NEW MEXICO DEPARTMENT OF HEALTH DEVELOPMENTAL DISABILITIES SUPPORTS DIVISION (DDSD) FISCAL YEAR 2018

NEW MEXICO DEPARTMENT OF HEALTH DEVELOPMENTAL DISABILITIES SUPPORTS DIVISION (DDSD) FISCAL YEAR 2018 STATE GENERAL FUND Services fr Individuals with Develpmental Disabilities, and FAMILY INFANT TODDLER PROGRAM / MEDICAID EPSDT Services fr infants and tddlers (birth t three) with, r at risk f Develpmental Delays and their families SERVICE DEFINITIONS AND STANDARDS EFFECTIVE JULY 1, 2017

TABLE OF CONTENTS INTRODUCTION... 3 GENERAL REQUIREMENTS... 3 STANDARDS FOR SERVICE PERSONNEL... 4 RESPITE... 6 CHILD FIND AND PUBLIC AWARENESS... 9 COMPREHENSIVE MULTIDISCIPLINARY EVALUATION... 11 FAMILY SERVICE COORDINATION... 17 EARLY INTERVENTION... 22 RESIDENTIAL SERVICES FOR ADULTS WITH DEVELOPMENTAL DISABILITIES 32 DAY SERVICES FOR ADULTS WITH DEVELOPMENTAL DISABILITIES... 37 SELF-DIRECTED FAMILY SUPPORT PROGRAM... 42 Page 2 f 45

INTRODUCTION These standards apply t the services prvided under State General Funded prvider agreements with the Develpmental Disabilities Supprts Divisin f the Department f Health fr State Fiscal Year 2018 (July 01, 2017 thrugh June 30, 2018). Services included in these standards are thse prvided t families f infants and tddlers (birth t 3) with r risk fr develpmental delays and thse prvided t individuals with develpmental disabilities. Fr Early Interventin and ther Family Infant Tddler Prgram services these standards clarify, interpret, and further enfrce the Human Services Department regulatins gverning the prvisins f 8.320.4 NMAC Medicaid Early Peridic Screening Diagnsis and Treatment services under Special Rehabilitatin Services and the 7.30.8 NMAC Requirements f the Family Infant Tddler Early Interventin Services The standards address each service prvided under State General Funded Prvider Agreements with the Develpmental Disabilities Supprts Divisin, with the exceptin f Outcme Based Services and Special Prjects (Outcme Based Service and Special Prject requirements will be individually described in each Scpe f Service incrprated int the State General Funded Prvider Agreements affected). These standards als include persnnel requirements fr peple emplyed by r cntracting with agencies prviding State General Funded services, knwn herein as the prvider. Individuals shuld expect t receive services that meet these standards. GENERAL REQUIREMENTS Pertinent laws and regulatins gverning the prvisin f services under the State General Funded Prvider Agreement with the Develpmental Disabilities Supprts Divisin f the Department f Health includes, but is nt limited t: Fair Labr Standards Act and Child Labr Laws New Mexic Nursing Practice Act (NMAC 26.12.2) and NM Bard f Nursing requirements gverning certified medicatin aides and administratin f medicatins. The Federal Individuals with Disabilities Educatin Act (IDEA), Part C DDSD/DOH Requirements fr Family Infant Tddler Early Interventin Services (NMAC 7.30.8) DDD/DOH Service Plans fr Individuals with DD Living in the Cmmunity (NMAC 7.26.5) DDD/DOH Rights f Individuals with DD Living in the Cmmunity (NMAC 7.26.5) DDD/DOH Client Cmplaint Prcedures (NMAC 7.26.4) DDD/DOH Prgram Standards fr DD Cmmunity Agencies (NMAC 7.26.6) DDD/DOH Individual Transitin Planning Prcess (NMAC 7.26.5) DDD/DOH Dispute Reslutin Prcess (NMAC7. 26.8) DHI/DOH Statewide Incident Management System Plicies and Prcedures DDSD/DOH Plicy Gverning the Training Requirements fr Direct Supprt Staff and Internal Service Crdinatrs, Serving Individuals with Develpmental Disabilities Reprting and Dcumentatin f DDSD Training Requirements Plicies and Prcedures fr Centralized Admissin and Discharge Prcess fr New Mexicans with Disabilities Plicy fr Behaviral Supprt Services DHI/DOH Criminal Recrds Screening fr Caregivers (NMAC 7.1.9) The Department f Health Prvider Agreements fr Fiscal Year 2016 And any rules, regulatins, plicies, directr s releases r interpretive memrandum published by DDSD/DOH that specify applicability t the State General Funded services described herein. Page 3 f 45

STANDARDS FOR SERVICE PERSONNEL PURPOSE The purpse f the standards fr service persnnel is t establish requirements fr the prvisin f services under State General Funded Prvider Agreements with the Develpmental Disabilities Supprts Divisin f the Department f Health. These standards apply t persnnel wh prvide the fllwing State General Fund services: Respite Services (Children and Adult), Adult DD Residential Services and Adult Day Services. The standards apply whether the persnnel are directly emplyed r subcntracting with the prvider agency, and are in additin t the requirements set frth in the remaining sectins f the State General Funded Service Standards. INTRODUCTION It is the intentin f the Develpmental Disabilities Supprts Divisin that State General Funded prviders cmply with these persnnel standards in rder t prmte the health and safety f individuals served. GENERAL PERSONNEL REQUIREMENTS All persnnel must be f gd integrity and pssess adequate physical, mental and emtinal stability t prvide services in a safe and respnsible manner. The prvider must screen all persnnel regarding their qualificatins, references, and emplyment histry. In additin, all prviders must cmply with the NMAC Title 7 Chapter 1 General health Prvisin Part 9 7.1.9.1: Caregivers Criminal Histry Screen Requirements as implemented by the Department f Health. EXCEPTION: Any agency prviding Hme Health Aide, Hmemaker/Cmpanin Services under a Hme Health Care Agency pursuant t the New Mexic Department f Health, Health Facility Licensing and Certificatin Bureau (NMAC 7.28.2) is exempt frm these persnnel standards. QUALIFICATIONS FOR DIRECT SERVICE PERSONNEL Direct service persnnel are persns paid t prvide face-t-face including telehealth services t the individual and family. Direct service persnnel must be eighteen (18) years r lder. Exceptins: Habilitatin services prvided under Adult DD Vcatinal/Habilitatin Services can emply direct care persnnel under the age f 18 years, but the emplyee must wrk directly under a supervisr, wh is physically present at all times; and the agency can assure the served individual is nt limited in access t all services and supprts. 1. Direct service persnnel shuld be available t cmmunicate in the language required by the individual r in the use f specific augmentative cmmunicatin system utilized by the individual. 2. Direct service persnnel must meet the cmpetencies specified by DDSD in the Plicy Gverning the Training Requirements fr Direct Supprt Staff and Internal Service Crdinatrs, Serving Individuals with Develpmental Disabilities (2/23/07). (Exceptin: Respite Services) 3. Direct service persnnel must have the ability t read and carry ut the requirements in an Individualized Family Service Plan (IFSP) r an Individual Service Plan (ISP). SUPERVISION REQUIREMENTS Persnnel wh are directly respnsible fr the supervisin f direct service persnnel must meet the fllwing requirements. 1. Emplyees wh supervise direct service persnnel r serve as a member f a supervisry team must be twenty-ne (21) years f age r lder. 2. Must pssess a high schl diplma r G.E.D. Page 4 f 45

