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Showing posts from August, 2013

NYS Early Intervention Program makes up more rule changes as they trip along

Here is an illustration for providers in the NYS Early Intervention Program that clearly illustrates the selfish orientation of thinking that is driving decision making on a central level at the Bureau of Early Intervention.

Exactly two months and two days ago, the Bureau of Early Intervention instructed providers to "accept claim amounts proposed by the insurer as payment in full from the insurer for the claim which are lower than the State-established EIP rate."  Although they explained that this would not impact payments from escrow in the short term, we explained that accepting these payments in this way would be problematic because of the long term intent of having providers accept payments directly from insurers.

TODAY we received a DIFFERENT set of instructions from the Bureau of Early Intervention that states:

Dear Colleague:

The Department is aware that insurers or insurer clearinghouses (Multiplan, Omni Plan) have sent expedited agreements to EI provide…

New York State Early Intervention: Roadmap through the end of 2013

My email box is flooded from colleagues asking about the NYS Early Intervention program - so I thought I would lay out the likely path toward the end of 2013 so people can plan appropriately for what lies ahead.

I also have a roadmap through 2014 and 2015 which will be published as a part of this series.  Stay tuned.

Fall, 2013: The already stressed EIP will continue to come apart at the seams.  Payments to providers will continue to be excruciatingly slow and complex.  Even more providers will leave the system creating even longer waiting lists for children and families.

There will be no immediate 'fix' because the legislature is out of session until January.

Governor Cuomo and his administrative team will continue to blame the insurance industry for the problem and will refuse to acknowledge their own roles in creating the mess.  This will lay the groundwork for insurance reforms that will be introduced next year in the Governor's Budget.  The State will stick to the …

Understanding Common Core Standards in two short videos.

Here is everything you need to know about Common Core standards in two short videos:




Enjoy!

Early intervention providers: Look the 'Gift Horse' in the mouth please.

I received this in email today:

Dear Colleague:

The NYS Department of Health (Department) is offering a one-time State safety net payment to Early Intervention providers, and will not proceed to implement the Preliminary Escrow Payment (PEP) proposal due to insufficient county participation.  

State safety net payments will be calculated as seventy-five percent of the value of claims submitted to insurers, with the exception of the medical assistance program, in the period April 1, 2013 through July 29, 2013 for which no known payment or denial has been received.  The State safety net payments will be reconciled commencing on October 1, 2013 by assigning to the Department twenty-five percent of each early intervention payment payable from the escrow account until such time as the State safety net payment is fully recovered.  The safety-net payment is a one-time payment made by the State.  All claims submitted by the provider, including those submitted to insurers in the per…

Note to politicians: Grandstanding on important policy issues does not win votes.

All press is not good press.  Especially when people get distracted from what the primary issues are.

In tonight's Capitol Confidential post there is a report that is headlined: "Therapists want to get paid, Tedisco sees 'War on Women.'"

The headline I would like to see is: "Children go without important therapy as NYS decimates Early Intervention Program."

A parallel example recently was the announced closure of O.D.Heck.  This announcement generated conversation about the plight of union jobs.  What got lost in the shuffle was the important human rights policy of de-institutionalization and the very real fact that there are problems with maintaining appropriate standards of care when we warehouse people who have disabilities.

How do concerns with the early intervention program degrade into a headline about the 'war on women"  and grandstanding on some cause du jour???  The cheapening and coarsening of our policy discourse in this way moves us…

George Barton: Birth and early influences.

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George Edward Barton was born on March 7, 1871.  That is a rather dry fact about one of the important founders of the occupational therapy profession - so what can be done to help give it context?

Context provides dimension - and if we want to learn a little about George Barton it might be helpful to know a little about his history.  His parents lived in Boston, Massachusetts.   His father was Edward H. Barton, the Secretary and Treasurer of the South Boston Savings Bank.  His mother was Rebecca Duncan (Boynton) Barton.

It was difficult to find other information about George Barton's parents, but a rather unexpected pair of portrait photographs were contained in some of his possessions that led me through this investigation.  Here is the first picture:


I recognized this photograph; it is an original portrait of Louisa May Alcott - but why would it be in the possession of George Barton?  Louisa May Alcott was born November 29, 1832 and she died on March 6, 1888.  That would have ma…

NYS Early Intervention botches billing for commercial insurance too

Today we received notification that some of our early intervention families have been sent our payments for the services we provided to children.  The payments are not supposed to be directed to the families - they are supposed to be directed to the providers or to the State for processing.

Based on our private billing experience as an outpatient clinic, it is uncommon for insurance companies to send reimbursements directly to enrollees, but it happens.  Most of the time when the insurance company does this the family hands the checks directly to us.  Unfortunately, some people don't understand what the checks are or in some situations they just view it as a 'payday' from the insurance company and they keep the payments for themselves.  We eventually learn about this after we call the insurance company after a period of non-payment and they tell us that the claims were paid.  Then we are in the awkward position of calling the patient and asking them to pay the funds that …

For Governor Cuomo: A lesson about the nature of the insurance industry

I have used this space as well as our Facebook page to chronicle the ongoing problems with municipal takeover of health care.  The problems with billing and payments to health care providers has gotten a lot of press lately and Governor Cuomo and his administration are taking some very well deserved lumps for their inept management of the Bureau of Early Intervention.

There is an apparent inability to understand the nexus of their legislative and regulatory fiats with the corresponding impact on service delivery.  All we get from our government is statements that the problem lies with private insurers that have failed to pay their share of the program's cost.

Albany intended to share costs, but they do not intend to share responsibility for their actions that contribute to the problem.

What they fail to understand is that when the government burdens a private entity you can count on the fact that there will be push-back from the private entities.  Failing to take this into consid…

More transparency to help in analysis of the NYS Early Intervention Program billing problems

On 7/15/13 I posted about how the interim State Fiscal Agent appeared to be trolling NYS Early Intervention Service Providers for private business.

In the interest of transparency, I wanted to update that issue.

In the email I referenced how UNYEIP stated that Director Hutton would write financial hardship letters for providers who have not been paid.  I attempted to verify this and the Bureau of Early Intervention would not admit that they would do this; this is the email that I received from them:

I was not able to find out anything further about hardship letters.  However, BEI made the announcement below on Friday [referencing how providers can borrow money that the State owes them - cja editorial comment].  Counties must sign and return an agreement to the Department if they choose to participate in the PEP.  Providers must also sign an agreement and return it to the Department if they wish to avail themselves of the PEP if the municipality is participating.  All informatio…