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ABC 2 + 2 = 4 ABC PRESENTATION TO THE SICC FUNDING COMMITTEE Discussion Draft: July 13, 2011 Early Support for Infants and Toddlers Program Cost Study WASHINGTON STATE DEPARTMENT OF EARLY LEARNING

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Page 1: PRE PRERPRSRN - ECTA Centerpdfs/waproject/SICC Funding Comm Pres_20… · PRESENTATION TO THE PRERPRSRN SICC FUNDING COMMITTEE Discussion Draft: July 13, 2011 Early Support for Infants

ABC

2 + 2

= 4ABCPRESENTATION TO THE SICC FUNDING COMMITTEE

Discussion Draft : July 13, 2011

Early Support for Infants and Toddlers Program Cost Study

WASHINGTON STATE DEPARTMENT OF EARLY LEARNING

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ESIT PROGRAM COST STUDY Summary Key Findings and Preliminary Recommendations

DISCUSSION DRAFT: JULY 13, 2011

2

PRESENTATION OVERVIEW

�� Study�Overview

�� Methodology

�� Data�Implications

�� Brief�Overview�of�Washington’s�Early�Intervention�System

�� Demographics�of�Children�Served

�� System-wide�Costs�and�Revenues

�� Baseline

�� Range�of�costs�and�revenues

�� Costs�and�Revenues�per�Child�by�Area

�� Costs�and�Revenues�by�Administrative�Structure

�� Family�Resource�Coordinators

�� Qualitative�Comments

�� Key�Findings�and�Recommendations

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ESIT PROGRAM COST STUDY Summary Key Findings and Preliminary Recommendations

DISCUSSION DRAFT: JULY 13, 2011

3

STUDY OVERVIEW

PURPOSE OF THE STUDY �� Determine�the�costs�and�revenues�available�for�providing�Part�C�birth�to�three�Early�

Intervention�Services�across�Washington

�� Help��ESIT�identify�and�recommend�funding�policies�that�will�lead�to�a�more�sustainable,�equitable,�and�cost�effective�system�of�services�across�our�state

�� Support�the�work�occurring�under�the�broader�System�Improvement�Project�

STUDY COMPONENTS �� Collect�and�analyze�data�on�Washington’s�Part�C�system;�financial�modeling

�� Gather�information�from�other�states�about�their�funding�systems

�� Identify�potential�funding�policies�and�practices�that�will�lead�to�a�more�effective�and�sustainable�system�of�services�statewide

Study Timeline: September 2010 - September 2011

WHERE WE ARE�� Completed�data�gathering

�� Built�a�financial�model

�� Submitted�draft�findings�and�recommendations�to�ESIT

NEXT STEPS�� Obtain�feedback�from�the�Funding�

Committee

�� Finalize�data�analysis

�� Submit�draft�and�final�reports�to�ESIT

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ESIT PROGRAM COST STUDY Summary Key Findings and Preliminary Recommendations

DISCUSSION DRAFT: JULY 13, 2011

4

METHODOLOGY

DATA COLLECTION �� �Round�1�Data�Collection:�Data�requests�were�sent�to�35�LLAs.

�� Round�2�Data�Collection:�School�Districts�(online�survey)�and�Service�Providers�(data�requests�sent�to�providers�identified�as�contractors�for�LLAs)

�� �Interviews�and�Site�Visits:�11�interviews�(8�in-person�site�visits�and�3�phone�interviews)

OTHER DATA SOURCES�� �ESIT:�Part�C�funding�data�by�geographic�area

�� OSPI:�special�education�birth�to�five�funding�levels�by�school�district

�� DSHS�DDD:�annual�funding�amounts�and�county�recipients�for�early�intervention�programs

�� DOH:�annual�funding�amounts�for�NDCs�and�the�Children�with�Special�Health�Care�Needs�Program

Many thanks to everyone who participated in our data gathering efforts!

