they decline consent?
     

Cindy Weigel

Megan Wolfe

1/24/13

If a parent has private insurance and declines to consent to billing that private insurance, the AEA or agency providing services CANNOT bill Medicaid for that service.  In Iowa, when a family signs up for Medicaid, they give consent to bill private insurance.  That is how Iowa Medicaid works.  Early ACCESS (EA) is now asking the family to consent a second time to that same practice of billing private insurance.  If the family changes their mind (because they did give consent when they signed up for Medicaid in Iowa) and does not want to allow Medicaid to bill the private insurance, your agency CANNOT bill Medicaid.  EA is not asking a family for any new consents that were not required to get Medicaid.  That is what makes this so confusing.  The family already consented to billing their private insurance in order to get Medicaid.  EA is now required to explicitly ask the family again if they will consent.  If they do not, do not submit Medicaid claims.

Jim Donoghue from the Dept. of Education will be providing guidance via a Medicaid Question and Answer document which will be released soon.  Families and service coordinators are encouraged to call Jim Donoghue, Bureau of Finance, Facilities, Operation and Transportation Services, 515-281-8505 if they have questions.

 

Transition to New System
Jackie Muller 1/24/13 How will the Web IFSP roll-over on Jan. 29th effect new intakes?
     

Cindy Weigel

Megan Wolfe

1/24/13

Every child who is currently in the web IFSP system will automatically be in the "new" system on January 29.  Every child in the system will have all the new tabs (P-R Screening) and fields that were available on the web IFSP test site that was used for training.  If a child is in the system and is beyond the post-referral stage of the process, staff will not go back and do anything with post-referral screenings.  The P-R Screening tab simply will show up because it is a new tab for everyone in the system.  If children were recently entered as a new intake, the option to complete post-referral screening is available and the information is entered into the system if a post-referral screening is completed.  When children in the current system move to the new IFSP, the new fields will show up for those children (i.e. family assessment tool used, new check boxes).  Depending on where that child is in the IFSP process, either you will fill in the information because you are at the stage of doing family assessments for example, or the fields will simply show up and you will not do anything with them.

State staff are working with programmers on January 29 to make sure everything rolls over correctly before allowing provider access back into the system.  This is to ensure that children already in the web IFSP system do not have any problems with their IFSPs.  Should we encounter programming bugs, we will work them out that day.

 

Using the ASQ:SE After the DAYC
Gina Greene 1/24/13 If one evaluator uses the DAYC to determine eligibility, can the service coordinator or other person evaluating use the ASQ:SE for more information about behavior (as the second evaluator)?
     

Cindy Weigel

Megan Wolfe

1/24/13 You are determining eligibility with the DAYC.  You can use whatever additional tools to gather information about the child and family, this includes ASQ:SE or other screeners as appropriate.

 

Third Person for IFSP Team
Jackie Muller 1/24/13 Who can be considered the third person for an IFSP meeting if the only services the family will be receiving are Service Coordination and ECSE developmental services (both services that are provided by one person)?
     

Cindy Weigel

Meghan Wolfe

1/28/13

This has been a hot topic of many discussions since the Part C Administrative Rules changed the definition of "multidisciplinary evaluation"  [manual page 7-2, Multidisciplinary means the involvement of two or more separate disciplines or professions and, with respect to evaluation of the child and family, and may include one individual who is qualified in more than one discipline or profession 120.24(1).  The multidisciplinary evaluation "team" may consist of one individual if that person is qualified in more than one discipline or profession].  If this is not the case, the evaluation "team" must be two or more individuals qualified in separate disciplines or professions.  Evaluation is done in all 10 areas for each child and you should not forget the providers that evaluate health, vision, hearing and nutrition are part of the evaluation team.

A third person is required as part of the IFSP team [manual page 12-1, IFSP team means the involvement of the parent and two or more individuals from separate disciplines or professions and one of these individuals must be the service coordinator (120.24)] because no single provider (service coordinator) should make decisions regarding the following:  (1) determining eligibility based on multiple sources of information (remember RIOT); and (2) developing an IFSP for the eligible child and family.  Any agency providing Early ACCESS services will have to determine who that third person will be in order to meet the law.  Do not forget to consider providers who evaluate health, vision, hearing and nutrition as both part of the multidisciplinary evaluation team and the IFSP team.

