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PA Bulletin, Doc. No. 00-941



[55 PA. CODE CHS. 4225 AND 4226]

Early Intervention Services

[30 Pa.B. 2785]

Statutory Authority

   The Department of Public Welfare (Department), under the authority of the Early Intervention Services System Act (act) (11 P. S. §§ 875-102--875-503), proposes to adopt amendments to read set forth in Annex A.


   The Department is proposing regulations under the authority of the act that directs the Department to develop regulations for early intervention services for infants and toddlers under 3 years of age.

   Community Early Intervention was initiated in 1971 with Federal P. L. No. 89-313 money going directly from the Department of Education to early intervention provider agencies.

   Early Intervention categorical funding was initiated during fiscal year 1975-76. The Education Amendments Act of 1974, P. L. No. 93-380, defined the intent of Federal P. L. 89-313 moneys. The Education Amendments Act of 1974, contained a provision that the Federal P. L. No. 89-313 money earned must be given directly to that child who generated the funds, for the provision of supplemental educational services only.

   As a result of this, the Department was directed to cease targeting of funds to specific agencies. A program revision request was developed for $1.5 million to replace, with State money, the amount of excess targeted Federal money so that programs could remain operational once the Federal funds were distributed equally. Legislative approval of this request allowed the Department to continue participation in the Federal P. L. No. 89-313 program. By receipt of State dollars, all eligible agencies serving eligible children were able to apply for Federal and State money to supplement the early intervention program. All eligible agencies (those who were serving children and submitting child counts) were offered the opportunity to receive Federal P. L. No. 89-313 funds.

   The Federal Rights to Education Act 94-142 required all states having responsibility for the education of children with disabilities to have requirements for procedural safeguards. The Federal Department of Education Program Review of 1979 cited the Commonwealth, specifically the Department, for not having a system of procedural safeguards and surrogate parent provisions as required.

   The Department established Chapter 4225 (relating to procedural safeguards for children in early intervention) to specify procedures for providing procedural safeguards for notice and consent; confidentiality; placement in least restrictive environment; development, implementation and review of individual program plans; and protection in evaluation for children in early intervention services; and established the rights the families were required to receive.

   In 1986, the Individuals with Disabilities Education Act (IDEA) went into effect. Federal Part H of IDEA required the Department to provide procedural safeguards for children enrolled in the early intervention program and include the child's family in the family assessment.

   Federal Part H of IDEA required that states designate a lead agency to be responsible for the Early Intervention Program. The act designates the Department to be responsible for the early intervention program for infants and toddlers under 3 years of age. The act also requires early intervention funding to be distributed through the county Mental Health/Mental Retardation Program (HM/HR) Offices. The legal entity may meet this requirement to assure appropriate early intervention services by contracting with public or private agencies that meet all the requirements and program standards of the act. The act further directed the Department to define and address all the issues concerning early intervention services by promulgating program regulations.

   Since the act directed the Department to promulgate program regulations, policy bulletins were issued to clarify early intervention services requirements. Office of Mental Retardation Bulletins 4225-91-01; 4225-91-02; 4225-91-03; 4225-91-04; and 4225-91-05 were issued and the Department monitored the effect of the policy bulletins. Along with policy bulletins, intense involvement began for stakeholders to work in conjunction with the Department to draft early intervention program regulations.

   Effective in 1997, IDEA was amended by Congress to update the law and the 1997 Amendment replaced Part H with Part C.

   The purpose of this chapter is to assure that quality early intervention supports and services are consistently managed. These regulations address the needs of the child and the family's concerns, priorities and resources related to enhancing the development of the child with an individualized family service plan (IFSP). The chapter also establishes criteria for eligibility, contracting guidelines, standards for service delivery, staff qualifications and parental rights established in Part C of IDEA.

   These proposed draft regulations are deleting Chapter 4225, 21 Pa.B. 2953 (June 29, 1991). The procedural safeguards are incorporated into the draft program regulations that will be in Chapter 4226.

Regulatory Development Process

   A work plan describing the process and time frames that would be followed leading to final promulgation of Chapter 4226 was completed in July 1997. The plan provided for regular consultation with the State Interagency Coordinating Council, parents, early intervention consultants, early intervention provider organizations, legislative staff members and representatives from the county mental health and mental retardation program offices.

   On September 22 and 23, 1997, December 11, 1997, and March 3, 1998, group meetings were held with Statewide representatives from the State Interagency Coordinating Council, parents, early intervention consultant organizations, provider organizations, legislative staff and the county mental health and mental retardation program offices. The meetings were convened to give briefings on the scope of the new chapter and to obtain input on major issues of particular concern to the different individuals and organizations represented. These meetings were referred to as stakeholder meetings.

   The first in the series of meetings with stakeholders was convened on September 22 and 23, 1997. Prior to this meeting, invited participants were sent a preliminary draft of the proposed amendments. They were asked to review the document, submit written comments and attend the meeting prepared to make suggestions to improve the proposed amendments. Approximately 55 people were invited to attend the meeting.

