Executive Proposals Imperil Early Intervention
Early Intervention (EI) provides extremely cost-effective developmental and therapeutic services to infants and toddlers, ages birth to 3. EI services have been proven to greatly enhance the skills of youngsters with developmental disabilities, thereby reducing the cost of future special education and other government supports.
EI providers are teetering on a fiscal precipice. Appallingly low 17-year-old rates, augmented by just one tiny 3% increase, were slashed in 2010 by 10% for most EI services, and in 2011 and by an additional 5% for all EI services. Providers agonize over whether they can afford to continue. Already, enormous deficits have driven providers from the field: 25 in New York City alone!
- Support the Executive proposal mandating commercial insurance reimbursement for covered EI services.
- Either set a minimum rate for EI at the current state rate or require the fiscal intermediary to pay providers the state rate and to bill insurance companies for any difference between the state rate and the negotiated rate.
- Require the fiscal intermediary to manage the appeals process and to pay providers the full state rate while appeals are pending.
To reduce state costs, an Executive proposal would require health insurance companies to reimburse covered EI services. Providers would join insurance networks, and a fiscal intermediary—not the provider—would shoulder much of the administrative burden, including managing the billing. With 40% of EI children covered by private insurance, this prudent proposal would create significant savings.
However, the proposed stipulation that providers negotiate their rate with the insurance companies, and accept the negotiated rate as full payment, would destroy EI. Providers cannot possibly survive on rates lower than the shamefully inadequate state rate! The proposal would also saddle providers with the additional burden of managing the appeals process while foregoing payment until the appeals were resolved. EI providers lack the expertise to handle appeals, nor do they have the financial reserves to continue providing services without payment.
- Reject the proposal to require an arm’s-length relationship between the evaluator and service provider.
- Ensure that children have the right to receive services from out-of-network providers if their condition so warrants.
Another Executive proposal would require that EI evaluators and service providers be from different agencies. The presumption here is that evaluators would refer to their own agencies. But under law, evaluators are prohibited from making recommendations as to the service provider or the type, frequency, or duration of services. Only the county Early Intervention Official may do so. Families often select the same agency as both evaluator and service provider because of the special competencies of that particular agency—for example, expertise in the child’s specific disabilities, in ability to speak the families’ language, and in having a convenient location. This proposal would curtail families’ right to select an appropriate evaluator and service provider. It would save no money, and is completely without merit.
In an additional blow to families, another proposal would add an insurance company representative to the team that develops the child’s Individualized Family Service Plan, thus compromising confidentiality, intimating parents, and inviting interference in treatment decisions. The proper role of the insurance company must be limited to paying for covered services.
If these harmful proposals are enacted, EI services are doomed. EI providers will be forced to shut down, and young children with disabilities will be cut off from the very services that could change their lives.
Non-public Special Education Schools and Preschools Need Rate Increase
The public school districts assign thousands of students with extremely severe disabilities to approved non-public schools because the public schools are unable—or unwilling—to serve them appropriately. These non-public schools are an extension of the public sector. In fact, for children under 5 years old, there are virtually no public-school services.
Despite rising costs, non-public school tuition rates have been frozen for the past three years. Providers have been unable to give cost-of-living raises to their staff, even though their staff are paid poorly compared with their public-school counterparts. Lack of a salary increase simply widens the gap, tempting non-public school teachers to quit for better-paying jobs in the public sector.
- Provide a tuition rate increase for non-public schools and preschools.
- Exempt non-public preschools from the MTA payroll tax.
- Reject the proposed requirement of an arm’s-length relationship between preschool evaluators and providers.
Disaster is brewing. Non-public schools—many running losses—cannot sustain a fourth year without the ability to cover increasing costs. It is imperative to provide an increase now to avert school closures. Otherwise, New York State will have to answer for the fate of the non-public school students it has abandoned.
Additionally, the Legislature excluded non-public preschools from the MTA payroll tax relief which it provided to school districts and non-public schools so as to maximize the amount of funding dedicated to children’s education. The non-public preschools have fewer resources than the school districts and must also be exempt.
Under a misperception, the Executive also included a proposal requiring that the preschool evaluator and the preschool provider be from different agencies. But clearly there is no conflict of interest between the parties because preschool evaluators are barred from making recommendations about the provider or the type, frequency, or duration of services. Only the Committee on Preschool Education may do so. This proposal limits family choice of an appropriate evaluator and provider without justification and must be rejected.