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Title: Section 69-4.9 - Standards for the provision of services

Effective Date


69-4.9 Standards for the provision of services.

(a) For purposes of this section, early intervention providers includes all approved agencies and individuals and early intervention program services means service coordination, evaluations, and early intervention services.

(b) On or before September 1, 2010 and thereafter, all approved providers shall comply with the criteria set forth in paragraph (4) of section 69-4.5(a).

(c) Each municipality shall ensure that the Early Intervention Program services contained in Individualized Family Service Plans are provided to eligible children, who reside in such municipality, and their families. Municipalities shall make reasonable efforts to ensure that Early Intervention Program services provided to children residing in the municipality are delivered in a manner that protects the health and safety of eligible children, in accordance with this subpart and with standards and procedures on health, safety, and sanitation developed by the Department for the Early Intervention Program.

(1) If an early intervention official reasonably believes that the early intervention provider is out of compliance with this subpart and/or with the Department's standards and procedures on health, safety, and sanitation, or otherwise posing an imminent risk of danger to children, parents, or staff, the municipality shall take immediate action to ensure the health and safety of such persons.

(2) Upon the taking of such action by the municipality, the early intervention official shall immediately notify the Department, for purposes of the initiation of an investigation which may result in the suspension, limitation or revocation of the early intervention service provider in accordance with procedures set forth in Section 69-4.24 of this Subpart.

(i) The Department shall notify all early intervention officials in the catchment area of the provider that an investigation has been initiated.

(d) All early intervention providers shall ensure that early intervention program services are delivered in a manner that protects the health and safety of eligible children. Early intervention providers shall:

(1) comply with standards for health, safety, and sanitation issued by the Department for the early intervention program, and for early intervention providers who are otherwise required to be approved by another state agency to deliver health or human services, complying with health, safety and sanitation standards issued by such other agency.

(2) ensure that only those individuals who are qualified in accordance with section 69-4.1(al) or 69-4.4, as applicable, deliver such services to eligible children and their families.

(3) protect the health, safety, and welfare of eligible children during delivery of early intervention services, including with respect to and as applicable:

(i) direct supervision of and interaction with children during the delivery of services;

(ii) infection control;

(iii) handling of food;

(iv) illness;

(v) equipment, materials, or other items used during service delivery; and

(vi) delivery of services in physical environments that protects the health and safety of children during service delivery.

(e) If the provider delivers services in a physical site or setting which is rented, leased, owned, or otherwise managed or operated by the provider, including a provider's home or private office, the provider shall maintain such physical site or setting in a manner that ensures a safe environment for eligible children and their families in accordance with this subpart, applicable State and local codes, including municipal fire codes, and standards for health, safety, and sanitation issued by the Department for the Early Intervention Program. Providers subject to this paragraph shall ensure that the physical site or setting where services are delivered protects the health and safety of early intervention program children with respect to:

(1) sanitation;

(2) handling of medications and food;

(3) illness, injury, or emergencies, including allergic reactions; and,

(4) its outdoor environment.

(f) The department and early intervention officials shall make reasonable efforts to ensure that early intervention program services delivered to eligible infants and toddlers:

(1) are family-centered, including parents in all aspects of their child's services and in decisions concerning the provisions of services;

(2) use a child development emphasis in intervention strategies, incorporating quality child development practices with necessary adaptations to enhance the eligible child's development;

(3) use an individualized approach for both children and their families, including consideration and respect for cultural, lifestyle, ethnic, and other individual and family characteristics; and

(4) use a team approach that is multidisciplinary, interdisciplinary, or transdisciplinary, including the expertise of all appropriate qualified personnel.

(g) Providers of early intervention program services shall:

(1) provide early intervention program services to an eligible child and family as authorized by the early intervention official and in conformance with the child's and family's individualized family service plan.

(2) provide timely notification of any changes in the provider's ability to deliver early intervention program services to the child and family in conformance with the individualized family service plan.

(i) Providers shall make reasonable efforts to notify the child's parent within a reasonable period prior to the date and time on which a service is to be delivered, of any temporary inability to deliver such service due to circumstances such as illness, emergencies,hazardous weather, or other circumstances which impede the provider's ability to deliver the service.

(ii) Providers shall notify the child's parent and service coordinator at least five (5) days prior to any scheduled absences due to vacation, professional activities, or other circumstances, including the dates for which the provider will be unable to deliver services to the child and family in conformance with the individualized family service plan and the date on which services will be resumed by such provider.

