Early Start Program

Health Net assists primary care physicians (PCPs) and families with referrals of identified children under age three who may be eligible to receive services from the Department of Developmental Services (DDS) Early Start program. Assistance may include contacting the local Regional Center administrative staff or the local Early Start Program by telephone or letter, or following up with the family, PCP or regional center to ensure the referral is complete and services are accessed.

Once the referral has been made, the PCP:

• Provides medically necessary covered diagnostic, preventive and treatment services identified in the individual family plan developed by the Early Start program.
• Consult and provide appropriate reports to the Early Start program intervention team
• Continues case management with assistance from the Health Net Medi-Cal Health Services Department when necessary

Primary care physicians (PCPs) need to identify infants and toddlers (from birth to 36 months) who may benefit from services provided by the Department of Developmental Services (DDS) Early Start rogram. These children may have the following risk conditions:

• Significant developmental delay in one or more of these areas:
  • Cognitive
  • Physical and motor
  • Communication
  • Emotional and social
  • Adaptive
• Established risk conditions expected to result in developmental delay, including:
  • Chromosomal disorders
  • Inborn errors of metabolism
  • Neurological disorders
  • Visual or hearing impairments
  • Family history of developmental delay

  When determining the need to make a referral to the DDS Early Start program for intervention services, consider:

• Stability of the infant's or toddler's medical condition
• Readiness of the infant and family to benefit from services
• Need for additional assessments to document developmental delay or disability

Primary care physicians (PCPs) identify infants and toddlers (from birth to 36 months) who are at risk or suspected of having a developmental disability or delay through health screenings and assessments, including:

• Initial comprehensive physical evaluation for congenital abnormalities and/or treatable medical conditions.
• Developmental screening using CHDP/EPSDT and/or American Academy of Pediatrics standards. PCP also arranges for the provision of medically necessary Behavioral Health Treatment (BHT) services even without a diagnosis of Autism Spectrum Disorder (ASD). Managed Health Network (MHN Inc.) provides the BHT services.
• Diagnosis and, if possible, etiology

PCPs are responsible for referring infants and toddlers identified as needing early intervention services to the local DDS Early Start program (administered by either the local Regional Center, education agency, or other designated agency) within two business days of determination of need. PCPs provide or arrange for all medically necessary covered services, including preventive care, referral for specialty or subspecialty consultation, and therapy services necessary to correct or ameliorate identified conditions.

Eligible infants and toddlers and their families may receive service coordination and developmental services from the local Regional Center or education agency, depending on the condition. PCPs participate or consult with staff of the local Regional Center or local education agency (LEA) in the development of the Individual Family Service Plan (IFSP).

If Health Net or a participating provider disagrees with the recommendation of the Early Start program staff, Health Net's public programs administrators are responsible for problem resolution. The Health Net Medi-Cal Health Services Department continues to coordinate and authorize all immediate covered health care needs for the member in collaboration with the primary care physician (PCP) until the matter is resolved.

Health Net's public programs administrators are available to participate in the community Local Interagency Coordination Areas (LICA). Health Net's public programs administrators work with the Regional Centers to enhance collaboration and coordination.

In situations where a child is eligible for both California Children's Services (CCS) and the Department of Developmental Services' (DDS) Early Start program, the primary referral is to CCS if diagnosis or treatment for a CCS-eligible condition is the primary concern. The primary care physician (PCP) must notify CCS and the local Regional Center simultaneously if both medical and DDS Early Start program intervention services are indicated.

Referrals to the local Department of Developmental Services (DDS) Early Start program are made through the local Regional Centers.

Federal law requires that primary care physicians (PCPs) refer children under age three identified as potentially requiring developmental intervention services for evaluation within two business days of determining the need for services. Health Net may provide either written or telephone referrals to the local Regional Center, education agency, or other locally designated agency.

Providers must provide the following services and information to the DDS Early Start program with each referral:

• Initial physical evaluations
  • A comprehensive physical examination and assessment for congenital abnormalities and treatable medical conditions
  • A review of the mother's prenatal and perinatal course to identify biomedical or environmental risks
  • Follow-up of newborn screening tests to assure normal values or initiate treatment
• Developmental screening
  • Provide developmental and behavioral assessment (using Child Health and Disability Prevention (CHDP) program; Early and Periodic Screening, Diagnosis, and Treatment (EPSDT); American Academy of Pediatrics (AAP) standards; or a combination). Detection of hearing or visual sensory deficits or early developmental problems are of significant interest
• Primary preventive and pediatric care, referrals for special consultations, and therapy services
  • Periodic, comprehensive physical examinations
  • Anticipatory parental guidance (for example, health education and injury prevention advice)
  • Immunizations, lead screening and hematocrit
  • Monitoring of nutrition status
• Diagnosis and, if possible, etiology
  • Complete family history, including prenatal course and genetic pedigree
  • Comprehensive medical evaluation to determine underlying causes (including genetic conditions) and any chromosome or metabolic tests performed