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

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 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 special needs of their infants and toddlers with disabilities;

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

(d) Reduce social services costs and minimize the likelihood of institutionalization of individuals with disabilities; and

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

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

(a) Reaffirm the importance of the family in all areas of the child's development and reinforce the role of the family in the decision-making processes regarding their child;

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

(c) Develop and implement a state-wide, comprehensive, coordinated, multidisciplinary, interagency program of early intervention services for all infants and toddlers with disabilities and their families;

(d) Enhance the capacity to provide quality early intervention services and expand and improve existing early intervention services being provided to infants and toddlers with disabilities;

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

(f) Guarantee financial assistance to local communities for the purposes of coordinating early intervention services in local communities and enhance their capacity to provide individualized early intervention services to all infants and toddlers with disabilities 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 two years of age who need early intervention services because:

(a) They are experiencing developmental delays, as measured by diagnostic instruments and procedures, as referenced in the Washington Administrative Code, in one or more of the following areas:

(i) Physical development;

(ii) Cognitive development;

(iii) Communication, language, and speech development;

(iv) Psychosocial development;

(v) Self-help skills;

(vi) Sensory functions; or

(b) They are at risk of experiencing substantial developmental delay if early intervention services are not provided due to:

(i) Established risk factors, which refer to diagnosed disorders where the condition is known to ultimately affect development or result in a disability such as Down's syndrome;

(ii) Biological risk factors, which refer to prenatal, perinatal, and postnatal events and genetic predispositions which increase the probability of delayed development or result in a disability, factors such as low birth weight, prematurity, and abnormal neurological findings; or

(iii) Environmental risk factors, which refer to high-risk environmental influences that may affect development or result in a disability, factors such as an adolescent parent, poverty, psychiatric stress, or known history of child abuse or neglect.

(2) "Early intervention services" are developmental services which:

(a) Are provided under public supervision;

(b) Are designed to meet the developmental needs of an infant or toddler with or at risk of a substantial developmental delay in any one or more of the areas listed in subsection (1)(a) of this section;

(d) When provided out of home, and as appropriate, offer the opportunity for infants and toddlers with and without disabilities to interact and the opportunity for their families to interact;

(e) Meet the standards of the state, as established by the interagency coordinating council and described in subsections (10) and (11) of this section;

(f) Include, but are not limited to, the following services:

(i) Family support such as family counseling, peer support, and respite care;

(ii) Special instruction;

(iii) Speech pathology and audiology;

(iv) Occupational therapy;

(v) Physical therapy;

(vi) Psychological services, including mental health;

(vii) Case management;

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

(ix) Early identification, screening, and assessments; and

(x) Health services necessary to enable the infant or toddler to benefit from the other early intervention services;

(g) Are provided by qualified personnel, including but not limited to:

(i) Special educators including teachers of the blind and vision specialists;

(ii) Speech and language pathologists and audiologists;

(iii) Occupational therapists;

(iv) Physical therapists;

(v) Psychologists;

(vi) Social workers;

(vii) Nurses;

(viii) Nutritionists;

(ix) Physicians;

(x) Mental health professionals;

(xi) Early childhood specialists; and

(h) Are provided in conformity with an individualized family service plan as described in section 7 of this act.

(3) "Council" means the state interagency coordinating council established under section 4 of this act.

(4) "Lead agency" means the state agency designated by the governor to perform the duties defined in section 5 of this act.

(5) "Local community" means a county either jointly, severally, or a portion thereof, which desires to form a local council.

(6) "Local council" means an interagency coordinating council established within a local community by a county governing authority for the purposes of coordinating early intervention services to infants and toddlers with disabilities and their families who reside within that community, as described in section 6 of this act.

(7) "Local lead agency" means the agency, whether a state agency, local agency, or service contractor which is designated by the local interagency coordinating council to serve as the fiscal and contracting agent within a local community.

(8) "Multidisciplinary team" means a group comprised of the parents or legal guardian and the service providers, as appropriate, described in subsection (2)(f) of this section, who are assembled for the purposes of:

(a) Assessing the developmental needs of an infant or toddler;

(b) Developing the individual family service plan; and

(c) Providing the infant or toddler and the family with the appropriate early intervention services, as detailed in the individualized family service plan.