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DISCUSSION DRAFT: JULY 13, 2011

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�� Since�there�is�currently�no�centralized�data�source,�this�data�collection�effort�resulted�in�more statewide data than ever before.�

�� This�is�a�planning-level study�and�is�not�a�precise�calculation�of�costs�and�revenues.�It�is�intended�to�provide�a�reasonable estimate�of�system-wide�and�geographic�area�costs�and�revenues.�

�� Because�early�intervention�is�a�highly�decentralized�system,�there�are�some�inconsistencies�in�the�data.�Where�possible,�we�made�adjustments�to�correct�for�these,�but�detailed�comparisons�of�one�geographic�area�to�another�must�be�interpreted�with�caution.

�� Challenges�encountered�included:�different�interpretations�of�data�requests�by�different�entities,�varying�sophistication�of�providers’�data�systems,�cases�of�non-responsiveness�to�follow-up�questions,�and�others.

DATA IMPLICATIONS

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ESIT PROGRAM COST STUDY Summary Key Findings and Preliminary Recommendations

DISCUSSION DRAFT: JULY 13, 2011

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BRIEF OVERVIEW OF EARLY INTERVENTION SYSTEM

35 Local Lead Agencies (LLAs)

�� Non-Profit�Agencies

�� County�Human�Services�Agencies�and�Health�Departments

�� Educational�Service�Districts

�� Health�Districts

�� Tribal�Nations

�� Community�College

Provide direct services

Combination of providing direct

services and contracting

> 100 Direct Service Providers

�� non-profit�organizations

�� educational�service�districts

�� local�health�jurisdictions

�� county�agencies

�� neurodevelopmental�centers

�� hospitals

�� independent�service�providers

�� other�providers

Coordinate local early intervention

system

Contract�with�LLA�to�either�provide�direct�services�or�subcontract�to�other�providers

295 School Districts

Direct46

16%

Direct & Contract

5117%Contract

16155%

Data N/A37

12%

Administrative Structures by Number of Districts

Contract Contract

Ways School Districts are involved in EI

By Number of SDs (n=295)

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ESIT PROGRAM COST STUDY Summary Key Findings and Preliminary Recommendations

DISCUSSION DRAFT: JULY 13, 2011

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There were approximately 9,600 Part C children served in 2010

ESTIMATED STATEWIDE COVERAGE OF PART C CHILDREN � Medicaid�enrollment

�� 45%�weighted�average�across�35�areas

�� Ranging�from�none�to�99-100%�in�some�areas

�� King�County:�40%�weighted�average

� Private insurance�coverage

�� 28%�weighted�average�across�35�areas

�� Ranging�from�none�to�55%�in�some�areas

�� King�County:�55%

� Military benefits�coverage

�� 5%�weighted�average�across�35�areas

�� Ranging�from�none�to�51%�in�some�areas�(Island�County)

�� King�County:�1%

� Other benefits�(Including�Indian�Health)�were�about�1%�weighted�average

FINANCIAL DEMOGRAPHICS

*�Please�note:�some�children�had�dual�coverage�-�Medicaid�and�private�insurance

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DISCUSSION DRAFT: JULY 13, 2011

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BASELINE SYSTEM-WIDE COSTS AND REVENUES

�� Estimates�include�the�whole�system,�including�LLAs,�school�districts,�and�other�providers

�� Statewide�costs�are�estimated��at�approximately�$61.3�M

�� Statewide�revenues�are�estimated�at�about�$61�M

�� “Other”�includes�grants,�local�levies,�fundraising�efforts,�etc.

�� The�system�costs�and�revenues�have�to�balance�-�however,�it�doesn’t�mean�that�there�is�sufficient�funding�in�the�system�to�provide�quality�services�for�all�children�who�need�them

-

$10,000,000

$20,000,000

$30,000,000

$40,000,000

$50,000,000

$60,000,000

$70,000,000

Revenue Cost

Other

Private Insurance & Military Benefits

Medicaid

Department of Health

County DD/Child DevelopmentServicesState Special Ed Funding

ESIT Part C Federal Funds

Indirect Costs

Other Direct Costs

FRC Costs

COSTS AND REVENUES BASELINE2010 Reported Estimated

Total Costs $61,334,000 100% $34,882,000 $26,452,000FRC Costs $8,418,000 14% $6,841,000 $1,578,000Other Direct Costs $35,545,000 58% $20,365,000 $15,179,000Indirect Costs $17,371,000 28% $7,676,000 $9,695,000