3. Emplyees wh supervise direct service persnnel must have a minimum f ne-year experience wrking with individuals with disabilities r related field; OR a degree in a related field may substitute fr experience. 4. Emplyees wh supervise direct service persnnel must meet the cmpetencies specified in the Develpmental Disabilities Supprts Divisin Plicy Gverning the Training Requirements fr Direct Supprt Staff and Internal Service Crdinatrs. 5. Must have the ability t read and carry ut the requirements in an IFSP r ISP. Page 5 f 45

RESPITE Respite is a flexible family supprt service that prvides shrt term, temprary care t peple with disabilities r children wh are at risk fr develpmental delay. This service allws families t take a break frm the daily rutine f care giving. Respite care prviders assist the individual in activities f daily living, prmte the individual s health and safety, as well as maintain a clean and safe envirnment. The family, in cllabratin with the prvider, will schedule respite services. SCOPE OF SERVICE Respite services include but are nt limited t: Assisting the individual t enhance self-help skills and carry ut activities f daily living; Prviding nn-medical health care; Preparing r assisting the individual in activities f daily living including preparatin f meals, eating, sleeping, washing etc.; Prviding pprtunities fr cmmunity and neighbrhd integratin and invlvement; Prviding pprtunities fr leisure, play and ther recreatinal activities; Prviding pprtunities and supprt t the individual t make chices in regard t daily activities depending n age and skill level. SERVICE REQUIREMENTS Specific requirements and cnditins that apply t respite services are: The staff t participant rati is typically 1:1 r 1:2 in family husehld r cmmunity settings fr the perid f time in which an individual is receiving respite services. A decisin based n the participant s needs and the respite prvider s capabilities shuld be made n a case-by-case basis if the respite prvider is ging t serve mre than ne individual at time. Service prvisin in a small grup is permissible when apprpriate t the individual and family; hwever; a minimum f a 1:4 staff t participant rati must be maintained if the respite is prvided t a grup. The decisin regarding the lcatin in which respite will be prvided shall be made in cnsultatin with the family. Lcatins where respite may be prvided include the fllwing: 1. The individual s/family s hme, 2. The respite care prvider s hme, 3. A cmmunity setting f the family s chice (e.g. cmmunity center, swimming pl, park etc.), 4. A center based setting, such as a respite hme, prvider lcatin r day care center. Respite hurs are allcated up t a maximum f 200 hurs per year per eligible recipient. The agency may nt allw any family t receive ver 200 hurs per year if they have a waiting list fr respite services. The respite crdinatr shuld meet with the family t determine each family s needs and hw they will utilize respite. Fr example: If the family wants 2 hrs per week in rder t d laundry, this wuld amunt t 104 hurs (2hrs X 52 weeks) per year. If the family wants ne day per mnth fr the parents t spend time tgether this wuld be 96 hurs (8 hrs X 12mnths) per year. Families/Individuals may request respite care hurs vernight r mre than ne day. Page 6 f 45

If respite is prvided in the respite prvider s hme, the hmewner r renter f the hme where the service is prvided shall ensure the safety f the hme including but nt limited t the presence f a smke detectr and fire extinguisher. Agencies prviding respite services will verify that respite prviders wh prvide respite services in their wn hme are made aware f this requirement. Respite prviders shuld nt prvide skilled nursing tasks including G-tube replacement, xygen adjustment, suctining etc. The family r a qualified nurse wrking within their scpe f practice must cmplete skilled nursing prcedures. ELIGIBILITY REQUIREMENTS FOR RESPITE SERVICES INCLUDES THE FOLLOWING: A child age 0 thrugh 3 years must be eligible fr Early Interventin Services and have Respite identified as a service in the Individualized Family Service Plan (IFSP). A child wh is between the age f 3 years thrugh 21 must meet ne f the fllwing: Have been previusly eligible, under the established cnditin r the develpmental delay eligibility criteria under the Family Infant Tddler Prgram (Age 3 thrugh 5 nly); r Be eligible fr Special Educatin under the Individuals with Disabilities Educatin Act (IDEA) Part B, administered by the Public Educatin Department (PED) under ne f the fllwing categries: i) Autism; ii) Develpmental Delay (age 3 thrugh 9 nly); iii) Intellectual Disability; iv) Multiple Disabilities; and v) Traumatic Brain Injury; r Determined t meet the eligibility f develpmental disability in accrdance with DDSD Plicy and n the NM Develpmental Disabilities Central Registry (waiting list). An adult age 22 r lder must have been determined develpmentally disabled in accrdance with DDSD Plicy and be n the Develpmental Disabilities (DD) Central Registry (waiting list). AGENCY REQUIREMENTS The prvider must adhere t the fllwing: A. Administrative requirements: The prvider will assure the eligibility f individuals receiving services and will maintain a participant recrd cntaining dcumentatin pertinent t service delivery such as cntact ntes, hurs f training, hurs f service. The prvider may require advance ntice frm the individual/family fr the scheduling f respite. The prvider will establish and maintain financial reprting and accunting fr each individual/family served. The prvider will prepare and submit quarterly summary reprts t the DDSD - Family Infant Tddler Prgram staff assigned t their regin f the State, using the frmat specified by the Family Infant Tddler Prgram. The prvider shall nt charge any fee t families fr Respite. The prvider may charge fr meals r entrance fees is these ccur during the time respite is prvided. B. Staffing Requirements: The prvider must adhere t the fllwing requirements regarding emplyees r cntract persnnel hired as respite prviders: A parent, spuse, primary caregiver r surrgate parent may nt prvide respite services if they reside in the same dwelling as the individual served. Respite care prviders must be at least 18 years ld. Respite care prviders must be certified in First Aid and CPR. CPR must be btained fr the ppulatin fr which they will be serving (either infants, adults r bth). Page 7 f 45

