Dear Members:

As you may know, yesterday the Executive Committee met with the DOH BEI and representatives from the Commissioner's office for several hours. All agenda items planned were addressed.

Please read the following carefully and feel free to share your comments and questions at either UNYEIP@yahoogroups.com (the list serve) or to UNYEIP@yahoo.com. There is a good deal of NEW information provided.

1. ARMS LENGTH STATUS

The ARM's Length Component that had appeared in the Governor's Original Legislation and which had been voted down by both the Senate and the Assembly will resurface. It will be reintroduced through either Proposed Regulations with an accompanying Public Comment Period or via Executive Order. Based on our two year's experience with the Executive Chamber, if it is introduced via Executive Order, the Governor will likely have an accompanying Public Comment period, though this is not required in the issuance of an Executive Order.

The ARM's Length Component in the original legislation required that Agencies who previously were able to conduct both evaluations and treatment, can no longer provide both for the same child. Through the Small Agency Alliance of UNYEIP and the many new Large Agencies that have now joined our ranks, we recognize that this will introduce for some, an increasing struggle to remain viable. The UNYEIP Executive Committee will be meeting shortly to discuss this further and to plan a response this expected initiative.

It is important to know, that at least one county has instituted an Arm's Length Component already and we have provided the DOH with data concerning this initiative. It is important to note, that the manner in which this county is coordinating this effort is unreasonable.

2. SUBCONTRACTORS NOW HAVE CHOICES

The definition of Provider according to SUBPART 69-4 of the Public Health Law Title II-A of Article 25 for the Early Intervention Program indicates that the definition of PROVIDER is the following:

"aj) Provider means an agency or individual approved in accordance with section 69-4.5 of this subpart to deliver service coordination, evaluations, and/or early intervention services."

Effective 4/1/13 ALL Providers as per the definition noted above will according to legislation approved on March 30th, 2012 as part of the annual Budgetary process be able to engage in the following:

provided however that the department may require that
30 approved evaluators, service coordinators and providers of early inter-
31 vention services enter into agreements with the department in order to
32 conduct evaluations or render service coordination or early intervention
33 services in the early intervention program. Such agreements shall set
34 forth the terms and conditions of participation in the program. If the
35 department requires that such providers enter into agreements with the
36 department for participation in the program, "approval" or "approved" as
37 used in this title shall mean a provider who is approved by the depart-
38 ment in accordance with department regulations and has entered into an
39 agreement with the department for the provision of evaluations, service
40 coordination or early intervention services. The department shall use
41 best efforts to ensure provider capacity in the early intervention
42 program.

That is, "Sub-Contractors" who presently subcontract from an agency will have a choice ie to EITHER continue to contract with an agency OR to enter into an agreement directly with the state.

We recognize that there may be some subcontractors who would like to continue to subcontract from the agencies and others who would like to enter into agreements with the DOH. For the latter, newly now truly independent contractors will be required to input their own billing and manage the administrative function currently performed by agencies in exchange for the complete DOH rate.

Effective 4/1/13, the "subcontractors" will have a choice of HOW they would like to do business with the DOH ie. through an agency or directly as an independent contractor. Issues that we have discussed readily in the past eg. adequate rates for service provision as well as the paperwork reduction initiative will likely become leverage issues as we move forward. The goal being to provide the best, most efficient, and cost effective direct care services.

3. ON INSURANCE CREDENTIALING
Several Member providers have reported receiving memorandum from a variety of sources requesting that they become "credentialed" with insurance companies as soon as possible. This is NOT an edict from the state and should not be acted upon.

4. "NEW" COUNTY REGULATIONS
Numerous members have reported receiving updated "NEW County Early Intervention Regulations." The Counties have some latitude to interpret regulations as do each of us. However, if these regulations, deviate from the regulations posted (http://w3.health.state.ny.us/dbspace/NYCRR10.nsf/56cf2e25d626f9f785256538006c3ed7/8525652c00680c3e852565a1005e2864?OpenDocument) for an unsubstantiated reason, they should be reported to the DOH BEI. UNYEIP will maintain weekly telephone contact with the DOH to advise them of "NEW" County regulations that DO NOT comply with regulations found at the previous link.

5. "NON-COMPLIANCE" OF 90 DAY PAYMENTS

UNYEIP continues to make the DOH acutely aware of the on-going non-compliance crisis in payments withheld to providers of Rockland County. A more individualized response will be forward to the UNYEIP members in this county shortly.

Please advise if there is any non-compliance in your county in the area of payment to providers in excess of 90 days.

6. EXECUTIVE ORDER 38 ON EXECUTIVE COMPENSATION

UNYEIP completed its first review of Executive Order 38 in preparation for the UNYEIP Proposal Response. It is CRITICAL at this juncture that ALL providers inclusive of independents, sub-contractors, small and large agencies, READ this document and provide input ASAP. Let YOUR voice be heard NOW.

UNYEIP clearly indicated to the DOH that there is presently NO MEASURABLE MEANS indicated in this document to ensure that 75-85% of state-funded dollars WILL go to DIRECT SERVICE Provision.

UNYEIP also indicated to the DOH that there is a lack of clarity with respect to delineation of compensation for Owners who are also Therapists -- noted particularly in small agencies.

The role of UNYEIP in this endeavor becomes crucial at this point to make meaningful suggestions ie. fill any unanswered holes.

It is CRITICAL at this juncture that ALL providers inclusive of independents, sub-contractors, small and large agencies, READ this document and provide input ASAP (see email addresses noted above). Let YOUR voice be heard NOW.

7. Executive Order on the Health Benefit Exchange

There was no information available as to the potential impact of this Executive Order on Early Intervention at this time. All are awaiting the decision of the Supreme Court on this matter.

NOTE: The UNYEIP Executive Committee will be attending and providing Public Comment at the SEICC Committee Meeting scheduled for next Wednesday, June 20th. YOU are advised to clear your schedule and attend. See details at http://www.unyeip.org/seicc-meeting.html

UNYEIP is growing rapidly and not only in NYS. There will be some exciting changes ahead in the organization of UNYEIP. Stay tuned.

With Sincere Thanks for all YOU do,

Leslie Grubler MA, CCC-SLP, TSHH
Founding Director, UNYEIP
United New York Early Intervention Providers and Parents as Partners (UNYEIP)
Email Address: UNYEIP@yahoo.com
Homepage: http://www.UNYEIP.org/
FACEBOOK: United New York Early Intervention Providers
LinkedIn: UNYEIP
Twitter: @UNYEIP
CELL:  917 355 5060 
FAX (718) 224 0103

UNYEIP has consulted with its member parents, independent contractors, subcontractors, and small agencies as well as its legal consultants, compensation and human resource professionals, and Executive Committee in developing this response to Governor Cuomo's Budget Proposals.  We have also been in the unique position of having met directly with the Department of Health Officials of  the Bureau of Early Intervention as well as the Deputy Secretary of Health four times in the past five months.  It is the perspective of UNYEIP that we have both a Governor and a Deputy Secretary of Health, leaders in the Executive Chamber, who value Early Intervention and who want to ensure that this program remains viable.  The Executive Committiee has reviewed carefully all aspects of the Budget Proposals.  We have consulted with the Department of Budget and have engaged the Department of Health in numerous conference calls to discern their intent with these proposals.