Total Revenues (Reported) $60,959,000 100% $60,959,000 ‐ESIT Part C Federal Funds $7,126,000 12% $7,126,000 ‐State Special Ed Funding  $34,569,000 57% $34,569,000 ‐County DD/Child Development Services $5,735,000 9% $5,735,000 ‐Department of Health $542,000 1% $542,000 ‐Medicaid $3,126,000 5% $3,126,000 ‐Private Insurance & Military Benefits $3,655,000 6% $3,655,000 ‐Other $6,207,000 10% $6,207,000 ‐

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�� Due�to�data�availability�issues,�a�significant�portion�of�the�cost�data�as�well�as�some�of�the�revenue�data�was�estimated.�For�this�reason,�we�estimated�likely�ranges�for�revenues�and�costs�(each�cost�and�revenue�component�has�its�own�“low”�and�“high”�assumption)

�� Total�revenues�likely�fall�in�the�range�of�$57.5M to $67.3M

�� State�Special�Education�Funding�amount�is�based�on�OSPI�allocation�–�it�is�unclear�what�portion�school�districts�choose�to�actually�use�for�birth-3�(Part�C)�versus�3-5�services

�� Medicaid�and�private�insurance�are�likely�understated�(not�all�providers�reported�revenues�and�not�all�providers�were�captured�in�the�study)

�� Total�costs�likely�fall�in�the�range�of�$52.3M to $66.5M

�� Wider�margin�of�error:�costs�were�imputed�using�information�from�similar�agencies,�adjusted�proportionally�based�on�staffing�levels�or�the�number�of�children�served�

RANGE OF COSTS AND REVENUES

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DISCUSSION DRAFT: JULY 13, 2011

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SYSTEM REVENUES

12%

57%

5%

9%

1%6%

0.4% 1%1%

8%

ESIT Part C Federal Funds

State Special Ed Funding

Medicaid

County DD

Dept of Health

Private Insurance

Military benefits

Other Federal Sources

Other City/ County Government

Other Private/ Non-Profit

�� State�Special�Education�Funding�channeled�through�school�districts�contributes�the�largest�amount�(approximately�57%)�of�the�funding�for�Part�C�early�intervention�services

�� Other�large�contributors:

�� Federal�Part�C�funding�(12%)

�� County�Department�of�Developmental�Disabilities�funding�(9%)

�� Other�combined�sources�(10%)�are�the�next�largest�contributors,�which�include�grants,�local�levies,�fundraising�efforts�by�providers,�etc.

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DISCUSSION DRAFT: JULY 13, 2011

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SYSTEM COSTS

�� FRC�costs�(including�salaries�and�benefits,�materials,�and�other�FRC-related�costs)�are�estimated�to�be�about�14%�of�total

�� Costs�for�other�direct�services�(excluding�FRC�costs)�are�estimated�to�account�for�about�58%�

�� Indirect�costs�are�estimated�to�be�approximately�28%�of�total�costs�of�providing�services.�These�costs�include:

�� Support�staff�salaries�and�benefits,

�� Occupancy,

�� Insurance,�and�others

14%

58%

28%

FRC

Other directcostsIndirect costs

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REVENUES PER CHILD BY AREA

�� County�DD�funding�is�a�major�source�of�revenue�for�early�intervention�in�some�counties,�while�others�cannot�access�this�funding�at�all�due�to�county-level�policy�decisions

�� An�area’s�ability�to�access�Medicaid�and�private�insurance�depends�largely�on�the�mix�of�service�providers.�Where�NDCs�or�other�larger�organizations�provide�a�significant�portion�of�the�services,�these�funding�sources�are�used�to�a�greater�extent

�� “All�Other”�sources�represent�a�significant�amount�of�funding,�mostly�in�larger�counties.�They�include�private�insurance�and�military�benefits,�other�federal�and�local�sources�(grants�and�levies),�private/non-profit�contributions�(fundraising,�special�events)�

�� In�many�small,�rural�areas�only�State�Special�Education�and�ESIT�Part�C�funding�is�used

�� These�areas�are�excluded�from�the�chart�as�the�total�number�of�children�served�is�less�then�10:

�� San�Juan�County�(9�children)�� Lincoln�County�(6�children)�� Columbia�County�(5�children)�� Garfield�County�(1�child)

�� Statewide�median�=�$5,800�per�child

Note:�Number�of�Part�C�Children�is�next�to�area�name�on�the�chart;$6,360�is�a�weighted�average�statewide.

- $2,000 $4,000 $6,000 $8,000 $10,000 $12,000

Klickitat County (15)

Mason County (43)

King County (2546)

Spokane County (692)

Pacific County (31)

Whitman County (44)

Kittitas County (39)

Chelan & Douglas Counties (209)

Cowlitz & Wahkiakum Counties (181)

Benton & Franklin Counties (459)

Kitsap County (446)

Skamania County (18)

Lewis County (87)

Snohomish County (1102)

Skagit County (166)

Pierce County (1059)

Whatcom County (245)

Island County (166)

Yakima County (462)

Asotin County (53)

Clallam County (79)

Grant County (133)

Clark County (510)

Okanogan County (108)

Walla Walla County (84)

Grays Harbor County (71)

Jefferson County (40)

Ferry, Pend Oreille, and Stevens Counties (59)

Thurston County (342)

Quileute Tribal School Service Area (10)

STATEWIDE AVERAGE

Revenues per Child by Geographic Area, 2010

ESIT Part C Federal Funds State Special Ed Funding Medicaid County DD All Other

Average = $6,360

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DISCUSSION DRAFT: JULY 13, 2011

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- $2,000 $4,000 $6,000 $8,000 $10,000 $12,000

Klickitat County (15)

King County (2546)

Mason County (43)

Spokane County (692)

Pacific County (31)

Grays Harbor County (71)

Cowlitz & Wahkiakum Counties (181)

Benton & Franklin Counties (459)

Ferry, Pend Oreille, and Stevens Counties (59)

Whitman County (44)

Island County (166)

Snohomish County (1102)

Okanogan County (108)

Clark County (510)

Chelan & Douglas Counties (209)

Clallam County (79)

Walla Walla County (84)

Kitsap County (446)

Asotin County (53)

Skagit County (166)

Yakima County (462)

Jefferson County (40)

Pierce County (1059)

Grant County (133)

Adams County (63)

Thurston County (342)

Kittitas County (39)

Whatcom County (245)

Lewis County (87)

Quileute Tribal School Service Area (10)

STATEWIDE AVERAGE

Costs per Child by Geographic Area, 2010

FRC Costs Other Direct Services Indirect Costs

Average = $6,400

COSTS PER CHILD BY AREA

�� Areas�where�many�school�districts�contract�for�services�typically�have�higher�indirect�costs�as�school�districts�keep�an�average�of�15%-20%�of�their�funding�to�cover�indirect�costs,�and�providers�average�indirect�costs�of�about�30%

�� These�areas�are�excluded�from�the�chart�as�the�total�number�of�children�served�is�less�then�10:

�� San�Juan�County�(9�children)

�� Lincoln�County�(6�children)

�� Columbia�County�(5�children)

�� Garfield�County�(1�child)

�� Statewide�median�=�$5,550�per�child

Note:�Number�of�Part�C�Children�is�next�to�area�name�on�the�chart;$6,400�is�a�weighted�average�statewide.

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REVENUES AND COSTS BY STRUCTURE

For�the�purposes�of�assessing�funding�and�costs,�we�defined�six�general�types�of�administrative�structures�that�are�prevalent�in�Washington�and�assigned�each�geographic�area�to�one�of�these�structures:

1.� LLA�Provides�Most�Services

2.� LLA�Provides�Some�Medically-related�Services�(OT,�PT,�Speech,�medical,�nursing)

3.� LLA�Provides�Only�Non-medically-related�Services�(all�other�services�-�e.g.�special�instruction,�family�training�and�counseling,�etc.)

