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= 4ABCPRESENTATION TO THE SICC FUNDING COMMITTEE
Discussion Draft : July 13, 2011
Early Support for Infants and Toddlers Program Cost Study
WASHINGTON STATE DEPARTMENT OF EARLY LEARNING
ESIT PROGRAM COST STUDY Summary Key Findings and Preliminary Recommendations
DISCUSSION DRAFT: JULY 13, 2011
2
PRESENTATION OVERVIEW
�� Study�Overview
�� Methodology
�� Data�Implications
�� Brief�Overview�of�Washington’s�Early�Intervention�System
�� Demographics�of�Children�Served
�� System-wide�Costs�and�Revenues
�� Baseline
�� Range�of�costs�and�revenues
�� Costs�and�Revenues�per�Child�by�Area
�� Costs�and�Revenues�by�Administrative�Structure
�� Family�Resource�Coordinators
�� Qualitative�Comments
�� Key�Findings�and�Recommendations
ESIT PROGRAM COST STUDY Summary Key Findings and Preliminary Recommendations
DISCUSSION DRAFT: JULY 13, 2011
3
STUDY OVERVIEW
PURPOSE OF THE STUDY �� Determine�the�costs�and�revenues�available�for�providing�Part�C�birth�to�three�Early�
Intervention�Services�across�Washington
�� Help��ESIT�identify�and�recommend�funding�policies�that�will�lead�to�a�more�sustainable,�equitable,�and�cost�effective�system�of�services�across�our�state
�� Support�the�work�occurring�under�the�broader�System�Improvement�Project�
STUDY COMPONENTS �� Collect�and�analyze�data�on�Washington’s�Part�C�system;�financial�modeling
�� Gather�information�from�other�states�about�their�funding�systems
�� Identify�potential�funding�policies�and�practices�that�will�lead�to�a�more�effective�and�sustainable�system�of�services�statewide
Study Timeline: September 2010 - September 2011
WHERE WE ARE�� Completed�data�gathering
�� Built�a�financial�model
�� Submitted�draft�findings�and�recommendations�to�ESIT
NEXT STEPS�� Obtain�feedback�from�the�Funding�
Committee
�� Finalize�data�analysis
�� Submit�draft�and�final�reports�to�ESIT
ESIT PROGRAM COST STUDY Summary Key Findings and Preliminary Recommendations
DISCUSSION DRAFT: JULY 13, 2011
4
METHODOLOGY
DATA COLLECTION �� �Round�1�Data�Collection:�Data�requests�were�sent�to�35�LLAs.
�� Round�2�Data�Collection:�School�Districts�(online�survey)�and�Service�Providers�(data�requests�sent�to�providers�identified�as�contractors�for�LLAs)
�� �Interviews�and�Site�Visits:�11�interviews�(8�in-person�site�visits�and�3�phone�interviews)
OTHER DATA SOURCES�� �ESIT:�Part�C�funding�data�by�geographic�area
�� OSPI:�special�education�birth�to�five�funding�levels�by�school�district
�� DSHS�DDD:�annual�funding�amounts�and�county�recipients�for�early�intervention�programs
�� DOH:�annual�funding�amounts�for�NDCs�and�the�Children�with�Special�Health�Care�Needs�Program
Many thanks to everyone who participated in our data gathering efforts!
ESIT PROGRAM COST STUDY Summary Key Findings and Preliminary Recommendations
DISCUSSION DRAFT: JULY 13, 2011
5
�� Since�there�is�currently�no�centralized�data�source,�this�data�collection�effort�resulted�in�more statewide data than ever before.�
�� This�is�a�planning-level study�and�is�not�a�precise�calculation�of�costs�and�revenues.�It�is�intended�to�provide�a�reasonable estimate�of�system-wide�and�geographic�area�costs�and�revenues.�
�� Because�early�intervention�is�a�highly�decentralized�system,�there�are�some�inconsistencies�in�the�data.�Where�possible,�we�made�adjustments�to�correct�for�these,�but�detailed�comparisons�of�one�geographic�area�to�another�must�be�interpreted�with�caution.
�� Challenges�encountered�included:�different�interpretations�of�data�requests�by�different�entities,�varying�sophistication�of�providers’�data�systems,�cases�of�non-responsiveness�to�follow-up�questions,�and�others.
