Practitioners around NY State begin learning about EI reform proposals

Earlier this week I noticed a large uptick in Google searches regarding early intervention that were landing on this blog so I started wondering what was going on. Turns out that there was a NYS Association of Counties meeting this week and the Department of Health gave a powerpoint presentation about the Governor's proposal. Copies of the powerpoint started to make their way around the State - and that got people doing some Internet searches for more information. Here is a link to the presentation for those who have not been able to see it yet.

The powerpoint doesn't offer information that is materially different than what is already listed in the proposed budget but it is in a more readable format.

The largest issues proposed include:
1. Providers will be approved through the Department of Health and won't have contracts with local municipalities.
2. There must be an arms length relationship between service coordinators, evaluators, and service providers.
3. Providers will be required to establish and maintain contracts or agreements with a sufficient number of insurers, including Medicaid and CHP.
4. Providers will have to use the State's Fiscal Agent to bill third party payors.
5. All of this will be achieved by a mandate on insurance companies requiring them to coordinate through the State Fiscal Agent to pay for EI services.

Details that are still a little unclear include how the rate will be negotiated. Currently, there is no alignment between EI rates paid by municipalities, rates paid by insurance companies, and the Medicaid rates. It is unclear whether or not the rates will change based on the information released so far. The current plan calls for providers to continue providing services whether or not they have been reimbursed - so there will need to be some clarity so providers understand the rule systems they are being asked to operate under for reimbursement.

It is likely that this will drive some providers out of the system and that will likely create delays in service provision. That means that private therapies, at least for families that have those resources, will likely replace the EI system as the de facto methodology for children receiving services. It is another form of indirect cost sharing, and is probably intentional.

Stay tuned for ongoing analysis.

Comments

If interested there is a petition you can sign to attempt to stop the current changes in NY state - http://www.thepetitionsite.com/1/stop-the-early-intervention-take-over/
Chris said…
Interestingly, I am not convinced that it should be stopped yet. There are still a lot of details that are not known. I understand practitioners concerns about having to interact with insurance companies directly, but I am wondering if a lot of those concerns are just fear of the unknown. We have been billing private insurance for services for over twelve years now and are already participating providers with all the plans - so this is not something that seems intimidating to us. What is a larger concern is the rate setting and negotiation of rates. I also don't know how they will resolve the level of benefit issue - EI visits will far outpace the allowable limits that most plans already offer. That means that a mandate on the insurance companies will be VERY expensive - and will give them cause to raise rates significantly. I think we need a lot more information before we decide if all this is good or bad.
I think changes may need to be made I just don't think having insurance cover it all is a smart idea. Personally, I do not think that providers should be allowed to evaluate children that would then go on their own caseload. I also think there should be a better system of checks and balances in terms of amount of services. I am concerned that EI services will get cut significantly if left to insurance coverage. I agree a large practice or contract agency will probably not find it too difficult to bill directly. A therapist just commented on my Facebook page about changes that were made in Indiana and some repercussions that have followed http://www.facebook.com/YourTherapySource
Chris said…
Interesting comments from that therapist in Indiana. I will look at their laws and see if the NY proposals look similar. I agree that there will probably be limits in place - and I think it will just drive people to use their private insurance anyway (outside of the EI system). It is an indirect way to get at cost sharing, and is probably the point of some changes anyway. I also like the arms-length proposal between evaluators and providers - that is something that has needed to be cleaned up for a really long time.

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