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The Texas Department of Assistive and Rehabilitative Services (DARS) has released their Legislative Appropriations Request (LAR). The full document can be found here: http://www.dars.state.tx.us/reports/lar2016_2017.pdf . This document represents the agency’s budget request for fiscal years 2016 and 2017 (taken together these are a biennium). This is the first step in the budget process, where the agency identifies what it needs and what special requests that it has. This will be matched in the beginning of the Legislative session in the spring of 2015 with a document by the Legislative Budget Board, which will be their view of what the agency needs. The agency will then spend the spring testifying before the Texas Legislature to secure its appropriations.

This is an extremely important document because there may very well be more significant changes on the horizon for the Early Childhood Intervention (ECI) program. Reading through the document, DARS tells us that in fiscal year (FY) 2013, ECI served approximately 25,000 children per month. In their LAR, they are projecting to serve a little over 22,800 by FY2017. This represents an almost 9 percent decrease. During this time, the average monthly number of hours of service per child per month is projected to increase from 2.61 hours/month to 2.93.

In their LAR, DARS is projecting that ECI will essentially maintain its budget in FY 2016, but will see a reduction of more than 15% during FY2017. In other words, in their baseline budget request DARS is telling us that they are projecting a decrease in funding and are projecting that they will need to serve fewer Texans between the ages of birth and three years old.

As a result of this, DARS is making two special requests for funding in their LAR on behalf of the ECI program. The first is a request of over $25,000,000 over the biennium just to maintain the projected FY2015 case levels. From page 189 of the LAR: “Federal IDEA Part C funding available to fund the ECI system in Texas has remained flat in recent history. However, ECI program costs associated with federal
requirements and not reimbursed by Medicaid has resulted in the agency using more federal IDEA Part C funding for allowable program expenses than projected. As DARS uses more IDEA Part C funding in fiscal years 2014-2016 to support ECI program costs, the result is less IDEA Part C funding available to maintain base funding levels and serve eligible children in fiscal year 2017. Funding for this exceptional item is to maintain the number of children served in fiscal year 2016 in fiscal year 2017 in the ECI
program.”

What does this mean? It means that Texas has consistently underfunded the ECI program, relying on a finite amount of Federal funding instead. That funding is running out, creating a shortfall. If that shortfall is not covered, Texas will have to provide ECI services to fewer children.

The second special request is an additional $25,000,000 over the biennium to increase monthly caseload to over 30,000 by FY2017. DARS is projecting that even with their more stringent eligibility criteria the number of young Texans who qualify for ECI is going to increase pretty dramatically by FY17.

My take on the bottom line, DARS needs an almost fifty million additional dollars over the biennium to continue to offer services to young Texans who qualify under the current eligibility criteria. If they can’t get that through the Legislature, there will be another difficult round of system changes that involve a combination of more stringent eligibility criteria (so fewer children are being served) combined with more family cost share.

I have gone to two meetings in Austin over the past two weeks. On January 15th I was at the Early Childhood Intervention (ECI) Advisory Council meeting. On January 23rd I was at the Arc of Texas’ Government Affairs (GA) Committee meeting. Both are important meetings for different reasons and I thought I’d take a few minutes to discuss them both.

