Illinois Compiled Statutes
Chapter 325 - CHILDREN
325 ILCS 20/ - Early Intervention Services System Act.

(325 ILCS 20/1) (from Ch. 23, par. 4151)
Sec. 1.
Short Title.
This Act may be cited as the Early Intervention Services System Act.

(Source: P.A. 87-680.)

(325 ILCS 20/2) (from Ch. 23, par. 4152)
Sec. 2.
Legislative Findings and Policy.
(a) The General Assembly finds that there is an urgent and substantial
need to:
(b) The General Assembly therefore intends that the policy of this
State shall be to:
(c) The General Assembly further finds that early intervention services
are cost-effective and effectively serve the developmental needs of
eligible infants and toddlers and their families. Therefore, the purpose
of this Act is to provide a comprehensive, coordinated, interagency,
interdisciplinary early intervention services system for eligible infants
and toddlers and their families by enhancing the capacity to provide quality
early intervention services, expanding and improving existing services, and
facilitating coordination of payments for early intervention services from
various public and private sources.

(Source: P.A. 91-538, eff. 8-13-99.)

(325 ILCS 20/3) (from Ch. 23, par. 4153)
Sec. 3. Definitions. As used in this Act:
(a) "Eligible infants and toddlers" means infants and toddlers
under 36 months of age with any of the following conditions:
"Eligible infants and toddlers" includes any child under the age of 3 who is the subject of a substantiated case of child abuse or neglect as defined in the federal Child Abuse Prevention and Treatment Act.
(b) "Developmental delay" means a delay in one or more of the following
areas of childhood development as measured by appropriate diagnostic
instruments and standard procedures: cognitive; physical, including vision
and hearing; language, speech and communication; social or emotional;
or adaptive. The term means a delay of 30% or more below the mean in
function in one or more of those areas.
(c) "Physical or mental condition which typically results in developmental
delay" means:
(d) "Informed clinical opinion" means both clinical observations and
parental participation to determine eligibility by a consensus of a
multidisciplinary team of 2 or more members based on their professional
experience and expertise.
(e) "Early intervention services" means services which:
(f) "Individualized Family Service Plan" or "Plan" means a written plan for
providing early intervention services to a child eligible under this Act
and the child's family, as set forth in Section 11.
(g) "Local interagency agreement" means an agreement entered into by
local community and State and regional agencies receiving early
intervention funds directly from the State and made in accordance with
State interagency agreements providing for the delivery of early
intervention services within a local community area.
(h) "Council" means the Illinois Interagency Council on Early
Intervention established under Section 4.
(i) "Lead agency" means the State agency
responsible for administering this Act and
receiving and disbursing public funds received in accordance with State and
federal law and rules.
(i-5) "Central billing office" means the central billing office created by
the lead agency under Section 13.
(j) "Child find" means a service which identifies eligible infants and
toddlers.
(k) "Regional intake entity" means the lead agency's designated entity
responsible for implementation of the Early Intervention Services System within
its designated geographic area.
(l) "Early intervention provider" means an individual who is qualified, as
defined by the lead agency, to provide one or more types of early intervention
services, and who has enrolled as a provider in the early intervention program.
(m) "Fully credentialed early intervention provider" means an individual who
has met the standards in the State applicable to the relevant
profession, and has met such other qualifications as the lead agency has
determined are suitable for personnel providing early intervention services,
including pediatric experience, education, and continuing education. The lead
agency shall establish these qualifications by rule filed no later than 180
days
after the effective date of this amendatory Act of the 92nd General Assembly.
(n) "Telehealth" has the meaning given to that term in Section 5 of the Telehealth Act.
(Source: P.A. 101-10, eff. 6-5-19; 102-104, eff. 7-22-21; 102-926, eff. 5-27-22.)

(325 ILCS 20/3a)
Sec. 3a. Lead poisoning. No later than July 1, 2020, the lead agency shall adopt rules to update 89 Ill. Adm. Code 500.Appendix E by: (i) expanding the list of Medical Conditions Resulting in High Probability of Developmental Delay to include lead poisoning as a medical condition approved by the lead agency for the purposes of this Act; and (ii) defining "confirmed blood lead level" and "elevated blood lead level" or "EBL" to have the same meanings ascribed to those terms by the Department of Public Health in 77 Ill. Adm. Code 845.20.

