NICU follow-up partnerships for infant therapy referrals

This guide is for pediatric OT, PT and SLP practices that see infants. A NICU follow-up program refers to a practice it can rely on: name clinicians with infant training, state your ages, settings, payers and real openings, take referrals through a secure route, send findings back, and explain how your services sit beside Part C early intervention.

It covers babies and toddlers only; the adult referrals guide covers adult referral sources. Where a rule is federal, the guide cites it; where states set their own version, it says which office to ask.

What does a NICU follow-up program need from a community practice?

It needs a practice that can safely take the particular infant it is about to refer, and it needs to know that before it sends the referral. A 2008 AAP policy statement frames discharge planning for high-risk neonates around making sure all necessary care is available and well coordinated after discharge.⁠¹⁰ The AAP’s 2023 clinical report sorts prematurity and NICU experiences by risk of developmental impairment and uses that framework to guide referral for appropriate therapies.⁠¹¹ Settle five things before you ask for those referrals.

The family needs the same clarity. An APTA Pediatrics fact sheet on the move from the NICU to early intervention asks that families know what follow-up to expect and whom to contact with concerns, and that everyone understand which follow-up PT settings exist and how the family gets to appointments.⁠¹²

Who refers infants to therapy after NICU discharge?

Referrals can come from anyone following the baby after discharge: the hospital’s follow-up clinic and its neonatologist or developmental pediatrician, NICU therapists and discharge planners, and the pediatrician who becomes the medical home. The AAP’s 2013 clinical report on early intervention and the medical home stresses timely referral and collaborative partnerships in care, including comanagement of infants with special health care needs.⁠¹³

The same team may be referring the baby to early intervention at the same time. Under Part C of the Individuals with Disabilities Education Act (IDEA), hospitals, physicians and parents are primary referral sources, and each state’s procedures must provide for referral as soon as possible and no more than seven days after a child is identified.⁠¹ Your practice is on that list as one of the “other clinics and health care providers”, so learn your state’s procedure.⁠¹ Parents can also call the program themselves; CDC tells families a doctor’s referral is not necessary.⁠¹⁴

So ask what the referral is for: one discipline-specific evaluation, such as PT for a head-turn preference, ongoing treatment, or an evaluation while the family waits for early intervention. Each calls for a different answer from your schedule.

How does private infant therapy fit beside Part C early intervention?

They are separate services that can run side by side: Part C is a public program each state administers through a lead agency its governor designates, and private outpatient therapy is care your practice delivers and bills on its own terms.⁠¹⁵ States differ in which agency leads Part C and what they call the program, and CDC tells families that each state has its own rules about eligibility and services.⁠^14,16

APTA Pediatrics’ comparison for physical therapy notes that the two often overlap and confuse families, and that an early intervention evaluation may or may not include a PT.⁠²⁰ Explain the difference in plain words, and never present your clinic as a replacement for the state program.

Which infants are eligible for Part C early intervention?

A child under three qualifies when the child needs services because of a developmental delay, measured by appropriate instruments in cognitive, physical, communication, social or emotional, or adaptive development, or because of a diagnosed condition with a high probability of resulting in delay.⁠²¹ Each state sets its own definition of developmental delay.⁠²² A state may also serve at-risk infants, a group the federal rule describes with factors such as low birth weight, respiratory distress as a newborn, lack of oxygen, brain hemorrhage and infection.⁠^21,23 A baby born early can qualify in one state and not the next, so leave the eligibility answer to the program.

Who pays for early intervention, and can families use both?

Some Part C work is always free, the rest follows the state’s system of payments, and families can use private therapy alongside it. Child find, evaluation and assessment, service coordination and IFSP work carry no fee; other services may carry sliding fees under written state policies, and a family that meets the state’s definition of inability to pay receives all Part C services at no cost.⁠³ Part C pays last, only for services a child is not entitled to have paid from another public or private source.⁠²⁴

A state generally needs the parent’s consent to bill private insurance for Part C services and must explain potential costs, including the loss of benefits under annual or lifetime coverage caps.⁠²⁵ Ask whether early intervention bills the plan your practice bills, so neither side is surprised by a benefit limit. On using both, the IFSP identifies services the child receives from other sources, and ASHA notes that private practices also serve infants outside Part C, billing insurance or the family.⁠^5,16

Can a private practice also be an early intervention provider?

That is your state’s decision: the lead agency supervises the EIS providers that deliver Part C services, and ASHA notes that requirements for SLPs in Part C programs vary by state.⁠^16,17 If you do both, keep them apart: Part C services follow the IFSP, and Part C’s confidentiality rules cover the records EIS providers keep under Part C.⁠^26,27 Separate records, billing and scheduling make that line easy to hold.

Which infant services do OT, PT and SLP each provide after the NICU?

Each discipline has its own part, so describe your services by discipline rather than as general infant therapy. Part C defines each one, and each profession’s documents add detail.