UNYEIP is aware that there are several organizations proliferating information thoughtlessly and irresponsibly.  By not providing you with all the information that you need to determine the focus of your advocacy, these organizations are hoping you will simply comply and be lead.  Resist this by becoming informed. 

Below please find the UNYEIP Response to the Governor's Budget Proposals in three parts.  Part One reflects the UNYEIP Response to the Budget Brief.  Part Two reflects the UNYEIP Response to Article VII.  Part Three reflects the UNYEIP Response to  the Assembly Yellow Book.  We have not provided a formal response to the Senate Blue Book since their review was too simplistic to provide adequate comment.

You will recognize as you review particularly Part 2, that UNYEIP has suggested changes in  the legislation and provided reasons for these changes.  Essentially, UNYEIP went the extra mile to faciliate changes for our legislators. While numerous groups have come forward to negate in one fell swoop ALL of the Early Intervention Proposals in this year's budget proposal, UNYEIP has not.  We invested the time to suggest alternatives to our legislators to ensure that NYS Early Intervention maintains viability in NYS for years to come in the best interests of all Early Intervention stakeholders,  in the best interests  of  our state's most vulnerable children, and in the best interests of the future of New York State.

We will posting more on our Legislator Campaign over the next few Days.  We will post this on our Action Alert Page. 

_Governor Cuomo's Budget Presentation 1/17/12:  http://www.governor.ny.gov/20122013ExecutiveBudget

Medicaid Redesign Team:  http://www.health.ny.gov/health_care/medicaid/redesign/

January 29, 2012

Dear Members:

1. Budget Announcements

a. We would ask that our members maintain open-mindedness regarding the Budget that Governor Cuomo issued on January 17th. While there have only been one or two articles written on the impact of this year's budget on Early Intervention across the state, the journalists and many other entities simply have not processed the entire budget as yet and/or do not come from a position of understanding what Early Intervention is or even what is actually IN the budget. The information that is being shared at present in the media, blogs, word of mouth, is mostly coming from the misinformed or those with compromised interests. Be Aware of This.

b. The 2012/2013 is a Work/Vision in Progress the product of significant consultations with stakeholders from all walks of life. It is both an effort in transparency as well as an effort to increase productivity and yield meaningful reform.

c. Over the last 21 months, UNYEIP has made significant headway on behalf of our most vulnerable children, families, and providers and is considered a respected coalition in Albany.

d. Albany is listening to us. We have been invited 4X in the past 5 months and have met personally with the Deputy Secretary of Health, Jim Introne during these visits as well as Brad Hutton, Jim Clancy and Frank Walsh of the Division of Budget. Jim Introne is highly regarded in the health professions as an individual who knows the value of early intervention and one who knows what children with disability need. His commitment to Early Intervention was evident to each of us -- providers and parents alike.

There will be more information to write on this issue, many more specifics, in future days. We will provide you with as much information as we can to ensure that you do understand.

As indicated, we are posting a great deal on facebook at http://www.facebook.com/UNYEIP

Feel free to send us a friend request.

II. NYS Early Intervention Day
Assemblyman Weprin is preparing a resolution for a date in March of 2012 as NYS Early Intervention Day. More details to follow.

III. Sign This Petition
If you have not already done so, sign our International Petition for World Early Intervention Day at http://www.thepetitionsite.com/1/Worldwide-Observance-of-Early-Intervention/

IV. Save the Date!
Check out our Unisphere Homepage and save the date 4/1/12 for Lighting the Unisphere in Pink and Blue for Autism Awareness and Early Intervention. http://www.unisphereinpinkandblueforautism.org/

V. New Email Address for UNYEIP
UNYEIP has a new Email Address however, the old one is just as good and both reflect the same inbox: UNYEIP@yahoo.com

That's all for now folks. Enjoy your weekend.

Leslie Grubler MA, CCC-SLP, TSHH
Founding Director, UNYEIP
United New York Early Intervention Providers and Parents as Partners (UNYEIP)
Email Address:  UNYEIP@yahoo.com
Homepage: http://www.UNYEIP.org
FACEBOOK: United New York Early Intervention Providers
LinkedIn:  UNYEIP
Twitter:  @UNYEIP
PH: (718) 213 5900
CELL: 917 355 5060
FAX (718) 224 0103

_

A UNYEIP Thanksgiving -- November 2011


We are thankful as parents and providers to those who listen….
To the heartbeats of children whose voice is not counted.

We are thankful as parents and providers to those who listen...
The legislators and administrators who have learned and become our allies.

We are thankful as parents and providers to those who listen….
To the consult of professionals from the front lines who know what "miracles" require...

We are thankful as parents and providers to those who listen….
From within the darkened walls of bureaucracy and have begun to learn how to say NO to what is NOT right.

We are thankful as parents and providers to those who listen…
And find other ways to balance budgets and introduce REAL REFORM

We are thankful as parents and providers to those who listen…
And who wholeheartedly reject an "End Justifies the Means" approach

We are thankful as parents and providers to those who listen…
And count themselves among the masses who truly care about our future, the well-being of our families, the well-being of our children.

We are thankful as parents and providers to those who listen…
And who speak the truth, are mindful of the existence of a moral compass and do not hide behind words from both sides of their mouths….

We are thankful as parents and providers to those who listen…
And seek to understand, seek to be present, seek to fulfill their commitments to Early Intervention and to the children and families served.

We are thankful as parents and providers to those who listen…
Who seek to understand the role of a home-based therapist and educator in the best interest of the special needs child

We are thankful as parents and providers to those who listen…
And advocate in their role for what is simply right rather than what it is that will achieve their next promotion

We are thankful as parents and providers to those who listen…
To the hearts of parents and the communications of children –
Who very often have no one else in their life who WILL listen and hope with them…..

                                                                 THANK YOU Mr. Hutton. 
We look forward to additional changes in the weeks and months to come particularly changes that will 
                      return our rate to Pre-April 2010 and services to those that are therapeutic to each child!

From: Bradley J. Hutton <bjh08@health.state.ny.us>
To: unitednyeiproviders@yahoo.com;
Sent: Friday, September 9, 2011 9:00 AM
Subject: Announcement on EI Regs

Dear Colleague - On April 13, 2011, the Department published a Notice of Proposed Rulemaking for the Early Intervention Program (EIP) proposing changes to the method of reimbursement for home and community-based visits, facility-based visits and service coordination in the EIP. The Department received public comments in response to these proposed changes through May 31, 2011 and subsequently held two forums for providers in New York City on June 28, 1011 and a third provider forum on June 30, 2011. The Department has removed from this regulatory package the changes to the payment of home and community-based and facility-based visits. The Department remains committed to continued examination of the EIP reimbursement methodology and intends to have more discussion about this and other proposals with its Reimbursement Advisory Panel in the coming months. The Department will proceed to implement the change to service coordination reimbursement to one that is based upon fixed payments.. The Department intends to publish a Notice of Revised Rulemaking for the service coordination change in the coming weeks and will announce a revised effective date for that change at that time.

If you have any questions about this announcement, please feel free to contact the Bureau of Early Intervention at bei@health.state.ny.us .

Sincerely,

Brad Hutton, M.P.H.
Acting Director
Center for Community Health

August 23, 2011

Dear Mr. Hutton:

As you know from my correspondence of July 25th, Rockland County has had unusually high non-compliance in their payments to the Early Intervention Program. I am writing to you once again to advise you that Rockland County is out of compliance in their payments to the Early Intervention Providers.  As of today, they are again 90-110 days out of compliance.

