Services covered under the Early Intervention Program include those outlined in the fee schedule. All Early Intervention services to be provided to a given recipient must be identified in the child’s Individual Family Service Plan (IFSP). These services are limited to those children eligible for Early Intervention services in accordance with the policy and procedures as outlined by the RI Department of Health. The IFSP of each child is used in determining services that are medically necessary under the requirements of EPSDT.
Early Intervention services are designed to serve children younger than three years of age who are experiencing developmental delays in one or more of the following areas: cognitive, physical, communicative, social/emotional or adaptive development skills.
Assessment: A comprehensive evaluation of child and family status conducted by a team of professionals which includes special education, health care, motor therapy, language therapy, and social work. The objective of the assessment process is to determine eligibility for services and to gather information to construct an individualized family service plan. Assessment is conducted after a child has been screened and is repeated annually thereafter as long as the child/family continues to receive intervention services.
Simple Assessment: A comprehensive evaluation of child and family status by a health care professional and no more than one other specialty.
Complex Assessment: A comprehensive evaluation of child and family status by a health care professional and 2 or more specialties.
Screening (In-take): A brief yet comprehensive appraisal of the child’s developmental status, significant unmet family needs, and a portrayal of the family’s existing social support network. The purpose of screening is to accurately identify children who require a multi-disciplinary team evaluation in an early intervention program. Screening is conducted one time, upon a child’s initial referral to early intervention.
Individual Family Service Plan Meetings: IFSP meetings are conducted upon a child’s initial assessment to determine eligibility for Early Intervention and annually thereafter as long as a child continues to receive early intervention services. The initial IFSP meeting shall minimally include the parent(s) of the child, other family members requested by the parent, other people providing services to the child who are not early intervention providers, the early intervention primary service provider, and at least one service provider who participated in the assessment process and will be providing services to the child and/or the family. The IFSP meeting initially establishes the service plan for the child and the family, and reviews and revises the plan at annual intervals thereafter, consistent with the results and findings derived from the annual multi-disciplinary team assessment.
Transition Planning: The planning of the transfer of children from early intervention into other environments at three years of age. Planning of such transitions commences when the child reaches 30 months, and must minimally include parent(s), the primary service provider, representative(s) from the public school district of the child’s residence, and other individuals as requested by the parent. Emerging from such meetings shall be a written summary of activities which will occur in order to maximize continuity of services and prevent disruption of a child’s progress.
Semi-Annual Progress Review: A formal review of the IFSP that occurs six months after each assessment, or more frequently if conditions warrant, or if a family requests such a review. Participants in this progress review shall minimally include the parent and primary service provider. The objective of this meeting shall be to review progress toward stated objectives, and develop and insert new objectives and methods where appropriate.
Developmental Monitoring: Designed for children and families who present evidence of vulnerability, yet do not require participation in a service option. Developmental monitoring involves systematic, periodic appraisal (minimally every 3 months) of a child’s and family's needs in order to determine:
- Referral for a transdisciplinary team assessment.
- Referral to and linkage with existing community-based health, educational, or social service programs; and
Service Coordination/Case Management
Case Management: Case Management refers to services provided by a professional mental health staff for the purpose of monitoring and assisting clients in their overall life situations, including gaining access to needed medical, social, educational and other services necessary to meeting basic human needs. These services may include, but are not necessarily limited to:
- Maintaining up-to-date assessments and evaluations for establishing eligibility for services.
- Participating in the treatment planning process and monitoring client progress in meeting the goals and objectives of the plan.
- Locating, coordinating and monitoring all necessary medical, educational, vocational, social and psychiatric services.
- Assistance with other activities necessary to maintain psychiatric stability in a community-based setting
Family Counseling: Family counseling is the practice of counseling parents or other family members by certified and/or licensed professionals who provide information, emotional support and guidance, and assist family members in the resolution of specific issues or problems.
Child Therapy: Individual child therapy is intensive, preventative, developmental, habilitative, or remedial treatment of a child for the purpose of accelerating the child’s development and functional skill acquisition, or the remediation of specific skill or behavioral deficits. These services are typically conducted by appropriately certified, or licensed clinicians, such as physical or occupational therapists, speech and language pathologists, and special educators.
Family/Child Therapy: Individual family/child intervention is intensive preventative, developmental, habilitative, or remedial treatment of a child for the purpose of accelerating the child’s development and functional skill acquisition and the remediation of specific skill or behavioral deficits. Other family members (parents, brothers, sisters, grandparents) are often the focus of this treatment in order that the therapeutic interventions are fully integrated into the child and family daily routines.
A secondary purpose of the family/child program is to enhance family members’ ability to enjoyably and productively interact with their child, and subsequently, to facilitate acquisition of behaviors that allow the child to interact maximally with the family. This program, while often occurring in the home, may be conducted in center-based programs as well.
Integrated Group Placement: A group program in which special needs and non-special needs children participate together. Includes individually designed instruction for the special needs children.
Parent/Child Group: The purpose of parent/child groups is to give support and provide useful models for parents’ behavior while they are interacting with their children. This service option provides preventative, developmental, habilitative, or remedial treatment to the parent and child in order to enhance the overall quality and quantity of interaction.