   Based on group recommendations, the proposed amendments were revised and sent back to the stakeholder group for written comments. Written comments were considered and further regulatory revisions were drafted prior to the December 11, 1997, meeting. Based on group recommendations again, all parties at the stakeholder meeting held on December 11, 1997, agreed to parallel Federal language from Federal Part C of IDEA where possible in drafting the proposed amendments to early intervention.

   Written comments were again considered, and further revisions were drafted prior to the stakeholder meeting held on March 3, 1998, and prior to submission of this document as proposed rulemaking.


   These proposed amendments are intended to apply to the legal entities administering early intervention services. The proposed amendments will direct legal entities to develop and implement a Statewide family-centered, comprehensive, coordinated, multidisciplinary, interagency system that provides early intervention services for infants and toddlers with disabilities and their families. The legal entities will administer approximately 260 early intervention service providers to provide consistent early intervention services.


   Chapter 4226 regulations are written to be applied to the legal entities that administer early intervention services. In addition to the general provisions and the Definition sections, the proposed chapter is divided into sections that fall under six additional headings.

   The Financial Administration heading contains §§ 4226.11--4226.15 that explain how the money is allocated and how the financial obligations are mandated. The General Requirements heading contains §§ 4226.21--4226.43 that detail the eligibility process, screening process and the training process. The Personnel heading contains §§ 4226.51--4226.57 that explains staffing requirements and qualifications.

   The Evaluation and Assessment heading contains §§ 4226.61--4226.63 that details how the initial evaluation should be coordinated with the child's family. The Individualized Family Service Plans (IFSPs) heading contains §§ 4226.71--4226.75 that details procedures for the IFSP development, review and evaluation. The last heading, Procedural Safeguards, contains §§ 4226.91--4226.105 that explain hearings, appeals, mediations and parental rights. The Procedural Safeguards were in effect since 1983 and the Department is proposing to incorporate the safeguards into the proposed rulemaking.

Need for Proposal

   The General Assembly directed, in section 302(a) of the act, that the Department develop regulations to comply with the act and the Individuals with Disabilities Education Act, as amended by the Individuals with Disabilities Education Act Amendments of 1997, 20 U.S.C.A. §§ 1431--1445. Specifically, the Department was authorized to develop regulations to govern the methods for locating and identifying eligible children; criteria for eligible programs; contracting guidelines; personnel qualifications and a system of preservice and inservice training; early intervention services; procedural safeguards; appropriate placement, including the least restrictive environment; a system of quality assurance, including evaluation of the developmental appropriateness; quality and effectiveness of programs; assurance of compliance with the program standards; and provisions of assistance to assure compliance; data collection and confidentiality; interagency cooperation at the State and local level through the State interagency agreement and local interagency agreements; content and development of IFSPs; and any other issues which are required under the act and Part H and Part C.

   In addition, the Legislative Budget and Finance Committee (LBFC) under the authority of House Resolution 354 recommended the Department should promulgate program regulations as required by the act. The LBFC determined the early intervention program would benefit from the structure that program regulations provide and would also promote standardization of practices and procedures among counties.

Financial Management

§§ 4226.11--4226.15 (relating to financial management)

   The proposed financial management section on financial administration of early intervention services applies Chapter 4300 (relating to county mental health and mental retardation fiscal manual), to the legal entities to identify allowable costs and the responsibility to access all private and public funding sources.

   The section explains why legal entities are responsible for administering all early intervention services, whether or not the services are eligible under Medicaid waiver.

General Requirements

§ 4226.21 (relating to delegation of responsibilities)

   This section allows a legal entity to contract with another agency to execute necessary requirements of this chapter. Although a legal entity possibly will contract with another agency to deliver early intervention services, the legal entity retains responsibility for assuring compliance with the program.

§ 4226.22 (relating to eligibility for early intervention services)

   The criteria and standards by which legal entities shall measure early intervention services eligibility for all eligible children are defined in this section.

§ 4226.23 (relating to waiver eligibility)

   This section of the regulations relate to the Medicaid waiver for the infants, toddlers and families reflects responsibilities for administration of services funded under this waiver.

   The Medicaid waiver is established under section 1915(c) of the Social Security Act. Waiver funded services have been available to provide services for individuals with mental retardation, since 1983. The Medicaid waiver for infants, toddlers and families is approved for a 3 year period from July 1, 1998, to June 30, 2001, and may be renewed for additional 5 year periods based on the approval of the Secretary of the Department of Health and Human Services.

   Proposed waiver regulatory provisions mirror county responsibilities that have already been established by a Department under Mental Retardation Bulletin 00-98-05, titled: Supplemental Grant Agreement for the infants, toddlers and families waiver, issued May 7, 1998. County MH/MR Program offices are required to sign this agreement as agents of the Commonwealth to assure Federal requirements are being met.

   Regulations for administration of the waiver include provisions dealing with fiscal administration, eligibility, provider enrollment, freedom of choice safeguards, service management, and maintenance of state assurances required by the Federal Health Care Financing Administration. The regulations will establish requirements for independent multidisciplinary team evaluations; implementation of family-centered principles, and monitoring of cost and utilization of services. The legal entities would be responsible to administer services funded under this waiver in accordance with these proposed amendments.

