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Reminder: ECI Providers Are Not Required to Have Site Visits Conducted by the State Medicaid Agency
Date: March 31, 2025
Attention: ECI Providers
Call to action: A reminder that ECI providers are not required to have a Medicaid site visit conducted by the state Medicaid agency as part of the MCO provider credentialing process. This is because ECI providers are designated ‘limited’ risk. Only providers who are designated as ‘moderate’ or ‘high’ risk are required to have site visits. Therefore, ECI providers do not have to provide a site survey certificate. Federal site visit requirements can be found in 42 Code of Federal Regulations § 455.432.
What is ECI? Early Childhood Intervention (ECI) is a statewide program for children, birth to age three, with disabilities and developmental delays. To be eligible for ECI and receive ECI services from an ECI contractor, a child must have a medically diagnosed condition that has a high probability of resulting in developmental delay, an auditory or visual impairment, or a developmental delay.
Additional information on ECI Services and MCOs: MCOs like Texas Children’s Health Plan (TCHP) must ensure members have access to ECI services, regardless of whether the MCO contracting process with the ECI providers is completed. In this case, MCO/TCHP must make arrangements to pay ECI providers an out-of-network (OON) rate until the contract(s) are in place. Additionally, MCOs/TCHP are required to reimburse OON providers when medically necessary covered services are not available through network providers. More information on ECI and OON requirements can be found in the Uniform Managed Care Manual (UMCM) 16.1.9.2, Out-of-Network Reimbursement for Early Childhood Intervention Services.
Next step for Providers: ECI Providers should share this communication with their staff.
If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.
For access to all provider alerts: https://www.texaschildrenshealthplan.org/providers/provider-news/provider-alerts.