Providers of Early Intervention Program (EIP) services, including service coordination, are responsible for maintaining complete clinical documentation related to the provision of early intervention services that are authorized on a child’s Individualized Family Service Plan (IFSP). Session and service coordination notes document that the early intervention provider delivered certain diagnostic, treatment and/or coordination services to a child and/or caregiver on a particular date. Session notes must be completed by all qualified personnel (i.e. special educator, physical therapist, social worker, etc.), based upon requirements of their profession. Session notes assist payors, parents, early intervention providers, and municipalities to substantiate that services were provided. The notes also assist in assessing the extent to which services are helping the child/family to attain the outcomes contained in the IFSP. Rendering providers must maintain original signed and dated session notes, following each child and family contact, which shall include the child’s name on each note or page; date of service on each note; type of service provided on each note or page; time in and time out on each session note; brief description of the activities occurring and the recipient’s progress made during the session as related to the outcome(s) contained in the IFSP; and the name, title, signature of the person rendering the service and the date the session note was written for each note. The rendering provider must also maintain original service logs signed by the parent or caregiver which document that services were received by the child on the date and during the period of time as recorded by the provider, for all Early Intervention services provided with the exception of service coordination. When services are delivered in groups, a separate and distinct session note for each child is required. Individual providers, who directly render services to a child and family, must maintain the original signed and dated session notes. Original early intervention records generated by qualified personnel who are employees of a municipality or provider agency should be retained by the respective municipality or provider agency. Service coordination notes must be completed by all initial service coordinators (ISCs) and ongoing service coordinators (OSCs) to fully document all activities related to the performance of their duties. Service coordination notes ensure that all service coordination activities provided on behalf of a child and family are documented and demonstrate that programmatic and regulatory requirements pertaining to service coordination are carried out. Service coordination notes must fully describe the nature and extent of service coordination services provided and must include the following information: child’s name; date of service; a description of the specific service coordination activity performed; name, date of contact, and purpose of contact for providers or others contacted on behalf of the child and family as necessary to implement the IFSP; start and end time for each contact; name, title (ISC or OSC) and signature of the service coordinator, as applicable. Service coordinators should maintain documentation of activities conducted with text messaging which includes time, to whom the text was sent, and the family are documented and demonstrate that programmatic and regulatory requirements pertaining to service coordination are carried out. Service coordination notes must fully describe the nature and extent of service coordination services provided and must include the following information: child’s name; date of service; a description of the specific service coordination activity performed; name, date of contact, and purpose of contact for providers or others contacted on behalf of the child and family as necessary to implement the IFSP; start and end time for each contact; name, title (ISC or OSC) and signature of the service coordinator, as applicable. Service coordinators should maintain documentation of activities conducted with text messaging which includes time, to whom the text was sent, and the information discussed. If a checklist is used as the service coordination note for a single contact, it must be signed and dated by the SC, and include start and end time for the contact. If a checklist is used across multiple contacts, the SC must indicate start and end time, and date and sign each contact. Alternatively, service coordination notes that are signed, dated, include start and end times, and refer to a checklist for the actual activities performed may be used. Signing multiple notes with one signature is not acceptable; each session note and each service coordination activity for a given date and time must have its own signature.Providers are responsible for delivering Early Intervention Program services to eligible children and their families as authorized by the Early Intervention Official and in conformance with the child’s and family’s Individualized Family Service Plan (IFSP), including the duration, frequency, and specific number of sessions. The provider must ensure that all records which verify that services were provided as authorized (including municipality service authorizations, IFSPs, and session notes) are available for examination by oversight agencies. Providers must also maintain documentation when services are not provided as authorized including documentation of the reason a service(s) was not provided. Providers must give timely notification to the parent, service coordinator and/or Early Intervention Official/Designee of any changes in the provider’s ability to deliver services according to the IFSP. Providers must make reasonable efforts to notify the child’s parent within a reasonable period of any temporary inability to deliver services due to illness, emergencies, hazardous weather, or other circumstances. Providers must notify the child’s parent and service coordinator at least five days prior to any scheduled absences due to vacation, professional activities, or other circumstances. Providers must maintain documentation of any such notifications. Documentation must also support that missed visits were rescheduled and delivered to the child and family by the provider, as clinically appropriate, agreed upon by the parent and in conformance with the IFSP. Providers must ensure that make-up sessions occur according to the provisions of the IFSP.