Respite care prviders prviding care t mre than ne participant must cmplete a frty (40) hur training prgram. Training can be specific t that participants needs. CPR and First Aid may cunt twards this requirement. Respite care prviders recruited specifically fr a single participant must cmplete a twenty (20) hur training prgram. Training can be specific t that participants needs. CPR and First Aid may cunt twards this requirement. Respite care prviders may access the tpics/requirements fr training specified in the Plicy Gverning the Training Requirements fr Direct Supprt Staff and Internal Service Crdinatrs Serving Individuals. This training dcument is available frm DDSD training unit and n the DDSD website. Respite care prviders may receive individual-specific training by the parent r family f the individual wh needs respite, which can cunt twards a prtin f the training requirement. Respite care prviders may take ther training as relevant t participants such as: HIPAA Privacy, videtapes n specific cnditins r syndrmes, child abuse reprting, research n the Internet fr specific cnditins etc. The agency may allw a reasnable perid f time fr cmpleting additinal training requirements but the time frame may nt exceed 6 mnths frm the date f hire. Respite care prviders must als participate in nging training with a minimum f ten (10) hurs per year after the first year. The respite prvider and emplyer shuld agree n training tpics t be cvered. Criminal recrds checks are mandatry and must be cmpleted in accrdance with the DHI/DOH Criminal Recrds Screening fr Caregivers (7 NMAC 1.9) Respite prviders must meet the DDSD Standards fr Service Persnnel lcated in frnt f this dcument REIMBURSEMENT Request fr reimbursement fr respite services under State General Funds shall be submitted mnthly in accrdance with directins prvided by the DDSD - Administrative Services Bureau (ASB) at the Department f Health. Respite prviders shuld utilize the service cmpnent that crrespnds with the age f the individual. The cmpnent categries are as fllws: Children s Respite (birth - 21): Reprting Categry 700026 Adult Respite (22 & lder): Reprting Categry 700015 The Unit Rate fr all services = $ 13.25 per hur. A prvider Agreement amendment is needed in rder t mve funds between the abve Service Units Reimbursement fr Respite Services is based n an hurly rate, based n face-t-face cntact. Nn-billable hurs include: Travel t and frm the individual s hme, except when the individual is being transprted. Attendance at training and ther persnnel develpment activities, which are nt face-t-face cntacts with the individual/family, preparatin f billing statements, prgress ntes, and/r quarterly reprts. Respite Services prvided under State General Fund (SGF) are nt available t Medicaid Waiver recipients. Respite Services cannt be c-funded with Adult AGF DD Residential Services. Respite Services cannt be billed fr the same hur (s) f the same day (s) with any ther DDSD Service. Page 8 f 45

CHILD FIND AND PUBLIC AWARENESS Child find and public awareness activities prmte identificatin and referral f eligible children with, r at risk fr, develpmental delays fr early interventin services and assist the child in becming Medicaid eligible (where apprpriate). These activities include public awareness, child find activities and interagency planning, presentatins and crdinatin t imprve child identificatin and/r service delivery, and presumptive eligibility activities. SCOPE OF SERVICE Child Find and Public Awareness activities include but are nt limited t the fllwing: Develpment f materials t infrm the general public abut the benefits and availability f early interventin services that are f n cst t families. Distributin f public awareness materials at sites that are frequented by parents f children f yung children (Materials include thse prduced by the prvider and thse generated by the New Mexic Family Infant Tddler Prgram). Outreach t ptential primary referral surces (including physicians; nurses; hspital staff; child care prviders; scial wrkers; Head Start / Early Head Start grantees; hme visiting prviders; Wmen Infant & Children (WIC); hmeless and dmestic vilence shelters, CYFD etc.) regarding early interventin services and infrming them f their respnsibility f helping the family with a referral if the family is cncerned abut their child s develpment r if their child is identified as having r being at risk fr develpmental delays. Prviding pprtunities fr develpmental screening and ther child find activities within the gegraphical area that they serve. Crdinating effrts with ther agencies and rganizatins (including public schls, Head Start prgrams, health centers etc.) regarding child find activities and events such as public health fairs r cmmunity utreach clinics. Cnducting presentatins/ seminars within the gegraphical area served n issues regarding early interventin t heighten awareness regarding early interventin and the availability f services. Cnduct a PE-MOSA (Presumptive Eligibility Medicaid On Site Applicatin Assistance) t assist families in accessing Medicaid eligibility (where apprpriate). SERVICE REQUIREMENTS The fllwing cnditins and requirements apply t Child Find and Public Awareness: Screening and ther child find activities are available t any child wh is birth t three years ld if the family has a cncern abut their child s develpment. (Nte: A child des nt have t receive a screening t receive a develpmental evaluatin). Public Awareness materials develped shuld meet the cultural and linguistic needs f the ppulatin served. All public awareness materials develped must indicate that the prvider agency is funded in part by the NM Department f Health - Family Infant Tddler (FIT) Prgram. Child Find and Public Awareness activities must be prvided t all cmmunities, Indian reservatins/puebls, and/r military bases within the gegraphical area served, as listed in the Prvider Agreement. Prviders shuld identify and target any underserved grups by cmparing numbers served cmpared t Census data. Interagency cllabratin with ther prviders (including Children s Medical Services, Medically Fragile, NMSD; NMBVI, etc.) is imprtant t ensure a streamlined referral and intake prcess and t avid duplicatin. Page 9 f 45