For torticollis, the APTA Academy of Pediatric Physical Therapy’s 2024 clinical practice guideline covers screening, examination, referral to other providers, intervention and discharge, and the academy publishes a handout for referring providers.⁠^28,30 For infants at high risk of cerebral palsy, a 2017 systematic review found the most predictive tools before 5 months’ corrected age were term-age MRI, the Prechtl Qualitative Assessment of General Movements and the Hammersmith Infant Neurological Examination, and urged prompt referral to diagnostic-specific early intervention.⁠³¹ List only what your clinicians deliver; if no one evaluates feeding, say so.

Who handles infant feeding: the SLP, the OT, or both?

Both disciplines work in feeding, so decide inside your practice who takes which feeding question and say it on your referral sheet. ASHA calls SLPs the preferred providers of dysphagia services within an interprofessional team that can include an OT or PT, and describes an infant evaluation covering prefeeding skills, readiness for oral feeding, breast or chest and bottle feeding, and caregivers feeding the child.⁠³² AOTA describes OT as playing a crucial role in feeding, eating and swallowing across the lifespan.⁠³³ Check each discipline’s state practice act.

Know your setting’s limit. ASHA states that instrumental swallowing evaluation is completed in a medical setting.⁠³² Tell the program how you arrange one when a clinical evaluation points to it, and through which physician.

How do you show a follow-up program your clinicians are infant-ready?

Name the clinicians, their discipline, their infant training and their limits, and let the program judge the fit. ASHA states that SLPs serving a pediatric population should be educated and appropriately trained, and lists knowledge an infant feeding evaluation needs, including medical issues of preterm and medically fragile newborns and respiratory support at home.⁠³² An APTA Pediatrics fact sheet calls neonatal physical therapy a subspecialty requiring advanced expertise and suggests building toward it by working with NICU graduates in early intervention, hospitals or follow-up programs.⁠³⁴ Follow-up work is a route into infant expertise, so write a supervised pathway for any clinician still building it.

Use corrected age throughout. AAP guidance explains that corrected age subtracts the weeks born early, counted from 40 weeks, and that using it for the first two years gives a better idea of when a preterm baby should reach common developmental goals.⁠³⁵ For feeding, ASHA adds that a premature infant’s skills follow neurodevelopmental level rather than chronological or adjusted age.⁠³²

Which infant assessments should your clinicians be trained to use?

The ones your discipline needs for the question asked and the ones the program already uses; list both by name. APTA Pediatrics’ neonatal fact sheet includes standardized assessments that bridge the NICU to early intervention and follow-up settings, and international guidelines for early detection of cerebral palsy, in what neonatal PTs should know.⁠³⁴ If the program uses the General Movements assessment or the Hammersmith examination, say whether anyone on staff is trained in either.⁠³¹

Keep milestone checklists in their place. CDC’s Learn the Signs. Act Early. program offers free milestone resources from 2 months through 5 years for family-engaged monitoring, but CDC states the milestones are not screening tools and should not establish medical necessity for services.⁠^9,36 Screening happens at well-child visits, which CDC reports the AAP recommends at least at 9, 18 and 30 months.⁠³⁷ Your evaluation answers a narrower question with standardized measures.

What equipment and space does infant therapy after the NICU require?

Enough to examine and treat a young infant safely and to fit a family arriving with everything the baby needs. The 2008 AAP statement counts infants dependent on technology among its four high-risk categories, and ASHA expects SLPs evaluating infant feeding to know respiratory support at home and alternative feeding modalities.⁠^10,32

• A clean infant mat and surfaces, with a cleaning routine you can describe
• Positioning supports, wedges and rolls for PT and OT
• For feeding services, the bottles, nipples and seating your clinicians use, and a private space for breast or chest feeding
• Floor space for a car seat, stroller and equipment such as an oxygen tank or feeding pump
• A quiet room with adjustable lighting, and an entrance one caregiver can manage

Ask the follow-up team which handling or positioning precautions apply to each infant rather than assuming them. The APTA Pediatrics transition sheet advises getting medical and developmental equipment in place before discharge and following up early.⁠¹² The pediatric PT guide covers publishing concrete access facts.

How should you describe infant openings, access and scheduling?

Separately for evaluations and ongoing treatment, by discipline and with a date, because the coordinator needs to know whether a baby can start treatment, not only be seen once. Say whether you see infants in the clinic, at home or both, and whether two disciplines can share one morning. The in-home guide covers describing a service area.

Ask how the family is getting to appointments. For a child on Medicaid, the state must tell families eligible for the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit that necessary transportation and scheduling assistance is available on request.⁠³⁸ If you keep an infant waitlist, the waitlist guide covers saying what it holds.

Which payers matter for NICU graduates, including Medicaid?