Keep in mind that alternate methods of participation as an IFSP team member at any IFSP team meeting, including the initial IFSP meeting, is acceptable.  Manual page 12-4 states the following:

If any of the required participants are unable to attend a meeting, arrangements must be made for the person's involvement through other means, including one of the following [120.343(1)(b)]:

   ♦     Participating in a telephone conference call.

   ♦     Having a knowledgeable authorized representative attend the meeting.

   ♦     Making pertinent records available at the meeting.

 

Testing When Child Has Known Condition
Gina Greene 1/23/13 When a child is referred with a 'known condition', the child is eligible for EA and a "test" does not have to be done to identify areas of concern. (Team may go straight to assessment.) For the Annual Meeting, do you have to "test" in the identified areas of concern or can you use assessment information?
     
Cindy Weigel 1/23/13

Yes, at an annual IFSP meeting, you are required to test areas of concern.  If there are no particular areas of concern, then you use any of the four RIOT processes on all areas.

Page 7-10: The "T" in RIOT stands for test.  Here is the description of what is meant by the term "test" when doing developmental and health tests in Early ACCESS:  Tests are a process of gathering direct information and providing a numeric measure of performance gathered through a variety of means. These means may include and are not limited to rubric assessments based on functional skills, functional behavioral assessments, curriculum based assessments, norm or criterion referenced assessments or performance assessments through the completion of specific tasks.

These tests or assessments assist with determining:
.       initial functioning level in all required areas of development;
.       the gap between the child's current level and expected developmental or age referenced performance;
.       additional areas where more in depth evaluation is needed; and
.       other sources to gather needed information.

 

IFSP Evaluation Team
Linda Boshart 1/21/13 For the child who has no apparent hearing concerns at the time of referral, is the audiologist who completes the hearing portion of the evaluation considered to be representing a discipline on the IFSP evaluation team? To think of it another way, do the two disciplines have to be involved in the eval of the six developmental domains (gross motor, fine motor, communication, cognitive, adaptive, and social/emotional) or can they be responsible for one or more of the other domains (health, hearing, vision, and nutrition)?
     

Cindy Weigel

Meghan Wolfe

1/22/13 The audiologist can be considered one of the evaluators.  The two evaluators are from any of the 10 domains that we evaluate for an initial IFSP.

 

Availability of New Tabs for IFSP
Brenda Jenkins 1/11/13 I have an annual review that I am holding on January 29. It is open right now and I will complete it on Jan. 29. Will the new tabs be added on that date to this IFSP or will it be the current format? I really don't want to change the date but don't want to have to come back & do additional paperwork that would be added.
     

Cindy Weigel

Megan Wolfe

1/11/13

The morning of January 29, 2013 the web IFSP system will not be accessible as the children will be transferred to the new system.  If there are no problems with the rollover, the system will be available after 12:00 noon to access all IFSPs.  If your meeting is held January 29, 2013, you will be using the new version of the IFSP, as that will be the only IFSP system available to use.

Providers are not required to "go back" and fill out any new tabs that are not relevant to your child/family.  For example, the new Post-Referral Screening tab is not relevant at an annual meeting therefore you will not fill it in.  There would not be anything to fill in as that tab is only relevant prior to an initial IFSP.  If you have any further questions, contact the Early ACCESS Regional Liaison in your region or agency.

 

Consent Revoked by One Parent
Cathy Ryba 1/8/13 Dad made a referral for his son for whom he has joint custody. Mom does not want the referral; nor is she interested in preschool services when son turns 3 in a couple months. If we serve son while with Dad and Mom is not involved, can Mom "revoke" service as is the case for Part B and we cannot serve even when at Dad's?
     

Cindy Weigel

Megan Wolfe

1/11/13

Response from Thomas Mayes, attorney, Division of Learning and Results:

1.  Each parent is to be invited to IFSP meetings, etc.

2.  We will analyze Part C similarly to Part B.  The pertinent text is 120.420(2) and 120.420(4).  Either parent with decision-making power may grant, withhold, or revoke consent (even if the consent was given by the other parent).  If a parent revokes consent to Early ACCESS, services must stop and the Regional Grantee can't use due process to get them to start again.  Rule 120.420(3).

If Mom revokes consent, the child may not be served even while the child is at Dad's house.

 

New "IFSP Team" Definition for Initial and Periodic Review Meeting
Shari Huecksteadt 1/7/13 Does the new definition of "IFSP Team" that is used for an initial IFSP meeting also pertain to periodic review meetings? For example, with the new definition there must be at least 3 people included for the initial IFSP meeting. Is this also true for periodic reviews or can it be the Service Coordinator and the parent if there are no other disciplines involved?
     

