Code of Maryland Regulations
Title 13A - STATE BOARD OF EDUCATION
Subtitle 13 - MARYLAND INFANTS AND TODDLERS PROGRAM
Chapter 13A.13.01 - Provision of Early Intervention Services to Infants and Toddlers and Their Families
Section 13A.13.01.03 - Definitions

Universal Citation: MD Code Reg 13A.13.01.03

Current through Register Vol. 52, No. 6, March 21, 2025

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

(1) "Act" means the Individuals with Disabilities Education Act as amended, 20 U.S.C. § 1400 et seq.

(2) "Adjusted age" means, for children born before 37 weeks gestation, the number of weeks born prematurely subtracted from the infant's chronological age. An infant's adjusted age is used until the infant's adjusted age is 12 months.

(3) "Annual evaluation" means the meeting conducted at least once a year to evaluate a child's IFSP and to revise its provisions, as appropriate.

(4) "Appropriate professional requirements" means entry-level requirements for personnel providing early intervention services that:
(a) Are based on the highest requirements in the State applicable to the profession or discipline in which a person is providing early intervention services; and

(b) Establish suitable qualifications for personnel providing early intervention services to eligible children and their families, who are served by State, local, and private agencies.

(5) "Assessment" means ongoing procedures used by qualified personnel throughout the period of a child's eligibility to identify the:
(a) Child's unique strengths and needs;

(b) Services appropriate to meet those needs;

(c) Resources, priorities, and concerns of the family; and

(d) Supports and services necessary to enhance the family's capacity to meet the developmental needs of the child.

(6) Assistive Technology Device.
(a) "Assistive technology device" means any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve the functional capabilities of children with disabilities.

(b) "Assistive technology device" does not include:
(i) A medical device that is surgically implanted, including a cochlear implant; or

(ii) The optimization, maintenance, or replacement of that device.

(7) Assistive Technology Service.
(a) "Assistive technology service" means a service that directly assists a child with a disability in the selection, acquisition, or use of an assistive technology device.

(b) "Assistive technology service" includes:
(i) Evaluation of the needs of a child with a disability, including a functional evaluation of the child in the child's customary environment;

(ii) Purchasing, leasing, or otherwise providing for the acquisition of assistive technology devices by children with disabilities;

(iii) Selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing, or replacing assistive technology devices;

(iv) Coordinating and using other therapies, interventions, or services with assistive technology devices, such as those associated with existing education and rehabilitation plans and programs;

(v) Training or technical assistance for a child with disabilities or, if appropriate, that child's family; and

(vi) Training or technical assistance for professionals, including individuals providing education and rehabilitation services, or other individuals who provide services to or are otherwise substantially involved in the major life functions of infants and toddlers with disabilities.

(8) Audiology."Audiology" means services which include:
(a) Identification of children with auditory impairment, using at-risk criteria and appropriate audiologic screening techniques;

(b) Determination of the range, nature, and degree of hearing loss and communication functions, by use of audiological evaluation procedures;

(c) Referral for medical and other services necessary for the habilitation or rehabilitation of children with auditory impairment;

(d) Provision of auditory training, aural rehabilitation, speech reading and listening devices, orientation and training, and other services;

(e) Provision of services for prevention of hearing loss; and

(f) Determination of the child's need for individual amplification, including selecting, fitting, and dispensing appropriate listening and vibrotactile devices, and evaluating the effectiveness of those devices.

(9) Consent.
(a) "Consent" means a parent:
(i) Has been fully informed of all information relevant to the activity for which consent is sought, in the parent's native language or other mode of communication;

(ii) Understands and agrees in writing to the carrying out of the activity for which the parent's consent is sought, and the consent describes that activity and lists the early intervention records, if any, that will be released and to whom; and

(iii) Understands that the granting of consent is voluntary on the part of the parent and may be revoked at any time.

(b) "Consent" includes consent given to an action before a parent revokes consent, so that revocation is not retroactive and does not negate an action that occurred after the consent was given and before the consent was revoked.

