State Rates & DSS Information
Below are the state rates and rules for Birth to Three Early Intervention Services (EIS) as of 10/1/17.
Evaluation: $180 per unit where one unit equals one person completing an evaluation regardless of the time required – max 2 units per day and 4 units per child per calendar year*.
Assessment: $120 per hour billable in 15 minute units – max 32 units (increased from 8 units effective 10/1/19) per child per day and per calendar year. Prior Authorization is required for assessments that will be more than 16 units per day.*
IFSP meetings: $120 per hour billable in 15 minute units – max 40 units per child per day and per calendar year*.
EI Treatment Service (EITS) – max 32 units per child per day and Prior Authorization to exceed this is not permitted.
Professional Rates: $120 per hour if only six 15 minute units are billed per practitioner per day. If more than six units are billed per practitioner per day all the units in the day a paid using $96 per hour.
Para professional Rates: $84 per hour if only six 15 minute units are billed per practitioner per day. If more than six units are provided per practitioner per day all the units in the day a paid using $48 per hour.
*NOTE: Prior authorization for exceeding the daily or annual maximums is completed by the Office of Early Childhood. With the exception of the 16 units per child per day for Assessments, Medicaid will never pay for units that exceed the maximums. Prior Authorization requests are completed within the Birth to Three Data System.
General Administrative Payment (GAP): $100 per child for the program with an IFSP on the 1st of the billing month that plans for less than 9 hours of service per month and as long as at least one service was provided during the billing month. GAPs for children that transfer programs are paid to the program with the IFSP on the 1st of the month as long as a service was provided by the sending program before the transfer. Receiving programs will be paid the GAP in the following month, as long as all the requirements for a GAP are in place.
For more details please review the Payment Procedure and the rates posted at the DSS webpage established for Birth to Three.
The State Plan Amendment was approved effective 10/1/17.
The “Special Services – Birth to Three Yrs” Fee Schedule is already online at the following website:
From this web page, go to “Provider”, then to “Provider Fee Schedule Download”.
Click on the “I Accept” button and scroll down to the fee schedule you are interested in viewing:
“Special Services – Birth to Three Yrs”
(procedure reference is listed in red in the left box on document)
Last updated 9/20/2019