Cindy Weigel

Megan Wolfe

1/17/13 At the periodic review, the team can consist of the family and service coordinator, if the only service the family receives is service coordination and there are no concerns at the periodic review.  See Required participants on page 14-3 of the EA Procedures Manual.

 

Pre-Referral Screening
Kathy Bartling 1/4/13 Our staff has pointed out that the guiding document for Post-Referral Screening appears to contradict itself. Under 'When can I do post-referral screening?' it says it can be done if the parent wants more information about their child's development prior to signing a Consent for EA Evaluation. Under 'When would I NOT do post-referral screening?' it says that if pre-referral screening was completed then post-referral screening will not be conducted. So what happens if pre-referral screening has been done by the doctor or another agency and the parents still want EA staff to screen first? Please provide further guidance for us to share with our staff.
     

Cindy Weigel

Megan Wolfe

1/5/13

If pre-referral screening was completed by a doctor or another agency parents should not be offered post-referral screening.  The law requires all parents be offered a full evaluation, it doesn't say all parents are offered post-referral screening. The service coordinator should ask the family for permission to request a copy of the pre-referral screening results.

Agencies should not offer screening to families when the child was referred to Early ACCESS as a result of a screening conducted by a doctor or another agency.  Instead, parents should be offered a full evaluation.  If parents request screening, we recommend you inform the family that completing another screening would not be recommended, since a screening has already been completed.  Then ask for permission to obtain the screening information.  Since screening by doctor or other provider has already been completed, Early ACCESS recommends and is offering the family a full evaluation.

Keep in mind that any post-referral processes occur within the 45 day timeline from referral to the initial IFSP meeting.

 

Child Count
Kathy Bartling 10/14/12 If an interim IFSP is submitted by 10/26, will the child be included in count or does the completed plan have to be an initial?
     
John Lee 10/26/12 If the IFSP or IEP meeting is held by the end of business today (count day) then the youngster is in.  Interim or "Real".  The paperwork and data entry can follow (as there is usually a "paper-lag").

 

Withdraw From Services Before First Service Delivered
Kathy Bartling 10/5/12 We have a signed consent for services and plan that was implemented where parent decided to withdraw from services before one of the providers could get out to see the child. The parent's decision to discontinue EA was made prior to 30 days out from the initial IFSP. Our service coordinator is unable to complete the exit because there is a First Service that was not delivered. This family has moved out of state and cannot be reached at this time. How do we proceed in this situation.
     

Cindy Weigel

Meghan Wolfe

10/5/12 The State has identified this as an issue and have spoken with web IFSP programmers to find a solution.  Situations like this force providers to put in a false first delivery note, which we don't want to happen because it provides false C1 data.  However, at this time there is no way to fix this until programming is corrected.  The Service Coordinator will need to put in a first service delivery note.  The note will say something like "first service not delivered as family decided to discontinue Early ACCESS services prior provider delivering first service."  Once this false first delivery note is entered the exit will be able to be completed.

 

Non-Iowa Resident Here Temporarily
Gina Green 9/25/12 We have a referral for Child A from District xxxx where it appears family is just visiting grandmother from another state. (and leaving again mid-November.) Do we have an obligation to complete evaluation and IFSP if not an Iowa resident?
     
Cindy Weigel 9/25/12 We do not have an obligation to complete evaluation and an IFSP for a child who is a  resident of another state and is only visiting grandmother between September 25 and mid-November.

 

Transportation Needed to Access Another IFSP Service
Cathy Ryba 9/20/12 A child will be on an IFSP with services in the home and attending Iowa School for the Deaf. Transportation from Harlan to ISD will be provided by the LEA. Should transportation be listed on the IFSP EI Services page when it is to attend the ISD preschool? Does that fit the definition of "transportation needed to access another IFSP service"? The SLP, ECS from the preschool are included on the IFSP.
     
Cindy Weigel 9/26/12 Part C services does include TRANSPORTATION and should be on the IFSP as an EI service (service code TR). Under Iowa Administrative Rules, types of early intervention services [281-120.13(2)p] you will find the following:  "Transportation and related costs" includes the cost of travel and other costs that are necessary to enable an infant or toddler with a disability and the child's family to receive early intervention services.
 
 

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