Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 500 - EARLY INTERVENTION PROGRAM › Subpart C - SERVICE DELIVERY REQUIREMENTS › Section 500.115 - Service Provider Requirements

Current through Register Vol. 48, No. 28, July 12, 2024
Service providers shall:
a) Not bill families for authorized EI
				services.
b) Participate in
				evaluation/assessment activities and the development, review and revision of
				IFSPs in a timely and comprehensive manner, and provide EI services in a family
				centered, ethical and culturally competent manner. Family members are to be an
				integral part of service planning, the child's participation in EI services,
				and the outcomes identified in the IFSP.
c) Provide accurate services as set forth in
				the IFSP in a timely manner.
d)
				Contact the Service Coordinator to request multidisciplinary team approval for
				proposed changes in the delivery of services to eligible children and to
				request parental consent prior to implementing any changes to services listed
				on the IFSP.
e) Agree that they
				shall not bill or receive reimbursement from the Department's centralized
				billing system for services in excess of what is authorized in the
				IFSP.
f) Agree not to terminate
				services for an eligible child without written notification to the child's
				Service Coordinator and family at least 30 days prior to the anticipated date
				of service termination.
g) Meet and
				maintain all applicable standards and regulations for individual and program
				licensure, certification and credentialing. Comply with all applicable State
				and federal laws and regulations for physical facilities in which services are
				made available.
h) Provide
				evaluation reports and direct service reports to the Service Coordinator as
				required by this Part and as necessary to the provision of EI services
				consistent with federal and State requirements.
i) Submit invoice of charges for billable
				services following service delivery, according to Department billing
				requirements.
j) With the parent's
				informed consent to use private insurance, unless an exemption is granted to a
				family, bill private insurance and/or any and all other third party payors
				before submitting invoices for EI reimbursement.
1) Bill the child's insurance carrier for
				each unit of EI service for which coverage may be available.
2) When the service is not exempted,
				providers who receive a denial of payment on the basis that the service is not
				covered under any circumstance under the plan are not required to bill that
				carrier for that service again until the following insurance benefit year. That
				explanation of benefits denying the claim, once submitted to the central
				billing office, shall be sufficient to meet the requirements of this subsection
				(j)(2) as to subsequent services billed under the same billing code provided to
				that child during that insurance benefit year.
3) Any time limit on a provider's filing of a
				claim for payment with the central billing office that is imposed through a
				policy, procedure, or rule of the Department shall be suspended until the
				provider receives an explanation of benefits or other final determination of
				the claim it files with the child's insurance carrier.
4) In all instances when an insurance carrier
				has been billed for EI services, whether paid in full, paid in part, or denied
				by the carrier, the provider must provide the central billing office, within 90
				days after receipt, a copy of the explanation of benefits form and other
				required information.
5) When the
				insurance carrier has denied the claim or paid an amount for the EI service
				billed that is less than the current State rate for EI services, the provider
				shall submit the explanation of benefits with a claim for payment, and the
				Department shall pay the provider the difference between the sum actually paid
				by the insurance carrier for each unit of service provided under the IFSP and
				the current State rate for EI services.
6) The State shall also pay the family's
				co-payment or co-insurance under its plan, but only to the extent that those
				payments plus the balance of the claim do not exceed the current State rate for
				EI services.
7) The provider may
				under no circumstances bill the family for the difference between its charge
				for services and that paid by the insurance carrier or by the State.