ECI Advisory Council meeting
The ECI meeting hinged around two things that are very important. The first was ECI’s annual performance report (APR) which is required by IDEA. ECI submits this report to the federal government each year. The report covers a number of federally mandated performance indicators. Two me, the two most important indicates are the child outcomes and the family outcomes:
• The child outcomes relate to both whether, as a result of ECI, children are making improvements and to whether they have caught up with their peers. Basically children are making improvements as a result of ECI, but the percentage of children who are functioning within age expectations as a result of ECI is declining.
• The family outcomes relate to whether ECI services help families to understand their rights, help families to effectively communicate their child’s needs, and whether it helps their children to develop and learn. In other words, this is where ECI asks the consumer about the effectiveness of the program. This indicator shows that families are very happy with the ECI services.
Why are child outcomes slipping in terms of functioning within age expectations? This one is complicated. Several years ago, ECI had to narrow the criteria of who is eligible for ECI services. This changed the mixture of the kids in the program, so the argument goes that this is having an impact on the ability to reach age expectations. This is a complicated argument because it seems that Texas is in the middle, nationally, in terms of eligibility for ECI services (i.e. some states have more rigid criteria, some have less rigid criteria) – but this isn’t something that I’m qualified to really quantify, so take this information with a grain of salt. According to the Early Childhood Technical Assistance Center (http://ectacenter.org/~pdfs/partc/part-c_sppapr_13.pdf#page=8) when compared nationally for the percentage of children reaching age expectations Texas is behind. However, examined another way Texas is one of 28-30 states (depends upon the outcome measure) that lost ground on this indicator over the last year.
With the family outcomes, this is powerful feedback and because of that I always get into a statistics debate in these meetings. DARS, in their 2014/2015 Legislative Appropriations Request, forecasted 25,187 children would be receiving ECI services each month in FY2012. The family outcome information is measured via a survey. Approximately 1200 families returned surveys. This number represents less than 5% of the people receiving ECI services. Now, this may be a statistically significant sample if you were writing a research paper, but it’s unclear how representative this really is of the entire state of Texas – which is always the source of my arguments on this one.
The second major issue from the ECI meeting was a piece of legislation from the 2013 legislative session, Senate Bill 1060. As background, a few years ago the state was unable to fund ECI at the level that was needed. As a result, ECI made three fundamental changes with profound consequences on the program. First, it narrowed eligibility. Second, it required providers to directly bill Medicaid. This reduced the administrative costs to DARS (i.e. it saved the state money) and required providers to develop a new skill set. Third, it required families to pay some of the costs of the services based upon their perceived ability to pay. This family cost share was expanded as a result of the appropriations that DARS received from the 2013 Legislature. SB1060 directs DARS to study the cost-effectiveness of the family cost share system and to implement rules to make it more cost-effective, as long as the changes don’t make receiving services cost-prohibitive. DARS will report on this to the Legislature by December 1st. In the legislation, cost-effectiveness is defined as: does the family cost share covering administrative expenses?
This seems fairly straightforward. Does the revenue brought in cover the costs? If not, what needs to be changed to make it so? The report that DARS is putting together, however, is a significant undertaking that is going to take a broad, comprehensive look at family cost share and administrative burden. DARS is also seeking input about the family cost share system and its impact on families, questions to consider:
• What needs to be included in this report?
• What information needs to be conveyed to the Legislature about family cost share?
• What should DARS be analyzing?
• How do we balance family cost-share with the desire to provide services and reality? The reality being that this is here to stay?
• Has family cost share made participating in ECI cost prohibitive?

Arc of Texas GA Committee meeting
I went to the Arc of Texas on the 23rd to attend the GA Committee meeting. For those of you that don’t know, the Arc of Texas is an advocacy organization on behalf of individuals with intellectual and developmental disabilities (IDD). They advocate on behalf of individuals with IDD, attempt to be effective with the legislative/appropriations process, train individuals with IDD to advocate on behalf of themselves, help educate the community about IDD issues and needs, and they attempt to keep everyone informed about issues that impact the IDD community.
The GA committee, to paraphrase its charge, has a duty to be very well educated about legislation, appropriations, policy, and matters impacting individuals with IDD and their families. Their task is to inform, educate, and guide the Arc of Texas and its board of directors in terms of how to act effectively particularly with the Legislature on behalf of individuals with IDD and their families.
This was the organizational meeting. The committee is made up of superstars. There are a lot of experienced, passionate, knowledgeable, hard-working people serving on this committee. The intent behind the committee was to review the past, chart out a structure for the future, and decide on some initial directions to focus on.
While the Legislature is not in session, things are not quiet and there is still work to be done. Senate Bill 7 is being implemented, legislative appropriation requests will need to be commented on beginning this summer, and legislation for the next session will be pre-filed beginning this fall. So this was a perfect time to meet with this committee.
The meeting began with reviewing the major pieces of legislation out of the last legislative session. Considerable time was spent discussing SB7. This took up the morning. This was important because you need to know where you’ve come from before you can decide where you are going.
The afternoon was spent looking forward. The committee developed three broad foci for the future, keep in mind that we may call these something totally different. The idea is to give us a place to start:
• Long-term services and supports: Medicaid waivers, Senate Bill 7, managed care, state supported living centers. It’s a big area.
• Education/Transition: ECI, K-12 and beyond, transition (which in Texas begins at 14). Again, another huge area.
• Employment/Transition/Transportation: Individuals with IDD want to find meaningful employment and it’s better for the state of Texas if they do. So this topic area covers employment, transitioning from school to being employed, and transportation. Transportation is huge because if you want to work, but are unable to drive yourself to work, then this is a barrier to being employable. Another huge area.
These three areas represent workgroups that the larger committee divided itself into. Some of us serve on one, some serve on all three. These workgroups are going to:
• Be researching these issues and developing recommendations for policy/legislative changes.
• Those recommendations will then be taken back to the full committee and will then become a draft of a legislative platform for the Arc of Texas.
• This draft platform will then go out to the various chapters and stakeholders for their input.
• After everyone’s input has been received, the GA committee will be developing a legislative platform for the Arc of Texas’ board of directors to vote on and then implement.

