Public Comments Response to DOH Proposed Regulations HLT-39-22-00020-P

Submitted by Agencies for Children’s Therapy Services (ACTS),
Steven Sanders, Executive Director
November 25, 2022

ACTS is pleased to submit our comments and recommendations to the Proposed Regulations published in the New York State Register on September 28, 2022 which are amendments to the Early Intervention Program (EI).

Prologue:

As general principal ACTS is OPPOSED to any measures that would lessen access to children from needed services in the EI Program. That could take the form of limiting important evaluations, or limiting the eligible pool of providers, or making services more scarce or difficult to access by parents or to render by providers. However, ACTS also recognizes that there are some changes that are proposed by operation of law or federal regulations that conform to certain changes. In those instances, while we may not agree we take no issue with those conforming amendments to state regulations. Moreover, ACTS applauds the efforts and proposals which ADD new professionals to the list of Qualified Providers in the EI program and reduces clock hours from 1,600 to 1,000 hours as a requirement for on-the-job experience. At a time when the EI program has lost over 2,000 rendering providers just since 2019, it is important to support and supplement existing therapists and to do all that is possible to reach as many children in need as possible by having a work force that can meet the IFSP mandates for every child.

As such:

ACTS OPPOSES the removal of School Psychologists from the definition of qualified professionals (69-4.1(al)(16)-(24). The hundreds of school psychologists that have been authorized by law to render services through June 30, 2024 are an important part of the workforce resource. Eliminating these very qualified professionals makes little sense when the EI Program suffers from an erosion of rendering providers. The addition of the new four categories of professionals is no guarantee that the work of school psychologists will be replaced in the short run or even the long run. By taking this action it is entirely possible that the EI Program will have a net of fewer providers in the first year and perhaps for years to come. Rather, it would make much better sense to adhere to the current law which sanctions school psychologists through June 30, 2024 and then reassess the workforce needs at that time.

ACTS OPPOSES reducing group sizes from a maximum of 12 to a maximum of 8. This drastic 33% reduction in class sizes will inevitably lead to fewer children being served and the need for more therapists being hired. EI Providers are already having great difficulty hiring sufficient staff today. There are currently waiting lists for service slots that cannot be filled. If this new proposed standard of 8 is adopted, that problem will be magnified exponentially. This is particularly true with children requiring ABA services. Furthermore, if occupational and/or speech therapy is discontinued these mandated services will be lost to children that need them. The fact that there is a projected savings of $200,000 to the State resulting from the change from a maximum of 12 children in a group session to 8 suggests that fewer services will be rendered and reimbursed.

ACTS OPPOSES the change in 69-4.30 regarding the delivery Supplemental Evaluations to ONLY be authorized in the IFSP and not be part of the MDE evaluation. We believe that such a change contradicts requirements in the Early Intervention Program. Establishing a new regulation that Supplemental Evaluations are exclusively driven by the IFSP may prevent children from receiving the most appropriate services in a timely matter, or at all for that matter. Children who commonly receive Supplemental Evaluations with delays involving motor, feeding and autism spectrum disorders will likely be affected the most. The proposed regulation suggests that ONLY if the child is eligible by the Core/MDE can a Supplemental Evaluation be recommended and only by the CORE/MDE Evaluation team. Again, this will limit services that otherwise may be identified as a need for the child. In short, if Supplemental Evaluations can only be approved at the IFSP meeting fewer services than needed will often result.

ACTS ALSO HAS CONCERNS about the time frame in which introductory service coordination training must be completed and when services may be furnished in relation to the Department approval (69-4.4(b). This change may delay when services may be rendered or result in agencies not being reimbursed for other services that in fact are rendered.

ACTS AGREES that the parents need ONLY sign session logs and not session notes (69-4.26). To a large extent signing both documents is redundant and adds a level of unnecessary burden on both parents and providers. HOWEVER, this standard needs to be applied to ALL COUNTIES. Otherwise, there will be a different standard in adjoining counties which will cause confusion and unnecessary paperwork. Moreover, requiring parents to sign both the session notes and the weekly logs is largely redundant

Summary:

ACTS appreciates and applauds the Bureau of Early Intervention for its thoughtful consideration of changes to the early Intervention Program that will enhance the delivery of quality services to the nearly 70,000 children and their families that rely on this critical developmental help for their infants and toddlers. However, we cannot help but comment that the greatest single change in the Program that will improve access to services is for a long overdue rate increase as endorsed by the EICC at their September meeting. Reimbursement rates in the Program is actually LESS in 2022 than it was in 2010 and this in spite of inflation which has dramatically increased expenses and the addition of significant new responsibilities placed upon agencies and providers. A rate increase in 2023 will solidify the advances that these proposed regulations attempt to make.