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Early Intervention Services

What are Early Intervention (EI) Services?

Early Intervention Services provide developmental supports and services to children from birth to three (3) years of age who have either a significant developmental delay or a diagnosed condition that has a high probability of resulting in developmental delay and are determined to be eligible for the Infant & Toddler Connection of Virginia program housed under the Department of Behavioral Health and Developmental Services (DBHDS).

The Early Intervention Program

The Early Intervention Program for Infants and Toddlers with disabilities (also known as Part C) is a federal program. In Virginia, this program is called the Infant & Toddler Connection of Virginia, and it provides EI services and supports to children between birth and 3 years of age who have a developmental delay or disability. These services can include Speech/Language Therapy (SLP), Occupational Therapy (OT), Physical Therapy (PT), Assistive Technology, and Targeted Case Management or Service Coordination, which is a service guaranteed to be provided to every family.

Who can Apply to Become an Early Intervention Provider?

Any provider of services who is enrolled with the Department of Medical Assistance Services (DMAS) and affiliated with one of the 40 Local Lead Agencies in Virginia can become an Early Intervention Provider to provide services under Virginia Medicaid. In order to provide and bill for Early Intervention (EI) Part C Services in Virginia Medicaid, Early Intervention providers must be certified as: (1) Early Intervention Professionals, or (2) Early Intervention Specialists and/or Early Intervention Case Managers through the Department of Behavioral Health and Developmental Services (DBHDS) and must be enrolled with DMAS. Virginia's certification process ensures that providers are qualified within their disciplines and have the knowledge and competencies necessary to serve infants and toddlers with disabilities and their families in the Virginia Early Intervention System. Provider requirements for Early Intervention are described at 12VAC30-50-131, 12VAC35-225 and in Appendix G of the DMAS Early Intervention Services Manual and the DBHDS Practice Manual.

What are the Benefits of Becoming an Early Intervention Provider?

Early Intervention (EI) providers provide supports and services that focus on increasing the child's participation in family and community activities that are important to daily development. EI providers benefit from rate differentials based on the necessity of services. EI providers are part of a network that provides programs and services throughout Virginia for families in need. More than 1,000 EI service coordinators, therapists and program administrators contribute their expertise to improving the lives of infants and toddlers with disabilities.

Early Intervention Certification Process

In order to provide and bill for Part C Early Intervention Services in Virginia, providers must be certified as Early Intervention Professionals, Early Intervention Specialists, and/or Early Intervention Case Managers. Virginia's certification process ensures that providers are qualified within their disciplines and have the knowledge and competencies necessary to serve infants and toddlers with disabilities and their families in the Virginia Early Intervention System. In order to be certified as an Early Intervention provider in Virginia, you must:

  1. Meet Discipline-Specific Requirements
  2. Complete Infant & Toddler Connection of Virginia EI Certification Courses
    • Providers must complete the Early Intervention Certification Courses with at least 80% accuracy.
    • Early Intervention Certification courses can be found on the Early Intervention Professional Development website
      • Create a user account
      • Click Initial Certification (required for all Virginia EI practitioners) and complete the following courses:
        • Overview: Mission and Key Principles of EI
        • The Early Intervention Process
        • Effective Practices for Implementing EI
        • Responsibilities of EI Practitioners
        • Child Development
        • Authentic Assessment
      • For EI Service Coordinators, you will need to complete:
        • The Many Facets of Service Coordination
  3. Submit an Online Application with DBHDS
    • Providers must submit an online application and receive confirmation of certification.
    • Practitioners must signify agreement with assurances on the application affirming knowledge of and compliance with the federal and state regulations and practices specified in the Infant & Toddler Connection of Virginia Practice Manual.
    • Providers must receive confirmation that the certification has been granted, and the provider must be affiliated with one of Virginia's Local Lead Agencies (LLA) Infant & Toddler Connection Systems prior to providing or billing for services.
    • For information about applying and submitting an application, go to the Infant & Toddler Connection of Virginia's EI Certification Step-by-Step webpage.
    • You will be notified of approval within one to three weeks and will be notified via email.
    • The provider will automatically be added to the DBHDS Roster as soon as they are approved. Providers must be affiliated with a local Early Intervention Part C System to provide Early Intervention Part C Services.
  4. Complete DMAS's Enrollment Process
    • All EI providers that participate with Virginia Medicaid and its contracted MCOs must be enrolled with DMAS for reimbursement of EI Services.
      • A DMAS participating provider is an agency, program, or person that meets the standards and requirements set forth by DMAS in Chapter 2 of the DMAS EI Provider Manual and has a current, signed Participation Agreement with DMAS.
      • Providers must also meet the practitioner qualifications set forth under Part C, abide by the Infant & Toddler Connection of Virginia Practice Manual, and adhere to the statutes and regulations governing Part C of IDEA.

The National Provider Identifier (NPI) is required on the Provider Enrollment Application.

Obtain an NPI by logging in or calling customer service at 800-465-3203. Create an account and submit an application.

Current processing times are taking longer than usual. If any of the information provided needs verification, a representative from the NPI Enumerator's Office will reach out to the contact information provided on the application.

Once the initial application is enumerated or the change request is processed, the NPI and Provider Enumeration System (NPPES) will automatically transmit a notification to all email addresses listed on the NPI record. If the NPI record does not contain an email address, the notification will be sent to the Business Mailing Address listed on the NPI record within 10 to 14 business days. The email notification will be sent from customerservice@npienumerator.com. If you do not receive the email notification, please check the spam filter or bulk/junk mail folder in all email accounts on file on the NPI record, as the email notification may have been filtered into another folder.

