Part C of the IDEA and Family Education and Support Programs: Use of the Established Condition List for Type I Eligibility May 23, 2019 When determining Type I Eligibility for Part C of the IDEA and Family Education and Support Programs: 1. The Program providers use the Established Condition Statement as completed and signed by a physician or psychologist. 2. After receipt of the Statement, the Program providers' designated personnel will refer to this Established Condition List to determine if the child's condition is one that is identified as meeting Type I Established Condition criteria in the Montana. 3. If yes, the Program provider completes the multidisciplinary assessment (with written consent from the family) of the child's needs and family's concerns, priorities, and resources to enhance the development of the child for the development of the IFSP. 4. If no, the Program provider (with written consent from the family) moves toward establishing Type II Measured Delay eligibility (50% delay in one developmental domain or two or more 25% delays in developmental domains) using a multidisciplinary evaluation team that includes the family, the service coordinator, and at least one other discipline. 5. If yes, the child meets Type II Measured Delay eligibility, the Program provider completes (with written consent from the family) the multidisciplinary assessment of the child's needs and family's concerns, priorities, and resources to enhance the development of the child for the development of the IFSP. 6. If no, the family receives written notification of the eligibility decision and the Program provider shares more appropriate referrals with the family. 7. Eligibility is determined annually, and child assessments are completed at least annually to monitor development and appropriately develop IFSPs based upon the child's assessed developmental needs and the family's concerns, priorities, and resources to enhance the development of the child. 1 | Page Montana DPHHS Part C of the IDEA Program and FES Program Established Condition List 6 12 2019 The following conditions meet the Type I Established Condition criteria in Montana The following conditions meet the Type I Established Condition criteria for Montana DPHHS Part C of the IDEA Program and FES Program 6 12 19. Medical Diagnosis Name Diagnosis Details Acrocallosal Syndrome, Schinzel Acrocallosal Syndrome, Schinzel Type (aka: Schinzel Acrocallosal Syndrome; Acrocallosal Syndrome, Schinzel Type; ACLS; ACS; Hallux duplication, postaxial polydactyly, absence of the corpus callosum, severe mental retardation syndrome) Adrenoleukodystrophy Adrenoleukodystrophy (aka: ALD; AMN; X-ALD; Addison disease and cerebral sclerosis; Adrenomyeloneuropathy; Siemerling-creutzfeldt disease; Bronze schilder disease; Schilder Disease; Melanodermic Leukodystrophy; sudanophilic leukodystrophy; Pelizaeus Merz... Agenesis of Corpus Callosum Agenesis of the Corpus Callosum (aka: Absence of the corpus callosum; Hypogenesis of the corpus callosum; Dysplastic corpus callosum) Aicardi Syndrome Aicardi Syndrome (aka: Agenesis of Corpus Callosum and Chorioretinal Abnormality; Agenesis of Corpus Callosum With Chorioretinitis Abnormality; Agenesis of Corpus Callosum With Infantile Spasms and Ocular Anomalies; Chorioretinal Anomalies with Agenesis ... Alexander Disease Alexander Disease Allan Herndon Syndrome Allan Herndon Syndrome (aka: Allan-Herndon-Dudley Syndrome (AHDS); Allan-Herndon-Dudley Mental Retardation) Alper Disease Alper Disease (aka: Alper's Diffuse Degeneration of Cerebral Gray Matter with Hepatic Cirrhosis; Alpers Progressive Infantile Poliodystrophy; Christensen's disease; Christensen-Krabbe disease; Diffuse Cerebral Degeneration in Infancy; Poliodystrophia Cer... Anencephaly Anencephaly Angelman Syndrome Angelman Syndrome (aka: AS) Aniridia Cerebellar Ataxia MD Aniridia Cerebellar Ataxia Mental Deficiency (aka: Gillespie syndrome; Aniridia, Partial-Cerebellar Ataxia-Oligophrenia; Aniridia-Cerebellar Ataxia-Mental Retardation)hrenia) Anophthalmia, bilateral Anophthalmia, bilateral Aphasia w brain damage Aphasia (with evidence of brain damage) (aka: aphemia with evidence of brain damage) Argininosuccinic aciduria Argininosuccinic aciduria (aka: Arginino Succinase Deficiency; ASA Deficiency; Argininosuccinate Lyase Deficiency; ASL Deficiency) 2 | Page The following conditions meet the Type I Established Condition criteria for Montana DPHHS Part C of the IDEA Program and FES Program 6 12 19. Medical Diagnosis Name Diagnosis Details Asphyxia w brain damage Asphyxia (with evidence of brain damage within athe first couple days of the event) Autism Spectrum Disorder Autism Spectrum Disorder (aka: Infantile Autism; Kanner Syndrome; Autistic Disorder; Asperger Syndrome; Asperger's