DARS ECI Compliance Guide
Introduction to the Guide
This compliance guide addresses requirements of the DARS ECI program that apply to all Texas contractors that receive IDEA, Part C funds and provide early childhood intervention services. The purpose of this compliance guide is to provide a list of authorities by topic in a useful format. Administrators must still comply with IDEA, the Code of Federal Regulation, the Texas Medicaid Providers Procedures Manual, and other authorities. It is a support for understanding your requirements, rights and duties as a contractor under federal laws and regulations and the relevant portions of the Texas Administrative Code.
The guide also has links to related regulations, Medicaid requirements, data entry requirements, and required forms. Because the TKIDS Manual and some forms are on the ECI extranet, only those with extranet privileges can access those links. For standardized and required elements forms, the link is to the ECI Provider Forms page. You will find the links to each specific form on that page.
This guide does not cover all state and federal requirements, nor does it cover local regulations. Please be aware that there are additional regulations that you must follow including all those for funding sources such as private insurance. State, federal and other requirements may change after the publication of this guide. DARS ECI will update the guide as needed, but the updates may not keep pace with the changes. You will still be responsible for keeping up-to-date on any changes to the requirements. This guide is part of a broader group of technical assistance materials provided by DARS ECI to promote compliance and performance.
How to Use This Guide
Throughout this guide, the word "you" means the administrator, program director or supervisor of ECI services. Other technical assistance materials are provided for other ECI audiences.
Note that live links to federal laws and regulations go to the most specific portion of the citation possible, depending on the specificity of the coding of the citation on the original page. In cases of a citation that is more specific than the link it connects to, be sure to scroll down on the link page and find the specific requirement that is cited.
Table of Contents
- General Rules
- Procedural Safeguards and Due Process Procedures
- Staff Qualifications
- Case Management for Infants and Toddlers with Developmental Disabilities
- Specialized Skills Training
- Referral, Pre-Enrollment and Developmental Screening
- Eligibility
- Evaluation and Assessment
- Individualized Family Service Plan (IFSP)
- Service Delivery
- Transition
- Child and Family Outcomes
- System of Fees
- Public Outreach
- Contract Requirements
A. General Rules
Federal Statutes
United States Code, Title 20, Chapter 33: Individuals with Disabilities Education Act (IDEA)
1401(1) Assistive technology device
1401(2) Assistive technology service
1401(3) Child with a disability
1401(4) Core academic subjects
1401(16) Infant or toddler with a disability
1401(23) Parent
1401(36) Ward of the State
1431 Findings and Policy
1432 Definitions
1435 Requirements for statewide system
Federal Regulations
Code of Federal Regulations, Title 34, Part 303: Early Intervention Program for Infants and Toddlers with Disabilities
§ 303.1 Purpose of the early intervention program for infants and toddlers with disabilities.
§ 303.2 Eligible recipients of an award and applicability of this part.
§ 303.3 Applicable regulations
§ 303.11 Early intervention service program.
§ 303.12 Early intervention service provider.
§ 303.18 Include; including.
§ 303.19 Indian; Indian tribe.
§ 303.22 Lead agency.
§ 303.27 Parent.
§ 303.101 State eligibility—requirements for a grant under this part.
§ 303.105 Positive efforts to employ and advance qualified individuals with disabilities.
§ 303.110 Minimum components of a statewide system.
§ 303.120 Lead agency role in supervision, monitoring, funding, interagency coordination, and other responsibilities.
§ 303.121 Policy for contracting or otherwise arranging for services.
§ 303.124 Data collection.
§ 303.125 State interagency coordinating council.
§ 303.203 Statewide system and description of services.
§ 303.205 Description of use of funds.
§ 303.222 Payor of last resort.
§ 303.227 Traditionally underserved groups.
§ 303.400 General responsibility of lead agency for procedural safeguards.
§ 303.403 Definitions.
§ 303.501 Permissive use of funds by the lead agency.
§ 303.510 Payor of last resort.
§ 303.701 State performance plans and data collection.
§ 303.702 State use of targets and reporting.
§ 303.720 Data requirements—general.
§ 303.721 Annual report of children served—report requirement.
§ 303.724 Annual report of children served—other responsibilities of the lead
agency.
State Regulations
Texas Administrative Code, Title 40, Part 2, Chapter 108, Division for Early Childhood Intervention Services, Subchapter A: General Rules
§108.101 Purpose
§108.103 Definitions
§108.105 Safety Regulations
§108.107 Health Standards for Early Childhood Intervention Services
Contract Requirements
XIII. General Provisions, B
XV. Responsibility
Required Forms
- DARS 4201, Surrogate Parent Identification of Need and Assignment: Word | PDF | Instructions
- DARS 4201-S, Identificación de necesidad y asignación de padres sustitutos: Word | Instrucciones
B. Procedural Safeguards and Due Process Procedures
Federal Statutes
United States Code, Title 20, Chapter 33: Individuals with Disabilities Education Act (IDEA)
1439 Procedural safeguards
Federal Regulations
Code of Federal Regulations, Title 34, Part 303: Early Intervention Program for Infants and Toddlers with Disabilities
§ 303.7 Consent.
§ 303.25 Native language.
§ 303.27 Parent.
§ 303.29 Personally identifiable information.
§ 303.37 Ward of the State.
§ 303.123 Procedural safeguards.
§ 303.310 Post-referral timeline (45 days).
§ 303.320 Screening Procedures
§ 303.322 Determination that a child is not eligible
§ 303.342(e) Procedures for IFSP development, review, and evaluation.
§ 303.345(a) Interim IFSPs—provision of services before evaluations and assessments are completed.
§ 303.401 Confidentiality and opportunity to examine records.
§ 303.402 Confidentiality.
§ 303.403 Definitions.
§ 303.404 Notice to parents.
§ 303.405 Access rights.
§ 303.406 Record of access.
§ 303.407 Records on more than one child.
§ 303.408 List of types and locations of information.
§ 303.409 Fees for records.
§ 303.410 Amendment of records at a parent’s request.
§ 303.411 Opportunity for a hearing.
§ 303.412 Result of hearing.
§ 303.413 Hearing procedures.
§ 303.414 Consent prior to disclosure or use.
§ 303.415 Safeguards.
§ 303.416 Destruction of information.
§ 303.417 Enforcement.
§ 303.420 Parental consent and ability to decline services.
§ 303.421 Prior written notice and procedural safeguard notice.
