N.Y. Comp. Codes R. & Regs. Tit. 10 §§ 69-4.5

Current through Register Vol. 46, No. 45, November 2, 2024

Section 69-4.5 - Approval of service coordinators, evaluators, and service providers

(a) Individuals and agencies shall apply to the Department for approval to provide evaluations, service coordination services, or early intervention services. The Department may reapprove providers, but no more frequently than every five years from the date of approval or subsequent reapproval. Upon receipt of notification from the Department, an agency or individual shall apply for reapproval if the agency or individual wishes to continue providing services in the early intervention program. The Department shall consider applications for approval and reapproval utilizing the criteria set forth in subdivision (4) of this section.

(1) Payee providers shall be enrolled and, as applicable, recertified as providers in the medical assistance program in accordance with the procedures for such enrollment and recertification established by the department, and shall provide documentation of the provider's enrolled and, if applicable, recertification status upon the department's request.

(2) Approved agency providers shall submit on a periodic basis consolidated fiscal reports to the department upon request. Approved individual providers shall submit information on revenues and expenses upon request of and on a form developed by the department.

(3) All approved providers shall be in compliance with the criteria set forth in paragraph (4) of this subdivision.

(4) Approval and reapproval of individuals and agencies shall be based on the following criteria:

(i) character and competence of the individual, or for agency providers, the owners, officers, including the chief executive officer and chief financial officer, members, shareholders who own 10 percent or more of the voting shares in the agency, directors or sponsors, the program director and other key employees, and the board of directors of a not-for-profit entity as determined by the department;

(ii) documented fiscal viability of the agency;

(iii) for individual providers, proof of current certificate, license, or registration in one of the disciplines set forth in subdivision (al) of section 69-4.1 and documentation of a minimum of 1,000 clock hours prior to the date of application to the Department for approval, delivering such service to children under five years of age in an early intervention, clinical pediatric, early childhood education program, which may include relevant experience obtained as part of a supervised educational program and/or clinical internship as a prerequisite for professional licensure, certification, or registration, and provided that such experience must have included direct experience in delivering services to children with disabilities and their families:

(iv) for agency providers, identification of all employees who will provide Early Intervention Program services, and where applicable, the employees' licenses, registrations, certifications, national provider identification numbers and expiration dates and such other information as may be required by the department;

(v) for agency providers, identification of all State-approved agency and individual contractors who will be utilized to provide services and where applicable, the persons' licenses, registrations, certifications, national provider identification numbers and expiration dates and other information as may be required by the department;

(vi) for agency providers, a comprehensive quality assurance plan that is approved by the Department for all service s offered by the agency, including evaluations, early intervention services, and service coordination. The quality assurance plan shall include, but not be limited to, ensuring qualified personnel have appropriate and current licensure, registration, and certification as applicable; ensuring continuing education and training requirements are met; and addressing how the agency will ensure that all documentation requirements to support billing and claiming for early intervention services are met. The agency program director shall be responsible for developing a quality assurance plan that is approved by the Department, for implementing such plan, and for monitoring that quality assurance requirements are met.

(vii) for agency providers, documentation that the agency has in its employment, or in accordance with this sub paragraph, will have in its employment, the following personnel:

(a) a professional employed on a full time basis who shall serve as the program director for the agency whose duties may include early intervention program service delivery and shall include administration and oversight responsibilities, including submission and oversight of the quality assurance plan pursuant to subparagraph (vi) of this paragraph. The program director shall have a minimum of two years of full-time equivalent experience in an early intervention, clinical pediatric, or early childhood education program serving children ages birth to five years of age, provided that:

(1) such experience shall have included direct experience in delivering services to children with disabilities and their families; and

(2) at least one year of such experience shall have been in the delivery of services to children less than three years of age and their families.

(b) a minimum of two qualified personnel or service coordinators who meet qualifications established in section 69-4.4 of this s ubpart, in addition to the Early Intervention Program director, each of whom provides evaluations, service coordination, or services to individuals with disabilities for a minimum of twenty hours each per week.