DATA IMPLICATIONS
ESIT PROGRAM COST STUDY Summary Key Findings and Preliminary Recommendations
DISCUSSION DRAFT: JULY 13, 2011
6
BRIEF OVERVIEW OF EARLY INTERVENTION SYSTEM
35 Local Lead Agencies (LLAs)
�� Non-Profit�Agencies
�� County�Human�Services�Agencies�and�Health�Departments
�� Educational�Service�Districts
�� Health�Districts
�� Tribal�Nations
�� Community�College
Provide direct services
Combination of providing direct
services and contracting
> 100 Direct Service Providers
�� non-profit�organizations
�� educational�service�districts
�� local�health�jurisdictions
�� county�agencies
�� neurodevelopmental�centers
�� hospitals
�� independent�service�providers
�� other�providers
Coordinate local early intervention
system
Contract�with�LLA�to�either�provide�direct�services�or�subcontract�to�other�providers
295 School Districts
Direct46
16%
Direct & Contract
5117%Contract
16155%
Data N/A37
12%
Administrative Structures by Number of Districts
Contract Contract
Ways School Districts are involved in EI
By Number of SDs (n=295)
ESIT PROGRAM COST STUDY Summary Key Findings and Preliminary Recommendations
DISCUSSION DRAFT: JULY 13, 2011
7
There were approximately 9,600 Part C children served in 2010
ESTIMATED STATEWIDE COVERAGE OF PART C CHILDREN � Medicaid�enrollment
�� 45%�weighted�average�across�35�areas
�� Ranging�from�none�to�99-100%�in�some�areas
�� King�County:�40%�weighted�average
� Private insurance�coverage
�� 28%�weighted�average�across�35�areas
�� Ranging�from�none�to�55%�in�some�areas
�� King�County:�55%
� Military benefits�coverage
�� 5%�weighted�average�across�35�areas
�� Ranging�from�none�to�51%�in�some�areas�(Island�County)
�� King�County:�1%
� Other benefits�(Including�Indian�Health)�were�about�1%�weighted�average
FINANCIAL DEMOGRAPHICS
*�Please�note:�some�children�had�dual�coverage�-�Medicaid�and�private�insurance
ESIT PROGRAM COST STUDY Summary Key Findings and Preliminary Recommendations
DISCUSSION DRAFT: JULY 13, 2011
8
BASELINE SYSTEM-WIDE COSTS AND REVENUES
�� Estimates�include�the�whole�system,�including�LLAs,�school�districts,�and�other�providers
�� Statewide�costs�are�estimated��at�approximately�$61.3�M
�� Statewide�revenues�are�estimated�at�about�$61�M
�� “Other”�includes�grants,�local�levies,�fundraising�efforts,�etc.
�� The�system�costs�and�revenues�have�to�balance�-�however,�it�doesn’t�mean�that�there�is�sufficient�funding�in�the�system�to�provide�quality�services�for�all�children�who�need�them
-
$10,000,000
$20,000,000
$30,000,000
$40,000,000
$50,000,000
$60,000,000
$70,000,000
Revenue Cost
Other
Private Insurance & Military Benefits
Medicaid
Department of Health
County DD/Child DevelopmentServicesState Special Ed Funding
ESIT Part C Federal Funds
Indirect Costs
Other Direct Costs
FRC Costs
COSTS AND REVENUES BASELINE2010 Reported Estimated
Total Costs $61,334,000 100% $34,882,000 $26,452,000FRC Costs $8,418,000 14% $6,841,000 $1,578,000Other Direct Costs $35,545,000 58% $20,365,000 $15,179,000Indirect Costs $17,371,000 28% $7,676,000 $9,695,000
Total Revenues (Reported) $60,959,000 100% $60,959,000 ‐ESIT Part C Federal Funds $7,126,000 12% $7,126,000 ‐State Special Ed Funding $34,569,000 57% $34,569,000 ‐County DD/Child Development Services $5,735,000 9% $5,735,000 ‐Department of Health $542,000 1% $542,000 ‐Medicaid $3,126,000 5% $3,126,000 ‐Private Insurance & Military Benefits $3,655,000 6% $3,655,000 ‐Other $6,207,000 10% $6,207,000 ‐
ESIT PROGRAM COST STUDY Summary Key Findings and Preliminary Recommendations
DISCUSSION DRAFT: JULY 13, 2011
9
