Agency presentationsVarious state agency representatives provided a brief overview of the rate setting practices used for their services.  The purpose of the presentations was to provide workgroup members with an understanding of what different state agencies do to set rates so that the strengths of each system may be incorporated into the preschool special education rate-setting recommendations.

OMRDD - Joanne Howard|
Basic Payment System

• OMRDD operates a variety of programs and rates are calculated differently depending on the service being offered.
• The service system has changed from an institution based system to a community based system.
• Budget approves a rate methodology.  OMRDD can issue prices if within the negotiated guidelines.

Highlights

• Providers may appeal budget based rates.  There are limitations outlined in regulation. Appeals must be submitted within 1 year of the close of the price period.  Biggest issue with timeliness of appeals is providers do not submit adequate documentation (CFR).
• Property costs are separately approved through a ‘prior property approval’.
• Services within the approved methodology are generally reimbursed in a timely manner.
• Depending on the service, rates may be billed on an hourly, daily or monthly basis. 
• 80% of services are Medicaid funded.
• OMRDD has very rigid audit/documentation standards.

DOH Early Intervention - Donna Noyes
Basic Payment System

• Providers who deliver EI services must be approved by DOH and under contract with a municipality.
• Providers bill and are reimbursed by municipalities.
• Municipalities are responsible for seeking reimbursement from Medicaid and commercial insurers in the first instance, and then submit claims to the State for the state share (50%).
• Providers are responsible for maintaining adequate documentation to bill third party payors and for supplying documentation/information needed by municipalities to seek such reimbursement.

Highlights

• All EI services (individual and group) are classified and defined in regulation. 
• Using 16 geographic regions, standardized rates for each service are developed.
• Billing rules for each service category are set forth in regulation.
• When necessary to fulfill a child’s IFSP, the local EI official can give prior approval to the provider to bill for additional visits above the billing limits. 

OCFS - Dan Zeidman
Basic Payment System

• Cost-based rate methodology for group care and foster family care.
• Model budget approach uses three major cost components for grouping and limiting reimbursement to cost parameters for direct care, property/maintenance and administration.  Providers can shift money within a cost component but not between the three.
• CPI is used for non-personal services (food, insurance, shelter, etc.).
• Annual trending.

Highlights

• Providers are allowed a rate consultation process anytime they receive a rate. 
• Rate intensification may be approved by OCFS to adjust to changing needs.  The rate intensification may be applied retroactively.  

SED Preschool Special Education - Tom Hamel
Basic Payment System

• Cost reports are submitted to SED.
• The cost reports are reviewed by SED accountants.
• Rate are calculated and sent to DOB for approval.
• DOB approves rate method.  If a rate is within the method it does not need to be reviewed by DOB.  DOB will post-certify the rate.
• The school is notified of the rate and has 15 days to comment.
• 30 cents per $1 is allotted for non-direct care costs (property, admin costs, etc).
• There are no property adjustments for pre-school.
• A rate adjustment will be considered to address health and safety concerns, non-compliance or programmatic increases.

External comment
Jane Ryan of JE Ryan & Associates provided a non-state agency perspective on the various rate systems.  She reviewed the strengths of the various systems and noted where improvements will assure timeliness and adequacy of rates.  Topics discussed include: property screens; staffing; the waiver process; 1:1 aides; reserve allowance; and, accountability. 

Information/resources workgroup members provided since last meeting (Dan Tworek)Workgroup members reviewed the listing of problems/issues as well as the list of recommendations outlined in the Conceptual Framework - Education Program Tuition/Rate Methodology Reform (white paper) developed by a provider Task Force and issued on March 3, 2005.  Workgroup members were instructed to consider these lists when developing recommendations for the Task Force. What does this information mean to the workgroup?  Do the workgroup recommendations address some of the policy concerns outlined in the paper? 

Wrap up
Workgroup members reached consensus that recommendations should be developed to address the following areas and were asked to submit other issues for further consideration:

1. Regionalization of SEIT rates.
2. Develop a set of “blended” parameters for SEIT services within an enrollment based payment system.
3. Reconcile teacher salaries and fringe with public school salaries and fringe. 
4. Ensure preschools rates are not in competition with EI rates for professional staff.
5. Require increased accountability, programmatic as well as fiscal (identify methods for such accountability).
6. Create incentives for group related services and group SEIT.
7. Streamline the rate approval and waiver processes.
8. Create a separate process for the property component of rates.
9. Allow for a fund balance (how would it be used?)

By the August 15 workgroup meeting a list of concrete recommendations should be developed so that they can be discussed and prioritized at the meeting.  This will be facilitated via email.

The next meeting is scheduled for Wednesday, August 15, 2007 at 44 Holland Avenue, conference room 4A.  The meeting will take place from 11-2.