(10) "Day" means a calendar day unless otherwise specified.

(11) "Department" means the Maryland State Department of Education.

(12) "Developmental Delay" means the presence of:
(a) A 25 percent delay, using a child's adjusted or chronological age and as measured and verified by appropriate diagnostic instruments and procedures, in one or more of the following developmental areas:
(i) Cognitive development;

(ii) Physical development, including vision and hearing;

(iii) Communication development;

(iv) Social or emotional development; or

(v) Adaptive development;

(b) Atypical development or behavior, which:
(i) Is demonstrated by abnormal quality of performance and function in one or more of the above specified developmental areas; or

(ii) Interferes with current development, and is likely to result in subsequent delay (even when diagnostic instruments or procedures do not document a 25 percent delay); or

(c) A diagnosed physical or mental condition that has a high probability of resulting in developmental delay, with examples of these conditions including:
(i) Chromosomal abnormalities;

(ii) Genetic or congenital disorders;

(iii) Severe sensory impairments;

(iv) Inborn errors of metabolism;

(v) Disorders reflecting disturbance of the development of the nervous system;

(vi) Congenital infections;

(vii) Disorders secondary to exposure to toxic substances, including fetal alcohol syndrome; and

(viii) Severe attachment disorders.

(13) "Duration" means the period of time over which services will be provided, such as when the child is expected to achieve the results or outcomes in his or her IFSP.

(14) "Early intervention record" means any personally identifiable information, as defined in §B(48) of this regulation, about a child or the child's family generated by the early intervention system which pertains to:
(a) Evaluation and assessment;

(b) Development of an individualized family service plan; or

(c) The delivery of early intervention services.

(15) Early Intervention Services (EIS).
(a) "Early intervention services" means continuous developmental services designed to meet the needs of an infant or toddler with a disability and the needs of the family to appropriately assist in the child's development that:
(i) Are selected in collaboration with the parents;

(ii) Meet the standards of the State;

(iii) Are provided at no cost; and

(iv) Are under public supervision by qualified personnel.

(b) "Early intervention services" include, but are not limited to:
(i) Assistive technology;

(ii) Audiology;

(iii) Family training, counseling, and home visits;

(iv) Health services;

(v) Medical services for diagnostic or evaluation purposes;

(vi) Nursing services;

(vii) Nutrition services;

(viii) Occupational therapy;

(ix) Physical therapy;

(x) Psychological services;

(xi) Service Coordination;

(xii) Sign language and cued language services;

(xiii) Social work services;

(xiv) Special instruction;

(xv) Speech-language pathology;

(xvi) Transportation; and

(xvii) Vision services.

(16) Early Intervention Service (EIS) Provider.
(a) "Early intervention service provider" means a public, private, or nonprofit entity or individual that provides early intervention services, consistent with 34 CFR § 303.12.

(b) "Early intervention service provider" may include the Department as the lead public agency responsible for providing early intervention services to infants and toddlers with disabilities in the State.

(17) "Elementary school" means a nonprofit institutional day or residential school, including a public elementary charter school that provides elementary education.

(18) "Eligible child" or "eligible children" means infants or toddlers with a disability as defined in §B(28) of this regulation.

(19) Evaluation.
(a) "Evaluation" means the procedures used by qualified personnel to determine a child's initial and continuing eligibility for early intervention services as an infant or toddler with a disability as defined in §B(28) of this regulation.

(b) "Evaluation" includes determining the child's status in each of the following developmental areas:
(i) Cognitive development;

(ii) Physical development, including vision and hearing;

(iii) Communication development;

(iv) Social or emotional development; and

(v) Adaptive development.

(20) "Extended school year (ESY)" means the individualized extension of specific special education and related services as defined in COMAR 13A.05.01.03B(26).

(21) "Family training, counseling, and home visits" means services provided, as appropriate, by social workers, psychologists, and other qualified personnel to assist the family of an infant or toddler with a disability in understanding the special needs of the child and enhancing the child's development.

