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December 2016 Texas Medicaid Provider Procedures Manual

Children’s Services Handbook : 2 Medicaid Children’s Services Comprehensive Care Program (CCP) : 2.7 Early Childhood Intervention (ECI) Services : 2.7.2 * Services, Benefits, Limitations, and Prior Authorization

2.7.2
ECI services are usually provided in the client’s natural environments, which are defined as settings that individual families identify as natural or normal for their family, including the home, neighborhood, and community settings in which children without disabilities participate. ECI services may be provided in the following places of service (POS): office/facility (POS 1), home (POS 2), outpatient (POS 5 applicable only to ECI services rendered in a Prescribed Pediatric Extended Care Center [PPECC]), and other locations (POS 9).
The Texas ECI Program uses evaluations and assessments to determine eligibility. Clients are eligible for ECI if they are 35 months of age and younger and have a developmental delay, a medically diagnosed condition that has a high probability of resulting in developmental delay, or an auditory or visual impairment as defined by the Texas Education Agency.
Under the Texas ECI Program, families and professionals work together to develop an Individualized Family Service Plan (IFSP) which is based on the unique needs of the client and the client’s family. The IFSP serves as the prior authorization for the services and documents the medical necessity for the services.
A single identified need and treatment goal (outcome on the (IFSP)) may be addressed by more than one discipline. Documentation of service provision must demonstrate the application of discipline specific knowledge (i.e., OT, PT, ST, SST) for each of the services provided.
ECI services must be provided as stated in 40 TAC, Part 2, Chapter 108.
Refer to:

Texas Medicaid & Healthcare Partnership
CPT only copyright 2014 American Medical Association. All rights reserved.