Medicaid and the family’s commercial plan, with the state’s Part C payment rules running alongside both; tell the program which plans you take before it refers. EPSDT covers children under 21 enrolled in Medicaid, and states must furnish all 1905(a) Medicaid-coverable, medically necessary services needed to correct or ameliorate health conditions.⁠³⁹

Federal Medicaid rules define PT and OT as services prescribed by a physician or other licensed practitioner under state law, and speech, hearing and language services as services a patient is referred for by one.⁠⁶ The state must require ordering or referring professionals to be enrolled, so check that the physician signing the order is enrolled with the program you bill.⁠⁷ Participation is plan by plan: states must require, through their contracts, that each Medicaid managed care plan have written policies for selecting and retaining its own network providers, so joining one plan does not put you in another’s network.⁠⁴⁰

For commercial plans, read each policy on orders, authorization and visit limits. For PT, APTA Pediatrics notes that direct-access states do not require a referral to provide PT though one may be needed for reimbursement, and that copayments and deductibles typically apply.⁠²⁰ For OT and SLP, check the payer and your practice act rather than assuming the PT rule. A discharge recommendation is not an authorization; the insurance and fees guide and the credentialing guide cover costs and joining plans.

How should a NICU follow-up referral reach your practice?

Through one secure route, to one owner, with a clinical review before anyone tells the family yes. HHS defines treatment to include coordination among providers and referral from one provider to another, and a covered entity may disclose protected health information for another provider’s treatment without the patient’s authorization, consistent with its notice of privacy practices.⁠⁸

1. Receive. The referral comes through your published secure route, not a personal email or text.
2. Log and acknowledge. Intake records it the day it arrives and tells the program.
3. Check completeness. Compare it with the packet list and request anything missing in one message.
4. Review fit. The named infant clinician decides whether the practice can take this baby safely.
5. Check the payer. Confirm the plan, any order or authorization, and whether early intervention bills it too.
6. Contact the family. In their preferred language, with a named person, a date and what to bring.
7. Report status. Scheduled, waiting on information, or unable to proceed, and why.

The intake call script covers the family call, and the pediatrician referral guide covers status categories you can reuse.

What should a NICU follow-up referral packet include?

Enough to judge fit and safety before the first visit; print the list on your referral sheet. HHS does not apply the minimum necessary standard to provider-to-provider treatment disclosures, but asking only for what you need keeps the packet usable.⁠⁸

• The referral question and discipline requested
• Date of birth, gestational age at birth and corrected age
• Discharge summary, diagnoses and current precautions
• Feeding method and plan, including tube feeding, and equipment at home
• Any NICU therapy notes
• Early intervention referral status, and the service coordinator if the family consents
• The order the payer requires, the family’s language, and a clinician to call with medical questions

What should your practice send back to the follow-up program?

Status first, then findings, then changes, through the route the program prefers. The APTA Pediatrics transition sheet asks both sides to share preferred contact methods and a plan for follow-up conversations, and APTA Pediatrics’ comparison sheet describes a clinic PT plan of care shared with the physician as appropriate.⁠^12,20

• Soon after receipt: the status message below
• After the evaluation: findings, the plan of care, frequency and anything needing medical attention
• On a change: a new concern, missed visits, a new plan or a referral elsewhere
• At discharge: the outcome and what the family was told to watch for

These are treatment communications, so HIPAA does not require an authorization for them; follow any stricter program policy or state law.⁠⁸ If a PT screen of an infant with torticollis points to something not muscular, the 2024 guideline addresses consultation with and referral to other health care providers, and the follow-up physician is the first call.⁠³⁰

How do you coordinate with an infant’s early intervention team?

Through the family and, with the parent’s consent, the service coordinator named on the IFSP, so the services support each other rather than overlap.⁠⁵ The early intervention program needs parental consent to disclose personally identifiable information, so ask the parent to sign the program’s release as well as yours.⁠⁴

Respect the family’s choices. Parents decide whether to accept or decline any early intervention service at any time, and declining one does not cost them the others.⁠⁴ ASHA states that families have a right to refuse services, and the APTA Pediatrics transition sheet calls families always in control of what they receive.⁠^12,16 Never tell a family to drop one service for the other. If both teams offer the same discipline, agree with the family how they fit and record it.

Plan for age three. Part C serves children under three unless a state extends it, and the IFSP must include steps toward preschool or other appropriate services.⁠^5,21 Tell the family and the program what you offer after the third birthday.

What does a well-handled NICU follow-up referral look like?

One that answers the referral question honestly and ends with findings sent back. The hypothetical below follows one referral.

How do you introduce your practice to a NICU follow-up program?

Ask how the program likes to hear from community providers, then send a short note with a one-page sheet built from your capacity statement and checklist. The pediatrician referral guide covers the outreach steps that carry over, including no gifts or payments for referrals.

Replace every bracket, and leave out any service, payer or opening you cannot deliver. If your clinic has a DrSensory listing, make it match: every clinic has a free basic listing, and a paid listing adds the ages and conditions treated, specialties, hours and family inquiries sent to the clinic. The profile guide covers claiming one.

