Chapter DHS 90

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;

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.