Early Intervention Training Program at the University of Illinois

The purpose of this page is to provide a comprehensive list of all the forms and resources referenced in the Understanding Illinois' Systems of Payments training module.  Please remember that policies and procedures for how and when to use each of these forms can be found in the CFC Procedure Manual (FY17).

• Forms
• Resource Modules
• Resources
  
  • Private Health Insurance Resources
  • Public Health Insurance Resources
  • Family Participation Fee Resources
  • Insurance/Fee Resources

Forms

The following forms are referenced in order of appearance in the training module.  Many forms can be found on the IDHS CFC Forms webpage.

• Notice of System of Payments and Fees (pdf)- Spanish (pdf)
• Acknowledgment of Receipt of Notices (pdf)- Spanish (pdf)
• CFC Fax Cover Sheet for Insurance Benefit Verification Requests/Updates (pdf)
• Tax Savings Account Information Sheet (pdf) - Spanish (pdf)
• Acknowledgment to Decline Exemption For Tax Savings Account (pdf) - Spanish (pdf)
• Pre-Billing Insurance Waiver Request (pdf)
• Consent to Use Private Insurance/Healthcare Plan Benefits and Assignment of Rights (pdf) - Spanish (pdf)
• Consent to Use Private Insurance/Healthcare Plan Benefits and Assignment of Rights for Specific Services (pdf) - Spanish (pdf)
• *updated* Screening Device for Determining Family Fees and Eligibility for All Kids and DSCC- English (pdf) - Spanish (pdf)
• Notice to Use Public Benefits-All Kids Enrolled or Potentially Eligible for All Kids (pdf) - Spanish (pdf)
• Consent To Use Personally Identifiable Information (PII) & Bill Public Benefits (pdf) - Spanish (pdf)
• Family Participation Fees Payment Agreement (pdf) - Spanish (pdf)
• Family Participation Fee Exemption Request (pdf) - Spanish (pdf)
• *updated* FY19 Family Participation Fees Program Fact Sheet (pdf) - Spanish (pdf)
• *updated* FY19 Family Fee Calculation (pdf) 

Resource Modules

Illinois System of Payment Resource Modules

These modules are available as a resource for those interested in learning more about the Systems of Payment related to early intervention services in Illinois. These modules are also a part of the "Service Coordination Online"  training sponsored by the Early Intervention Training Program.  

Resources

Private Health Insurance Resources

• 10 Considerations When Families in EI Have Employer Self-Funded Insurance Plans (pdf): A guide for the discussions service coordinators have with families when they have employer self-funded health insurance.  Revised April 2016

• Understanding Your Medical Insurance (pdf):  A handout service coordinators may want to share with families so they can better understand their medical benefits.

Public Health Insurance Resources

• 10 Reasons to Consider Applying for AllKids when Potentially Eligible (pdf): A guide for the discussions service coordinators have with families who are potentially eligible for AllKids.
• Five Reasons to Use Public Insurance for Early Intervention (pdf): A guide for the discussion service coordinators have with families who enter early intervention with public health insurance.
• AllKids (Website): Where you will find more information on the All Kids program customers including the AllKids application for those who have not already enrolled.
• AllKids (EITP Resource Page): Where you will find resources as they relate to Healthcare for All Kids including a link to the All Kids website, an All Kids presentation, and All Kids training information.
• EI & the Medical Home (EITP Resource Page): Where you will find a variety of resources related to coordinating care between early intervention and the primary care medical home.  Care Coordination and analysis is one of the benefits of disclosing personally identifiable information between EI and the program that administers AllKids.

Family Participation Fee Resources

• Family Fees (EITP Resource Page): Where you will find a variety of resources related to family fees in the Illinois Early Intervention System. Resources include policies and procedures for family fees, a questions and answers document, and a sample fee invoice.
• Family Rights (EITP Resource Page): Where you will find information as it relates to the family's role in early intervention and rights in both early intervention and special education. The Family Rights Handbook is also available for download on this resource page.

Insurance/Fee Resources

• Paying for EI Services Information Sheet: (click here for Spanish version) A resource developed by the Illinois Early Intervention Clearinghouse to assist families with some of their frequently asked questions around they payment for services. 
• Insurance & Family Fee in Early Intervention (pdf): A resource developed by a service coordinator to help highlight the benefits of participating in early intervention even when private insurance is utilized and when there is a family participation fee.
• What to do when... (pdf): A guide to help service coordinators think about things to consider with a variety of scenarios they might encounter with families as they review the use of insurance and the family participation fee with them.  Revised April 2016
• Insurance and Form Use Flowchart (pdf) This flowchart helps determine what questions to ask and what forms to complete regarding family fees and insurance.  Revised April 2016
  
• Insurance Decision Tree (pdf) This flowchart helps outline what forms to use, rules to follow, and permissions to obtain when working with families with insurance.