(9) "Individualized family service plan" means a written plan designed to address the needs of the infant or toddler with disabilities and the family as specified in section 7 of this act.

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

(11) "Health and safety standards" means those standards which address the facilities where early intervention services are offered, excluding the child's home. Such standards include, but are not limited to, the size of a facility, communicable disease, social environment, nutrition, immunization, and fire codes.

NEW SECTION. Sec. 3. For the purposes of implementing this chapter, the governor shall have the following responsibilities:

(1) To appoint the members and the chair of a state interagency coordinating council. The term of appointment shall not exceed three years. No member shall serve more than two consecutive terms. No member shall serve more than one term as chair of the council. In making appointments to the council, the governor shall ensure that the membership of the council reasonably represents the population of the state. The council shall have an administrative board consisting of:

(a) At least three parents of children less than ten years of age with disabilities;

(b) At least three public or private providers of early intervention services, with at least one of these representatives being a private provider;

(d) At least one person involved in personnel preparation;

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

(f) Others selected by the governor, not exceeding a total administrative board membership of fifteen;

(2) To designate a lead agency as specified in section 5 of this act;

(3) To ensure that the secretary of social and health services, the secretary of health, the director of the department of community development, and the director of the department of services for the blind, with the assistance of the superintendent of public instruction, jointly develop and maintain a state-wide system of coordinated, comprehensive, multidisciplinary, interagency programs providing early intervention services to all infants and toddlers with disabilities and their families by 1991. Such system shall include the following minimum components:

(a) A timely, comprehensive, multidisciplinary evaluation of the functioning of each infant and toddler with disabilities and the needs and strengths of the families;

(b) An individualized family service plan for each infant and toddler with disabilities;

(c) A comprehensive child find system, including a system, for making referrals to service providers that includes timelines and provides for the participation by primary referral sources;

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

(e) A system for compiling data on the number of infants and toddlers with disabilities 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.

Each of the agencies listed in subsection (3) of this section shall participate as permanent members of the interagency coordinating council and shall ensure, for purposes of this chapter, that:

(i) Uniform sets of administrative codes dealing with early intervention services are adopted by each agency;

(ii) There is reasonable transition between systems;

(iii) Funds made available under this chapter shall be shared by all participating agencies in a manner that enables the optimum provision of necessary services for the child and the family;

(4) There are uniform program and health and safety standards; and

(5) Program policies dealing with infants and toddlers with disabilities and their families reflect the policy priorities of the council.

NEW SECTION. Sec. 4. A state interagency coordinating council shall be established in the manner described in section 3(3)(e) of this act.

(1) The council shall have the following authority, duties, and responsibilities:

(a) To oversee the duties of the lead agency, as set forth in section 5 of this act, and the responsibilities of the secretary of social and health services, the superintendent of public instruction, the secretary of health, the director of the department of community development, and the director of the department of services for the blind, as set forth in section 3 of this act;

(b) To be the policy-making body for administration of the provisions of this chapter;

(c) To meet at least four times per year at the call of the chair or by request of one-third of the administrative board; and such meetings shall be publicly announced, and open and accessible to the general public;

(d) To hire staff and obtain the services of such professional, technical, and clerical personnel as may be necessary to carry out its functions.

(2) Other functions of the council shall be as follows:

(a) To establish bylaws by which the council will conduct its business in accordance with this chapter and existing administrative code;

(b) To assure adherence to implementation timelines for a state-wide comprehensive, coordinated, interagency system of early intervention services;

(c) To prepare and submit an annual report to the governor on the status of early intervention programs for infants and toddlers with disabilities and their families operated within the state;

(d) To develop a public awareness program focusing on early identification of infants and toddlers with disabilities;

(e) To resolve intraagency and interagency disputes;

(f) To establish personnel standards which are consistent with state-approved or recognized certification, licensing, registration, or other comparable requirements that apply to the area in which early intervention services are provided;

(g) To develop a comprehensive system of personnel recruitment, preparation, and staff development;

(h) To ensure the development, maintenance, evaluation, and revision of program standards;

(i) To ensure the development, maintenance, evaluation, and revision of health and safety standards;

(j) To monitor the activities of the lead agency and other agencies providing early intervention services within the state; and

(k) To develop and conduct models for detecting infants and toddlers with disabilities or who are at risk of experiencing disabilities or substantial developmental delays.

