H-0588

AN ACT Relating to early intervention services for infants and toddlers; adding a new chapter to Title 70 RCW; making an appropriation; providing an effective date; and declaring an emergency.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION. Sec. 1. (1) The legislature finds that there is an urgent and substantial need to:

(a) Enhance the development of all infants and toddlers with disabilities or special needs in the state of Washington in order to minimize developmental delay and maximize individual potential for adult independence;

(b) Enhance the capacity of families to meet the needs of their infants and toddlers with disabilities or special needs and maintain family integrity;

(c) Reduce the educational costs per child by minimizing the need for special education and related services after infants and toddlers with disabilities or special needs reach school age;

(d) Reduce social services costs and minimize the likelihood of institutional or out-of-home placement of children with disabilities or special needs;

(e) Reduce the health costs of preventable secondary impairments and disabilities by improving the long-term health of infants and toddlers with disabilities or special needs; and

(f) Reduce the human costs to families and society.

(2) The legislature therefore intends that the policy of this state is to:

(a) Affirm that all children are valued members of society;

(b) Affirm the importance of the family in all areas of the infant's or toddler's development and reinforce the role of the family in the decision-making processes regarding their infant or toddler;

(c) Ensure that services are provided in ways that are as nonintrusive as possible, that respect individual and family privacy, and that support families' access to legal safeguards;

(d) Ensure that services are provided in ways that promote dignity and respect for individual differences and that acknowledge and respect differences in race, religion, ethnic and cultural background, gender, age, disability, sexual orientation, geography, and economic status;

(e) Provide assistance and support to the family of an infant or toddler with a disability or special need that addresses the individual needs of that family;

(f) Coordinate and enhance the state's existing early intervention services to ensure a state-wide, community-based, comprehensive, coordinated, multidisciplinary, interagency program of early intervention services for all infants and toddlers with disabilities or special needs and their families;

(g) Ensure that personnel necessary to provide early intervention services are appropriately and adequately trained and that every effort is made to utilize existing early intervention personnel without replacement;

(h) Facilitate the coordination of payment for early intervention services from federal, state, local, and private sources including public and private insurance coverage; and

(i) Guarantee financial assistance to county lead agencies for the purposes of coordinating early intervention services in their communities and enhance their capacity to provide individualized early intervention services to all infants and toddlers with disabilities or special needs and their families.

NEW SECTION. Sec. 2. Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.

(1) "Infants and toddlers with disabilities" means children from birth through three years of age who need early intervention services because:

(a) Based on standard evaluation procedures, they are experiencing delays in one or more of the following areas of development:

(i) Sensory or physical, including vision, hearing, or fine or gross motor;

(ii) Cognitive;

(iii) Communication;

(iv) Psychosocial;

(v) Self-help skills; or

(b) They have a diagnosed physical or mental condition that has a high probability of resulting in functional delay. Examples of such conditions include, but are not limited to:

(i) Chromosomal abnormalities associated with mental retardation such as down syndrome;

(ii) Congenital central nervous system birth defects or syndromes such as myelomeningocele or fetal alcohol syndrome;

(iii) Established central nervous system deficits resulting from hypoxia, trauma, or infection;

(iv) Significant vision or hearing impairments;

(v) AIDS; or

(vi) Medically fragile.

(2) "Infants and toddlers with special needs" means children from birth to three years of age who have an increased likelihood of experiencing a disability or developmental delay due to biological or environmental factors, or both. Infants or toddlers with special needs and their families will be eligible for the services described in section 6 of this act if:

(a) The infant's or toddler's parents or a qualified professional, or both, express concern regarding the infant's or toddler's development; or

(b) The infant or toddler is experiencing a biological or environmental factor, or both, that substantially increases the probability that the infant's or toddler's development will be delayed in the future. Biological and environmental factors include, but are not limited to the following:

(i) Abnormal neurological finding, e.g. seizures, microcephaly, macrocephaly;

(ii) Asphyxia;

(iii) Central nervous system infection or trauma;

(iv) Major congenital abnormality, e.g. craniofacial anomalies;

(v) Sibling diagnosed with neurological disabilities;

(vi) Documented history of abuse or neglect;