The function of our Early Intervention Providers should be to focus on the provision of service to children 0-3 with special needs. Instead, they must busy themselves with placing urgent phone calls to the Finance Director and Assistant Budget Directors of Rockland County and others to determine the status of payments -- phone calls that are not returned. 

The Early Intervention Program is blessed with several Agency Owners in Rockland County who have extended themselves financially in the recent past to ensure that their independent contractors are paid.  These same providers are no longer in the position to do this not because they don't want to but because they cannot.We have already seen NUMEROUS excellent Early Intervention Programs throughout NYS close their doors.  Lack of attention to this matter may result in Rockland County agencies closing their doors as well.  Soon, they will have no choice.  They have lost the confidence of those that contract from them -- through no fault of their own.

Certainly, you can consider this "another system complaint," however, it is important that you do more than this.  Ensure that these programs are paid and that not one more day pass without this matter resolved.  I am certain that I do not have to review with you that these stakeholders of NYS Early Intervention have endured enough. 
To add a nearly 120 day waiting period for payment is completely unreasonable. 

All stakeholders in Rockland County Early Intervention are impacted by the egregious lack of attention to this matter.  This includes the the agencies, the subcontractors, the parents and most importantly, the children.I look forward to your prompt attention to this matter.


Sincerely,


Leslie Grubler MA, CCC-SLP, TSHH
Founding Director, UNYEIP
United New York Early Intervention Providers (UNYEIP)
UnitedNYEIProviders@yahoo.com/
http://unitednyeiproviders.weebly.com/
FACEBOOK: UNYEIP
TWITTER:  UNYEIP
PH: (718) 213-5900
CELL: 917 355 5060
FAX (718) 224 0103

August 19, 2011

Dear Mr. Hutton
        As you know, both A384/S4013C and S2911/A4296 were signed into law by Governor Cuomo this past Wednesday, August 17th.  In addition to the concerns listed below, there are parts of the latter (which impacts the OT Practice Act) that OT's have been waiting on for nearly 10 years.  NOTE:  It appears that pieces of A384/S4013C will confound this legislation.UNYEIP recognizes that regulations that impact early intervention will likely change to support this legislation.  When preparing new regulations, please consider the following with respect to A384/S4013C:

1.       Impingement on Direct Access:
      The Allied Health Professions inclusive of Speech-Language Pathology, Occupational Therapy, and Physical Therapy are presently direct access services that either do NOT require or have limited requirements for a script/prescription from a Medical Doctor as state-mandated practice. 
      The Professions of Physical Therapy and Occupational Therapy recently acquired the facility for direct access i.e. that a patient can see an allied health professional noted above without having to be referred by a medical doctor.
       Several municipalities across the state have required this practice of Early Intervention Providers.
That is, a medical doctor must provide a script for Occupational and Physical Therapy EI services. In some cases, the OT and PT acquire the script themselves and in other municipalities the service coordinator acquires the script.

2.       Barrier to care:
      This legislation REQUIRES parents to provide a script from a Medical Professional.  In many counties, providers or service coordinators have already been performing this function.  Typically, when a professional requests documentation from another professional, there is no fee charged by the medical professional.  A parent requesting a script without the benefit of a "well-baby visit' runs the risk of being charged a fee by the medical professional. 

3.       No indication as to what services require a script from the medical doctor. ADDITIONAL BARRIER TO CARE:
       It is unclear as to whether intervention services AND evaluation services require a script from a medical doctor.  Will it be necessary for Parents to acquire two scripts – one for evaluation and one for intervention? Will additional medical appointments be necessary? It is unclear as to when in the process the parent will be required to receive a prescription/referral ie. at the point of entry, post-evaluation, post-IFSP or ALL of the previous

4.       No requirement for parents to have health insurance, ANOTHER BARRIER TO CARE/INSURANCE REIMBURSEMENT:
       This legislation does not require families whose children are eligible for NYS Early Intervention to have health insurance coverage. According to recent data received, on the average 48% of parents have health insurance. Given that parents will now be required to provide a script/prescription from a medical provider, will every family be required to have a physician? If a visit is necessary outside of the "well-baby care checkup," the services that a medical professional provides will likely yield a fee.  Many primary care physicians today, charge a fee for anything ie. pharmacological refills, form completion, scripts.  This will cost families more and will, therefore, function as a barrier to care. In several counties, a medical professional is on-call for the municipality; however, this is not the case in most municipalities.

5.       Does not provide relief for all early intervention services offered:
       There is no reference as to how services provided by special educators or applied behavior analysts (aba therapists -- those who provide services to children with autism) will be reimbursed since they clearly provide an educational service.

6.       Does not require insurance companies to cover early intervention services:
       There is nothing in this legislation that requires insurance companies to cover Early Intervention Services.  If an insurance company has already indicated that EI Services are not covered in its plan, there is nothing in this legislation that enables the insurance company to cover these services.

7.       No  mechanism outlined to address return of funds to EI:
      There is no specification for how or if the revenue received from commercial insurers will be redirected back to Early Intervention.

8.       No mechanism outlined which describes how this legislation will improve commercial insurance receipts:
      Historically, the municipalities have averaged approximately 2% collection with 48% of families covered by insurance.  How will this legislation increase receipts from insurance companies? There is no indication of how this will positively change the circumstances that are presently occurring.

9.       No indication as to whether the DOH has already established acceptable rates in conjunction with insurance companies or whether a negotiation is needed.ANOTHER BARRIER TO CARE:
       It is unclear as to whether the DOH in conjunction with the insurance department has already worked on reimbursement rates for services provided in Early Intervention and whether these reimbursement rates are now acceptable to the insurance companies. It is also unclear as to whether the reimbursement rates effective 5/1 will be reduced further as a result.  Already, NYS Early Intervention has incurred significant reductions in rates over the last 17 months, more so than any other group associated with NYS.

10.   No indication as to whether EI services covered by insurance companies will require a co-pay. ANOTHER BARRIER TO CARE:
       It is unclear whether insurance companies will be permitted to request a “co-pay” for services provided and whether families will be required to pay these “co-pays.” If a child has multiple services, parents could be required to pay several co-pays. Can our parents afford this? Has this been anticipated? Who will manage receipt of co-pays if this occurs?

11.   There is no indication that this bill will change the underlying workings of insurance companies ie. enable them to cover early intervention:
      Won’t passing this legislation in fact be a fruitless effort because the State Government will receive little return and there are no legislative avenues to sue or argue against rejected claims?

12.   No re-submission allowance of rejected claims:
       What if the insurance company rejects the claim? Is there adequate time spelled out in this legislation to ensure that resubmissions will be considered.

13.   Have municipalities been adequately trained to bill insurance companies:
       Are our municipalities skilled, trained, and do they possess the sophistication necessary to ensure that bills submitted will be reimbursed?  Are our municipalities currently staffed to manage this responsibility in a way that ensures increased receipts?

14.   How will the state regulations have to change with respect to evaluations if early intervention becomes a service covered by all insurance companies:
      Typically, insurance companies require their own re-evaluations which will likely be frequent. Most accepted standardized assessments require that the tools be administered infrequently to ensure that the results are not confounded or compromised.

