§ 391.308 — Early Steps Program

Florida § 391.308

• Jurisdiction: Florida
• Title: XXIX
• Ch. 391: CHILDREN’S MEDICAL SERVICES

Text

The department shall implement and administer part C of the federal Individuals with Disabilities Education Act (IDEA), which shall be known as the “Early Steps Program.”

(1) PERFORMANCE STANDARDS. — The department shall ensure that the Early Steps Program complies with the following performance standards: (a) The program must provide services from referral through transition in a family-centered manner that recognizes and responds to unique circumstances and needs of infants and toddlers and their families as measured by a variety of qualitative data, including satisfaction surveys, interviews, focus groups, and input from stakeholders. (b) The program must provide individualized family support plans that are understandable and usable by families, health care providers, and payors and that identify the current level of functioning of the infant or toddler, family supports and resources, expected outcomes, and specific early intervention services needed to achieve the expected outcomes, as measured by periodic system independent evaluation. (c) The program must help each family to use available resources in a way that maximizes the child’s access to services necessary to achieve the outcomes of the individualized family support plan, as measured by family feedback and by independent assessments of services used by each child. (d) The program must offer families access to quality services that effectively enable infants and toddlers with developmental disabilities and developmental delays to achieve optimal functional levels as measured by an independent evaluation of outcome indicators in social or emotional skills, communication, and adaptive behaviors.

(2) DUTIES OF THE DEPARTMENT. — The department shall: (a) Annually prepare a grant application to the United States Department of Education for funding early intervention services for infants and toddlers with disabilities and their families pursuant to part C of the federal Individuals with Disabilities Education Act. (b) Jointly with the Department of Education, provide a reading initiative as an early intervention service for infants and toddlers. (c) Annually develop a state plan for the Early Steps Program. 1. The plan must assess the need for early intervention services, evaluate the extent of the statewide need that is met by the program, identify barriers to fully meeting the need, and recommend specific action steps to improve program performance. 2. The plan must be developed through an inclusive process that involves families, local program offices, health care providers, and other stakeholders. (d) Ensure local program offices educate hospitals that provide Level II and Level III neonatal intensive care services about the Early Steps Program and the referral process for the provision of developmental evaluation and intervention services. (e) Establish standards and qualifications for developmental evaluation and early intervention service providers, including standards for determining the adequacy of provider networks in each local program office service area. (f) Establish statewide uniform protocols and procedures to determine eligibility for developmental evaluation and early intervention services. (g) Establish a consistent, statewide format and procedure for preparing and completing an individualized family support plan. (h) Promote interagency cooperation and coordination, with the Medicaid program, the Department of Education program pursuant to part B of the federal Individuals with Disabilities Education Act, and programs providing child screening such as the Florida Diagnostic and Learning Resources System, Healthy Start, and the Help Me Grow program. 1. Coordination with the Medicaid program shall be developed and maintained through written agreements with the Agency for Health Care Administration and Medicaid managed care organizations as well as through active and ongoing communication with these organizations. The department shall assist local program offices to negotiate agreements with Medicaid managed care organizations in the service areas of the local program offices. Such agreements may be formal or informal. 2. Coordination with education programs pursuant to part B of the federal Individuals with Disabilities Education Act shall be developed and maintained through written agreements with the Department of Education. The department shall assist local program offices to negotiate agreements with school districts in the service areas of the local program offices. (i) Develop and disseminate the knowledge and methods necessary to effectively coordinate benefits among various payor types. (j) Provide a mediation process and if necessary, an appeals process for applicants found ineligible for developmental evaluation or early intervention services or denied financial support for such services. (k) Competitively procure local program offices to provide services throughout the state in accordance with chapter 287. The department shall specify the requirements and qualifications for local program offices in the procurement document. (l) Establish performance standards and other metrics for evaluation of local program offices, including standards for measuring timeliness of services, outcomes of early intervention services, and administrative efficiency. Performance standards and metrics shall be developed in consultation with local program offices. (m) Provide technical assistance to the local program offices.

(3) ELIGIBILITY. — The department shall apply the following eligibility criteria if specific funding is provided, and the associated applicable eligibility criteria are identified, in the General Appropriations Act: (a) Infants and toddlers are eligible for an evaluation to determine the presence of a developmental disability or the risk of a developmental delay based on a physical or medical condition. (b) Infants and toddlers determined to have a developmental delay based on informed clinical opinion and an evaluation using a standard evaluation instrument which results in a score that is 1.5 standard deviations from the mean in two or more of the following domains: physical, cognitive, communication, social or emotional, and adaptive. (c) Infants and toddlers determined to have a developmental delay based on informed clinical opinion and an evaluation using a standard evaluation instrument which results in a score that is 2.0 standard deviations from the mean in one of the following domains: physical, cognitive, communication, social or emotional, and adaptive. (d) Infants and toddlers determined to have a developmental delay based on informed clinical opinion and an evaluation using a standard evaluation instrument which results in a score that is 1.5 standard deviations from the mean in one or more of the following domains: physical, cognitive, communication, social or emotional, and adaptive. (e) Infants and toddlers determined to have a developmental delay based on informed clinical opinion. (f) Infants and toddlers at risk of developmental delay based on an established condition known to result in developmental delay, or a physical or mental condition known to create a risk of developmental delay.

