Chapter DHS 90

DHS 90.11(1)(b)6. 6. Coordinating with medical and other health care providers; and

DHS 90.11(1)(b)7. 7. Facilitating the development of transition plans under s. DHS 90.10 (5) (f).

DHS 90.11(1)(c) (c) Qualifications of the service coordinator.

DHS 90.11(1)(c)1. 1. A service coordinator shall have at least one year of supervised experience working with families with special needs, and have demonstrated knowledge and understanding about:

DHS 90.11(1)(c)1.a. a. Children in the age group birth to 3 who are eligible for the program;

DHS 90.11(1)(c)1.b. b. Part C and the federal implementing regulations, 34 CFR Pt. 303, and this chapter; and

DHS 90.11(1)(c)1.c. c. The nature and scope of services available under the birth to 3 program and how these are financed.

DHS 90.11(1)(c)2. 2. The service coordinator may be a person from the list of qualified personnel in s. DHS 90.08 (3) (b), another person with experience and training indicated under subd. 1. or a parent facilitator.

DHS 90.11(2) (2) Early intervention services—general conditions and general role of providers.

DHS 90.11(2)(a) (a) General conditions for early intervention services.

DHS 90.11(2)(a)1. 1. Appropriate early intervention services for an eligible child and the child’s family, provided to the maximum extent appropriate to the needs of the child in natural environments, including the home and community settings in which children without disabilities participate, shall be based on the developmental needs of the child and shall be provided with the written consent of the parent. Services shall be provided in collaboration with the parent, by qualified personnel, and in compliance with this chapter and Part C requirements.

DHS 90.11(2)(a)2. 2. The county administrative agency shall provide or arrange for the provision of early intervention core services at no cost to the child’s parent and shall provide or arrange for the provision of other early intervention services identified in the child’s IFSP. The county administrative agency shall determine the parental cost share of early intervention services costs not met by third party payers in accordance with s. DHS 90.06 (2) (i).

DHS 90.11(2)(a)3. 3. Funds allocated for the birth to 3 program may not be used to satisfy a financial commitment for services that would have been paid for from another public or private source if it were not for the establishment of the program. Funds allocated for the birth to 3 program may only be used for early intervention services that an eligible child needs but is not currently entitled to under any other federal, state, local government or private funding source.

DHS 90.11 Note Note: Federal law at 20 USC 1479 permits the use of birth to 3 program funds to provide a free and appropriate public education, in accordance with the requirements of 20 USC 1411 to 1420, to children with disabilities from their third birthday to the beginning of the following school year.

DHS 90.11(2)(b) (b) General role of early intervention service providers.

DHS 90.11(2)(b)1. 1. A provider of early intervention services shall do all of the following:

DHS 90.11(2)(b)1.a. a. Follow the requirements of this chapter;

DHS 90.11(2)(b)1.b. b. Consult with parents, other service providers and community agencies to ensure that the service is effective;

DHS 90.11(2)(b)1.c. c. Educate parents, other service providers and community agencies in regard to the provision of that type of service;

DHS 90.11(2)(b)1.d. d. When a member of the team, participate in the EI team’s assessment of a child, any family-directed assessment of the family and development of integrated goals and outcomes for the IFSP;

DHS 90.11(2)(b)1.e. e. When a member of the team, train other team members to implement aspects of his or her discipline according to standards of practice of the discipline; and

DHS 90.11(2)(b)1.f. f. Make a good faith effort to assist each eligible child in achieving the outcomes of the child’s IFSP.

DHS 90.11(2)(b)2. 2. Service providers, including service coordinators, shall attend or otherwise avail themselves of 5 hours of training each year related to early intervention. For service providers without previous experience with Wisconsin’s early intervention program, the 5-hour training requirement in the first year of service provision shall include a basic orientation to the program. Training may be inservice training, conferences, workshops, earning of continuing education credits or earning of higher education credits.

DHS 90.11(2)(b)3. 3. A service provider is not liable if an eligible child does not achieve the growths projected in the child’s IFSP.

DHS 90.11(3) (3) Early intervention core services.

DHS 90.11(3)(a) (a) County administrative agencies shall make the following core services available at no cost to all families that have a child who is eligible or may be eligible for the birth to 3 program:

DHS 90.11(3)(a)1. 1. Identification and referral;

DHS 90.11(3)(a)2. 2. Screening;

DHS 90.11(3)(a)3. 3. Evaluation;

DHS 90.11(3)(a)4. 4. Assessment for an eligible child;

DHS 90.11(3)(a)5. 5. Development of the IFSP for an eligible child and family;

DHS 90.11(3)(a)6. 6. Service coordination for an eligible child and family; and

DHS 90.11(3)(a)7. 7. Protection of parent and child rights by means of the procedural safeguards.