§ 303.422 Surrogate parents.
§ 303.430 State dispute resolution options.
§ 303.431 Mediation.
§ 303.432 Adoption of State complaint procedures.
§ 303.433 Minimum State complaint procedures.
§ 303.434 Filing a complaint.
§ 303.435 Appointment of an impartial due process hearing officer.
§ 303.436 Parent rights in due process hearing proceedings.
§ 303.437 Convenience of hearing and timelines.
§ 303.438 Civil action.
§ 303.440 Filing a due process complaint.
§ 303.441 Due process complaint.
§ 303.442 Resolution process.
§ 303.443 Impartial due process hearing.
§ 303.444 Hearing rights.
§ 303.445 Hearing decisions.
§ 303.446 Finality of decision; appeal; impartial review.
§ 303.447 Timelines and convenience of hearings and reviews.
§ 303.448 Civil action.
§ 303.449 State enforcement mechanisms.
§ 303.520 Policies related to use of public benefits or insurance or private insurance to pay for Part C services.
§ 303.521(b) and (e) System of payments and fees.
§ 303.721(c) Annual report of children served—report requirement.
State Regulations
Texas Administrative Code, Title 40, Part 2, Chapter 108, Division for Early Childhood Intervention Services, Subchapter B: Procedural Safeguards and Due Process Procedures
§108.201 Purpose
§108.203 Responsibilities
§108.205 Prior Written Notice and Procedural Safeguards Notice
§108.207 Parental Consent
§108.209 Parent Rights in the IFSP Process
§108.211 Parent
§108.213 Surrogate Parents
§108.215 Early Childhood Intervention Procedures for Filing Complaints
§108.217 Procedures for Investigation and Resolution of Complaints
§108.218 Mediation
§108.219 Confidentiality Notice to Parents
§108.221 Access Rights
§108.223 Fees for Records
§108.225 Amendment of Records at Parent's Request
§108.227 Opportunity for a Hearing
§108.229 Minimum Requirements for Conducting a Hearing
§108.231 Results of Hearing
§108.233 Release of Personally Identifiable Information
§108.235 Safeguards
§108.237 Record Retention Period
§108.239 Destruction of Information
§108.241 Release of Records
Related Regulations
Code of Federal Regulations, Title 34, Part 99: FERPA
Contract Requirements
XVI. Confidentiality
XXVI. Use of Electronic Signatures and Consents
XXVII. Client Records
XXVIII. Records Retention
XXIX. Record Review
Required Forms
- DARS4005, Consent by Foster Parent or Medical Consenter for Health Passport: Word | PDF | Instructions
- DARS4005-S, Permiso de los Padres Temporales u Otorgantes de Consentimiento Médico para el Pasaporte de Salud: Word | Instrucciones
- DARS4201, Surrogate Parent Identification of Need and Assignment: Word | PDF | Instructions
- DARS4201-S, Identificación de necesidad y asignación de padres sustitutos Word | Instrucciones
Required Elements for Prior Written Notice and Consent
C. Staff Qualifications
Federal Statutes
United States Code, Title 20, Chapter 33: Individuals with Disabilities Education Act (IDEA)
Subchapter III, Sect. 1435(a)(8)(9)
Federal Regulations
Code of Federal Regulations, Title 34, Part 303: Early Intervention Program for Infants and Toddlers with Disabilities
303.12(a)(2)(ii) Early Intervention Services, General
303.12(e) Early Intervention Services, Qualified Personnel
303.22 Qualified
State Regulations
Texas Administrative Code, Title 40, Part 2, Chapter 108, Division for Early Childhood Intervention Services, Subchapter C: Staff Qualifications
Medicaid Requirements
State Plan Amendment 10-052 Case Management Services; State Plan Amendment 10-068 ECI and EPSDT
Contract Requirements
XIII. General Provisions A.3
XXII. Certifications, A
Attachment No. 1, Section I Scope of Work
Data Entry Requirements
Employee Administration, p 85-89
Appendix A—Employee Administration, p 147-149
Sample Forms
Individual Professional Development Plan (IPDP)
D. Case Management for Infants and Toddlers with Developmental Disabilities
Federal Statutes
United States Code, Title 20, Chapter 33: Individuals with Disabilities Education Act (IDEA)
1436(d)(7) the identification of the service coordinator…
Federal Regulations
Code of Federal Regulations, Title 34, Part 303: Early Intervention Program for Infants and Toddlers with Disabilities
§ 303.34 Service coordination services (case management).
§ 303.343 IFSP Team meeting and periodic review.
§ 303.344(g) Content of an IFSP.
§ 303.521(b) System of payments and fees.
