Hyatt Regency Capital Hill Washington DC July 29, 2012

Transcription

1 Hyatt Regency Capital Hill Washington DC July 29, 2012 Welcome and Introductions President s s Report Treasurer s Report Committee Reports Data Committee Finance Committee Legislative Committee Impact of 2011 Regulations Joint Session State Issues/Challenges 1

2 Erin Kinavey 12 years: Arizona, Connecticut, Delaware, Georgia, Hawaii, Idaho, Kansas, Maryland, Massachusetts, New Jersey, New Mexico, North Carolina, Oklahoma, Texas, Utah, Vermont Washington 11 years: Alaska, American Samoa, Iowa, Mississippi, Nevada, New Hampshire, North Dakota, Northern Marianas, Rhode Island, West Virginia, Wisconsin 10 years: Illinois, Louisiana, Missouri, Pennsylvania Tennessee 2

3 34 states: No discussions related to dropping out 6 states: Prepared documents about: What would system be like with no federal Part C funding; or Benefits to state for continued participation money Comments: Deficit budget is forcing us to narrow eligibility Concerns about new regulations but have not risen to the level of dropping out Program eliminated during legislative session but was saved by advocates Budget staff say program unsustainable 3

4 Increased Costs 25% 25% Budget Availability 11% Rate of Growth 11% 28% Increased Cost of children with complex needs Other All states indicated that they would continue to participate through June 2013 Comments: If new regulations impact insurance revenue all bets are off 4

5 Comments: Increased accountability for eligibility decisions Review of appropriateness of services Positions left vacant Implementing or increasing family fees Service package limits for at-risk children Explored possible options for cost containment Restricting eligibility 5

6 Implement Family Fees Require use of insurance or assess fee Reduce provider reimbursement Require prior approval for excessive services Narrow eligbility Other Other: Identify and diversify additional funds Expand Medicaid authorized services Restructure administration Request additional appropriation Eligibility changes Family cost share 6

7 No change in eligibility 7% 22% 45% Eligibility more restrictive Broadened eligibility 2% 24% Planning to change this year Other Other: Adjustment to prematurity calculation Removed percent of delay and moved to standard deviation Proposed narrowing eligibility but legislature opposed and provided additional funding For those changing eligibility all are narrowing 7

8 No policy or procedure 5% Other 20% Enroll in tracking 17% Seek alternative programming 2% Refer to other community agencies 56% Comments: Home visiting programs Formal tracking Periodic monitoring Provide resource information Provide take home activities 8

9 Planned Services: 5.6 hours Delivered Services: 5.3 hours Twenty-one states could provide that information Average Length of time in Part C: 16 months 25 states could provide that information Budget not finalized 24% Funding increased 13% Funding reduced 16% Funding frozen 47% 9

10 Agencies: g 4 Contractors: 6 Comments: Limited distance Reduction in rates Decrease in next 12 months 3% Decreased rates 28% Increase in next 12 months 5% Frozen rates 56% Increased rates 8% 10

11 Ron Benham 2012 Revenue Membership: $99,500 Interest: $39.86 Cash Balance Checking: $8, Savings: $73,

12 2012 Budget Expenditures to Date Percentage of Budget Annual Meeting $10, $ % Board Planning Retreat $5, $3, % Executive Director $51, $25, % Governmental Liaison $38, $19, % Travel $10, $ % Web Maintenance $ $ % Web Server $1, $ % Office Supplies $ $ % Directors and Officers Insurance $1, $1, % Association Membership Fees $ $ % Committee Activities/Products $3, $ % Other: $ $ % Total $122, $ 51, % 12

13 Data Finance Legislative Co-Chairs: Pam Roush and Lisa Balivet 13

14 Largest Committee with 28 members Board Charge for 2012 Birth Cohort Study Data Survey Target Population: Children born in 2007 Target Population: Children born in 2007 who were referred, evaluated or served at any point during the three years they would have been eligible for Part C. 14