DHS 90.11(3)(b) (b) With parent consent a third party may be billed for evaluation and assessment activities. The service coordinator shall ensure that the parent, prior to giving consent, is informed and understands that because of third party billing the parent may incur financial loss, including but not limited to a decrease in benefits or increase in premiums or discontinuation of the policy.

DHS 90.11(4) (4) Other early intervention services. A county administrative agency shall provide or arrange for the provision of other early intervention services. The county administrative agency shall determine the parental cost share of early intervention services costs not met by third party payers in accordance with s. DHS 90.06 (2) (i). Parental cost share for early intervention services shall begin with services designated in IFSPs developed or reviewed on or after March 1, 2002. Types of other early intervention services include the following:

DHS 90.11(4)(a) (a) Assistive technology services and devices. Assistive technology services and devices, to include:

DHS 90.11(4)(a)1. 1. Evaluating the needs of a child with a disability for an assistive technology device, including a functional evaluation of the child in the child’s customary environment;

DHS 90.11(4)(a)2. 2. Purchasing, leasing or otherwise providing for the acquisition of assistive technology devices for children with disabilities;

DHS 90.11(4)(a)3. 3. Selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing or replacing assistive technology devices;

DHS 90.11(4)(a)4. 4. Coordinating and using other therapies, interventions or services with assistive technology devices, such as those associated with existing education and rehabilitation plans and programs;

DHS 90.11(4)(a)5. 5. Training or technical assistance for a child with disabilities or, if appropriate, the family of a child with disabilities, in the use of an assistive technology device; and

DHS 90.11(4)(a)6. 6. Training or technical assistance for professionals, including individuals providing education or rehabilitation services, employers and other individuals who provide services to or are otherwise substantially involved in the major life functions of children with disabilities.

DHS 90.11(4)(b) (b) Audiology services. Audiology services, to include:

DHS 90.11(4)(b)1. 1. Identification of children with audiological impairment, using risk criteria and appropriate audiological screening techniques;

DHS 90.11(4)(b)2. 2. Determination of the range, nature and degree of hearing loss and communication functions by use of audiological evaluation procedures;

DHS 90.11(4)(b)3. 3. Referral for medical and other services necessary for habilitation or rehabilitation;

DHS 90.11(4)(b)4. 4. Provision of auditory training, aural rehabilitation, speech reading and listening device orientation and training;

DHS 90.11(4)(b)5. 5. Provision of services for prevention of hearing loss;

DHS 90.11(4)(b)6. 6. Determination of the child’s need for individual amplification, including selecting, fitting and dispensing appropriate listening and vibrotactile devices, and evaluating the effectiveness of those devices; and

DHS 90.11(4)(b)7. 7. Provision of consultation to and training of parents, other service providers and community agencies in regard to audiology services.

DHS 90.11(4)(c) (c) Communication services. Communication services, also called speech and language services, to include:

DHS 90.11(4)(c)1. 1. Identification, diagnosis and assessment of children with communicative or oral pharyngeal disorders or delays in development of communication skills, which include delays in the acquisition of communication skills during preverbal and verbal phases of development; in the development of receptive and expressive language, including spoken and non-spoken means of expression; in oral-motor development; and in auditory awareness and processing. This also includes identification of the need for the acquisition of sign language and augmentative communication devices or systems;

DHS 90.11(4)(c)2. 2. Referral for and coordination with medical or other professional services necessary for the habilitation or rehabilitation of children with communicative or oral pharyngeal disorders and delays in development of communication skills;

DHS 90.11(4)(c)3. 3. Services for the habilitation, rehabilitation or prevention of communicative or oropharyngeal disorders and delays in development of communication skills, including services directed at the acquisition of sign language, the development of auditory awareness skills and speech production and the use of augmentative communication devices;

DHS 90.11(4)(c)4. 4. Development of augmentation devices or systems, including communication boards and sign language; and

DHS 90.11(4)(c)5. 5. Provision of consultation to and training of parents, other service providers and community agencies in regard to communication services.

DHS 90.11(4)(d) (d) Family education and counseling services. Family education and counseling services, to include:

DHS 90.11(4)(d)1. 1. Services provided by qualified personnel to assist the family or caregiver in caring for the child, understanding the special needs of the child, enhancing the child’s development, modeling appropriate parent-child interactions and providing information on child development; and

DHS 90.11(4)(d)2. 2. Providing informal support and connecting parents with other parents. This may include parent to parent match programs and parent support groups.