§ 4226.24 (relating to comprehensive child find system)

   Available services are directed to be coordinated by the legal entity to allow eligible children within a defined geographical location the opportunity to receive all eligible early intervention services and supports. This pro-posed section requires a legal entity to develop an effective method to locate all eligible infants and toddlers and deliver the needed early intervention services. Legal entities must coordinate this child find system with the local interagency coordinating council and all other appropriate programs.

§§ 4226.25--4226.32 (relating to screening and tracking)

   These sections detail the processes of initial screening of children who may be eligible for early intervention services. They describe and provide information concerning how eligibility is determined and when the multidisciplinary evaluations (MDE) team makes recommendations for further evaluations.

   These sections define procedures to perform the screening as well as providing how information shall be shared in writing with the families. This information concerns the developmental status of their infants or toddlers and the supports and services that will be available to address the individualized needs of each child and family, based on the priorities and resources identified by the family.

   The criteria for an at-risk child is defined here as stated in the act, and the legal entity is directed to develop a tracking system for at-risk children.

§ 4226.33 (relating to legal entity monitoring responsibilities)

   This section requires a legal entity to monitor its early intervention service providers. The legal entity is required to monitor all early intervention services that occur within a defined geographical location, or any services that are contracted to an agency outside its defined geographical location. The legal entity is required to monitor each early intervention service provider at least once every 12 months.

§ 4226.34 (relating to community evaluations)

   The regulations will require at least once in every 3 years, the legal entity to conduct an early intervention self-assessment review to ensure that all early intervention services are accomplishing their desired program goals and to ensure family satisfaction is occurring.

   The Department will continue to develop the assessment process and provide training to the legal entities. During the past 5 years, the Department was paying an outside entity to develop and pilot an assessment instrument, based on Federal and State statute and Department policy bulletins. The Department has been using a formalized monitoring instrument for 3 years. The assessment process and the instrument for self-assessment are based on family-centered principles and other best practices.

§§ 4226.35--4226.37 (relating to training; preservice training; and annual training)

   All professional and para-professional personnel providing early intervention services will be required to have preservice training as outlined in the regulations prior to working with family and children.

   The Department will determine how many hours of training early intervention staff will receive on an annual basis. At least 24 hours of training on an annual basis seems to be the most appropriate. This training is required to be in early childhood developmental and health areas.

§ 4226.38 (relating to criminal history record check)

   This section is proposed to ensure that the legal entities comply with, and monitor the Child Protective Services Law, 23 Pa.C.S. §§ 6301--6384 (Act 33). Although all legal entities and all early intervention service agencies must already comply with Act 33, a section in the proposed Early Intervention regulations will reinforce to all staff persons what is required in Act 33.

§ 4226.41 (relating to traditionally underserved groups)

   To ensure that all proposed populations within a defined geographical location are equally involved in the planning and implementation of early intervention services, this section is intended to allow families access to culturally competent services.

§§ 4226.42 (relating to local interagency coordinating council)

   When the act was enacted, the Department was directed to establish and maintain local interagency coordinating councils for defined geographic areas. This council is required by the Education of the Handicapped Act Amendments of 1986 (P. L. No. 99-457, 100 Stat. 1145).

   This section directs the legal entity to ensure the local interagency coordinating councils are established, and to whom membership is to be limited. This section clarifies the powers and duties of the local council and establishes its authorization in the advisement and comments on the development of local interagency agreements. This section directs the local interagency coordinating council with whom it shall communicate regarding local interagency agreements.


§§ 4226.51--4226.57 (relating to personnel)

   The personnel sections define and outline specific qualifications and activities required of services coordinators and the early interventionists who perform early intervention services within each legal entity. A grandfather clause is included in the personnel qualifications for hiring and promoting before the effective date of these regulations.

   The Department reviewed the literature regarding personnel qualifications and considered other regulations that are being applied to similar services. The Department determined that early interventionists and service coordinators do not have state-required certification, licensure or registration. The qualifications and activities outlined in these regulations are comparable with similar services in other regulations.

Evaluation and Assessment

§§ 4226.61--4226.63 (relating to evaluation and assessment)

   These proposed sections require evaluation and assessment to determine initial and ongoing eligibility for early intervention services. Evaluation and assessment provides information for IFSP. These sections propose to mandate parental consent and nondiscriminatory practices.


§§ 4226.71--4226.75 (relating to IFSP)

   The outcome of evaluation and assessment is a written plan using information obtained during the evaluation and assessment process. The IFSP is a detailed description of services and supports, which will be provided to an infant or toddler and family, for a maximum period of 12 months with a review process every 6 months or less.

   Federal Part C of IDEA specifies that the family is required to be involved in the planning, development, review and evaluation of the IFSP.

   These sections detail the IFSP, which must be completed for each eligible child. Guidelines for the development, review, evaluation and content of the IFSP are detailed; when and where an IFSP meeting will be conducted is detailed; participants to be included in IFSP meetings and reviews are listed; and the steps for transition from early intervention are explained.