(vii) Evidence of prenatal exposure to drugs;

(viii) Birth weight of less than one thousand five hundred grams or prematurity with less than thirty-three weeks of gestation;

(ix) Severe nutritional deficits, e.g. failure to thrive;

(x) Severe, chronic illness;

(xi) HIV-positive or HIV-positive biological mother;

(xii) Biological mother is less than seventeen years of age;

(xiii) Maternal education is less than the eighth grade level;

(xiv) Family is homeless;

(xv) Parental disabilities due to either documented developmental disabilities, psychiatric disorder, substance abuse, or severe protracted illness, or any combination of these disabilities;

(xvi) Poverty based on family income less than one hundred thirty-three percent of the federal poverty level.

NEW SECTION. Sec. 3. Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.

(1) "Early intervention services" means the developmental services defined in subsection (2) of this section, the tracking and information services defined in subsection (3) of this section, and the early identification services defined in subsection (4) of this section. Early intervention services are:

(a) Provided under public supervision;

(b) Selected by the parents;

(d) Provided by or under the supervision of qualified personnel, including but not limited to:

(i) Early childhood special educators;

(ii) Vision specialists and teachers of the blind;

(iii) Speech-language pathologists and audiologists;

(iv) Occupational therapists;

(v) Physical therapists;

(vi) Psychologists;

(vii) Social workers;

(viii) Nurses;

(ix) Nutritionists;

(x) Physicians;

(xi) Mental health professionals;

(xii) Early childhood specialists; and

(xiii) Family resources coordinators.

(2) "Developmental services" means services that are:

(a) Designed to meet the developmental needs of each infant or toddler with disabilities;

(b) Provided in conformity with an individualized family service plan as described in section 5 of this act;

(c) Offered in the setting or settings most appropriate for the infant or toddler with disabilities and the family in their community;

(d) Provided on a year round basis;

(e) Designed to offer the opportunity, as appropriate, for an infant or toddler with disabilities to interact with children who do not have disabilities when such services are provided out of home;

(f) Consistent with the standards described in section 4 (13) and (14) of this act;

(g) Services that include the following:

(i) Family resources coordination;

(ii) Family support including, but not limited to counseling, peer support, training, and social work;

(iii) Special instruction;

(iv) Speech-language pathology and audiology;

(v) Occupational therapy;

(vi) Physical therapy;

(vii) Psychological services including therapy;

(viii) Medical services for diagnostic or evaluation purposes only;

(ix) Nursing;

(x) Nutrition;

(xi) Health services necessary to enable the infant or toddler with disabilities to benefit from the other early intervention services; and

(xii) Transportation.

(3) "Tracking and information services" means tracking to ensure that the infant or toddler receives periodic early identification services defined in subsection (4) of this section to document the development of the child and information to the parents about child development and parenting.

(4) "Early identification services" means developmental screening and referral.

NEW SECTION. Sec. 4. Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.

(1) "Parent" means the parent, guardian, or a person acting as a parent of a child with disabilities or special needs, or someone who has been appointed as a surrogate. The term does not include the state if the child is a ward of the state.

(2) "Family resources coordination" means an ongoing process consisting of activities to assist the child and family to:

(a) Identify, obtain, and effectively utilize services and other resources; and

(b) Be informed of their rights and procedural safeguards.

(3) "Family resources coordinator" means the person, as agreed upon by the family, who will be responsible for facilitating the development of an individualized family service plan and for providing family resources coordination as defined in subsection (1) of this section.

(4) "Multidisciplinary" means the involvement of two or more disciplines or professions in the provision of integrated and coordinated services including evaluation and assessment activities and development of the individualized family service plan.

(5) "Evaluation" means a timely, comprehensive, multidisciplinary evaluation process for the purpose of determining an infant or toddler's initial and continuing eligibility.

(6) "Assessment" means a comprehensive and multidisciplinary assessment of the unique needs and strengths of the infant and toddler with disabilities for the purpose of developing and updating an individualized family service plan for each infant and toddler. Parents shall be fully participating members of the multidisciplinary assessment team.

(7) "Individualized family service plan" means a written plan jointly developed by the family and service providers for providing collaborative developmental services for eligible infants or toddlers with disabilities and the family as specified in section 5 of this act.