In other words, there is a lot of work to be done in a short period of time!

The Texas Comptroller has certified that the funds are available for the appropriations bills that came out of the 2013 Legislature. There is mixed news for people with intellectual and developmental disabilities and their families.
With regards to the Department of Assistive and Rehabilitative Services (DARS) and Early Childhood Intervention, there is good news and bad news for Early Childhood Intervention (ECI):
 ECI is seeing an almost 18% increase in its funding, from ~$270 million for the current biennium to ~$318 million for the upcoming one. Both respite and the administrative oversight of ECI are being funded at the same amounts as in the current biennium. In addition, the Legislature wants to see the number of hours of services per child per month to increase from an average of 2 hours to an average of 2.9 hours.
 The bad news is that the ECI appropriation has a rider. The rider says that anyone receiving ECI services who has a family income greater than 400% of the federal poverty level must pay 100% of the cost of the services.
It’s great that ECI funding is expanding and that the Legislature wants to see more hours of services per month per child. It will be interesting to hear DARS’ forecasts on how this will impact the number of children served. The rider is concerning and has significant long-term implications for both providers and the people that will be receiving ECI services. This will mean that some families will opt not to receive the services because they cannot afford it and others may be driven to private providers, which means that current ECI providers will have to learn how to be competitive with private providers.
With regards to the Department of Aging and Disability Services (DADS) and their long term services and supports appropriation, there is mixed news that reflects the shift to managed care that is being driven by Senate Bill 7. First, some programs are seeing a reduction in funding:
 Primary home care (~42% reduction): Provides non-skilled personal care services. Reduction is due to STAR+PLUS and this service will eventually be eliminated.
 Day Activity and Health Services (~67% reduction): Another casualty to STAR+PLUS.
 Community-Based Alternatives (~22% reduction): due to STAR+PLUS.
 ID Community Services (~7% reduction): Administrative expenses are being transferred elsewhere and some of the individuals receiving services are being transferred to the Texas Home Living Waiver.
 Promoting Independence Services (~5% reduction): Another casualty due to STAR+PLUS.
 Hospice (~5% reduction)
There are a number of programs seeing an increase in funding, including several waiver programs that are seeing a large increase in funding:
 Community Attendant Services (11% increase): Seems to be balancing out the reduction in primary home care.
 Home Community-Based Services (HCS) (15% increase)
 CLASS (10% increase)
 Deaf Blind Multiple Disabilities (38% increase)
 Medically Dependent Children (6% increase)
 Texas Home Living Waiver (63% increase)
 Nursing Facility Payments (4% increase)
 Medicare Skilled Nursing Facility (6.5% increase)
 Balancing Incentive Program: 14.7 million
 State Supported Living Centers (~2% increase)
It should be noted that none of the bills that sought to establish realignment committees for the State Supported Living Centers (SSLC), closure of the SSLCs, or bills of rights for people with intellectual and developmental disabilities passed. There are no riders directing DADS to close SSLCs, or explore closing SSLCs, only a rider to develop a ten year plan for the SSLCs.
The expansion of the waiver programs is great news. But the reality is that managed care is coming as a result of Senate Bill 7, so we’re going to be in uncharted territory soon. The fact that the Legislature will not move on the SSLCs is interesting.

Two identical bills have been filed in the Texas Legislature relating to Early Childhood Intervention (ECI).  The first is HB 1098 by Rep. Zerwas, the second is SB 1060 by Sen. Nelson.  These bills read like it is their desire to make ECI profitable.  As I read them, these bills have two parts. The first part (section 117.077) requires the Department of Assistive and Rehabilitative Servcies (DARS) to study the cost-effectiveness of the family cost share system of ECI.