(Source: P.A. 101-10, eff. 6-5-19; 101-599, eff. 12-6-19.)

(325 ILCS 20/3b)
Sec. 3b. Services delivered by telehealth. An early intervention provider may deliver via telehealth any type of early intervention service outlined in subsection (e) of Section 3 to the extent of the early intervention provider's scope of practice as established in the provider's respective licensing Act consistent with the standards of care for in-person services. This Section shall not be construed to alter the scope of practice of any early intervention provider or authorize the delivery of early intervention services in a setting or in a manner not otherwise authorized by the laws of this State.

(Source: P.A. 102-104, eff. 7-22-21.)

(325 ILCS 20/4) (from Ch. 23, par. 4154)
Sec. 4. Illinois Interagency Council on Early Intervention.
(a) There is established the Illinois Interagency Council on Early
Intervention. The Council shall be composed of at least 20 but not more than
30 members. The members of the Council and the designated chairperson of the
Council shall be appointed by the Governor. The Council member representing the
lead agency may not serve as chairperson of the Council. The Council shall be
composed of the following members:
The Council shall meet at least quarterly and in such places as it deems
necessary. Terms of the initial members appointed under paragraph (2) shall be
determined by lot at the first Council meeting as follows: of the persons
appointed under subparagraphs (A) and (B), one-third shall serve one year
terms, one-third shall serve 2 year terms, and one-third shall serve 3 year
terms; and of the persons appointed under subparagraphs (C) and (D), one
shall serve a 2 year term and one shall serve a 3 year term. Thereafter,
successors appointed under paragraph (2) shall serve 3 year terms. Once
appointed, members shall continue to serve until their successors are
appointed. No member shall be appointed to serve more than 2 consecutive
terms.
Council members shall serve without compensation but shall be reimbursed
for reasonable costs incurred in the performance of their duties, including
costs related to child care, and parents may be paid a stipend in accordance
with applicable requirements.
The Council shall prepare and approve a budget using funds appropriated
for the purpose to hire staff, and obtain the services of such
professional, technical, and clerical personnel as may be necessary to
carry out its functions under this Act. This funding support and staff
shall be directed by the lead agency.
(b) The Council shall:
No member of the Council shall cast a vote on or participate substantially
in any matter which would provide a direct financial benefit to that member
or otherwise give the appearance of a conflict of interest under State law.
All provisions and reporting requirements of the Illinois Governmental Ethics
Act shall apply to Council members.

(Source: P.A. 97-902, eff. 8-6-12; 98-41, eff. 6-28-13.)

(325 ILCS 20/5) (from Ch. 23, par. 4155)
Sec. 5. Lead Agency. The Department of Human Services is designated the
lead agency and shall
provide leadership in establishing and implementing the coordinated,
comprehensive, interagency and interdisciplinary system of early intervention
services. The lead agency shall not have the sole responsibility for
providing these services. Each participating State agency shall continue
to coordinate those early intervention services relating to health, social
service and education provided under this authority.
The lead agency is responsible for carrying out the following:

(325 ILCS 20/6) (from Ch. 23, par. 4156)
Sec. 6.
Local Structure and Interagency Councils.
The lead agency,
in conjunction with the Council
and as defined by
administrative rule,
shall
define local service areas and define the
geographic boundaries of each so that all areas of the State are included
in a local service area but no area of the State is included in more than
one service area. In each local service area, the lead agency
shall designate a regional entity responsible for the
assessment of
eligibility and services and a local interagency council responsible for
coordination and design of child find and public awareness. The regional
entity shall be responsible for
staffing the local council, carrying out child find and public awareness
activities, and providing advocacy for eligible families within the given
geographic area. The regional entity is the prime
contractor
responsible to the lead agency for implementation of this
Act.
The lead agency, in conjunction with the Council, shall create local
interagency councils. Members of each local interagency council shall
include, but not be limited to, the following: parents; representatives
from coordination and advocacy service providers; local education agencies;
other local public and private service providers; representatives from
State agencies at the local level; and others deemed necessary by the local
council.
Local interagency councils shall:
(Source: P.A. 91-538, eff. 8-13-99.)