(3) No member of the 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. 5. The governor shall designate a lead agency which will have the following responsibilities:

(1) The administration of funds under section 10 of this act;

(2) The identification and coordination of all available financial resources within the state from federal, state, local, and private sources;

(3) The entry into formal interagency agreements that define the financial responsibility of each agency to pay for early intervention services and procedures for resolving disputes and includes all additional components necessary to ensure meaningful cooperation and coordination;

(4) The entry into contracts with agencies within a local community which have been designated by the local interagency coordinating council as the lead agency within the community;

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

(6) The writing of all necessary policy statements, procedures, and administrative code provisions in conjunction with and with the approval of the council; and

(7) Such other duties as may be assigned by the council.

NEW SECTION. Sec. 6. Each county governing authority shall appoint a local interagency coordinating council to plan and coordinate services for infants and toddlers with disabilities and their families and to provide directly or indirectly such services to infants and toddlers and their families who reside within the county or counties served by the local council. The governing authorities of more than one county by joint action may appoint a single local interagency coordinating council.

(1) In making appointments to the local council, the county governing authority shall include, without limitation, representatives from the following areas, if appropriate to the local community:

(a) Parents of children under ten years of age with disabilities. The local council shall contain at least three parents, or at least thirty percent of the total council shall be parents;

(b) The public health districts;

(d) Local developmental disabilities providers;

(e) Local governing bodies;

(f) County developmental disabilities coordinators;

(g) Regional developmental disabilities staff;

(h) A local personnel preparation program;

(i) Head start/early childhood education and assistance programs;

(j) Local medical providers;

(k) Hospitals;

(l) Private therapists;

(m) Child care providers; and

(n) The mental health profession.

(2) The local interagency coordinating council shall have the following authority:

(a) To be the policy-making body for administration of the provisions of this chapter at the community level;

(b) To determine the array of services needed in the community providing that:

(i) There is no diminishment of existing services including a twelve-month service year; and

(ii) Qualified personnel in one service system are not replaced by less-qualified personnel in another system;

(d) To designate one local agency or service provider as the lead agency at the community level;

(e) To designate which agency or agencies will be the primary providers of early intervention services in the community;

(f) To facilitate agreements between primary providers and other agencies that assure the provision of needed services;

(g) To resolve local level intraagency and interagency disputes;

(h) To monitor the activities of the local lead agency and any other agencies providing early intervention services within the community.

(3) In addition to the above-mentioned authority and duties, the local council shall have the following responsibilities:

(a) To develop a local public awareness program focusing on services for infants and toddlers with disabilities;

(b) To conduct child find efforts within the local community, in coordination with state-wide efforts;

(c) To establish fixed points of referral for the community that assures a timely evaluation and placement of an eligible child in one or more components of the early intervention program;

(d) To offer opportunities for disabled infants and toddlers and nondisabled infants and toddlers to interact; also to offer opportunities for their families to interact;

(e) To establish bylaws by which the local council will conduct its business in accordance with this chapter and any existing rules or regulations;

(f) To meet at least six times per year, publicly announce such meetings, and make such meetings open and accessible to the general public; and

(g) To prepare and submit an annual report to the state interagency coordinating council on the status of early intervention programs for infants and toddlers with disabilities and their families operated within the community.

(4) No member of the local 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. 7. (1) Infants and toddlers with disabilities and their families shall receive the following:

(a) A comprehensive multidisciplinary assessment of the needs of the infant or toddler and the needs and strengths of the family, and the identification of services to meet such needs, within a reasonable time following the initial referral;

(b) An explanation of the assessment and all service options in the family's native language or through an interpreter for the deaf, if necessary, accommodating cultural differences; and

(c) A written individualized family service plan developed by a multidisciplinary team of which the parents are fully participating members; and

(2) The individualized family service plan shall be developed within a reasonable time following the completed assessment required by subsection (1)(a) of this section.

