RD431 - Report on Virginia’s Part C Early Intervention System - July 1, 2013 - June 30, 2014


Executive Summary:
In the 2014 Appropriation Act, paragraph H.2. of Item 308 directs the Department of Behavioral Health and Developmental Services (DBHDS) 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 FY2014 and Beyond

The additional state funds allocated by the Governor and the General Assembly for the end of FY2013 and for FY2014 made a significant difference in helping Virginia’s Part C early intervention system recover from the significant budget shortfalls and noncompliance with federal requirements experienced in FY2013. Local systems resumed child find (outreach) efforts and those local systems that had cut services in FY2013 are now serving all eligible children. Looking ahead, the system is still growing and remains stressed. While revenue realized through the Medicaid Early Intervention Services Program continues to provide funding for services to children with Medicaid, the amount of funding (i.e., federal, state, local, private insurance, and family fees) available for services to children without Medicaid and the reimbursement rate for service coordination (i.e., case management) for children with Medicaid are inadequate to cover the costs for these services. Unless funding keeps pace with growth, Virginia runs the risk of falling back into noncompliance, which puts federal funding at risk and results in children and families not getting the supports and services they need in a timely and effective manner. The Department, in collaboration with other state agencies and local stakeholders, is continuing to identify and evaluate possible sources of additional revenue, to closely monitor the local fiscal situation and to ensure local system personnel have the skills to provide effective oversight of local budgets and spending. DBHDS is providing guidance and management support to the local lead agencies to address these issues.

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 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.

• Local systems incur additional costs as ITOTS cannot accept data from local information systems. Additional time is spent preparing manual or Excel reports.

• 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 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 incremental data system improvements have been implemented to address data integrity and better reporting, fiscal constraints and competing data priorities within the Department 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.

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. The Department has designated $250,000 for FY2015 to develop such an interface for Part C early intervention data. The interface itself will not expand the type of data collected in ITOTS but will provide a foundation upon which service delivery and financial data can be added and collected directly from local systems in the future. Until such a system is fully developed and implemented, the Department’s challenges in meeting federal and state reporting requirements will continue.