Procedural Safeguards

§§ 4226.91--4226.105 (relating to conflict resolution procedures and parental rights)

   In these sections of the proposed amendments, the Department outlines procedures, parental rights and child status within a program during review and resolution of individual complaints.

   These sections define the provisions of the procedural safeguards system for infants, toddlers and their families. The sections specify the legal entities' responsibilities relative to the actual processing of requests from families and the requirements that must be met to assist the families in understanding their rights regarding consent, native language, personally identifiable information and the parent's rights to examine records or to decline services.

   Federal Part C of the 1997 amendments to IDEA specify that mediation between the legal entity and families is required for all issues concerning the early intervention services each child is receiving. This section requires the legal entity to ensure that procedures are adopted to allow the mediation process to occur.

   This section outlines policies and procedures available to families, on a voluntary basis, for resolution of disputes through an independent mediation process.

§ 4226.105 (relating to surrogate parents)

   This section will establish the procedures a legal entity must adopt to ensure the rights of eligible children when appointing surrogate parents.

   Also in this section, the qualifications and rights of surrogate parents and foster parents will be established.

Summary of Fiscal Note

   In drafting proposed Chapter 4226, consideration was given to the effect the regulations will have on the cost of providing early intervention services. These regulations incorporate requirements already imposed under the act, Part C of the IDEA, and accompanying regulations, and the infants, toddlers and families Medicaid waiver approved by the Health Care Financing Administration, all of which are currently in place. Therefore, no additional cost or savings is anticipated.

Paper Requirements

   There are no additional paperwork requirements for these proposed amendments.

Effective Date

   The final-form regulations will take effect upon publication as final rulemaking in the Pennsylvania Bulletin.

Sunset Date

   No sunset date has been established for these proposed amendments.

Public Hearings

   The Department will hold public hearings as follows:

Western Region
July 17, 2000
Western Instructional Support Center
5347 William Flynn Highway, Route 8
Gibsonia, PA 15044
10 a.m.--1 p.m.
Central Region
July 24, 2000
Central Instructional Support Center
6340 Flank Drive, Suite 600
Harrisburg, PA 17112
10 a.m.--1 p.m.
Southeast Region
July 25, 2000
Eastern Instructional Support Center
200 Anderson Road
King of Prussia, PA 19406
10 a.m.--1 p.m.

   Requests to provide verbal comments are to be addressed to:

Mary PuskarichTom Harfman
Western Region OMRNortheast Region OMR
1403 State Office Building315 State Office Building
300 Liberty Avenue100 Lackawanna Avenue
Pittsburgh, PA 15222Scranton, PA 18503
(412) 565-5144(570) 963-4391
Vicki Stillman-ToomeyPaul Hindman
Southeast Region OMRCentral Region OMR
306 State Office BuildingRoom 430 Willow Oak    Building
1400 Spring Garden StreetP. O. Box 2675
Philadelphia, PA 19130Harrisburg, PA 17105-2675
(215) 560-2247(717) 772-6507

   Individuals wishing to comment at the public forums are requested to limit their comments to 5 minutes. Three copies of written comments are also requested to be provided.

Public Comment Period

   Interested parties are invited to submit written comments, suggestions or objections regarding the proposed amendments to the Department of Public Welfare, Mel Knowlton, P. O. Box 2675, Harrisburg, PA 17105-2675, (717) 783-5764, fax (717) 787-6583 within 60-calendar days after the date of publication in the Pennsylvania Bulletin. All comments received within 60-calendar days will be reviewed and considered in the preparation of the final-form regulations. Comments received after the 60-day comment period will be considered for subsequent revisions of these proposed amendments.

Regulatory Review Act

   Under section 5(a) of the Regulatory Review Act (71 P. S. § 745.5(a)) on May 23, 2000, the Department submitted a copy of these proposed amendments to the Independent Regulatory Review Commission (IRRC) and to the Chairpersons of the House Committee on Aging and Youth and the Senate Committee on Public Health and Welfare. In addition to submitting the proposed amendments, the Department has provided IRRC and the Committees with a copy of a detailed Regulatory Analysis Form prepared by the Department in compliance with Executive Order 1996-1, ''Regulatory Review and Promulgation.'' A copy of this material is available to the public upon request.

   Under section 5(g) of The Regulatory Review Act, if IRRC has objections to any portion of the proposed amendments, it will notify the Department within 10 days of the close of the Committees' review period. The notification shall specify the regulatory review criteria, which have not been met by that portion. The Regulatory Review Act specifies detailed procedures for review, prior to final publication of the amendments of objections raised by the Department, the General Assembly and the Governor.


   Fiscal Note:  14-452. No fiscal impact; (8) recommends adoption.

Annex A




   (Editor's Note:  As part of this rulemaking, the Department is proposing to delete the text of Chapter 4225, which appears at 55 Pa. Code pages 4225-1--4225-27, serial pages (247755)--(247786). The following Chapter 4226 is new. It has been printed in regular type to enhance readability.)

§§ 4225.1--4225.4.  (Reserved).

§§ 4225.11--4225.15.  (Reserved).