15.   How will the script provided by a medical doctor alter approved EI services?
      Given that according to this legislation, a script from a medical professional is necessary, will Early Intervention, therefore, have to provide services that support the script as it is written? If they do not, what is the likelihood that the services will NOT be reimbursed?

16.   Beware the experts:
       We question whether medical providers are adequately informed of when therapy is necessitated and how much therapy is necessary.  Typically, their experience with “therapeutic” norms is limited.

17.   Who will benefit:
       Given the necessity for medical professionals to provide a prescription for services in this legislation, doesn’t it, therefore, provide monetary gain for medical professionals?

        As a result of impending changes to Early Intervention including the use of 15 minute increments, and utilization of CPT and IC9 Codes, we presume that the DOH is attempting to represent the Early Intervention Program as a Medical Model to insurance companies to enable reimbursement.  However, the differences between a medical model and a developmental model operationally are significant.  To integrate the two is more reflective of an extreme extrapolation.

       While it is noteworthy that this legislation signed by our Governor is to assist the counties in Mandate Relief and to assist in funding Early Intervention,  it is important to ensure,  that the regulations initiated as a result of this legislation are well thought out so as not to create a further barrier to care.

Should you have any questions, please advise.

Sincerely,
Leslie Grubler MA, CCC-SLP, TSHH
Founding Director, UNYEIP
United New York Early Intervention Providers (UNYEIP)
UnitedNYEIProviders@yahoo.com/
http://unitednyeiproviders.weebly.com/
FACEBOOK: United New York Early Intervention Providers
PH: (718) 213 5900
CELL: 917 355 5060
FAX (718) 224 0103

August 10, 2011
The Honorable Governor Andrew Cuomo
Executive Chamber
NYS State Capitol Building
Albany, NY 12224

Dear Honorable Governor Andrew Cuomo: 

The membership of the United New York Early Intervention Providers and Parents As Partners’ coalition has reviewed legislation A000384B/S4013B which is suggested to “Facilitate payment of claims by health insurers to municipalities for early intervention services.”

Respectfully, we request that you VETO this legislation.  There is NO indication in this legislation that payment will be facilitated to Early Intervention via commercial insurance companies.

As you know, the change imposed by this legislation is to amend state “insurance law” to foster compliance by insurance companies to cover the services provided through Early Intervention.

Our concerns are several:
1.       Impingement on Direct Access:
      The Allied Health Professions inclusive of Speech-Language Pathology, Occupational Therapy, and Physical Therapy are presently direct access services that do NOT require a script/prescription from a Medical Doctor as state-mandated practice. 
      The Profession of Physical Therapy just recently acquired the facility for direct access i.e. that a patient can see an allied health professional noted above without having to be referred by a medical doctor.
       Several municipalities across the state have required this practice of Early Intervention Providers.
That is, a medical doctor must provide a script for Occupational and Physical Therapy EI        services. In some cases, the OT and PT acquire the script themselves and in other municipalities the service coordinator acquires the script.
       The legislation amends state insurance law which does NOT appear to be limited to services
provided in Early Intervention.  Therefore, to approve this legislation would actually set back our        professions particularly for independent contractors, small business entrepreneurships who also        work with older populations and whose patients are able to see providers directly without doctor        referral.
2.       Barrier to care:
      This legislation REQUIRES parents to provide a script from a Medical Professional.  In many counties, providers or service coordinators have already been performing this function.  Typically, when a professional requests documentation from another professional, there is no fee charged by the medical professional.  A parent requesting a script without the benefit of an appointment runs the risk of being charged a fee by the medical professional.  Haven’t the changes imposed over the last 17 months introduced more than enough barriers to Early Intervention Services? Or is this the underlying goal – that is, if services are not readily accessible they will not be used?
3.       No indication as to what services require a script from the medical doctor. ADDITIONAL BARRIER TO CARE:
       It is unclear as to whether intervention services AND evaluation services require a script from a medical doctor.  Will it be necessary for Parents to acquire two scripts – one for evaluation and one for intervention? Will additional medical appointments be necessary? It is unclear as to when in the process the parent will be required to receive a prescription/referral ie. at the point of entry, post-evaluation, post-IFSP or ALL of the previous
4.       No requirement for parents to have health insurance, ANOTHER BARRIER TO CARE:
       This legislation does not require families whose children are eligible for NYS Early Intervention to have health insurance coverage. Given that parents will now be required to provide a script/prescription from a medical provider, will every family be required to have a physician? If a visit is necessary outside of the annual well-baby care checkup, the services that a medical professional provides will likely yield a fee.  Many primary care physicians today, charge a fee for anything ie. pharmacological refills, form completion, scripts.  This will cost families more and will, therefore, function as a barrier to care. In several counties, a medical professional is on-call for the municipality; however, this is not the case in most municipalities.
5.       Does not provide relief for all early intervention services offered:
       There is no reference as to how services provided by special educators or applied behavior analysts (aba therapists -- those who provide services to children with autism) will be reimbursed since they clearly provide an educational service.
6.       Does not require insurance companies to cover early intervention services:
       There is nothing in this legislation that requires insurance companies to cover Early Intervention Services.  If an insurance company has already indicated that EI Services are not covered in its plan, there is nothing in this legislation that enables the insurance company to cover these services.
7.       No  mechanism outlined to address return of funds to EI:
      There is no specification for how or if the revenue received from commercial insurers will be redirected back to Early Intervention.
8.       No mechanism outlined which describes how this legislation will improve commercial insurance receipts:
      Historically, the municipalities have averaged approximately 2% collection with 48% of families covered by insurance.  How will this legislation increase receipts from insurance companies? There is no indication of how this will positively change the circumstances that are presently occurring.
9.       No indication as to whether the doh has already established acceptable rates in conjunction with insurance companies or whether a negotiation is needed.ANOTHER BARRIER TO CARE:
       It is unclear as to whether the DOH in conjunction with the insurance department has already worked on reimbursement rates for services provided in Early Intervention and whether these reimbursement rates are now acceptable to the insurance companies. It is also unclear as to whether the reimbursement rates effective 5/1 will be reduced further as a result.  Already, NYS Early Intervention has incurred significant reductions in rates over the last 17 months, more so than any other group associated with NYS.
10.   No indication as to whether EI services covered by insurance companies
will require a co-pay. ANOTHERBARRIER TO CARE:
       It is unclear whether insurance companies will be permitted to request a “co-pay” for services provided and whether families will be required to pay these “co-pays.” If a child has multiple services, parents could be required to pay several co-pays. Can our parents afford this? Has this been anticipated? Who will manage receipt of co-pays if this occurs?
11.   There is no indication that this bill will change the underlying workings of insurance companies ie. enable them to cover early intervention:
      Won’t passing this legislation in fact be a fruitless effort because the State Government will receive little return and there are no legislative avenues to sue or argue against rejected claims?
12.   No re-submission allowance of rejected claims:
       What if the insurance company rejects the claim? Is there adequate time spelled out in this legislation to ensure that resubmissions will be considered.
13.   Have municipalities been adequately trained to bill insurance companies:
       Are our municipalities skilled, trained, and do they possess the sophistication necessary to ensure that bills submitted will be reimbursed?  Are our municipalities currently staffed to manage this responsibility in a way that ensures increased receipts?
14.   How will the state regulations have to change with respect to evaluations if early intervention becomes a service covered by all insurance companies:
      Typically, insurance companies require their own re-evaluations which will likely be frequent. Most accepted standardized assessments require that the tools be administered infrequently to ensure that the results are not confounded or compromised.
15.   How will the script provided by a medical doctor alter approved EI services?
      Given that according to this legislation, a script from a medical professional is necessary, will Early Intervention, therefore, have to provide services that support the script as it is written? If they do not, what is the likelihood that the services will NOT be reimbursed?
16.   Beware the experts:
       We question whether medical providers are adequately informed of when therapy is necessitated and how much therapy is necessary.  Typically, their experience with “therapeutic” norms is limited.
17.   Who will benefit:
       Given the necessity for medical professionals to provide a prescription for services in this legislation, doesn’t it, therefore, provide monetary gain for medical professionals?