Providers of Early Intervention Program (EIP) services must follow all requirements of Title 34 of the Code of Federal Regulations (CFR) and other applicable legal requirements for confidentiality.
PI-42B: Storage of child/family records must be secure. All records containing personally identifiable information must be maintained in secure locations, such as a file or room that can be locked when unattended. Records must be disposed of using an appropriate method such as shredding.
PI-42C: Off-site storage of child/family records must be secure. Records stored off-site that contain personally identifiable information must be maintained in secure locations, such as a file, room, or storage unit that is locked. The method of retrieving these files must also maintain the confidentiality of these records. Records must be disposed of using an appropriate method such as shredding. When a professional records management company is used for off-site storage of records containing personally identifiable information, confidentiality requirements must be followed by this company during the storage, retrieval, and disposal of records. The provider’s contract with this company must meet all confidentiality requirements of FERPA and Title 34 CFR applicable to child/family records within the EIP.
PI-42E: Confidentiality of electronic records that are stored on computer must be maintained. Internal controls must be in place when information is stored on computers that limit access to authorized staff within an agency or to the individual provider. This includes, but is not limited to, password protection and secure storage of discs, CD’s, DVD’s and/or other removable storage devices.PI-42F: Confidentiality must be maintained when e-mail is used. Due to the potential for breach of confidentiality, child specific identifiable information may not be transmitted via e-mail unless rigorous administrative, technical and physical safeguards are in place including, but not limited to, password.protection, firewall software, and encryption. Email communication of personally identifiable information takes place exclusively on a Secure Socket Layer encrypted server.
All parties involved in the sending and receipt of an electronic record must be able to maintain the confidentiality of that record. Child specific identifiable information includes a list of personal characteristics or other information that would make it possible to identify the child, the parent or other family members with reasonable certainty. In addition to obvious identifiers such as name, address, etc., the combination of facts presented in the e-mail (e.g., initials, family composition, unique diagnosis, heritage, neighborhood, etc.) should not be able to identify a particular family or child.
If the parent is agreeable or requests the use of unencrypted e-mail for communication of personally identifiable information, there is a specific written parental consent which includes specifics of the dangers to breach of confidentiality inherent in using email; parties who will be involved in email communication; and what information will be shared via email.
PI-42G: Confidentiality of faxed information must be maintained. Safeguarding of faxed information requires, but is not limited to, the use of a fax cover sheet that includes a confidentiality statement. The provider must also ensure that the fax recipient maintains a secure site where faxed information would not be accessible to unauthorized personnel or to the general public.
PI-42I: A record must be kept of all individuals, other than authorized individuals, who access a child’s record, including the date of access and the purpose for which the record was accessed. When this access log contains multiple child names, there is a method for maintaining the confidentiality of each child/family.
PI-42J: Parents must be notified of the process that they must follow to inspect and review all records pertaining to their child. This notification should include a description of the process including how parents would make the request to the rendering provider, who they must speak to, and other details. If a parent is unable to submit a request to review records in writing, a verbal request should be accepted. The provider’s written policy must describe this process.
PI-42K: Parental access to their child’s record must be ensured by the rendering provider. Access to records includes: a review of the record by the parent or a representative on behalf of the parent unless such access is prohibited under State or federal law; an explanation and interpretation of material included in any EI record from the rendering provider upon request; and a copy of any record from the rendering provider within 10 working days of the request (if the request is made as part of mediation or an impartial hearing, a copy must be provided within 5 days.)
