New York State Association of County Health Officials. Proposal to Restructure New York s Early Intervention Program

Transcription

1 New York State Association of County Health Officials Proposal to Restructure New York s Early Intervention Program January 14, 2003

2 New York State Association of County Health Officials Proposal to Restructure New York s Early Intervention Program The New York State Association of County Health Officials (NYSACHO) recommends the restructuring of New York s Early Intervention (EI) program by (1) reforming the model of care, (2) increasing provider accountability, and (3) revising the distribution of fiscal responsibility. NYSACHO believes that the restructuring of EI must first and foremost ensure that families of children with developmental delay and disabilities are assured appropriate and quality services through a family-oriented model that provides parents with the knowledge and tools to address the special needs of their children. At the same time, training, monitoring, and approval of providers, including evaluators and service coordinators, must be improved. Finally, financial responsibility for this program must more accurately reflect the contributions and roles of state and local governments, insurers, and families. Background In November, 2002, NYSACHO surveyed New York City and the 57 counties in New York State regarding Early Intervention (EI) expenditures incurred in 1993, 1997, and 2000; and forecasted for That survey documented a 41-fold increase statewide in total local EI expenditures from 1993, the year the program was implemented, to Local EI budgets accounted for increasingly large percentages of local health department budgets: on average, EI expenditures represented 6% of health department budgets in 1993 but were projected at 81% of total department budget in Between 1993 and 2002, cost for services increased 44-fold while the number of active children in the program increased 7-fold. On average for the three reporting years of 1997, 2000 and 2002, administration accounted for 11% of total costs. In the nine years since the program was implemented, EI expenditures have rapidly dwarfed those of all other public health programs. If expenditures continue unabated in the face of the current fiscal crisis, EI threatens to deplete critical and already scarce resources needed to safeguard the health and safety of all New Yorkers. Action must be taken immediately in order to protect the public health infrastructure while preserving the benefits of the EI program. Model of Care At the program s inception, one of the guiding principles and federal mandates of EI was to provide parents with the knowledge and tools to meet the identified special needs of their children; the purpose of professional intervention was to support and enable that family education process. This intent, which was consistent with and supported by the Federal statute, has not been met in New York State: the Early Intervention program in New York is a clinically-focused program of direct service provision, with family training secondary and only used to support service delivery by professionals. 2

3 Current research shows the consultative model of family competency-enhancement to be more efficient and effective in meeting family-identified functional outcomes. NYSACHO believes that reform of the Early Intervention program must have this supportive model of service provision, aimed at enhancing the capacity of the family to manage the special needs of a child with disability, as its overriding goal. Consonant with this change in philosophy must be a revision of the categories of service to those that are family-oriented and not driven by service provider interests. The current service taxonomy encourages and indeed virtually compels counties to create Individualized Family Services Plans (IFSPs) that perpetuate this providercentered view of the program. NYSACHO recommends that a work group, supported by national consultants, be convened to develop categories of service and service delivery models that can be used in local IFSP processes to achieve family-oriented plans of care. New categories of service should: 1. facilitate the achievement of child-specific developmental milestones and functional outcomes considering the family s concern, resources and priorities; 2. ensure family involvement in the delivery of EI services and supports for infants and toddlers via a consultative model in a natural environment in accordance with the IDEA; and 3. relate to objective discharge criteria. Finally, services not related to developmental milestones should be more clearly identified and better coordinated to achieve and support a family-oriented model of care while avoiding cost shifting and placing inappropriately broad responsibilities directly on the EI system. Training regarding community resources and related services, information and referral functions, and assistance to families with transition should be required. Specific health services under Section of the Federal IDEA regulations that are necessary to enable a child to benefit from other early intervention services but that are excluded from EI, should be more clearly defined and identified. Provider Accountability NYSACHO recommends that the current range of independent and agency providers should be retained statewide, even while training and monitoring are enhanced. NYSACHO first recommends that a more comprehensive, joint local/state provider application process with improved standards for the approval and recertification of independent and agency providers should be instituted. NYSACHO also believes that the New York Early Intervention computer information system (NYEIS) currently under development should be tailored to maximally support the legal and fiduciary responsibilities of the New York State Department of Health as lead agency and of municipalities as both the EI Official and the local contracting authority responsible for payment, administration and oversight of the EI program. In addition, NYSACHO recommends the following specific actions relative to service provision, evaluation, and service coordination. 3

