Upcoming Webinars 

Disclaimer

The analysis of any legal or medical billing is dependent on numerous specific facts — including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly. CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

Menu
Log in


Log in

Florida Early Intervention Definitions M-R

Medical Services      

Services that are for diagnostic or evaluation purposes provided by a licensed physician to determine a child's developmental status and need for early intervention services.

Medical Savings Account    

A Medical Savings Account (MSA) refers to an medical savings account program in which tax-deferred deposits can be made for medical expenses. Withdrawals from the MSA are tax-free if used to pay for qualified medical expenses. The MSA must be coupled with a high-deductible health plan (HDHP).

Medically Necessary or Medical Necessity

“Medically necessary” or “medical necessity” means that the medical or allied care, goods, or services furnished or ordered must:

Meet the following conditions:

    • Be necessary to protect life, to prevent significant illness or significant disability, or to alleviate severe pain;
    • Be individualized, specific, and consistent with symptoms or confirmed diagnosis of the illness or injury under treatment, and not in excess of the patient’s needs;
    • Be consistent with generally accepted professional medical standards as determined by the Medicaid program, and not experimental or investigational;
    • Be reflective of the level of service that can be safely furnished, and for which no equally effective and more conservative or less costly treatment is available; statewide; and
    • Be furnished in a manner not primarily intended for the convenience of the recipient, the recipient's caretaker, or the provider.
The fact that a provider has prescribed, recommended, or approved medical or allied care, goods, or services, does not, in itself, make such care, goods or services medically necessary or a medical necessity or a covered service.

Method/ Method of Delivery           

Method means how a service is provided.  Method may include, training/education activities, providing resource material, modifying the environment, positioning, equipment, coaching/consulting among providers/family, exploring/identifying options, planning, teaching, supporting, etc. 

Multidisciplinary     

The involvement of two or more separate disciplines or professions with respect to–-

    • Evaluation of the child and assessments of the child and family which is conducted by two or more individuals from separate disciplines or professions.
    • The IFSP Team must include the involvement of the parent and two or more individuals from separate disciplines or professions, and one of these individuals must be the service coordinator.

Native Language      

The language or mode of communication normally used by a person, or in the case of a child, the language used by the parents or caregiver(s) of the child, except for the purposes of evaluation and assessment, the language normally used by the child, if determined developmentally appropriate for the child by qualified personnel conducting the evaluation or assessment.

Native language, when used with respect to an individual who is deaf or hard of hearing, blind or visually impaired, or for an individual with no written language, means the mode of communication that is normally used by the individual (such as sign language, Braille, or oral communication).

Natural Environments        

The day-to-day routines, activities and places that promote learning opportunities for an individual child and family.  This means settings, including home and community settings that are natural or typical for the child’s age peers who have no disabilities.

Norm Referenced     

A norm referenced test is one that has been given to a large number of children intended to be representative of the general population that then defines how average or "typically-developing" children score.  A score on this type of tests permits comparison between a child's performance and the performance of a group of children of similar age.

Notification   

For all children enrolled in Early Steps, without regard to reason for eligibility, the LES provides (unless the parent opts out as set forth in the Early Steps “Understanding Notification” brochure) the following information to the Department of Education (SEA) and the local school district for Child Find Purposes only:  child’s name, child’s date of birth, parent(s) name(s), and parent contact information.

Nursing Services      

Includes:

    • The assessment of health status for the purpose of providing nursing care, including the identification of patterns of human response to actual or potential health problems;
    • Provision of nursing care to prevent health problems, restore or improve functioning, and promote optimal health and development; and
    • Administration of medications, treatments, and regimens prescribed by a licensed physician.

Nutrition Services    

Includes: 

    •  Conducting individual assessments in--
      • Nutritional history and dietary intake;
      • Anthropometric, biochemical, and clinical variables;
      • Feeding skills and feeding problems; and
      • Food habits and food preferences;
    • Developing and monitoring appropriate plans to address the nutritional needs of children eligible; and
    • Making referrals to appropriate community resources to carry out nutrition goals.

