April 5, 2016
Commissioner Veronda L. Durden
Department of Assistive and Rehabilitative Services
4800 N. Lamar Blvd.
Austin, Texas 78756
RE:Comments on 2018-2019 DARS Legislative Appropriations Request
Dear Commissioner Durden,
Thank you for the opportunity to provide stakeholder input regarding the 2018-2019 DARS Legislative Appropriations Request. As leaders of the state’s ECI Advocacy Coalition, we collaborate with organizations around the state to raise awareness about the importance of a strong and effective Early Childhood Intervention (ECI) program to families, communities and the State.
The ECI program plays a critical role in helping Texas children reach their potential. Parents throughout the state rely on ECI to help them successfully navigate the challenges and opportunities of raising children with disabilities or developmental delays. Children rely on ECI to help them learn to walk, communicate with their families, or meet other developmental goals. Schools rely on ECI to prepare children to succeed when they start elementary school.
Over the last year, our organizations have engaged community leaders, families, ECI providers, health professionals and educators around the state to identify ways to strengthen the ECI program and ensure every eligible family can access effective ECI services. As ECI is an entitlement under Part C of the federal Individuals with Disabilities Education Act (IDEA), we expect that caseload growth will be included in base budget. In addition, based on our research and community engagement efforts, the ECI Advocacy Coalition leadership strongly believes the following recommendations are critical to ensuring optimal outcomes for Texas children and families:
Exceptional item: Ensure Pending Acute Therapy Rate Reductions in Medicaid do not Reduce ECI Access
The proposed cuts will have a significant impact on access to ECI services. To ensure the cuts do not impede access to ECI services, it is essential that any potential reduction in Medicaid funding for acute therapy services within the ECI program be offset with an increase in General Revenue and associated federal funding. An alternative approach would be to carve out acute therapy services provided by ECI programs from the proposed rate reductions and maintain the current rate structure for other ECI services.
Exceptional Item: Boost Funding for ECI to Meet the Needs of All Eligible Children
In 2012, Texas ECI served 1.96 percent of children under three years old, well below the national average of 2.77 percent and national leader of 7.18 percent. In addition, with estimated population growth in Texas, level funding for ECI must keep pace with need. If DARS can remove administrative barriers placed on providers and increase their Child Find efforts, as detailed below, more children with severe developmental delays will be referred to ECI. The benefit of increased access will positively affect children served by the program and ensure they are meeting developmental milestones and are school-ready.
DARS also highlighted in its recent outcomes materials that effective early intervention services lead to cost-savings down the road, including reduced need for special education in the K-12 system.
Exceptional Item: Provide Dedicated Funding for Child Find Services
To ensure that all children with developmental delay can access appropriate services, the federal Part C of Individuals with Disabilities Education Act (IDEA) requires that states operate a comprehensive Child Find system and public awareness program. In the past, Texas invested in these crucial outreach efforts by providing ECI contractors dedicated funding for Child Find staff whose role was to communicate regularly with pediatricians, child care directors, and other referral sources about ECI services and eligibility. We were surprised to recently learn that Texas no longer provides dedicated Child Find funding. Based on our recent survey of 46 (of 49) ECI contractors, 43 percent of ECI contractors stopped employing a full-time Child Find staff person in the past four years due to budget constraints. The impact of reduced support for Child Find is borne out in performance data. In 2012, Texas ECI served 1.96 percent of children under three years old, well below the national average of 2.77 percent and national leader of 7.18 percent. If the Texas legislature reinstated dedicated funding for Child Find staff, it could increase communication with pediatricians and other referral sources and better ensure all eligible children and families are identified and appropriately served.
Rule Change: Measure ECI Performance Based on Outcomes
The goal of ECI is to help children overcome their developmental or physical challenges and be ready to succeed in school. The State should measure performance by focusing on outcomes, not just service hours. When a pediatrician refers a family to ECI, she does not prescribe a recommended set of service hours to ensure developmental improvement. Instead, the pediatrician refers families to ECI because providers assess the needs of each unique child and enact individualized plans designed to improve the child’s developmental trajectory. Therefore, whether children are improving developmentally and hitting developmental targets should be the focus of how Texas measures ECI performance. These outcomes measures should include those tracked by DARS for federal reporting purposes, including percent of children who (1) demonstrate significant growth rate in social-emotional, use of language and use of behaviors to meet the child’s needs and (2) children’s development meets age expectations.
Rule Change: Require Private Insurance Companies in Texas to Cover Specialized Skills Training and Service Coordination Provided by Early Intervention Specialists and Speech Therapy Provided by Speech and Language Pathologists Licensed by Their State Board
One of the fiscal strains on ECI providers is most private insurers do not pay for (1) Specialized Skills Training (SST) and service coordination provided by Early Intervention Specialists or (2) Speech Therapy provided by speech and language pathologists. Clearly speech and language therapy is essential for children with language and speech delays. In addition, SST provides parents with training on how to help their child overcome developmental challenges and is an integral component of ECI’s comprehensive services. In Texas, because most private insurance companies do not cover SST delivered by Early Intervention Specialists and speech and language therapy delivered by speech and language pathologists, ECI providers bill that cost to the DARS ECI Contracts. As private insurers are receiving the benefits of these services without paying for them, Texas could reduce the cost to taxpayers by requiring private insurers to cover SST and speech therapy services.
Thank you for the opportunity to submit comments on behalf of the ECI Advocacy Coalition on the DARS Legislative Action Request. Please let any of the undersigned organizations know if we can provide further information or background on the above recommendations.
Texans Care for Children
Disability Rights Texas
The Arc of Texas
Texas Council for Developmental Disabilities
Texas Pediatric Society
Easter Seals Central Texas