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Finance : State seeks added fees
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Posted by sylvia on Tuesday, November 08, 2005 (17:59:24)
Post Gazette August 2005
By Joe Fahy
Parents across Pennsylvania are learning just how much it may cost for them to continue receiving Medicaid-funded services for their children with disabilities.
State officials plan to seek federal approval for monthly fees ranging from $23 to $1,000 a month, depending on family income and size. The fees are part of an effort by Gov. Ed Rendell and state lawmakers to scale back the cost of Medicaid, a state-federal program that serves certain groups of poor and disabled people.
About 38,000 Pennsylvania families with disabled children receive a variety of specialized services through Medicaid at no cost to them. This fiscal year, the price tag for those services for so-called "loophole" children will be more than $400 million, according to state officials.
The proposed fees, which would affect about 22,000 families earning $40,000 or more a year, could be modified based on public comment or on input from the federal Centers for Medicare and Medicaid Services, said Niles Schore, special assistant in the office of income maintenance for the state Department of Public Welfare.
Consumers will have the opportunity to comment once the proposal is published in the Pennsylvania Bulletin late this week, he said.
A local advocacy group, meanwhile, is already at work to keep any fees from being imposed.
Calling the proposal a "disability tax," the Advisory Board on Autism and Related Disorders -- called ABOARD -- sent e-mail messages yesterday to several thousand families urging them to contact Sens. Arlen Specter, Rick Santorum and other officials in an effort to block the fees, said Howard Carpenter, ABOARD's president.
Marsha Blanco, president of Achieva, another local group serving people with disabilities, said it is unfair for families to pay both health insurance fees through their employers and the new fee for services that often aren't covered by private insurance plans.
If parents decide to no longer receive Medicaid coverage for their children, she noted, the cost of many of those services will have to be paid by school districts.
Consequently, the Pennsylvania School Boards Association may try to assess the impact of the proposed fees on local school budgets, said Tim Allwein, assistant executive director.
"It's a potential reason to increase property taxes in many districts," Allwein said yesterday.
Annette Eastly, of Franklin Park, said she had no intention of dropping Medicaid coverage for her son Anthony, 11, who has autism and obsessive compulsive disorder. He receives speech therapy and a variety of other services.
But she said doing so would likely send her looking for a job. That would pose a challenge, she added, because she spends several hours or more on most school nights taking her son to appointments and helping him with schoolwork.
Mary Ellen Greacen, of Shaler, was relieved that the proposed fees would not be higher for families who have more than one child enrolled in Medicaid. Her sons Alec, 8, and Ian, 6, both have autism and receive services.
She, too, planned to keep her sons enrolled in Medicaid, but said paying more than $100 a month in the new fees would be a hardship.
"It's very frustrating," she said.
State officials note that 83 percent of families required to pay fees would pay less than $100 a month. The premiums would be charged on a sliding scale based on a family's federal adjusted gross income.
The lowest fees would be imposed on families earning $40,000 to $50,000 a year. They would pay as little as $23 a month for a seven-member family, and as much as $30 a month for a two-member family.
The highest fees would be paid by families earning $250,000 or more a year. A seven-member family would pay $774 a month, while a two-member family would pay $1,000.
Officials note that the proposed fees would save the state about $11 million this fiscal year, about half the savings the state initially said it might need to identify.
"We've made every attempt to be reasonable," Shore said.
But Carpenter said the fact that the fees are less than expected "doesn't change the reality that they're still doing this."
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Finance : Ontario's Largest Autism Service Provider Applauds Ruling on Autism Funding
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Posted by Sylvia on Sunday, May 08, 2005 (21:42:03)
CNW Group 04/04/05
Kerry's Place Autism Services (KPAS) applauds
the recent ruling by Justice Francis Kiteley that arbitrarily cutting off
access to funding for behavioural analysis (ABA) based on age is
discriminatory. "The decision as to the kind and level of support provided to
each individual should be based on the individual's needs and likelihood of
being able to benefit from the treatment rather than an arbitrary age cut-
off," stated Dr. Glenn Rampton, KPAS's Chief Executive Officer.
Dr. Rampton
added that while it is true that the research evidence indicates that older
children and their families are likely to profit more from a broader range of
supports such as family support counselling, and respite, there is no research
evidence that would argue for an across the board cut-off for ABA at age five
or six.
Dr. Rampton expressed concern that this was not the only area in which
the government discriminates against individuals with autism spectrum disorder
(ASD), using as evidence the fact that the Ministry of Community and Social
Services often refuses to allow developmental services' funding to be used to
support extremely needy individuals with Asperger's Syndrome, because they
don't score below a certain level on an I.Q. test.