Occupational Therapy        

Services to address the functional needs of a child related to adaptive development, adaptive behavior and play, and sensory, motor, and postural development. These services are designed to improve the child's functional ability to perform tasks in home, school, and community settings, and include:

    • Identification, assessment, and intervention; 
    • Adaptation of the environment, and selection, design, and fabrication of assistive and orthotic devices to facilitate development and promote the acquisition of functional skills; and
    • Prevention or minimization of the impact of initial or future impairment, delay in development, or loss of functional ability.

Opt-out         

A process by which parents of a child served under IDEA, Part C may object in writing to notification to the Department of Education (SEA) and the local school district (LEA), after being informed that notification will occur in the absence of objection by the parent.

Outcomes      

A statement of change that a family wants to see for their child or family as a result of their involvement in Early Steps.

Paraprofessional      

A trained person who serves as an assistant or aide to a certified or licensed professional.

Parent

A "parent" means:

    • A biological, adoptive or foster parent of a child (unless a foster parent is prohibited by State law from serving as a parent);
    • A guardian (but not the State if the child is a ward of the State);
    • An individual acting in the place of a natural or adoptive parent (including a grandparent, stepparent or other relative) with whom the child lives, or an individual who is legally responsible for the child's welfare; or 
    • Except as used in IDEA sections 615(b)(2) and 639(a)(5), an individual assigned under either of those sections to be a surrogate parent.

Personally Identifiable Information          

Personally identifiable information includes: 

    • The name of the child, the child's parent, or other family member;
    • The address of the child;
    • A personal identifier, such as the child's or parent's social security number; or
    • A list of personal characteristics or other information that would make it possible to identify the child with reasonable certainty.

Physical Therapy     

Services to address the promotion of sensorimotor function through enhancement of musculoskeletal status, neurobehavioral organization, perceptual and motor development, cardiopulmonary status, and effective environmental adaptation. These services include: 

    • Screening, evaluation, and assessment of infants and toddlers to identify movement dysfunction; 
    • Obtaining, interpreting, and integrating information appropriate to program planning to prevent, alleviate, or compensate for movement dysfunction and related functional problems; and 
    • Providing individual and group services or treatment to prevent, alleviate, or compensate for movement dysfunction and related functional problems.

Placement     

Entails the service setting and location.

Plan of Care (POC) 

A comprehensive and individualized written plan for implementation of Early Intervention Services and Therapy Services for an eligible child and the child's family enrolled in Early Steps.

Point of Service Plan (POS)

In a POS plan, insured members may choose, at the point of service, whether to receive care from a physician within the plan’s network or to go out of the network for services. The POS plan provides less coverage for health care expenses provided outside the network than for expenses incurred within the network. Also, the POS plan will usually require insured members to pay deductibles and coinsurance costs for medical care received out of network.

Preferred Provider Organizations (PPOs)

PPOs offer a provider network to meet the health care needs of insured individuals. A traditional insurance carrier provides the health benefits. An insurer contracts with a group of health care providers to control the cost of providing benefits to insured individuals. These providers charge lower-than-usual fees because they require prompt payment and serve a greater number of patients. Insured individuals usually choose who will provide their health care, but pay less in coinsurance with a preferred provider than with a non-preferred provider.

Prekindergarten Program for Children with Disabilities    

The Prekindergarten Program for Children with Disabilities (the preschool component of Part B in Florida), is provided by the local school district to meet the child’s needs for specially designed instruction and related services, ages three through five.  Eligibility for special education is based on criteria in State Board of Education rules.

Premature     

An infant born prior to 37 weeks gestation.

Primary Service Provider (PSP)    

The identified professional on the IFSP team that works with the child/family/primary caregivers on a regular basis and with other members of the team providing services directly, through consultation and/or joint visits.

Private Insurance     

Private insurance refers to health coverage that can be issued to individuals, to employees of an employer offering health coverage, or to individuals that are members of association groups. Some health coverage in Florida is provided by self insured funds, not regulated by the State of Florida. Although there are other forms of health insurance, the three main categories of health insurance are:

    • Policies that offer comprehensive or “major medical” coverage;
    •  Policies that provide managed care services [Preferred Provider Organizations (PPOs); Health Maintenance Organizations (HMOs); Point of Service plans (POS); Provider Service Network (PSN)]. –
    •  Policies that provide limited benefits.
    • In addition to traditional health coverage or managed care plans, some families may access programs designed to give individuals tax advantages to offset health care costs such as a health savings account (HSA), medical savings account (MSA), health flexible spending arrangement (FSA), or health reimbursement arrangement (HRA).