In cunties where there is mre than ne FIT prvider agency, prviders shall crdinate child find and public awareness activities and events in rder t prevent duplicatin f effrt and t efficiently use time and resurces, e.g. deciding wh will d utreach t which referral surces; wh will distribute FIT public awareness materials t which sites; and crdinatin f child find events, etc. This crdinatin shuld be reflected in the annual Child Find / Public Awareness Plan that is submitted t the FIT Prgram. In cunties where there is mre than ne FIT prvider agency, referral surces shuld be infrmed that the referral is t the Family Infant Tddler (FIT) Prgram and that there are x number f FIT prviders that prvide service crdinatin and early interventin services in the cunty that can receive a referral. The prvider will prmte the FIT prgram by using the FIT public awareness materials that list all prviders in that area. If there is a request fr infrmatin regarding a specific agency, infrmatin regarding that agency can be passed ut at that time. AGENCY REQUIREMENTS The prvider must adhere t the fllwing: A. Administrative Requirements Establish and maintain financial reprting and accunting fr expenditures under this service. Maintain a recrd f time spent by staff twards the scpe f service listed abve. Maintain a lg f where, when and hw (e.g. by mail, presentatins, visit by staff etc.) materials have been distributed. Send ne cpy f all public awareness materials prduced t the FIT Prgram reginal Prvider Manager. Ensure that demgraphic and referral infrmatin n all children and families is entered int the Family Infant Tddler Prgram database. Infrmatin must be entered n all children and families that are referred t early interventin, even if they are fund t nt be eligible fr IDEA part C services. Ensure cmpliance with the regulatins fr the Family Infant Tddler Early Interventin Prgram NMAC 7.30.8. Submit an Annual Perfrmance Reprt (APR) within the required timeframe (usually within 60 days fllwing the end f the fiscal year) and in the frmat prvided by the Family Infant Tddler Prgram Submit an annual Child Find / Public Awareness plan within the first 60 days f the fiscal year using the template prvided by the FIT Prgram. Submit a reprt using the template prvided by the FIT Prgram within 30 days f the end f each quarter. B. Staffing Requirements Any staff within the prvider agency can cnduct Child Find and Public Awareness activities. Screening activities shuld nly be cnducted under the direct supervisin f a Develpmental Specialist II. REIMBURSEMENT Request fr reimbursement fr child find / public awareness shall be submitted mnthly in accrdance with directins prvided by the DDSD - Administrative Services Bureau at the Department f Health. Reprting Categry 700024 Unit Rate: $1.00 Reimbursement shall be made based n cst reimbursement i.e. the invice shall be based n the activity that ccurred that mnth. Reimbursement fr Child Find / Public Awareness activities will nt ccur until the FIT Prgram has received and apprved the annual Child Find / Public Awareness plan. Page 10 f 45

COMPREHENSIVE MULTIDISCIPLINARY EVALUATION The Cmprehensive Multidisciplinary Evaluatin (CME) is designed t infrm the eligibility determinatin prcess thrugh a timely, nn-discriminatry, cmprehensive and interdisciplinary apprach. The evaluatin is designed t determine the develpmental status f the child and t determine eligibility fr early interventin services. The evaluatin shall include parent/caregiver reprt, infrmatin frm the rutines based interview prcess and must cver the fllwing develpmental areas: Cgnitive Physical/ mtr (including visin and hearing) Cmmunicatin Scial r emtinal Adaptive behavir SCOPE OF SERVICE This service includes activities prvided by early interventin persnnel fr cmpletin f an initial cmprehensive multidisciplinary develpmental evaluatin (in accrdance with NMAC 7.30.8) fr children wh are referred t the FIT Prgram. Evaluatin persnnel shuld have an early childhd develpment backgrund. Evaluatin persnnel shuld als be trained in FIT evaluatin and eligibility prcedures and the tl(s) that they are administering. Evaluatin and assessment tls shall be used in accrdance with the manual and established prtcls. T ensure accurate evaluatin results, evaluatins must be cnducted in an envirnment where the child typically spends his/her day. Activities required include: If the team decides t first cnduct a develpmental screening fr a child referred and in accrdance with NMAC 7.30.8 10. E. the Ages and Stages Questinnaire (ASQ) shall be utilized. The team shall use a rutines-based interview prcess and use all phases f the Infant-Tddler Develpmental Assessment (IDA) as the apprved statewide tl as part f the Cmprehensive Multidisciplinary Evaluatin. Infrmatin frm the rutines-based interview prcess shall be included in the CME reprt nting child strengths and parent cncerns. (Fr mre infrmatin n assessment and evaluatin: http://www.cdd.unm.edu/ecln/fit/fitstf/evalassessment.html) A review and summary f the child s recrds related t current health status and prir medical histry. Given the unique characteristics f yung infants and the challenges f determining their develpmental levels: Fr infants under ne mnth f age (adjusted) the IDA will nt be used. Instead, ne f the apprved tls belw shall be used tgether with infrmed clinical pinin. Infrmed clinical pinin (http://www.nectac.rg/~pdfs/pubs/nntes10.pdf) is used by early interventin prfessinals in the evaluatin and assessment prcess in rder t make a recmmendatin as t initial and cntinuing eligibility fr services under Part C and as a basis fr planning services t meet child and family needs. Infrmed clinical pinin makes use f qualitative and quantitative infrmatin t assist in frming a determinatin regarding difficult-t-measure aspects f current develpmental status and the ptential need fr early interventin. (Fr infrmatin n hw t use Infrmed Clinical Opinin fr eligibility in the NM FIT Prgram, please see NMAC 7.30.8 G and the NM FIT Technical Assistance Dcument n Evaluatin and Assessment) Infrmed clinical pinin shall include the fllwing: An evaluatin f the child s level f functining in each f the fllwing develpmental areas: Cgnitive develpment; Physical develpment, including visin and hearing; Page 11 f 45