How do you keep a NICU follow-up partnership working over time?

Review it with the program on an agreed schedule, using a few counts and the reasons referrals stalled, and update the sheet whenever a clinician, payer or opening changes. Count referrals by discipline, time to the status message and to the first evaluation, evaluations attended, summaries sent, and referrals unable to proceed by reason. Keep the counts free of infant identifiers; the records stay in your protected system. Tell the program promptly when an infant-trained clinician leaves or a plan contract ends.

Sources

1. Code of Federal Regulations. 34 CFR 303.303, Referral procedures (eCFR; Title 34 up to date as of October 21, 2026). Checked October 23, 2026.
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   “Provide for referring a child as soon as possible, but in no case more than seven days, after the child has been identified”; “primary referral sources include— (1) Hospitals, including prenatal and postnatal care facilities; (2) Physicians; (3) Parents, including parents of infants and toddlers”; “(8) Other clinics and health care providers”.
2. Code of Federal Regulations. 34 CFR 303.310, Post-referral timeline (45 days) (eCFR; Title 34 up to date as of October 21, 2026). Checked October 23, 2026.
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   “any screening under § 303.320 (if the State has adopted a policy and elects, and the parent consents, to conduct a screening of a child); the initial evaluation and the initial assessments of the child and family under § 303.321; and the initial IFSP meeting under § 303.342 must be completed within 45 days from the date the lead agency or EIS provider receives the referral of the child”; the timeline does not apply for any period when “The child or parent is unavailable” because of “exceptional family circumstances that are documented in the child’s early intervention records” or when “The parent has not provided consent” “despite documented, repeated attempts”.
3. Code of Federal Regulations. 34 CFR 303.521, System of payments and fees (eCFR; Title 34 up to date as of October 21, 2026). Checked October 23, 2026.
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   “The payment system and schedule of sliding or cost participation fees that may be charged to the parent for early intervention services under this part”; “if the parent or family meets the State’s definition of inability to pay, the infant or toddler with a disability must be provided all part C services at no cost”; “The following are required functions that must be carried out at public expense, and for which no fees may be charged to parents: (1) Implementing the child find requirements in §§ 303.301 through 303.303. (2) Evaluation and assessment”; “(3) Service coordination services”; “The development, review, and evaluation of IFSPs and interim IFSPs”.
4. Code of Federal Regulations. 34 CFR 303.420, Parental consent and ability to decline services (eCFR; Title 34 up to date as of October 21, 2026). Checked October 23, 2026.
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   “The lead agency must ensure parental consent is obtained before”; “Disclosure of personally identifiable information consistent with § 303.414”; “Determine whether they, their infant or toddler with a disability, or other family members will accept or decline any early intervention service under this part at any time, in accordance with State law”; “May decline a service after first accepting it, without jeopardizing other early intervention services under this part”.
5. Code of Federal Regulations. 34 CFR 303.344, Content of an IFSP (eCFR; Title 34 up to date as of October 21, 2026). Checked October 23, 2026.
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   “To the extent appropriate, the IFSP also must— (1) Identify medical and other services that the child or family needs or is receiving through other sources, but that are neither required nor funded under this part”; “The IFSP must include the name of the service coordinator”; “The IFSP must include the steps and services to be taken to support the smooth transition of the child”; “Preschool services under part B of the Act, to the extent that those services are appropriate”; “Other appropriate services”.
6. Code of Federal Regulations. 42 CFR 440.110, Physical therapy, occupational therapy, and services for individuals with speech, hearing, and language disorders (eCFR; Title 42 up to date as of October 21, 2026). Checked October 23, 2026.
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   “Physical therapy means services prescribed by a physician or other licensed practitioner of the healing arts within the scope of his or her practice under State law and provided to a beneficiary by or under the direction of a qualified physical therapist”; “Occupational therapy means services prescribed by a physician or other licensed practitioner of the healing arts within the scope of his or her practice under State law and provided to a beneficiary by or under the direction of a qualified occupational therapist”; “Services for individuals with speech, hearing, and language disorders means diagnostic, screening, preventive, or corrective services provided by or under the direction of a speech pathologist or audiologist, for which a patient is referred by a physician or other licensed practitioner of the healing arts within the scope of his or her practice under State law”.
7. Code of Federal Regulations. 42 CFR 455.410, Enrollment and screening of providers (eCFR; Title 42 up to date as of October 21, 2026). “The State Medicaid agency must require all ordering or referring physicians or other professionals providing services under the State plan or under a waiver of the plan to be enrolled as participating providers”. Checked October 23, 2026.
8. U.S. Department of Health and Human Services, Office for Civil Rights. Uses and Disclosures for Treatment, Payment, and Health Care Operations (HIPAA guidance; content last reviewed July 26, 2013). Checked October 23, 2026.