§§ 4225.21--4225.50.  (Reserved).

§§ 4225.61--4225.64.  (Reserved).

§§ 4225.71--4225.82.  (Reserved).

§§ 4225.91--4225.99.  (Reserved).

§§ 4225.101--4225.106.  (Reserved).



4226.4.Legal authority.


4226.11.Financial administration.
4226.12.Waiver funds.
4226.13.Nonsubstitution of funds.
4426.14.Documentation of other funding sources.
4226.15.Interim payments.


4226.21.Delegation of responsibilities.
4226.22.Eligibility for early intervention services.
4226.23.Waiver eligibility.
4226.24.Comprehensive child find system.
4226.25.Initial screening.
4226.26.Purpose of initial screening.
4226.27.Content of screening.
4226.28.Recommendation to parents.
4226.29Notice of parent.
4226.30.At-risk children.
4226.31.Tracking system.
4226.32.Contacting families.
4226.33.Monitoring responsibilities.
4226.34.Community evaluations.
4226.36.Preservice training.
4226.37.Annual training.
4226.38.Criminal history records check.
4226.39.Penalties for noncompliance.
4226.41.Traditionally underserved groups.
4226.42.Local interagency coordinating council.
4226.43.Confidentiality of information.


4226.51.Service coordination.
4226.52.Provision of service coordination.
4226.54.Requirements and qualifications.
4226.55.Early interventionist.
4226.56.Requirements and qualifications.
4226.57.Effective date of personnel qualifications.


4226.61.Parental consent.
4226.63.Nondiscriminatory procedures.


4226.72.Procedures for IFSP development, review and evaluation.
4226.73.Participants in IFSP meetings and periodic reviews.
4226.74.Content of an IFSP.
4226.75.Provision of services before evaluation and assessment are completed.


4226.91.General responsibility of legal entity program for procedural safeguards.
4226.92.Notice of rights.
4226.93.Conflict resolution.
4226.95.Consent and native language information.
4226.96.Opportunity to examine records.
4226.97.Prior notice; native language.
4226.98.Parent consent.
4226.99.Parental right to decline service.
4226.100.Administrative resolution of individual child complaints by an impartial decisionmaker.
4226.101.Parent rights in administrative hearings.
4226.102.Impartial hearing officer.
4226.103.Convenience of proceedings; timeliness.
4226.104.Status of a child during proceedings.
4226.105.Surrogate parents.


§ 4226.1.  Introduction.

   (a)  Early intervention services and supports are provided to families and eligible children under 3 years of age maximize the child's developmental potential. Early intervention services for an infant and toddler are provided in conformity with an IFSP.

   (b)  Early intervention services are founded on a partnership between families and early intervention personnel which is focused on the unique needs of the child and the concerns and priorities of each family and builds on family and community resources.

§ 4226.2.  Purpose.

   This chapter establishes required procedures and standards for the early intervention program.

§ 4226.3.  Applicability.

   This chapter applies to a legal entity providing early intervention services.

§ 4226.4.  Noncompliance.

   The failure of a public legal entity to comply with this chapter so that needs of children eligible under this chapter are not being adequately met, shall subject the public legal entity to penalties consistent with section 512 of the Mental Health and Mental Retardation Act of 1966 (50 P. S. § 4512).

§ 4226.5.  Definitions.

   The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:

   Appropriate professional requirements--Entry level requirements that:

   (i)  Are based on the highest requirements in the profession or discipline in which a person is providing early intervention services to enable the individual to obtain licensure, certification or registration in the profession.

   (ii)  Establish suitable qualifications for personnel providing early intervention services under this part to eligible children and their families who are served by public and private agencies.

   Assessment--The ongoing procedures used throughout the period of a child's eligibility under this part to identify the following:

   (i)  The child's unique strengths and needs and the services appropriate to meet those needs.

   (ii)  The resources, priorities and concerns of the family and the identification of supports and services necessary to enhance the family's capacity to meet the developmental needs of its infant or toddler with a disability.

   Assistive technology device--An item, piece of equipment or product system, whether acquired commercially off the shelf, modified or customized, that is used to increase, maintain or improve the functional capabilities of children with disabilities.

   Assistive technology service--A service that directly assists a child with a disability in the selection, acquisition or use of an assistive technology device. The term includes:

   (i)  The evaluation of the needs of a child with a disability, including a functional evaluation of the child in the child's customary environment.

   (ii)  Purchasing, leasing or otherwise providing for the acquisition of assistive technology devices by children with disabilities.

   (iii)  Selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing or replacing assistive technology devices.

   (iv)  Coordinating and using other therapies, interventions or services with assistive technology devices, such as those associated with existing education and rehabilitation plans and programs.

   (v)  Training or technical assistance for a child with disabilities or, if appropriate, that child's family.

   (vi)  Training or technical assistance for professionals (including individuals providing early intervention services) or other individuals who provide services to or are otherwise substantially involved in the major life functions of individuals with disabilities.

   At risk infant or toddler--An individual under 3 years of age eligible for screening and tracking as defined by the Early Intervention Systems Services Act (11 P. S. §§ 875-101--875-503).