As background, after the budget cuts in the last legislative session, DARS adopted a sliding family cost share for ECI based on family income.  This was one of their strategies to continue prvoding services in the face of the budget cuts.  The first part of this bill reads like it’s attempting to make ECI profitable (cost-effective means that family cost share revenue is greater than total administrative costs):
• DARS is required to collect data which lets them determine this information and evaluate the cost-effectiveness of the program.
• DARS is required to consider changes to make the program more cost-effective but may decline to make them if DARS does not feel that these changes will make the program more cost-effective.
• DARS is required to report on this by December 2014.

Now, this section gives DARS some wiggle room:
• “Total administrative costs” is not defined in the legislation. For example, is that the cost of DARS oversight? Or is it ECI provider expenses for providing the service (therapists, front office staff, case supervision, etc)? Or just partial expenses of providing the service (for example, only office staff but not therapists)? Etc.
• If DARS does not judge it possible to make the program profitable they do not have to implement the changes.

The second part (section 117.078) is a little more concerning and instructs DARS to consider implementing family cost share provisions based upon the family’s size and adjusted gross income with families in higher income brackets being required to pay more that those same families paid before this bill’s implementation. This family cost share is already in progress based upon family income, but I’m reading this as a requirement to increase those amounts. Now, the legislation instructs DARS “to consider” doing this, as opposed to saying that DARS must do this, so there’s some wiggle room. But the legislation represents the Legislature’s philosophy that families should be paying for more of these types of services.

The Legislature is seeking new ways to provide these services as well as the Medicaid services.  The idea being to control expenses and provide more services to more people.  In this legislation, the intent is to use the profits of the family cost share to provide more services to more children.  HB 1098 is being heard in the Human Services committee of the House on Tuesday, 3/12/13.

The Texas Legislature has released their budget bills, House Bill 1 and Senate Bill 1.  When passed, these bills will be the funding for state agencies in 2014 and 2015.    This information is important because it has an impact on the various state agencies to provide services.

The proposed budget for Early Childhood Intervention, administrated by the Department of Assistive and Rehabilitative Services, is mixed.  In the current biennium, ECI will receive $274,144,828 to provide services, provide respite services, and ensure the quality of ECI statewide.  This current biennium represented a sharp decrease in funding compared to the previous one.  As a result, DARS had to implement a number of changes to help contain costs while continuing to provide services.

These changes included implementing a family cost share.  In other words, families paid for a portion of their child’s ECI services according to a sliding scale based upon family income (families with more income paid more).  Another change was to require ECI providers to directly bill Medicaid to be reimbursed.  This saved DARS money because it meant that DARS no longer had to do this.  However, this was a skill set that many providers did not have and has led to challenging decisions such as: Do I hire a provider or someone knowledgeable about Medicaid billing?  Finally, DARS narrowed the criteria of who is eligible for ECI services, which meant that fewer children are receiving services today.

Now, this last change especially has had some ramifications.  By narrowing the eligibility, the make-up of the children receiving ECI services has changed.  This has resulted in their being more severely impacted by delays, requiring more services, increasing the cost of those services.   As a result, DARS is projecting that if funding for ECI remains flat over the 2014/2015 biennium, they will have to narrow eligibility even further.

In the current biennium, DARS is receiving approximately $274 million for ECI.  They asked for approximately $334 million, which took into account the state’s population increases, projected future demand, and the change in the make-up of children receiving those services.  Both HB1 and SB1 are recommending that ECI receive $297 million in funding, which represents an 8.5% increase over the current biennium.

While the increase in funding is a positive thing, it does come close to what DARS needs to continue offering services at the current eligibility level.  It is likely that if the budget passes as is, that DARS will have to narrow the eligibility in the upcoming biennium.

Now, neither budget bill is set in stone.  There will be lots of opportunities for input.  First, you can contact your representative and senator and provide feedback.  Second, there will be plenty of budget hearings over the next few months where written testimony and in-person testimony can be provided.  The budgets will go through a cycle of hearings, adjustments, and both the Senate and House versions will need to be reconciled before it goes to the Governor for his signature.

In previous postings I have discussed issues that have arisen as a result of funding constraints for Early Childhood Intervention (ECI) in Texas.  As a result of funding constraints, the state agency that oversees ECI (Department of Assistive and Rehabilitative Services, DARS) had to make changes to ECI which included:

  • Narrowing the eligibility of who qualifies for ECI
  • Implementing a family cost share so that parents pay for some of the services
  • Requiring ECI providers to directly bill Medicaid for reimbursement

 

These changes had unintended consequences.  Because eligibility was narrowed, it resulted in the children being admitted to the program needing greater services.  This means that ultimately as the population increases, the program will have to be narrowed even further (if funding remains static) due to this.

