Effective Date: July 1, 1996 CT Birth to Three System
Date Revised: July 1, 2014
Title:
Purpose: Section 17a-248e (c) of the C.G.S. requires that the Individualized Family
Service Plan (IFSP) be developed in consultation with the child’s pediatrician or primary health care provider.
Overview
The family, the child’s service providers and the child’s primary health care providers
(PHCP) must work together as a team for the Birth to Three services to be truly comprehensive, multidisciplinary and family centered.
Interacting with the Child’s Pediatrician or Primary Health Care Provider
The following steps should be taken to ensure that the PHCP participates in the development of the initial IFSP:
1. When a referral is made to the Birth to Three System by a parent, personnel at the toll free intake number will ask for the name of their child’s PHCP.
When the child
’s PHCP makes a referral on behalf of the parent, intake personnel will discuss the importance of the PHCP in the eligibility and IFSP process.
The PHCP will be asked for their preferred method of contact. Intake personnel will attempt to gather any information related to diagnosed conditions affecting eligibility.
2. At the first meeting with the family, the service coordinator will review any medical information gathered at referral and ask for parent Consent to Obtain
Information form (Form 3-2). If the child has a diagnosed condition as reported by the parent, the service coordinator should attempt to get confirmation from the
PHCP.
At the first meeting with the family, the service coordinator should also ask the parent for Consent to Release Information (Form 3-3) so that the PHCP . may know the eligibility outcome for their patient. Once the evaluation is complete, the service coordinator should fax a copy of the single page eligibility decision to the child’s health care provider. This is done for all completed evaluations, whether the child is eligible or not.
3.
Ideally, the PHCP can contribute information, observations, or concerns at any time during a child’s enrollment in the Birth to Three System, but participation may vary widely across individual providers and practices. At a minimum a complete copy of the IFSP including all supporting reports will be sent to the
PHCP primary health care provider with the cover letter, Form 3-6 requesting

Interacting with Physicians page 2 that the PHCP review the plan and indicate agreement by signing the service page. To expedite return of the signed service page a faxed copy is acceptable.
If the child is covered under commercial health insurance, a doctor or APRN licensed in one of the states bordering Connecticut (RI, NY, or MA) may sign a
Connecticut IFSP if he or she is the child’s PHCP as long as this is in compliance with their plan. If the child is covered under Medicaid, then the PHCP must be enrolled in the Department of Social Services provider database, whether licensed in Connecticut or a bordering state.
5.
The IFSP will require a new signature from the child’s PHCP annually and if, as a result of a review, there are increases in the frequency or intensity of existing services or additional services are added to the plan. Form 37 is the cover letter to accompany it.
NOTE: If the parent(s) and primary care provider agree that services must begin immediately, an Interim IFSP can be written to authorize services for a child who is eligible for CT Birth to Three services. The interim IFSP must be signed by the child's primary health care provider (faxed copy is permissible). All evaluations must be completed and a meeting held to develop the full IFSP within 45 days of initial referral.
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References:
Section 17a-248e (c) of the C.G.S.
Form 3-2, Authorization for Programs to Obtain Information
Form 3-3, Authorization for Programs to Release Information
Form 3-6, Physician IFSP Cover Letter
Form 3-7, Physician IFSP Review Cover Letter
Initial Evaluation and Assessment Procedure