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   ““Treatment” generally means the provision, coordination, or management of health care and related services among health care providers or by a health care provider with a third party, consultation between health care providers regarding a patient, or the referral of a patient from one health care provider to another.”; “A covered entity may, without the individual’s authorization”, “disclose protected health information for the treatment activities of any health care provider (including providers not covered by the Privacy Rule)”; “covered entities are not required to apply the minimum necessary standard to disclosures to or requests by a health care provider for treatment purposes”; “Any use or disclosure of protected health information for treatment, payment, or health care operations must be consistent with the covered entity’s notice of privacy practices.”.
9. Centers for Disease Control and Prevention. Key Points about CDC’s Milestone Checklists (CDC Learn the Signs. Act Early. page). Checked October 23, 2026.
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   “They should not be used as screening or diagnostic tools to detect developmental delays.”; “CDC’s developmental milestones should not be used to establish medical necessity for the initiation or continuation of services. They also should not be used as justification to discontinue services.”.
10. American Academy of Pediatrics, Committee on Fetus and Newborn. Hospital discharge of the high-risk neonate (policy statement, Pediatrics 2008;122(5):1119-1126, doi:10.1542/peds.2008-2174, PMID 18977994; abstract). Checked October 23, 2026.
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    “This statement draws on the previous classification of high-risk infants into 4 categories: (1) the preterm infant; (2) the infant with special health care needs or dependence on technology; (3) the infant at risk because of family issues; and (4) the infant with anticipated early death”; “Recommendations are given to aid in deciding when discharge is appropriate and to ensure that all necessary care will be available and well coordinated after discharge”.
11. American Academy of Pediatrics, Council on Children With Disabilities and Committee on Fetus and Newborn (Davis BE, Leppert MO, German K, Lehmann CU, Adams-Chapman I). Primary Care Framework to Monitor Preterm Infants for Neurodevelopmental Outcomes in Early Childhood (clinical report, Pediatrics 2023;152(1):e2023062511, doi:10.1542/peds.2023-062511, PMID 37357736; abstract). Checked October 23, 2026.
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    “It consolidates extensive contemporary outcome research from 2005 onward into an easy-to-use framework and stratifies prematurity and NICU experiences by degree of risk for developmental impairments”; “guides additional assessment and referral for appropriate therapies”.
12. APTA Academy of Pediatric Physical Therapy, Neonatology and Early Intervention Special Interest Groups. Providing Translational Physical Therapy Services from the Neonatal Intensive Care Unit to Early Intervention (fact sheet, November 2020; member-produced and, by its own statement, not a position of APTA Pediatrics or APTA). Checked October 23, 2026.
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    “Physical therapists working in the NICU and EI settings should be aware of state, program, and hospital system referral procedures for optimal communication and continuity of care.”; “Information on the local EI providers should be provided in such a way that families know what follow-up to expect and who to contact with concerns.”; “Support families in accessing medical and developmental equipment, as well as nutritional and community resource support, before they leave the NICU and follow up on these resources early in the EI referral process.”; “NICU therapists, caregivers, and EI therapists should all have a clear understanding of expected follow-ups, such as follow-up physical therapy settings available and including how the family will get to any follow-up appointments.”; “All NICU therapists, caregivers, and EI therapists should have access to preferred methods of contact for one another and a plan for what follow-up conversations will occur.”; “Families are always in control of what services they receive, at what frequency”.
13. American Academy of Pediatrics, Council on Children With Disabilities (Adams RC, Tapia C). Early intervention, IDEA Part C services, and the medical home: collaboration for best practice and best outcomes (clinical report, Pediatrics 2013;132(4):e1073-e1088, doi:10.1542/peds.2013-2305, PMID 24082001; abstract). Checked October 23, 2026.
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    “Economic, health, and family-focused data each underscore the critical role of timely referral for relationship-based, individualized, accessible early intervention services and the need for collaborative partnerships in care”; “comanagement of infants with special health care needs, including the monitoring of services provided and outcomes achieved”.
14. Centers for Disease Control and Prevention. Early Intervention (CDC Learn the Signs. Act Early. page). Checked October 23, 2026.
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    “Each state, territory, or commonwealth has its own early intervention program and rules about eligibility and services.”; “May include speech therapy, physical therapy, occupational therapy, and other types of therapies or services based on the needs of the child and family.”; “If your doctor is not able to connect you, you can reach out yourself. A doctor’s referral is not necessary.”.
15. Code of Federal Regulations. 34 CFR 303.22, Lead agency (eCFR; Title 34 up to date as of October 21, 2026). Checked October 23, 2026.
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    “Lead agency means the agency designated by the State’s Governor under section 635(a)(10) of the Act and § 303.120 that receives funds under section 643 of the Act to administer the State’s responsibilities under part C of the Act”.
16. American Speech-Language-Hearing Association. Early Intervention (ASHA Practice Portal, professional issues). Checked October 23, 2026.