(8) "County" means a county or counties which jointly or severally establish a county early childhood interagency coordinating council.

(9) "Early childhood council" means an early childhood interagency coordinating council that is established within a county or counties in accordance with section 7 of this act.

(10) "County lead agency" means a local public agency that is consistent with and designated by the state lead agency to serve as the fiscal and contracting agent for a county in accordance with section 8 of this act.

(11) "State council" means the state early childhood interagency coordinating council established under section 9 of this act.

(12) "State lead agency" means the state agency designated by the governor to perform the duties defined in section 11 of this act.

(13) "Program standards" means those standards which address the coordination and provision of early intervention services. The standards may include, but are not limited to, personnel qualifications, staff to child ratio, caseload, maximum class size, and length of the program.

(14) "Health and safety standards" means those standards that address the facilities where early intervention services are offered, excluding the infant's or toddler's home. Such standards shall meet all federal, state, and local laws, rules, and regulations pertaining to, but not limited to:

(a) Immunization;

(b) Communicable disease;

(d) Social environment;

(e) Size of facility;

(f) Fire code; and

(g) Accessibility.

NEW SECTION. Sec. 5. (1) Infants and toddlers with disabilities and their families shall be entitled to receive:

(a) An evaluation;

(b) An assessment of the unique needs and strengths of the infant or toddler and the identification of services to meet such needs;

(c) An explanation of the evaluation and assessment and all service options in the family's primary language or through a certified interpreter for the deaf, if necessary;

(d) Family resources coordination;

(e) An individualized family service plan that accommodates cultural differences and is developed by a multidisciplinary team including the family resources coordinator with the parents as fully participating members of the team; and

(f) Any developmental services that are included in the infant's or toddler's individualized family service plan.

(2) The individualized family service plan shall be in the family's primary language, when necessary to ensure understanding, and contain the following:

(a) A statement of the infant's or toddler's present levels of cognitive development, sensory or physical development including vision, hearing, fine and gross motor, communication skills including speech and language, psychosocial development, and self-help skills;

(b) With the concurrence of the family, a statement of the family's strengths and concerns related to enhancing the development of the infant or toddler with disabilities;

(c) A statement of the major outcomes expected to be achieved for the infant or toddler with disabilities and the family, including the criteria, procedures, and timelines used to determine the degree of progress toward achieving the desired outcomes; and whether modifications or revisions of the outcomes or services are necessary;

(d) A statement of specific developmental services necessary to meet the individual needs of the infant or toddler with disabilities and the family, and should include the frequency, intensity, and method of delivering these services;

(e) A statement of the health status and medical needs of the infant or toddler with disabilities, and shall include the names of the child's health care providers;

(f) The projected dates for initiation of services and the anticipated duration of such services;

(g) The name of the family resources coordinator; and

(h) The steps to be taken supporting the transition of the infant or toddler from one setting to another.

(3) The individualized family service plan serves as the comprehensive service plan for all agencies involved in providing developmental services to the infant or toddler with disabilities and the family.

(4) The individualized family service plan must be evaluated at least once a year.

(5) The family resources coordinator and the family shall review the individualized family service plan at six-month intervals or more often based on the needs of the infant or toddler with disabilities and the family.

NEW SECTION. Sec. 6. Infants and toddlers with special needs as defined in section 2(2) of this act and their families are eligible to receive the following services:

(1) Periodic developmental screening to determine whether an evaluation and assessment are needed;

(2) Tracking to ensure that the infant or toddler receives periodic developmental screening and to document the development of the child;

(3) Information about and referral to other services as appropriate; and

(4) Information to the parents about child development and parenting.

NEW SECTION. Sec. 7. Each county shall establish a county early childhood interagency coordinating council to coordinate and enhance existing early intervention services and assist each community to meet the needs of infants and toddlers with disabilities or special needs and their families.

(1) The early childhood coordinating council shall have the following responsibilities:

(a) With the county lead agency, jointly prepare and submit, as defined in section 8(3) of this act, the early intervention plan and the annual report on the status of early intervention services for infants and toddlers with disabilities or special needs and their families within the county;

(b) Advise and assist the county lead agency and recommend policy for administration of the provisions of this chapter at the county level;

(d) Assist in the development of informal community support for eligible families residing within the county;

(e) Promote the development of private financial resources and community volunteer support; and

(f) Advise and assist the state council in determining services needed at the county level.

