Rate Setting - 8/15/07

Temporary Task Force on Preschool Special Education
Rate-Setting Workgroup
August 15, 2007 Meeting Minutes

Attendees
Brian Bennett (NYSUT), Jyothsna Buddharaju (DOB), Tom Connolly (Agencies for Children’s Therapy Services), Susan Constantino (CP of NY), Mary Garrett (Capital District Beginnings), Eddie Lee (OMRDD), Tom Hamel (SED), Dan Kinley (NYSUT), Pamela Madeiros (Alliance for Children with Special Needs), Harold Matott (SED), Nelly Odondi (DOB), D. Phillips (Capital District Beginnings), Sara Silver (Magi), Dan Tworek (CP of NY)

Via conference call
Sally McKay (NYC Department of Education), Jane Ryan (JE Ryan & Associates)

Absent
Mike Grossfeld (All About Kids), Mark Jasinski (Ithaca City School District), Patsy Yang-Lewis (Westchester County Department of Health)

Organization
The meeting minutes from August 1, 2007 were adopted by the workgroup. There was some discussion regarding the proper use of SEIT. Workgroup consensus was that some parameters for SEIT use should be developed. A continuing minority opinion express by Mike Grossfeld was that SEIT services should be expanded in order to move the child out of special class as soon as possible and into a main-streamed school. This issue is being reviewed by the service delivery workgroup.

Sara Silver from Magi will be sitting in on the workgroup meetings to ensure the final report captures workgroup discussion. There were no objections to the meeting being recorded.

The facilitator and group leader reviewed the agenda. The main goal of the meeting will be to discuss and refine the recommendations to be presented to the Task Force at the August 23 meeting. The draft rate setting methodology (attached) developed by Tom Hamel and circulated to the workgroup will be a useful tool in the implementation details. The desired principles of a new methodology are reflected in the draft.

Issue Statements
Workgroup members began to discuss concrete recommendations via email prior to the meeting. The group facilitator organized these recommendations to address the specific issues first identified by the full Task Force (worksheet attached). The workgroup used this document as a starting point in refining and organizing the recommendations.

The question was posed if there were any issues that should be added or deleted from this list. It was agreed that the list was complete. All the issues are important and should be discussed. The workgroup needs to add detail to flush out both the issues and the recommendations. There may be some issues/recommendations that need to be referred to another workgroup.

There was some discussion regarding prioritizing the issues. It was decided that this should be done later in the process.

Implementing the Recommendations (and resource implications)
The workgroup began to discuss the recommendations identified on the worksheet. In doing so it was determined the issues can best be discussed in 6 categories:

Issues/recommendations suggested for referral to the full Task Force or other workgroups are in bold.

County Participation
The consensus of the workgroup was to recommend that the county role in preschool special education be phased out, both fiscally and programmatically. There is no value-added because of county participation. If the counties were to be eliminated there would need to be a “phase out” plan. The workgroup agreed this may take several years. There needs to be more discussion regarding what would be required to make this happen. The Department of Budget did not agree with this position.

Rate Methodology
The following issues are addressed in the draft rate-setting methodology reviewed by the group:

Redundancies and inefficiencies in the rate-setting process. Specifically duplicative efforts and/or inconsistencies in county, school district and State paperwork and accounting processes lead to payment lags.
- Overhaul of methodology deletes the possibility of 3 different rates and addresses the three tiered system.
Rate changes/waiver process. Process takes too long, not responsive in a timely manner.
- New methodology creates upper cost limits therefore reducing the necessity for waiver requests.
- Streamline the waiver process. SED would be allowed to approve waiver requests within approved parameters. Requests exceeding parameters would require DOB approval.
Reconciliation. The current methodology causes problems in budgeting and cash flow.

The draft methodology does not require reconciliation.

Recruitment and retention.
- Non-competitive salaries are the biggest obstacle in recruiting and retaining staff. Geographically competitive salaries must be included in the allowable costs parameters.
- Are there non-rate setting incentives to maintain staffing capacity? Refer to full Task Force.
Rate methodologies and relationship to efficiency.
- The draft rate methodology recognizes efficiencies such as class size, number of classes, staffing ratios, etc.

Special Education Itinerant Teacher (SEIT)
SEIT rates do not adequately reimburse cost. The group agreed that SEIT should remain a tuition based service.

There should be a framework for “blending parameters.” The draft rate methodology may be used as a starting point for these parameters.
There should be regional rates for SEIT after reevaluation of regional groupings to ensure sufficient sensitivity to local variations (consider ‘breaking up’ NYC).
Create incentives for group SEIT.
Include case management services in the rate methodology. Refer to service delivery workgroup. What would case management look like?
Clear guidelines for the use of SEIT. Refer to service delivery workgroup.
Schools should be encouraged to develop programs that will encompass the needs of students beyond the traditional 5 hour program. Refer to service delivery.
Align general education and special education hours of operation. Refer to service delivery.

Related Services Only
The related service only rates may not adequately reimburse all reasonable costs, are inconsistent between counties, and significantly differ with comparable Early Intervention reimbursement.

Regionalize related service rates. Consider Early Intervention reimbursement levels to ensure competitiveness.
Provide incentives for group RSO.
NYS is the only state providing RSO through IDEA. Why? Refer to service delivery. How should RSO be provided? Can costs be better maintained?

1:1 aides, 1:1 nurses
Providers felt they are not reimbursed the actual cost for 1:1 services. 1:1 services are required by IEPs and currently paid for as an add-on.

To address the issue of 1:1 aides, Tom Hamel believes providers should be instructed to report the actual cost of 1:1 aides on the CFRs to ensure adequate reimbursement.
New and appropriate 1:1 nursing regional rates for LPNs and RNs were also suggested.

Accountability
This issue was not identified initially by the full Task Force but was highlighted by some of the state agencies during the rate methodology presentations. In order for rate reform to be supported by increasingly scarce public resources, clear and tangible indicators of accountability must be identified. While the draft rate methodology does have some accountability features built in, the workgroup would recommend a higher level of fiscal oversight to be performed by SED.

Workgroup Next Steps
The draft recommendations will be organized and presented to the Task Force.

Dan Tworek will write the piece related to the new methodology pulling from the draft methodology developed by Tom Hamel and circulated to the workgroup, as well as, reviewing the issues identified in the 2005 “white paper,” Conceptual Framework Education Program Tuition/Rate Methodology Reform authored by various provider associations. This will include recommendations related to county participation.
Pam Madeiros will refine the SEIT issue statements and recommendations.
Jessica Janeski will refine the Related Service Only issue statements and recommendations.
Eddie Lee will develop a new issue statement and refine recommendations relating to accountability.

It was recognized that there may not be enough time to circulate these recommendations to the workgroup prior to the Task Force meeting. This will be noted and workgroup members will have an opportunity to comment. Eddie Lee will be responsible for synthesizing the recommendations organized by various group members into a summary report to be presented at the Task Force meeting on August 23, 2007 (report attached).

Wrap up
Eddie Lee solicited mid-point input from workgroup members. The workgroup felt that a lot has been accomplished in such a short time period thanks to effective meeting facilitation and leadership.

The next workgroup meeting is scheduled for September 12 from 11am-5pm and will take place at 44 Holland Avenue, Albany, conference room 4C.