(325 ILCS 20/7) (from Ch. 23, par. 4157)
Sec. 7. Essential Components of the Statewide Service System. As
required by federal laws and regulations, a statewide system of
coordinated, comprehensive, interagency and interdisciplinary programs shall
be established and maintained. The framework of the statewide system shall
be based on the components set forth in this Section. This framework shall
be used for planning, implementation, coordination and evaluation of the
statewide system of locally based early intervention services.
The statewide system shall include, at a minimum:
In addition to these required components, linkages may be established
within a local community area among the prenatal initiatives affording
services to high risk pregnant women. Additional linkages among at risk
programs and local literacy programs may also be established.
Within 60 days of the effective date of this Act, a five-fiscal-year
implementation plan shall be submitted to the Governor by the lead agency
with the concurrence of the Interagency Council on Early Intervention. The
plan shall list specific activities to be accomplished each year, with cost
estimates for each activity. No later than the second Monday in July of
each year thereafter, the lead agency shall, with the concurrence of the
Interagency Council, submit to the Governor's Office a report on
accomplishments of the previous year and a revised list of activities for
the remainder of the five-fiscal-year plan, with cost estimates for each.
The Governor shall certify that specific activities in the plan for the
previous year have been substantially completed before authorizing relevant
State or local agencies to implement activities listed in the revised plan
that depend substantially upon completion of one or more of the earlier
activities.

(Source: P.A. 98-41, eff. 6-28-13.)

(325 ILCS 20/8) (from Ch. 23, par. 4158)
Sec. 8. Authority to Promulgate Rules and Regulations. The lead
agency shall develop rules and regulations under this Act within one year
of the effective date of this Act. These rules shall reflect the intent of
federal regulations adopted under Part C of the Individuals with Disabilities Education Improvement Act of 2004 (Sections 1431 through 1444 of Title 20 of the United States Code).

(Source: P.A. 97-902, eff. 8-6-12.)

(325 ILCS 20/9) (from Ch. 23, par. 4159)
Sec. 9. Role of Other State Entities. The Departments of Public
Health, Human Services, Children and Family
Services, and Healthcare and Family Services; the University of Illinois Division of Specialized
Care for Children; the State Board of Education;
and any other State agency which directly or
indirectly provides or administers early intervention services shall adopt
compatible rules for the provision of services to eligible infants and
toddlers and their families within one year of the effective date of this Act.
These agencies shall enter into and maintain formal interagency
agreements to enable the State and local agencies serving eligible children
and their families to establish working relationships that will increase
the efficiency and effectiveness of their early intervention services. The
agreement shall outline the administrative, program and financial
responsibilities of the relevant State agencies and shall implement a
coordinated service delivery system through local interagency agreements.
There shall be created in the Office of the Governor an Early Childhood
Intervention Ombudsman to assist families and local parties in ensuring
that all State agencies serving eligible families do so in a comprehensive
and collaborative manner.

(Source: P.A. 98-41, eff. 6-28-13.)

(325 ILCS 20/10) (from Ch. 23, par. 4160)
Sec. 10. Standards. The Council and the lead agency, with assistance
from parents and providers, shall develop and promulgate policies and
procedures relating to the establishment and implementation of program and
personnel standards to ensure that services provided are consistent with
any State-approved or recognized certification, licensing, registration, or
other comparable requirements which apply to the area of early intervention
program service standards. Only State-approved public or private early
intervention service providers shall be eligible to receive State and
federal funding for early intervention services. All early childhood
intervention staff shall hold the highest entry requirement necessary for that
position.
To be a State-approved early intervention service provider, an individual
(i) shall
not have served or completed, within the preceding 5 years, a sentence for
conviction of any felony that the Department establishes by rule and (ii) shall
not have been indicated as a perpetrator of child abuse or neglect, within the
preceding 5 years, in an investigation by Illinois (pursuant to the Abused and
Neglected Child Reporting Act) or another state. The Department is authorized
to receive criminal background checks for such providers and persons applying
to be such a provider and to receive child abuse and neglect reports regarding
indicated perpetrators who are applying to provide or currently authorized to
provide early intervention services in Illinois. Beginning January 1, 2004,
every provider of State-approved early intervention services and every
applicant to provide
such services must authorize, in writing and in the form required by the
Department, a State and FBI criminal background check, as requested by the Department, and check of child abuse and neglect
reports regarding the provider or applicant as a condition of authorization to
provide early intervention services. The Department shall use the results of
the checks only to determine State approval of the early intervention service
provider and shall not re-release the information except as necessary to
accomplish that purpose.