(2) The early childhood council shall, to the extent possible, reflect the population and cultural diversity of the county. The early childhood council membership shall include, but not be limited to:

(a) At least three parents of children under ten years of age with disabilities or special needs with at least thirty percent of the total council being parents; and

(b) As appropriate to the county, representatives from the following areas:

(i) Health, including public health districts, neuromuscular centers, private therapists, mental health professionals, local medical and health care providers, and hospitals;

(ii) Developmental disabilities, including developmental disabilities centers, county developmental disabilities boards or staff, and regional developmental disabilities staff;

(iii) Education including public school districts or head start early childhood education and assistance programs;

(iv) Social services; and

(v) Other areas that might include elected officials, local personnel preparation programs, Native American tribes, child care providers, business, professional associations, advocacy groups, organizations, or academies.

(3) The early childhood council shall:

(a) Establish and maintain bylaws by which the early childhood council shall conduct its business under this chapter and any other state rules governing public advisory boards, committees, or councils; and

(b) Meet at least six times per year with such meetings publicly announced, and open and accessible to the general public.

(4) No member of the early childhood council shall cast a vote on any matter which would provide direct financial benefit to that member or otherwise give the appearance of a conflict of interest.

NEW SECTION. Sec. 8. The county lead agency, as designated by the state lead agency shall:

(1) Be responsible for ensuring that:

(a) The services defined in sections 5 and 6 of this act are available and accessible for all eligible infants and toddlers and their families residing within the county;

(b) A public awareness program focusing on services for infants and toddlers with disabilities or special needs exists within the county;

(d) There exists a fixed point of referral in each community to facilitate access to early intervention services.

(2) Have general administration and monitoring functions, within the county, associated with this chapter that include:

(a) Administration of funds provided to the county lead agency under section 16 of this act;

(b) Entry into contracts with agencies that are designated by the county lead agency as primary providers of early intervention services to be funded under this chapter within the county;

(c) Entry into formal interagency agreements that define the financial responsibility of each public agency for paying for early intervention services, establish procedures for resolving disputes, and ensure meaningful cooperation and coordination;

(d) Development of procedures to ensure that services are provided to infants and toddlers with disabilities or special needs and their families in a timely manner pending the resolution of any disputes among public agencies or service providers;

(e) Facilitation of agreements between primary providers and other agencies that assure the provision of early intervention services where needed; and

(f) Facilitation of interagency coordination, collaboration, and assistance in the resolution of county interagency disputes.

(3) With the county early childhood council, jointly:

(a) Develop an early intervention plan to be submitted to the state lead agency and the state council on an annual basis. The plan must consider other plans developed within the county that address the needs of infants and toddlers and must incorporate those plans as feasible. The plan shall address:

(i) Ways existing early intervention services might be better coordinated;

(ii) Ways to enhance existing early intervention services to better serve infants and toddlers with disabilities or special needs and their families;

(iii) Types of needed services, both formal and informal, currently not available in the county and how these services might be provided; and

(iv) How early intervention funding made available to the county lead agencies by appropriation will most efficiently provide services to eligible infants and toddlers and their families;

(b) Prepare and submit an annual report to the state council and the state lead agency on the status of early intervention services for infants and toddlers with disabilities or special needs and their families within the county; and

(c) Establish a membership process for the early childhood council that represents the community's concerns and has provisions for the grandfathering of parent and nonparent members of existing councils that approximate the functions of the early childhood council described in section 7 of this act.

NEW SECTION. Sec. 9. The governor shall appoint a state early childhood interagency coordinating council.

(1) The state council shall advise and assist the state lead agency to:

(a) Carry out the duties of the lead agency established in section 11 of this act;

(b) Develop policy for administration of the provisions of this chapter;

(d) Establish a process that seeks information from service providers, family resources coordinators, parents, and others about any federal, state, or local policies that impede timely delivery of early intervention services and provide for steps to ensure that any policy problems identified are resolved;

(e) Resolve disputes between agencies;

(f) Identify sources of fiscal and other support for services under this chapter;

(g) Assign financial responsibility to the appropriate public agency; and

(h) Promote interagency agreements.