As a result of impending changes to Early Intervention including the use of 15 minute increments, and utilization of CPT and IC9 Codes, we recognize that the DOH appears to be attempting to represent the Early Intervention Program as a Medical Model to insurance companies perhaps to enable reimbursement.  Early Intervention is a developmental model engaging allied health professionals and educators.    

While it is noteworthy that Legislation has been introduced to presumably assist the counties or appear to assist the counties in Mandate Relief and to assist in funding Early Intervention, we do need the right legislation, one which reflects the needs of the constituency, one that provides more than it takes away, and one that is clear and well thought out – that does not complicate but facilitates access to the program.  It is important to note that other changes/mechanisms need to be put in place in order to effect positive change in the area of Early Intervention and commercial insurance reimbursement.

UNYEIP would be happy to initiate/facilitate the development of the RIGHT LEGISLATION, Mr. Governor and will if you VETO this legislation.

The membership of UNYEIP is available should you need our assistance.

Sincerely,

Leslie Grubler MA, CCC-SLP, TSHH
Founding Director, UNYEIP
United New York Early Intervention Providers (UNYEIP)
UnitedNYEIProviders@yahoo.com/
http://unitednyeiproviders.weebly.com/
FACEBOOK:  United New York Early Intervention Providers
PH: (718) 213 5900
CELL:  917 355 5060
FAX (718) 224 0103

Dear Deputy Secretary of Health James Introne:

Yesterday, members of UNYEIP in conjunction with Rockland County Legislator Frank Sparaco  initiated a meeting in the Legislative Chambers of Rockland County. to discuss non-payment to both Early Intervention agency providers and Early Intervention independent contractors in excess of the 90-day permissible waiting period,  for services that have been rendered to children in the NYS Early Intervention Program.   At present, numerous agencies and independent contractors in Rockland County have not been paid since March of this year. 

As we had discussed in our meeting of June 14th, over the last 16 months the numerous changes that have occurred in Early Intervention both legislatively and via regulation are having a decimating impact on the program, its providers, and the state's most vulnerable children -- those 0-3 with developmental disabilities. 
At present, Early Intervention providers statewide are wondering whether this is the intention of our new Governor and his administration?

Yesterday's meeting was extremely well attended.  Attendees included the following:
Rockland County Executive Chief of Staff, Sean Mathews
Rockland Finance Director, Stephen DeGroat
Rockland Deputy Budget Director Steve Grogan
Rockland County Commissioner of Health Dr. Joan Facelle
Rockland Deputy Commissioner of Health Kathy Henry
Rockland Director of Early Intervention Deborah Roth
Rockland Legislators John Murphy and Frank Sparaco
Chiefs of Staff for State Assembly Member  Zebrowski, Chris Bresnan.Communication Director for Assembly Member Ellen Jaffee,  Mike Vigra
Numerous Agency CEO's, owners, and directors
Independent Contractors and subcontractors from across the County

While several suggestions were raised as to how the county could potentially pay the Early Intervention Providers in Rockland County for  the short term, the following was clear:

a.  The State owes the county $70 million dollars to date.
b.  The County cannot continue to fund its unfunded mandates given Governor Cuomo's 2% Real Estate Tap Cap
c.  The County is considering suing the state for funding not provided
d.  Medicaid and Social Security funding appeared to be prioritized
e.  NYS Early Intervention at both the County and the State Level HAVE NOT been prioritized

AGAIN, the children of Early Intervention, children who have no voice and no vote are the victims.  The state is clearly choosing to mortgage its future. 

Is this the intention of our new Governor and his administration?

Is this the intention of our new Governor to communicate to parents and providers of children with special needs that they are at the bottom of the state's priorities?

As you already know, our Early Intervention Providers have endured the largest reductions in their rate of any group/department in the state over the last 16 months: 
a.  A regulatory reduction of 10% effective 4/1/10
b.  A legislative reduction of 5% effective 5/1/10
c.  A regulatory reduction introduced as the WEF/travel reduction of 4.5% effective 5/1/11 (reflects Rocklands cut)

Is it the intention of our new Governor to watch our providers foreclose on their homes, claim bankruptcy and our Early Intervention agencies close?

Additionally, our state's most vulnerable children have suffered because
a.  their qualified providers are leaving the field
b. suspected violations of IDEA Part C that have impacted duration and frequency of services
c. the delivery of services to eligible children is being confounded as children are deemed ineligible by a system seeking to reduce costs at ALL costs -- rather than cost-effectively.

Because it is clear that what is occurring n Early Intervention in Rockland County could potentially happen in other counties,   UNYEIP would like to go on record in advising you that we will not permit this to and will use all means to ensure that it does not.  As UNYEIP continues to embrace agencies, municipalities, independent contractors and subcontractors statewide, it is our hope that you will work together with us to find cost-effective approaches rather than cost-savings approaches to manage this program, a program that historically has been successful in changing the lives of children and families, a program that we and the State of New York can not afford to undermine.

At present, as a result of the issues that have emanated that are imploding Early Intervention in Rockland County,  I am requesting a meeting with Governor Cuomo at his earliest convenience and would appreciate your assistance in this regard.

Sincerely,

Leslie Grubler MA, CCC-SLP, TSHH
Founding Director, UNYEIPUnited New York Early Intervention Providers (UNYEIP)
UnitedNYEIProviders@yahoo.com/
http://unitednyeiproviders.weebly.com/
FACEBOOK: United New York Early Intervention Providers
PH: (718) 213 5900
CELL: 917 355 5060
FAX (718) 224 0103

UNYEIP 7/14/2011

In Response to Public Forums conducted June 28th and June 30th, A Letter to Brad Hutton, BEI Director,

July 12, 2011

Dear Mr. Hutton:

It has been officially two weeks since Public Forums were conducted as an outcome to the April 13th Proposed Rule-Making. The Executive Committee of UNYEIP has met and discussed input received from our members. 

In our effort to inform and maintain the conversation initiated on June 28th, we have provided for you a review of the significant issues addressed inclusive of the matter of the 15 minute increment methodology. 

In some cases, questions were asked but the answers received were unclear. These questions and/or affirmations are re-stated below. 

I.  Please advise as to the status of the following issues which, as you indicated, reflect a lack of compliance with IDEA Part C:

A.  What actions have been taken thus far to address the unilateral decision-making of the EIOD's?
B. What actions have been taken thus far to address the matter of eligible children not receiving services?

C. What action has been taken thus far to address the matter of untherapeuticmandates? That is, if you recall, mandates issued by the EIOD were reported to be not reflective of acomprehensive plan created across disciplines by therapists and educators to meet reasonable developmental objectives and outcomes.

