Provider Alert! Reminder: Federal Entitlement to Medicaid and Early Childhood Intervention (ECI) Services

Date: July 12, 2022

Attention: All Providers

Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.

Call to action: The purpose of this communication is to remind providers of the Medicaid beneficiary rights regarding access to similar services from more than one provider type. This includes Early Childhood Intervention (ECI) contracted providers.

Background:

Early Childhood Intervention (ECI) is a statewide program for children, birth to age three, with disabilities and developmental delays. To be eligible for ECI and receive ECI services from an ECI contractor, a child must have a medically diagnosed condition that has a high probability of resulting in developmental delay, an auditory or visual impairment, or a developmental delay.

Resources:

Early Childhood Intervention Services Overview
https://www.hhs.texas.gov/services/disability/early-childhood-intervention-services

ECI Information for Health & Medical Professionals
https://www.hhs.texas.gov/services/disability/early-childhood-intervention-services/eci-information-health-medical-professionals

Explanation of federal entitlement and ECI services:

• Access to medically necessary services is a federal entitlement under both Title XIX of the Social Security Act (Medicaid) and Part C of the Individuals with Disabilities Education Act (IDEA).
• Eligible children are entitled to receive Medicaid medically necessary services from IDEA Part C Early Childhood Intervention (ECI) contractors and other Medicaid service providers.
• Independent practitioners, home health agencies, rehabilitation clinics, and ECI contractors may provide complementary Medicaid-funded services to the same child.
  • Access to services from ECI contractors cannot create a barrier and does not preclude members’ access to complementary Medicaid funded services typically provided by home health agencies and rehabilitation clinics.
  • Therefore, members may receive medically necessary Medicaid services in addition to ECI services.

Next steps for providers: Providers should refer eligible families to the ECI program if they have identified a developmental issue or medical diagnoses that is likely to result in a development delay. Referrals can be initiated by the family or the provider by completing the form available at https://www.hhs.texas.gov/sites/default/files/documents/services/disability/eci/eci-referral-form-icd-10.pdf.

Independent practitioners, home health agencies, and rehabilitation clinics should provide authorized medically necessary services regardless of members’ participation with services provided by an ECI program.

If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.

For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.