Evaluation & Eligibility FIT Annual Meeting 2012

Andy Gomm Jen Brown

Jennifer Rosinia

1

Agenda

Infant-Toddler Developmental Assessment (IDA): ◦ Key elements – Jennifer Rosinia, PhD, OTR/L; National Consultant on IDA for New Mexico

FIT Rules NMAC 7.30.8 & DDSD Standards – changes: ◦ Infants <1 month and <4 months ◦ Eligibility process ≥25% Developmental Delay -1.5 standard deviations below the mean Informed Clinical Opinion Medical conditions

◦ Redetermination of eligibility

2

Key Principles of the IDA Process

Jennifer Rosinia, PhD, OTR/L; National Consultant on IDA for New Mexico

(See handout)

3

4

5

Determining eligibility under each category

Eligibility Determination Rules

NMAC 7.30.8 10. G. (2) The multidisciplinary team shall review and consider

information, including: medical records; observations; information gathered from the parent(s); information regarding the child’s development from the use of the approved evaluation tool(s); and any other tools used, in order to provide their opinion regarding the determination of the child’s eligibility.

(5) A statement of the child’s eligibility for the FIT program shall be documented in the evaluation report.

Note: The child can be made eligible under more than one category and the CME report should include each category under which the child is eligible. FIT-KIDS will be updated in the future to allow entry of more than one category

6

Evaluation Rules

NMAC 7.30.8.10 F. Evaluation (8) The evaluation team shall use the

tool(s) approved by the FIT Program. Other domain specific tools may be used in addition to the approved tool(s).

(9) The tool(s) used in the evaluation shall be administered by certified or licensed personnel who have received training in the use of the tool(s).

7

8

Determining Developmental Delays

Developmental Delay - Rule

NMAC 7.30.8.10. G. Eligibility determination (a) Developmental delay: a delay of 25% or more, after

correction for prematurity, in one or more of the following areas of development: cognitive; communication; physical/motor; social or emotional; adaptive ◦ (i) 25% delay shall be documented utilizing the tool(s)

approved by the FIT Program; ◦ (ii) If the FIT Program approved tool does not indicate a

25% delay, a domain-specific tool may be used to establish eligibility if the score is 1.5 standard deviations below the mean or greater.

◦ (iii) Informed clinical opinion in accordance with this rule may be used if a clear developmental level cannot be gained through the use of the approved tool(s) or domain-specific tools; or when there are inconsistencies in the child’s performance or inconsistencies in the results of the evaluation; and shall be documented as “significant atypical development”.

9

Definition: Informed clinical opinion

NMAC 7.30.8 7. LL. “Informed clinical opinion” means the

knowledgeable perceptions of the evaluation team who use qualitative and quantitative information regarding aspects of a child’s development that are difficult to measure in order to make a decision about the child’s eligibility for the FIT Program.

10

Informed Clinical Opinion - Rule

NMAC 7.30.8.10. G. Eligibility determination (4) Informed clinical opinion may be used by the

evaluation team to determine eligibility when the approved tool(s) or other domain-specific tool are not able to establish a developmental level due to the age of an infant or the child’s level of arousal and ability to participate at the time of the assessment; or when there are inconsistencies in the child’s performance or inconsistencies in the results of the evaluation; and the team determines that the child has significant atypical development.

11

Informed Clinical Opinion - Rule

NMAC 7.30.8.10. G. Eligibility determination (a) If informed clinical opinion is used to

determine the child’s eligibility, documentation must be provided to justify the child’s eligibility.

(b) A second level review and sign off shall occur within the early intervention provider agency by someone of equal or higher certification or licensure that was not part of the evaluation team.

(c) Informed clinical opinion may only be used to qualify a child for more than one year with review and approval of the FIT Program.

12

Definition: Significant atypical development

NMAC 7.30.8 7. PPP. “Significant atypical development” means

the eligibility determination under developmental delay made using Informed Clinical Opinion, when 25% delay cannot be documented through the state approved evaluation tool, but where there is significant concern regarding the child’s development.

13

Established Condition & Biological Medical Risk 14

Determining eligibility under Established Condition or Biological Medical Risk

Established condition & Bio / Med risk - Rule

NMAC 7.30.8.10. G. Eligibility determination (b) Established condition: a diagnosed physical,

mental, or neurobiological condition that has a high probability of resulting in developmental delay. The established condition shall be diagnosed by a health care provider and documentation shall be kept on file. Established conditions include the following:

(i) genetic disorders with a high probability of developmental delay, including chromosomal anomalies including Down syndrome and Fragile X syndrome (in boys); inborn errors of metabolism including Hurler syndrome; and other syndromes, including Prader-Willi and Williams;…..