D. What actions have been taken thus far to ensure that no parent is requested to "pick" a minimum number of services for his/her child. eg. “Which developmental domain is more important to you motor or speech...walking or talking?”

E.  You indicated that IFSP development must include all members of the IFSP team, that the EIOD is only one part of that team when it comes to determining the services to be provided, that it is against IDEA Part C for an EIOD to ask a parent to choose which services they want.  What action has been taken thus far to address this issue?


II. Numerous times in both NYC and Syracuse, you had indicated that essentially your hands are tied with respect to the degree to which NYS EI has been impacted and that providers should contact their legislators and/or the Executive Chamber.

A.  We plan to be meeting with the Governor.  Would you prefer to facilitate this meeting, or would you like UNYEIP to make this connection independent of your office.

B.  We have legislation both in place and in draft to protect our future interests.
C. Given that $6.2 million in savings must be demonstrated in NYS EI, in what other areas of BEI, have you considered making changes to achieve this savings? NOTE:  UNYEIP made nearly 30 recommendations in our NYS Budget Proposals -- none of which have been implemented thus far.

D.  Since December of 2010, UNYEIP has been advising you and the SEICC members of the significant decrease in mandates offered to children in NYC Early Intervention and various other counties across the state.  We have also been advising you of the significant decline in cases.  NYC composes 49% of NYS Early Intervention.  NYS Early Intervention has ALREADY experienced a savings in expenditures.  Where is this savings reflected and/or accounted for in the NYS DOH BEI Budget? Please provide the statistical enrollment data requested four times to date for the 4/10-12/10 in NYC.



III.  There appears to have been an uneven sharing of information on your part at both forums ie NYC and Syracuse. 

A. In response to provider comments regarding the reduction in rates experienced by providers, you indicated in Syracuse, that BEI receives 100 applications for new DOH BEI Provider positions weekly.  This figure is also stated in the most recent Revised State Performance Plan. Please provide data to substantiate this figure.  We understand that the reputation of the NYS DOH EI is no longer what it once was.  Colleagues are no longer interested in seeking contracting opportunities offered by the DOH BEI. Agencies are closing.
B. At each of the Public Forums, there was a proliferation of comments expressed on the quality of skill that providers bring to the field of Early Intervention.  Please respond to the statement, "If rates offered by the DOH BEI are not considered livable, how do you expect to attract good, qualified, talented people? The rates currently offered will attract those with less skill, training and undeveloped talent and experience with the multitude of factors in delivering home care to young populations and family training.  NYS EI needs candidates who are qualified and talented.
C. At the Syracuse Public Forum, providers were advised that the rates associated with the 15 minute increments would be "front-loaded" so the first 15 minute increment would be paid at a higher rate and that subsequent increments would be paid at a lower rate. This is a significant issue. Why wasn’t this information shared at the NYC Public Forum.   How will this in fact increase the "incentive for providers to work with children for longer periods of time” (not that this ‘incentive’ supports individualization) -- which is one of the original intentions of the introduction of this 15 minute increment methodology? Professionals make decisions on the duration of services based upon their clinical judgement and the needs of the child -- NOT monetary gain. References to “incentives” and “pricing” needs to be removed from the conversation.
D.  Women comprise 93% of the now 2000 UNYEIP Providers.  It was stated by you in Syracuse that women are not the targets in the numerous rate reductions that have been introduced in NYS DOH BEI.  We cannot comment on the intent of the NYS DOH BEI at present, but the result clearly reflects that women have been impacted severely by the reductions and regulatory changes introduced by the NYS DOH BEI over the last 15 months, we have and others have.
E.  In Syracuse, you were asked to continue to convene regular outreach meetings to keep lines of communication open to which you agreed.   We are assuming that the same applies to NYC.
F.  The open forum ended in Syracuse with you being asked to provide your word of honor that funds would be directed to address pay inequities for therapists as soon as monies are available.  You had given your word and asked for our word that we would return to allow you to give us good news in person. It is our hope that GOOD NEWS arrives sooner rather than later in the best interests of the NYS EI Program. In NYC you indicated, “Ultimately it may require a movement of therapists out of EI to demonstrate that you need to have more pay” which providers appreciated hearing from you. It is our understanding that the Executive Chamber has not even begun to focus on NYS Early Intervention.  It is for this reason that we plan to meet with the Governor. 
G.  In Syracuse you indicated that although the state does not have funding to study factors like the cancellation rates, that cancellation rates are something that do need to be investigated as well as: a. cost information, b. base salaries, c. percent of administrative costs, d. fringe expenses, and e. travel costs. You stated that the state needed to look at a better way to compensate for missed visits, working within the rules established by Medicaid.  PCG was awarded the contract to establish and provide input on the Rate Reimbursement Methodology.
What is PCG working on if not a thru e noted above?


IV.  A. The 15 Minute Increment Methodology was described as though it was set in stone. B.  The schedule provided in the PPT presentations at the Public Forums provided a limited and uninformed interpretation of what a day in the life of a DOH BEI Provider is.

A.  At the SEICC Meeting of June 14th, it was announced that a rule-revision would be introduced into the state register with a 30 day Public Comment period.  From provider input received thus far, it is anticipated that this comment period will be active.  There is clear disagreement in the introduction of this methodology from the front-line professionals who provide the Early Intervention services which are the foundation of the future maintenance of this program.  Input was requested in the Public Comment period.  Input was requested in the Public Forum. Voluminous input was provided in both.  To minimize and/or dismiss this input is to minimize the democratic process that a Rule-Making is based upon. 

NOTE:  Clearly, data received from the rule-making public comment period as well as all forums, provided the representatives of the DOH BEI as well as the three PCG Consultants and two RAP committee members (charged with revising the reimbursement methodology) present in NYS, with in depth professional consultation of the impact, management, and manifestation of Rate Reimbursement in NYS, gratis. UNYEIP members and members of our Executive Board have not only voiced our concerns but have provided professional consultation at no charge to the state. We expect an outcome that responds to the voluminous input that you have received.

B.  According to your statement(s), rates were not available at the Public Forums due to the fact that the Director of Budget either has not approved them as yet or they have not been computed.  If the intent is to employ the 15 minute increment methodology, it is important that the juxtaposition of a further reduction in rate NOT be coupled with  a 15 minute increment methodology which is  already NOT favored. 
C. Employing the 15 minute increment methodology is contra-indicated and does not support home-based intervention particularly in the manner in which home-based services are delivered.  In NYS EI, children are treated via scheduled appointments with family members or day care providers.  As such, the "flexibility" that the 15 minute increment methodology may provide in other work environments cannot apply in an environment involving the formal scheduling of families, children, teams of providers, and day care personnel. To do so would be to attempt to apply flexibility to a parent, provider, day care schedule that is fixed and encumbered by other appointment commitments – a logistical flaw.  Sessions must be mutually exclusive events that cannot be randomly overlapped.  The only potential way this could work is for the provider and the family to schedule “gaps” which would result in non-productive time and limit services provided to the family and by the provider.  Is this the “cost-saving” intent? Therefore, an adequate "fit" is needed between the payment mechanism and demand characteristics of the treatment. For example, fee-for-service billing mechanisms requiring therapists to document 15-minute increments of service fit poorly with several hallmark features of EI: variable and functionally-driven duration of sessions; therapist travel to the homes, schools, and neighborhoods; attendance at team and IFSP meetings, and frequent telephone contact
with the family and others participating in treatment.
D. With respect to the “one day schedule” you provided in your PPT presentation, note that  a provider WOULD have to work 2 more hours daily to recoup the income lost via another rate reduction.  As was stated over and over again, the providers are unable to meet their financial commitments at present -- whether it is to their mortgage company, to their children's education payments etc.  This is not and has not been President Obama's intention when he introduced ARRA funding.  Clearly, providers are losing their jobs and their homes which IS further contributing to the high foreclosure rate in NYS.