If there are any further questions regarding this message, please send an email to customerservice@npienumerator.com or call 1-800-465-3203 between the hours of 9 a.m. and 5 p.m. Eastern Time.

More information about the NPI and how to obtain one can be found on the Centers for Medicare and Medicaid Services (CMS) website under Regulations and Guidance, Administrative Simplification, National Provider Identifier Standard (NPI).

Any provider of services must be enrolled with Department of Medical Assistance Services (DMAS) prior to billing for any services provided to individuals who are enrolled in Medicaid/Family Access to medical Insurance Security (FAMIS) Plus or FAMIS. A participating provider is a person who has a current, signed participation agreement with DMAS.

DMAS’s online provider enrollment process may be accessed through the Provider Enrollment link located on the DMAS Medicaid Enterprise System (MES) Provider Resources site.

As a part of the enrollment process, providers must complete a Participation Agreement applicable to their provider type. In the case of a group practice, hospital, or other agency or institution, the authorized agent of the provider institution must sign the agreement. For group practice, hospital, or other agency or institution, DMAS must receive prior written ratification of the identity of any designated authorized representative and the fact that a principal-agent relationship exists.

A National Provider Identifier (NPI) number must be obtained from the National Plan and Provider Enumeration System (NPPES) and provided with the enrollment application. An enrolled provider’s NPI is used by MES to manage provider information across functions. For example, this number must be used on all claims submitted to DMAS.

Provider NPIs may be disclosed to other Covered Healthcare Entities pursuant to Centers for Medicaid and Medicare Services (CMS) regulations requiring the disclosure of NPIs as a part of HIPAA-compliant standard transactions. (Please reference the Healthcare Information Portability and Accountability Act (HIPAA) of 1996.) 

If you have any questions regarding the enrollment process, please email Provider Enrollment Services at VAMedicaidProviderEnrollment@gainwelltechnologies.com or phone toll free 1-888-829-5373 or local 1-804-270-5105.

For additional information, please see the PRSS Federal 21st Century Cures Act Notice Memo and 2023 Early Intervention PRSS Enrollment Guidance.

There are 40 local EI systems throughout the Commonwealth of Virginia. Systems are divided into six regions. Each region is assigned a Monitoring Specialist and Technical Assistance Consultant. EI providers might have already contacted their area's LLA, which is fine at any point in the certification, enrollment or credentialing process. Before billing, providers must have some relationship with an LLA (i.e. contractual, employment, etc.) in order to bill for services. An EI provider will not be able to bill for all services unless the provider has contracted with all DMAS managed care organizations (MCOs).

  • Providers must contact a Local System Manager in their region of choice to complete the contracting/agreement process with an LLA.
  • Providers can find a complete list of Local System Managers by area at the Infant & Toddler Connection of Virginia website.
  • Once associated with the LLA and fully certified as an EI provider, providers will be added to the DMAS Early Intervention Master Roster, which is a database of all credentialed EI providers, professionals, specialists, and EI Case Managers (CCC Plus and Medallion 4.0). All MCOs will have access to this list to ensure that EI providers are reimbursed correctly.
  • Note: At any time during the process of becoming an Early Intervention provider, providers may reach out to the LLA to let them know where they are in the process. The LLA can be part of the process of assisting the provider in completing their certification. Although a provider can start the process of contracting with their LLA, a provider will not be able to bill for EI services unless contracted with all DMAS MCOs.

Providers who wish to serve EI members enrolled in a Virginia Medicaid Managed Care Organization (MCO) must be credentialed and contracted by the specific health plan. Prior to contracting providers must be certified by DBHDS and enrolled with DMAS. Any provider that is not contracted with the MCOs is referred to as "non-par" or a non-participating provider and will not be able to bill for services.

  • Each MCO has their own specific credentialing process for the EI provider. Each MCO has a process chart that describes what steps a provider will need to take to contract with an MCO. View the MCO EI Process Charts.

If a provider has additional questions, contact the MCO directly by accessing the CCC Plus MCO Contact List or the Medallion 4.0 MCO Contact List.

Scenario I - Center Based Services

If you are a physical therapist who is providing a group treatment session in a center-based environment, you will bill T1026 without a modifier. If you are a physical therapist providing an individual treatment session in a center-based environment, you will then bill T1026 with the U1 modifier because individual services are paid at a higher rate than group services.

Scenario II - Treatment Team

If you are a provider of developmental services (Reimbursement Category 2) participating in an IFSP team meeting with the family and child present, you will bill T1024 without the U1 modifier. If you are a physical therapist (Reimbursement Category 1) participating in a treatment team meeting without the family and child present, you will bill T1024 with the U1 modifier.

Medicaid Early Intervention Services Program Reimbursement Information

DMAS requires managed care organizations (MCOs) to conduct Model of Care (MOC) trainings for providers. The MCO will determine whether an Early Intervention provider will be required to complete the trainings per their credentialing requirements.

All Early Intervention Certification Courses can be found in Step 2 of the Early Intervention Certification Process:

If you have any Early Intervention specific questions, please send your inquiries to m4earlyintervention@dmas.virginia.gov with your name, email, and phone number. If your question is specific to a member, please include their Medicaid ID number, member name, and date of birth. We look forward to hearing from you.

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