(c) an agency applying for reapproval shall, at the time of application, submit documentation that it has in its employment the personnel required in this sub paragraph;

(viii) adherence to, and for purposes of reapproval, evidence of demonstrated compliance with all applicable Federal and State laws, regulations, standards and guidelines;

(ix) delivery of services on a twelve-month basis and flexibility in the hours of service delivery, including weekend and evening hours in accordance with eligible children's IFSPs;

(x) agreement to participate and, for purposes of reapproval, evidence of participation in continuing professional and clinical education relevant to early intervention services, including services and clinical issues unique to children less than three years of age, and in-service training on state and local policies and procedures of the Early Intervention Program, including department-sponsored training;

(xi) adherence to, and for purposes of reapproval, demonstrated compliance with the confidentiality requirements applicable to the Early Intervention Program as set forth in Federal and State law and regulations;

(xii) provision of copies of all organizational documents requested by the department and documentation of licensure or approval granted to the individual or agency by other regulatory agencies;

(xiii) for the purposes of reapproval, documentation that corrective actions required by the department have been implemented and non-compliance corrected to the satisfaction of the department;

(xiv) provision of such additional pertinent information or documents necessary for approval or reapproval, as requested by the department.

(5) In addition to the criteria set forth above, for reapproval of an agency or individual, the department may also consider:

(i) any actions taken against the provider's license, certification, or registration, any criminal convictions, or any actions taken pursuant to section 69-4.24 of this Subpart;

(ii) the results of any investigations performed by the department pursuant to section 69-4.17(i) of this Subpart;

(iii) the results of monitoring reviews, complaint investigations and fiscal audits performed by the department, municipalities or either of their agents; and

(iv) other information and documents pertinent to the provider's character and competence.

(b) Repealed

(c) If there is a transfer, assignment, or other disposition of 10 percent or more of an interest or voting rights in the approved agency provider; or if there is a transfer, assignment, or other disposition of less than 10 percent of an interest or voting rights in the approved agency provider, but the transfer, assignment, or other disposition together with all prior transfers, assignments, or other dispositions within the last 5 years subsequent to the date of the agency provider's approval by the department would, in the aggregate, involve 10 percent or more of an interest in the approved agency provider, the approved agency provider shall notify the department as soon as practicable, but no later than 5 business days after the intended effective date of the transfer, assignment, or other disposition. The notice shall include a statement as to whether the approved agency provider intends to continue to participate in the Early Intervention Program. Upon receipt of such notice, the department may determine that the approved agency provider must initiate a reapproval process.

(d) Providers approved and reapproved to deliver early intervention evaluations, service coordination services and Early Intervention Program services shall meet with or otherwise communicate with parents and other service providers, including participation in case conferencing and consultation. Agencies shall further require that its employees comply with the provisions of this section and require compliance with this subdivision in its contracts with individual providers.

(e)

(1) Approved providers shall not disseminate, or cause to be disseminated on their behalf, marketing materials that are false, deceptive, or misleading. Upon the department's request, providers shall periodically submit copies of marketing materials for review. Marketing materials that do not comply with the provisions of this subdivision may be a basis for action against the provider's approval in accordance with the provisions of section 69-4.24 of this Subpart. The department shall develop standards on appropriate marketing materials and shall require that marketing materials that seek to promote or advertise Early Intervention Program evaluations or services adequately inform parents or guardians of potentially eligible or at-risk children less than three years of age about the Early Intervention Program. Marketing materials that seek to promote or advertise Early Intervention Program evaluations or services shall include the following statements or their equivalent:

(i) Clear identification that the Early Intervention Program, and early intervention services available through the Early Intervention Program, are for children less than three years of age who have or are suspected of having a developmental delay and/or disability.

(ii) A statement that the Early Intervention Program is a public program funded by New York State and county governments.

(iii) A statement that all children must be referred to the municipality to access Early Intervention Program services, and including the municipal agency's telephone number.

(iv) Clear identification of the provider referenced in the marketing and advertising materials, and an accurate statement that the provider is approved as a provider of Early Intervention Program services and that it is in an agreement with the department to deliver Early Intervention Program services.