(3) The individualized family service plan shall be in writing and in the family's native language when appropriate and necessary to ensure understanding and accommodate cultural differences, and shall contain the following:

(a) A statement of the infant's or toddler's present levels of physical development, cognitive development, communication skills, language and speech development, psychosocial development, any sensory impairment, and self-help skills based on objective criteria;

(b) A statement of the family's strengths and needs related to enhancing the development of the infant or toddler with disabilities based on objective and observable criteria;

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

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

(e) A statement of the health status, and medical needs of the infant or toddler and family to support the development of the child, and the names of the health care providers;

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

(g) The name of the case manager who will be responsible for the implementation of the plan and coordination with other agencies and persons; and

(h) The steps to be taken supporting the transition of the infant or toddler to other services.

(4) The individualized family service plan shall serve as the singular comprehensive service plan for all agencies involved in providing early intervention service to the infant or toddler and the family.

(5) The individualized family service plan shall be evaluated once a year. A review of the plan shall occur at three-month intervals for children up to age eighteen months, and at six-month intervals thereafter, or more often based on the needs of the infant or toddler and the family.

NEW SECTION. Sec. 8. The procedural safeguards to be included in the state-wide system shall provide, at a minimum, the following:

(1) The timely administrative resolution of complaints by parents;

(2) The right to confidentiality of personally identifiable information;

(3) The opportunity for the parents or guardian to examine and receive a copy of records relating to assessment, screening eligibility determinations, and the development and implementation of the individualized family service plan;

(4) Procedures to protect the rights of the infant or toddlers with disabilities whenever the parents or guardian 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 the state agency providing early intervention services, to act as a surrogate for the parents or guardian;

(5) Written prior notice to the parents or guardian 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;

(6) Procedures designed to assure that the notice required by subsection (5) of this section fully informs the parents or guardian, in the parents' or guardian's native language or by use of an interpreter for the deaf, unless it clearly is not necessary to do so, of all procedures available pursuant to this section;

(7) During the pendency of any proceeding or action involving a complaint, unless the agency and the parents or guardian 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;

(8) Any dispute not satisfactorily resolved by the local lead agency can be brought before the local interagency coordinating council, or its designee; and

(9) If the dispute cannot be adequately resolved by the local interagency coordinating council, it can be brought before the state interagency coordinating council's administrative board, or its designee.

NEW SECTION. Sec. 9. The use of early intervention funds provided under this chapter to supplant funds from other sources is not permitted. All local and state programs for infants and toddlers with disabilities shall, at a minimum, maintain the public funding which supported infant and toddler programs at levels as of July 1, 1988.

Nothing in this section shall be construed to permit:

(1) The reduction of local, state, medical, or other assistance available;

(2) The alteration of eligibility under Title V of the social security act, relating to maternal and child health;

(3) The alteration of eligibility under Title XIX of the social security act, relating to medicaid for infant and toddlers with disabilities;

(4) The reduction of early intervention services provided by the office of the superintendent of public instruction, the department of social and health services, the department of community development, or the department of services for the blind.

The council shall, in accordance with this chapter, make grants to local councils to assist the local communities, adhering to this chapter, to provide comprehensive, coordinated, multidisciplinary, interagency, early interventions services for infants and toddlers with disabilities and their families.

NEW SECTION. Sec. 10. The sum of six million five hundred sixty-three thousand dollars, or as much thereof as may be necessary, is appropriated for the biennium ending June 30, 1991, from the general fund to the agency designated as the lead agency by the governor for the purpose of planning and implementing a state-wide system of coordinated, comprehensive, multidisciplinary, interagency programs which provide early intervention services, and for the purpose of delivering needed services to unserved and underserved infants and toddlers with disabilities and their families.

NEW SECTION. Sec. 11. Sections 1 through 9 of this act shall constitute a new chapter in Title 70 RCW.

NEW SECTION. Sec. 12. This act shall take effect July 1, 1990.