�� Due�to�data�availability�issues,�a�significant�portion�of�the�cost�data�as�well�as�some�of�the�revenue�data�was�estimated.�For�this�reason,�we�estimated�likely�ranges�for�revenues�and�costs�(each�cost�and�revenue�component�has�its�own�“low”�and�“high”�assumption)
�� Total�revenues�likely�fall�in�the�range�of�$57.5M to $67.3M
�� State�Special�Education�Funding�amount�is�based�on�OSPI�allocation�–�it�is�unclear�what�portion�school�districts�choose�to�actually�use�for�birth-3�(Part�C)�versus�3-5�services
�� Medicaid�and�private�insurance�are�likely�understated�(not�all�providers�reported�revenues�and�not�all�providers�were�captured�in�the�study)
�� Total�costs�likely�fall�in�the�range�of�$52.3M to $66.5M
�� Wider�margin�of�error:�costs�were�imputed�using�information�from�similar�agencies,�adjusted�proportionally�based�on�staffing�levels�or�the�number�of�children�served�
RANGE OF COSTS AND REVENUES
ESIT PROGRAM COST STUDY Summary Key Findings and Preliminary Recommendations
DISCUSSION DRAFT: JULY 13, 2011
10
SYSTEM REVENUES
12%
57%
5%
9%
1%6%
0.4% 1%1%
8%
ESIT Part C Federal Funds
State Special Ed Funding
Medicaid
County DD
Dept of Health
Private Insurance
Military benefits
Other Federal Sources
Other City/ County Government
Other Private/ Non-Profit
�� State�Special�Education�Funding�channeled�through�school�districts�contributes�the�largest�amount�(approximately�57%)�of�the�funding�for�Part�C�early�intervention�services
�� Other�large�contributors:
�� Federal�Part�C�funding�(12%)
�� County�Department�of�Developmental�Disabilities�funding�(9%)
�� Other�combined�sources�(10%)�are�the�next�largest�contributors,�which�include�grants,�local�levies,�fundraising�efforts�by�providers,�etc.
ESIT PROGRAM COST STUDY Summary Key Findings and Preliminary Recommendations
DISCUSSION DRAFT: JULY 13, 2011
11
SYSTEM COSTS
�� FRC�costs�(including�salaries�and�benefits,�materials,�and�other�FRC-related�costs)�are�estimated�to�be�about�14%�of�total
�� Costs�for�other�direct�services�(excluding�FRC�costs)�are�estimated�to�account�for�about�58%�
�� Indirect�costs�are�estimated�to�be�approximately�28%�of�total�costs�of�providing�services.�These�costs�include:
�� Support�staff�salaries�and�benefits,
�� Occupancy,
�� Insurance,�and�others
14%
58%
28%
FRC
Other directcostsIndirect costs
ESIT PROGRAM COST STUDY Summary Key Findings and Preliminary Recommendations
DISCUSSION DRAFT: JULY 13, 2011
12
REVENUES PER CHILD BY AREA
�� County�DD�funding�is�a�major�source�of�revenue�for�early�intervention�in�some�counties,�while�others�cannot�access�this�funding�at�all�due�to�county-level�policy�decisions
�� An�area’s�ability�to�access�Medicaid�and�private�insurance�depends�largely�on�the�mix�of�service�providers.�Where�NDCs�or�other�larger�organizations�provide�a�significant�portion�of�the�services,�these�funding�sources�are�used�to�a�greater�extent
�� “All�Other”�sources�represent�a�significant�amount�of�funding,�mostly�in�larger�counties.�They�include�private�insurance�and�military�benefits,�other�federal�and�local�sources�(grants�and�levies),�private/non-profit�contributions�(fundraising,�special�events)�
�� In�many�small,�rural�areas�only�State�Special�Education�and�ESIT�Part�C�funding�is�used
�� These�areas�are�excluded�from�the�chart�as�the�total�number�of�children�served�is�less�then�10:
�� San�Juan�County�(9�children)�� Lincoln�County�(6�children)�� Columbia�County�(5�children)�� Garfield�County�(1�child)
�� Statewide�median�=�$5,800�per�child
Note:�Number�of�Part�C�Children�is�next�to�area�name�on�the�chart;$6,360�is�a�weighted�average�statewide.