15 2007 Birth Cohort Study Referred to Part C Eligible for Part C Elig Elig based on Rate DD DD Rate Evaluated Exited Part B Eligible % State % Birth Births # % # % # % % # % % # B23 s AK 11, % % 723 7% 49% * * * % 3% CT 41,048 6,147 15% 5,863 14% 4,293 10% 73% 3,756 9% 71% 2,023 47% 5% FL 239,120 23,155 10% 18,095 8% 13,289 6% 73% 10,550 4% 69% 5,939 45% 2% IA 40,835 * * * * * * * 1,759 4% * 1,310 * 3% IL 179,061 27,213 15% 20,171 11% 17,790 10% 88% 16,911 9% 88% 7,626 43% 4% KS 41,951 5,641 13% 4,515 11% 3,726 9% 83% 3,330 8% 81% 1,765 47% 4% LA 60,312 10,562 18% 8,238 14% 4,867 8% 59% 4,122 7% 55% 1,931 40% 3% MA 77,934 22,055 28% 21,102 27% 15,181 19% 72% 13,420 17% 69% 6,134 40% 8% MD ,578 15% % % 75% % 76% % 4% MS 46,455 3,587 8% 3,529 8% 2,005 4% 57% 1,531 3% 50% % 2% MO 81,833 6,148 8% 5,075 6% 2,757 3% 54% 1,662 2% 42% 1,808 66% 2% NH 14,136 1,014* 7% 1,014 7% 838 6% 83% * * * % 3% NJ 116,063 16,618 14% 15,858 14% 11,841 10% 75% 11,665 10% 74% % 3% NM 30,605 6,307 21% 4,554 15% 4,533 15% 100% 3,460 11% 99% % 5% NY % % % 69% % 68% % 6% NC 130,886 16,280 12% 11,408 9% 8,313 6% 73% 6,779 5% 69% 3,012 36% 2% PA 150,322 23,455 16% 20,366 14% 15,005 10% 74% 13,814 9% 72% 5,841 39% 4% RI 12, % 2,255 18% 1,813 15% 80% 1,446 12% 77% % 6% TX 409,289 63,511 16% 44,636 11% 30,673 7% 69% 23,972 6% 63% 8,865 29% 2% UT 55,063 5,268 10% 4,693 9% 3,648 7% 78% 2,598 5% 71% 1,442 40% 3% VA 107,261 10,902 10% 7,619 7% 5,959 6% 78% * * * 1,712 29% 2% WV 22, % % % 87% % 86% % 3% 2010 Single Day Count 2010 Single Day Percentage 2010 Cumulative Count 2010 Cumulative Percentage 2007 Birth Cohort Number Served 2007 Birth Cohort Percent served 2010 B 3 State Census Alaska % 1, % 32, % Connecticut 4, % 8, % 117, % Florida 13, % 26, % 637,815 13, % Illinois 18, % 33, % 495,710 17, % Kansas 3, % 7, % 123,099 3, % Louisiana 4, % 9, % 188,193 4, % Maryland 7, % 14, % 217,560 7, % Massachusetts 15, % 32, % 217,691 15, % Mississippi 2, % nr nr 125,257 2, % Missouri 4, % nr nr 231,982 2, % New Hampshire 1, % 3, % 40, % New Jersey 10, % 21, % 319,713 11, % New Mexico 4, % 5, % 86,492 4, % New York 30, % 69, % 693,268 34, % North Carolina 9, % 18, % 376,163 8, % Pennsylvania 17, % 33, % 70% 432,581 15, % 00% Rhode Island 1, % 3, % 33,788 1, % Texas 28, % 61, % 1,151,310 30, % Utah 3, % 7, % 159,028 3, % Virginia 7, % 13, % 303,439 5, % West Virginia 2, % 4, % 61,983 2, % Average 3.21% 6.60% 8.72% Median 3.31% 6.66% 9.00% Minimum 1.88% 4.36% 3.00% Maximum 6.96% 14.85% 19.00% 15