Center Developmental Group: Specifically designed instruction and therapy for a group of special needs children for the purpose of maximizing developmental or functional progress.
Parent/Education/Support Group: Parent education and support groups are primarily directed towards parents for the purpose of providing information and skills which will increase their ability to successfully care for their child. This service option provides parents with the opportunity to support and learn from one another as well as from program staff.
Other Group Service: Other group services provided to a child/family which are not included in the services listed above.
Consultation to Day Care: For eligible children attending day care programs, the purpose of this consultation is to facilitate the child’s continued learning as well as successful accommodation and full participation in these settings. The consultant’s role is to assist the provider in incorporating any individually designed instruction and therapy needed by the child into ongoing program activities.
Consultation to Other Agency: Children/families may be serviced by community-based medical, social, educational, or childcare services as a result of their participation in early intervention. The purpose of this consultation is to facilitate successful accommodation and full participation of children/families in these settings. The consultant’s role is to assist the outside provider in incorporating any individually designed instruction and therapy needed by the child into ongoing program activities.
Physical Therapy: Services prescribed by a physician and provided to a recipient by and under the direction of a qualified physical therapist. It includes any necessary supplies and equipment.
Occupational Therapy: Services prescribed by a physician and provided to a recipient by and under the direction of a qualified occupational therapist. It includes any necessary supplies and equipment.
Services for Individuals with Speech, Hearing, and Language Disorders: Diagnostic, screening, preventive, or corrective services provided by or under the direction of a speech pathologist or audiologist, for which a patient is referred by a physician. It includes any necessary supplies and equipment.
Center Development Group: Other group services provided to a child/family which are not included in the services listed above.
Nutrition Services: Diagnostic, screening, preventive, or corrective services provided by or under the direction of a nutritionist, for which a patient is referred by a professional of the healing arts.
Nursing Services: Those services prescribed by a physician or provided by or under the direction of a qualified nurse. It includes any necessary supplies and equipment.
Transportation Services: Those transporting services provided which were prescribed by a professional of the healing arts to address the medical needs. Transportation services do not include transport from the recipient’s residence to the primary education setting or return.
Assistive Technology Device: Any item, piece of equipment or product system, whether acquired commercially off the shelf, modified or customized, used to increase, maintain, or improve the functional capabilities of children with disabilities.
Assistive Technology Service: A service that directly assists a child with disabilities in the selection, acquisition, or use of an assistive technology device.
Services are covered for both categorically and medically needy recipients.
The following table lists all covered services for Early Intervention Program treatment and counseling. The table shows the procedure code, service description, if the service requires prior authorization (Y-yes or N-no).
||Screening - Early Intervention (EI)
||Assessment: Simple - Early Intervention (For Complex Assessment Use Modifier 22)
||Progress Review - Early Intervention
||Individual Family Service Plan (IFSP) Meeting - Early Intervention
||Developmental Monitoring - Early Intervention
||Transition Planning - Early Intervention
Service Coordination/Case Management
|Non-Medical Case Management - Early Intervention
||Medical Case Management - Early Intervention
||Psychological Session, Individual - Child - Early Intervention
||Psychological Session, Individual - Child and Family - Early Intervention
||Psychological Session, Individual - Family - Early Intervention
||Psychological Session, Group - Integrated - Early Intervention
||Psychological Session, Group - Center Development - Early Intervention
||Psychological Session, Group - Parent and Child - Early Intervention
||Psychological Session, Group - Parent Education - Early Intervention
||Psychological Session, Group - Other - Early Intervention
||Consultative Service in Day Care - Early Intervention
||Consultative Service in Other Agency - Early Intervention
||Physical Therapy (PT) Evaluation
||Physical Therapy Service - Early Intervention
||Occupational Therapy (OT) Evaluation
||Occupational Therapy Service - Early Intervention
||Speech Therapy Evaluation - Early Intervention
||Speech Therapy Service - Early Intervention
||Center Development Group Evaluation - Early Intervention
||Center Development Group Service - Early Intervention
||Early Intervention - Nutritional Services
||Early Intervention - Nursing Services
||Early Intervention - Transportation
Assistive Technology Device
||Assistive Technology Service (Minimum 40-50 Min.)
Covers children birth to 3 years of age.
Medical Case Management (X0675) cannot be billed for individuals who are enrolled in a managed care program.
If procedure code X0243 is billed as a complex multi-disciplinary assessment, modifier ‘22’ must be billed.
Service Coordination/Case Management Services as well as Rehabilitation Services should be billed in one-half (1/2) hour units rounding to the nearest half hour. Therefore, a service must last fifteen minutes or longer in order to bill for a half-hour unit. It is not permissible to add together several short visits to reach the minimum for a billable unit.
For all other service categories, the fee is based on a minimum 40-50 minute session.
All services, except for Evaluation Services, must be billed according to the information contained in the Individualized Family Service Plan (IFSP).
There is no recipient co-pay or patient liability for these services.
Early Intervention providers are limited to Early Intervention programs licensed and funded by the RI Department of Health in accordance with established State regulations.