 

Texas is not the only state experiencing challenges with providing ECI to children and infants.  The IDEA Infant and Toddler Coordinators Association (www.ideainfanttoddler.org) does an annual survey of IDEA Part C (i.e. ECI) coordinators about implementation issues and challenges.   The 2011 survey is located here: www.ideainfanttoddler.org/pdf/2011_State_Challenges.pdf .  The survey results are sobering.

 

I’ll look at this report dealing with several matters:

  • Eligibility for ECI
  • Service delivery
  • Fiscal matters
  • Participation in Part C

 

Eligibility:

Texas narrowed the eligibility of infants and toddlers who qualify for ECI, as a result fewer children are admitted into ECI.  Of the 50 states and 3 territories surveyed:

  • 20 states require one of the following for eligibility for ECI: at least 25% delayed in two or more domains, 30% delay in one or more domains, 33% delay in one domain, 1.3 standard deviations in two domains, 1.5 standard deviations in one domain
  • 18 states require one of the following for eligibility for ECI: 40% delay in one domain, 50% delay in one domain, 1.5 standard deviations in two or more domains, 1.75 standard deviations in one domain, 2 standard deviations in one domain, 2 standard deviations in two or more domains.

 

In other words, 38 states are more restrictive than Texas in terms of eligibility criteria.  In addition, ten states made their eligibility criteria more restrictive over the last three years.  One made theirs broader.  Ten are changing their criteria this year.

 

Service Delivery:

Looking at all states, the number of direct services hours that were delivered, per child per month, has declined by approximately 22% from 2009 to 2011.  In 2011, the nationwide median for number of hours of delivered services, per child, per month, was 4.5 hours.

 

Fiscal Matters:

As a result of funding challenges:

  • 8 states have implemented family cost shares or increased those fees
  • 9 states have required the use of private insurance for ECI
  • 9 states have narrowed eligibility
  • 8 states have required prior approval when service hours exceed a specific amount
  • 13 states have reduced ECI provider reimbursement

 

21 states have conducted some type of study or planning process as a result of the fiscal situation.

 

In other words, like Texas, a lot of states are experiencing funding challenges with ECI.

 

Participation in Part C:

Worryingly, according to this survey, eight states are discussing or planning dropping out of Part C.  Most of this is due to the cost of the program and population growth (i.e. it’s not a sustainable program).

 

It’s a sobering look at the rest of the country and hopefully provides some perspective on what is happening in Texas currently.

 

Yesterday I participated in the Children’s Policy Council’s briefing for the Texas legislature.  The Children’s Policy Council (CPC) was established by the 2001 Legislature to help provide recommendations to the state about integrating services to children with special needs to provide the services that are needed in a more effective, cost-effective, and integrated way.   It’s membership is primarily parents of children with special needs, which allows it to provide a unique perspective to the state.  Every even-numbered year, the CPC produces a report with recommendations for the Legislature.  The 2012 report can be found here: http://www.hhsc.state.tx.us/si/C-LTC/2012-CPC-Leg-Report.pdf .

 

The CPC conducted a briefing based upon the recommendations found in the report to the Legislature and state agency employees in the state capital yesterday.   I’m happy to report that staffers from about 25 representatives and senators attended as well as staffers from the Department of Assistive and Rehabilitative Services, the Department of Aging and Disability Services, and the Health and Human Services Commission.

 

I discussed the need to fully fund Early Childhood Intervention (ECI).  I have covered a lot of the issues elsewhere (see: http://wp.me/pZf7K-7F for the most recent summary), but none of the CPC assumed knowledge on the part of the people attending the briefing.  I began by discussing what ECI is and what it does.  I explained that there is a narrow window (birth to age three) when services can be provided to children that might be less expensive and easier due to the fact that children are developing rapidly at this age.  Failing to address delays at this age doesn’t make them go away, it makes them someone else’s problem (the school districts and society’s) which becomes more difficult and more expensive as the child ages.

 

After that I covered the history.  Namely that the funding for ECI has been cut for several years.  In fiscal year 2010 it was 197 million dollars.  In FY2012 it was 163 million dollars.  In FY2014, DARS is asking for 145 million with an additional 40 million in exceptional items.  The result of this has had an impact on how many children receive services as well as who those children are.  As I have written about elsewhere, I explained the consequences of the Legislature’s short-sightedness with ECI and explained why it needs to be fully funded.