State Regulations
Texas Administrative Code, Title 40, Part 2, Chapter 108, Division for Early Childhood Intervention Services, Subchapter D: Case Management for Infants and Toddlers with Developmental Disabilities
§108.403 Definitions
§108.404 Recipient Eligibility for Early Childhood Intervention (ECI) Case Management Services
§108.405 Case Management Services
§108.406 Parent Refusal
§108.407 Medicaid Service Limitations
§108.409 Conditions for Case Management Provider Agency Participation
§108.411 Assignment of Service Coordinator
§108.415 Documentation
§108.417 Due Process
Related Regulations
Code of Federal Regulations, Title 34, Part 99: FERPA
Data Entry Requirements
TKIDS Manual:
Options, p 11; Close, p 15; Editing Data Entry Errors, p 16; Case Pre-Enrollment/Screening, p 32; Required Data Fields Table, p 35; Case Management and Targeted Case Management (CM/TCM), p 57; Required Data Fields Table, p 59; Transition, p 73; Case Actions, p 75; Global Actions, p 98
Appendix A - TKIDS Data Dictionary--Pre-Enrollment/Screening, p 113-114; Family, p 118-119; Family Members, p 119-121; Third Party Benefits, p 122-124; Case Management and Targeted Case Management (CM/TCM), p 124-125; Transition-p 139-140
Appendix B –Edit, Logical Consistency and Validation Checks—Family, p 154; Third Party Benefits, p 154; CM/TCM, p 154; IFSP, p 154-155
Medicaid Requirements
Texas Medicaid Provider Procedures Manual, Volume 1, Section 1: Provider Enrollment and Responsibilities
1.1 Provider Enrollment
1.2 Payment Information
1.3 Provider Reenrollment
1.4 Change of Ownership Requirements
1.5 Provider Responsibilities
1.7 Medicaid Waste, Abuse, and Fraud Policy
1.8 Texas Medicaid Limitations and Exclusions
1.9 Forms
Texas Medicaid Provider Procedures Manual, Volume 1, Section 2: Texas Medicaid Fee-for-Service Reimbursement
2.1 Payment Information
2.2 Fee-for-Service Reimbursement Methodology
2.3 Reimbursement Reductions
2.6 Medicare Crossover Claim Reimbursement
2.7 Federal Medical Assistance Percentage (FMAP)
Texas Medicaid Provider Procedures Manual, Volume 1, Section 3: TMHP Electronic Data Interchange (EDI)
3.1 TMHP EDI Overview
3.2 Electronic Billing
3.3 Gaining Access
3.4 Training
3.5 Electronic Transmission Reports
3.6 Provider Check Amounts Available Online
3.7 Third Party Vendor Implementation
3.8 Forms
Texas Medicaid Provider Procedures Manual, Volume 1, Section 4: Client Eligibility
4.1 General Medicaid Eligibility
4.2 Eligibility Verification
4.3 Medicaid Identification and Verification
4.4 Restricted Medicaid Coverage
4.4.2 Client Limited Program
4.4.3 Hospice Program
4.5 CHIP Perinatal Program
4.6 Medically Needy Program (MNP)
4.7 Medicaid Buy-In for Children (MBIC) Program
4.11 Medicare and Medicaid Dual Eligibility
4.12 Contract with Outside Parties
4.13 Third Party Liability (TPL)
4.14 Health Insurance Premium Payment (HIPP) Program
4.17 Forms
Texas Medicaid Provider Procedures Manual, Volume 1, Section 6: Claims Filing
6.1 Claims Information
6.2 TMHP Electronic Claims Submission
6.3 Coding
6.4 Claims Filing Instructions
6.5 CMS -1500 Paper Claim Filing Instruction
6.11 Remittance and Status (R&S) Report
6.12 Other Insurance Claims Filing
6.13 Medicare Claims
6.14 Filing Medicare Primary Paper Claims
6.15 Medically Needy Claims Filing
6.17 Claims for Medicaid Hospice Clients Not Related to the Terminal Illness
6.18 Claims for Texas Medicaid and CSHCN Services Program
6.20 Children’s Health Insurance Program (CHIP) Perinatal Claims
6.21 Forms
Texas Medicaid Provider Procedures Manual, Volume 1, Section 7: Appeals
7.1 Appeal Methods
7.2 Refunds to TMHP
7.3 Appeals to HHSC Texas Medicaid Fee-for-Service
7.4 Cost Report Settlement Appeal Process
7.5 Forms
Texas Medicaid Provider Procedures Manual, Volume 1, Appendix D: Acronym Dictionary
Texas Medicaid Provider Procedures Manual, Volume 2: Children's Services Handbook
Section 2: Medicaid Children’s Comprehensive Care Program (CCP)
2.5 Early Childhood Intervention (ECI) Services
Section 7: Contact TMHP
Section 9: Claim Form Examples
Contract Requirements
XIII. General Provisions A.3, A.9
XXXIV. Standards for Program and Financial Management, A.3, A.4
XXXVIII. Reporting Requirements and Inspections
Attachment No. 1, Section I Scope of Work
Attachment No. 1, Section II Measurable Outputs and Outcomes, C, E, F
Attachment No. 2, Section I Respite Services – Scope of Work
Required Forms
- DARS4005, Consent by Foster Parent or Medical Consenter for Health Passport: Word | PDF | Instructions
- DARS4005-S, Permiso de los Padres Temporales u Otorgantes de Consentimiento Médico para el Pasaporte de Salud: Word | Instrucciones
- DARS4201, Surrogate Parent Identification of Need and Assignment: Word | PDF | Instructions
- DARS4201-S, Identificación de necesidad y asignación de padres sustitutos: Word | Instrucciones
E. Specialized Skills Training
Federal Regulations
Code of Federal Regulations, Title 34, Part 303: Early Intervention Program for Infants and Toddlers with Disabilities
§ 303.13(b)(14) Special Instruction includes
State Regulations
Texas Administrative Code, Title 40, Part 2, Chapter 108, Division for Early Childhood Intervention Services, Subchapter E: Specialized Skills Training
§108.501 Specialized Skills Training (Developmental Services)
§108.503 Recipient Eligibility
§108.505 Conditions for Provider Agency Participation
§108.507 Due Process
Medicaid Requirements
Texas Medicaid Provider Procedures Manual, Volume 1, Section 1: Provider Enrollment and Responsibilities
1.1 Provider Enrollment
1.2 Payment Information
1.3 Provider Reenrollment
1.4 Change of Ownership Requirements
1.5 Provider Responsibilities
1.7 Medicaid Waste, Abuse, and Fraud Policy
1.8 Texas Medicaid Limitations and Exclusions
1.9 Forms
Texas Medicaid Provider Procedures Manual, Volume 1, Section 2: Texas Medicaid Fee-for-Service Reimbursement
2.1 Payment Information
2.2 Fee-for-Service Reimbursement Methodology
2.3 Reimbursement Reductions
2.6 Medicare Crossover Claim Reimbursement
2.7 Federal Medical Assistance Percentage (FMAP)
Texas Medicaid Provider Procedures Manual, Volume 1, Section 3: TMHP Electronic Data Interchange (EDI)
3.1 TMHP EDI Overview
3.2 Electronic Billing
3.3 Gaining Access
3.4 Training
3.5 Electronic Transmission Reports
3.6 Provider Check Amounts Available Online
3.7 Third Party Vendor Implementation
3.8 Forms
Texas Medicaid Provider Procedures Manual, Volume 1, Section 4: Client Eligibility
4.1 General Medicaid Eligibility
4.2 Eligibility Verification