15

Established condition & Bio / Med risk - Rule

NMAC 7.30.8.10. G. Eligibility determination (viii) conditions recognized by the FIT Program as

established conditions for purposes of this rule. A genetic disorder, perinatal factor, neurologic condition, sensory abnormality, physical impairment or mental/psychosocial disorder that is not specified above must be recognized by the FIT Program in order to qualify as an established condition for purposes of this rule. A Department of Health physician, designated by the FIT Program manager, shall make a determination of whether a proposed condition will be recognized within seven (7) days of the FIT Program manager’s receipt of the request for review.

16

Recognized Medical Conditions

1. Referral received from medical provider 2. Look up diagnosis and ICD-9 on FIT list / website 3. If listed on FIT recognized conditions list keep

medical record on file showing diagnosis 4. If not listed on FIT recognized conditions list send

request to review the diagnosis to the FIT regional manager

5. FIT regional manager forwards request to designated Department of Health Physician

6. DOH physician shall make a determination of whether a proposed condition will be recognized within seven (7) days of the FIT Program manager’s receipt of the request for review.

17

Recognized Medical Conditions – (Example from another state)

18

CME for Infants - Standards

Given the unique characteristics of infants and the challenges of determining their developmental levels: ◦ For infants under one (< 1) month of age

(adjusted) the IDA will not be used. Instead one of the approved tools below shall be used together with informed clinical opinion.

◦ For infants over one (>1) month of age (adjusted) and under four (<4) months of age (adjusted) the IDA shall be used in conjunction with one of the following approved tools:

19

Definition: Adjusted Age

NMAC 7.30.8 7. B. “Adjusted age (corrected age)” means

adjusting / correcting the child’s age for children born prematurely (i.e. born less than 37 weeks gestation). The adjusted age is calculated by subtracting the number of weeks the child was born before 40 weeks of gestation from their chronological age. Adjusted Age (Corrected Age) should be used until the child is 24 months of age.

20

CME for Infants - Standards

◦ Approved tools for infants include: AIMS (Alberta Infant Motor Scale) TIMP (Test of Infant Motor Performance) Infant Toddler Sensory Profile Peabody Developmental Motor Scale (PDMS-2) Motor Skills Acquisition Checklist REEL-3 Newborn Individualized Developmental Care and Assessment Program (NIDCAP) - for use with newborns in the NICU setting only Other tools as approved by the FIT Program.

21

CME for Infants - Standards

Due to the varying nature and purpose of the scores of each of the above approved tools, the scores themselves will not lead to eligibility but rather they will provide additional information for the team to consider in reaching a determination of the child's developmental status.

22

CME - Billing Standards

This unit may be billed only one time per eligible child and billing may only be submitted once the written evaluation report has been completed. Ongoing assessment activities with the child and family are billed based on the location where services were provided.

If a child is evaluated and determined not eligible or exits the FIT Program and, due to concerns is referred again to the FIT Program after at least 6 months, the provider may conduct and bill for an additional comprehensive multidisciplinary evaluation.

23

Annual Redetermination of eligibility - Rule

H. Redetermination of eligibility (1) The child’s eligibility for the FIT Program

shall be re-determined annually in accordance with the eligibility determination requirements of this rule.

(2) The child’s continued eligibility shall be documented on the IFSP.

(3) If the child no longer meets the requirements under the original eligibility category, the team will determine if the child meets the criteria for one of the other eligibility categories before exiting the child.

24

Annual Redetermination of Eligibility - Guidance

The IFSP team can use current ongoing assessment information combined with use of the IDA process to determine the child’s continued eligibility for the NM FIT Program...

In order to maintain the integrity of the IDA process, the multidisciplinary team of at least two professionals from different disciplines would come together to discuss and synthesize information that has been gathered through each professional’s ongoing assessments, incl: ◦ Developmental information obtained through assessment

tools ◦ Review and updating of the child’s health & medical status ◦ Information regarding the child’s performance in daily living

activities, reported by the parents & other caregivers

25

Further training & Support

Webinars: ◦ Tues 07/17/12 (9:00 – 11:00) ◦ Fri 07/20/12 (9:00 – 11:00) ◦ Webinar will be recorded an posted on website

Evaluation and Assessment TA Document Web-based training on IDA Ongoing support to IDA leads Support in using approved tools with the

IDA for infants. Medical conditions on the website

26