- $2,000 $4,000 $6,000 $8,000 $10,000 $12,000
Klickitat County (15)
Mason County (43)
King County (2546)
Spokane County (692)
Pacific County (31)
Whitman County (44)
Kittitas County (39)
Chelan & Douglas Counties (209)
Cowlitz & Wahkiakum Counties (181)
Benton & Franklin Counties (459)
Kitsap County (446)
Skamania County (18)
Lewis County (87)
Snohomish County (1102)
Skagit County (166)
Pierce County (1059)
Whatcom County (245)
Island County (166)
Yakima County (462)
Asotin County (53)
Clallam County (79)
Grant County (133)
Clark County (510)
Okanogan County (108)
Walla Walla County (84)
Grays Harbor County (71)
Jefferson County (40)
Ferry, Pend Oreille, and Stevens Counties (59)
Thurston County (342)
Quileute Tribal School Service Area (10)
STATEWIDE AVERAGE
Revenues per Child by Geographic Area, 2010
ESIT Part C Federal Funds State Special Ed Funding Medicaid County DD All Other
Average = $6,360
ESIT PROGRAM COST STUDY Summary Key Findings and Preliminary Recommendations
DISCUSSION DRAFT: JULY 13, 2011
13
- $2,000 $4,000 $6,000 $8,000 $10,000 $12,000
Klickitat County (15)
King County (2546)
Mason County (43)
Spokane County (692)
Pacific County (31)
Grays Harbor County (71)
Cowlitz & Wahkiakum Counties (181)
Benton & Franklin Counties (459)
Ferry, Pend Oreille, and Stevens Counties (59)
Whitman County (44)
Island County (166)
Snohomish County (1102)
Okanogan County (108)
Clark County (510)
Chelan & Douglas Counties (209)
Clallam County (79)
Walla Walla County (84)
Kitsap County (446)
Asotin County (53)
Skagit County (166)
Yakima County (462)
Jefferson County (40)
Pierce County (1059)
Grant County (133)
Adams County (63)
Thurston County (342)
Kittitas County (39)
Whatcom County (245)
Lewis County (87)
Quileute Tribal School Service Area (10)
STATEWIDE AVERAGE
Costs per Child by Geographic Area, 2010
FRC Costs Other Direct Services Indirect Costs
Average = $6,400
COSTS PER CHILD BY AREA
�� Areas�where�many�school�districts�contract�for�services�typically�have�higher�indirect�costs�as�school�districts�keep�an�average�of�15%-20%�of�their�funding�to�cover�indirect�costs,�and�providers�average�indirect�costs�of�about�30%
�� These�areas�are�excluded�from�the�chart�as�the�total�number�of�children�served�is�less�then�10:
�� San�Juan�County�(9�children)
�� Lincoln�County�(6�children)
�� Columbia�County�(5�children)
�� Garfield�County�(1�child)
�� Statewide�median�=�$5,550�per�child
Note:�Number�of�Part�C�Children�is�next�to�area�name�on�the�chart;$6,400�is�a�weighted�average�statewide.
ESIT PROGRAM COST STUDY Summary Key Findings and Preliminary Recommendations
DISCUSSION DRAFT: JULY 13, 2011
14
REVENUES AND COSTS BY STRUCTURE
For�the�purposes�of�assessing�funding�and�costs,�we�defined�six�general�types�of�administrative�structures�that�are�prevalent�in�Washington�and�assigned�each�geographic�area�to�one�of�these�structures:
1.� LLA�Provides�Most�Services
2.� LLA�Provides�Some�Medically-related�Services�(OT,�PT,�Speech,�medical,�nursing)
3.� LLA�Provides�Only�Non-medically-related�Services�(all�other�services�-�e.g.�special�instruction,�family�training�and�counseling,�etc.)