(Source: P.A. 98-41, eff. 6-28-13.)

(325 ILCS 20/11) (from Ch. 23, par. 4161)
Sec. 11. Individualized Family Service Plans.
(a) Each eligible infant or toddler and that infant's or toddler's family
shall receive:
(b) The Individualized Family Service Plan shall be evaluated once a year
and the family shall be provided a review of the Plan at 6-month intervals or
more often where appropriate based on infant or toddler and family needs.
The lead agency shall create a quality review process regarding Individualized
Family Service Plan development and changes thereto, to monitor
and help ensure that resources are being used to provide appropriate early
intervention services.
(c) The initial evaluation and initial assessment and initial
Plan meeting must be held within 45 days after the initial
contact with the early intervention services system. The 45-day timeline does not apply for any period when the child or parent is unavailable to complete the initial evaluation, the initial assessments of the child and family, or the initial Plan meeting, due to exceptional family circumstances that are documented in the child's early intervention records, or when the parent has not provided consent for the initial evaluation or the initial assessment of the child despite documented, repeated attempts to obtain parental consent. As soon as exceptional family circumstances no longer exist or parental consent has been obtained, the initial evaluation, the initial assessment, and the initial Plan meeting must be completed as soon as possible. With parental consent,
early intervention services may commence before the completion of the
comprehensive assessment and development of the Plan. All early intervention services shall be initiated as soon as possible but not later than 30 calendar days after the consent of the parent or guardian has been obtained for the individualized family service plan, in accordance with rules adopted by the Department of Human Services.
(d) Parents must be informed that early
intervention
services shall be provided to each eligible infant and toddler, to the maximum extent appropriate, in the natural
environment, which may include the home or other community settings. Parents must also be informed of the availability of early intervention services provided through telehealth services. Parents
shall make
the final decision to accept or decline
early intervention services, including whether accepted services are delivered in person or via telehealth services. A decision to decline such services shall
not be a basis for administrative determination of parental fitness, or
other findings or sanctions against the parents. Parameters of the Plan
shall be set forth in rules.
(e) The regional intake offices shall explain to each family, orally and
in
writing, all of the following:
(f) The individualized family service plan must state whether the family
has private insurance coverage and, if the family has such coverage, must
have attached to it a copy of the family's insurance identification card or
otherwise
include all of the following information:
(g) A copy of the individualized family service plan must be provided to
each enrolled provider who is providing early intervention services to the
child
who is the subject of that plan.
(h) Children receiving services under this Act shall receive a smooth and effective transition by their third birthday consistent with federal regulations adopted pursuant to Sections 1431 through 1444 of Title 20 of the United States Code. Beginning January 1, 2022, children who receive early intervention services prior to their third birthday and are found eligible for an individualized education program under the Individuals with Disabilities Education Act, 20 U.S.C. 1414(d)(1)(A), and under Section 14-8.02 of the School Code and whose birthday falls between May 1 and August 31 may continue to receive early intervention services until the beginning of the school year following their third birthday in order to minimize gaps in services, ensure better continuity of care, and align practices for the enrollment of preschool children with special needs to the enrollment practices of typically developing preschool children.
(Source: P.A. 101-654, eff. 3-8-21; 102-104, eff. 7-22-21; 102-209, eff. 11-30-21 (See Section 5 of P.A. 102-671 for effective date of P.A. 102-209); 102-813, eff. 5-13-22; 102-962, eff. 7-1-22.)

(325 ILCS 20/12) (from Ch. 23, par. 4162)
Sec. 12. Procedural safeguards. The lead agency shall adopt procedural safeguards that meet federal
requirements and ensure effective implementation of the safeguards
for families
by each
public agency involved in the provision of early intervention
services under this Act.
The procedural safeguards shall provide, at a minimum, the following:
(Source: P.A. 100-159, eff. 8-18-17.)