4 Service Provision NYSACHO supports the delineation of services into two components in order to increase accountability. 1. Core services that all providers should conduct: ensuring team meeting model, or inter- disciplinary consultation model, in a structured format, for all children/families receiving more than one service (excluding service coordination); providing oversight of service delivery in an organized and scheduled manner; maintaining written QA activities and/or internal monitoring instruments/procedures; planning and implementing staff development activities and maintaining records of completion/participation; and for agency providers, mentoring in an organized and scheduled manner those employees/contractors who do not meet minimum experience requirements. 2. Direct services that should be provided in accordance with an approved IFSP. Evaluation NYSACHO recognizes the critical role played by evaluators in determining eligibility and helping to ensure the development of appropriate IFSPs. Accordingly, NYSACHO recommends three actions to improve the current system of evaluation: 1. develop a statewide system of evaluators independent of service providers to reduce potential for conflict of interest; 2. institute a statewide system for training and certification of EI evaluators ensuring compliance with law and regulations; and 3. establish a system for pre-ifsp peer review of evaluations relative to eligibility determinations, which can be accessed by EI Officials as appropriate. In addition, NYSACHO recommends that a stronger statewide program be instituted for training and qualifying administrative law judges in federal Individuals with Disabilities Education Act (IDEA) and in New York State Public Health Law Article 25. Service Coordination NYSACHO recommends that a standard, statewide definition of service coordination be developed that specifically defines billable activities. Currently, there is wide variability in what constitutes initial and ongoing service coordination. NYSACHO also urges that the current time-based payment methodology and standards for documenting service coordination be retained and more closely monitored. Changes in documentation requirements or movement towards a capitated method of payment should not be implemented until the State Department of Health and Division of Budget have examined the potential impact on efficiency, quality and cost of service coordination. 4

5 Financial Responsibility NYSACHO immediately opposes any increase in EI rates of payment. Chapter 82 of the Laws of 2002 provides for a 3% increase in rate of payment to EI providers retroactive to December 1, 2002, for the purposes of recruitment and retention of staff. Approval of the rates and of the State Medicaid Plan amendment is pending by the State Division of Budget and by the federal Centers for Medicare and Medicaid Services, respectively. Confronted by State and local budget deficits and gloomy economic forecasts, passage of a rate increase would be irresponsible. NYSACHO also strongly recommends that the current price-based rate methodology in EI be retained. The existing non-provider specific price-based rate methodology must not be altered until the basic model of care has been restructured and implemented to become more closely aligned with original federal intent. Any proposal to move to a cost-based, cost-report driven system, in particular one that includes capital costs, must be opposed: such a proposal would significantly increase costs without any evidence that access to or quality of services would be increased, and would conflict with the spirit and letter of the federal IDEA. Finally, NYSACHO recommends a more equitable distribution of the financial responsibility of this statewide program to reduce the current disproportionate burden on local tax dollars. 1. The 50% State share of program costs for services should extend to county administrative activities. Currently, counties receive thirty cents on the dollar in state aid reimbursement for EI activities. 2. So long as counties continue to be required to bill third party insurers for EI services, administrative guidance must be issued that reflects a reasonable investment of county resources. Most critical to any real improvement in levels of insurance reimbursement, however, is the amendment of State insurance laws so that private insurance helps pay for EI services as was originally intended. NYSACHO supports reintroduction of a draft bill (introduced in 2002 as A11436) as the best means to achieve a reduction in tax levy share of expenses. 3. A statewide and uniform means-tested family contribution system for direct services should be instituted