News & Media

01.25.2013 |  

Background: 

Brain research demonstrates that the stimulation and interaction a child receives during the first five years of life are critical to permanent brain development. As part of the Individuals with Disabilities Education Act (IDEA), the Early Intervention (EI) program provides evaluations and services to infants and toddlers who have developmental delays or disabilities and their families. Early Intervention is cost-effective and helps infants and toddlers at the time when services can make the biggest difference.

Budget Proposal: 

Governor Cuomo’s 2013-2014 Executive Budget proposal would restructure Early Intervention, linking EI services with health insurance coverage. While we support the goal of requiring private health insurance companies to contribute to the cost of EI, we are concerned about parts of the proposal. Among other provisions, the budget proposal would:

• Allow a health insurance representative to be part of the team that develops and reviews a child’s Individualized Family Services Plan (IFSP), giving the health insurance company a voice in determining a child’s EI services for the first time. 
• Require EI providers to join health insurance networks, negotiate their reimbursement rates with health insurers, and exhaust all appeals of claim denials by health insurers before being paid by EI, likely leading to a further reduction in the number of experienced EI providers available to serve children. 
• Require children to be evaluated and served by evaluators and service providers within the children’s health insurance network, without a clear process for obtaining an exception for children who need specialized service providers.

The Executive Budget proposal would also change the EI evaluation system. Children who already have a diagnosed physical or mental condition likely to result in a developmental delay would no longer have the right to a full initial evaluation, making it harder to determine the type and amount of services that would be appropriate.

TAKE ACTION: 

Call or e-mail your state legislators and tell them that you are concerned that the Early Intervention proposals in the Health and Mental Hygiene Article VII Budget Bill would make it harder to access high-quality EI services. Tell legislators that they should not allow health insurance representatives to participate in IFSP meetings; should reject the proposed restrictions on the evaluators and service providers available to serve children; and should ensure that providers are paid at sufficient rates so that they continue working with young children. A sample e-mail is below.

To reach your state legislators, call the Senate switchboard (518-455-2800) and Assembly switchboard (518-455-4100) and give your zip code. Alternatively, you can find your NY State Senator here and your NY Assembly Member here. E-mail lists are available here and here.

Key legislators include: 

Assembly Health Committee Chair Richard Gottfried:
GottfriedR@assembly.state.ny.us or 518-455-4941

Senate Health Committee Chair Kemp Hannon:
hannon@nysenate.gov or 518-455-2200

Assembly Speaker Sheldon Silver:
Speaker@assembly.state.ny.us or 518-455-3791

Senate Co-Leader Dean Skelos:
skelos@nysenate.gov or 518-455-3171

Senate Co-Leader Jeffrey Klein:
jdklein@senate.state.ny.us or 518-455-3595

Sample e-mail: 

Protect Early Intervention
As a [parent of a child who receives Early Intervention services], I am very concerned about the Early Intervention budget proposals. First, just as health insurance representatives do not participate in meetings between doctors and patients, health insurance representatives should not be able to participate in IFSP meetings. The role of health insurance companies should be to help pay for services, not to decide what services are appropriate. Second, I am concerned that the proposal would restrict access to services by requiring the use of in-network evaluators and providers without a clear process for getting an exception. Young children should have access to the most appropriate EI providers regardless of their health insurance networks. Third, I am concerned that the requirements that EI providers negotiate their rates with health insurance companies and file appeals of health insurance claim denials will drive experienced providers from the EI field, making it harder for young children to access the services they need. Fourth, I am concerned that children who already have a diagnosed physical or mental condition likely to result in a developmental delay would no longer have the right to a full initial EI evaluation, making it harder to determine the type and amount of services that would be appropriate.

Please ensure that the budget addresses these concerns and protects access to high-quality EI services.

For more information and updates, please sign up for the Advocates for Children of New York listserv or contact Randi Levine at rlevine@advocatesforchildren.org.

Forward this alert to others who may be interested in taking action.