   Audiology services--Includes the following:

   (i)  Identification of children with auditory impairment, using audiologic screening techniques.

   (ii)  Determination of the range, nature and degree of hearing loss and communication functions, by use of audiological evaluation procedures.

   (iii)  Referral for medical and other services necessary for the habilitation or rehabilitation of children with auditory impairment.

   (iv)  Provision of auditory training, aural rehabilitation, speech reading and listening device orientation and training, and other services.

   (v)  Provision of services for prevention of hearing loss.

   (vi)  Determination of the child's need for individual amplification, including selecting, fitting, and dispensing appropriate listening and vibrotactile devices, and evaluating the effectiveness of those devices.

   Child--An individual under 3 years of age who has been determined eligible for services under this chapter.

   County MH/MR program (legal entity)--A MH/MR program established by a county or two or more counties acting in concert and includes a complex of services providing a continuum of care in the community for the mentally disabled.

   Department--The Department of Public Welfare of the Commonwealth.

   Developmental delay--The extent or type of developmental delay that a child demonstrates to be eligible for early intervention services.

   Early intervention program--The development, management and administration of the delivery of services in a geographic location that is directed toward meeting the developmental needs of children and their families eligible under this chapter.

   Early intervention services--Developmental services that are:

   (i)  Provided under public supervision.

   (ii)  Provided at no cost to families.

   (iii)  Designed to meet the developmental needs of an infant or toddler with a disability in any one or more of the following areas:

   (A)  Physical development.

   (B)  Cognitive development.

   (C)  Communication development.

   (D)  Social or emotional development.

   (E)  Adaptive development.

   (iv)  Meeting the requirements of this chapter.

   (v)  Including the following:

   (A)  Family training, counseling and home visits.

   (B)  Special instruction.

   (C)  Speech-language pathology and audiology services.

   (D)  Occupational therapy.

   (E)  Physical therapy.

   (F)  Psychological services.

   (G)  Service coordination services.

   (H)  Medical services only for diagnostic or evaluation purposes.

   (I)  Early identification, screening and assessment services.

   (J)  Health services necessary to enable the infant or toddler to benefit from the other early intervention services.

   (K)  Social work services.

   (L)  Vision services.

   (M)  Assistive technology devices and assistive technology services.

   (N)  Transportation and related costs that are necessary to enable an infant or toddler and the infant's or toddler's family to receive another service described in this paragraph.

   (vi)  Provided by qualified personnel, including at a minimum, the following:

   (A)  Special educators.

   (B)  Speech-language pathologists and audiologists.

   (C)  Occupational therapists.

   (D)  Physical therapists.

   (E)  Psychologists.

   (F)  Social workers.

   (G)  Nurses.

   (H)  Nutritionists.

   (I)  Family therapists.

   (J)  Orientation and mobility specialists.

   (K)  Pediatricians and other physicians.

   (L)  Early interventionists.

   (M)  Service coordinators.

   Evaluation--Procedures used to determine a child's initial and continuing eligibility under this chapter, consistent with the definition of ''infants and toddlers with disabilities'' including determining the status of the child in each of the developmental areas.

   Family training, counseling and home visits--Services provided by social workers, psychologists and other qualified personnel to assist the family of a child eligible under this chapter in understanding the special needs of the child and enhancing the child's development.

   Health services--

   (i)  Services necessary to enable a child to benefit from the other early intervention services during a time that the child is receiving medical intervention. The term includes the following:

   (A)  Clean intermittent catheterization, tracheostomy care, tube feeding, the changing of dressings or colostomy collection bags.

   (B)  Consultation by physicians with other service providers concerning the special health care needs of an eligible child that will need to be addressed in the course of providing other early intervention services.

   (ii)  The term does not include the services that are:

   (A)  Surgical in nature (such as cleft palate surgery, surgery for club foot or the shunting of hydrocephalus).

   (B)  Purely medical in nature (such as hospitalization for management of congenital heart ailments, or the prescribing of medicine or drugs for any purpose).

   (C)  Devices necessary to control or treat a medical condition.

   (D)  Medical-health services (such as immunizations and regular ''well-baby'' care) that are routinely recommended for all children.

   IFSP--Individualized family service plan--A written plan for providing early intervention services to a child eligible under this chapter and the child's family.

   Infant and toddler with disabilities--An individual under 3 years of age who needs early intervention because the individual meets one of the following conditions:

   (i)  Is experiencing developmental delays in one or more of the areas of cognitive development, physical development, communication development, social or emotional development, and adaptive development.

   (ii)  Has a diagnosed physical or mental condition which has a high probability of resulting in developmental delay.

   Legal entity--A public or private entity responsible for administering the early intervention program in a defined geographical location.

   Location--The actual place where a service will be provided.

   MDE--Multidisciplinary evaluation.

   Method--How a service is provided including whether the service is given directly to the child with family/child care participation or without family/child care participation, or if the service is provided as instruction to the family or caregiver.

   Multidisciplinary--The involvement of two or more disciplines or professions in the provision of integrated and coordinated services, including evaluation and assessment activities and development of the IFSP.

