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

2. 2019 OSEP Leadership Conference
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 %
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 Alice Ridgway, Connecticut Charlene Robles, Hawaii

22. 2019 OSEP Leadership Conference
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)