Progress Monitoring

A systematic approach to observing or checking a child’s progress and evaluating the effectiveness of intervention strategies. In progress monitoring, a child’s current levels of functioning and measurable goals or outcomes are determined.  Progress toward specific skills is then measured on a regular basis (e.g., weekly or monthly). Progress monitoring generates useful data for determining whether intervention strategies need to be adjusted and may provide evidence related to the child’s continuing eligibility.  Progress monitoring data may be in one or more of the following formats:  compilation forms, graphs, or narrative explaining any changes or specific circumstances.

Provider Service Network (PSN)   

In this type of plan there is a network established or organized and operated by a health care provider or group of affiliated health care providers.

Psychological Services         

Includes:  

    • Administering psychological and developmental tests and other assessment procedures;
    • Interpreting assessment results;
    • Obtaining, integrating, and interpreting information about child behavior, and child and family conditions related to learning, mental health, and development; and
    • Planning and managing a program of psychological services, including psychological counseling for children and parents, family counseling, consultation on child development, parent training, and education programs.

Public Agency           

Includes the lead agency (Florida Department of Health, Children’ Medical Services), and any other political subdivision of the state that is responsible for providing early intervention services to children eligible under Part C of the IDEA.  This may include agencies receiving funds under Part C of the IDEA as well as agencies that are involved in the state's Early Steps system or carry out a function required under IDEA, Part C, but do not directly receive IDEA, Part C funds.

Public Awareness and Education

Activities that focus on the early identification of children who are eligible for Early Steps and include the preparation and dissemination by the lead agency to all primary referral sources, especially hospitals and physicians, of materials for parents on the availability of early intervention services.

Public Insurance      

As discussed in these policy and guidance documents, public insurance refers to Medicaid. Medicaid provides medical coverage to individuals and families who are categorically eligible (e.g., low income families with children, low income people who have disabilities, and foster children). The family-related Medicaid coverage groups in Florida are based on three pieces (or titles) of the federal Social Security Act:

    • Title IV (Grants to States for Aid and Services to Needy Families with Children and for Child Welfare Services)
    • Title XIX (Grants to States for Medical Assistance Programs)
    • Title XXI (State Children's Health Insurance Program-SCHIP, called the Florida KidCare program) 
    • Medicaid recipients may obtain services through Medicaid providers of their choice on a “fee-for-service” basis or through Medicaid managed care plans.  The Agency for Health Care Administration (ACHA) is the agency in charge of administering Medicaid services in Florida.

Qualified (qualified personnel)       

IDEA, Part C regulations define qualified as personnel who have met State approved or recognized certification, licensing, registration or other comparable requirements that apply to the area in which the person is providing early intervention services.”

Referral         

Provision of information regarding a child who is potentially eligible for early intervention services through Early Steps due to possible developmental delay or established condition.

Referral Source        

An individual, facility or agency that refers a child to the appropriate public agency within the system.  Referral sources include: hospitals, (including prenatal and postnatal facilities), physicians, parents, day care programs, local educational agencies, public health facilities, other social service agencies, and other health care providers.

Referral to Preschool Special Education   

In Florida, referral to preschool special education is a separate and distinct process and should occur as outlined in the transition plan in the child’s IFSP.

Respite          

Appropriate short-term, episodic care which is provided due to the planned or emergency absence of a family member or primary caregiver.  Respite is provided to meet a unique, temporary need.  The purpose of respite services is to minimize stress that families and caregivers experience from addressing all the needs related to having a child with a disability or an emergency need of the caregiver.  Respite is an early intervention service if it is identified on the IFSP as necessary to enable the family or caregiver to successfully meet the developmental outcomes for their child.

Reference

Florida Early Steps Policy Manual Definitions


Powered by Wild Apricot Membership Software