PI-42M: The procedure to address amendment of their child’s records must protect the parent’s rights. The parent has the right to request an amendment to their child’s record to the rendering provider when the parent believes the information contained in the record is inaccurate, misleading, or violates the privacy or other rights of their child. If the rendering provider decides not to amend the record as requested, the rendering provider informs the Early Intervention Official (EIO) of this decision. The Early Intervention Official is responsible for informing the parent in writing of the provider’s decision not to amend the record and that the parent has the right to a hearing. The hearing will be conducted by an individual designated by the municipality who does not have a direct interest in the outcome of the hearing. If information in the record is found to be inaccurate, misleading, or to violate the privacy of the child/family, the rendering provider will amend the information and will inform the family’s service coordinator. The service coordinator is required to ensure the contents of the record are amended as requested and notify the parent of the amendment in writing or provide a verbal explanation in their dominant language unless not feasible to do so.
PI-42O: Written parental consent must be obtained before personally identifiable information is disclosed to anyone other than authorized individuals. Written parental consent for release of or obtaining information must include the entity releasing and the entity obtaining the information; which records will be obtained or released; the purpose for the disclosure of information; the date the parent signed the consent; and the signature of the person in parental authority and their relationship to the child. Only information appropriate to a request should be released.
PI-42Q: The provider must have a confidentiality procedure to protect sensitive information (such as sexual or physical abuse, treatment for mental illness or mental health problems, HIV status, communicable disease status, the child’s parentage, etc.). HIV-related information can only be disclosed if the parent signs the New York State form for Release of Medical Information and Confidential HIV Related Information (DOH 2557) or New York State Department of Health, Authorization for Release of Health Information (Including Alcohol/Drug Treatment and Mental Health Information) and Confidential HIV/AIDS Information, (DOH 5032). All written disclosures of confidential HIV information must be accompanied by a statement prohibiting re-disclosure. Agency providers must identify a staff person who has the responsibility for guaranteeing the confidentiality of sensitive information.
PI-42S: The electronic record process allows for determination of the date, time and author of the original entry. The electronic record system prevents the record from being altered after it was created by an unauthorized individual allowing only access by the author or persons that have appropriate access rights to this record, such as administrators. The electronic record process allows for corrections and amendments, and documents the date, time and name of the person who made the change. In instances where paper records are scanned, the author must have signed the document before it was scanned or it was signed by means of electronic signature. The scanned documents must be retained in a secure manner. If entries to the electronic record are menu driven, such as drop down or check box for fields such as service type, location, method of intervention, child’s response, carryover, CPT/ICD codes, etc., they are appropriate to the service(s) provided and the rendering provider is identified as having selected the entry. The provider has set up a system of internal controls that ensure that actual completed service delivery drives Early Intervention claim submission, as well as Medicaid and third party billing. Electronic records are accessible, for program monitoring, fiscal auditing and other auditing activities without the need for special programming, software, language etc.
PI-42T: Agency providers must ensure that all employees, independent contractors, consultants, and volunteers with access to personally identifiable information complete annual confidentiality training. The agency must have a written policy that states how the staff is kept informed of confidentiality requirements (i.e., annual confidentiality training). The agency must also maintain documentation of annual confidentiality training.
Agency providers must employ and/or subcontract with only those individuals who are qualified to deliver services according to the New York State Department of Health’s Early Intervention Program qualified personnel requirements. Agency providers must have a process that includes verification at the time of initial hire by checking the State Education Department, Office of Professions, or Office of Teaching websites. They must have a process in place that includes periodic checks of the State Education Department, Office of Professions, or Office of Teaching websites, to ensure employees and contractors have current credentials. The provider’s written policy should describe both initial and periodic verification of provider qualifications via these websites.
The agency must have a process for ensuring that all employees/subcontractors providing service coordination are qualified in accordance with Early Intervention Program (EIP) regulation. Documentation demonstrating the appropriate qualifications of any person delivering service coordination services must be available for review. All individuals providing service coordination must be qualified in accordance with EIP regulation as evidenced by two years’ experience providing service coordination; or one year of service coordination and one year experience in a service setting with infants and toddlers with developmental delays or disabilities; or one year service coordination and an associate degree in health or human services; or a bachelor’s degree in health or human services. Supervision must be carried out for students enrolled in an accredited university training program; individuals with internship, supplementary, or conditional initial certificates; and individuals completing their licensing requirements.
