Developing and Sustaining a Part C Finance System:

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Developing and Sustaining a Part C Finance
System
Connecticut
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Ongoing Monitoring of

• Demographics

• Expenditures

• State Economics

• Political Context

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Demographic InformationTrends in Children Served
Fiscal Year 2003
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Demographic InformationEligibility
Moderate eligibility criteria (-2SD in one area,
-1.5 SD in two areas)
List of diagnosed conditions with high
probability of resulting in a developmental delay
Children with other diagnosed conditions plus
mild delays are also eligible
Children with -2SD in speech only plus a
biological factor are eligible
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Massachusetts 5.29 Hawaii 3.64 Indiana 3.42 Del
aware 2.93 Wyoming 2.86 New Hampshire 2.63 Florida
2.57 Wisconsin 2.56 Arkansas 2.56 Rhode
Island 2.51 Kansas 2.41 Pennsylvania 2.38 Vermont
2.38 Maryland 2.34 Maine 2.28 South
Dakota 2.15 West Virginia 2.26 Colorado 2.26 Virgi
nia 2.07 Michigan 1.78 Ohio 1.70 Mississippi 1.65
Minnesota 1.56 North Carolina 1.51 Iowa 1.46 New
Mexico 1.41 Washington 1.32 Louisiana 1.21 Alabama
1.18
IDEA Part C
Percentage of children under the age of 3
receiving services as of 12/1/2001 (excludes
at-risk)
New York 4.15 Connecticut 2.97 Kentucky 2.39 Idaho
2.15 Tennessee 2.09 Illinois 1.93 Utah 1.93 New
Jersey 1.92 Texas 1.86 Puerto Rico 1.71 California
1.67 Oregon 1.42 Nebraska 1.36 South
Carolina 1.31 Georgia 0.98
Alaska 2.21 Montana 1.84 Oklahoma 1.83 North
Dakota 1.59 D.C. 1.45 Missouri 1.28 Arizona 1.27
Nevada 1.03
Moderate Eligibility
Narrow Eligibility
Broad Eligibility
Data Source Westat
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Funding Sources Direct Services
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Expenditures
Funding deficits in each of previous three years
covered by transfers from other department
accounts
Data Source Monthly Invoices
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State Economics Budget Surpluses Deficits
Fiscal Years 1985 - 2002
Data Source Legislative Office of Fiscal
Analysis
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Political Economic Context
Republican Governor - proposes to end entitlement
Democratic majorities in House Senate but not
veto-proof. No obvious champions.

• The states worst budget crisis since 1991
  chaos
• layoffs - January
• early retirements - June
• lead agency reorganizes to 3 regions - June
• no budget agreement until August

Strong provider trade association. Birth to
Three providers function as part of a much larger
group
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Redesign the Finance System
Demographics
Decrease number of eligible children (or at least
prevent further increases)
Funding Sources
Increase revenue for direct services
1. Family cost participation
2. Shift in Part C allocation
3. Increase in insurance revenue
Decrease expenditures for direct services by
modifying some payment rules for programs
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Change demographics through small, measurable
eligibility changes
Review diagnosed conditions list
Revise modifications that expanded eligibility
Provide safety net of enhanced developmental
monitoring
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Expand Funding Sources
Reallocate admin costs saved by reorganization
Expand coverage to include all services
Charge families on sliding scale
?
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Change payment policieswithin Connecticut
political and economic context
Make small changes that do not affect larger
overall provider community

• Change policy on continuing to pay programs for
  up to 8 consecutive weeks of no service to no
  payment for any month of no service
  (cancellations by family less than 24-hours in
  advance excluded)

• Change payment of additional fee-for-service
  rates for children needing intensive services.
  Pay for those hours over 15 instead of 13.

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Infrastructure Changes
Statutes - family fees, insurance coverage
Regulations - family fees, credentialing
Provider Contracts - modifications to payments
Procedures - eligibility, family fees, provider
payments, insurance
Data System - eligibility, provider payments,
family fees
Billing contractor - for family fees
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Guidance and ongoing support
New materials for primary referral sources
families
Two forums for program directors with follow-up
New procedures - hard copies, cds, website
Letter to families, phone calls from families
Questions and answers - hard copies, posted on
data network
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Ongoing Monitoring
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(No Transcript)
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Families Declining Initial Evaluation
Percent of all eligibility determinations
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Percentage of children exiting due to withdrawal
by their parents
Letter announcing fees sent to all families
Percent of all withdrawals