E. Additionally, the “one day schedule” provided appears to be applying a format or schedule that a 9-5 employee may be expected to adhere to or follow with perhaps the assumption that if that sample schedule was followed then the professional would make X amount of money based on some ballpark predetermined (by the state) 'salary' or income that we should/could achieve. We are independent contractors.  This logic does not apply.  

F. The 15 minute increment methodology is a medical model.  CPT Codes do not account for services provided in Early Intervention, parent training and do not explain the work done by our special educators.  How do you theorize that Medicaid will cover billing of Early Intervention services when CPT codes are presently inadequate?
G. Numerous counties are functioning within the guidelines of the basic and extended rates as was evidenced in a show of hands in Syracuse.  In several counties, providers can only reflect on their billing a basic session of 30 minutes even though providers may often stay at least 15 minutes longer undocumented. Given that the introduction of the 15 minute increment methodology was based upon the assumption that the basic and extended rate was not functioning, what accommodation can you recommended in this regard since the assumption appears to be false. If this rule change was introduced primarily due to concerns over interpretation of the basic and extended rate, why has there been no overt effort  on the part of BEI to address interpretation issues directly with counties/municipalities instead of further penalizing therapists?  

H. The 2011/2012 Budget Proposal included a 10% reduction to reimbursement rates.  A 5% was agreed upon by the legislature – however MUCH MORE HAS ALREADY BEEN ACHIEVED BY NYS DOH BEI.  Between WEF and the Travel Factor as well as the projected decrease from the proposed 15 minute billing increment, in addition to reductions in expenditures resulting from decreased mandates, increased standards for eligibility, EIOD actions that are non-compliant with IDEA Part C, it appears that NYS DOH BEI Independent Contractors have taken the largest hit of any other contractor/employee in NYS!
I. As indicated previously, an alternative to the 15 minute increment methodology must be introduced that does not impinge on or threaten therapeutic intervention and does not further reduce the reimbursement rate. If a new reimbursement methodology is introduced, how do you plan to ensure that all providers are communicated to?

V.  Several departments of the DOH provide their employees and contractors with what is considered a blending period ie. an announcement of a rate reduction in advance of the actual rate reduction.  At the very least, a 3 month period should follow the announcement ie. prior to the actual implementation.

VI. NYS DOH BEI unit must establish and regulate rate reductions imposed on providers by agencies that impose additional rate reductions that are excessive.  The rate variability of some agencies NOT all, both inter and intra-agency does not reflect transparency and introduces ethical concerns.  NOTE:  It should be noted that several agencies across the state typically try very hard to minimize additional provider reductions.  Additionally, while merit pay does not apply to independent contractors, it is applied loosely and inconsistently by some agencies with uncertain guidelines.  Inexplicable rate inequity taints morale. What actions are you planning to initiate to ensure that agency reductions are NOT excessive?

VII.  Paperwork Reduction Initiative:  You have heard numerous times throughout the last 15 months of the inequity in paperwork demands on providers between municipalities and intra-agency.  The proliferation of paperwork and the necessity to complete this paperwork in the course of our role has NOT been accounted for adequately in the fringe factor.  Redundancies in meaningless paperwork persist.  The NYS DOH BEI must take the lead in this initiative to unburden the front line providers and enable them to spend their valuable time meeting the needs of children and families. Note the following (a thru h) and then respond to the question, What action are you taking to reduce paperwork demands placed on providers?

Note the following:
A.  Some municipalities do not require 3 mos or 9 mos progress notes.  Eliminate this statewide.

B.  NYC paperwork requirements are excessive.  Audit the necessity for this encumbrance. Eliminate current justification paperwork.  Replace it with formal reevaluation already permitted in new regulations.
C. Session notes need to be standardized -- this will not only be cost-savings but cost effective and less burdensome to providers.  Session notes can not and should not be revised based on individual audit outcomes.
D. Limit redundant requests for information on any/all forms.
E. Change the language currently noted on IFSP's to support licensing practices statewide. Note:  the IFSP now reads as reflective of ONLY a parent teaching program rather than a professional edutherapeutic AND parent training tool.  Revise – unless your intent is to completely eliminate the quality of the medical and educational program parameters that have been established and/or unless you are seeking to eliminate qualified professionals and replace them with unqualified paras/interventionists/assistants. This is what appears to be occurring.  If so, please advise.
F. If the desire is for the quality of paperwork to improve, then providers must be provided with paperwork that is meaningful and not redundant.
G. Given that a wage and travel equalization factor has been instituted (inequitably and based on 2005 data), we would like to suggest a Paperwork Equalization Factor.  Subcontractors in NYC not only receive significantly lower rates as a result of agency cuts/administrative costs but are subject to extremes in paperwork initiated by the NYC DOH  as well as additional paperwork requirements of agencies. 
H. With respect to the proposed 15 minute billing methodology, this restriction on rate methodologies will increase administrative time and decrease the time available for service provision. Currently providers spend increasingly more of their time on documentation, leaving little time for direct services. Requiring that services must be billed in 15 minute increments will further exacerbate this problem by increasing paperwork burdens and leaving less time for client services.


VIII. Embedded coaching IS proliferating across the state -- it is a cost-savings philosophy but not cost-effective.  Children of early intervention require talented and experienced professionals who have the skill to work with families and train them on how to integrate goals into activities of daily living. Consideration should be given to using this methodology as an introductory training for new independent contractors. 
Additionally, since December of 2010, you have been advised of the efforts to initiate Embedded Coaching in NYC.   In NYC, $600,000 dollars of ARRA funds have been spent and it has been introduced along with untherapeutic mandates.  The model of Embedded Coaching that exists in Early Intervention across the country is limited at best.  The model of Embedded Coaching adapted by NYC is actually eclectic and, as such, cannot be assumed to be grounded in evidence-based practice.  One would have to ask, "Which practice exactly?"  Imposing schedules, rates, and methodologies ie telling independent contractors how and when they will fulfill their contract and how much remuneration they can expect is counter to the definition of independent contractor in NYS.  This is of significant concern in particular in labor law.
How will the DOH BEI work to reconcile this issue so that there is no further confusion as to whether independent contractors are functioning and are treated as independent contractors and NOT employees?