 

With one exception, all of the other presenters at this briefing were parents.  This was powerful as it provided a human face to the services and programs that the CPC is recommending.  One of the parents, Cheryl Fries, began her presentation by talking about her “D Day,” the day her family received the diagnosis of their child’s disability.  She told those attending the briefing that each parent of a special needs child has their D Day burned into their memory and that none of us asked to be part of this club, but we’re all members nonetheless.  I thought that was a powerful statement and I’m going to borrow that in the future.

 

The one exception was Dr. Carl Tapia, who is a pediatrician specializing in children with special needs.  He discussed the CPC’s recommendations for reforming acute Medicaid services.  The CPC has been involved in making recommendations to the state about redesigning both long term services and supports as well as acute Medicaid services.

 

I found the briefing to be a positive experience.  We had a good turnout and I felt that they were attentive and asked questions.  Now how things play out during the upcoming session is anyone’s guess…

Yesterday (10/10/12) I attended the Early Childhood Intervention (ECI) Advisory Committee quarterly meeting. There were several interesting items that came up in the meeting:
• Report on family outcomes
• Consequences to the system changed to ECI in Texas
• Providers of ECI in Texas

Family Outcomes
The Department of Assistive and Rehabilitative Services (DARS) ECI staff does an annual report to the federal Office of Special Education Programs. Among other things, ECI reports on three family outcome indicators:
1. How helpful has ECI been on helping families know their rights?
2. How helpful has ECI been for communicating their child’s needs?
3. How helpful has ECI been in helping the child to develop and learn?

Each indicator is made up of 6-8 questions. These indicators are measured via a survey that is conducted amongst half of the ECI providers in December.

For the fiscal year that just ended (FY2012), the three indicators declined relative to the year before, though they all met the targets that the state has set. Drilling down into the indicators, it appears that three concerns were responsible for this decline:
• Transition education from ECI to the next stage
• Education about the range of services available to the family and the child
• Helping children get along with others: in terms of behavior but also in terms of things like day care placement

There are two cautions about this survey and its results. First, the timing is important. This survey went out just as the system-wide changes to ECI were really beginning to kick in. It’s unclear our reflective these survey results are of the situation today, a year after the system-wide changes were implemented. Second, the sample size is incredibly small. These survey results are based on 943 responses. In December of 2011 there were 25,035 children enrolled in ECI. With the survey going out to half the programs, there are somewhere around 12,517 potential children in that population (although that is dependent on the size of the programs surveyed). 943 out of 12,517 represent a sample size of 7.5%. Here’s the problem: a sample size that is too small means you are unsure if the survey results adequately reflect the population. Normally when conducting surveys you figure out what type of sample size you need. When I asked about this, I got a deflecting-type of answer.

Consequences of System Changes
The system-wide changes to ECI (narrowing of eligibility, family cost share, provider direct billing of Medicaid, and measureable outcomes) have had effects on providers, families, and children. For the providers, they have been in an identity crisis and have had to gradually shift their focus away from families and more towards business, billing, and measuring/assessing outcomes.

For everyone else, the consequences of the system-wide changes have been complicated. First, by narrowing eligibility fewer children are being served. In FY2010 there were 32,101 children being served. In FY2012, there were 25,035. This is a 22% reduction. Second, by narrowing eligibility the mix of who is receiving ECI has changed. In 2010, 16% of those children were “atypical” in the sense that they were not developing at the “normal” rate. Today that group makes up 3% of the ECI population whereas there are a greater percentage of children with a medical diagnosis or developmental delays. This means that those individuals still receiving services require more intensive services. As a result, the average direct services per child per month has increased from 2.1 hours in FY2010 to 2.7 hours in FY2012 (a 29% increase). It is expected to eventually move up to 2.9. On the surface this sounds positive, but as the population of Texas increases and if funding stays static, it means that fewer children will be able to be served in future years.

Providers of ECI
Since FY2010, the number of ECI providers in Texas has declined from 58 to 51, or a 12% reduction. Of the seven providers that were lost, 3 were independent school districts and 2 were education service centers. In other words, 5/7 of the providers lost were related to the public school system. This is largely because as providing ECI has become more complicated in terms of narrowed eligibility, direct billing of Medicaid, and outcomes assessment the public school system is deciding that this is too difficult given that working with 0-3 year olds isn’t part of their purpose for being here.

