Fiscal Strategies to Support and Sustain Early Intervention Services

1. Fiscal Strategies to Support and Sustain Early Intervention Services Kyla Patterson, Virginia Alice Ridgway, Connecticut Charlene Robles, Hawaii

2. OSEP Disclaimer 2019 OSEP Leadership Conference DISCLAIMER: The contents of this presentation were developed by the presenters for the 2019 OSEP Leadership Conference. However, these contents do not necessarily represent the policy of the Department of Education, and you should not assume endorsement by the Federal Government. (Authority: 20 U.S.C. 1221e-3 and 3474)

3. Welcome and Session Objectives • Understand 3 states’ fiscal challenges, the strategies they used, and the impacts of their efforts • Virginia • Connecticut • Hawaii • Discuss effective strategies used or are planning to use to address your state’s fiscal challenges

4. ITCA Fiscal Initiative Through collaborative efforts of ITCA, NCSI, ECTA, DaSY and OSEP, finance academies for state teams (5 different cohorts) have been held covering a range of fiscal topics: • major funding sources (with in-depth articulation and sharing of successful examples of state utilization); • identification of influence webs within state systems (e.g. state Medicaid director, managed care organization leadership, legislative champion(s)); • strategic finance planning; • use of fiscal data and allocation and distribution of funds; collection and management of resources; and • resource accountability

5. Fiscal Planning • Participation in the ITCA Fiscal Initiative has contributed to states’ knowledge of how fiscal data, including data from the finance component of the ECTA System Framework, can be used to inform fiscal planning and practices to improve the fiscal component of the system.

6. Virginia • Department of Behavioral Health and Developmental Services • 40 Local Lead Agencies • State EI Funds, Medicaid, Private Insurance, Family Fees

7. Virginia - Challenge Annual funding shortfalls in some local systems • Allocation formula for distribution of federal and state funds equitable? • Local lead agency knowledge and skills sufficient for effective local fiscal management and oversight?

8. Virginia - Activities • Evaluation of allocation formula • Orientation process and materials • New budget and fiscal report review protocols and checklists

9. Virginia - Impacts Improved: • Credibility • Knowledge and skills • Consistency

10. Connecticut • Office of Early Childhood (new stand alone agency) • 32 EIS programs (6 autism specialty, 3 hearing specialty) • $60 Million total budget for direct services • 53% Medicaid (including state match) • 37% State Part C funds • 3% Family Cost Participation Fees • 3% Federal Part C funds • 2% Federal Part B funds (child find) • 2% Commercial Insurance

11. Connecticut - Challenge 2010 letter from CMS finally enforced by the state. ~Required to unbundle Medicaid rates and move from “pay and chase” to “chase and pay”. EVERYTHING CHANGED

12. Connecticut - Plate Tectonics 101

13. Connecticut - Activities • RFP > PCG as Central 3rd Party Billing Contractor • Every Procedure and Contract Changed • “State Rates” set by DSS for Medicaid are OK • Set Rules General Administrative Payment (GAP) • New State Plan Amendment & 1915(b)4 Waiver • New Audit Protocols at DSS and OEC

14. Connecticut – Additional Activities • EPSDT EIS Services include • Evaluation • Assessment • IFSP meeting • EI “Treatment” Services • Joint visits permitted even if same discipline • Transition Conferences and IEP meetings are considered EITS “to support the family”

15. Connecticut - Impacts • Complete mistrust of all four data systems… OEC, PCG, DXC/DSS and Change Healthcare • Significant increase (2x) in Medicaid Revenue • True interagency collaboration with DSS • Skin in the Game – insurance data is improving • Increased productivity at provider level • $1.1 M deficit due to more children, covered

16. Hawaii • Hawaii Part C is within the Department of Health • 19 Early Intervention Programs • 16 Purchase of Service (Contracted) • 3 State Operated (Dept. of Health) • Funding Source: State General Funds and Federal Funds • Reimbursement Claims: Medicaid and Tricare • No family fees or private insurance claims

17. Hawaii - Challenges • Hawaii Part C funding remained leveled for at least 5 years • Low reimbursement rate for service providers • Inadequate salaries for providers and support staff • Recognized that funding was insufficient to sustain Part C program • Natural increase in cost for services and cost of living

18. Hawaii - Activities • Conducted a Rate and Salary Study by the Western Interstate Commission for Higher Education (WICHE) • Submitted a supplemental budget request for $2.7M • Received $2.7M funding beginning July 1, 2019; funds added to Part C base budget • Communicated need to increase shortage differential for difficult to fill State provider positions • Department of Health increased shortage differential for provider positions • Implemented Fiscal Action Plan • Infant Toddlers Coordinator Association Fiscal Initiative, Cohort IV • Completed Early Childhood Technical Assistance (ECTA) System Framework – Fiscal • Working on DaSy Fiscal Profiles • Exploring Medicaid reimbursement – Early Periodic Screening and Developmental Testing (EPSDT)

19. Hawaii - Impacts • Budget adjustments for all Purchase of Service providers (contracted) • Increased all provider reimbursement rates by 15 - 30% • Increased all program administrative salaries by 20% • Increased indirect expense budget by 11.8% • Increased mandatory training rate from $150/day to $300/day • Shortage differentials for providers increased (State operated) • Increased activity in recruitment and positions are being filled • ITCA Fiscal Initiative Action Plan • Ensures fiscal activities are in place to improve and sustain Hawaii Part C system

20. Discussion • Who have you found to be key partners in your state as you work to improve your fiscal systems? • What’s one creative strategy you’ve used to address a state fiscal challenge that another state might benefit from knowing? • What is the top fiscal challenge you face in your state and what is one strategy you’re using or planning to use to address it?

21. Contact Information Kyla Patterson, Virginia k.patterson@dbhds.virginia.gov Alice Ridgway, Connecticut Alice.Ridgway@ct.gov Charlene Robles, Hawaii charlene.robles@doh.hawaii.gov

22. OSEP Disclaimer 2019 OSEP Leadership Conference DISCLAIMER: The contents of this presentation were developed by the presenters for the 2019 OSEP Leadership Conference. However, these contents do not necessarily represent the policy of the Department of Education, and you should not assume endorsement by the Federal Government. (Authority: 20 U.S.C. 1221e-3 and 3474)