2015 Early Intervention (EI) Colorado State Plan Policies and Procedures: An Update for EI Providers Early Intervention Colorado October 2, 2015

Program Overview 2  Colorado Department of Human Services (CDHS) is the Lead Agency for the Part C of IDEA grant and the statewide EI system  EI Colorado program is housed in the CDHS Office of Early Childhood, Division of Community and Family Support  EI Colorado contracts with the 20 Community Centered Boards (CCBs) to provide EI services statewide

Program Overview 3 General Supervision and Data Fiscal Accountability Program Initiatives EI Colorado Team Structure

Program Overview 4  Early Intervention Colorado Program  Ardith Ferguson, Director  General Supervision and Data  Christy Scott, Manager  Ashley Ness, Data Specialist  Fiscal Accountability  Beth Cole, Manager  Program Initiatives  Lenita Hartman, Manager  Laura Merrill, Training and Personnel Development Coordinator,  Wayla Murrow, Technical Assistance and Outreach Coordinator  Tracy Sperry, Program Assistant

FY Data 5 Referred – 12,897 (final count) Evaluated – 9,192 and 80% eligible (? Is this correct?) Unduplicated Count – 13,316 Average Monthly Enrolled Count – 7,340 Total Budget $48,167,964 * * State General Fund, federal Part C grant, Medicaid, Early Intervention Services Trust and local funds

EI Colorado State Plan 6  Policies and Procedures Page at  Colorado Code of Regulations (CCR) , Sections at sos.state.co.us  Fiscal Management and Accountability Procedures (FMAP) at Policies, Fiscal Managementwww.eicolorado.org  Medicaid Billing Manual

Future EI Rules and Part C Grant Timelines Revised EI Rules 1 st Board Hearing April 2016 Revised EI Rules 2 nd Board Hearing May 2016 Effective July 1, 2016 Application, Budget & Revised Policies & Procedures public review January 20 – March 20, 2016 Public Comment and Hearings February 19 – March 20, 2016 Application due to Office of Special Education Programs April 21, 2016 Policies and Procedures Effective July 1, State Systemic Improvement Plan (SSIP) Phase II: Implementation and Evaluation Plan September 2015 – February 2016 Public Engagement January – February 2016 SSIP Phase II due to Office of Special Education Programs April 1, 2016 Implementation Effective July 1, 2016

EI Colorado State Plan 8  Overall template is:  Title of subsection  Federal and State authority reference  Rule number  Rule language  Procedure(s), if necessary  Other related documents, if necessary, in text box

EI Colorado State Plan  Definitions  Created new definitions and revised current definitions  Revised definitions for:  Abuse and/or neglect  Assessment  Added definitions for:  Coaching  Evidence-based practices  Evidence-informed strategies 9

EI Colorado State Plan  Definitions  Added definitions (cont’d…):  Family Assessment  Frequency  Intensity  Method  Model  Multidisciplinary  Multidisciplinary Service Providers Model  Primary Service Provider Model  Single Provider Model  Telehealth 10

EI Colorado State Plan Important New Definitions  “Coaching” means a relationship-based strategy used by appropriately trained personnel with a family member, other caregiver, or another provider to support what is already working to help a child develop and to increase their knowledge and use of new ideas to achieve child or family outcomes.  “Evidence-based practices” mean practices that integrate research that has demonstrated efficacy and with consideration of the situation, goals, and values of the child, family and professionals.  “Evidence-informed strategies” mean the use of nationally recognized recommended practices to inform the effective delivery of early intervention services. 11

EI Colorado State Plan Important New Definitions  “Multidisciplinary Service Providers Model” means a model in which two (2) or more qualified providers who have different training and experience provide ongoing services as identified in an IFSP. In this model the providers work independently of each other with minimal interaction with other team members, and perform interventions separately from others while working on discipline-specific goals.

EI Colorado State Plan Important New Definitions  “Primary Service Provider Model” means a model of service delivery that utilizes one main qualified provider from any discipline that is the best fit to address the child and family outcomes as identified in an IFSP. Other team members support the primary service provider through teaming and may provide co-visits under this model.  “Single Provider Model” means a model of early intervention service provision in which one provider is utilized to meet the child’s and family’s needs as identified in an IFSP.