(v) A statement that all services provided under the Early Intervention Program are provided at no out-of-pocket cost to parents, but that health insurance subject to New York State Insurance Law may be accessed for reimbursement for early intervention services provided to eligible children and their families.

(vi) A statement that eligibility for the Early Intervention Program can be determined only by approved evaluators under an agreement with the department.

(vii) A statement that if a child is found eligible for the Early Intervention Program, all needed early intervention services must be identified by the IFSP team, including the parent and the early intervention official.

(viii) A statement that authorization from the early intervention official is required for a qualified early intervention provider to furnish early intervention services to the child.

(ix) A statement that when early intervention services are delivered in child care settings or community locations that require a fee, the parent is responsible for paying any associated costs with such access to child care or community locations.

(2) Service coordinators, evaluators and approved providers, and any individual or entity which performs paid or unpaid marketing activities related to Early Intervention Program services on their behalf, shall not engage in any marketing and advertising practices that offer incentives, or could be construed or appear to offer incentives of any kind to the parents or relatives of an eligible or potentially eligible child, or to the service coordinator, evaluator, the referral source, or other approved providers authorized to deliver services to an eligible or potentially eligible child, that attempts to or would appear to influence selection of a service cooridnator, evaluator or provider of services.

(3) Approved agency providers shall not offer incentives or appear to offer incentives to its employees or subcontractors in the form of payment, performance evaluations, or other awards or benefits that are based on the number of referrals and/or services authorized under the Early Intervention Program.

(f) Approved individuals shall notify the department within two business days if his or her license is suspended, revoked, limited or annulled, regardless of whether the suspension or limitation is stayed. Approved individuals and agencies shall notify the department within two days if a contract the provider holds with an agency provider is terminated for any reason. Approved agency providers shall ensure that services are delivered by those authorized to do so and shall only employ or contract with individuals who are licensed, registered or certified in compliance with applicable provisions of law, in one of the disciplines set forth in section 69-4.1(al) of this Subpart.

(g) Approved providers shall comply with title VI of the Civil Rights Act of 1964, section 504 of the Federal Rehabilitation Act of 1973, and all other State and Federal statutory and constitutional non-discrimination provisions which prohibit discrimination on the basis of race, color, national origin, handicap, age, sex, religion and marital status.

(h) All applicants shall receive written notice of their approval or reapproval to deliver service coordination services, evaluations, and/or Early Intervention Program services, and that an agreement with the department may be required to participate in the Early Intervention Program.

(i) Approved providers shall notify the department in writing of any changes made subsequent to approval or reapproval of professional license, certificate, or registration; or for agency providers, transfers, assignments, or other dispositions of less than 10 percent of an interest or voting rights of the agency; identification; address and location; and catchment area.

(j) An approved agency or individual provider who intends to cease providing service coordination services, evaluations or early intervention services, or in the case of an agency, intends to cease ownership, possession or operation of the agency, or chooses to voluntarily terminate status as an approved service coordination, evaluation and/or service provider agency, shall:

(1) submit to the department and early intervention official written notice of such intention and a plan for transition of children not less than 90 days prior to the intended effective date of such action; and

(2) collaborate with municipalities and the department to ensure a smooth transition of eligible children and their families to other approved providers.

(k) Municipalities shall provide the department with such information or documentation as requested and in a content, format and frequency determined by the department.

(l) Agency providers shall periodically, upon request of the department, provide the department with information on its State-approved agency and individual employees and contractors utilized by the agency in the provision of Early Intervention Program services. Information to be provided includes the provider's name, license, registration or certification, national provider identification number and expiration dates, and other such information as may be required by the department.

N.Y. Comp. Codes R. & Regs. Tit. 10 §§ 69-4.5

Amended New York State Register November 30, 2016/Volume XXXVIII, Issue 48, eff. 11/30/2016

Amended New York State Register December 5, 2018/Volume XL, Issue 49, eff. 12/5/2018

Amended New York State Register November 13, 2019/Volume XLI, Issue 46, eff. 11/13/2019

Amended New York State Register February 14, 2024/Volume XLVI, Issue 7, eff. 2/14/2024