(325 ILCS 20/13) (from Ch. 23, par. 4163)
Sec. 13. Funding and Fiscal Responsibility.
(a) The lead agency and every
other participating State agency may receive and expend funds appropriated
by the General Assembly to implement the early intervention services system
as required by this Act.
(b) The lead agency and each participating State agency shall identify
and report on an annual basis to the Council the State agency funds utilized
for the provision of early intervention services to eligible infants and
toddlers.
(c) Funds provided under Section 633 of the Individuals with
Disabilities Education Act (20 United States Code 1433) and State funds
designated or appropriated for early intervention services or programs
may not be used to satisfy a
financial commitment for services which would have been paid for from
another public or private source but for the enactment of this Act, except
whenever considered necessary to prevent delay in receiving appropriate early
intervention services by the eligible infant or toddler or family in a
timely manner. "Public or private source" includes public and private
insurance coverage.
Funds provided under Section 633 of the Individuals with
Disabilities Education Act
and State funds designated or appropriated for early intervention services or
programs
may be used by the lead agency to pay the
provider of services (A) pending reimbursement from the appropriate State
agency
or (B) if (i) the claim for payment is denied in whole or in part by a public
or private source, or would be denied under the written terms of the public
program or plan or private plan, or (ii) use of private insurance for the
service has been exempted under Section 13.25. Payment under item (B)(i) may
be made based on a pre-determination telephone inquiry supported by written
documentation of the denial supplied thereafter by the insurance carrier.
(d) Nothing in this Act shall be construed to permit the State to reduce
medical or other assistance available or to alter eligibility under Title V
and Title XIX of the Social Security Act relating to the Maternal Child
Health Program and Medicaid for eligible infants and toddlers in this State.
(e) The lead agency shall create a central billing office to receive and
dispense all relevant State and federal resources, as well as local
government or independent resources available, for early intervention
services. This office shall assure that maximum federal resources are
utilized and that providers receive funds with minimal duplications or
interagency reporting and with consolidated audit procedures.
(f) The lead agency shall, by rule, create a system of
payments by families, including
a schedule of fees. No fees, however, may be charged for: implementing
child find,
evaluation and assessment, service coordination, administrative and
coordination activities related to the development, review, and evaluation of
Individualized Family Service Plans, or the implementation of procedural
safeguards and other administrative components of the statewide early
intervention system.
The system of payments, called family fees, shall be
structured on a sliding
scale based on the family's ability to pay. The family's coverage
or lack
of coverage under a public or private insurance plan or
policy
shall not be a factor in determining the amount of the
family fees.
Each family's fee obligation shall be
established annually, and shall be paid by
families to
the central billing office in
installments. At the written request of the family, the fee obligation shall be
adjusted prospectively at any point during the year upon proof of a change in
family income or family size. The inability of the parents
of an eligible child to pay family fees due to catastrophic
circumstances or extraordinary expenses shall not result in
the denial of services to the child or the child's family.
A family must document its extraordinary expenses or other catastrophic
circumstances
by showing one of the following: (i) out-of-pocket medical expenses in excess
of 15% of gross income; (ii) a fire, flood, or other disaster causing a direct
out-of-pocket loss in excess of 15% of gross income; or (iii) other
catastrophic
circumstances causing out-of-pocket losses in excess of 15% of gross income.
The family must present proof of loss to its service coordinator, who shall
document it, and the lead agency shall determine
whether the fees shall be reduced, forgiven, or suspended within 10 business
days after
the family's request.
(g) To ensure that early intervention funds are used as the payor of last
resort for early intervention services, the lead agency shall determine at the
point of early intervention intake, and again at any periodic review of
eligibility thereafter or upon a change in family circumstances, whether the
family is eligible for or enrolled in any program for which payment is made
directly or through public or private insurance for any or all of the early
intervention services made available under this Act. The lead agency shall
establish procedures to ensure that payments are made either directly from
these public and private sources instead of from State or federal early
intervention funds, or as reimbursement for payments previously made from State
or federal early intervention funds.

(Source: P.A. 98-41, eff. 6-28-13.)