(22) "Free appropriate public education" (FAPE) has the meaning stated in 34 CFR § 303.15 and COMAR 13A.05.01.03B(27).

(23) "Frequency" means the rate at which services are provided, including the number of sessions over a particular period of time, such as daily, weekly, or monthly.

(24) Health Services.
(a) "Health services" means services necessary to enable a child to benefit from other early intervention services during the time the child is receiving early intervention services, consistent with 34 CFR § 303.16.

(b) "Health services" include, but are not limited to:
(i) Clean intermittent catheterization, tracheostomy care, tube feeding, the changing of dressings or osteotomy collection bags, and other health services; and

(ii) Consultation by physicians with other service providers concerning the special health care needs of eligible children that will need to be addressed in the course of providing other early intervention services.

(c) "Health services" do not include:
(i) Services which are surgical in nature such as cleft palate surgery, surgery for club foot, or the shunting of hydrocephalus;

(ii) Services purely medical in nature such as hospitalization for management of congenital heart ailments, or the prescribing of medicine or drugs for any purpose;

(iii) Services that are related to implementation, optimization (e.g., mapping), maintenance, or replacement of a medical device that is surgically implanted, including cochlear implant;

(iv) Devices necessary to control or treat a medical condition such as heart monitors, respirators and oxygen, and gastrointestinal feeding tubes and pumps; and

(v) Medical health services such as immunizations and regular well-baby care that are routinely recommended for all children.

(25) "Homeless children" has the meaning stated in section 725 of the McKinney-Vento Homeless Assistance Act, as amended, 42 U.S.C. 11431 et seq. for homeless children and youths.

(26) "Include" means that the items named are not all of the possible items that are covered, whether like or unlike the ones named.

(27) "Individualized education program (IEP)" means a written statement for a student with a disability that is developed, reviewed, and revised in accordance with 34 CFR §§ 300.320 -300 . 324 and COMAR 13A.05.01.08 and .09.

(28) "Individualized family service plan" means a written plan for providing early intervention and other services to an eligible child and the child's family, consistent with 34 CFR § 303.344 that is:
(a) Based on the multidisciplinary evaluation and assessment of the child, and the assessment of the child's family, in accordance with 34 CFR § 303.321;

(b) Written to include the content specified in 34 CFR § 300.344 ;

(c) Implemented as soon as possible, but not more than 30 days following receipt of parental consent, consistent with 34 CFR § 303.420; and

(d) Developed jointly by the family and appropriate qualified personnel involved in the provision of early intervention services, in accordance with 34 CFR §§ 303.342, 303.343, and § 303.345.

(29) Infant or Toddler with a Disability.
(a) "Infant or toddler with a disability" means a child, birth through 2 years old, who is eligible for early intervention services, as documented by appropriate qualified personnel, as having a developmental delay as defined by §B(11) of this regulation; or

(b) A child, 3 years old until the beginning of the school year following the child's fourth birthday, who:
(i) Previously received early intervention services, in accordance with Part C of the Act and this chapter; and

(ii) Is identified as a child with a developmental delay or disability, consistent with 34 CFR § 300.8 and COMAR 13A.05.01.06.

(30) "Intensity" means whether a service is provided on an individual or group basis.

(31) "Interim service coordinator" means the individual designated at the single point of entry to assist the referred child and family through the initial multidisciplinary evaluation and assessment and individualized family service plan process.

(32) "Length" means the length of time a service is provided during each session of that service.

(33) "Local governing authority" means the local elected official or officials with executive authority in each jurisdiction.

(34) "Local lead agency" means the public agency designated by the local governing authority in each county and Baltimore City to administer the interagency system of early intervention services under the direction of the Department, in accordance with Education Article, § 8-416, Annotated Code of Maryland.

(35) "Local school system" means any of the 24 public school systems in the State responsible for providing public elementary or secondary education.

(36) "Location" means the actual place or places where a service will be provided.