I attended a webinar today run by the Office of Special Education Programs (OSEP), which among other things monitors and verifies the compliance of states with the Individuals with Disabilities Education Act (IDEA). IDEA is the act that establishes that children with disabilities are guaranteed free appropriate public education in the least restrictive environment possible. It provides for early childhood intervention and for special education.

The webinar dealt with the fact that OSEP is going to be requiring states to identify something focused that they are going to improve as a result of the monitoring and verification system. The thought is that simply being compliant with IDEA does not equate to improving the results for children with disabilities.

This focused topic will include the following:
• It will be developed in conjunction with key stakeholders
• It will involve gathering and analyzing data to support informed decision making
• It may bring some OSEP resources to bear on the topic
• It will result in a change in practices related to the results of the topic
• Data will demonstrate improved results

In the webinar, OSEP’s representative continually made the point that the topic will be state driven, even though OSEP is mandating that this be done.

On the surface, this sounds like a good idea. However, it’s one of those things that breaks down when you get into the details.

Concepts like this come from something called Total Quality Management (TQM). TQM comes from manufacturing and the idea is to continuously improve the process of manufacturing so that output increases, mistakes decrease, and quality improves.

Outside of assembly lines it deals with identifying outcomes, measuring them, and basing decisions around improving them. Done over a period of time this theoretically results in continuous improvement of the organization. In other words, if you improve the results of the measurement that must mean you are doing a better job. You can see where this would work with an assembly line, but it breaks down outside of that. For example, improving test scores does not mean that children are better prepared for college or for work, it means they are better at taking those specific tests.

This is a concerning trend for two reasons. First, states are going to devote a lot of resources and staff to documenting that they are improving their outcomes. These resources could have been better spent providing and funding direct services. Second, states are going to focus their efforts, policies, and budgetary decisions around improving measurements and not about improving the lives of children.

I have provided links below to OSEP, IDEA, and the State Advisory Panel on Special Education. The advisory panel website has the power point for the webinar (it’s the May 20th webinar).

Links:
Office of Special Education Programs (OSEP): http://www2.ed.gov/about/offices/list/osers/osep/index.html

Individuals with Disabilities Education Act:
http://idea.ed.gov/

State Advisory Panels on Special Education:
http://www.stateadvisorypanel.org/

The draft of the House budget is out and as I wrote in an earlier blog it results in a substantial cut to DARS’ ability to provide early childhood intervention (ECI) services to the children of Texas. Essentially, if this budget were passed DARS would go from serving some 34,000 children in ECI to serving 26,000.

This reduction would be occurring while the population of Texas is increasing. In practical terms this would mean that DARS would need to tighten up the eligibility requirements so that fewer children would qualify for ECI.

Currently, DARS estimates that a little over 34,000 children will be served by ECI. If the current House budget is passed, it will go into effect on September 1. DARS will not kick out children that are currently being served by ECI, so between now and September 1 DARS will need to establish rules to tighten the eligibility requirements. This will mean that as children age out of ECI, fewer will enter so that the program will eventually average out to around 26,000 children being served (i.e. there will be periods where fewer are being served).

Why is this happening? On first reading, the impact of the House bill to DARS’ budget is not that bad, of the three strategies related to ECI only one has a reduction in funding, and this only around 1%. This should not equate to an almost 25% reduction in children served.

The problem is that none of DARS’ exceptional item requests are being funded. DARS asked for almost $28,000,000 a year to replace one-time federal stimulus funding. That federal funding is what increased the number of children served to its current level, without it DARS must reduce the number of children being served by ECI.

What does ECI do? It works with families, in the family unit, to provide therapies and services to children age 0-3 with disabilities. In other words, it gives parents the knowledge and confidence to get their children a good head start. Without ECI it will fall on the school districts to make up the difference, this is at a time where they are having budget issues as well.

What can be done? Probably the first step is to alert the Legislature about the importance of ECI. The second one is a philosophical one, should state dollars be used to replace what was meant to be one-time federal stimulus funding? The third step is to seriously reconsider ECI. DARS has done benchmarking of ECI compared to other states and Texans receive far less services than other states. There needs to be a careful, systematic, rethinking of how Texas provides ECI. It needs to be done in a manner that really thinks through all the ripple effects of change. Perhaps some form of scaling based upon disability severity, more severe could maintain the current programs and less could go to more of a group program that would cost less…