(4) DUTIES OF THE LOCAL PROGRAM OFFICES. — A local program office shall: (a) Evaluate a child to determine eligibility within 45 calendar days after the child is referred to the program. (b) Notify the parent or legal guardian of his or her child’s eligibility status initially and at least annually thereafter. If a child is determined not to be eligible, the local program office must provide the parent or legal guardian with written information on the right to an appeal and the process for making such an appeal. (c) Secure and maintain interagency agreements or contracts with local school districts in a local service area. (d) Provide services directly or procure services from health care providers that meet or exceed the minimum qualifications established for service providers. The local program office must become a Medicaid provider if it provides services directly. (e) Provide directly or procure services that are, to the extent possible, delivered in a child’s natural environment, such as in the child’s home or community setting. The inability to provide services in the natural environment is not a sufficient reason to deny services. (f) Develop an individualized family support plan for each child served. The plan must: 1. Be completed within 45 calendar days after the child is referred to the program; 2. Be developed in conjunction with the child’s parent or legal guardian who provides written consent for the services included in the plan; 3. Be reviewed at least every 6 months with the parent or legal guardian and updated if needed; and 4. Include steps to transition to school or other future services by the child’s third birthday. (g) Assess the progress of the child and his or her family in meeting the goals of the individualized family support plan. (h) For each service required by the individualized family support plan, refer the child to an appropriate service provider or work with Medicaid managed care organizations or private insurers to secure the needed services. (i) Provide service coordination, including contacting the appropriate service provider to determine whether the provider can timely deliver the service, providing the parent or legal guardian with the name and contact information of the service provider and the date and location of the service of any appointment made on behalf of the child, and contacting the parent or legal guardian after the service is provided to ensure that the service is timely delivered and to determine whether the family requests additional services. (j) Negotiate and maintain agreements with Medicaid providers and Medicaid managed care organizations in its area. 1. With the parent’s or legal guardian’s permission, the services in the child’s approved individualized family support plan shall be communicated to the Medicaid managed care organization. Services that cannot be funded by Medicaid must be specifically identified and explained to the family. 2. The agreement between the local program office and Medicaid managed care organizations must establish methods of communication and procedures for the timely approval of services covered by Medicaid. (k) Develop agreements and arrangements with private insurers in order to coordinate benefits and services for any mutual enrollee. 1. The child’s approved individualized family support plan may be communicated to the child’s insurer with the parent’s or legal guardian’s permission. 2. The local program office and private insurers shall establish methods of communication and procedures for the timely approval of services covered by the child’s insurer, if appropriate and approved by the child’s parent or legal guardian. (l) Provide to the department data necessary for an evaluation of the local program office performance.

(5) ACCOUNTABILITY REPORTING. — By December 1 of each year, the department shall prepare and submit a report that assesses the performance of the Early Steps Program to the Governor, the President of the Senate, the Speaker of the House of Representatives, and the Florida Interagency Coordinating Council for Infants and Toddlers. The department must address the performance standards in subsection (1) and report actual performance compared to the standards for the prior fiscal year. The data used to compile the report must be submitted by each local program office in the state. The department shall report on all of the following measures: (a) Number and percentage of infants and toddlers served with an individualized family support plan. (b) Number and percentage of infants and toddlers demonstrating improved social or emotional skills after the program. (c) Number and percentage of infants and toddlers demonstrating improved use of knowledge and cognitive skills after the program. (d) Number and percentage of families reporting positive outcomes in their infant’s and toddler’s development as a result of early intervention services. (e) Progress toward meeting the goals of individualized family support plans. (f) Any additional measures established by the department.

(6) STATE INTERAGENCY COORDINATING COUNCIL. — The Florida Interagency Coordinating Council for Infants and Toddlers shall serve as the state interagency coordinating council required by 34 C.F.R. s. 303.600. The council shall be housed for administrative purposes in the department, and the department shall provide administrative support to the council.

(7) TRANSITION TO EDUCATION. — (a) At least 90 days before a child reaches 3 years of age, the local program office shall initiate transition planning to ensure the child’s successful transition from the Early Steps Program to a school district program for children with disabilities or to another program as part of an individual family support plan. (b) At least 90 days before a child reaches 3 years of age, the local program office shall: 1. Notify the local school district in which the child resides and the Department of Education that the child may be eligible for special education or related services as determined by the local school district pursuant to ss. 1003.21 and 1003.57, unless the child’s parent or legal guardian has opted out of such notification; and 2. Upon approval by the child’s parent or legal guardian, convene a transition conference that includes participation of a local school district representative and the parent or legal guardian to discuss options for and availability of services. (c) The local school district shall evaluate and determine a child’s eligibility to receive special education or related services pursuant to part B of the federal Individuals with Disabilities Education Act and ss. 1003.21 and 1003.57. (d) The local program office, in conjunction with the local school district, shall modify a child’s individual family support plan or, if applicable, the local school district shall develop an individual education plan for the child pursuant to ss. 1003.57, 1003.571, and 1003.5715, which identifies special education or related services that the child will receive and the providers or agencies that will provide such services. (e) If a child is determined to be ineligible for school district program services, the local program office and the local school district shall provide the child’s parent or legal guardian with written information on other available services or community resources. (f) The local program office shall negotiate and maintain an interagency agreement with each local school district in its service area pursuant to the Individuals with Disabilities Education Act, 20 U.S.C. s. 1435(a)(10)(F). Each interagency agreement must be reviewed at least annually and updated upon review, if needed.

Legislative History

s. 5, ch. 2004-245; s. 22, ch. 2004-350; s. 9, ch. 2016-238; s. 8, ch. 2021-10; s. 3, ch. 2025-95.