(37) "Maryland Infants and Toddlers Program" means the program within the Department responsible for the planning, supervision, monitoring, and technical assistance for the implementation of Part C of the Act and this chapter.

(38) "Medical services" means services provided by a licensed physician for diagnostic or evaluation purposes to determine a child's developmental status and need for early intervention services.

(39) "Method" means how a service is provided.

(40) "Multidisciplinary" means the involvement of two or more disciplines or professions in the provision of integrated and coordinated services, including evaluation and assessment activities and the development of the IFSP consistent with 34 CFR § 303.24.

(41) Native Language.
(a) "Native language" means the language or mode of communication normally used by an individual who is limited English proficient, or the language normally used by the parent of the child, consistent with 34 CFR § 303.25.

(b) "Native language" includes the language of the child, if determined developmentally appropriate for the child by qualified personnel conducting the evaluation or assessment.

(c) "Native language" includes the mode of communication that is normally used by an individual:
(i) Who is blind or visually impaired;

(ii) Who is deaf or hard of hearing; or

(iii) With no written language.

(41) "Natural environments" means settings that are natural or typical for a same-aged infant or toddler without a disability, including home or community settings, consistent with 34 CFR § 303.126.

(42) Nursing Services. "Nursing services" means services which include the:
(a) Assessment of health status for the purpose of providing nursing care, including the identification of patterns of human response to actual or potential health problems;

(b) Provision of nursing care to prevent health problems, restore or improve functioning, and promote optimal health and development; and

(c) Administration of medications, treatments, and regimens prescribed by a licensed physician.

(44) "Nutritional services" means services which include:
(a) Conducting individual assessments in:
(i) Nutritional history and dietary intake such as anthropometric, biochemical, and clinical variables;

(ii) Feeding skills and feeding problems; and

(iii) Food habits and food preferences;

(b) Developing and monitoring appropriate plans to address the nutritional needs of eligible children based on the findings in (a) of this subsection; and

(c) Making referrals to appropriate community resources to carry out nutrition goals.

(45) Occupational Therapy.
(a) "Occupational therapy" means services to address the functional needs of a child related to:
(i) The performance of self-help skills;

(ii) Adaptive behavior and play; or

(iii) Sensory, motor, and postural development.

(b) "Occupational therapy" is designed to improve the child's functional ability to perform tasks in home, school, and community settings, and includes:
(i) Identification, assessment, and intervention;

(ii) Adaptations of the environment;

(iii) Selection, design, and fabrication of assistive and orthotic devices to facilitate development and promote the acquisition of functional skills; and

(iv) Prevention or minimization of the impact of initial or future impairment, delay in development, or loss of functional ability.

(46) Parent.
(a) "Parent" means:
(i) A biological or adoptive parent;

(ii) A guardian authorized to act as the child's parent, or authorized to make early intervention, educational, health, or developmental decisions for the child;

(iii) An individual acting in the place of a biological or adoptive parent including a grandparent, stepparent, or other relative with whom the child lives, or an individual who is legally responsible for the child's welfare;

(iv) A foster parent with whom the student lives, if the foster parent has been granted limited guardianship for educational decision-making purposes by the court that has placed the child in foster care; or

(v) A surrogate parent who has been appointed in accordance with 34 CFR § 303.422 and consistent with Regulation .13 of this chapter.

(b) "Parent" does not include:
(i) An EIS provider or public agency responsible for the provision of any service to a child or any family member of the child; or

(ii) The State, if the child is a ward of the State.

(47) Participating Agency.
(a) "Participating agency" means an individual, agency, entity, or institution that collects, maintains, or uses personally identifiable information to implement Part C of the Act and the regulations in this chapter with respect to a particular child.

(b) "Participating agency" includes the lead agency and EIS providers of services including service coordination, evaluations, and assessments.

(c) "Participating agency" does not include primary referral sources, or public agencies that act solely as funding sources for Part C services.

(48) "Periodic review" means the multidisciplinary review of the IFSP, conducted every 6 months, or more frequently if conditions warrant, or at the family's request.