EI Colorado State Plan Important New Definitions  “Telehealth” means a form of service provision that utilizes secure interactive videoconferencing to deliver early intervention services.

EI Colorado State Plan 15  Service Coordination  B.9. Removes requirement to provide open choice of providers in order to meet the requirement to follow the funding hierarchy  IFSP  I.1. Adds that model is included along with method as required content on the IFSP service page

Questions 16

July 1, 2015 Changes in FMAP  Pages 18-24:  Removes the personnel from service descriptions and revises the descriptions of the methods (description of qualified personnel is now an attachment)  Adds Teaming, Evaluation and Assessment to all appropriate services and uses the definitions in the State Plan  Adds supervision where it is allowable under the service descriptions and adds the requirement for an Assistive Technology (AT) evaluation to be conducted prior to an AT device being purchased 17

Changes in FMAP  Page 26, footnote 8: Clarifies that the only plans that must meet a deductible are HSA tax-qualifying plans.  Page 31: Clarifies the relationship between Medicaid (HCPF) and Denver Health HMO, as well as Medicaid’s relationship with the Behavioral Health Organizations (BHOs) 18

Changes in FMAP  Page 32: Clarifies that if a family has Medicaid as a secondary plan and declines use of their primary insurance, then they are also declining the use of Medicaid  Page 35: Clarifies how CHP+ (Colorado Access) must be billed 19

Other EI Colorado State Plan Appendices 20  A – Memorandum of Understanding  B – State Transition Interagency Agreement  C – General Supervision and Monitoring Procedures  D – Fiscal Management and Accountability Procedures  E – A Family Guide to the Coordinated System of Payments for Early Intervention Services  F – Personnel Standards  G – Colorado Interagency Coordinating Council

State Systemic Improvement Plan 21  Indicator 11: The State’s State Performance Plan (SPP)/Annual Performance Report (APR) includes a State Systemic Improvement Plan  Measurement: The State’s SPP/APR includes a comprehensive, multi-year State Systemic Improvement Plan (SSIP), focused on improving results for infants and toddlers with disabilities and their families

SSIP 22 FY  Phase I – Analysis  Phase II – Plan  Infrastructure Development  Support for EIS Program and/or EIS Provider Implementation of Evidence-based Practices  Evaluation  Phase III – Implementation and Evaluation

SSIP 23  Phase I – Analysis - submitted 4/1/15  Phase II – Plan – due 4/1/16  Infrastructure Development  Support for EIS Program and/or EIS Provider Implementation of Evidence-based Practices  Evaluation  Phase III – Implementation and Evaluation – due 4/1/17-19 Focus for improvement: Evidence-based practices consistently implemented from referral through transition

Colorado SSIP Improvement Activities 24  Develop a CDHS/DCFS EI Program data system to ensure that data will be available for monitoring, evaluation, and improvement planning for both compliance and quality indicators  Integrate the Individualized Family Service Plan (IFSP) Process with the Child Outcomes Summary (COS) Process  Implement a Statewide System of Family Assessment, Using Department-Approved Family Assessment Tools and Provide Training, Technical Assistance and Quality Assurance Monitoring

Colorado Measurable Result 25 The SSIP Systemic Improvement Measurable Result (SIMR) is: Infants and toddlers who receives early intervention services in Colorado will demonstrate increased growth in the use of appropriate behaviors to meet their needs.

Other Initiatives 26  Telehealth Pilot and Policies and Procedures Task Force  Provider shortages  Part C – Early Start Denver Model (C-ESDM)  UNC Project TREE  Early Childhood Mental Health (ECMH) endorsement  Neonatal Intensive Care Unit (NICU) Project  Marsico Study and Gap Analysis of Early Care and Learning Settings and Infants and Toddlers with Special Health and Developmental Needs

Questions 27

Next Steps 28  What’s going well in the EI system?  Are there system challenges that EI Colorado needs to be aware of?  What is the best format to disseminate information to EI providers?  What are additional topics of interest?

CONTACTS 29 Ardith Ferguson, Program Director Beth Cole, Fiscal Accountability Manager Early Intervention Colorado Department of Human Services, Office of Early Childhood 1575 Sherman Street, Denver, CO 80203