(Abridged from the Reforming Madates, Relieving Costs Report. Click here for the full report )
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 three 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. There is no income eligibility for the Early Intervention Program.
Counties are responsible to pay 100 percent of the cost of Early Intervention services in the first instance.
All Early Intervention services for children with special needs should be covered by commercial health insurers. The Governor and the State Legislature need to require third party health insurance coverage to ensure that county claims are accepted as medically necessary and paid at the Early Intervention approved rate. Although 48 percent of the children served are covered by private insurers, those private plans cover only 2 percent of the cost. This reform would ensure the fiscal and programmatic integrity of the program for State and local taxpayers and the growing number of families who have children who need these vital services.
Mandate recommendations: In the nearer term, county officials from across the State have identified specific mandate relief opportunities that would save money, improve service, or both.
1. Coordinate transportation services with other health and human services programs.
2. Include means testing and require parental contribution.
3. Permit counties to obtain and analyze income and to establish local standards governing contributions from families.
4. The county may need to be involved in the administration of this program; however, counties should be permitted to tailor the program so that it reflects the counties’ economic and societal values and standards.
5. Offer insurance, similar to Medicaid, at a sliding scale fee for families that are over the income limit of “free” Medicaid but cannot afford an insurance policy.
6. Use a capitation method to reimburse for Service Coordination. This eliminates the minutia of calculating “minutes” for reimbursement and allows agencies to mange Service Coordination in a better manner.
7. Require screening as opposed to evaluation for all children referred to EI who are suspected of having a disability and have no diagnosis.
8. Define the EI models to focus on family training as opposed to “therapy.”
9. The evaluator should not be the service provider. The State should consider evaluation centers, which would result in more open dialogue related to determination of appropriate services.
10. Define use of “informed clinical opinion” in all developmental areas more clearly. This should be based on research.
11. Eliminate the option of children staying in EI past the third birthday.
12. NYSDOH and NYSED should review and reissue the joint memorandum on transition since the process has changed significantly in the EI regulations and these changes do not concur with NYSED guidance.
13. Consider possibility of changing eligibility requirement to requiring a 50 percent developmental delay for initial eligibility, 33 percent for continued eligibility.
14. Address issue of “clinical opinion.” Current regulations allow eligibility under clinical opinion.
15. Provide ONLY EIP services that are entitled by the federal government, that is, Child Find, Evaluation, Service Coordination and the development of the Individualized Family Services Plan.
16. Allow an initial screening of the referred child by an Initial Service Coordinator to determine if the child needs to have a full multidisciplinary evaluation.
17. Change the service delivery model to a family training model; that is, allow a primary interventionist to work with the family one time a week rather than a disciplinary specific provider.
18. A methodology should be developed to decrease the highest rate to the upstate average range of $59.00 to $63.00.
19. Evaluation rates should be revisited. The lowest rate in upstate counties is $369.00 for a multidisciplinary evaluation. The six counties that pay the highest Early Intervention rates pay $471.00.
20. The Home and Community Based Waiver needs greater oversight to ensure that only those families who qualify based on the original intent of the program are eligible.