Chapter DHS 90

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;

DHS 90.11(4)(j)2. 2. Obtaining, interpreting and integrating information appropriate to program planning, to prevent, alleviate or compensate for movement dysfunctions and related functional problems;

DHS 90.11(4)(j)3. 3. Providing individual and group services and treatment to prevent, alleviate or compensate for movement dysfunction and related functional problems; and

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

DHS 90.11(4)(k) (k) Psychological services. Psychological services, to include:

DHS 90.11(4)(k)1. 1. Administering psychological and developmental tests and other assessment procedures, interpreting results, and obtaining, integrating and interpreting information about child behavior and child and family conditions related to learning, mental health and development;

DHS 90.11(4)(k)2. 2. Planning and managing a program of psychological services, including psychological counseling for children and parents, family counseling, consultation on child development, and parent education; and

DHS 90.11(4)(k)3. 3. Provision of consultation to and training of parents, other service providers and community agencies in regard to psychological services.

DHS 90.11(4)(L) (L) Social work services. Social work services, to include:

DHS 90.11(4)(L)1. 1. Making home visits to evaluate a child’s living conditions and patterns of parent-child interactions;

DHS 90.11(4)(L)2. 2. Preparing a social and emotional developmental assessment of the child within the family context;

DHS 90.11(4)(L)3. 3. Providing individual and family group counseling with parents and other family members, and appropriate social skill-building within the family context;

DHS 90.11(4)(L)4. 4. Working with problems in a child’s and family’s living situation, at home, in the community and at any center where early intervention services are provided, that affect the child’s maximum utilization of early intervention services; and

DHS 90.11(4)(L)5. 5. Identifying, mobilizing and coordinating community resources and services to enable the child and family to receive maximum benefit from early intervention services; and

DHS 90.11(4)(L)6. 6. Provision of consultation to and training of parents, other service providers and community agencies in regard to social work services.

DHS 90.11(4)(m) (m) Special instruction. Special instruction, to include:

DHS 90.11(4)(m)1. 1. Evaluation and assessment in all areas of development;

DHS 90.11(4)(m)2. 2. Designing learning environments and activities that promote the child’s acquisition of skills in a variety of developmental areas including cognitive processes, communication, motor skills and social interaction;

DHS 90.11(4)(m)3. 3. Curriculum planning, including the planned interaction of personnel, materials and time and space, that leads to achieving the outcomes in the child’s individualized family service plan;

DHS 90.11(4)(m)4. 4. Providing families with information, skills and support related to enhancing the skill development of the child;

DHS 90.11(4)(m)5. 5. Working with a child to enhance the child’s development;

DHS 90.11(4)(m)6. 6. Working with other providers to develop an understanding of the child’s disability and the impact of that disability on the child’s development;

DHS 90.11(4)(m)7. 7. Providing support and consultation to child care providers and others in integrated child care settings; and

DHS 90.11(4)(m)8. 8. Provision of consultation to and training of parents, other service providers and community agencies in regard to special instruction services.

DHS 90.11(4)(n) (n) Transportation and related costs of travel. Transportation and related costs of travel, whether mileage or by taxi, common carrier or other means, and including tolls and parking, necessary to enable an eligible child and the child’s family to receive early intervention services.

DHS 90.11(4)(o) (o) Vision services. Vision services, to include:

DHS 90.11(4)(o)1. 1. Evaluation and assessment of visual functioning, including the diagnosis and appraisal of specific visual disorders, delays and abilities;

DHS 90.11(4)(o)2. 2. Referral for medical and other professional services necessary for habilitation or rehabilitation of visual functioning disorders, or both;

DHS 90.11(4)(o)3. 3. Communication skills training for all environments, visual training, independent living skills training and additional training to activate visual motor abilities; and

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

DHS 90.11(5) (5) Service delivery.

DHS 90.11(5)(a) (a) Location of services. To the maximum extent appropriate to the needs of the child, early intervention services shall be provided in the child’s natural environments, including home and community settings where children without disabilities participate. A setting other than a natural environment may be used only when early intervention outcomes cannot be satisfactorily achieved for the child in a natural environment. If reasons exist for providing services in settings other than the child’s natural environments, those reasons shall be documented in the child’s IFSP.

DHS 90.11(5)(b) (b) Method of service delivery. Early intervention services shall be provided in ways that are most appropriate for meeting the needs of eligible children and their families. These may include parent and child activities, group activities, one-to-one sessions, and provision of a resource such as staff time.

DHS 90.11(6) (6) Qualified personnel.

DHS 90.11(6)(a) (a) Early intervention services for eligible children and their families may only be provided by qualified personnel listed in this subsection who meet Wisconsin requirements for practice of their profession or discipline or other professionally recognized requirements, as follows:

DHS 90.11(6)(a)1. 1. Audiologists shall have at least a master’s degree in audiology from an accredited institution of higher education and be registered or licensed under ch. 459, Stats.;

DHS 90.11(6)(a)2. 2. Early intervention program assistants shall be at least 18 years of age and meet one of the following requirements:

DHS 90.11(6)(a)2.a. a. Have at least 3 years of experience in supervising structured youth activities;

DHS 90.11(6)(a)2.b. b. Have completed at least 3 years of college education;

DHS 90.11(6)(a)2.c. c. Have a combination of education and experience under subds. 1. and 2. totaling 3 years; or

DHS 90.11(6)(a)2.d. d. Have completed a 2-year program in child care and development approved by the Wisconsin department of public instruction.