(49) "Personally identifiable information" means information that includes:
(a) The name of:
(i) The child;

(ii) The child's parent; or

(iii) Other family member;

(b) The address of the child;

(c) A personal identifier such as the child's Social Security number or child identification number; and

(d) A list of personal characteristics or other information that would make it possible to identify the child with reasonable certainty.

(50) Physical Therapy Services.
(a) "Physical therapy services" means services to address the promotion of sensorimotor function through enhancement of:
(i) Musculoskeletal status;

(ii) Neurobehavioral organization;

(iii) Perceptual and motor development;

(iv) Cardiopulmonary status; or

(v) Effective environmental adaptation.

(b) "Physical therapy services" includes:
(i) Screening, evaluation, and assessment of infants and toddlers to identify movement dysfunction;

(ii) Obtaining, interpreting, and integrating information appropriate to program planning to prevent, alleviate, or compensate for movement dysfunction and related functional problems; and

(iii) Providing individual and group services or treatment to prevent, alleviate, or compensate for movement dysfunction and related functional problems.

(51) Primary Referral Sources.
(a) "Primary referral sources" means an individual, agency, entity, or institution that may suspect an infant or toddler as having a developmental delay who may benefit from EIS.

(b) "Primary referral sources" include:
(i) Parents;

(ii) Physicians;

(iii) Child care programs;

(iv) Domestic violence shelters and agencies;

(v) Early learning programs;

(vi) Health care clinics and providers;

(vii) Homeless family shelters;

(viii) Hospitals, including prenatal and postnatal care facilities;

(ix) Public agencies;

(x) Public health facilities; and

(xi) Staff in the State child welfare system.

(52) "Profession" means a specific occupational category that:
(a) Provides early intervention services to eligible children and their families;

(b) Has been established or designated by the State; and

(c) Has a required scope of responsibility and degree of supervision.

(53) "Psychological services" means services that include:
(a) Administering psychological and developmental tests, and other assessment procedures;

(b) Interpreting assessment results;

(c) Obtaining, integrating, and interpreting information about child behavior and child and family conditions related to learning, mental health, and development; and

(d) Planning and managing a program of psychological services including:
(i) Psychological counseling for children and parents;

(ii) Family counseling;

(iii) Consultation on child development;

(iv) Parent training; or

(v) Education programs.

(54) "Public agency" means:
(a) The lead agency; or

(b) Any other agency or political subdivision.

(55) "Qualified personnel" means persons who have met State approved or recognized certification, licensing, registration, or other comparable requirements that apply to the area in which the personnel are conducting evaluations and assessments or providing early intervention services, including:
(a) Audiologists;

(b) Family therapists;

(c) Nurses;

(d) Occupational therapists;

(e) Orientation and mobility specialists;

(f) Pediatricians and other physicians for diagnostic and evaluation purposes;

(g) Physical therapists;

(h) Psychologists;

(i) Registered dieticians;

(j) Social workers;

(k) Special educators, including teachers of children with hearing impairments and teachers of children with visual impairments;

(l) Speech and language pathologists;

(m) Vision specialists, including ophthalmologists and optometrists; and

(n) Other services and personnel as defined in §B(15) and (58) of this regulation.

(56) "Scientifically based research" has the meaning given in the term Section 9101(37) of the Elementary and Secondary Education Act of 1965, as amended.

(57) Screening.
(a) "Screening" means procedures or activities carried out by, or under the supervision of, the local lead agency or EIS provider to identify infants and toddlers suspected of having a disability and in need of early intervention services, at the earliest possible age, consistent with 34 CFR § 303.320.

(b) "Screening" includes the administration of appropriate instruments by qualified personnel.

(58) Service Coordination.
(a) "Service coordination" means activities to assist and enable an eligible child and the child's family to receive the rights, procedural safeguards, and services that are authorized to be provided under the State's system of early intervention services.