4.3 Medicaid Identification and Verification
4.4 Restricted Medicaid Coverage
4.4.2 Client Limited Program
4.4.3 Hospice Program
4.11 Medicare and Medicaid Dual Eligibility
4.12 Contract with Outside Parties
4.13 Third Party Liability (TPL)
4.17 Forms
Texas Medicaid Provider Procedures Manual, Volume 1, Section 6: Claims Filing
6.1 Claims Information
6.2 TMHP Electronic Claims Submission
6.3 Coding
6.4 Claims Filing Instructions
6.5 CMS -1500 Paper Claim Filing Instruction
6.11 Remittance and Status (R&S) Report
6.12 Other Insurance Claims Filing
6.13 Medicare Claims
6.14 Filing Medicare Primary Paper Claims
6.15 Medically Needy Claims Filing
6.17 Claims for Medicaid Hospice Clients Not Related to the Terminal Illness
6.18 Claims for Texas Medicaid and CSHCN Services Program
6.20 Children’s Health Insurance Program (CHIP) Perinatal Claims
6.21 Forms
Texas Medicaid Provider Procedures Manual, Volume 1, Section 7: Appeals
7.2 Refunds to TMHP
7.3 Appeals to HHSC Texas Medicaid Fee-for-Service
7.4 Cost Report Settlement Appeal Process
7.5 Forms
Texas Medicaid Provider Procedures Manual, Volume 1, Appendix D: Acronym Dictionary
Texas Medicaid Provider Procedures Manual, Volume 2: Children's Services Handbook
Section 2: Medicaid Children’s Comprehensive Care Program (CCP)
2.5 Early Childhood Intervention (ECI) Services
Section 6: Claims Resources
Section 7: Contact TMHP
Section 9: Claim Form Examples
Contract Requirements
XIII. General Provisions A.3
XXVIII. Records Retention
XXXIV. Standards for Program and Financial Management, A.3
XXXVIII. Reporting Requirements and Inspections
Attachment No. 1, Section I Scope of Work
Attachment No. 1, Section II Measurable Outputs and Outcomes, C, D, G
Attachment No. 1, Section IV Special Provisions, C
Data Entry Requirements
TKIDS Manual:
Planned Services, p 63; Delivered Services, p 67; Required Data Fields Tables, p 70
Appendix A—Planned Service, p 128-138
Appendix B –Edit, Logical Consistency and Validation Checks—IFSP, p 154-155
F. Referral, Pre-Enrollment and Developmental Screening
Federal Statutes
United States Code, Title 20, Chapter 33: Individuals with Disabilities Education Act (IDEA)
1435(a)(5) A comprehensive child find system
1435(a)(6) A public awareness program focusing on early identification of infants and toddlers with disabilities
Federal Regulations
Code of Federal Regulations, Title 34, Part 303: Early Intervention Program for Infants and Toddlers with Disabilities
§ 303.206 Referral policies for specific children.
§ 303.300 General.
§ 303.303 Referral procedures.
§ 303.310 Post-referral timeline (45 days).
§ 303.320 Screening Procedures
§303.420 Parental consent and ability to decline services.
State Regulations
Texas Administrative Code, Title 40, Part 2, Chapter 108, Division for Early Childhood Intervention Services, Subchapter G: Referral, Pre-Enrollment, and Developmental Screening
§108.701 Referral Requirements
§108.705 Child Referred before Birth
§108.707 Pre-Enrollment Activities
§108.709 Optional Developmental Screenings
Medicaid Requirements
Contract Requirements
XIII. General Provisions, A.14
XXXIV. Standards for Program and Financial Management, A.3
XXXVIII. Reporting Requirements and Inspections
Attachment No. 1, Section I Scope of Work
Data Entry Requirements
TKIDS Manual:
Child Date, p 9; Options, p 10; Options, p 11; Case Dispositions, p 12; Saving Data, p 15; Close, p 15; Exceptions to data that can be edited, p 16; Accessing a Child’s Case Information, p 21; Child/Case Create, p 22; Required Data Fields Table, p 26; Child Referral, p 26; Required Data Fields Table, p 30; Case Pre-Enrollment/Screening, p 32; Required Data Fields Table, p 35; Family, p 44; Interim IFSPs, p 62; Disposition Changes, p 81; Instructions for Transfers, p 84; Cases Still in Referral, p 105
Appendix A - TKIDS Data Dictionary —Child/Case Create, p 107; Referral, p 107-110; Referral Detail, p 110-112; Pre-Enrollment/Screening, p 113-114; Family, p 118-119; Family Members, p 119-121; Actions, p 140-141; Disposition Change, p 141-147; Follow-Along, p 147-148
Appendix B –Edit, Logical Consistency and Validation Checks—Child/Case Create, p 153; Child Referral, p 153; Pre-Enrollment/Screening, p 153-154; Exit and Closure, p 156; Disposition Change Data, p 156
Appendix C – Birth Weight Conversion, p 158-160
G. Eligibility
Federal Statutes
United States Code, Title 20, Chapter 33: Individuals with Disabilities Education Act (IDEA)
1434 Eligibility
Federal Regulations
Code of Federal Regulations, Title 34, Part 303: Early Intervention Program for Infants and Toddlers with Disabilities
§ 303.5 At-risk infant or toddler.
§ 303.7 Consent.
§ 303.10 Developmental delay.
§ 303.21 Infant or toddler with a disability.
§ 303.111 State definition of developmental delay.
§ 303.322 Determination that a child is not eligible
§ 303.421 Prior written notice and procedural safeguard notice.
§ 303.440 Filing a due process complaint.
§ 303.445 Hearing decisions.
State Regulations
Texas Administrative Code, Title 40, Part 2, Chapter 108, Division for Early Childhood Intervention Services, Subchapter H: Eligibility
§108.801 Definitions
§108.803 Eligibility
§108.804 Eligibility Statement
§108.805 Initial Eligibility Criteria
§108.807 Continuing Eligibility Criteria
Contract Requirements
XXXIV. Standards for Program and Financial Management, A.3
XXXVIII. Reporting Requirements and Inspections
Attachment No. 1, Section I Scope of Work
Data Entry Requirements
TKIDS Manual:
Options, p 11, Case Dispositions, p 12; Exceptions to data that can be edited, p 16; Updating Data, p 16; Entering Eligibility Information, p 38; Required Data Fields Table; Medical, p 48; Required Data Fields, p 52; Disposition Changes, p 81; Cases Still in Eligibility Determination, p 105
Appendix A - TKIDS Data Dictionary —Eligibility, p 116-118; Medical, p 121-122; Disposition Change, p 141-147; Follow-Along, p 147-148
Appendix B –Edit, Logical Consistency and Validation Checks—Evaluation/Assessment, p 154; Exit and Closure, p 156; Disposition Change Data, p 156
Appendix D – Qualifying Diagnoses: Names and ICD-9 Codes, p 161-172
Required Elements Forms
Eligibility Statement
H. Evaluation and Assessment
Federal Statutes
United States Code, Title 20, Chapter 33, Individuals with Disabilities Education Act (IDEA)
1435(a)(3) A timely, comprehensive, multidisciplinary evaluation…
Federal Regulations
Code of Federal Regulations, Title 34, Part 303: Early Intervention Program for Infants and Toddlers with Disabilities
§ 303.24 Multidisciplinary.
