Friday, May 12, 2006

Changes to Indiana First Steps Early Intervention Services

April 12, 2006

Dear First Steps Parent,

Changes are coming to Indiana’s First Steps system. I am writing to explain them, and to ask for your support and cooperation as we move forward together. I also hope to reassure you that, as a result of these changes, First Steps will be able to continue providing the highest quality early intervention services, now, and in the years to come.

Cost Share and Insurance Access Changes – Effective May 1, 2006
In 2005, the Indiana General Assembly passed a law requiring First Steps to change its family cost share program. These changes were reviewed, and approved, via the State’s rule-making process, and will be effective for services provided beginning May 1, 2006. Please refer to the enclosed chart for an idea of how your payment may be affected, and please note that if the cost share amount exceeds the actual cost of a service, you will pay the lesser of the two per visit, up to the total monthly maximum.

If (since your last annual review) you have experienced a reduction in income or an increase in out-of-pocket medical expenses not covered by your insurance, your cost share can be adjusted accordingly. Please contact your service coordinator as soon as possible, to ensure your health insurance, income, and medical expense information is up-to-date. Keep in mind that all resident family members are included when determining uncovered medical expenses.

To ease the impact of the cost share change, this year’s General Assembly passed a law requiring families to provide First Steps with information on all health insurance plans covering eligible children, as well as written consent to bill for services provided. This is helpful because if First Steps subsequently receives an insurance payment for a covered visit, your cost share for that visit will be reimbursed. However, you will still have to pay your full cost amount upon receiving services.

If you have not already provided both your insurance information and consent to bill, or if your insurance information has changed since your last IFSP, please contact your service coordinator immediately. Even if your insurance data has not been entered into the First Steps system by May 1, it will be applied retroactively to services beginning May 1. Please note that if you have reason to believe insurance billing would somehow present a hardship for your family or employer, you can request a waiver review by contacting your service coordinator

New Eligibility Criteria for First Steps – Effective May 1, 2006
In 2005, FSSA brought together a stakeholder group (comprised of parents, providers, and other concerned parties) to examine ways to ensure the continued viability of the First Steps system. A subcommittee was formed to review our eligibility criteria; due to its recommendations, our requirements have been tightened slightly.

Per current practice, your child’s eligibility for continued services will still be determined by a multi-disciplinary team of early intervention practitioners. At your child’s next annual IFSP, the early intervention team will re-evaluate your child’s eligibility. Under the new criteria, your child will still be eligible for continued early intervention services if he or she:

· Has been diagnosed with a physical or mental condition that is known to result in a high probability of developmental delay. These conditions include, but are not limited to, chromosomal abnormalities or genetic disorders, neurological disorders, congenital malformations, sensory impairments (including vision or hearing), severe toxic exposure (including prenatal exposure), neurological abnormalities in the newborn period, or birth weight of 1,500 grams (3.3 pounds) or less; or,

· Is shown to have a delay of 20% or more in two areas of development OR of 25% or more in one area of development (adjusted for prematurity).

One of our goals is to help your child reach an appropriate level of functioning ~ when this happens, it is cause for celebration! Per current practice, if at any point in the IFSP cycle your child’s ongoing providers indicate he has surpassed the eligibility criteria they will advise you and your IFSP team in order to facilitate your child’s graduation from First Steps.

New Service Coordination Structure – Effective on or before July 1, 2006
In order to improve supervision and support for those who perform the most important function in the First Steps system, our System Point of Entry (SPOE) offices are in the process of assuming direct responsibility for service coordination. The exact timing of the change may vary from SPOE to SPOE, but by no later than July 1, service coordinators (SCs) will be local SPOE employees.

Under this new system, most SCs will be either full- or half-time employees, and the total number of SCs required statewide will be reduced. Further, some current SCs have already indicated they will not be applying for these positions. As a result, it is possible your current SC may leave the system on or before July 1; you will be contacted by the SPOE as soon as they become aware of a departure.

Throughout this transition, you deserve to receive high quality services from your current SC; however, if you learn your SC has left the system before you are contacted by the SPOE, if you feel that your child’s needs are no longer being met by your current SC, or if you have concerns about this transition (or your child’s Spring/Summer transition from First Steps) please contact the SPOE immediately. While there will undoubtedly be glitches here and there, your local SPOE is anxious to work with you to make this a positive change for you and your family.

While I realize change can be unsettling, it can also lead to great good. It is my sincere belief this will be true of the changes coming to First Steps, and I greatly appreciate your patience while we continue to work to make First Steps a strong and sustainable force for good, long into the future.


Lora Miller
First Steps
Division of Disability and Rehabilitative Services
FSSA - State of Indiana

The chart below provides a guide to how your First Steps cost share payment may be affected by legislative changes. To learn where your family’s income falls within the 2006 Federal income poverty guidelines, please go to:

To learn the exact percentage of Federal income poverty level First Steps currently has on file for your family (as well as the income, medical expense, and insurance data on which it was calculated) please contact your service coordinator or local SPOE office.


Please note that if the cost share amount exceeds the actual cost of a service, you will pay the lesser of the two per visit, up to the total monthly maximum.

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