(325 ILCS 20/13.5)
Sec. 13.5. Other programs.
(a) When an application or a review of
eligibility for early
intervention services is made, and at any
eligibility redetermination
thereafter, the family shall be asked if it
is currently enrolled in
any federally funded, Department of Healthcare and Family Services administered, medical programs, or the Title V program
administered by the University of Illinois
Division of
Specialized Care for Children. If the
family is enrolled in any of these
programs, that information shall be put on
the individualized family service
plan and entered into the computerized case
management system, and shall
require that the individualized family
services plan of a child who has been
found eligible for services through the
Division of Specialized Care for
Children state that the child is enrolled
in that program. For those
programs in which the family is not
enrolled, a preliminary eligibility
screen shall be
conducted simultaneously
for (i) medical assistance
(Medicaid) under
Article V of the Illinois Public Aid Code, (ii)
children's
health insurance program (any federally funded, Department of Healthcare and Family Services administered, medical programs) benefits
under the
Children's Health Insurance Program Act, and (iii)
Title V
maternal and child health services provided
through the
Division of Specialized Care for Children of the
University
of Illinois.
(b) For purposes of determining family fees
under
subsection (f) of Section 13 and determining
eligibility for
the other programs and services specified in
items (i)
through (iii) of subsection (a), the lead agency
shall
develop and use, within 60 days after the effective
date of
this amendatory Act of the 92nd General Assembly,
with the
cooperation of the Department of Public Aid (now Healthcare and Family Services)
and the
Division
of Specialized Care for Children of the
University of
Illinois, a screening device that provides
sufficient
information for the early intervention regional
intake
entities or other agencies to establish eligibility for
those
other programs
and shall, in cooperation with the Illinois
Department of Public Aid (now Healthcare and Family Services) and the Division
of Specialized Care for Children, train the
regional intake entities
on using the screening device.
(c) When a child is
determined eligible for and enrolled
in the early intervention
program and has been found to at least meet
the threshold income
eligibility requirements for any federally funded, Department of Healthcare and Family Services administered, medical programs, the regional intake entity
shall complete an application for any federally funded, Department of Healthcare and Family Services administered, medical programs with the family and forward it
to the
Department of Healthcare and Family Services for a determination of
eligibility. A parent shall not be required to enroll in any federally funded, Department of Healthcare and Family Services administered, medical programs as a condition of receiving services provided pursuant to Part C of the Individuals with Disabilities Education Act.
(d) With the cooperation of the Department of Healthcare and Family Services, the lead agency shall establish procedures that
ensure
the timely and maximum allowable recovery of payments
for all
early intervention services and allowable
administrative
costs under Article V of the Illinois Public Aid
Code and the
Children's Health Insurance Program Act and shall include
those procedures in the interagency agreement required under subsection (e) of
Section 5 of this Act.
(e) For purposes of making referrals for final
determinations of eligibility for any federally funded, Department of Healthcare and Family Services administered, medical programs benefits
under the Children's Health Insurance Program Act and for medical assistance
under Article V of the Illinois Public Aid Code,
the lead agency shall require each early intervention regional intake entity to
enroll as an application agent in order for the entity to complete any federally funded, Department of Healthcare and Family Services administered, medical programs
application as authorized under Section 22 of the Children's Health Insurance
Program Act.
(f) For purposes of early intervention services that may be provided
by the Division of Specialized Care for Children of the University of Illinois
(DSCC), the lead agency shall establish procedures whereby the early
intervention regional
intake entities may determine whether children enrolled in the early
intervention program may also be eligible for those services, and shall
develop, within 60 days after the effective date of this amendatory Act of the
92nd General Assembly, (i) the inter-agency agreement required under subsection
(e) of Section 5 of this Act, establishing that early intervention funds are to
be used as the payor of last resort when services required under an
individualized family services plan may be provided to an eligible child
through the DSCC, and (ii) training
guidelines for the regional intake entities
and providers that explain eligibility and billing procedures for
services through DSCC.
(g) The lead agency shall require that an
individual applying for or renewing
enrollment as a provider of services in the
early intervention program state whether or
not he or she is also enrolled as a DSCC
provider. This information shall be noted
next to the name of the provider on the
computerized roster of Illinois early
intervention providers, and regional intake
entities shall make every effort to refer
families eligible for DSCC services to
these providers.

(Source: P.A. 98-41, eff. 6-28-13.)