§ 303.25 Native language.
§ 303.113 Evaluation, assessment, and nondiscriminatory procedures.
§ 303.300 General.
§ 303.310 Post-referral timeline (45 days).
§ 303.320 Screening Procedures
§ 303.321 Evaluation of the child and assessment of the child and family.
§ 303.322 Determination that a child is not eligible
§ 303.409 Fees for records.
§ 303.420 Parental consent and ability to decline services.
§ 303.421 Prior written notice and procedural safeguard notice.
§ 303.440 Filing a due process complaint.
§ 303.445 Hearing decisions.
§ 303.521(b) System of payments and fees.
State Regulations
Texas Administrative Code, Title 40, Part 2, Chapter 108, Division for Early Childhood Intervention Services, Subchapter I: Evaluation and Assessment
§108.901 Definitions
§108.903 Evaluations
§108.905 Determination of Hearing and Auditory Status
§108.907 Determination of Vision Status
§108.909 Comprehensive Needs Assessment
§108.911 Ongoing Assessment
§108.913 Identifying Nutritional Needs
§108.915 Identifying Assistive Technology Needs
§108.917 Autism Screening
Medicaid Requirements
Texas Medicaid Provider Procedures Manual, Volume 1, Section 1: Provider Enrollment and Responsibilities
1.1 Provider Enrollment
1.2 Payment Information
1.3 Provider Reenrollment
1.4 Change of Ownership Requirements
1.5 Provider Responsibilities
1.7 Medicaid Waste, Abuse, and Fraud Policy
1.8 Texas Medicaid Limitations and Exclusions
1.9 Forms
Texas Medicaid Provider Procedures Manual, Volume 1, Section 2: Texas Medicaid Fee-for-Service Reimbursement
2.1 Payment Information
2.2 Fee-for-Service Reimbursement Methodology
2.3 Reimbursement Reductions
2.6 Medicare Crossover Claim Reimbursement
2.7 Federal Medical Assistance Percentage (FMAP)
Texas Medicaid Provider Procedures Manual, Volume 1, Section 3: TMHP Electronic Data Interchange (EDI)
3.1 TMHP EDI Overview
3.2 Electronic Billing
3.3 Gaining Access
3.4 Training
3.5 Electronic Transmission Reports
3.6 Provider Check Amounts Available Online
3.7 Third Party Vendor Implementation
3.8 Forms
Texas Medicaid Provider Procedures Manual, Volume 1, Section 4: Client Eligibility
4.1 General Medicaid Eligibility
4.2 Eligibility Verification
4.3 Medicaid Identification and Verification
4.4 Restricted Medicaid Coverage
4.4.2 Client Limited Program
4.4.3 Hospice Program
4.11 Medicare and Medicaid Dual Eligibility
4.12 Contract with Outside Parties
4.13 Third Party Liability (TPL)
4.17 Forms
Texas Medicaid Provider Procedures Manual, Volume 1, Section 5: Fee-for-Service Prior Authorizations
5.1 General Information About Prior Authorization
5.3 Benefit Code
5.4 Submitting Prior Authorization Forms
5.5 Prior Authorization Submission Methods
5.6 Verifying Prior Authorization Status
5.7 Prior Authorization Notifications
5.8 Prior Authorization Denials Appeals Process
5.9 Closing a Prior Authorization
5.10 Submitting Claims for Services That Require Prior Authorization
Texas Medicaid Provider Procedures Manual, Volume 1, Section 6: Claims Filing
6.1 Claims Information
6.2 TMHP Electronic Claims Submission
6.3 Coding
6.4 Claims Filing Instructions
6.5 CMS -1500 Paper Claim Filing Instruction
6.11 Remittance and Status (R&S) Report
6.12 Other Insurance Claims Filing
6.13 Medicare Claims
6.14 Filing Medicare Primary Paper Claims
6.15 Medically Needy Claims Filing
6.17 Claims for Medicaid Hospice Clients Not Related to the Terminal Illness
6.18 Claims for Texas Medicaid and CSHCN Services Program
6.20 Children’s Health Insurance Program (CHIP) Perinatal Claims
6.21 Forms
Texas Medicaid Provider Procedures Manual, Volume 1, Section 7: Appeals
7.1 Appeal Methods
7.2 Refunds to TMHP
7.3 Appeals to HHSC Texas Medicaid Fee-for-Service
7.4 Cost Report Settlement Appeal Process
7.5 Forms
Texas Medicaid Provider Procedures Manual, Volume 1, Appendix D: Acronym Dictionary
Texas Medicaid Provider Procedures Manual, Volume 2: Children's Services Handbook
Section 2: Medicaid Children’s Comprehensive Care Program (CCP)
2.5 Early Childhood Intervention (ECI) Services
2.6 Medical Nutrition Counseling Services (CCP)
2.10 Therapy Services (CCP)
Section 6: Claims Resources
Section 7: Contact TMHP
Section 9: Claim Form Examples
Texas Medicaid Provider Procedures Manual, Volume 2: Medicaid Managed Care Handbook
Section 1: General Information
Section 2: Overview of Medicaid Managed Care
2.1 Managed Care Services
2.2 Provider Enrollment and Responsibilities
2.3 General Information About Client Enrollment in Managed Care
2.5 Cultural Competency and Sensitivity
2.6 Reimbursement
2.7 Managed Care Plan Changes
2.9 Claims Filing for Managed Care Services
2.10 MCO/Dental Plan Appeals, Complaints, and Fair Hearings
Section 3: STAR Program
Section 4: STAR+PLUS Program
Section 5: NorthSTAR Program
Section 6: STAR Health Program
Section 11: Contact Information
Contract Requirements
XXVII. Records Retention
XXVIII. Record Review
XXXIII. Standards for Program and Financial Management, A.3
XXXV. Payment and Advances, F
XXXVII. Reporting Requirements and Inspections
Attachment No. 1, Section I Scope of Work
Data Entry Requirements
TKIDS Manual:
Options, p 10; Updating Data, p 16; Evaluation/Assessment, p 36; Required Data Fields Table, p 43; Medical, p 48; Required Data Fields, p 52; Interim IFSPs, p 62; Case Actions, p 75
Appendix A - TKIDS Data Dictionary —Evaluation/Assessment, p 114-116, Actions, p 140-141
Appendix B –Edit, Logical Consistency and Validation Checks—Evaluation/Assessment, p154
I. Individualized Family Service Plan (IFSP)
Federal Statutes
United States Code, Title 20, Chapter 33: Individuals with Disabilities Education Act (IDEA), Subchapter III
1435(a)(8) Requirements for statewide system, A comprehensive system of personnel development…
Federal Regulations
Code of Federal Regulations, Title 34, Part 303: Early Intervention Program for Infants and Toddlers with Disabilities
§ 303.7 Consent.