   Native language--The language or mode of communication normally used by the parent of an eligible child. If the parent is deaf or blind, or has no written language, the mode of communication shall be that normally used by the parent (such as sign language, braille or oral communication). The written information is translated orally or by other means to the parent in the parent's native language or other mode of communication.

   Natural environments--Settings that are natural or normal for the child's age peers who have no disabilities.

   Nursing services--Include:

   (i)  The assessment of health status for the purpose of providing nursing care, including the identification of patterns of human response to actual or potential health problems.

   (ii)  Provision of nursing care to prevent health problems, restore or improve functioning, and promote optimal health and development.

   (iii)  Administration of medications, treatments and regimens prescribed by a licensed physician.

   Nutrition services--Include:

   (i)  Conducting individual assessments in the following:

   (A)  Nutritional history and dietary intake.

   (B)  Anthropometric, biochemical and clinical variables.

   (C)  Feeding skills and feeding problems.

   (D)  Food habits and food preferences.

   (ii)  Developing and monitoring appropriate plans to address the nutritional needs of children eligible under this chapter, based on the findings in subparagraph (i).

   (iii)  Making referrals to appropriate community resources to carry out nutrition goal.

   Occupational therapy--An array of services to address the functional needs of a child related to adaptive development, adaptive behavior and play, and sensory, motor and postural development, which are designed to improve the child's functional ability to perform tasks in home, school and community settings, and includes the following:

   (i)  Identification, assessment and intervention.

   (ii)  Adaptation of the environment, and selection, design, and fabrication of assistive and orthotic devices to facilitate development and promote the acquisition of functional skills.

   (iii)  Prevention or minimization of the impact of initial or future impairment, delay in development or loss of functional ability.

   Parent--A natural or adoptive parent, a guardian, a person acting as a parent of a child or a surrogate parent who has been appointed under § 4226.105 (relating to surrogate parents). The term does not include the county agency.

   Personally identifiable information--Information that would make it possible to identify a particular child or family including one or more of the following:

   (i)  The name of the child, the child's parent or other family member.

   (ii)  The address of the child or family.

   (iii)  A personal identifier, such as the child's or parent's Social Security number.

   (iv)  A list of personal characteristics or other information that would make it possible to identify the child with reasonable certainty.

   Physical therapy--An array of services to address the promotion of sensory/motor function through enhancement of musculoskeletal status, neurobehavioral organization, perceptual and motor development, cardiopulmonary status, and effective environmental adaptation, and includes:

   (i)  Screening, evaluation and assessment of infants and toddlers to identify movement dysfunction.

   (ii)  Obtaining, interpreting and integrating information appropriate to program planning to prevent, alleviate or compensate for movement dysfunction and related functional problems.

   (iii)  Providing individual and group services or treatment to prevent, alleviate or compensate for movement dysfunction and related functional problems.

   Psychological services--Includes:

   (i)  Administering psychological and developmental tests and other assessment procedures.

   (ii)  Interpreting assessment results.

   (iii)  Obtaining, integrating and interpreting information about child behavior, and child and family conditions related to learning, mental health, and development.

   (iv)  Planning and managing a program of psychological services, including psychological counseling for children and parents, family counseling, consultation on child development, parent training and education programs.

   Qualified--Meeting State-approved or recognized certification, licensing, registration or other comparable requirements that apply to the area in which the person is providing early intervention services.

   Service coordination (case management)--The activities carried out by a service coordinator to assist and enable an eligible child and the child's family to receive the rights, procedural safeguards and services that are authorized to be provided under the early intervention program.

   Special instruction--Includes:

   (i)  The design of learning environments and activities that promote the child's acquisition of skills in a variety of developmental areas, including cognitive processes and social interaction.

   (ii)  Curriculum planning, including the planned interaction of personnel, materials and time and space, that leads to achieving the outcomes in the child's individualized family service plan.

   (iii)  Providing families with information, skills and support related to enhancing the skill development of the child.

   (iv)  Working with the child to enhance the child's development.

   Speech-language pathology--Includes:

   (i)  Identification of children with communicative or oropharyngeal disorders and delays in development of communication skills, including the diagnosis and appraisal of specific disorders and delays in those skills.

   (ii)  Referral for medical or other professional services necessary for the habilitation or rehabilitation of children with communicative or oropharyngeal disorders and delays in development of communication skills.

   (iii)  Provision of services for the habilitation, rehabilitation or prevention of communicative or oropharyngeal disorders and delays in development of communication skills.

   Transportation and related costs--Includes the cost of travel (for example--mileage, or travel by taxi, common carrier, or other means) and other costs (for example--tolls and parking expenses) that are necessary to enable a child eligible under this part and the child's family to receive early intervention services.

   Vision services--Includes:

   (i)  Evaluation and assessment of visual functioning, including the diagnosis and appraisal of specific visual disorders, delays and abilities.

   (ii)  Referral for medical or other professional services necessary for the habilitation or rehabilitation of visual functioning disorders, or both.