(325 ILCS 20/13.10)
Sec. 13.10.
Private health insurance;
assignment. The lead agency
shall determine, at the point of new applications
for early
intervention services, and for all children enrolled
in the early
intervention program, at the regional intake offices,
whether
the child is insured under a private health insurance
plan or
policy.

(Source: P.A. 98-41, eff. 6-28-13.)

(325 ILCS 20/13.15)
Sec. 13.15. Billing of insurance carrier.
(a) Subject to the restrictions against
private
insurance use on the basis of material risk of
loss of
coverage, as determined under Section 13.25, each
enrolled
provider who is providing a family with early
intervention
services shall bill the child's insurance carrier for
each
unit
of early intervention service for
which coverage may be
available. The lead agency may exempt from the
requirement of this paragraph any early intervention service
that it has deemed not to be covered by insurance plans.
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 paragraph as to subsequent services billed under the same
billing code provided to that child during that insurance benefit year. 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 lead agency 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.
(b) In all instances when an insurance carrier has
been billed for early intervention 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, with a copy
of the explanation
of benefits form and other information in the manner prescribed by the lead
agency.
(c) When the insurance carrier has denied the
claim or paid an amount for the early intervention service
billed that is less than the current State rate for early
intervention services, the provider shall submit the
explanation of benefits with a claim for payment, and the lead
agency shall pay the provider the difference between the sum
actually paid by the insurance carrier for each unit of service
provided under the individualized family service plan and
the current State rate for early intervention services.
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 early intervention services. The
provider may under no circumstances bill the family for the
difference between its charge for services and that which
has been paid by the insurance carrier or by the State.

(Source: P.A. 97-813, eff. 7-13-12.)

(325 ILCS 20/13.20)
Sec. 13.20.
Families with insurance coverage.
(a) Families of children with insurance
coverage,
whether public or private, shall incur no greater
or less
direct out-of-pocket expenses for early intervention
services
than families who are not insured.
(b) Managed care plans.
(Source: P.A. 92-307, eff. 8-9-01.)

(325 ILCS 20/13.25)
Sec. 13.25.
Private insurance; exemption.
(a) The lead
agency shall establish procedures for a
family, whose child is eligible to receive early
intervention
services, to apply for an exemption restricting the
use of
its private insurance plan or policy based on
material risk
of loss of coverage as authorized under subsection (c) of this Section.
(b) The lead agency shall make a final determination on a request
for an
exemption within 10 business days after its receipt of a
written
request for an exemption at the regional intake
entity.
During that 10 days, no claims may be filed
against the
insurance plan or policy. If the exemption is
granted, it
shall be noted on the individualized family service
plan, and
the family and the providers serving the family
shall be
notified in writing of the exemption.
(c) An exemption may be granted on the basis of material risk of loss of
coverage only if the family
submits documentation with its request for an exemption that
establishes (i) that the
insurance plan or policy covering the child is an
individually
purchased plan or policy and has been purchased by a
head of a
household that is not eligible for a group medical insurance
plan, (ii) that the policy or plan has a
lifetime cap that applies to one or more specific types of early
intervention services specified in the family's individualized family service
plan, and that coverage could be exhausted during the period covered by the
individualized
family service plan, or
(iii) proof of another risk that the lead agency, in its discretion, may have
additionally established and defined as a ground for exemption by rule.
(d) An exemption under this Section based on material risk of loss of
coverage may apply
to all
early intervention services and all plans or
policies
insuring the child, may be limited to one or more
plans or
policies, or may be limited to one or more types
of early
intervention services in the child's individualized
family
services plan.

(Source: P.A. 92-307, eff. 8-9-01.)

(325 ILCS 20/13.30)
Sec. 13.30. System of personnel development. The lead agency shall provide training to early intervention providers and may
enter into contracts to meet this requirement. If such contracts are let, they
shall be bid under a public request for
proposals that shall be posted on the lead agency's early intervention website
for
no less than 30 days. This training shall include, at
minimum, the following types of instruction:
(a) Courses
in birth-to-3 evaluation and treatment of children with
developmental disabilities and delays
(1) that are taught by fully credentialed early intervention providers or
educators with
substantial experience in evaluation and treatment of
children from birth to age 3 with developmental
disabilities and delays, (2) that cover these topics within each of
the disciplines of audiology, occupational therapy,
physical therapy, speech and language pathology, and
developmental therapy, including the social-emotional domain of development,
(3) that are held no less than
twice per year, (4) that offer no fewer than 20 contact
hours per year of course work, (5) that are held in no
fewer than 5 separate locales throughout the State, and
(6) that give enrollment
priority to early intervention providers who do not meet
the
experience, education, or continuing education requirements
necessary to be fully credentialed early intervention providers; and
(b) Courses held no less than twice per year for
no fewer than 4 hours each in no fewer than 5 separate
locales throughout the State each on the following topics:
(Source: P.A. 98-41, eff. 6-28-13.)

