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The document outlines the process for justifying changes in the frequency, intensity, or method of services provided under the NYC Early Intervention Program. It includes sections for documenting the child's information, service history, family involvement, coordination with other team members, and specific justifications for requested changes. The form requires detailed responses to ensure completeness and facilitate appropriate adjustments to the child's Individualized Family Service Plan (IFSP).

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Click ‘Get Form’ to open it in the editor.
Begin by entering the Child’s EI ID Number and DOB. Ensure accuracy as this information is crucial for identification.
Fill in the Child’s Name, Provider’s Name, Discipline, and Therapist Phone Number. This section establishes who is providing services.
Complete the Agency Name and Supervisor details. These fields are essential for accountability and communication.
In the Authorization Information section, provide dates for IFSP Start and End, along with authorized service details. Be precise to avoid delays.
Address the Request for Change section by indicating any changes in service frequency or duration. Clearly state what you are requesting.
Respond to each Required Justification Component thoroughly. Number your responses as indicated to ensure clarity and completeness.

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How is early intervention funded in NYS?

Your county EIP or the New York City EIP will help you get services if your child is found to be eligible. Health insurance, including private insurance and Medicaid, may be used to pay for early intervention services. EIP services must be provided at no cost to you and will not affect your insurance coverage.

What diagnoses would qualify a child for early intervention?

have a developmental delay of at least 25% in one or more areas of cognitive, receptive language, expressive language, social or emotional, adaptive, or physical and motor development including vision and hearing; or.

What are the disadvantages of early intervention?

Drawbacks of early intervention therapy include: Limited services: Early intervention therapy may not provide all the services a child needs, particularly if they have complex needs. This means that families may need to supplement early intervention therapy with private therapy.

How do I start early intervention in NYC?

Get Started by Making a Referral Calling 311 and asking for Early Intervention. Completing the Early Intervention Program Referral Form (Fillable PDF) and faxing it to the Citywide Early Intervention Referral Unit.

Is early intervention free in NYC?

Early Intervention is a free program that provides services to children birth to age three who have developmental delays or disabilities. In New York City the program is run by the Department of Health and Mental Hygiene.

nyc early intervention referral form

NYC Early Intervention Policy and Procedure Manual Early Intervention NYC rates Nassau County Early Intervention forms Early Intervention ages 3-5 NYC Early Intervention Referral form NYS Early Intervention Provider application Early Intervention NYC phone number EI Policy and Procedure Manual

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How much does early intervention pay in NY?

The estimated total pay for a Early Intervention Specialist is $71,060 per year in the New York City Ny area, with an average salary of $67,014 per year. These numbers represent the median, which is the midpoint of the ranges from our proprietary Total Pay Estimate model and based on salaries collected from our users.

How are early intervention services paid for?

Covered by your health insurance, Medicaid, or Indian Health Services. Some insurers will cover early intervention services, and some will not. In most cases, you must give your written consent before anyone involved with early intervention can access your private or public health insurance for payment.

Nyc early intervention forms 2025

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