(2) The state council shall work with all state agencies providing or paying for early intervention services to assist in the development and adoption of:

(a) Uniform sets of administrative codes dealing with early intervention services;

(b) A system to provide reasonable transition between programs;

(d) Personnel standards for certification and training.

(3) In carrying out the duties assigned to the state council, the state council shall:

(a) Establish and maintain bylaws by which the state council shall conduct its business in accordance with this chapter and existing administrative code;

(b) Meet at least four times per year at the call of the chair or by request of one-third of the state council. Such meetings shall be publicly announced, and open and accessible to the general public;

(d) Convene a meeting of early childhood council chairs at least twice per year;

(e) Prepare and submit an annual report to the governor and state lead agency on the status of early intervention services for infants and toddlers with disabilities or special needs and their families within the state; and

(f) Have the ability to hire staff and obtain the services of such professional, technical, and clerical personnel as may be necessary to carry out the functions of the state council.

NEW SECTION. Sec. 10. (1) In making appointments to the state council, the governor shall ensure that the membership of the state council reasonably represents the population and cultural diversity of the state. The state council shall have no more than fifteen members and consist of:

(a) At least four parents of children with disabilities or special needs less than six years of age at the time of the parent's appointment;

(b) At least three public or private providers of early intervention services with at least one representative from each sector;

(d) One person involved in personnel preparation; and

(e) Other members representing each of the appropriate state agencies involved in the provision of, or payment for, early intervention services to infants and toddlers with disabilities or special needs and their families.

(2) No member of the state council shall cast a vote on any matter which would provide direct financial benefit to that member or otherwise give the appearance of a conflict of interest under state law.

NEW SECTION. Sec. 11. The state lead agency, as designated by the governor, shall:

(1) Ensure that a state-wide system of early intervention services is developed and maintained. The system shall include:

(a) The services defined in sections 5 and 6 of this act;

(b) A comprehensive early identification and referral system;

(c) A public awareness program focusing on early identification of infants and toddlers with disabilities or special needs; and

(d) A central directory that includes early intervention services, resources and experts within the field available in the state, and early intervention research and demonstration projects being conducted in the state;

(2) Be responsible for the general administration of a state-wide system of early intervention services including:

(a) Writing of all policy, procedures, and administrative code, in conjunction with and with the approval of the state council, that are necessary for implementation of this chapter;

(b) Administration of funds provided under section 17 of this act;

(c) Supervision and monitoring of agencies, programs, and activities that receive assistance under this chapter to ensure compliance with the provisions of this chapter;

(d) Identification and coordination of all available sources of financial and other support for early intervention services within the state from federal, state, local, and private sources;

(e) Entry into formal interagency agreements that define the service delivery and financial responsibilities of each public agency providing or paying for early intervention services. Such interagency agreements must include procedures for resolving disputes and all additional components necessary to ensure meaningful cooperation and coordination;

(f) Entry into contracts with county lead agencies;

(g) Development of procedures to ensure that services are provided to infants and toddlers with disabilities or special needs and their families in a timely manner pending the resolution of any disputes among public agencies or service providers;

(h) Implementation of procedural safeguards as specified in section 12 of this act;

(i) Establishment of standards and a comprehensive system of personnel development that ensures that personnel necessary to carry out this chapter are appropriately and adequately trained;

(j) Establishment and maintenance of personnel standards that are consistent with state-approved or recognized certification, licensing, registration, or other comparable requirements;

(k) Development, maintenance, evaluation, and revision of program standards and health and safety standards; and

(l) Compiling data on the number of infants and toddlers with disabilities or special needs and their families in the state in need of early intervention services, the number of such infants and toddlers and their families served, the types of services provided, and other information as may be required.