(325 ILCS 20/13.32)
Sec. 13.32.
Contracting.
The lead agency may enter into contracts for some
or all of its responsibilities under this Act, including but not limited to,
credentialing and enrolling providers; training under Section 13.30;
maintaining a central billing office; data collection and analysis;
establishing and maintaining a computerized case management system accessible
to local referral offices and providers; creating and maintaining a system for
provider credentialing and enrollment; creating and maintaining the central
directory required under subsection (g) of Section 7 of this Act; and program
operations. If contracted, the contract shall be subject to a public request
for proposals as described in the Illinois Procurement Code, notwithstanding
any exemptions or alternative processes that may be allowed for such a contract
under that Code, and, in addition to the posting requirements under that Code,
shall be posted on the early intervention website maintained by the lead agency
during the entire bid period. With the exception of contracts with or grants to
regional intake entities, any of these listed responsibilities currently under
contract or grant that have not met these requirements shall be subject to
public bid under this request for proposal process no later than July 1, 2002
or the date of termination of any contract in place.
Contracts with or grants to regional intake entities must be made subject to
public bid under a request for proposals process no later than July 1, 2005.

(Source: P.A. 92-307, eff. 8-9-01; 93-147, eff. 1-1-04.)

(325 ILCS 20/13.50)
Sec. 13.50. (Repealed).

(Source: P.A. 96-1000, eff. 7-2-10. Repealed by P.A. 98-41, eff. 6-28-13.)

(325 ILCS 20/14) (from Ch. 23, par. 4164)
Sec. 14.
(Repealed).

(Source: P.A. 87-680. Repealed by P.A. 91-538, eff. 8-13-99.)

(325 ILCS 20/15) (from Ch. 23, par. 4165)
Sec. 15.

The Auditor General of the State shall conduct a follow-up
evaluation of the system established under this Act, in order to evaluate
the effectiveness of the system in providing services that enhance the
capacities of families throughout Illinois to meet the special needs of
their eligible infants and toddlers, and provide a report of the evaluation
to the Governor and the General Assembly no later than April 30, 2002. Upon
receipt by the lead agency, this report shall be posted on
the early intervention website.

(Source: P.A. 92-307, eff. 8-9-01.)

(325 ILCS 20/16) (from Ch. 23, par. 4166)
Sec. 16.
This Act takes effect upon becoming law.

(Source: P.A. 87-680.)

(325 ILCS 20/20)
Sec. 20.
Early Intervention Services Revolving Fund.
There is created a
revolving fund to be known as the Early Intervention Services Revolving Fund,
to be held by the lead agency.
The Early Intervention Services Revolving Fund shall be used to the extent
determined necessary by the lead agency to pay for early intervention services.
Local Accounts for such purposes may be established by the lead agency.
Expenditures from the Early Intervention Services Revolving Fund shall be
made in accordance with applicable program provisions and shall be limited to
those purposes and amounts specified under applicable program guidelines.
Funding of the Fund shall be from family fees, insurance company payments,
federal financial participation received as reimbursement for expenditures from
the Fund, and appropriations made to the State agencies involved in the
payment for early intervention services under this Act.
Disbursements from the Early Intervention Services Revolving Fund shall be
made as determined by the lead agency or its designee. Funds in the Early
Intervention Services Revolving Fund or the local accounts created under this
Section that are not immediately required for expenditure may be invested in
certificates of deposit or other interest bearing accounts.
Any interest earned shall be deposited in the Early
Intervention Services Revolving Fund.

(Source: P.A. 89-106, eff. 7-7-95; 89-499, eff. 6-28-96.)