16 Need for Knowledge of State Data Systems ARRA Funding Expand existing system Develop new system Survey Components Data Infrastructure Data Collection Data Security Data Validation Data Analyses Staffing Target to Complete Survey Data Manager Co-Chairs: Ron Benham and Kim Wedel 16

17 19 Committee Members Charge for 2012: Finance/Medicaid Survey Insurance Initiative Data on impact of System of Payments Monitoring of ACA Review of Finance Think Tank 17

18 49 of 56 States (86% of states and jurisdictions) responded to survey 40 states (71%) in 2010 Of the 49 states, 45 (93%)provided some fiscal data 35 (88%) in 2010 Lead Agency Eligibility Health Education Other A B 19 C 18

19 Federal: $967,523,029 State: $2,161,959,182 Local: $379, 656,772 58% 4% 38% Federal State Local Total Known Funding: $3,509,138, states could identify fund sources utilized and 100% of revenue generated 12 states could identify fund sources utilized and 76-99% of revenue generated 7 states could identify fund sources utilized and 50-75% of revenue generated 9 states could identify fund sources utilized by 50% or less of revenue generated. 19

20 Fund Source Identified Revenue Percent of Total EI Revenues Average percent across states and Range State Part C Allocation $ 955,589,779 27% 15% (0% 78%) Medicaid $ 831,807,445 24% 22% (0% 74%) State General Funds $ 672,987,227 19% 14% (0% 83%) Federal Part C $ 408,290,110 12% 28% (6% 100%) Local Government $ 241,300,787 7% 2% (0% 54%) Part C PART B 619 Part B 611 Medicaid SCHIP Title V Champus Trica are WIC Early Head St art SSBG CCDBG TANF Number of States Utilizing the Fund Source Other 20

21 2% 3% 1% 1% 42% 51% Medicaid Part C TANF Other Part B 619 Part B 611 Medicaid State M atch State Part C State General Fun nds Title V State CSHCN State TANF MOE State Special Ed Lottery Funds s Tobacco Funds s State DD Fund s State Mental Hea alth Deaf Blind Schoo ols SSBG Suppleme nt Other Number of States Utilizing the Fund Source

22 3% 1% 4% 16% 31% 45% State Part C General Funds Medicaid State Match State Special Ed TANF MOE All Other ocal Education Age ency Foundations Special Fundraisin ng Local Governmen nt Cash Donations L United Way HMO/Managed Ca are Private Insuranc e Family Fees Other Number of States Utilizing the Fund Source

23 4% 4% 10% 18% 64% Local Government Private Insurance Family Fees County Tax Levy All Other 30% State Part C (18) 25% 20% 15% 10% 5% 0% 27% 24% 19% 12% Medicaid (39) State General Funds (23) Part C (45) Local Government (7) 7% 2% 1% Private Insurance (16) Managed Care (6) 23

24 Federal Funds Used for Infrastructure Part C 619 Part B Medicaid State Personnel Regional Personnel Local Personnel Title V SICC Child Find Public Awareness Eligibility Determination Comprehensive System of Personnel Development Monitoring Dispute Resolution Data System IFSP Development SCHIP Champus TANF WIC SSBG E Head Start CCDBG Other State Funds Used for Infrastructure Medicaid Match State Part C State General Funds Tobacco Funds Dev Disabilities Deaf Blind State Special Ed State Personnel Regional Personnel Local Personnel SICC Child Find Public Awareness Eligibility Determination Comprehensive System of Personnel Development Monitoring Dispute Resolution Data System IFSP Development TANF Other 24

25 Local Funds Used for Infrastructure LEA County Tax Levy Foundations Fundraising Local Government State Personnel Regional Personnel Local Personnel SICC Child Find Public Awareness Eligibility Determination Comprehensive System of Personnel Development Monitoring Dispute Resolution Data System IFSP Development Cash United Way Managed Care Insurance Family Fees Other Number of Funds Used to Support Infrastructure Federal State Local State Personnel Regional Local Personnel SICC Child Find Public Awareness Eligibility Determination Comprehensive System of Personnel Development Monitoring Dispute Resolution Data System IFSP Development