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    “EI services can also be provided outside of Part C programs in settings such as neonatal intensive care units, pediatric rehabilitation hospitals or clinics, preschools, and private practices. Services in these settings may not be covered by federal or state dollars but may be billed to public or private insurance or to the family.”; “States may differ in terms of which agency they designate to lead the Part C program (e.g., Department of Health, Department of Education, or Department of Rehabilitation Services) and what they choose to name their EI system (e.g., Infants and Toddlers, Early Steps, Strong Start).”; “Requirements for audiologists and speech-language pathologists (SLPs) who work in Part C EI programs also vary by state”; “Families do have a right to refuse EI services.”; “SLPs in EI are qualified to provide services to families and their young children who demonstrate, or are at risk for developing, delays or disabilities in communication, speech, language, cognition, emergent literacy, and/or feeding and swallowing.”.
17. Code of Federal Regulations. 34 CFR 303.120, Lead agency role in supervision, monitoring, funding, interagency coordination, and other responsibilities (eCFR; Title 34 up to date as of October 21, 2026). Checked October 23, 2026.
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    “Each system must include a single line of responsibility in a lead agency designated or established by the Governor”; “The general administration and supervision of programs and activities administered by agencies, institutions, organizations, and EIS providers receiving assistance under part C of the Act”.
18. Code of Federal Regulations. 34 CFR 303.342, Procedures for IFSP development, review, and evaluation (eCFR; Title 34 up to date as of October 21, 2026). Checked October 23, 2026.
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    “A review of the IFSP for a child and the child’s family must be conducted every six months, or more frequently if conditions warrant, or if the family requests such a review”; “informed written consent, as described in § 303.7, must be obtained, as required in § 303.420(a)(3), prior to the provision of early intervention services described in the IFSP”; 34 CFR 303.340 requires an IFSP “developed by a multidisciplinary team, which includes the parent”.
19. Code of Federal Regulations. 34 CFR 303.126, Early intervention services in natural environments (eCFR; Title 34 up to date as of October 21, 2026). Checked October 23, 2026.
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    “To the maximum extent appropriate, in natural environments”; “In settings other than the natural environment that are most appropriate, as determined by the parent and the IFSP Team, only when early intervention services cannot be achieved satisfactorily in a natural environment”; 34 CFR 303.26 defines natural environments as “settings that are natural or typical for a same-aged infant or toddler without a disability, may include the home or community settings”.
20. APTA Academy of Pediatric Physical Therapy, Early Intervention and Hospital-Based Special Interest Groups. Comparison of Early Intervention and Hospital / Clinic-Based Physical Therapy Services (fact sheet, 2020; member-produced and, by its own statement, not a position of APTA Pediatrics or APTA). Checked October 23, 2026.
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    “Many times, EI and hospital/clinic-based physical therapy overlap, and can lead to confusion for families and caregivers.”; “Eligibility varies by state.”; “Child may be referred by a health care provider or the family. Physician referral may be required. In states with direct access, physician referral is not required for provision of physical therapy services but may be needed for reimbursement.”; “Early intervention evaluation may or may not include an evaluation by a PT.”; “The PT’s evaluation includes a plan of care that is shared with the physician and other team members, as appropriate.”; “Families should verify their individual coverage from their insurance companies prior to receiving services as copayments and deductibles typically apply to receiving PT services.”.
21. Code of Federal Regulations. 34 CFR 303.21, Infant or toddler with a disability (eCFR; Title 34 up to date as of October 21, 2026). Checked October 23, 2026.
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    “Infant or toddler with a disability means an individual under three years of age who needs early intervention services because the individual— (1) Is experiencing a developmental delay, as measured by appropriate diagnostic instruments and procedures, in one or more of the following areas: (i) Cognitive development. (ii) Physical development, including vision and hearing. (iii) Communication development. (iv) Social or emotional development. (v) Adaptive development; or (2) Has a diagnosed physical or mental condition that— (i) Has a high probability of resulting in developmental delay”; “Infant or toddler with a disability may include, at a State’s discretion, an at-risk infant or toddler”; “may include, at a State’s discretion, a child with a disability who is eligible for services under section 619 of the Act and who previously received services under this part until the child enters, or is eligible under State law to enter, kindergarten or elementary school”.
22. Code of Federal Regulations. 34 CFR 303.111, State definition of developmental delay (eCFR; Title 34 up to date as of October 21, 2026). “Each system must include the State’s rigorous definition of developmental delay”; “Specify the level of developmental delay in functioning or other comparable criteria that constitute a developmental delay”. Checked October 23, 2026.
23. Code of Federal Regulations. 34 CFR 303.5, At-risk infant or toddler (eCFR; Title 34 up to date as of October 21, 2026). Checked October 23, 2026.
