Funding

Funding Early Intervention Services

Funding Eligible Services

State and Federal law requires that early intervention services be provided to eligible children at no cost to families.  Pennsylvania’s Department of Public Welfare/Office of Child Development receives money from the federal and state government, including Medical Assistance, Infants, Toddlers and Families (ITF) Medicaid Waiver and State tax dollars.  The County Behavioral and Developmental Programs and Early Intervention Program receives an allocation from the Office of Child Development and provides local match dollars.  In accordance with 4226.13, Early Intervention funds may not be used to satisfy a financial commitment for early intervention services if another public or private funding source is available to pay for the services as it is the funding of last resort.

When a child is eligible for Early Intervention services, an Individualized Family Service Plan (IFSP) is developed and each service is listed indicating the type of funding that will be used.  Early Intervention eligible services can be funded in a variety of ways:

  • Infants, Toddlers and Families (ITF) Medicaid Waiver
  • Medical Assistance, EPSDT
  • Behavioral and Developmental Programs and Early Intervention Allocation
  • Private Insurance
  • Other/Generic Funding Sources

Non Early Intervention Services are also documented on the IFSP and coordinated by the Service Coordinators and can be funded through accessing Community Resources through programs such as WIC, SSI, etc.

Private insurance may be used with the consent of the parent to pay for early intervention services as long as such use will not result in a cost to the family, including but not limited to the following:

  • A decrease in available lifetime coverage or any other benefit under an insurance policy.
  • An increase in premiums or the discontinuation of the policy.
  • An out-of-pocket expense such as the payment of a deductible amount in filing a claim.

Families are also under no obligation to apply for Medical Assistance in order to pay for early intervention services.  However, Service Coordinators encourage and inform families about Medical Assistance benefits for children with disabilities regardless of parental income.

Services are available for children regardless of how services are funded. Services on the IFSP may not be denied or delayed because another public or private funding source, including Medicaid, is unavailable.

Some of the services that are eligible to be paid for through the Wayne County Early Intervention Program using the funding sources listed above, but are not limited to:

  • Assistive Technology
  • Physical Therapy
  • Audiology Services
  • Psychological Services
  • Family Training, Counseling
  • Service Coordination
  • Health Services
  • Social Work Services
  • Medical Services
  • Special Instruction
  • Nursing Services
  • Speech-Language Pathology
  • Nutrition Services
  • Transportation
  • Occupational Therapy
  • Vision Services

 Infants, Toddlers & Families Medicaid Waiver (ITF)

 

The Pennsylvania Department of Public Welfare has received approval from the Federal government to provide early intervention services funded under a Medicaid Waiver for infants, toddlers and families.  As a condition of federal financial participation and in accordance with Office of Child Development and Early Learning Bulletin # 00-98-07, Eligibility and Freedom of Choice in Medicaid Waiver for Infants, Toddlers & Families; the County and agencies providing services to infants and toddlers who receive services funded with these dollars must satisfy a certain level of care, as well as specific financial eligibility requirements.

To be eligible for ITF Waiver funded services, a child must:

  • Be determined to need early intervention services, which meet the definition of waiver habilitation.
  • Be eligible for Medical Assistance as determined by the County Assistance Office.
  • Be under the age of three years.
  • Meet the ICF/MR/ORC level of care criteria for the waiver, as determined by a qualified professional and the County MH/MR program:

–          A 50% delay in at least one or a 33% delay in at least two of the following developmental areas:

  • Cognitive
  • Physical, including hearing and vision
  • Communication
  • Social & Emotional
  • Adaptive or Self-Help

–     The child’s conditions are likely to continue indefinitely for a period of at least 12 months.

  • Have waiver funded services explained to and chosen by the child’s family or legal representative before waiver funded services are provided.
  • Be receiving services in the natural environment.
  • Be receiving services with the presence and participation of the child’s caregiver.

 

Every child will continue to receive services regardless of whether parents choose to participate in the waiver or other funding sources.

In accordance with Office of Child Development and Early Learning Bulletin

# 00-98-07, Eligibility and Freedom of Choice in Medicaid Waiver for Infants, Toddlers and Families Renewal; each child’s level of eligibility must be recertified at least once annually for the child to continue to be eligible for waiver funded IFSP services.  This recertification process will be conducted in conjunction with the child’s annual IFSP, whenever possible.

  • Families are assured of certain information and due process rights under the waiver in accordance with OCDEL Announcement: EI-08 #06, IDEA EI Complaint Procedures and OCDEL Announcement: EI – 07 #3, Mediation Procedure for Early Intervention, Pt C ITF Waiver Operating Agreement.  These rights are in addition to rights afforded under other federal and state funding streams, including EPSDT and Act 212.  The County MH/MR program is responsible for notifying the family regarding their rights under the various programs and funding streams and will provide assistance to families in filing due process, fair hearings, and appeals.  The families will be informed that they are still entitled to all safeguards, under IDEA Part C, regardless of their choice to obtain waiver funding or the determination of their child’s eligibility for waiver funded services.

Link to the Parent Guide to Due Process Hearings:

http://odr-pa.org/due-process/overview/

Interim payments

When necessary to prevent a delay in the receipt of early intervention services by an infant or toddler with a disability or the infant or toddler’s family, State early intervention funds may be used to pay the provider of services pending reimbursement from the funding source that has ultimate responsibility for the payment. Wayne County Behavioral and Developmental Programs and Early Intervention shall seek reimbursement from the responsible funding source to cover the interim payments made for early intervention services.

 Documentation of other funding sources

The service coordinator shall maintain written documentation that attempts have been made to exhaust all other private and public funding sources available to an infant or toddler with a disability and the infant or toddler’s family, as required by §  4226.13, in the infant or toddler’s record.  Specific procedures relating hereto are found in the Service Coordination section of this policy and procedure manual.