DHS 90.11(4)(e) (e) Health care services.

DHS 90.11(4)(e)1. 1. Health care services necessary to enable a child to benefit from other early intervention services under this subsection while receiving those other early intervention services. These include:

DHS 90.11(4)(e)1.a. a. Clean and intermittent catheterization; tracheotomy care; tube feeding, changing a dressing or colostomy collection bag and other health care services; and

DHS 90.11(4)(e)1.b. b. Consultation provided by physicians to other service providers concerning the special health care needs of eligible children that have to be addressed in the course of providing early intervention services.

DHS 90.11(4)(e)2. 2. “Health care services” does not include:

DHS 90.11(4)(e)2.a. a. Services that are surgical in nature such as cleft palate surgery or surgery for club foot;

DHS 90.11(4)(e)2.b. b. Services that are purely medical in nature such as hospitalization for management of a congenital heart ailment or the prescribing of medicine or drugs for any purpose;

DHS 90.11(4)(e)2.c. c. Devices necessary to control or treat a medical condition; or

DHS 90.11(4)(e)2.d. d. Medical health services such as immunizations and “well baby” care that are routinely recommended for all children.

DHS 90.11(4)(f) (f) Medical services. Medical services only for diagnostic or evaluation purposes. These are services provided by a licensed physician to determine a child’s developmental status and need for early intervention services.

DHS 90.11(4)(g) (g) Nursing services. Nursing services, to include:

DHS 90.11(4)(g)1. 1. The assessment of health status for the purpose of providing nursing care, including identification of patterns of human response to actual or potential health problems, and the assessment of home environment and parent-child interactions for the purpose of providing interventions and referrals to support parents and enhance the child’s development;

DHS 90.11(4)(g)2. 2. Provision of nursing care to prevent health problems, restore or improve functioning and promote optimal health and development. This includes identification of family concerns and coordination of available resources to meet those concerns;

DHS 90.11(4)(g)3. 3. Administration of medications, treatments and regimens prescribed by a physician licensed under ch. 448, Stats.; and

DHS 90.11(4)(g)4. 4. Provision of consultation to and training of parents, other service providers and community agencies in regard to nursing services.

DHS 90.11(4)(h) (h) Nutrition services.

DHS 90.11(4)(h)1. 1. Nutrition services, to include:

DHS 90.11(4)(h)1.a. a. Identifying dietary and nutritional needs;

DHS 90.11(4)(h)1.b. b. Developing and monitoring appropriate nutritional plans based on assessment results;

DHS 90.11(4)(h)1.c. c. Conducting individual assessments in nutritional history and dietary intake: anthropometric, biochemical and clinical variables; feeding skills and feeding problems; and food habits and food preferences;

DHS 90.11(4)(h)1.d. d. Providing nutritional treatment and intervention and counseling parents and caregivers on appropriate nutritional intake, based on assessment results; and

DHS 90.11(4)(h)1.e. e. Making referrals to appropriate community resources to carry out nutritional goals.

DHS 90.11(4)(h)2. 2. “Nutrition services” does not include coverage of the cost of food supplements, vitamins or prescription formulations designed to improve or maintain a child’s nutritional status.

DHS 90.11(4)(i) (i) Occupational therapy services. Occupational therapy services that address the functional needs of a child related to the performance of self-help skills or to adaptive development, and to adaptive behavior and play, and sensory, motor and postural development. These services are designed to improve the child’s functional ability in home and community settings and include:

DHS 90.11(4)(i)1. 1. Identification, assessment and intervention;

DHS 90.11(4)(i)2. 2. Adaptation of the environment, and selection, design and fabrication of assistive and orthotic devices to facilitate development and promote the acquisition of functional skills;

DHS 90.11(4)(i)3. 3. Prevention or minimization of the impact of initial or future impairment, delay in development or loss of functional ability; and

DHS 90.11(4)(i)4. 4. Provision of consultation to and training of parents, other service providers and community agencies in regard to occupational therapy services.

DHS 90.11(4)(j) (j) Physical therapy. Physical therapy services to promote sensorimotor functions through the enhancement of musculoskeletal status, neurobehavioral organization, perceptual and motor development, cardiopulmonary status and effective environmental adaption. These services include:

DHS 90.11(4)(j)1. 1. Screening, evaluation and assessment of infants and toddlers to identify movement dysfunction;