Agency providers who are approved to deliver Applied Behavioral Analysis (ABA) using ABA aides must comply with early intervention regulation regarding the supervision and qualification of ABA aides, and must have all documentation of requirements available for review.
* If you received notice of immediate remediation for this finding, please attach the corrective action plan immediate remediation response that you have provided to the NY State Department of Health Early Intervention Program.
All agency providers must have written policies and procedures that includes a process for all potential employees or contracted individuals, administrators, consultants, interns or volunteers who will have the potential for regular or substantial contact with children to be screened through the NYSJC before determining whether to hire or allow any such person to have regular and substantial contact with children. Under NYS Social Services Law, all early intervention providers must have procedures and written policies to screen all new or prospective employees, contractors, consultants, and volunteers who will have regular and substantial contact with children receiving early intervention services through the New York State Central Register of Child Abuse and Maltreatment (SCR). If notice is received from the SCR that a person is the subject of an indicated report of child abuse or maltreatment, it is advisable that the provider seek appropriate legal counsel in making a determination whether to hire an applicant for employment or a consultant who will have the potential for regular and substantial contact with children receiving early intervention services. Please note that employees/contractors who will have substantial contact with children may not deliver services without supervision before the results of the screen are received. Supervision of an employee/contractor who has not yet received clearance from the SCR must be provided by the responsible provider agency.
All providers must be aware of the procedures to report suspected child abuse and maltreatment according to Sections 413-415 of the New York State Social Services Law. Policies and procedures must demonstrate that individual providers, agency employees and subcontractors are aware of the requirements to report suspected child abuse and maltreatment or to cause a report to be made, including notification to the New York State Central Register of Child Abuse and Maltreatment (SCR) according to Sections 413-415 of the Social Services Law. All early intervention providers must have policies and procedures in place to address reporting suspected child abuse or maltreatment either directly to the SCR or to an appropriate authority. Providers may make a report directly to the SCR. Reports which are made to the SCR should be made immediately by telephone. Providers may also report suspected child abuse and maltreatment to a responsible party such as the local child protective services, the Early Intervention Official/Designee, the child’s Early Intervention (EI) service coordinator, and/or an EI supervisor. The provider should have a complete written policy that includes a description of the procedure to report suspected child abuse or maltreatment to the SCR or an appropriate authority (SCR, local CPS, EIO/D, EI SC, or an EI supervisor), guidance regarding identifying abuse or maltreatment, and the telephone number(s) to use to report child abuse for non-mandated reporters and mandated reporters.
Providers must ensure that universal precautions are utilized when early intervention services are being delivered. A supply of disposable gloves must be available in the service area, including in home and community settings, to be readily accessible for use in accordance with universal precautions and must be used when in contact with body fluids. Additionally, practice must ensure the use of universal precautions when handling potentially infectious bodily fluids (e.g., blood), including cleaning and disinfecting of soiled surfaces and adequate disposal of waste. A sanitizing solution of 1 tablespoon of bleach in 1 quart of water prepared fresh each day, or an equivalent product, must be used to disinfect when potentially infectious bodily fluids (e.g., blood) are present. If an equivalent product is used for disinfectant purposes, including a commercially prepared product or solution, it must be used according to the manufacturer’s instructions and must be stated in writing to be effective against HIV and Hepatitis B and C, and safe for use with young children. Practice must also include the disposal of waste in a secure, leak-proof plastic bag, a sharps container or disposal in covered plastic lined waste cans.
Due to the declared state of emergency for COVID-19, the New York State Department of Health Bureau of Early Intervention is revising the Health and Safety Standards for the Early Intervention Program guidance document. Please be aware that additional guidance will be forthcoming. In the interim, providers should state in their written Health & Safety policies and procedures that they will use cleaning and disinfecting products for handling bodily fluids and soiled surfaces according to the directions on the label for safe and effective usage, and must additionally note that they will update their Health and Safety policies and procedures when the successor document becomes available.
Additionally, it is important to note that the practice of bringing the same toys or other materials into multiple homes and community-based settings during in-person EI service delivery has the potential to transmit COVID-19 or other viral or bacterial infections. Therefore, until further notice, bringing materials and toys from outside into home and community-based settings is strictly prohibited.