26 Federal Funds Used for Direct Services Part C 619 Part B Medicaid SCHIP Title V Champus WIC E Head Start SSBG TANF Assistive Technology Audiology Family Training & Counseling Health Medical Nursing Nutrition Occupational Therapy Physical Therapy Psychological Services Service Coordination Special Instruction Speech Language Pathology Sign and Cued Language Social Work Transportation Vision Other State Funds Used for Direct Services Medicaid Match State Part C State General Funds Tobacco Funds Dev Disabilities Deaf Blind State Special Ed Assistive Technology Audiology Family Training & Counseling Health Medical Nursing Nutrition Occupational Therapy Physical Therapy Psychological Services Service Coordination Special Instruction Speech Language Pathology Sign and Cued Language Social Work Transportation Vision Respite TANF Other 26

27 Local Funds Used for Direct Services LEA County Tax Levy Foundations Fundraising Local Government Assistive Technology Audiology Family Training & Counseling Health Medical Nursing Nutrition Occupational Therapy Physical Therapy Psychological Services Service Coordination Special Instruction Speech Language Pathology Sign and Cued Language Social Work Transportation Vision Respite Cash United Way Managed Care Insurance Family Fees Number of Funds Used to Support Direct Services Federal State Local Assistive Technology Audiology Family Training & Counseling Health Medical Nursing Nutrition Occupational Therapy Physical Therapy Psychological Services Service Coordination Special Instruction Speech Language Pathology Sign and Cued Language Social Work Transportation Vision Respite

28 Category of Medicaid Used for Infrastructure Administration General EPSDT Rehabilitation Managed Care 1115C Waiver School-based Waiver Autism Waiver 1915i Waiver State Personnel Local Personnel SICC Child Find Public Awareness Eligibility Determination Comprehensive System of Personnel Development Monitoring Data System IFSP Development Category of Medicaid Used for Direct Service Administration General EPSDT Rehabilitation Managed Care 1115C Waiver School-based Waiver Assistive Technology Audiology Family Training & Counseling Health Medical Nursing Nutrition Occupational Therapy Physical Therapy Psychological Services Service Coordination Special Instruction Speech Language Pathology Social Work Transportation Vision Respite Autism Waiver 1915i Waiver 28

29 Insurance Only 14 states Family Fees Only 3 states Both Insurance and Family Fees 15 states Of the 29 states that access insurance, only 13 (45%) could identify the revenue generated. Of the 18 states that have a family fee system, only 9 (50%) states could identify the revenue generated Co-Chairs: Linda Goodman and Carolyn Stiles 29

30 15 committee members Charge from the Board Develop reauthorization position Monitoring NPRMs Tracking of national issues related to Part C. Reauthorization Summit Step 1: Committee conducted a methodical review of statute to identify potential areas of change and developed document for members Step 2: Members will review document and discuss recommendations of the committee and prioritize areas of change Step 3: Committee will take the work of the members and further develop the issues 30

31 Six Organizations ITCA DEC 619 Consortium AUCD/ECSIG EIFA Family Voices Topics: What is Part C Evidence-based Practice Natural Environments Funding Transition Proceedings Document What is Early Intervention Evidence-based Practice Natural Environments Transition Funding 31

32 Reauthorization Summit Proceedings Document Worksheet Identify y recorder 32

33 The ITCA National and Regional Parent Leadership Awards are given annually to acknowledge outstanding state / regional, and/or national parent leadership on behalf of the Part C program for infants and toddlers with developmental delays or disabilities and their families. Parents may be nominated on the basis of significant contributions, in either a volunteer or paid capacity, during a specific period of time, or for exceptional efforts over a period of several years. These efforts may range from family support efforts, recruiting and/or training families, serving on committees, working on legislative initiatives etc. 33

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