4.� LLA�Provides�FRCs�only
5.� LLA�Provides�FRCs�and�Acts�as�Pass��Through
6.� LLA�Acts�as�Pass��Through�Only
We�reviewed�revenue�and�cost�distribution�per�child�for�these�six�structures�to�determine�if�any�presented�uniques�advantages�or�challenges:
�� Distribution�of�revenue sources�is�most�dependent�on�the�type�of�organization�accessing�the�funding.�Where�NDCs�or�other�larger�non-profits�provide�a�significant�portion�of�the�services,�there�is�more�access�to�funding�sources�(such�as�Medicaid,�private�insurance,�and�fundraising)
�� Generally,�FRC cost per child�is�lowest�where�an�agency�is�only�providing�FRC�services�(model�4�and�5)�and�FRC�duties�are�not�performed�by�therapists,�educators,�and�others�who�typically�earn�higher�salaries.�However,�these�costs�are�also�influenced�by�the�type�of�employing�agency
� Indirect rates�are�higher�where�the�LLA�is�acting�as�a�pass�through�(models�5�and�6),�as�school�districts�are�often�contracting�with�the�LLA�who�in�turn�contracts�with�another�provider.�Each�of�the�agencies�involved�has�an�administrative�expense
�� Further�conclusions�on�service�costs�are�difficult�to�establish�without�considering�hours�and�quality�of�services�provided
ESIT PROGRAM COST STUDY Summary Key Findings and Preliminary Recommendations
DISCUSSION DRAFT: JULY 13, 2011
15
FAMILY RESOURCES COORDINATORS (FRC)
�� Statewide�there�were�about�280�FRCs�in�2010
�� Across�all�geographic�areas�the�average�caseload�was�about�30.6
�� Across�all�geographic�areas�the�average�direct�cost�per�FRC�FTE�was�about�$56,000.�Direct�costs�include�salaries,�benefits,�supplies,�and�travel�costs
Note:�Number�of�FRCs�is�next�to�area�name�on�the�chart;Some�numbers�are�still�being�investigated�(marked�by�***�in�the�table
4644
2751
5046
31N/A
188
551
1538
196
3415
2520
4510
204040
140
395
***18
48
5028
2431
0 10 20 30 40 50 60
Yakima County (7)Whitman County (1.25)
Whatcom County (7)Walla Walla County (1.5)
Thurston County (5)Spokane County (15)
Snohomish County (37)Skamania County (0)
Skagit County (9)San Juan County (1)
Quileute Tribal School Service Area (3)Pierce County (13)Pacific County (2)
Okanogan County (3)Mason County (29)Lincoln County (1)
Lewis County (5)Klickitat County (2)Kittitas County (1)Kitsap County (27)King County (63.8)
Jefferson County (2)Island County (5)
Grays Harbor County (1.04)Grant County (2)
Garfield County (2)Ferry, Pend Oreille, and Stevens Counties (4)
Cowlitz & Wahkiakum Counties (5.2)Columbia County (0.4)
Clark County (6)Clallam County (3)
Chelan & Douglas Counties (5)Benton & Franklin Counties (7)
Asotin County (1)Adams County (4)
STATEWIDE AVERAGE
Average Annual Caseload of All
FRCs: 31
Average Annual Case Load
ESIT PROGRAM COST STUDY Summary Key Findings and Preliminary Recommendations
DISCUSSION DRAFT: JULY 13, 2011
16
QUALITATIVE COMMENTS
BARRIERS AND OPPORTUNITIES FOR PROVISION OF EI SERVICES
Lack of Qualified Providers
�� Difficulty�in�finding�and�retaining�qualified�providers�of�particular�services.�
�� Most�frequently�mentioned:�physical�therapists,�occupational�therapists,�and�speech�therapists/speech�language�pathologists.�
�� Also�finding�providers�who�are�bi/multi-lingual�and�are�sensitive�to�cultural�issues.
Funding Uncertainties
�� Part�C�and�DDD�funding�has�remained�the�same�for�several�years,�as�costs�and�demand�for�services�have�risen.�This�creates�stress�on�service�providers�who�are�expected�to�do�more�with�less,�but�whose�increased�workloads�reduce�their�ability�to�provide�adequate�service.�
�� These�issues�are�felt�more�acutely�in�rural�areas�because�apportionment�funding�might�be�insufficient�to�cover�costs�for�practitioners�and/or�specialized�services�if�there�is�a�small�number�of�eligible�children.