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    “At-risk infant or toddler means an individual under three years of age who would be at risk of experiencing a substantial developmental delay if early intervention services were not provided to the individual”; “At the State’s discretion, at-risk infant or toddler may include an infant or toddler who is at risk of experiencing developmental delays because of biological or environmental factors that can be identified (including low birth weight, respiratory distress as a newborn, lack of oxygen, brain hemorrhage, infection, nutritional deprivation”.
24. Code of Federal Regulations. 34 CFR 303.510, Payor of last resort (eCFR; Title 34 up to date as of October 21, 2026). Checked October 23, 2026.
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    “funds under this part may be used only for early intervention services that an infant or toddler with a disability needs but is not currently entitled to receive or have payment made from any other Federal, State, local, or private source”.
25. Code of Federal Regulations. 34 CFR 303.520, Policies related to use of public benefits or insurance or private insurance to pay for Part C services (eCFR; Title 34 up to date as of October 21, 2026). Checked October 23, 2026.
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    “The State may not use the private insurance of a parent of an infant or toddler with a disability to pay for part C services unless the parent provides parental consent”, except where the state meets the exceptions in paragraph (b)(2); the state must give the parent “a copy of the State’s system of payments policies that identifies the potential costs that the parent may incur when their private insurance is used to pay for early intervention services under this part (such as co-payments, premiums, or deductibles or other long-term costs such as the loss of benefits” under the policy's annual or lifetime coverage caps.
26. Code of Federal Regulations. 34 CFR 303.13, Early intervention services (eCFR; Title 34 up to date as of October 21, 2026). Checked October 23, 2026.
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    “Are provided in conformity with an IFSP”; “Occupational therapy includes services to address the functional needs of an infant or toddler with a disability related to adaptive development, adaptive behavior, and play, and sensory, motor, and postural development”; “Adaptation of the environment, and selection, design, and fabrication of assistive and orthotic devices to facilitate development and promote the acquisition of functional skills”; “Physical therapy includes services to address the promotion of sensorimotor function through enhancement of musculoskeletal status, neurobehavioral organization, perceptual and motor development, cardiopulmonary status, and effective environmental adaptation”; “Screening, evaluation, and assessment of children to identify movement dysfunction”; “Speech-language pathology services include— (i) Identification of children with communication or language disorders and delays in development of communication skills”; “Provision of services for the habilitation, rehabilitation, or prevention of communication or language disorders and delays in development of communication skills”.
27. Code of Federal Regulations. 34 CFR 303.401, Confidentiality and opportunity to examine records (eCFR; Title 34 up to date as of October 21, 2026). Checked October 23, 2026.
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    “the regulations in §§ 303.401 through 303.417 ensure the protection of the confidentiality of any personally identifiable data, information, and records collected or maintained pursuant to this part by the Secretary and by participating agencies, including the State lead agency and EIS providers”.
28. APTA Academy of Pediatric Physical Therapy. Congenital Muscular Torticollis Clinical Practice Guideline & Implementation Resources (web page). “Physical therapists provide assessment of the infant’s neck and postural asymmetries, determine a plan of care that includes stretching, parent education and home programs to address asymmetrical postures.”; its resources include a “CMT Referring Provider Handout”. Checked October 23, 2026.
29. American Occupational Therapy Association. Early Intervention (AOTA practice settings page). “Occupational therapy practitioners provide early intervention services to support the development and learning of babies and young children with developmental delays and disabilities and their families.”. Checked October 23, 2026.
30. Sargent B, Coulter C, Cannoy J, Kaplan SL. Physical Therapy Management of Congenital Muscular Torticollis: A 2024 Evidence-Based Clinical Practice Guideline From the American Physical Therapy Association Academy of Pediatric Physical Therapy (Pediatric Physical Therapy 2024;36(4):370-421, doi:10.1097/PEP.0000000000001114, PMID 39356257; abstract). Checked October 23, 2026.
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    “Congenital muscular torticollis (CMT) is a postural condition evident shortly after birth.”; “The 2024 CMT CPG addresses: education for prevention, screening, examination and evaluation including recommended outcome measures, consultation with and referral to other health care providers, classification and prognosis, first-choice and evidence-informed supplemental interventions, discontinuation from direct intervention, reassessment and discharge”.
31. Novak I, Morgan C, Adde L, et al. Early, Accurate Diagnosis and Early Intervention in Cerebral Palsy: Advances in Diagnosis and Treatment (systematic review, JAMA Pediatrics 2017;171(9):897-907, doi:10.1001/jamapediatrics.2017.1689, PMID 28715518, PMCID PMC9641643; abstract). Checked October 23, 2026.
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    “Before 5 months’ corrected age, the most predictive tools for detecting risk are term-age magnetic resonance imaging (86%-89% sensitivity), the Prechtl Qualitative Assessment of General Movements (98% sensitivity), and the Hammersmith Infant Neurological Examination (90% sensitivity).”; “Clinicians should understand the importance of prompt referral to diagnostic-specific early intervention to optimize infant motor and cognitive plasticity, prevent secondary complications, and enhance caregiver well-being.”.
