Published in the Westchester Guardian, July 2014
The human brain is complex and the workings of this magnificent instrument is largely unknown to aspects of human and scientific understanding. Like any illness, a disease of the brain when caught early is very treatable. The younger the brain, the greater the capacity for development, training and retraining. Hence the New York State implementation of its Early Intervention Program.
“The New York State Early Intervention Program (EIP) is part of the national Early Intervention Program for infants and toddlers with disabilities and their families. First created by Congress in 1986 under the Individuals with Disabilities Education Act (IDEA), the EIP is administered by the New York State Department of Health through the Bureau of Early Intervention. In New York State, the Early Intervention Program is established in Article 25 of the Public Health Law and has been in effect since July 1, 1993. To be eligible for services, children must be under 3 years of age and have a confirmed disability or established developmental delay, as defined by the State, in one or more of the following areas of development: physical, cognitive, communication, social-emotional, and/or adaptive.” NYS Dept. of Health. (Why 1993, and not earlier?)
“Yesterday’s shortcuts are today’s nightmares. The race is quicker when we’re stricter.” Mark O’Brien
In the NYS 2013-14 budget, a change was made whereby providers, speech, language therapists, etc., would no longer submit claims directly to the respective agency from their home county who would verify the claim, pay the provider and then seek reimbursement from the private insurance company or Medicaid. However, with new provisions providers must now submit documentation to State Fiscal Agents (SFA) under contract with the NYS Department of Health, which caused unexpected devastating payment delays and places huge administrative tasks on the EI providers. Thousands have gone without proper therapy due to this “simple” change in NYS law. Who selects the SFAs and who audits them?
“Balanced budget requirements seem more likely to produce accounting ingenuity than genuinely balanced budgets.” Thomas Sowell
“In 2010, the total expenditures for the NYS EI program was approximately $650 million with the counties required to spend $330 million under State law. Recent data revealed that counties submit to third party insurers between $90-100 million in claims for eligible EI services of which only about two percent of claims are being reimbursed.” From the New York State Association of Counties. NYSAC Expanded Fact Sheet: The SFY 2012 Governor’s Budget Proposal for Children with Special Needs.” The above raises more questions than it answers. What happened to the other 98% not recouped? Are individual counties affected differently? Does anyone fully audit the cash flow, reimbursements and expenditures? The entire NYS 2013-14 total operating budget is $90.2 billion, possibly making the Early Intervention budget less than 1% with a current caseload of approximately 70,000 children. Its relative small size should not be a detriment to fixing this issue. Can the overall cost/benefit effect per child be calculated?
The real cause was probably trying to relieve the respective counties from monetary burdens – unfunded mandates which were being passed down to their residents via their tax assessments. Residents are under extreme tax and fiscal constraints as well as the towns in which they reside. Reviews of ways, means and methods to reduce these sometimes excessive burdens are logically being sought in all programs, but sometimes short-sightedness, causes other deeper, long-term issues to prevail. Speech Language Pathologist Kelly Fagan, “Research shows that $1 spent on Early Intervention (EI) saves between $7 and $17 spent on trying to correct those problems later on.”
The EI providers, under this new law, were placed with something that was not in their respective fields of discipline – filing, tracking and appealing insurance claims. How can they establish resources for dealing with insurance companies? How can they, especially small agencies, navigate the complexities of insurance regulations and Medicaid payment systems while trying to develop programs and work for the disabled? How can they develop an infrastructure (staff) without the financial backing and timely reimbursement? “Providers received no payment for this increased work load. In fact, EI has not experienced a rate increase in 16 years, but has had reimbursement rate cuts in 2010 and 2011.” New York State Speech, Language, Hearing Association (NYSSLHA). Increasing client fees just add to the financial stress of the very taxpayers you wanted to aid with the elimination of unfunded mandates.
The result of this new billing implementation is causing tremendous grief throughout the EI therapeutic community are supported by a post- EI implementation compiled by the Coalition of Westchester Providers Workgroup, of 96 agencies representing 41 NYS counties. Some results include:
- 5 % are planning to reduce or close their EI programs.
- 3% report children waiting for services.
- 7% have less availability.
- 1% are in a worse financial position.
- 5% have more difficulty in billing.
- 3% have said the cash flows are worse.
- 7% rating working with their insurance companies are ‘poor’ or ‘very poor’.
From the NYSSLHA: 64% of respondents are no longer taking new children, 49% of respondents report that they are looking for employment outside of the EI program and 25% indicate that they have already found employment outside the program.
To rectify the situation, there are two bills, one in the Senate (S6002) and one in the House (A8316). In summary, the bill will “require the SFA to pay EI providers directly within 30 days of the receipt of the initial claim from a provider. The SFA would be responsible for tracking all claims.” NYSSLHA who supports the new bill, but states, “The new payment model is fundamentally flawed because it is contrary to common commercial insurance company practices in NYS.” No vote has been taken as of this writing and they are no longer in session. Why does it take so long?
“You can’t grow long-term if you can’t eat short-term. Anybody can manage short. Anybody can manage long. Balancing those two things is what management is.” Jack Welch
It is easy to place the blame on politicians who are working with complex financial, legal and bureaucratic structures while trying to supply needed tax relief to a demanding, sometime short-sighted populace and a media focusing on quick, simple stories to retain viewer interest.
Then there is the insurance industry whose primary goal is not providing a service but providing a more than adequate profit margin to stockholders – which is completely contrary to what providers and consumers need. Maybe it’s about time the regulated insurance industry become strictly a not–for –profit industry, thereby creating corporate entities based on service, not on return of equity.
#1101
Glenn Slaby Blog