Please consult the Department of Environmental Conservation’s (DEC) list of products registered in New York State and identified by the EPA as effective against COVID-19 when used according to label direction, at the following link:
Providers of Early Intervention Program (EIP) services must ensure that only appropriate strategies are used when a child exhibits self-injurious or aggressive behavior that threatens the well-being of the child or others. Corporal punishment, emotional or physical abuse or maltreatment, and the use of aversive intervention in any form are strictly prohibited when providing EIP services. 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: contingent application of noxious, painful, intrusive stimuli or activities; any form of noxious, painful, or intrusive spray (including water or other mists), inhalant, or tastes; 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; movement limitation used as punishment, including but not limited to helmets and mechanical restraint devices; physical restraints; blindfolds; and, white noise helmets and electric shock. 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. The provider’s written policy should clearly prohibit the use of corporal punishment, emotional or physical abuse or maltreatment, and the use of aversive interventions in any form during the provision of EIP services. When physical interventions are needed, training and supervision must be provided to staff on their use. The appropriate people must be informed when a child is exhibiting behaviors requiring intervention including the parent, the service coordinator and/or the Early Intervention Official. Parents cannot be asked to sign waivers or consent forms to allow the provider to use punishments for unwanted behaviors. When self-injurious or aggressive behavior is persistent and ongoing, the provider must take appropriate actions, including seeking the expertise of qualified personnel and obtaining parent approval for interventions. The service coordinator and Early Intervention Official are notified when serious injury occurs to the child or when the child injures others. A behavior management plan must be developed by qualified personnel with appropriate expertise and documented in the child record. The service coordinator is notified when outside expertise is needed to develop a behavior plan. The behavior management plan must be in writing and signed by the parent. The plan must be developed in concert with the child’s family and providers of early intervention services, and other clinical experts as needed. A medical evaluation should be conducted to address medical conditions. The plan should be a result of a thorough assessment of cause or behavioral functions, and should be implemented by appropriately trained individuals. All providers serving the child should have a copy of the behavior management plan. The parent has the right to revoke approval of the plan at any time.
Providers must ensure that their equipment, materials, and toys are in good condition and free of lead or other known safety issues. The provider must have a procedure for regular cleaning of equipment, materials, and toys used in the provision of early intervention services. Toys, equipment, and materials must be isolated and sanitized if used by an ill child. For disinfecting and sanitizing of toys, a soaking solution of 1 teaspoon of bleach in 1 gallon of water prepared fresh each day should be used.
There must be a process for ascertaining that toys are free of lead or other known safety hazards that includes checking new toys, equipment and materials through the U.S. Consumer Product Safety Commission website before introducing them to children and their families, to ensure the item(s) have not been recalled. Additionally, the website is checked periodically for updates.
Due to the declared state of emergency for COVID-19, the New York State Department of Health Bureau of Early Intervention is revising the Health and Safety Standards for the Early Intervention Program guidance document. Please be aware that additional guidance will be forthcoming. In the interim, providers should state in their written Health & Safety policies and procedures that they will use cleaning and disinfecting products for handling bodily fluids and soiled surfaces according to the directions on the label for safe and effective usage and must additionally note that they will update their Health and Safety policies and procedures when the successor document becomes available. Additionally, it is important to note that the practice of bringing the same toys or other materials into multiple homes and community-based settings during in-person EI service delivery has the potential to transmit COVID-19 or other viral or bacterial infections. Therefore, until further notice, bringing materials and toys from outside into home and community-based settings is prohibited.
Please consult the Department of Environmental Conservation’s (DEC) list of products registered in New York State and identified by the EPA as effective against COVID-19 when used according to label direction, at the following link:
All agency providers are required to maintain a quality assurance (QA) plan. Agencies must designate quality assurance professionals for each type of service. The quality assurance professional must be an agency employee who was licensed/certified in their respective profession. Documentation must be maintained that demonstrates the quality assurance activities are consistent with the plan for each type of service.