Cmmunicatin develpment; Scial r emtinal develpment; and, Adaptive develpment. A review f the pertinent recrds related t the child s current health status and medical histry, and can include areas such as, but nt limited t: feeding, sleeping, mtr, behavir state regulatin, cmmunicatin, visual tracking and auditry respnses All 5 develpmental dmains and pertinent infrmatin shall be addressed in the CME reprt as well as parent reprt and shall include a statement and apprval signature indicating that Infrmed Clinical Opinin was used. Apprved tls fr infants under 1 mnth f age include: AIMS (Alberta Infant Mtr Scale) TIMP (Test f Infant Mtr Perfrmance) Infant Tddler Sensry Prfile Mtr Skills Acquisitin Checklist Newbrn Individualized Develpmental Care and Assessment Prgram (NIDCAP) - fr use with newbrns in the newbrn intensive care setting nly Newbrn Behavir Assessment Scale (NBAS) Other tls as apprved by the FIT Prgram Due t the varying nature and purpse f the scres f each f the abve apprved tls, the scres themselves will nt lead t eligibility, but rather they will prvide additinal infrmatin fr the team t cnsider in reaching a determinatin f the child's develpmental status and eligibility determinatin. Fr infants ver ne mnth f age (adjusted) and under fur mnths f age including adjusted age, the IDA shall be used in cnjunctin with ne f the fllwing apprved tls listed belw. All 5 develpmental dmains shall be assessed and addressed in the CME reprt, including parent/caregiver infrmatin. Apprved tls fr infants ver ne mnth f age (adjusted) and under fur mnths include: AIMS (Alberta Infant Mtr Scale) TIMP (Test f Infant Mtr Perfrmance) Infant Tddler Sensry Prfile Peabdy Develpmental Mtr Scale (PDMS-2) Mtr Skills Acquisitin Checklist REEL-3 The Rssetti Infant Tddler Language Scale Other tls as apprved by the FIT Prgram. Other develpmental dmain specific tls may be used in additin t the IDA as part f the Cmprehensive Multidisciplinary Evaluatin (CME). If the IDA des nt indicate a 25% delay, a develpmental dmain specific tl can be used t infrm eligibility under develpmental delay based n either a -1.5 SD r the use f Infrmed Clinical Opinin. Fr children referred between 18 mnths and 30 mnths f age the M-CHAT-R Autism screening shall be cnducted as part f their Cmprehensive Multidisciplinary Evaluatin (CME). The CME reprt shall indicate that the M-CHAT was cmpleted, prvide the results f the M-CHAT, and discuss any utcmes such as fllw up and referral as determined by the results f the MCHAT. Fr children referred wh are yunger than 18 mnths the M-CHAT-R/F Autism screening shall be cnducted nce the child is 18 mnths ld and again at 24 mnths f age (Persnnel may bill fr the time spent cnducting the screening based n the lcatin where the screening takes place). Referral fr a diagnstic evaluatin shall be made, with the cnsent f the parent(s), if the result f the M- CHAT-R/F, including cmpletin f the supplemental questins is High Risk. A cnsultatin with the Early Childhd Evaluatin Prgram (ECEP) can ccur when there is a lw risk M-CHAT- R/F scre Page 12 f 45

with a mderate t high levels f prvider cncerns. Cnsultatin with a supervisr r Evaluatin Lead is recmmended as well as cnsultatin with NMSBVI and NMSD fr children with visin and hearing lss regarding any questin abut whether t pursue a referral t ECEP. The MCHAT authrs d nt recmmend adjusting fr prematurity (therefre d nt adjust fr prematurity. (http://mchatscreen.cm/) The CME must address the child s visn using the NMSVBI screening tl r frmal visn testing results. A statement summarizing the results must be prvided in the written evaluatin reprt. If visn screening results indicate a cncern, a referral shall be made t NMSBVI with cnsent f the parent/caregiver. NMSVBI will prvide fllw up t the family by cllabrating with the child s Primary Care Prvider and/r a pediatric phthalmlgist and the FIT prvider agency. The Family Service Crdinatr is respnsible fr fllwing up n any visin cncerns. The IDA was nt designed t evaluate children with visin and/r hearing lss. If a visin r hearing diagnsis is knwn prir t the CME evaluatin, NMSBVI r NMSD shuld be cnsulted t cllabrate with the CME team. Fr a child wh is blind, the CME team, in cllabratin with NMSBVI, will administer The Oregn Prject Skills Inventry, in lieu f the IDA, as it is nrmed n blind and visually impaired children. (The Oregn Prject Inventry Tl and training t be prvided by NMSBVI). Fr a child wh has visual impairments r lw visin, but wh is nt blind, the IDA may be used with supplemental items frm the Oregn Prject Skills Inventry with cnsultatin frm NMSBVI: The CME team will cnsult with NMSBVI t determine which tl and prcess will be mst apprpriate t measure the child s develpmental skills, given his/her diagnsis: The IDA may be used with supplemental items frm the Oregn Prject Skills Inventry and with cnsultatin frm NMSBVI; r The Oregn Prject Skills Inventry will used in lieu f the IDA NMSBVI can cntribute visin infrmatin that will be included in the visin sectin f the CME reprt, but NMSBVI is NOT cnsidered t be a secnd r third discipline n the CME team. The CME must address the child s hearing thrugh either dcumented Newbrn Hearing Screening results (valid fr nly 6 mnths frm the date f the screen); r a hearing screening that utilizes OAE and tympanmeter r frmal hearing test results. A statement summarizing the results must be prvided in the written evaluatin reprt. Children failing/referring n mre than tw cnsecutive hearing screens will be referred t their Primary Care Prvider fr medical/audilgical fllw-up. FIT prviders will cntact the NMSD Reginal Supervisr fr cnsultatin and guidance regarding all children wh have been identified as having a hearing cncern. Once a permanent hearing lss is identified r suspected, a frmal referral fr services will be made t the NMSD Reginal Supervisr, with family/caregiver cnsent. The Family Service Crdinatr is respnsible fr fllwing up n any hearing cncerns. Fr a child that has a hearing lss and/r is deaf, the fllwing tls are apprved: The Visual Cmmunicatin and Sign Language Checklist, The McCarther-Bates Cmmunicative Develpmental Inventries The Language Develpment Scale The REEL-3 NMSD will cnsult with the CME team, administer ne r mre f these tls which have been nrmed n children wh are deaf r hard f hearing and this infrmatin will be used t supplement develpmental infrmatin gained frm the IDA. Page 13 f 45