Complexity of Funding Sources
�� While�having�multiple�funding�sources�creates�more�opportunities�for�families�to�access�services,�it�puts�an�additional�burden�on�LLAs�in�having�to�adhere�to�a�variety�of�administrative,�tracking,�reporting,�and�billing�systems,�further�straining�their�ability�to�provide�adequate�services.
ESIT PROGRAM COST STUDY Summary Key Findings and Preliminary Recommendations
DISCUSSION DRAFT: JULY 13, 2011
17
QUALITATIVE COMMENTS
BARRIERS AND OPPORTUNITIES FOR ACCESSING EI FUNDING SOURCES
Issues with Private Insurance
�� Difficulty�in�dealing�with�private�insurance�companies,�related�to�co-pays�and�deductibles.�Billing�private�insurance�companies�is�both�costly�and�time-consuming,�and�dealing�with�them�is�confusing�because�their�requirements�seem�to�be�ever-changing.�
�� There�is�also�a�conflict�with�requirements�that�services�not�be�provided�“off-site,”�which�is�in�conflict�with�the�Natural�Environments�mandate.
Issues with Medicaid
�� Expensive�to�bill�Medicaid�and�time-consuming.
�� Provider�One�billing�system�has�been�an�issue:�lower�reimbursement�rates,�a�high�percentage�of�denials,�a�slower�process,�an�increase�in�errors,�and�a�frustrating�process�in�reaching�someone�when�a�claim�is�denied.�Some�providers�have�begun�to�refuse�Medicaid�as�a�form�of�payment�because�of�these�issues.
Funding Inequities
�� Because�geographic�areas�do�not�all�have�access�to�the�same�funding�sources,�there�is�a�strong�perception�of�inequity�among�LLAs�across�the�state.�DDD�and�CDS�funds�are�not�available�everywhere.�
�� The�lack�of�one�strong�entity�administering�funds�for�EI�negatively�impacts�the�program.�Multiple�funding�sources�actually�increase�the�cost�of�providing�services�because�of�the�greater�needs�to�administer�the�individual�programs.
ESIT PROGRAM COST STUDY Summary Key Findings and Preliminary Recommendations
DISCUSSION DRAFT: JULY 13, 2011
18
GROWING AVAILABLE FUNDING FOR EARLY INTERVENTION SERVICES � Medicaid funding is underutilized -�IDEA�Part�C�statute�requires�fiscal�participation�from�Medicaid,�
but�local�programs�do�not�use�Medicaid�consistently,�if�at�all.�
�ΠDevelop�a�State�Plan�Amendment�to�be�submitted�to�CMS
�ΠCommunicate�changes�to�all�providers�with�clear�policy�guidance,�training,�and�technical�assistance
�ΠDevelop�an�easy-to-follow�billing�procedures�manual
�ΠEncourage�automatic�school-based�billing�systems�for�IFSPs,�similar�to�IEPs
�ΠExplore�the�use�of�third�party�billers
� Limited Access to Private Insurance -�for�a�variety�of�reasons,�many�providers�and�school�districts�do�not�bill�private�insurance�for�services.�
�ΠDevelop�policy�and�infrastructure�to�ensure�that�all�providers�(including�school�districts)�are�billing�private�insurance
�ΠDevelop�communication�materials�for�school�districts�and�providers�to�use�with�families�
�ΠSupport�legislation�that�would�require�insurance�companies�to�include�early�intervention�services�under�their�plans�
� Not All Potential Revenue Sources are Being Accessed
�ΠPerform�systematic�review�of�potential�funding�sources�in�Washington�(including�partnerships,�potential�expansion�of�Family�Cost�Participation�to�include�family�fees,�etc.)
�ΠDevelop�and�implement�a�comprehensive�funding�plan
KEY FINDINGS & RECOMMENDATIONS
ESIT PROGRAM COST STUDY Summary Key Findings and Preliminary Recommendations
DISCUSSION DRAFT: JULY 13, 2011
19
DISTRIBUTION OF FUNDING AMONG GEOGRAPHIC AREAS � Unequal Access to State Funding Sources -�State�funding�sources�like�DDD,�DOH,�and�Special�
Education�funding�comprise�about�two�thirds�of�system�revenues,�but�depending�on�type�of�providers�in�any�geographic�area,�not�all�areas�have�equal�access�to�these�sources.�Also,�having�multiple�funding�sources�administered�by�different�agencies�may�be�actually�increasing�the�cost�of�providing�services�because�of�the�greater�needs�to�administer�the�individual�programs.