32. American Speech-Language-Hearing Association. Pediatric Feeding and Swallowing (ASHA Practice Portal, clinical topics). Checked October 23, 2026.
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    “Speech-language pathologists (SLPs) are the preferred providers of dysphagia services and are integral members of an interprofessional team.”; “SLPs who serve a pediatric population should be educated and appropriately trained to do so”; additional team members may include “an OT or a PT”; “Feeding skills of premature infants will be consistent with neurodevelopmental level rather than chronological age or adjusted age.”; “The clinical evaluation for infants from birth to 1 year of age includes an evaluation of prefeeding skills, an assessment of readiness for oral feeding, an evaluation of breastfeeding/chestfeeding and bottle-feeding ability, and observations of caregivers feeding the child.”; SLPs should have extensive knowledge of, among other things, “medical issues common to preterm and medically fragile newborns”, “respiratory support in the hospital and at home” and “alternative feeding modalities”; “Appropriate referrals to medical professionals should be made when anatomical or physiological abnormalities are found during the clinical evaluation.”; “Instrumental evaluation is completed in a medical setting.”.
33. American Occupational Therapy Association. Occupational therapy and feeding, eating and swallowing (AOTA clinical topics page). “Occupational therapy practitioners play a crucial role in addressing feeding, eating, and swallowing challenges for clients across the lifespan.”. Checked October 23, 2026.
34. APTA Academy of Pediatric Physical Therapy. Neonatal Physical Therapy Practice: Roles, Subspecialty Training and Resources for Evidence-Based Practice (fact sheet, October 2022; member-produced and, by its own statement, not a position of APTA Pediatrics or APTA). Checked October 23, 2026.
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    “The American Physical Therapy Association Academy of Pediatrics and the American Board of Physical Therapy Residency and Fellowship Education have recognized neonatal physical therapy as a subspecialty area of practice requiring advanced expertise.”; “pediatric therapists will benefit from initially working with NICU graduates in early intervention, hospitals including pediatric intensive care settings, and/or follow-up programs”; “Collaborate with NICU follow-up programs to ensure early NICU risks are used to determine the need for referral to NICU follow-up”; “Reliability and validity in standardized assessments that bridge the NICU to early intervention and NICU follow-up settings”; “International guidelines for the early detection of cerebral palsy”.
35. American Academy of Pediatrics, HealthyChildren.org. Corrected Age For Preemies (last updated December 10, 2018; adapted from the AAP book Understanding the NICU). Checked October 23, 2026.
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    “Begin with your baby’s actual age in weeks (number of weeks since the date of birth) and then subtract the number of weeks your baby was preterm. This is your baby’s corrected age.”; “To determine the number of weeks’ preterm your baby was at birth, subtract gestational age at birth from 40.”; “During the first 2 years, using your baby’s corrected age will give you a better idea when he or she should reach common developmental goals.”.
36. Centers for Disease Control and Prevention. About Learn the Signs. Act Early. (CDC program page). Checked October 23, 2026.
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    “The Learn the Signs. Act Early. (LTSAE) program aims to improve early identification of developmental delays and disabilities, including autism, by facilitating family-engaged developmental monitoring and promoting developmental screening”; “LTSAE provides free, family-friendly, high-quality, and research-based resources to engage families and providers in monitoring children’s developmental milestones from ages 2 months through 5 years.”.
37. Centers for Disease Control and Prevention. Developmental Monitoring and Screening (CDC Learn the Signs. Act Early. page). Checked October 23, 2026.
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    “The American Academy of Pediatrics (AAP) recommends developmental screening for all children during regular well-child visits at least at these ages”: “9 months”, “18 months”, “30 months”; “Developmental screening can be done by your child’s health care provider, and by other professionals in healthcare, early childhood education, community, or school settings who have been trained in using these tools.”.
38. Code of Federal Regulations. 42 CFR 441.56, Required activities (eCFR; Title 42 up to date as of October 21, 2026). the Medicaid agency must inform EPSDT-eligible individuals or their families “That necessary transportation and scheduling assistance described in § 441.62 of this subpart is available to the EPSDT eligible individual upon request”. Checked October 23, 2026.
39. Centers for Medicare & Medicaid Services, Medicaid.gov. Early and Periodic Screening, Diagnostic, and Treatment (Medicaid benefits page). Checked October 23, 2026.
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    “The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid.”; “States are required to furnish all 1905(a) Medicaid coverable, appropriate, and medically necessary services needed to correct and ameliorate health conditions, based on certain federal guidelines.”.
40. Code of Federal Regulations. 42 CFR 438.214, Provider selection (eCFR; Title 42 up to date as of October 21, 2026). “The State must ensure, through its contracts, that each MCO, PIHP, or PAHP implements written policies and procedures for selection and retention of network providers”. Checked October 23, 2026.

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. It is general guidance on running a therapy practice, not legal, compliance, billing or financial advice. Early intervention, Medicaid and licensure rules differ by state, so confirm them with your state’s lead agency, Medicaid program and licensing board.