If apprpriate NMSD staff may functin as an additinal r third discipline fr the CME as a Develpmental Specialist. Cnsultatin with NMSD shall ccur: During the CME fr a child with a hearing lss During the CME fr a child whse parents are deaf, NMSD shall be cnsulted t assess the child s ASL skills. (NMSD wuld nt be an nging member f the child s IFSP team b/c the child des nt have a hearing lss) E & A t assess a child s ASL skills when the child s parents are deaf The cmpleted and typed Cmprehensive Multidisciplinary Evaluatin (CME) reprt written in family friendly language shall include: reasn fr referral, medical histry, parent/caregiver cncerns, the child strengths and interests, visn and hearing status and summarizes the child s functining in each develpmental dmain gives a picture f the child s verall functining and ability t participate in family and cmmunity life, includes a statement regarding the child s eligibility fr the FIT Prgram and recmmends appraches and strategies t be cnsidered by the IFSP team when develping utcmes. A FIT Prgram Evaluatin Summary Frm, which summarizes the evaluatin results, may be used if the full evaluatin reprt will nt be cmpleted at the time f the initial IFSP. Hwever, the full evaluatin reprt must be cmpleted and given t the team, including the family, within 30 days f the evaluatin. This service unit includes the participatin f early interventin persnnel in determining the child s eligibility fr the FIT Prgram. SERVICE REQUIREMENTS These cnditins and requirements apply t the Cmprehensive Multidisciplinary Evaluatin: Children are eligible fr this service wh: Are frm birth t three years ld (If a child is referred t the FIT Prgram fewer than 45 days prir t the child s third birthday an evaluatin will nt be cnducted.) Reside in the state f New Mexic Have been referred fr evaluatin r early interventin services Have received prir infrmed cnsent frm their parent(s) The prvider is respnsible fr determining eligibility fr early interventin services, and maintaining dcumentatin f eligibility status n file. AGENCY REQUIREMENTS The prvider must adhere t the fllwing: A. Administrative Requirements Establish and maintain financial reprting and accunting fr each child. Establish and maintain a cnfidential recrd fr each family served that includes signed cnsent and release frms, prgress ntes and cntact lgs. The typed reprt that addresses all develpmental dmains, visin, hearing, and medical infrmatin, shall serve as dcumentatin fr Cmprehensive Multidisciplinary Evaluatin. A Plicy and Prcedure Manual must be maintained and updated regularly t reflect current plicies cnsistent with FIT Prgram requirements related t at least, the fllwing activities: Intake Cmprehensive Multidisciplinary Evaluatins Page 14 f 45

A quality assurance plan will be develped that includes, but is nt limited t develping an nging mnitring prcess, which regularly reviews cmpliance, and prvides fr the evaluatin f quality and the family s satisfactin with the Cmprehensive Multidisciplinary Evaluatin. The prvider will develp a quality assurance plan that includes, but is nt limited t develping an nging mnitring prcess that evaluates the quality, and effectiveness f services prvided and the families satisfactin with services. Ensure that demgraphic, eligibility data and evaluatin data is entered int the FIT Prgram database FIT-KIDS (Key Infrmatin Data System) within 30 days fllwing the respective activity. Cmprehensive Multidisciplinary Evaluatins must be prvided t all families referred in the gegraphical area served under the DDSD Prvider Agreement. Submit an Annual Perfrmance Reprt (APR) within the required timeframe (usually within 60 days fllwing the end f the fiscal year) and in the frmat prvided by the Family Infant Tddler Prgram Cnduct Crrectin f Nncmpliance activities, as necessary, in accrdance with requirements and frmat prvided by the FIT Prgram. Crrectin f identified nncmpliance must ccur within ne year f the date f the written ntificatin f the nncmpliance (finding/deficiency), and must be twfld. (1) The prvider agency must demnstrate that it is crrectly implementing the regulatry requirement (based n updated data) fr which it was previusly nncmpliant, and (2) fr any nncmpliance cncerning a child specific requirement, the prvider agency must demnstrate that it has crrected each individual case f nncmpliance (althugh late), unless the child is n lnger within the jurisdictin f the early interventin prgram The prvider shall nt charge any fee t families fr the Cmprehensive Multidisciplinary Evaluatin. B. Staffing Requirements The agency must prvide adequate supervisin t all staff prviding Cmprehensive Multidisciplinary Evaluatin. Persnnel cnducting a Cmprehensive Multidisciplinary Evaluatin must have a BS/BA r higher and Develpmental Specialists must be certified at level II r III. Persnnel must be trained and/r licensed t administer instruments used in an evaluatin. The Multidisciplinary evaluatin team shall include persnnel frm tw r mre f the fllwing disciplines: 1. Audilgist licensure frm the NM Audilgy Bard 2. Develpmental Specialist certificatin II r III in accrdance with Family Infant Tddler Prgram regulatins (NMAC 7.30.8) and DDSD Plicy 3. Family therapist licensure frm the Cunseling and Therapy Practice Bard as a Family Therapist, Prfessinal Clinical Mental Health Cunselr, Prfessinal Mental Health Cunselr, r Registered Mental Health Cunselr 4. Nurse licensure frm the NM Bard f Nursing as a registered nurse 5. Nutritinist licensure frm the NM Nutritin and Dietetics Practice Bard 6. Occupatinal Therapist licensure frm the NM Bard f Occupatinal Therapy Practice 7. Physical Therapist licensure frm the NM Physical Therapy Licensing Bard 8. Psychlgist licensure frm the NM Bard f Psychlgist Examiners 9. Scial wrker licensure frm the NM Bard f Scial Wrk Examiners 10. Speech/Language Pathlgist licensure frm the NM Bard Speech, Language Pathlgy, Audilgy and Hearing Aid Dispensers Bard Page 15 f 45

