Workgroup 3—Delivery Systems
FINAL meeting minutes from 
8/13/2007

Group Leader: Rebecca Cort
Attendees: Michael Grossfeld and Mary Curtis (via video conference); Dan Tworek  (representing Susan Constantino), Mark Jasinski, Robert Frawley, Jyothsna Buddharaju (representing Lisa Timoney), and Joanne LaCrosse (representing Sandy Rybaltowski) were present in Albany.

Observers: Pam Madeiras (Greenburg Traurig), Tom Connelly [Agencies for Children’s Therapies Services (ACTS)], and Jessica Morelli (NYSAC) in Albany; Barbara Greene (TheraCare), Karen Lazarus (ACTS), and Gail Kligman (ACTS) by video conference. 

Guest Speakers:  Hal Matott, Stew Hubbard (SED Audit Services) and Sue Washburn (Early Development Center, Inc.)

Facilitator: Donna Meixner               
Recorders: Tina Goodwin Segal and Denise Corbett

Meeting Start-up
Donna Meixner welcomed everyone and provided an overview of the agenda. The recorder offered corrections to the minutes which were accepted and the minutes were then approved. After roundtable introductions, the facilitator asked for a volunteer to report out on this meeting. Bob Frawley agreed to present the group’s work at the August 23rd  Task Force meeting.

There was a request to add an agenda item to discuss the language of the Statement of Purpose and Principles. Since this meeting had a full agenda already, the work group member was asked to bring his revision to the Task Force meeting next week when the statement would be discussed. That member will put the request into writing since he will be unable to attend the next meeting.

Transportation Costs by County—Hal Matott and Stew Hubbard
The cost for transporting preschoolers for special education services is approximately 20% of the total costs for services. These costs are capped by county and the majority of counties stay within their caps. Counties are reimbursed 59 ½ % for transportation costs (up to an established number of trips). There are some smaller counties that have difficulties staying within their caps. In these counties there may be only a small number of children who need services, often resulting in bussing for greater distances to get services. Counties can also experience high transportation costs if they have few providers or if their providers are clustered in one area of the county; this, in turn, increases travel distances and requires longer commutes, both of which increase costs.

The Work Group had questions for the presenters:

Why is there a cap?
Who are the children being transported?
Are there alternatives ways of transporting children?
Is there a way for children to be transported via the general education system for transportation?
Are there advantages to offering incentives for parents to transport children?

In the discussion that followed Hal and Stew explained that the cap on transportation stems from an audit in 1997 that pointed to a mismanagement of transportation funds for preschool special education services. As a result, the state developed caps that were region specific to ensure that counties were as cost effective as possible in managing their transportation funds. The current county caps were established in 2003-2004 and take into account multiple factors by county, e.g., number and location of providers, number/percent of children served, etc. There have been COLA increases of 3-4% per year since 2004. In the near future, it is likely that these caps/costs will rise even more due to fuel costs.

Under IDEA, transportation is available to ensure that children are not precluded from programs/services because they can’t get there. This does not necessarily mean that every child must be transported by school bus or at the counties’ expense. If a parent says they can’t transport, (under IDEA) this need must be accommodated. Generally, transportation is provided for children who are in a tuition based program, not for children who are receiving Related Services Only. When a child requires a 1-1 aide or nurse the cost for that service (during transportation) is part of the transportation cost. This significantly increases the cost for those trips. UPK does not fund transportation. The point was made that counties have very little control over these costs even with a bidding process.

The group agreed that they would like more information about density/county (% of children transported/county) and number of providers by county. Then some sort of comparison by county, taking demographics into account, might yield insight into model practices or factors that create large swings in expenditures. This type of information could be useful in helping counties to devise strategies to control transportation costs. The work group may want to consider a recommendation to conduct such a study.

Hal agreed to send (electronically) the density/county and the number of providers by county to Becky who will distribute this information to the group.

State Survey Follow-up—Sue Washburn
Sue is continuing to follow-up with contacts in GA to find out about Medicaid reimbursements in that state. FL has provided additional information about promising practices and Sue will forward links about Response to Intervention models that FL state contacts found useful.

Becky followed up with a PA state contact about the merging of PA’s  EI program with its special education preschool services. The service provision for both is through intermediate units (BOCES-type delivery system) According to this PA state representative, it is not a totally unified system and there are many hurdles that still need to be addressed. PA is comparable to NY in that it also serves a fairly high percentage of children. PA’s cost per pupil is $4,400; this is approximately half NYS’s per pupil cost.  But it’s still very hard to compare the two states.

Sue also gave a brief report on CA. They have 60,000 pre-schoolers on IEPs but with CA having such a large population, this is still a relatively low percentage of children receiving special education services. CA contacts reported a strong emphasis on professional development. The state has an accountability project that is based on a common set of Desired Results across a set of domains. EI and preschool are working on collaborative initiatives to improve data sharing and transitioning processes from EI to preschool. CA is about to roll out their state Early Learning Standards.

Sue concluded by stating that the summary table comparing the 5 states is nearly done and should be ready by the end of the week (August 17).

Report Outline/Drafting
The handout listing the suggested report outline was circulated and reviewed. There was a brief discussion about what needs to be included with each recommendation. Recommendations will be discussed in terms of pros and cons, contingencies, and, where possible, the potential impact. 

Recommendations for Delivery Systems
Before beginning the discussion of preliminary recommendations that will be forwarded to the full Task Force, Donna clarified the discussion process with the work group. The decision by the work group was to begin with a “broad brush” approach before digging too deeply into identifying strategies/barriers. The group also agreed that they would adhere to the criteria in the Statement of Purpose and Principles as they proceeded with their discussion of the recommendations.

There are two tables appended at the end of these minutes. The first presents the recommendations that were discussed and either tabled or supported as recommendations to be forwarded to the task force. The second table presents the list of recommendations that were not yet fleshed out through group discussion.

Action Items and Next Meeting

What…

Who…

By When…

Suggested revision to the statement of purpose and principles

Mike Grossfeld

 For Full Task Force Mtg

Report out at next TF next meeting

Bob Frawley

Aug 23rd

Identify % of children by county who receive transportation and # of providers by county

Hal Matott

ASAP –by Friday

Links for Response to Intervention models

Sue Washburn

ASAP – this week

Percentage of preschool and EI costs reimbursed by Medicaid

Becky Cort/ Donna Noyes/ Brad Hutton

ASAP

Add an August meeting on 8/28 or 8/31 (will email all members)

Becky Cort

ASAP

“parking lot” issue: in the final report, the Delivery Systems section should probably appear before the Rate Setting section for a more logical flow of information

Becky Cort

TBD