§ 303.20 Individualized family service plan.
§ 303.24 Multidisciplinary.
§ 303.25 Native language.
§ 303.114 Individualized family service plan (IFSP).
§ 303.126 Early intervention services in natural environments.
§ 303.300 General.
§ 303.310 Post-referral timeline (45 days).
§ 303.340 Individualized family service plan—general.
§ 303.342 Procedures for IFSP development, review, and evaluation.
§ 303.343 IFSP Team meeting and periodic review.
§ 303.344 Content of an IFSP.
§ 303.345 Interim IFSPs—provision of services before evaluations and assessments are completed.
§ 303.346 Responsibility and accountability.
§ 303.409 Fees for records.
§ 303.430 State dispute resolution options.
§ 303.521(b) System of payments and fees.
State Regulations
Texas Administrative Code, Title 40, Part 2, Chapter 108, Division for Early Childhood Intervention Services, Subchapter J: Individualized Family Service Plan (IFSP)
§108.1001 Definitions
§108.1003 IFSP
§108.1005 Medical Review for Early Childhood Intervention Services
§108.1007 Interim IFSP
§108.1009 Participants in Initial and Annual Meetings to Evaluate the IFSP
§108.1011 Participants in Meetings for a Child with Auditory or Visual Impairments
§108.1013 Participants in Periodic Reviews
§108.1015 Content of the IFSP
§108.1017 Complete Periodic Review
§108.1019 Annual Meeting to Evaluate the IFSP
§108.1021 Partial Review of the IFSP
Contract Requirements
XXVII. Records Retention
XXVIII. Record Review
XXXIII. Standards for Program and Financial Management, A.3
XXXVII. Reporting Requirements and Inspections
Attachment No. 1, Section I
Attachment No. 1, Section II Measurable Outputs and Outcomes, C, D, E, F
Attachment No. 1, Section IV Special Provisions, C
Attachment No. 2, Section I Respite Services – Scope of Work
Data Entry Requirements
TKIDS Manual:
Options, p 11; Editing Data Entry Errors, p 16; IFSP, p 60; Transition, p 73; Case Actions, p 75
Appendix A - TKIDS Data Dictionary —IFSP, p 125-128; Planned Service, p 128-138; Actions, p 140-141; IFSP, p 154-155; Business Rules for Deleting an IFSP, p 155
Required Forms
- DARS4005, Consent by Foster Parent or Medical Consenter for Health Passport: Word | PDF | Instructions
- DARS4005-S, Permiso de los Padres Temporales u Otorgantes de Consentimiento Médico para el Pasaporte de Salud: Word | Instrucciones
- DARS4006, Individualized Family Services Plan (IFSP) Services Page: Word | Instructions
- DARS4006-S, Individualized Family Services Plan (IFSP) Services Page: Word | Instrucciones
Required Elements Forms
Required Elements for the IFSP
Required Elements for Periodic Review of the IFSP
Required Elements for Annual Review of the IFSP
Required Elements for IFSP Transition Steps and Transition Services
Sample Forms
Sample IFSP
Sample Periodic Review of the IFSP
Sample Annual Meeting to Evaluate the IFSP
Sample IFSP Transition Steps and Services
J. Service Delivery
Federal Statutes
United States Code, Title 20, Chapter 33: Individuals with Disabilities Education Act (IDEA), Subchapter III
1436(d)(8) Content of plan, the steps to be taken to support the transition…
Federal Regulations
Code of Federal Regulations, Title 34, Part 303: Early Intervention Program for Infants and Toddlers with Disabilities
§ 303.13 Early intervention services.
§ 303.16 Health services.
§ 303.26 Natural environments.
§ 303.32 Scientifically based research.
§ 303.112 Availability of early intervention services.
§ 303.126 Early intervention services in natural environments.
§ 303.344 Content of an IFSP.
§ 303.345 Interim IFSPs—provision of services before evaluations and assessments are completed.
§ 303.346 Responsibility and accountability.
§ 303.420 Parental consent and ability to decline services.
§ 303.421 Prior written notice and procedural safeguard notice.
§ 303.430 State dispute resolution options.
§ 303.432 Adoption of state complaint procedures.
§ 303.440 Filing a due process complaint.
§ 303.445 Hearing decisions.