   (iii)  Communication skills training, orientation and mobility training for all environments, visual training, independent living skills training and additional training necessary to activate visual motor abilities.


§ 4226.11.  Financial administration.

   Chapter 4300 (relating to county mental health and mental retardation fiscal manual) applies to the County Mental Health and Mental Retardation Program legal entity for purposes of identifying allowable costs and for the general financial administration of early intervention services.

§ 4226.12.  Waiver funds.

   The legal entity shall allocate and expend supplemental grant funds for the provision of services for infants, toddlers and families under the home and community waiver known as the Infant, Toddlers and Families Medicaid Waiver approved by the Department of Health and Human Services under section 1915(c) of the Social Security Act (42 U.S.C.A. § 1396n(c)).

§ 4226.13.  Nonsubstitution of funds.

   (a)  Early intervention State funds may not be used to satisfy a financial commitment for services that would have been paid for from another public or private funding sources. A legal entity is responsible for providing all of the early intervention services in the child's IFSP whether or not those services are eligible under the Medicaid program.

   (b)  Parents who have private insurance are not required to use their insurance. The parents may volunteer to use their insurance. Parents will not suffer financial losses, which include one or more of the following:

   (1)  A decrease in available lifetime coverage or any other benefit under an insurance policy.

   (2)  An increase in premiums or the discontinuation of the policy.

   (3)  An out-of-pocket expense such as the payment of a deductible amount in filing a claim.

§ 4226.14.  Documentation of other funding sources.

   (a)  Written documentation that all other private and public funding sources available to the child and family have been accessed and exhausted shall be kept with the child and family's permanent legal entity's file.

   (b)  Written procedures used by the legal entity, and approved by the Department, to identify and access all other private and public funding sources shall be kept.

§ 4226.15.  Interim payments.

   (a)  When necessary to prevent a delay in the receipt of early intervention services by an infant, toddler or family in a timely fashion, early intervention State funds shall be used to pay the provider of services pending reimbursement from the agency or funding source that has ultimate responsibility for the payment.

   (b)  The legal entity shall seek reimbursement from the appropriate funding source to cover the interim payments incurred for early intervention services.


§ 4226.21.  Delegation of responsibilities.

   The legal entity shall comply with this chapter. The legal entity may contract with another agency for delivery of services that are required in this chapter. The legal entity shall ensure compliance by all agencies providing services under the requirements of this chapter.

§ 4226.22.  Eligibility for early intervention services.

   (a)  The legal entity shall ensure that early intervention services are provided to all eligible children who meet one or more of the following eligibility criteria:

   (1)   The child is experiencing a developmental delay, as measured by appropriate diagnostic instruments and procedures indicating that the child is delayed by 25% of the child's chronological age in one or more developmental areas:

   (i)  Cognitive development.

   (ii)  Physical development, including vision and hearing.

   (iii)  Communication development.

   (iv)  Social or emotional development.

   (v)  Adaptive development.

   (2)  The child is delayed in one or more of the developmental areas: cognitive development; physical development, including vision and hearing; communication development; social or emotional development; or adaptive development. Delay in developmental areas shall be documented by the test performance of 1.5 standard deviations below the mean on accepted or recognized standard tests for infants and toddlers.

   (3)  The child has a diagnosed physical or mental condition which has a high probability of resulting in a developmental delay as specified in paragraph (1). A child who is determined by a multidisciplinary team as having an identifiable physical or mental condition, but who is not exhibiting delays in a developmental area at the time of diagnosis, is included as a child with a high probability of resulting in developmental delay.

   (b)  Informed clinical opinion may be used when there are no standardized measures or the standardized procedures are not appropriate for a child's chronological age or developmental area. Informed clinical opinion makes use of qualitative and quantitative information to assist in forming a determination regarding difficult-to-measure aspects of current developmental status and the potential need for early intervention.

§ 4226.23.  Waiver eligibility.

   (a)  The legal entity shall ensure that infants and toddlers until the age of 3 are eligible for level of care in accordance with the criteria for an ICF/MR or ICF/ORC as follows:

   (1)  A licensed psychologist, certified school psychologist or a licensed physician shall certify that the applicant or recipient has significantly subaverage intellectual functioning which is documented by one of the following:

   (i)  Performance that is more than two standard deviations below the mean as measurable on a standardized general intelligence test.

   (ii)  Performance that is slightly higher than two standard deviations below the mean of a standardized general intelligence test during a period when the person manifests serious impairments or adaptive behavior.

   (2)  A professional shall certify that the applicant or recipient has other related conditions that include cerebral palsy and epilepsy, as well as other conditions--such as autism-- other than mental illness--that result in impairments of general intellectual functioning or adaptive behavior, and require early intervention services and treatment.

   (3)  A professional certifies that the applicant or recipient has impairments in adaptive behavior as provided by an assessment of adaptive functioning which shows that the applicant or recipient has one of the following:

   (i)  Significant limitations in meeting the standards of maturation, learning, personal independence or social responsibility of the applicant's or recipient's age and cultural group evidenced by a minimum of a 50% delay in one or 33% delay in two of the following developmental areas:

   (A)  Cognitive development.

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