4.� LLA�Provides�FRCs�only

5.� LLA�Provides�FRCs�and�Acts�as�Pass��Through

6.� LLA�Acts�as�Pass��Through�Only

We�reviewed�revenue�and�cost�distribution�per�child�for�these�six�structures�to�determine�if�any�presented�uniques�advantages�or�challenges:

�� Distribution�of�revenue sources�is�most�dependent�on�the�type�of�organization�accessing�the�funding.�Where�NDCs�or�other�larger�non-profits�provide�a�significant�portion�of�the�services,�there�is�more�access�to�funding�sources�(such�as�Medicaid,�private�insurance,�and�fundraising)

�� Generally,�FRC cost per child�is�lowest�where�an�agency�is�only�providing�FRC�services�(model�4�and�5)�and�FRC�duties�are�not�performed�by�therapists,�educators,�and�others�who�typically�earn�higher�salaries.�However,�these�costs�are�also�influenced�by�the�type�of�employing�agency

� Indirect rates�are�higher�where�the�LLA�is�acting�as�a�pass�through�(models�5�and�6),�as�school�districts�are�often�contracting�with�the�LLA�who�in�turn�contracts�with�another�provider.�Each�of�the�agencies�involved�has�an�administrative�expense

�� Further�conclusions�on�service�costs�are�difficult�to�establish�without�considering�hours�and�quality�of�services�provided

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FAMILY RESOURCES COORDINATORS (FRC)

�� Statewide�there�were�about�280�FRCs�in�2010

�� Across�all�geographic�areas�the�average�caseload�was�about�30.6

�� Across�all�geographic�areas�the�average�direct�cost�per�FRC�FTE�was�about�$56,000.�Direct�costs�include�salaries,�benefits,�supplies,�and�travel�costs

Note:�Number�of�FRCs�is�next�to�area�name�on�the�chart;Some�numbers�are�still�being�investigated�(marked�by�***�in�the�table

4644

2751

5046

31N/A

188

551

1538

196

3415

2520

4510

204040

140

395

***18

48

5028

2431

0 10 20 30 40 50 60

Yakima County (7)Whitman County (1.25)

Whatcom County (7)Walla Walla County (1.5)

Thurston County (5)Spokane County (15)

Snohomish County (37)Skamania County (0)

Skagit County (9)San Juan County (1)

Quileute Tribal School Service Area (3)Pierce County (13)Pacific County (2)

Okanogan County (3)Mason County (29)Lincoln County (1)

Lewis County (5)Klickitat County (2)Kittitas County (1)Kitsap County (27)King County (63.8)

Jefferson County (2)Island County (5)

Grays Harbor County (1.04)Grant County (2)

Garfield County (2)Ferry, Pend Oreille, and Stevens Counties (4)

Cowlitz & Wahkiakum Counties (5.2)Columbia County (0.4)

Clark County (6)Clallam County (3)

Chelan & Douglas Counties (5)Benton & Franklin Counties (7)

Asotin County (1)Adams County (4)

STATEWIDE AVERAGE

Average Annual Caseload of All

FRCs: 31

Average Annual Case Load

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QUALITATIVE COMMENTS

BARRIERS AND OPPORTUNITIES FOR PROVISION OF EI SERVICES

Lack of Qualified Providers

�� Difficulty�in�finding�and�retaining�qualified�providers�of�particular�services.�

�� Most�frequently�mentioned:�physical�therapists,�occupational�therapists,�and�speech�therapists/speech�language�pathologists.�

�� Also�finding�providers�who�are�bi/multi-lingual�and�are�sensitive�to�cultural�issues.

Funding Uncertainties

�� Part�C�and�DDD�funding�has�remained�the�same�for�several�years,�as�costs�and�demand�for�services�have�risen.�This�creates�stress�on�service�providers�who�are�expected�to�do�more�with�less,�but�whose�increased�workloads�reduce�their�ability�to�provide�adequate�service.�

�� These�issues�are�felt�more�acutely�in�rural�areas�because�apportionment�funding�might�be�insufficient�to�cover�costs�for�practitioners�and/or�specialized�services�if�there�is�a�small�number�of�eligible�children.

Complexity of Funding Sources

�� While�having�multiple�funding�sources�creates�more�opportunities�for�families�to�access�services,�it�puts�an�additional�burden�on�LLAs�in�having�to�adhere�to�a�variety�of�administrative,�tracking,�reporting,�and�billing�systems,�further�straining�their�ability�to�provide�adequate�services.

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QUALITATIVE COMMENTS

BARRIERS AND OPPORTUNITIES FOR ACCESSING EI FUNDING SOURCES

Issues with Private Insurance

�� Difficulty�in�dealing�with�private�insurance�companies,�related�to�co-pays�and�deductibles.�Billing�private�insurance�companies�is�both�costly�and�time-consuming,�and�dealing�with�them�is�confusing�because�their�requirements�seem�to�be�ever-changing.�

�� There�is�also�a�conflict�with�requirements�that�services�not�be�provided�“off-site,”�which�is�in�conflict�with�the�Natural�Environments�mandate.

Issues with Medicaid

�� Expensive�to�bill�Medicaid�and�time-consuming.

�� Provider�One�billing�system�has�been�an�issue:�lower�reimbursement�rates,�a�high�percentage�of�denials,�a�slower�process,�an�increase�in�errors,�and�a�frustrating�process�in�reaching�someone�when�a�claim�is�denied.�Some�providers�have�begun�to�refuse�Medicaid�as�a�form�of�payment�because�of�these�issues.

Funding Inequities

�� Because�geographic�areas�do�not�all�have�access�to�the�same�funding�sources,�there�is�a�strong�perception�of�inequity�among�LLAs�across�the�state.�DDD�and�CDS�funds�are�not�available�everywhere.�

�� The�lack�of�one�strong�entity�administering�funds�for�EI�negatively�impacts�the�program.�Multiple�funding�sources�actually�increase�the�cost�of�providing�services�because�of�the�greater�needs�to�administer�the�individual�programs.

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GROWING AVAILABLE FUNDING FOR EARLY INTERVENTION SERVICES � Medicaid funding is underutilized -�IDEA�Part�C�statute�requires�fiscal�participation�from�Medicaid,�

but�local�programs�do�not�use�Medicaid�consistently,�if�at�all.�

�ΠDevelop�a�State�Plan�Amendment�to�be�submitted�to�CMS

�ΠCommunicate�changes�to�all�providers�with�clear�policy�guidance,�training,�and�technical�assistance

�ΠDevelop�an�easy-to-follow�billing�procedures�manual

�ΠEncourage�automatic�school-based�billing�systems�for�IFSPs,�similar�to�IEPs

�ΠExplore�the�use�of�third�party�billers

� Limited Access to Private Insurance -�for�a�variety�of�reasons,�many�providers�and�school�districts�do�not�bill�private�insurance�for�services.�

�ΠDevelop�policy�and�infrastructure�to�ensure�that�all�providers�(including�school�districts)�are�billing�private�insurance

�ΠDevelop�communication�materials�for�school�districts�and�providers�to�use�with�families�

�ΠSupport�legislation�that�would�require�insurance�companies�to�include�early�intervention�services�under�their�plans�

� Not All Potential Revenue Sources are Being Accessed

�ΠPerform�systematic�review�of�potential�funding�sources�in�Washington�(including�partnerships,�potential�expansion�of�Family�Cost�Participation�to�include�family�fees,�etc.)

�ΠDevelop�and�implement�a�comprehensive�funding�plan

KEY FINDINGS & RECOMMENDATIONS

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DISTRIBUTION OF FUNDING AMONG GEOGRAPHIC AREAS � Unequal Access to State Funding Sources -�State�funding�sources�like�DDD,�DOH,�and�Special�

Education�funding�comprise�about�two�thirds�of�system�revenues,�but�depending�on�type�of�providers�in�any�geographic�area,�not�all�areas�have�equal�access�to�these�sources.�Also,�having�multiple�funding�sources�administered�by�different�agencies�may�be�actually�increasing�the�cost�of�providing�services�because�of�the�greater�needs�to�administer�the�individual�programs.

�ΠExplore�centralizing�DD�and�OSPI�Special�Education�funding�sources�in�the�Department�of�Early�Learning�ESIT�Program

�ΠContinue�working�to�align�DD�and�Part�C�eligibility�criteria�to�facilitate�access�and�minimize�administrative�burden

� School District Administrative Fees Vary Significantly Statewide -�School�districts�charge�administrative�fees�(recovery�rates)�ranging�from�5%�to�over�50%�on�their�contracts�with�LLAs�and�service�providers.

�ΠEstablish�minimum�monthly�negotiated�rates�or�cap�percentages�school�districts�can�charge�for�administration

�Î Encourage�use�of�performance�based�contracting�to�ensure�the�level�of�service�districts’�children��receive�from�providers

� ESIT Part C Funding Allocation Does Not Always Accurately Reflect Child Count or Address Other Funding Inequities

�ΠAnalyze�average�child�count�trends�and�compare�to�point�in�time�child�count

�ΠUpdate�allocation�formula�to�reflect�child�count�trends�-�phase�in�implementation�only�with�additional�funding�to�ensure�no�area�experiences�a�funding�decrease

�ΠWith�additional�funding,�explore�directing�dollars�to�areas�that�cannot�access�DD�funding

KEY FINDINGS & RECOMMENDATIONS

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DISCUSSION DRAFT: JULY 13, 2011

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QUALITY OF INFORMATION FOR DECISION MAKERS � Lack of consistent information on local costs and funding sources -�ESIT�has�no�consistent�and�

comprehensive�statewide�data�on�actual�costs�and�revenues�for�EI�service�provision.�This�makes�it�difficult�for�ESIT�to�administer�its�Part�C�responsibilities�and�make�informed�policy�choices.

�ΠDefine�data�needs�and�establish�(or�modify�existing)�collection�mechanism

�ΠUse�contracting�tools�to�require�systematic�reporting�

� Local providers require policy guidance on a number of early intervention issues -�providers�and�districts�are�inconsistent�in�approaches�to�service�provision�and�billing.�

�Î Ensure�consistency�and�availability�of�policy�guidance�on�DEL’s�website�and�through�other�channels�as�appropriate

KEY FINDINGS & RECOMMENDATIONS

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OTHER KEY FINDINGS � Costs for FRC services vary dramatically by area -�minimum�job�requirements,�local�salaries,�

and�job�sharing�arrangements�have�led�to�significantly�varying�costs�per�FTE�by�service�provider�and�geographic�area.�In�addition,�FRC�requirements�are�different�statewide,�ranging�from�high�school�diploma�and�state�training�to�Master’s�degree.�This�is�a�concern�to�some�providers,�as�it�can�affect�the�quality�of�services.

� FRC Caseloads vary significantly by area.�This�can�lead�to�inconsistent�quality�of�service�for�Washington�families.

� Some administrative structures have higher indirect costs�for�services�-�when�multiple�contracting�agencies�are�involved,�indirect�costs�are�higher

�� E.g.:�models�where�the�school�district�contracts�with�the�LLA�who�in�turn�contracts�with�another�service�provider,�require�three�layers�of�administrative�costs,�whereas�models�with�a�central�service�provider�only�require�one�or�two

� Costs per child for EI services vary across the state -�without�understanding�the�service�hours�provided�for�each�child,�it�is�difficult�to�draw�conclusions.�It�likely�reflects�inequity�in�the�level�of�service�received�by�children�in�different�geographic�areas�as�well�as�the�varying�cost�structures�of�individual�service�providers.

� Summertime service is a challenge�-�school�districts�provide�services�mostly�only�during�the�school�year�and�pay�their�contractors�for�8-10�months.�Some�providers�have�stepped�in�to�cover�summertime�services,�but�in�many�areas�there�is�a�service�gap�while�the�school�is�not�in�session.

KEY FINDINGS & RECOMMENDATIONS