State Regulations
Texas Administrative Code, Title 40, Part 2, Chapter 108, Division for Early Childhood Intervention Services, Subchapter K: Service Delivery
§108.1103 Early Childhood Intervention Services Delivery
§108.1105 Capacity to Provide Early Childhood Intervention Services
§108.1107 Group Services
§108.1111 Service Delivery Documentation Requirements
Medicaid Requirements
Texas Medicaid Provider Procedures Manual, Volume 1, Section 1: Provider Enrollment and Responsibilities
1.1 Provider Enrollment
1.2 Payment Information
1.3 Provider Reenrollment
1.4 Change of Ownership Requirements
1.5 Provider Responsibilities
1.7 Medicaid Waste, Abuse, and Fraud Policy
1.8 Texas Medicaid Limitations and Exclusions
1.9 Forms
Texas Medicaid Provider Procedures Manual, Volume 1, Section 2: Texas Medicaid Fee-for-Service Reimbursement
2.1 Payment Information
2.2 Fee-for-Service Reimbursement Methodology
2.3 Reimbursement Reductions
2.6 Medicare Crossover Claim Reimbursement
2.7 Federal Medical Assistance Percentage (FMAP)
Texas Medicaid Provider Procedures Manual, Volume 1, Section 3: TMHP Electronic Data Interchange (EDI)
3.1 TMHP EDI Overview
3.2 Electronic Billing
3.3 Gaining Access
3.4 Training
3.5 Electronic Transmission Reports
3.6 Provider Check Amounts Available Online
3.7 Third Party Vendor Implementation
3.8 Forms
Texas Medicaid Provider Procedures Manual, Volume 1, Section 4: Client Eligibility
4.1 General Medicaid Eligibility
4.2 Eligibility Verification
4.3 Medicaid Identification and Verification
4.4 Restricted Medicaid Coverage
4.4.2 Client Limited Program
4.4.3 Hospice Program
4.11 Medicare and Medicaid Dual Eligibility
4.12 Contract with Outside Parties
4.13 Third Party Liability (TPL)
4.17 Forms
Texas Medicaid Provider Procedures Manual, Volume 1, Section 6: Claims Filing
6.1 Claims Information
6.2 TMHP Electronic Claims Submission
6.3 Coding
6.4 Claims Filing Instructions
6.5 CMS -1500 Paper Claim Filing Instruction
6.11 Remittance and Status (R&S) Report
6.12 Other Insurance Claims Filing
6.13 Medicare Claims
6.14 Filing Medicare Primary Paper Claims
6.15 Medically Needy Claims Filing
6.17 Claims for Medicaid Hospice Clients Not Related to the Terminal Illness
6.18 Claims for Texas Medicaid and CSHCN Services Program
6.20 Children’s Health Insurance Program (CHIP) Perinatal Claims
6.21 Forms
Texas Medicaid Provider Procedures Manual, Volume 1, Section 7: Appeals
7.1 Appeal Methods
7.2 Refunds to TMHP
7.3 Appeals to HHSC Texas Medicaid Fee-for-Service
7.4 Cost Report Settlement Appeal Process
7.5 Forms
Texas Medicaid Provider Procedures Manual, Volume 1, Appendix D: Acronym Dictionary
Texas Medicaid Provider Procedures Manual, Volume 2: Behavioral Health, Rehabilitation, and Case Management Services Handbook
Section 4: Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT) and Licensed Professional Counselor (LPC)
4.1 Enrollment
4.2 Services, Benefits, Limitations, and Prior Authorization
4.3 Documentation on Requirements
4.4 Claims Filing and Reimbursement
Section 6: Physician, Psychologist, and Licensed Psychological Associate (LPA) Providers
6.1 Enrollment
6.2 Services, Benefits, Limitations, and Prior Authorization
6.3 Outpatient Behavioral Health Services
6.10 Psychological and Neuropsychological Testing
6.11 Psychotherapy or Counseling
6.13 Noncovered Services
6.15 Claims Filing and Reimbursement
Section 9: Claims Resources
Section 10: Contact TMHP
Section 11: Forms
Section 12: Claim Form Examples
Texas Medicaid Provider Procedures Manual, Volume 2: Children's Services Handbook
Section 2: Medicaid Children’s Comprehensive Care Program (CCP)
2.5 Early Childhood Intervention (ECI) Services
2.6 Medical Nutrition Counseling Services (CCP)
2.10 Therapy Services (CCP)
Section 6: Claims Resources
Section 7: Contact TMHP
Section 9: Claim Form Examples
Texas Medicaid Provider Procedures Manual, Volume 2: Medicaid Managed Care Handbook
Section 1: General Information
Section 2: Overview of Medicaid Managed Care
2.1 Managed Care Services
2.2 Provider Enrollment and Responsibilities
2.3 General Information About Client Enrollment in Managed Care
2.5 Cultural Competency and Sensitivity
2.6 Reimbursement
2.7 Managed Care Plan Changes
2.9 Claims Filing for Managed Care Services
2.10 MCO/Dental Plan Appeals, Complaints, and Fair Hearings
Section 3: STAR Program
Section 4: STAR+PLUS Program
Section 5: NorthSTAR Program
Section 6: STAR Health Program
Section 11: Contact Information
Contract Requirements
XIII. General Provisions A.3
XXVII. Records Retention
XXVIII. Record Review
XXXIII. Standards for Program and Financial Management, A.3
XXXV. Payments and Advances, F
XXXVII. Reporting Requirements and Inspections
Attachment No. 1, Section I Scope of Work
Attachment No. 1, Section II Measurable Outputs and Outcomes, B, C, D, G
Attachment No. 1, Section IV Special Provisions, C
Data Entry Requirements
TKIDS Manual:
Options, p 11; Close, p 15; Editing Data Entry Errors, p 16; Medical, p 48; Required Data Fields Tables, p 52; Planned Services, p 63; Delivered Services, p 67; Required Data Fields Tables, p 70
Appendix A - TKIDS Data Dictionary --Medical, p 121-122; Planned Service, p 128-138; Delivered Service, p 138-139; IFSP, p 154-155
K. Transition
Federal Statutes
United States Code, Title 20, Chapter 33: Individuals with Disabilities Education Act (IDEA), Subchapter III
1436(d)(8) Content of plan, the steps to be taken to support the transition of the toddler with a disability to preschool or other appropriate services
Federal Regulations
Code of Federal Regulations, Title 34, Part 303: Early Intervention Program for Infants and Toddlers with Disabilities
§ 303.23 Local educational agency.
§ 303.36 State educational agency.
§ 303.209 Transition to preschool and other programs.
§ 303.210 Coordination with Head Start and Early Head Start, early education, and child care programs.
§ 303.344(h) Content of an IFSP.