(a) Missed visits may be rescheduled and delivered to the child and family by such provider, as clinically appropriate, agreed upon by the parent and in conformance with the child's and family's IFSP.

(iii) Providers shall notify the child's service coordinator and early intervention official of the intent to permanently cease the delivery of early intervention program services to an individual child and the child's family, for any reason, at least thirty days prior to the date on which the provider intends to cease providing services.

(3) Consult with parents, other service providers (including primary health care providers; family day care homes, and day care centers), and representatives of appropriate community agencies to ensure the effective provision of services.

(4) Provide support, education, and guidance to parents and other caretakers (including other family members, family day care, and day care centers) regarding the provision of those services.

(5) Participate in the multidisciplinary team's assessment of a child and the child's family and in the development of integrated goals and outcomes for the Individualized Family Service Plan.

(6) Maintain and make available to the municipality and the Department upon request, complete financial records and clinical documentation related to the provision of early intervention services including such information and documentation as necessary to support provider billing to third party payors (including the medical assistance program), the municipality, and the State, and to permit a full fiscal audit by appropriate State and municipal authorities.

(7) Maintain records in accordance with section 69-4.17(a) of this subpart that document the performance of activities required to be completed by the provider on behalf of an eligible child and the child's family.

(h) To the maximum extent appropriate to the needs of the child, early intervention services shall be provided in natural environments.

(i) The use of aversive intervention in any form is strictly prohibited when providing early intervention program services to an eligible child. For purposes of this section, aversive intervention means an intervention that is intended to induce pain or discomfort to a child for the purpose of modifying or changing a child's behavior or eliminating or reducing maladaptive behaviors, including but not limited to the following:

(1) contingent application of noxious, painful, intrusive stimuli or activities;

(2) any form of noxious, painful, or intrusive spray (including water or other mists), inhalant, or tastes;

(3) contingent food programs that include the denial or delay of the provision of meals or intentionally altering staple food or drink to make it distasteful;

(4) movement limitation used as punishment, including but not limited to helmets and mechanical restraint devices;

(5) physical restraints;

(6) blindfolds; and,

(7) white noise helmets and electric shock.

(8) Aversives do not include such interventions as voice control, limited to loud, firm commands; time-limited ignoring of a specific behavior; positive reinforcers such as small amounts of food used as a reward for successful completion of a clinical task or token fines as part of a token economy system; brief physical prompts to interrupt or prevent a specific behavior; or interventions prescribed by a physician for the treatment or protection of the child.

(9) Nothing in this subsection shall preclude the use of behavior management techniques to prevent a child who is undergoing episodic behavioral or emotional disturbance from seriously injuring him/herself or others. Emergency physical interventions may be used to prevent a child from seriously injuring him/herself or others. Such interventions, which shall not include mechanical restraints, shall be used only in situations in which alternative procedures and methods not involving the use of physical force cannot reasonably be employed to prevent or minimize injury and shall only be used for as long as the duration of the incident. Emergency physical interventions shall not be used as a punishment or as a substitute for systematic behavioral interventions that are designed to change, replace, modify or eliminate a targeted behavior. Staff who may be called upon to implement emergency physical interventions shall be provided with appropriate training in safe and effective physical restraint procedures. Emergency physical interventions shall be included in a behavior management plan that is developed by qualified personnel with appropriate expertise and documented in the child's record to address persistent, ongoing behavior which is injurious to the child or others.

(i) The behavior management plan shall be in writing and signed by the parent.

(ii) The plan shall be developed in concert with the child's family and providers of early intervention services and with parent consent and other clinical experts as needed.

(iii) The child shall be at significant physical risk (injury, malnutrition, or other physical harm).

(iv) A medical evaluation shall be conducted to address medical conditions.

(v) The plan shall be a result of a thorough assessment of cause or behavioral functions.

(vi) The plan shall include positive strategies to reduce or prevent the occurrence of the behavior including building replacement behaviors, when planned physical restraint is involved.

(vii) The plan shall be based on positive reinforcement approaches, where contingent food programs are involved.

(viii) The plan shall be implemented by appropriately trained individuals.

(ix) The parent shall have the right to revoke approval of the plan at any time, and request that a new behavior management plan be developed in accordance with the requirements of this subsection.


VOLUME A-1a (Title 10)