(b) "Service coordination" includes:
(i) Assisting families in gaining access to, and coordinating the provision of, the early intervention services;

(ii) Coordinating the performance of evaluations and assessments;

(iii) Facilitating and participating in the development, review, and evaluation of individualized family service plans;

(iv) Coordinating, facilitating, and monitoring the delivery of service across agencies to ensure that the services are provided in a timely manner;

(v) Conducting follow-up activities to determine that appropriate early intervention services are provided;

(vi) Informing families of their rights and procedural safeguards;

(vii) Coordinating the funding sources for early intervention services;

(viii) Facilitating the development of a transition plan to preschool, school, or other services, if appropriate;

(ix) Informing families of the availability of advocacy services;

(x) Coordinating with medical and health providers; and

(xi) Assisting families to get required immunizations for eligible children, in compliance with COMAR 10.06.04.

(59) "Service coordinator" means the individual designated in the IFSP to carry out service coordination activities.

(60) Sign Language and Cued Language Services.
(a) "Sign language and cued language services" means teaching:
(i) Sign language;

(ii) Cued language; or

(iii) Auditory oral language.

(b) "Sign language and cued language services" includes providing:
(i) Oral transliteration services;

(ii) Sign language interpretation; or

(iii) Cued language interpretation.

(61) "Single point of entry" means the contact point in the local jurisdiction designated by each local lead agency to accept referrals from primary referral sources and others who suspect a developmental delay in an infant or toddler.

(62) "Social work services" means services that may include:
(a) Making home visits to evaluate a child's living conditions and patterns of parent-child interaction;

(b) Preparing a psychosocial developmental assessment of the child within the family context;

(c) Providing individual and family-group counseling with parents and other family members and appropriate social skill-building activities with the child and parents;

(d) Working with those problems in a child's and family's living situation, such as home, community, and any center where early intervention services are provided that affect the child's maximum utilization of early intervention services; and

(e) Identifying, mobilizing, and coordinating community resources and services to enable the child and family to receive maximum benefit from early intervention services.

(63) "Special instruction" means services that may include:
(a) The design of learning environments and activities that promote the child's acquisition of skills in a variety of developmental areas including cognitive processes and social interaction;

(b) Curriculum planning including the planned interaction of personnel, materials, and time and space that leads to achieving the outcomes in the child's individualized family service plan;

(c) Providing families with information, skills, and support related to enhancing the skill development of the child; and

(d) Working with the child to enhance the child's development.

(64) "Speech-language pathology" means services which may include:
(a) Identification of children with communicative, language, or oral pharyngeal disorders and delays in development of communication skills;

(b) Diagnosis and appraisal of specific speech language disorders and delays;

(c) Referral for medical or other professional attention necessary for the habilitation or rehabilitation of communicative, language, or oral pharyngeal disorders and delays in development of communication skills; and

(d) Provision of habilitative, rehabilitative, or preventative services for communicative or oral pharyngeal disorders and delays in development of communication skills.

(65) "Transportation" means the cost of travel that are necessary to enable an eligible child and the child's family to receive early intervention services and includes mileage, travel by taxi, common carrier, or other means, and other related costs, such as tolls and parking expenses.

(66) Vision Services.
(a) "Vision services" means services that include the evaluation and assessment of visual functioning, including the diagnosis and appraisal of specific visual disorders, delays, and abilities;

(b) "Vision services" include referral for medical or other professional services necessary for the habilitation or rehabilitation of visual functioning disorders, or both; and

(c) "Vision services" include:
(i) Communication skills training;

(ii) Orientation and mobility training for all environments;

(iii) Visual training;

(iv) Independent living skills training; and

(v) Additional training necessary to activate visual motor abilities.

(67) Ward of the State.
(a) "Ward of the State" means a child:
(i) For whom a State or county agency or official has been appointed legal guardian; or

(ii) Who has been committed by a court of competent jurisdiction to the legal custody of a State or county agency or official with the express authorization that the State or county agency or official make educational decisions for the child.

(b) "Ward of the State" does not include a foster child who has a foster parent who meets the definition of a parent as defined in §B(45) of this regulation.

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