State Regulations
Texas Administrative Code, Title 40, Part 2, Chapter 108, Division for Early Childhood Intervention Services, Subchapter L: Transition
§108.1201 Purpose
§108.1203 Definitions
§108.1205 Transition Education and Information for the Family
§108.1207 Transition Planning
§108.1211 LEA Notification of Potentially Eligible for Special Education Services
§108.1213 LEA Notification Opt Out
§108.1215 Reporting Late LEA Notifications of Potentially Eligible for Special Education Services
§108.1217 LEA Transition Conference
§108.1219 Transition to LEA Services
§108.1221 Transition Into the Community
Contract Requirements
XXVII. Records Retention
XXVIII. Record Review
XXXIII. Standards for Program and Financial Management, A.3
XXXVII. Reporting Requirements and Inspections
Attachment No. 1, Section II Measurable Outputs and Outcomes, F
Data Entry Requirements
TKIDS Manual:
Options, p 11, Case Dispositions, p 12; Exceptions to data that can be edited, p 16; Transfer and Exit Dates, p 29; Transition, p 73; Case Actions, p 75; Disposition Changes, p 81; Instructions for Transfers, p 84; Inactive Cases for Children Over Three, p 104
Appendix A - TKIDS Data Dictionary —Referral, p 109; Transition-p 139-140; Actions, p 140-141; Disposition Change, p 141-147
Appendix B –Edit, Logical Consistency and Validation Checks—Transition, p 155-156; Exit and Closure, p 156; Disposition Change Data, p 156
Required Elements Forms
Required Elements for LEA Notification and Transition Conference
Required Elements for IFSP Transition Steps and Transition Services
Sample Forms
Sample IFSP Transition Steps and Services
L. Child and Family Outcomes
Federal Statutes
United States Code, Title 20, Chapter 33: Individuals with Disabilities Education Act (IDEA), Subchapter III
1435(a)(14) Requirements for statewide system
State Regulations
Texas Administrative Code, Title 40, Part 2, Chapter 108, Division for Early Childhood Intervention Services, Subchapter M: Child and Family Outcomes
§108.1301 Child Outcomes
§108.1303 Family Outcomes
Contract Requirements
XXVII. Records Retention
XXVIII. Record Review
XXXIII. Standards for Program and Financial Management, A.3
XXXVII. Reporting Requirements and Inspections
Data Entry Requirements
TKIDS Manual:
Options, p 11; Child Outcomes, p 71
Appendix A - TKIDS Data Dictionary —Child Outcomes, p 139
Appendix B –Edit, Logical Consistency and Validation Checks—Child Outcomes, p 156
M. System of Fees
Federal Regulations
Code of Federal Regulations, Title 34, Part 303: Early Intervention Program for Infants and Toddlers with Disabilities
§ 303.500 Use of funds, payor of last resort, and system of payments.
§ 303.510 Payor of last resort.
§ 303.520 Policies related to use of public benefits or insurance or private insurance to pay for Part C services.
§ 303.521 System of payments and fees.
State Regulations
Texas Administrative Code, Title 40, Part 2, Chapter 108, Division for Early Childhood Intervention Services Subchapter N: System of Fees
§108.1401 Purpose
§108.1403 Definitions
§108.1405 Family Cost Share System Administration
§108.1407 Parent Rights Related to the Family Cost Share System
§108.1409 Early Childhood Intervention Services Provided at No Cost to the Parent
§108.1411 IFSP Services Subject to the Family Cost Share Amount
§108.1413 Family Monthly Maximum Payment
§108.1415 Information Used to Calculate Family Cost Share Amount
§108.1419 Third-Party Payors
§108.1421 Review of Family Cost Share Amount
§108.1423 Reconsideration and Adjustment of Family Cost Share Obligation
§108.1425 Billing Families for IFSP Services
§108.1427 IFSP Services Subject to Suspension for Nonpayment
§108.1429 Program Fiscal and Recordkeeping Policies
Contract Requirements
XIII. General Provisions, A.5, A.6, A.10, A.11, A.12
XXVII. Records Retention
XXVIII. Record Review
XXXIII. Standards for Program and Financial Management, A.3, A.4, A.5
XXXV. Payments and Advances, F
XXXVI. Program Income
XXXVII. Reporting Requirements and Inspections, B, C
Attachment No. 1, Section II Measurable Outputs and Outcomes, A
Attachment No. 1, Section VI Budget
Data Entry Requirements
TKIDS Manual:
Option, p 11; Updating Data, p 16; Third-Party Benefits, p 53; Required Data Fields Table, p 56
Appendix A - TKIDS Data Dictionary —Family, p 118-119, Medical, p 121-122, Third Party Benefits, p 122-124
Appendix B –Edit, Logical Consistency and Validation Checks—Family, p 154; Third Party Benefits, p 154
Required Forms
- DARS4206, Family Cost Share Review Attestation
- DARS4206-S, Declaración de revisión de la participación de la familia en los costos
Sample Forms
Family Cost Share Agreement
Consent to Bill Third Party Payors and Release Personally Identifiable Information
N. Public Outreach
Federal Statutes
United States Code, Title 20, Chapter 33, Individuals with Disabilities Education Act (IDEA) Subchapter III
1435(a)(5) In general; A comprehensive child find system…
1435(a)(6) In general; A public awareness program focusing on early identification of infants and toddlers with disabilities…
1435(a)(7) In general; A central directory that includes information on early intervention services…
Federal Regulations
Code of Federal Regulations, Title 34, Part 303: Early Intervention Program for Infants and Toddlers with Disabilities
303.160 Minimum components of a statewide system
303.162 Central directory
303.164 Public awareness program
303.165 Comprehensive child find system
303.301 Central directory
303.320 Public awareness program
303.321 Comprehensive child find system
State Regulations
Texas Administrative Code, Title 40, Part 2, Chapter 108, Division for Early Childhood Intervention Services, Subchapter O: Public Outreach
§108.1501 Public Outreach
§108.1502 Definitions
§108.1503 Child Find
§108.1505 Public Awareness
§108.1507 Publications
§108.1509 Interagency Coordination with Texas Education Agency
§108.1511 Interagency Coordination with Head Start and Early Head Start
§108.1513 Interagency Coordination with the Texas Department of Family and Protective Services (DFPS)
§108.1515 Interagency Coordination with Local Agencies
Contract Requirements
XIII. General Provisions, A.7, A.9
XVII. Copyrights, Publications, and Patents, C
Attachment No. 1, Section I Scope of Work
Data Entry Requirements
TKIDS Manual:
Referral Details, p 28; Family, p 44; Required Data Fields Table, p 47
Appendix A - TKIDS Data Dictionary —Referral, p 107-110; Referral Detail, p 110-112
O. Contract Requirements
State Regulations
Texas Administrative Code, Title 40, Part 2, Chapter 108, Division for Early Childhood Intervention Services, Subchapter P: Contract Requirements
§108.1601 Definitions
§108.1603 Application and Program Requirements for Early Childhood Intervention Services
§108.1605 Contract Award
§108.1607 Contract
§108.1609 Performance Management
§108.1611 Remedial Contract Actions
§108.1613 Financial Management and Recordkeeping Requirements
§108.1615 Data Collection and Reporting
§108.1617 Local Reporting
Required Forms
- DARS 1309, Notice of Appeal Rights: Word | PDF | Instructions