NEW SECTION. Sec. 12. The state lead agency shall establish procedural safeguards for infants and toddlers and their families to be included in the state-wide system of early intervention services that, at a minimum, include the following:

(1) The timely administrative resolution of individual complaints;

(2) The effective implementation of the safeguards by each public agency involved in the provision of early intervention services under this chapter;

(3) A mediation system to guide both parties toward a mutually satisfactory solution of disputes. Neither party shall be obligated to resolve the dispute with this process. The mediation service shall be:

(a) A voluntary process until July 1, 1995, at which time if the parents request mediation, a local service provider shall enter into mediation;

(b) Provided by properly trained and certified mediators;

(d) Selected by the early childhood coordinating council in each county;

(4) The right to initiate a hearing for the resolution of disputes;

(5) Confidentiality of information that may identify the parties involved;

(6) The opportunity for parents to examine and receive a copy of records relating to screening, evaluation, assessment, and the development and implementation of the individualized family service plan;

(7) Procedures to protect the rights of the infants or toddlers with disabilities or special needs whenever the parents of the child are not known, or unavailable, or the child is a ward of the state, including the assignment of an individual, who shall not be an employee of any state agency providing services, to act as a surrogate for the parents;

(8) Written prior notice to the parents of the infant or toddler whenever the state agency or service provider proposes to initiate or change, or refuses to initiate or change, the identification, evaluation, placement, or the provision of early intervention services to the infant or toddler with disabilities or special needs;

(9) The notice required by subsection (8) of this section shall fully inform the parents in the parents' primary language, or by use of a certified interpreter for the deaf, of all procedures available pursuant to this section; and

(10) During the pendency of any proceeding or action involving a hearing, unless the agency and the parents otherwise agree, the child shall continue to receive the early intervention services currently being provided or if applying for initial services shall receive the services even if such services are in dispute.

NEW SECTION. Sec. 13. The state lead agency shall establish procedures for the resolution of complaints about the system including receiving and resolving any complaint that one or more requirements of this chapter are not being met.

NEW SECTION. Sec. 14. For the purposes of implementing this chapter, the governor shall:

(1) Ensure that state agencies involved in the provision of, or payment for, early intervention services to infants and toddlers with disabilities or special needs and their families shall coordinate and collaborate in the planning and delivery of such services;

(2) With the recommendation of the state council, designate the state lead agency specified in section 11 of this act to administer the provisions of this chapter and to ensure the state lead agency establish and maintain a state-wide system of coordinated, comprehensive, multidisciplinary, interagency programs providing early intervention services to all infants and toddlers with disabilities or special needs and their families;

(3) Appoint the members of the state council; and

(4) Appoint a chair of the state council based on the recommendations from the state council.

NEW SECTION. Sec. 15. No state or local agency currently providing early intervention services to infants and toddlers with disabilities or special needs may use funds appropriated for the purposes of this chapter to supplant funds from other sources. No state or local agency may delay, interrupt, or divert funds appropriated in the 1991-93 biennium for early intervention programs for infants and toddlers with disabilities or special needs from those programs.

Each county shall ensure that the implementation of this chapter will not cause any interruption in existing early intervention services for infants and toddlers with disabilities or special needs.

Nothing in this chapter shall be construed to permit the restriction or reduction of eligibility under Title V of the Social Security Act, P.L. 90-248, relating to maternal and child health or Title XIX of the Social Security Act, P.L. 89-97, relating to medicaid for infants and toddlers with disabilities or special needs.

NEW SECTION. Sec. 16. The state lead agency shall, in accordance with this chapter, enter into contracts with the county lead agencies to assist in the provision of comprehensive, coordinated, multidisciplinary, interagency early intervention services for infants and toddlers with disabilities or special needs and their families within the county. The county early intervention plans described in section 8(3) of this act shall be used to assist the state lead agency in determining what funding should be provided to the counties to address gaps in early intervention services. Funds made available under this chapter shall be disbursed in a manner that enables the optimum provision of necessary services for eligible infants and toddlers and their family.

NEW SECTION. Sec. 17. The sum of thirteen million one hundred eighteen thousand seven hundred fifty dollars, or as much thereof as may be necessary, is appropriated for the biennium ending June 30, 1993, from the general fund to the state agency designated as the state lead agency by the governor for the purposes of this act.

NEW SECTION. Sec. 18. Sections 1 through 16 of this act shall constitute a new chapter in Title 70 RCW.

NEW SECTION. Sec. 19. This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and shall take effect July 1, 1991.