DHS 90.11(6)(a)2m. 2m. Marriage and family therapists shall be licensed [certified] under ch. 457, Stats.;

DHS 90.11(6)(a)3. 3. Nutritionists shall be registered or be eligible for registration as dietitians by the American dietetic association, and dietitian technicians shall have at least an associate degree from an accredited institution of higher education and be registered as dietitian technicians by the American dietetic association;

DHS 90.11(6)(a)4. 4. Occupational therapists shall be licensed under ch. 448, Stats.; and occupational therapy assistants shall be licensed under ch. 448, Stats.;

DHS 90.11(6)(a)5. 5. Orientation and mobility specialists shall have completed an orientation and mobility program approved by the association for education and rehabilitation of the blind and visually impaired;

DHS 90.11(6)(a)6. 6. Parent facilitators shall be parents of children with disabilities who are hired by county administrative agencies or service providers on the basis of their demonstrated skills in planning, communicating and providing support to the parents of eligible children;

DHS 90.11(6)(a)7. 7. Pediatricians and other physicians shall be licensed under ch. 448, Stats., and physician assistants shall be certified under s. 448.05 (5), Stats.;

DHS 90.11(6)(a)8. 8. Physical therapists shall be licensed under ch. 448, Stats., and physical therapist assistants shall have graduated from a 2-year college level program approved by the American physical therapy association;

DHS 90.11(6)(a)9. 9. Psychologists shall be licensed under ch. 455, Stats.;

DHS 90.11(6)(a)10. 10. Registered nurses shall be licensed under s. 441.06, Stats., and licensed practical nurses shall be licensed under s. 441.10, Stats.;

DHS 90.11(6)(a)11. 11. Rehabilitation counselors shall have at least a master’s degree in rehabilitation counseling or a related field;

DHS 90.11(6)(a)12. 12. School psychologists shall be licensed under ch. 115, Stats., and ch. PI 34;

DHS 90.11(6)(a)13. 13. Social workers shall be certified under ch. 457, Stats.;

DHS 90.11(6)(a)14. 14. Special education teachers, including early childhood special education teachers, vision teachers and hearing teachers, shall be licensed through the department of public instruction; and

DHS 90.11(6)(a)15. 15. Speech and language pathologists shall have at least a master’s degree in speech and language pathology from an accredited institution of higher education and be registered or licensed under ch. 459, Stats., or shall be licensed under ch. 115, Stats., and ch. PI 34.

DHS 90.11(6)(b) (b) Early intervention personnel under par. (a) 2., 3., 4., 6., 7., 8. and 10. who are paraprofessionals shall work under supervision as defined by standards of the profession or standards developed by the department.

DHS 90.11 History History: Cr. Register, June, 1992, No. 438, eff. 7-1-92; emerg. r. and recr. (1) (b), (2), (3), (4) (intro.), (a), (b), (e), (j), (n) and (o); am. (4) (c) (intro.), 3., (d) 1., (i) (intro.) and (5) (a), renum. (6) to be (6) (a) and am. (6) (a) 6., cr. (6) (b), eff. 1-1-93; r. and recr. (1) (b), (2), (3), (4) (intro.), (a), (b), (e), (h), (j), (n) and (o); am. (4) (c) (intro.), 3., (d) 1., (i) (intro.) and (5) (a), renum. (6) to be (6) (a) and am. (6) (a) 6., cr. (6) (b), Register, June, 1993, No. 450, eff. 7-1-93; am. (2) (b) 2., (4) (intro.) (6) (a) 13., r. (2) (b) 4., renum. (3) (intro.) to be (3) (a) (intro.) and am., cr. (3) (b) and (6) (a) 2m., Register, April, 1997, No. 496, eff. 5-1-97; am. (1) (c) 1. b., (2) (a) 1., 2., (b) 1. d., (4) (b) 5., 6., (c) 3., 4., (g) 2., 3., (i) 2., 3., (j) 2., 3., (k) 1., 2., (L) 4., 5., (m) 2., 6., 7., (o) 2., 3. and (5) (a), renum. (2) (b) 1. e. to be (2) (b) 1. f., cr. (2) (b) 1. e., (4) (b) 7., (c) 5., (g) 4., (i) 4., (j) 4., (k) 3., (L) 6., (m) 8., (o) 4., Register, September, 1999, No. 525, eff. 10-1-99; corrections in (2) (a) 2. and (4) (intro.) made under s. 13.93 (2m) (b) 7., Stats, Register, September, 1999, No. 525; emerg. am. (2) (a) 2. and (4) (intro.), eff. 10-1-01; correction in (6) (a) 4. made under s. 13.93 (2m) (b) 7., Stats., Register February 2002 No. 554; CR 01-106: am. (2) (a) 2. and (4) (intro.), Register February 2002 No. 554, eff. 3-1-02; CR 03-033: am. (1) (b) 7., (3) (b), (6) (a) 4., 10., 11. and 14. Register December 2003 No. 576, eff. 1-1-04; corrections in (6) (a) 12. and 15. made under s. 13.93 (2m) (b) 7., Stats., Register December 2004 No. 588.

DHS 90.12 DHS 90.12 Procedural safeguards for parents.

DHS 90.12(1) (1) Prior notice.

DHS 90.12(1)(a) (a) A reasonable time before a county administrative agency or service provider proposes or refuses to initiate or change any of the following, the county administrative agency or service provider shall provide written notice to the parent and ensure that the parent understands the notice: