RD261 - Report on Virginia’s Part C Early Intervention System -- July 1, 2011 - June 30, 2012

Executive Summary:
In the 2012 Appropriation Act, paragraph H.2. of Item 315 directs the Department of Behavioral Health and Developmental Services to report the following information to the Chairmen of the Senate Finance and House Appropriations Committees on October 1 of each year: (a) total revenues used to support Part C services, (b) total expenses for all Part C services, (c) total number of infants and toddlers and families served using all Part C revenues, and (d) services provided to those infants and toddlers and families.

Overview of Fiscal Climate for Part C in FY2012

The fiscal climate in Virginia’s Part C Early Intervention System became less stable in FY2012. The September 30, 2011 end of funding for Part C under the federal American Recovery and Reinvestment Act (ARRA) and the rapidly increasing number of children receiving services in the Part C early intervention system resulted in significant and growing budget shortfalls. While the Medicaid revenue realized through the Medicaid Early Intervention Services Program continued to adequately fund services for children with Medicaid, the amount of funding (federal, state, local, private insurance, family fees) available for services to children without Medicaid and the reimbursement rate for service coordination for children with Medicaid are inadequate to cover the costs for these services. In FY2012, the Department was able to offset some of the local systems’ budget shortfalls with one-time additional funds realized from vacant positions, efficiencies within the Department, and savings from the Department’s facilities operations. However, three local systems reduced or cut services to eligible children and families in FY2012 due to budget shortfalls and in violation of federal Part C regulations.

Looking ahead, deficits in excess of $8.5 million are anticipated in FY2013 due to continued increases in the numbers of children eligible to receive Part C early intervention services and the expectation that none of the sources of additional funds that were accessed in FY2012 will be available in FY2013. The Department, in collaboration with other state agencies and local stakeholders, is continuing to identify and evaluate possible sources of additional revenue and possible system changes needed to ensure the long-term financial stability of the Part C early intervention but additional state general funds will be required for Part C early intervention for FY2013.

Data System Update

The existing early intervention data system, the Infant and Toddler Online Tracking System (ITOTS), was developed and implemented in 2001 primarily to meet annual federal reporting requirements related to child data. The system provides data on who is getting services and includes the number of children by local system, race/ethnicity, gender, age, and the reason for eligibility. Reports can be pulled for point-in-time data on who is being served, annual review, and limited trend data. ITOTS now presents a number of challenges to the Department in meeting federal and state reporting requirements, including the following:

• Child data is collected in ITOTS only at entry into the early intervention system and is not collected as child status or service needs change.

• No financial data for Part C services is collected through ITOTS, resulting in a burdensome paper process for collection and reporting of comprehensive and reliable data related to the cost of providing services and the revenue sources that are accessed in providing services.

• ITOTS data reports are limited in scope and, therefore, the analysis of the available data does not allow analysis of outcomes.

ITOTS allows for the collection of data on the services planned on each child’s initial IFSP but does not provide for the collection of data on how those services change over time, on delivered services, or on payment for services. Because of the significant limitations of this system, there is no mechanism available for local systems or for DBHDS to get the kind of real-time, ongoing data that would be necessary to effectively and efficiently monitor service delivery for individual children, to study trends and patterns, or to monitor funding sources and service costs by child or by local system.

Between 2006 and 2010, a number of initiatives were implemented to analyze and improve ITOTS. Although data system improvements have been implemented to address data integrity and better reporting, fiscal constraints and competing data priorities within the agency led to delays in developing or purchasing a data system with the complete functionality necessary to enter and report on delivered services and to have more complete and accurate revenue and expense data. The cost of enhancing or replacing the ITOTS system is projected to be $961,500 in the first year and $161,500 in the second year.

Since 2011, the Health and Human Resources Secretariat has been committed to developing a consistent, comprehensive and non-duplicative data system for use across Virginia’s Health and Human Resources agencies rather than developing or enhancing program-specific data systems.
Since many local agencies and service providers have or are in the process of developing and implementing electronic health record systems, the Department’s focus on data collection for all programs (not just the Part C early intervention system) has shifted to identifying and implementing the most effective and efficient mechanism for importing the data already collected by local systems into a state database through which that data can be aggregated, analyzed and reported. Until such a system is implemented, ITOTS will continue to be used and the Department’s challenges in meeting federal and state reporting requirements will continue.

Revenue and Expense Data

The table below shows revenue from all sources as reported by the 40 local early intervention systems for FY2012. [See table "Total Revenue to Support Part C Early Intervention Services" on page 3 of the report.]

In accordance with Item 315.H.2., the chart below provides detail about the total amount of federal and state Part C funds and ARRA funds expended in FY2012 for Part C early intervention services as reported by the 40 local lead agencies and 59 private providers. [See table "Total Expenditures for all Part C Early Intervention Services" on page 3 of the report.]

Total Number of Infants, Toddlers and Families Served

A total of 15,676 infants, toddlers and families received Part C early intervention services in the one-year period from July 1, 2011 – June 30, 2012. This number represents an 11.4% increase over the previous year. This continues the trend of significant growth of an almost 52% increase in the number of children served from FY2007 to FY2012, including 15% increase in the number of children served last year. The increase is due primarily to Virginia’s efforts to identify and enroll all eligible children per federal child find requirements. In addition, Virginia added prematurity as an automatic eligibility criterion for service in December 2010, which also may have contributed to the increase in children enrolled.

The following table breaks down the services that were provided to Part C eligible infants and toddlers by the type of early intervention service determined to be needed in order to achieve the child’s outcomes as listed on the child’s Individualized Family Service Plan (IFSP). [See table "Services Provided to Those Infants, Toddlers and Families" on page 4 of the report.]

In addition to the services listed on IFSPs, a total of 9,882 children received an evaluation to determine eligibility and/or an assessment for service planning in FY2012.