Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 50 - AMOUNT, DURATION, AND SCOPE OF MEDICAL AND REMEDIAL CARE SERVICES › Part III - Amount, Duration, and Scope of Services › Section 12VAC30-50-131 - Services provided by certified Early Intervention practitioners under EPSDT

Current through Register Vol. 40, No. 24, July 15, 2024
A. Definitions.
				  The following words and terms when used in these regulations shall have the
				  following meanings unless the context clearly indicates otherwise:
"DBHDS" means the Department of Behavioral Health and
					 Developmental Services, the lead state agency for Early Intervention services
					 appointed by the Governor in accordance with Chapter 53 (§ 2.2-5300 et
					 seq.) of Title 2.2 of the Code of Virginia.
"Early Intervention services" or "EI" means services
					 provided through Part C of the Individuals with Disabilities Education Act ( 20
					 USC § 1431 et seq.), as amended. Early Intervention services are
					 specialized rehabilitative services covered in accordance with
					 42 CFR
					 440.130(d), which are
					 designed to meet the developmental needs of each child and the needs of the
					 family related to enhancing the child's development, and are provided to
					 children from birth to age three who have (i) a 25% developmental delay in one
					 or more areas of development, (ii) atypical development, or (iii) a diagnosed
					 physical or mental condition that has a high probability of resulting in a
					 developmental delay.
"Individualized family service plan" or "IFSP" means a
					 comprehensive and regularly updated statement specific to the child being
					 treated containing, but not necessarily limited to, treatment or training
					 needs, measurable outcomes expected to be achieved, services to be provided
					 with the recommended frequency to achieve the outcomes, and estimated timetable
					 for achieving the outcomes. The IFSP is developed by a multidisciplinary team
					 that includes the family, under the auspices of the local lead agency.
"Local lead agency" means an agency under contract with the
					 Department of Behavioral Health and Developmental Services to facilitate
					 implementation of a local Early Intervention system as described in Chapter 53
					 (§ 2.2-5300 et seq.) of Title 2.2 of the Code of Virginia.
"Primary care provider" means a practitioner who provides
					 preventive and primary health care and is responsible for providing routine
					 Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) screening and
					 referral and coordination of other medical services needed by the child.
B. Coverage for Early Intervention
				  services.
1. Early Intervention services
				  shall be reimbursed for individuals younger than 21 years of age who meet
				  criteria for Early Intervention services established by DBHDS in accordance
				  with Chapter 53 (§ 2.2-5300 et seq.) of Title 2.2 of the Code of
				  Virginia.
2. Early Intervention
				  services shall be recommended by the child's primary care provider or other
				  qualified EPSDT screening provider as necessary to correct or ameliorate a
				  physical or mental condition.
3.
				  Early Intervention services shall be provided in settings that are natural or
				  normal for an infant or toddler without a disability, such as the home, unless
				  there is justification for an atypical location.
4. Except for the initial and periodic
				  assessments, Early Intervention services shall be described in an IFSP
				  developed by the local lead agency and designed to prevent or ameliorate
				  developmental delay within the context of the Early Intervention services
				  system defined by Chapter 53 (§ 2.2-5300 et seq.) of Title 2.2 of the Code
				  of Virginia.
5. Medical necessity
				  for Early Intervention services shall be defined by the IFSP. The IFSP shall
				  describe service needs in terms of amount, duration, and scope. The IFSP shall
				  be approved by the child's primary care provider.
6. Covered Early Intervention services
				  include the following functions provided with the infant or toddler and the
				  child's parent or other authorized caregiver by a certified Early Intervention
				  professional:
a. Assessment, including
				  consultation with the child's family and other service providers, to evaluate:
(1) The child's level of functioning in the
				  following developmental areas: cognitive development; physical development,
				  including vision and hearing; communication development; social or emotional
				  development; and adaptive development;
(2) The family's capacity to meet the
				  developmental needs of the child; and
(3) Services needed to correct or ameliorate
				  developmental conditions during the infant and toddler years. EI services
				  include, but are not limited to, PT, OT, and speech therapy as described in
				  42 CFR
				  440.110, and developmental/rehabilitative
				  services as described in 42
				  CFR 440.130(d). All licensed
				  PT, OT, and speech therapy providers shall comply with requirements of
				  42 CFR
				  440.110. All EI providers are certified to
				  provide EI services by the Virginia Department of Behavioral Health and
				  Developmental Services.
b. Participation in a multidisciplinary team
				  review of assessments to develop integrated, measurable outcomes for the
				  IFSP.
c. The planning and design of
				  activities, environments, and experiences to promote the normal development of
				  an infant or toddler with a disability, consistent with the outcomes in the
				  IFSP.
7. Covered Early
				  Intervention services include the following functions when included in the IFSP
				  and provided to an infant or toddler with a disability and the child's parent
				  or other authorized caregiver by a certified Early Intervention professional or
				  by a certified Early Intervention specialist under the supervision of a
				  certified Early Intervention professional:
a.
				  Providing families with information and training to enhance the development of
				  the child.
b. Working with the
				  child with a disability to promote normal development in one or more
				  developmental domains.
c.
				  Consulting with the child's family and other service providers to assess
				  service needs; and plan, coordinate, and evaluate services to ensure that
				  services reflect the unique needs of the child in all developmental
				  domains.