RD505 - Report on Virginia’s Part C Early Intervention System – July 1, 2017 – June 30, 2018 – November 15, 2018

Executive Summary:

Congress enacted early intervention legislation in 1986 as an amendment to the Education of Handicapped Children’s Act (1975) to ensure that all children with disabilities from birth to the age of three would receive appropriate early intervention services. This amendment formed Part H of the Act, which was re-authorized in 1991 and renamed the Individuals with Disabilities Education Act (IDEA). When the IDEA was re-authorized in 1998, Part H became Part C of the Act. IDEA was reauthorized most recently in December 2004. Virginia has participated in the federal early intervention program, under IDEA, since its inception.

In 1992, the Virginia General Assembly passed legislation that codified an infrastructure for the early intervention system that supports shared responsibility for the development and implementation of the system among various agencies at the state and local levels. The Department of Behavioral Health and Developmental Services (DBHDS) was designated and continues to serve as the State Lead Agency. The broad parameters for the Part C system are established at the state level to ensure implementation of federal Part C regulations. Within the context of these broad parameters, 40 local lead agencies manage services across Virginia.

In 2012, the General Assembly appropriated the state funds necessary to increase the Medicaid reimbursement rate for early intervention targeted case management from $120 per month to $132 per month for FY 2013, beginning July 1, 2012. In order to address a looming $8.5 million deficit in funding for early intervention due to significant increases in the number of children served and static federal funding, the General Assembly provided critical support for Virginia’s early intervention system in 2013 by allocating an additional $2.3 million in state general fund dollars for early intervention in FY 2013 and another $6 million for FY 2014. In recognition of continued growth, annual increases were allocated in FY 2015 – FY 2017 and the General Assembly allocated a total of $17.2 million, $18.1 million, and $19.1 million for FY 2018, FY 2019 and FY 2020, respectively.

In FY2018, reported expenses exceeded reported revenue by almost $6 million (8%). The following data underscore the picture of financial stress within the early intervention system and the importance of continued revenue growth in order to support the infants, toddlers and their families who need these critical services:

• The number of children served in the Part C early intervention system increased by almost 6% from FY 2017 to FY 2018. While the General Assembly has increased state Part C funding to support this growth, revenue from a number of other key funding sources, including federal Part C funds, local funds and family fees, have remained stagnant and revenue from non-Part C state general funds has declined.

• Increases in the number of substance exposed infants, earlier identification of autism spectrum disorders and improved statewide collaboration with Neonatal Intensive Care Units (NICUs) is expected to result in continued, and potentially even higher, annual increases in the number of children referred to and served in Virginia’s early intervention system.

• Increasing costs over time have resulted in widespread reports from service providers in FY 2018 that the early intervention rates set in 2009 no longer cover the cost of providing early intervention services. In addition to impacting the need for additional funds, this discrepancy in cost versus reimbursement is contributing to emerging provider shortages and, therefore, high caseloads.

• Fourteen local systems requested additional funds from DBHDS in FY 2018 in order to support the expenses of the local system, including the cost of providing services. DBHDS was able to provide the full amount needed only because of additional FY 2018 state Part C funds allocated by the General Assembly through a caboose bill and one-time additional state general funds from savings in other DBHDS programs. Savings within the Part C system covered only 29% of the additional funds needed.

To the maximum extent possible, the following narrative, charts and other graphics respond to the legislative requirements as delineated in Item 312.H2. The following data is based on revenue and expenditure reports received from the 40 local lead agencies and includes data from the private providers with whom the local lead agencies contract.