REIMBURSEMENT Request fr reimbursement fr Cmprehensive Multidisciplinary Evaluatin shall be submitted mnthly thrugh the FIT-KIDS (Key Infrmatin Data System) in accrdance with directins frm the Department f Health. Staff entering data related t billing shall cmplete the nline FIT-KIDS training. Request fr reimbursement fr Cmprehensive Multidisciplinary Evaluatin shall be submitted in accrdance with directins prvided by the DDSD - Administrative Services Bureau (ASB) at the Department f Health. Cmprehensive Multidisciplinary Evaluatin Reprting Categry 700023 Rate: $630.00 Medicaid Rate: $630.00 Unit: ne cmpleted evaluatin H2000 TL Unit: ne cmpleted evaluatin This unit is paid fr the initial multidisciplinary develpmental evaluatin that is cmpleted in accrdance with 7.30.8 NMAC. This rate cvers the wrk f multidisciplinary evaluatin team members in cnducting direct assessment activities, administering instruments and tls with child and family, reviewing medical and ther recrds r reprts, and writing the cmprehensive develpmental evaluatin reprt. While the Evaluatin Summary Frm may be used t develp the IFSP, this time unit cannt be billed until the full CME reprt has been written. This CME unit may be billed nly ne time per eligible child and billing may nly be submitted nce the written evaluatin reprt has been cmpleted. Onging assessment activities with the child and family are billed based n the lcatin where services were prvided and the service being prvided. If a child is evaluated and determined nt eligible r exits the FIT Prgram and, due t cncerns is referred again t the FIT Prgram after at least 6 mnths, the prvider may cnduct and bill fr an additinal cmprehensive multidisciplinary evaluatin. If a child is re-referred r transfers t anther agency less than six mnths frm the last date f FIT services since they exited and they were eligible fr the FIT Prgram at the time they exited e.g. the family culd nt be lcated and shw up several mnths later either with the same FIT prvider agency r with a different prvider agency the current IFSP shall be used t prvide services until a new ne is cmpleted. Prir apprval fr a secnd CME fr children under 6 mnths can be requested frm the FIT Prgram if the child presents with new cncerns nt identified in the current CME. If a child is re-referred r transferred mre than 6 mnths after their last day f service, and if the child presents with new cncerns nt identified in the current CME, a new CME can be cnducted. Billing fr a secnd CME thrugh DOH is prcessed thrugh a paper claim that must be signed by the FIT prvider manager. Billing fr a CME exceptin is dne utside f FIT-KIDS. If the CME cannt be cmpleted befre the child mves t anther cmmunity e.g. they are in temprary husing (shelter, fster hme etc.) time spent cnducting the evaluatin can be billed as nging assessment under Early Interventin (see Early Interventin Services). If a develpmental screening is cnducted in accrdance with NMAC 30.30.8 10.E prir t the full CME, the screening is included in the reimbursement fr the CME. If a develpmental screening is cnducted fr a child referred and accrdance with NMAC 30.30.8 10. E and it is determined that the child is nt suspected f having a develpmental delay and therefre des nt receive a full CME, the agency may bill fr the early interventin time taken t cnduct the screening and bill accrding t the lcatin where the screening ccurred. Page 16 f 45

FAMILY SERVICE COORDINATION Family service crdinatin services are activities carried ut by a designated individual t assist and enable the families f children frm birth t three, t access, and if determined eligible, receive early interventin services. The family service crdinatr helps t develp the Individual Family Service Plan (IFSP); assists the family in receiving all services identified; crdinates thse services; ensures that they are delivered in a timely manner, and seeks additinal services and r supprts that may help the child r family. The Family Service Crdinatr wrks with the family t determine their service needs and if the family chses t be invlved in service crdinatin respnsibilities they shuld be supprted in that rle. SCOPE OF SERVICE Family service crdinatin includes but is nt limited t the fllwing: Crdinating intake, evaluatins and assessments and the prcess f determining eligibility. Facilitating and participating in the develpment f the initial and annual Individual Family Service Plan (IFSP) as well as the 6-mnth review f the IFSP. Facilitating the cmpletin f the initial and exit ratings fr the Early Childhd Outcmes. Assisting families in identifying and accessing all available services and resurces, nt just thse related t the child s cnditin (e.g. husing, mental health services etc.). Crdinating and mnitring the delivery f IFSP services (including subcntractrs and prviders frm ther agencies). Infrming families f advcacy services and empwering the family t enhance their wn Family Service Crdinatin skills. Crdinating with medical and health prviders. Facilitating the develpment f a transitin planning prcess fr each child and family. Gathering and researching resurce infrmatin fr the family and making referrals where apprpriate. SERVICE REQUIREMENTS These cnditins and requirements apply t family service crdinatin: Family service crdinatin shall be prvided upn referral f the child and family t the FIT Prgram. Family service crdinatin is therefre prvided during the intake and evaluatin prcess prir t determining the child s eligibility. (Nte: Fr newbrns the intake, evaluatin and IFSP will be cnducted after the child and family return hme). If a child is referred t Part C fewer than 45 days prir t the child s third birthday an intake and evaluatin will nt be cnducted. The Family Service Crdinatr will let the family knw f preschl ptins available in the cmmunity, e.g. preschl special educatin; Head Start; private preschls, etc. and will assist with a referral t thse entities, with the cnsent f the parent(s). During the intake prcess the family service crdinatr will have the family cmplete a Freedm f Chice Frm t select a FIT Prvider in cunties where there is mre than ne prvider agency. The Freedm f Chice Frm will als be used when a family is transferring int a cunty where there is mre than ne FIT Prvider agency. The Family Service Crdinatr, tgether with the family and the evaluatin team cllabrate t determine eligibility fr the FIT Prgram and maintain dcumentatin f eligibility status n file. If it is determined that the child des nt meet any f the eligibility criteria, family service crdinatin will be discntinued. The Family Service Crdinatr will prvide infrmatin t the family abut ther early learning services in the cmmunity (hme visiting, Early Head Start, child care etc.) and infrm the Page 17 f 45

