Wis. Admin. Code DHS § DHS 90.11

Current through October 28, 2024

Section DHS 90.11 - Service provision

(1) COORDINATION.

(a)Role of the service coordinator. The service coordinator shall coordinate the delivery of all services across agency lines and serve as the single point of contact in helping a family obtain the services the child and family need as described in the IFSP.

(b)Functions of the service coordinator. Service coordination activities include:

1. Coordinating the performance of evaluation and assessments as described in ss. DHS 90.08 and 90.09;

2. Facilitating and participating in development, review and evaluation of the IFSP;

3. Assisting parents in identifying available service providers;

4. Facilitating access to services and coordinating and monitoring the timely provision of services;

5. Informing parents of the availability of advocacy services;

6. Coordinating with medical and other health care providers; and

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

(c)Qualifications of the service coordinator.

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:

a. Children in the age group birth to 3 who are eligible for the program;

b. Part C and the federal implementing regulations, 34 CFR Pt. 303, and this chapter; and

c. The nature and scope of services available under the birth to 3 program and how these are financed.

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.

(2) EARLY INTERVENTION SERVICES-GENERAL CONDITIONS AND GENERAL ROLE OF PROVIDERS.

(a)General conditions for early intervention services.

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.

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).

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.

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.

(b)General role of early intervention service providers.

1. A provider of early intervention services shall do all of the following:

a. Follow the requirements of this chapter;

b. Consult with parents, other service providers and community agencies to ensure that the service is effective;

c. Educate parents, other service providers and community agencies in regard to the provision of that type of service;

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;

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

f. Make a good faith effort to assist each eligible child in achieving the outcomes of the child's IFSP.

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.

3. A service provider is not liable if an eligible child does not achieve the growths projected in the child's IFSP.

(3) EARLY INTERVENTION CORE SERVICES.

(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:

1. Identification and referral;

2. Screening;

3. Evaluation;

4. Assessment for an eligible child;

5. Development of the IFSP for an eligible child and family;

6. Service coordination for an eligible child and family; and

7. Protection of parent and child rights by means of the procedural safeguards.

(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.

(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:

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

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;

2. Purchasing, leasing or otherwise providing for the acquisition of assistive technology devices for children with disabilities;

3. Selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing or replacing assistive technology devices;

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;

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

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.

(b)Audiology services. Audiology services, to include:

1. Identification of children with audiological impairment, using risk criteria and appropriate audiological screening techniques;

2. Determination of the range, nature and degree of hearing loss and communication functions by use of audiological evaluation procedures;

3. Referral for medical and other services necessary for habilitation or rehabilitation;

4. Provision of auditory training, aural rehabilitation, speech reading and listening device orientation and training;

5. Provision of services for prevention of hearing loss;

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

7. Provision of consultation to and training of parents, other service providers and community agencies in regard to audiology services.

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

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;

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;

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;

4. Development of augmentation devices or systems, including communication boards and sign language; and

5. Provision of consultation to and training of parents, other service providers and community agencies in regard to communication services.

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

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

2. Providing informal support and connecting parents with other parents. This may include parent to parent match programs and parent support groups.

(e)Health care services.

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:

a. Clean and intermittent catheterization; tracheotomy care; tube feeding, changing a dressing or colostomy collection bag and other health care services; and

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.

2. "Health care services" does not include:

a. Services that are surgical in nature such as cleft palate surgery or surgery for club foot;

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;

c. Devices necessary to control or treat a medical condition; or

d. Medical health services such as immunizations and "well baby" care that are routinely recommended for all children.

(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.

(g)Nursing services. Nursing services, to include:

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;

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;

3. Administration of medications, treatments and regimens prescribed by a physician licensed under ch. 448, Stats.; and

4. Provision of consultation to and training of parents, other service providers and community agencies in regard to nursing services.

(h)Nutrition services.

1. Nutrition services, to include:

a. Identifying dietary and nutritional needs;

b. Developing and monitoring appropriate nutritional plans based on assessment results;

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;

d. Providing nutritional treatment and intervention and counseling parents and caregivers on appropriate nutritional intake, based on assessment results; and

e. Making referrals to appropriate community resources to carry out nutritional goals.

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.

(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:

1. Identification, assessment and intervention;

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;

3. Prevention or minimization of the impact of initial or future impairment, delay in development or loss of functional ability; and

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

(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:

1. Screening, evaluation and assessment of infants and toddlers to identify movement dysfunction;

2. Obtaining, interpreting and integrating information appropriate to program planning, to prevent, alleviate or compensate for movement dysfunctions and related functional problems;

3. Providing individual and group services and treatment to prevent, alleviate or compensate for movement dysfunction and related functional problems; and

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

(k)Psychological services. Psychological services, to include:

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;

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

3. Provision of consultation to and training of parents, other service providers and community agencies in regard to psychological services.

(L)Social work services. Social work services, to include:

1. Making home visits to evaluate a child's living conditions and patterns of parent-child interactions;

2. Preparing a social and emotional developmental assessment of the child within the family context;

3. Providing individual and family group counseling with parents and other family members, and appropriate social skill-building within the family context;

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

5. Identifying, mobilizing and coordinating community resources and services to enable the child and family to receive maximum benefit from early intervention services; and

6. Provision of consultation to and training of parents, other service providers and community agencies in regard to social work services.

(m)Special instruction. Special instruction, to include:

1. Evaluation and assessment in all areas of development;

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;

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;

4. Providing families with information, skills and support related to enhancing the skill development of the child;

5. Working with a child to enhance the child's development;

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;

7. Providing support and consultation to child care providers and others in integrated child care settings; and

8. Provision of consultation to and training of parents, other service providers and community agencies in regard to special instruction services.

(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.

(o)Vision services. Vision services, to include:

1. Evaluation and assessment of visual functioning, including the diagnosis and appraisal of specific visual disorders, delays and abilities;

2. Referral for medical and other professional services necessary for habilitation or rehabilitation of visual functioning disorders, or both;

3. Communication skills training for all environments, visual training, independent living skills training and additional training to activate visual motor abilities; and

4. Provision of consultation to and training of parents, other service providers and community agencies in regard to vision services.

(5) SERVICE DELIVERY.

(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.

(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.

(6) QUALIFIED PERSONNEL.

(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:

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.;

2. Early intervention program assistants shall be at least 18 years of age and meet one of the following requirements:

a. Have at least 3 years of experience in supervising structured youth activities;

b. Have completed at least 3 years of college education;

c. Have a combination of education and experience under subds. 1. and 2. totaling 3 years; or

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

2m. Marriage and family therapists shall be licensed [certified] under ch. 457, Stats.;

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;

4. Occupational therapists shall be licensed under ch. 448, Stats.; and occupational therapy assistants shall be licensed under ch. 448, Stats.;

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;

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;

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

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;

9. Psychologists shall be licensed under ch. 455, Stats.;

10. Registered nurses shall be licensed under s. 441.06, Stats., and licensed practical nurses shall be licensed under s. 441.10, Stats.;

11. Rehabilitation counselors shall have at least a master's degree in rehabilitation counseling or a related field;

12. School psychologists shall be licensed under ch. 115, Stats., and ch. PI 34;

13. Social workers shall be certified under ch. 457, Stats.;

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

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.

(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.

Wis. Admin. Code Department of Health Services DHS 90.11

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.