�ΠExplore�centralizing�DD�and�OSPI�Special�Education�funding�sources�in�the�Department�of�Early�Learning�ESIT�Program
�ΠContinue�working�to�align�DD�and�Part�C�eligibility�criteria�to�facilitate�access�and�minimize�administrative�burden
� School District Administrative Fees Vary Significantly Statewide -�School�districts�charge�administrative�fees�(recovery�rates)�ranging�from�5%�to�over�50%�on�their�contracts�with�LLAs�and�service�providers.
�ΠEstablish�minimum�monthly�negotiated�rates�or�cap�percentages�school�districts�can�charge�for�administration
�Î Encourage�use�of�performance�based�contracting�to�ensure�the�level�of�service�districts’�children��receive�from�providers
� ESIT Part C Funding Allocation Does Not Always Accurately Reflect Child Count or Address Other Funding Inequities
�ΠAnalyze�average�child�count�trends�and�compare�to�point�in�time�child�count
�ΠUpdate�allocation�formula�to�reflect�child�count�trends�-�phase�in�implementation�only�with�additional�funding�to�ensure�no�area�experiences�a�funding�decrease
�ΠWith�additional�funding,�explore�directing�dollars�to�areas�that�cannot�access�DD�funding
KEY FINDINGS & RECOMMENDATIONS
ESIT PROGRAM COST STUDY Summary Key Findings and Preliminary Recommendations
DISCUSSION DRAFT: JULY 13, 2011
20
QUALITY OF INFORMATION FOR DECISION MAKERS � Lack of consistent information on local costs and funding sources -�ESIT�has�no�consistent�and�
comprehensive�statewide�data�on�actual�costs�and�revenues�for�EI�service�provision.�This�makes�it�difficult�for�ESIT�to�administer�its�Part�C�responsibilities�and�make�informed�policy�choices.
�ΠDefine�data�needs�and�establish�(or�modify�existing)�collection�mechanism
�ΠUse�contracting�tools�to�require�systematic�reporting�
� Local providers require policy guidance on a number of early intervention issues -�providers�and�districts�are�inconsistent�in�approaches�to�service�provision�and�billing.�
�Î Ensure�consistency�and�availability�of�policy�guidance�on�DEL’s�website�and�through�other�channels�as�appropriate
KEY FINDINGS & RECOMMENDATIONS
ESIT PROGRAM COST STUDY Summary Key Findings and Preliminary Recommendations
DISCUSSION DRAFT: JULY 13, 2011
21
OTHER KEY FINDINGS � Costs for FRC services vary dramatically by area -�minimum�job�requirements,�local�salaries,�
and�job�sharing�arrangements�have�led�to�significantly�varying�costs�per�FTE�by�service�provider�and�geographic�area.�In�addition,�FRC�requirements�are�different�statewide,�ranging�from�high�school�diploma�and�state�training�to�Master’s�degree.�This�is�a�concern�to�some�providers,�as�it�can�affect�the�quality�of�services.
� FRC Caseloads vary significantly by area.�This�can�lead�to�inconsistent�quality�of�service�for�Washington�families.
� Some administrative structures have higher indirect costs�for�services�-�when�multiple�contracting�agencies�are�involved,�indirect�costs�are�higher
�� E.g.:�models�where�the�school�district�contracts�with�the�LLA�who�in�turn�contracts�with�another�service�provider,�require�three�layers�of�administrative�costs,�whereas�models�with�a�central�service�provider�only�require�one�or�two
� Costs per child for EI services vary across the state -�without�understanding�the�service�hours�provided�for�each�child,�it�is�difficult�to�draw�conclusions.�It�likely�reflects�inequity�in�the�level�of�service�received�by�children�in�different�geographic�areas�as�well�as�the�varying�cost�structures�of�individual�service�providers.
� Summertime service is a challenge�-�school�districts�provide�services�mostly�only�during�the�school�year�and�pay�their�contractors�for�8-10�months.�Some�providers�have�stepped�in�to�cover�summertime�services,�but�in�many�areas�there�is�a�service�gap�while�the�school�is�not�in�session.
KEY FINDINGS & RECOMMENDATIONS