Directory > Resources for Children with Special Needs
Early Intervention Program (EIP)
New York State law requires that all primary referral sources (e.g., primary care physicians (PCPs), specialists, hospitals, etc.) shall, within two working days of identifying a child under 3 years of age with either a risk factor for developmental delay or an actual developmental delay or disability, refer that child to the Local Early Intervention Agency (LEIA) corresponding to the child's county of residence. In most cases, the LEIA is the County Department of Health. Parental consent is required for referral. The EIP has two components:
- The Infant Child Health Assessment Program (ICHAP) serves as the "child find" component. Only children with a risk factor for developmental delay should be referred to this component. Referred children are tracked to insure that their pediatricians/PCPs conduct periodic developmental assessments and if such assessments indicate developmental delay, the program facilitates referrals to the EIP component.
- The Early Intervention Program (EIP) provides for evaluation and developmental services when a child has or is suspected of having a developmental delay. Services are provided by the LEIA's network of approved EIP providers. The LEIA is under no obligation to use providers in the child's health plan network. When the services rendered are covered by a third party, the LEIA is authorized to bill the third party on behalf of the servicing provider.
For information please call the New York State Growing Up Healthy Hotline at 1-800-522-5006 (TTY/TDD: 1-800-655-1789). You may also call the LEIAs at:
- New York City: 1-800-577-BABY (1-800-577-2229) or 1-212-219-5213
- Nassau County: 1-516-227-8661
- Suffolk County: 1-631-853-3100
- Westchester County: 1-914-813-5094
- Orange County: 1-845-291-2333
- Rockland County: 1-845-364-2625
Preschool Supportive Health Services Program (PSHSP)
When children between 3 and 4 years of age are identified as having or are at risk of developmental disability, pediatricians/PCPs shall, with parental consent, refer the children to the Committee on Special Preschool Education serving the school district in which the children reside. This program ensures that such children are evaluated and receive needed special education and that disability-related health services are provided by PSHSP providers approved by the Committee on Preschool Special Education. The program is under no obligation to use providers in the child's health plan network. The school district bills the state for services rendered to Medicaid managed care members. When the services rendered to non-Medicaid members are covered by a third party, the school district is authorized to bill the third party on behalf of the servicing provider.
School Supportive Health Services Program (SSHSP)
When children between 5 and 21 years of age are identified as at risk for or having a developmental disability, pediatricians/PCPs shall, with parental consent, refer the children to the Committee on Special Education serving the school district in which the children reside. This program ensures that such children are evaluated and receive needed special education and that disability-related health services are provided by SSHSP providers approved by the Committee on Special Education. The program is under no obligation to use providers in the child's health plan network. The school district bills the state for services rendered to Medicaid managed care members. When the services rendered to non-Medicaid members are covered by a third party, the school district is authorized to bill the third party on behalf of the servicing provider.
Physically Handicapped Children's Program (PHCP)
PHCP provides financial assistance for medical care and support services to children that have severe, long-term health problems and chronic disabilities. Eligible conditions include birth defects, physical handicaps and other conditions that can be improved with treatment and early intervention.
PHCP has two components: the Diagnosis and Evaluation Program and the Treatment Program. Diagnostic services are available to all children who are believed to have physically disabling conditions or serious chronic illnesses. To receive diagnostic services, families do not have to satisfy local financial eligibility criteria, but prior authorization from the local PHCP must be obtained. Diagnostic services are provided through approved specialty centers or medical specialists. If the child is covered by health insurance or Medicaid, these funding sources must be billed first. If the child has neither insurance nor Medicaid, then the authorized services are paid for directly by the PHCP.
The treatment component reimburses health care providers for services rendered to eligible children. Inpatient hospital care, physician office visits, durable medical equipment and pharmaceuticals are examples of items covered by the program. PHCP will cover the cost of medically needed care and supplies not covered by some health insurance plans, such as over the counter drugs/supplies and transportation.
Application for the Treatment Program must be made to the county in which the child resides. There are some variations between counties for conditions covered and financial eligibility. Financial criteria are designed to assist families with low incomes or inadequate private health insurance. All services provided under PHCP must have prior authorization from the county health department.
