Provider Notice issued 02/22/16

Clarification of Prior Approval for Children’s Physical and Occupational Therapy Services Effective with Dates of Service Beginning November 16, 2015

To: Enrolled Physical, Occupational and Speech Therapists; Physicians; Advanced Practice Nurses; Local Health Departments; Home Health Agencies; and Hospitals
Date: February 22, 2016
Re: Clarification of Prior Approval for Children’s Physical and Occupational Therapy Services Effective with Dates of Service Beginning November 16, 2015

The purpose of this Informational Notice is to clarify language in the notice “Prior Approval for Children’s Physical and Occupational Therapy Services Effective with Dates of Service Beginning November 16, 2015” released October 23, 2015.

That notice provided: “Children between the ages of 0 and 3 may be eligible to receive their physical and/or occupational therapy services through the Illinois Early Intervention (EI) Program, which provides resources and supports to children with diagnosed disabilities or developmental delays. Families should first make application to the Early Intervention Program for these services before the therapy provider submits a prior authorization request to the Department.”

To clarify:  Children between the ages of 0 and 3 who are determined eligible to receive their physical and/or occupational therapy services through the DHS EI Program may continue to utilize EI Program services.  The DHS EI Program will continue to authorize services for its participants.  Prior approval through HFS for EI services is not required.  If a child is not determined eligible for the EI Program, the therapy provider must submit a prior authorization request to HFS.

As a reminder, an objective developmental screening should first be conducted by the medical provider at priority intervals at the 9- and 18-month visits, and at the 24- and/or 30-month visits. Further guidance regarding objective developmental screening is in Section HK-203.5 of the Handbook for Providers of Healthy Kids Services.  A list of screening tools approved by HFS for reimbursement can be found in the Appendices. Based on the results of the screening or clinical judgment, children three years of age or younger needing a comprehensive evaluation for suspected developmental delay should be referred to the local EI Program Child and Family Connections (CFC) office. Providers are encouraged to make referrals using the “Standardized Illinois Early Intervention Referral Form” (HFS Form 650), available on HFS’ Medical Program Forms webpage. An Early Intervention Care Coordination Toolkit instructs providers how to use the standardized referral form.  A list of the 25 CFC offices in Illinois can be found at the Department of Human Services (DHS) Office Locator site.

Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 1-877-782-5565.

Felicia F. Norwood
Director