family that they can return fr a develpmental screening if they are cncerned abut their child s develpment in the future. A family will have nly ne Family Service Crdinatr designated n the IFSP, regardless f whether the child may be eligible fr mre than ne prgram. Families must be infrmed when there is a change in their Family Service Crdinatr and if the Family Service Crdinatr is n extended leave, anther Family Service Crdinatr must be assigned. The Family Service Crdinatr will cmplete the Public and Private Insurance frm with each family at intake and at least annually t determine if the child is r may be eligible fr Medicaid r if they are cvered under a private insurance plan. The Family Service Crdinatr shall btain cnsent frm the parent(s) t bill their private and public insurance (including Medicaid). Cnsent shall be dcumented n the Prir Written Ntice frm. A family may direct the level f supprt and assistance that they need frm their Family Service Crdinatr and may chse t perfrm sme f the Family Service Crdinatr functins themselves. A family may nt be paid t prvide Family Service Crdinatin fr their child and family. The Family Service Crdinatr shall make cntact with the family nce a mnth, at a minimum, in rder t meet the requirement fr crdinating and mnitring the delivery f services. If a face-tface visit with the family l des nt ccur that mnth due t a family reasn, then that will be dcumented in the case ntes in the child s recrd. The Family Service Crdinatr will discuss with each family their need fr family supprts, including: parent-t-parent supprt; parent training; respite; and ther resurces and referrals. The Family Service Crdinatr will crdinate the cllectin f infrmatin and data fr the Early Childhd Outcme scre in accrdance with the ECO Manual. The ECO scre is t be determined by the IFSP team within 60 days f the initial IFSP and at exit. The Family Service Crdinatr will crdinate with the Medically Fragile Case Management Prgram if the child is als eligible fr medically fragile services in rder t align and avid duplicatin f services. This may include jint meetings and sharing f recrds with the cnsent f the parent(s). If a child is transferring frm anther state r anther FIT prvider agency where the child/family received early interventin services, family service crdinatin will be prvided t the family immediately, and the family s IFSP frm their previus agency will functin as the plan fr services until a new IFSP is develped. If the child is being transferred frm anther FIT Prvider agency, the FIT Prgram Child/Family Transfer frm must be cmpleted by the transferring agency accrding t the specified requirements n the frm. The frm and dcuments must be sent t the receiving agency within fur (4) wrking days f the receiving agency being ntified f the transfer by phne. The receiving prvider agency will hld an IFSP meeting t review and update as necessary within 30 days f the transfer. The family service crdinatr will manage the transitin prcess beginning with the transitin plan at the initial IFSP, which is then updated by the child s 2 nd birthday (24 mnths f age) and finalized at the transitin cnference. The family service crdinatr will plan and schedule the transitin cnference t be held at least 3 mnths, but n mre than 9 mnths prir t the child s third birthday. This includes isending the referral, assessment summary frm and invitatin t all parties wh will be attending the meeting. The family service crdinatr facilitates the transitin cnference and fllwsup n implementatin f the actin steps t ensure a smth and effective transitin fr the child and family. The family service crdinatr will Invite t the IFSP, with parent/caregiver permissin, ther peple prviding services and supprts t the child and family, including: child care staff; Early Head Start; ther early learning prviders; hme visiting prviders; WIC; medical prviders; Medically Fragile Prviders; respite prviders; Infant Mental Health; autism prviders; etc. In rder t exit a child and their family frm services when there has been a series f unexcused nshws, i.e. where the parent(s) did nt ntify the agency, the Family Service Crdinatr (FSC) must Page 18 f 45

cnduct a hme visit r phne call with the child s parent(s) t discuss the reasn fr the n shws and explain the imprtance f regular early interventin, while at the same time remaining sensitive t any special family circumstances influencing participatin patterns. If the FSC is nt able t cntact the parent(s), the agency shall send a Prir Written Ntice infrming them that early interventin services will end if they d nt cntact the agency by a given date. Prir Written Ntice shall als be sent if the parent(s) infrms the FSC that they n lnger want t receive early interventin services. The FSC shall recrd the steps taken in the child s recrd. The parent(s) may request t be rereferred at any time, and n evaluatin t determine the child s eligibility will be cnducted if the re-referral is within 6 mnths. AGENCY REQUIREMENTS The prvider must adhere t the fllwing: A. Administrative Requirements Establish and maintain financial reprting and accunting fr each child served. Establish and maintain a cnfidential recrd fr each child served, which include the fllwing: signed cnsent and release frms; current evaluatin and assessment results; dcumentatin f eligibility determinatin; Medical and ther apprpriate recrds; IFSP dcuments; prgress ntes and cntact ntes. Cntact ntes / case ntes must include date, time in/time ut, a brief descriptin f the service prvided and the first initial and last name f the Family Service Crdinatr. Dcumentatin must include all time spent with the family and wrk dne n behalf f the family, regardless f the length f time required fr billing purpses. A Plicy and Prcedure Manual must be updated regularly t reflect current plicies cnsistent with FIT Prgram requirements related t at least, the fllwing activities: Initial IFSP develpment Annual IFSP develpment IFSP review and revisins Transdisciplinary Team Apprach and cnsultatin Transitin Plans and cnferences Exit A quality assurance plan will be develped that includes, but is nt limited t develping an nging mnitring prcess, which regularly reviews cmpliance, and prvides fr the evaluatin f quality, effectiveness f the services prvided and the family s satisfactin with the fllwing required activities: Utilize the state FIT Prgram IFSP Frms fr all eligible children and families. Ensure that all data is entered int the FIT Prgram database FIT-KIDS (Key Infrmatin Data System) within 30 days fllwing the respective activity. This includes demgraphic data, IFSP data (including initial IFSP delay reasns), transitin plan and cnference dates (including cnference delay reasns), Early Childhd Outcmes (ECO), delivered services data, and exit data. Ensure cmpliance with the regulatins fr the Family Infant Tddler Early Interventin Prgram NMAC 7.30.8 Family Service Crdinatin must be prvided frm the time f referral t all eligible children and families in the gegraphical area served under the DDSD Prvider Agreement. Submit an Annual Perfrmance Reprt (APR) within the required timeframe and in the frmat prvided by the FIT Prgram. Cnduct Crrectin f Nncmpliance activities, as necessary, in accrdance with requirements and frmat prvided by the FIT Prgram. Crrectin f identified nncmpliance must ccur within ne year f the date f the written ntificatin f the nncmpliance (finding/deficiency), and must be Page 19 f 45