Established Conditions EI Colorado Guidance

Current Guidance:

EI Colorado has adopted this definition of Established Condition: “Established condition” for an infant or toddler means a diagnosed physical or mental condition that has a high probability* of resulting in significant delays in development and is listed in the Established Conditions Database.

*high probability=50% or greater delay in development long term

EI Colorado Current Rule:

RULE 8 CCR 1405-1

5.111 CHILD IDENTIFICATION

E. Eligibility Determination Based on an Established Condition

1. There shall be supporting documentation from a qualified health professional maintained in the child’s record for a diagnosed physical or mental condition.

Therefore, the EI Colorado Program determines what is acceptable for the required supporting documentation. There are four (4) pieces of information needed to determine a child eligible under this category.

1. Name of Qualified Health Professional

2. Their Discipline/Credential

3. Hospital/Medical Practice

4. Name of Established Condition

By utilizing the EI Referral form (paper or online) and completing the fields containing the four required pieces of documentation, it is enough to determine a child eligible.

(No additional paperwork needed)

Access links to: The EI Referral form and Qualified Health Professional Definition, and the Established Condition Database.

Additionally, medical paperwork, hospital exit summary forms, or other professional documentation presented that contains the diagnosis, name of qualified health professional, their discipline/credentials, Hospital/Practice name may be accepted as proof of diagnosis.

This paperwork does not have to be submitted to EI Colorado. A Care Navigator (CN) or intake Service Coordinator (SC) may view this paperwork in person, via a telehealth visit, or email to obtain the necessary pieces of information to establish eligibility and enter data for the IFSP.

If all required documentation is included on the EI Referral form, or supporting documentation is verified by the care navigator or intake service coordinator, the requirements for documentation have been met.

It is best practice to check the Established Condition Database each time a referral is received with a medical diagnosis.

Frequently Asked Questions:

Q: What are reasonable expectations of the family on providing the necessary documentation?

A: The family should provide the name of the primary care provider, medical home or clinic that can provide information about the child’s diagnosis.

Q: What if the family does not have a primary care provider or medical home?

A: At a minimum the family should be able to provide the name of a medical professional who has been previously involved in the care of the child referred. If not, the child will proceed on to evaluation.

Q: What if the family does not have specific information about their child’s diagnosis or are not sure of the official terminology?

A: If the intake CN/SC is not able to verify the four pieces of required information, an evaluation will be scheduled. If documentation becomes available, the child will be made eligible and moved forward in the process.

Q: What information does our system need to move forward?

A: Four data elements are required for a child to be eligible based on an established condition. 1) Name of Condition or Diagnosis 2) Hospital/Practice 3) Qualified Health Professional, and 4) Credential. These four data elements are listed on the EI Screening Record. In March 2023 the EI Data System will be updated and these four data elements will be available on the EI Referral Case and Parent Report will be added to the credential drop-down options.

Best practice is to view or obtain supporting paperwork from a medical facility involved with the family. However, if not available right away, this will not hold up the process for the child and verbal statements of required information will be accepted.

Q: It was suggested that a Established Condition Cover Sheet be created and used so that all children passed on to a local program with an established condition may have some documentation from EI Colorado. Is this possible?

A: An ESTABLISHED CONDITION COVER SHEET has been developed that Care Navigators will use when passing on a child with an Established Condition. This form serves as supporting documentation to determine eligibility and shall be maintained in the child’s record. This cover sheet will be used until all information can be easily captured in the Data System for review, and the use of this sheet will be re-evaluated on an ongoing basis.

Q: What is the process if a child is determined eligible based on an established condition, and it is discovered after the fact that the diagnosis was changed/incorrect/not accurate?

A: The child may continue to be enrolled in Early Intervention with an active IFSP. However, minimally, at the Annual IFSP meeting, if the child has no delay’s, and there are no concerns, the child will be exited from the program. This is true for all children enrolled in EI at the annual IFSP meeting. When a child is determined to be functioning at age-expected levels when compared with chronological age, and the IFSP team determines that continuing services is not needed to continue progress, the child will be exited from services.

Q: Who is responsible for obtaining the 4 required pieces of information to determine eligibility based on an established condition? Care Navigators? Or is it handed off to local EI programs?

A: Care Navigators will be responsible for obtaining this information and determining eligibility prior to sending on to the local EI program.