For more information, please call the New York State Growing Up Healthy Hotline at 1-800-522-5006 or:
- New York City: 1-212-676-2950
- Nassau County: 1-516-571-0801
- Suffolk County: 1-631-853-2286
- Westchester County: 1-914-813-5328
- Orange County: 1-845-568-5280
- Rockland County: 1-845-364-2081
Glossary terms found on this page:
Services that have been approved for payment based on a review of EmblemHealth's policies.
Services that have been approved for payment based on a review of EmblemHealth's policies.
Any medically determinable physical or mental impairment that can be expected to result in death or that has lasted or can be expected to last for a continuous period of not less than 12 months and renders the member unable to engage in any substantial gainful activities.
Medical equipment, goods, implements and prosthetics that are prescribed for patient care, usually in an outpatient setting. Examples of such equipment include hospital beds, wheelchairs and walkers.
A determination of whether or not a person meets the requirements to participate in the plan and receive coverage under the plan.
A professionally licensed individual, facility or entity giving health-related care to patients. Physicians, hospitals, skilled nursing facilities, pharmacies, chiropractors, nurses, nurse-midwives, physical therapists, speech pathologist and laboratories are providers. All network providers are health care providers, but not all providers are network providers.
An institution which provides inpatient services under the supervision of a physician, and meets the following requirements:
- Provides diagnostic and therapeutic services for medical diagnosis, treatment and care of injured and sick persons and has, as a minimum, laboratory and radiology services and organized departments of medicine and surgery
- Has an organized medical staff which may include, in addition to doctors of medicine, doctors of osteopathy and dentistry
- Has bylaws, rules and regulations pertaining to standards of medical care and service rendered by its medical staff
- Maintains medical records for all patients
- Has a requirement that every patient be under the care of a member of the medical staff
- Provides 24-hour patient services
- Has in effect agreements with a home health agency for referral and transfer of patients to home health agency care when such service is appropriate to meet the patient's requirements
Service provided after the patient is admitted to the hospital. Inpatient stays are those lasting 24 hours or more.
Acronym for Medicare Advantage. An alternative to the traditional Medicare program in which private plans run by health insurance companies provide health care benefits that eligible beneficiaries would otherwise receive directly from the Medicare program.
Any form of health plan that uses selective provider contracting to have patients seen by a network of contracted providers and that requires prior approval of certain services.
A jointly funded federal and state program that provides hospital and medical coverage to the low-income population and certain aged and disabled individuals.
Professional services rendered by a physician for the treatment or diagnosis of an illness or injury.
An individual and each of his or her eligible dependents, including Medicare beneficiaries who are enrolled or participate in a benefit program and who are entitled to receive covered services from the practitioner pursuant to such benefit program and the terms of the practitioner's agreement.
The group of physicians, hospital, and other medical care providers that a specific plan has contracted with to deliver medical services to its members.
A family physician, family practitioner, general practitioner, internist or pediatrician who is responsible for delivering or coordinating care. Also called a primary care physician.
A health plan that offers benefits in-network and out-of-network. In-network services are available to enrollees at lower out-of-pocket cost than the services of non-network providers. In addition, PPO enrollees may self-refer to any network provider at any time. Also called a Preferred Provider Organization.
A family physician, family practitioner, general practitioner, internist or pediatrician who is responsible for delivering or coordinating care. Also called a PCP.
A medical practitioner or covered facility recognized by EmblemHealth for reimbursement purposes. A provider may be any of the following, subject to the conditions listed in this paragraph:
- Doctor of medicine
- Doctor of osteopathy
- Doctor of podiatric medicine
- Physical therapist
- Nurse midwife
- Certified and registered psychologist
- Certified and qualified social worker
- Nurse anesthetist
- Speech-language pathologist
- Clinical laboratory
- Screening center
- General hospital
- Any other type of practitioner or facility specifically listed in the member's Certificate of Insurance as a practitioner or facility recognized by EmblemHealth for reimbursement purposes
A provider must be licensed or certified to render the covered service. The covered service must be within the scope of the Provider's license or certification.
A recommendation by a physician that an enrollee receive care from a specialty physician or facility.