IX.  It was announced at the 6/14 SEICC Meeting that Public Forums would be provided in Syracuse and NYC in response to a large volume of responses received during the 4/13 Rule-Making.  Public Forums were scheduled in both Syracuse and NYC that did not comply with the Open Meetings Law.  Note Below:
A.  Registration was closed prematurely.  The maximum capacity of rooms in NYC was clearly double the registration accepted.  Room arrangement included the use of tables which were not functional and actually took up space.  NOTE: "(d) Public bodies shall make or cause to be made all reasonable efforts to ensure that meetings are held in an appropriate facility which can adequately accommodate members of the public who wish to attend such meetings." [OML] Numerous providers were denied access in NYC in their effort to register due to what was described as a full house.
B. 1. Any meeting of a public body that is open to the public shall be open to being photographed, broadcast, webcast, or otherwise recorded and/or transmitted by audio or video means. As used herein the term “broadcast” shall also include the transmission of signals by cable." [OML] In NYC, videotaping was NOT permitted. However, in other Public Forums offered at this location, it was permitted. This reflects a lack of transparency. 

X.  You indicated that there would be a significant decrease in IPRO audits conducted on Independent Contractors. Please provide additional information on this matter.



Please advise as to when the Revision to the Rule-Making will be published and when the 30-Day Comment Period will end.


It should be noted that we have requested a meeting with the Assistant Commissioner of NYC DOH, Dr. Marie Casolino and are awaiting her response.


As was indicated, it is our hope in meeting with you at the Public Forums, speaking during the Public Comment periods of SEICC meetings, RAP Committee Meetings, our presence at Executive SEICC meetings,  and individual meetings with you and your team throughout the last 15 months that the decisions made by the DOH BEI will  meet the needs of our children with developmental delays and their families, comply with IDEA Part C and improve the quality of the NYS EI Program.

We look forward to your reply.

Sincerely,


Leslie Grubler MA, CCC-SLP, TSHH
Founding Director, UNYEIP
United New York Early Intervention Providers (UNYEIP)
UnitedNYEIProviders@yahoo.com/
http://unitednyeiproviders.weebly.com/
FACEBOOK: United New York Early Intervention Providers
PH: (718) 213 5900
CELL: 917 355 5060
FAX (718) 224 0103

UNYEIP 7/12/2011

On the heels of our lobby day and press conference this past Tuesday, I would personally like to thank each of you for listening to our issues and committing to doing the absolute best that you can to preserve and protect the Early Intervention Program in New York State.  In your current Joint Budget Meetings, please consider and make note of the following significant issues:

*                  For every dollar spent in Early Intervention, the state saves $7-17 in future costs (Heckman/Journal of the AMA).

*                   Early Intervention works and efficiently.

*                   Effective 4/1/2010, providers in NYS received at least a 10% reduction in their reimbursement rate resulting from a REGULATORY CHANGE IMPOSED BY OUR FORMER DOH COMMISSIONER.  Those providers who contract from agencies received greater than 10% and up to 20% of a decrease to their rate reimbursement.

*                   Children with autism spectrum disorders as well as others with significant delays/disorders will be amongst those most seriously impacted by changes to Early Intervention.  As rates decline and as services levels decline, providers will leave the field of Early Intervention.  Children will no longer receive adequate services to meet their needs, enable progress, foster permanent change. Experienced professionals skilled in the art of early intervention will leave the field.

*                   Providers wil not be able to endure another 10% rate reduction in NYS.  Providers will not be able to endure a 2% reduction as indicated in the MRT.

*                   The DOH continues to have the regulatory authority to change rates of providers at any time.  This is significant because two items in Governor Cuomo’s current budget proposals will be imposed upon providers irrespective of the legislative process unless legislative oversight is introduced in the form of legislation.  PLEASE INTRODUCE LEGISLATION TO BLOCK THIS UNILATERAL DECISION-MAKING and RETURN POWER TO THE LEGISLATURE AND THE PEOPLE.  These two items are: 
1. 15 minute Session Increments – which will reduce rates in NYC by 1/3 and likely yield reduced session time 
2. Wage Equalization Factor which according to the Director of Early Intervention in a meeting that I had with him on March 15th will “yield much greater than a 1-2 dollar increase/decrease in rates per session.”  

*                  Effective 2010, speech eligibility standards increased.  The DOH data indicated that Speech is the most frequent service rendered.  DOH data also indicated that NYC is the most costly and highest volume municipality.  The 15 minute session increment and wage equalization factor will further reduce rates.

*                Effective 9/1/10, new regulations were imposed on Small Agencies that required them to change their organizational structure.  Most could not survive and closed.  Women compose 93% of small businesses and independent contractors treating children in Early Intervention.  Closing small businesses and essentially putting independent contractors who also are corporation owners out of business is in direct contrast to Governor Cuomo’s Executive Order #8 signed on February 17th, 2011.  Removing Barriers to Establishing Minority - And Women - Owned Business Enterprises in NYS.

*                   As noted in the UNYEIP Budget Proposals, Cost-shifting Medicaid Reimbursement and Commercial Health Care Reimbursement to Agencies who are untrained will not benefit the system.  Agencies will need to enter at least a two year learning curve, will need to hire new staff, will need to lower their reimbursement rate to pay their providers (projected to be 5-6 dollars per session), before a level of sophistication can be achieved to guarantee a return.  NOTE:  NYS is only able to achieve a 2% reimbursement rate.  What makes NYS think that the agencies will do better?

*                   The Budget Proposals introduced by the Bureau of Early Intervention reflect the maintenance of mediocrity, a familiar budget ax not a fine scalpel – much needed when administering a system to our most vulnerable children.  This is contrary to Governor Cuomo’s request that what are introduced are meaningful reforms.  Children, our most meaningful human resource, are no longer treated as children but as faceless statistics.  This is NOT HOW WE SHOULD BE APPROACHING THIS TASK, that is, unless we are no longer the child-centered society that we were once proud to be.

*                   If all changes are enacted by the legislature, the rates of independent contracts would be reduced by 60%.  Coupled with state-imposed declines in caseload and frequency and length in session, independent contractors will no longer be able to make a living in NYS at all.

*                  Question the data that was presented (likely unknowingly) by Commissioner Shah in the March 3rd Budget Meetings – how current is it? What is the source?  ie. he indicated that in NYS children receive on the average 20 hours of services per month versus the national average of 6 hours.  Our anecdotal evidence suggests that our children receive services at the rate equal to or less than the national average.

*                   Curiously, in the last year, caseloads have declined in NYS in numerous counties.  Frequency of services has declined as well eg.  a child now receives 1 session at 60 minutes per month when in fact previously he/she may have received 2 sessions for 30 minutes per week.  Current frequencies/times are non-therapeutic.  These issues have been directed to the DOH BEI, who indicate that they are not aware of this occurrence and that data from 4/1/10 will not be available until 5/1/11.

*                  Children eligible to receive services are not receiving the services. There is an apparent increase in Early Intervention Officials recommending service frequency/time that are not consistent and significantly less than  the evaluation parameters would allow.

*                  The above has yielded declines in provider caseloads by 40-70% as compared to last year at this time -- this on top of the 4/1/10 regulatory rate reduction.

*                  Seventy-five percent of independent contractors indicated via UNYEIP survey that they will leave the field. This would leave EI, a specialized field, without properly trained, experienced and seasoned staff to meet the needs of children with special needs. 


Leslie Grubler MA, CCC-SLP, TSHH
Founding Director, UNYEIP
United New York Early Intervention Providers (UNYEIP)
UnitedNYEIProviders@yahoo.com/
http://unitednyeiproviders.weebly.com/
FACEBOOK: United New York Early Intervention Providers
PH: (718) 213 5900
CELL: 917 355 5060
FAX (718) 224 0103