Disorder; Pervasive Developmental Disorder; PDD; Pervasive Developmental Disorder-Not Otherwise Specified; PDD-NOS) Baller Gerold Syndrome Baller Gerold Syndrome (aka: Craniosynostosis with Radial Defects, Craniosynostosis-Radial Aplasia Syndrome) Bannayan Riley Ruvalcaba Bannayan Riley Ruvalcaba (aka: Bannayan Riley Ruvalcaba Syndrome; BRRS, Bannayan-Zonana syndrome (BZS); Macrocephaly, multiple lipomas, and hemangiomata; Macrocephaly, pseudopapilledema, and multiple hemangiomata; Riley-Smith syndrome; Ruvalcaba-Myhre-Sm... Bardet-Biedl Syndrome Bardet-Biedl Syndrome (aka: Biedl-Bardet Syndrome; Laurence Moon-Biedl) Batten Disease Batten Disease (aka: CLN3, JNCL, Neuronal Ceroid Lipofuscinosis, Juvenile, Spielmeyer-Sjogren Disease, Vogt-Spielmeyer Disease, or Vogt-Spielmeyer-Sjogren Disease) Borjeson Syndrome Borjeson Syndrome (aka: BORJ; Borjeson-Forssman-Lehmann Syndrome; BFLS) Brain Tumor Brain Tumor (aka: brain cancer; brain teratoma; glioma; astrocytoma; glioblastoma multiforme; ependymoma; oligodendroglioma; medulloblastoma; meningioma; Schwannoma; acoustic neuroma; craniopharyngioma; germ cell tumor of the brain; germinoma; pineal reg... C Syndrome C Syndrome (aka: Opitz Trigonocephaly Syndrome, Trigonocephaly "C" Syndrome, Trigonocephaly Syndrome) Cardiofaciocutaneous Syndrome Cardiofaciocutaneous syndrome (aka: CFC syndrome, Cardio-facial-cutaneous syndrome, Facio-cardio- cutaneous syndrome) Cerebellar agenesis Cerebellar Agenesis (aka: Cerebellar Aplasia; Cerebellar Hemiagenesis; Cerebellar Hypoplasia; Cerebellar Atrophy) Cerebral atrophy Cerebral atrophy Cerebral Dysgenesis Cerebral Dysgenesiias Cerebro Oculo Facio Skel Syndrome Cerebro Oculo Facio Skeletal Syndrome (aka: COFS Syndrome, Cerebrooculofacioskeletal Syndrome, Cockayne Syndrome type II, Pena Shokeir II Syndrome, Pena Shokeir Syndrome Type II) Cerebromalacia Cerebromalacia (aka: Encephalomalacia) CHAMP 1 Champ 1 gene mutation CHARGE Syndrome CHARGE Syndrome (aka: CHARGE Association) 3 | Page The following conditions meet the Type I Established Condition criteria for Montana DPHHS Part C of the IDEA Program and FES Program 6 12 19. Medical Diagnosis Name Diagnosis Details Chromosome 10, Monosomy 10p Chromosome 10, Monosomy 10p (aka: 10p Deletion Syndrome (Partial); Chromosome 10, 10p- Partial; Chromosome 10, Partial Deletion (short arm)) Chromosome 11, Partial Monosomy 11q Chromosome 11, Partial Monosomy 11q (aka: 11q- Syndrome; Partial, Deletion 11q Syndrome, Partial; Distal 11q Monosomy; Distal 11q- Syndrome; JBS; Jacobsen Syndrome; Monosomy 11q, Partial; Partial Monosomy of Long Arm of Chromosome 11; 11q14 deletion; 11q21 deletion; 11q14-21 deletion) Chromosome 11, Partial Trisomy 11p14.3 Chromosome 11, Partial Trisomy 11p14.3 Chromosome 11, Partial Trisomy 11q Chromosome 11, Partial Trisomy 11q (aka: 11q Partial Trisomy, Chromosome 11; Partial Trisomy 11q13-qter, Chromosome 11; Partial Trisomy 11q21-qter;, Chromosome 11; Partial Trisomy 11q23- qter; Distal Trisomy 11q; Partial Trisomy 11q; Trisomy 11q, Partial) Chromosome 12 Deletion Chromosome 12 deletion Chromosome 12 Partial Trisomy Partial Trisomy 12 Chromosome 13, Partial Monosomy 13q Chromosome 13, Partial Monosomy 13q (aka: 13q- Syndrome, Partial; Deletion 13q Syndrome, Partial; Monosomy 13q, Partial; Partial Monosomy of the Long Arm of Chromosome 13) Chromosome 14 Deletion Chromosome 14 deletion Chromosome 14 Ring Chromosome 14 Ring (aka: Ring 14; Ring Chromosome 14; r14) Chromosome 14, Trisomy Mosaic Chromosome 14, Trisomy Mosaic (aka: Trisomy 14 Mosaic; Trisomy 14 Mosaicism Syndrome; Trisomy 14 Syndrome) Chromosome 15 Ring Chromosome 15 Ring (aka: Ring 15; Ring 15 Chromosome; Ring 15 Chromosome (mosaic pattern); r15) Chromosome 15, Distal Trisomy 15q Chromosome 15, Distal Trisomy 15q (aka: Chromosome 15, Trisomy 15q2; Distal Duplication 15q; Partial Duplication 15q Syndrome) Chromosome 15q11-q13 Dup Chromosome 15q11-q13 duplication (aka: Isodicentric 15; Inverted duplication 15) Chromosome 15q24 microdeletion Chromosome 15q24 Microdeletion Syndrome syndrome Chromosome 16 Duplication Chromosome 16 Duplication Chromosome 17q12 Duplication Chromosome 17q12 Duplication Chromosome 18 Ring Chromosome 18 Ring (aka: Ring 18; Ring Chromosome 18; r18) Chromosome 18, Tetrasomy 18p Chromosome 18, Tetrasomy 18p (aka: Tetrasomy, Short Arm of Chromosome 18) Chromosome 19p duplication Chromosome 19p duplication 4 | Page The following conditions meet the Type I Established Condition criteria for Montana DPHHS Part C of the IDEA Program and FES Program 6 12 19. Medical Diagnosis Name Diagnosis Details Chromosome 20q Trisomy Chromosome 20q Trisomy (aka: Chromosome 20q Duplication; Partial Trisomy 20q; Trisomy 20q11.2; Chromosome 20q11.2 Duplication; Trisomy 20) Chromosome 22 Ring Chromosome 22 Ring