The individuals themselves,
parents and service find such discrimination hard to understand and deal with,
since providing a reasonable level of support is more cost effective in the
long run. As in the situation with ABA in the early years, until now, the
government has had a tendency to focus on short term savings rather than long
term investment, and in particular, has not understood how important this is
in addressing the special needs of individuals with ASD.
Kerry's Place Autism Services provides a broad range of community
outreach, clinical, vocational and accommodation support to more than 1000
individuals and their families across much of Southern Ontario. With a staff
of more than 430, KPAS is by far the largest provider of such services across
all age ranges in Ontario.
For further information: please contact Dr. Glenn Rampton at
(905) 841-6611 ext 306 or at grampton@kerrysplace.org. Background
information on Kerry's Place Autism Services may be obtained at
www.kerrysplace.org
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Finance : Disorder overtaking special ed
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Posted by sylvia on Friday, September 24, 2004 (19:39:02)
Philly Burbs 24/09/2004
By Jo Ciavaglia and Marion Callahan (The Intelligencer)
A year at Yale University costs about $12,000 less than it costs to educate one student with autism disorders in a Bucks or Montgomery County school system.
Districts can spend $50,000 a year educating a child with this lifelong disorder that impairs communication and social interaction skills.
That price tag is nearly three times what is spent on the typical special education student in Pennsylvania. And it's about five times the yearly cost of educating the average public school student.
If the past is any indication, officials can expect continued double-digit increases in the number of autistic children entering public schools. That trend threatens to burst special education budgets, which already are growing at rates exceeding state and federal special education subsidies.
In 1999, the Upper Moreland School District had five students with autism disorders. By last year, there were 19, and Upper Moreland paid $693,000 in tuition for them.
Last year the North Penn School district served 49 autistic students. This year the number is up to 57.
Charles Lambert, director of special education and support services for Upper Moreland School District, said the number of students with autistic disorders continues to grow annually.
"The range of the type of kids being identified with autistic disorders has broadened," he said. "We are seeing more and more children coming to us from early intervention services. Clearly, it costs us more money because kids have such unique and intense needs."
School officials say the cost to educate students with autistic disorders through the Montgomery County Intermediate Unit costs districts at least $40,000 per student. The cost can surge above $50,000 if a student requires a residential program or one-on-one assistance at all times for safety reasons.
Over the 16 years the typical special education student attends public school, one autistic child could cost school districts as much as $800,000 - not factoring in annual cost increases, according to state officials. Many local districts already spend $1 million or more annually on autistic support and services.
Since 1999-2000, the number of Bucks County school-age children receiving special education for autism disorders has jumped at least 22 percent every year. In Montgomery County, the number of children receiving special education for autism disorders more than doubled between 1999 and 2000 and jumped by more than 29 percent annually. The numbers mirror national autism growth trends, according to the U.S. Department of Education.
Like the Ivy League, the best public education is an expensive but worthwhile investment, education experts and advocates for the autistic say. The sooner children are diagnosed and receive specialized education and behavioral help, the better the chances they'll acquire skills and abilities to lead more productive lives and save taxpayers money on long-term care, they say.
Bucks ranks third among Pennsylvania's 67 counties for the number of school-age children receiving special education for autism disorders. In 1993-94, the county had 64 kids. In 2002-03, it had 448 - a 700 percent increase. No other special education category comes close to the same yearly growth rate.
School districts contract with the intermediate unit to provide autistic support programs, which carry the highest per-student tuition rate: $27,706 for regular autistic support programs and $44,169 for the more intensive Applied Behavioral Analysis. Those costs don't include other related services that may be required.
Gary Otto, director of student services for North Penn School District, said this year the district invested $100,000 to launch its own program and decrease the number of students who have to be sent to the intermediate unit. The district serves the highest number of autistic students in the region. While the program is a cost-saving measure, it also allows students to get the services they need in their home district.
"The goal for any special education program is to bring the students closer to home," he said. "We don't want to have to always put them on a bus and send them far and wide."
Typically, for tuition, transportation, evaluations and other services, the price tag can reach $60,000 per child with autism. That's far more than the additional $7,000 in school services that the average special education student receives, said David Mandell, co-chairman of the Pennsylvania Autism Task Force.
School systems throughout Pennsylvania feel the pressure. Statewide, in 10 years, the number of school-age children in special education for autism disorders has increased more than eight-fold, from 634 to 5,145 in 2002-03, the most recent year state statistics are available.
"If you looked at the percent of special education budgets that are dealing with autism and autism-related classes and services from 10 years ago, it's increased tremendously," said Tim Allwein, spokesman for the Pennsylvania School Boards Association.
"It's not easy to treat, No. 1, and it's not cheap to get those kids a good education," Allwein added. "In many districts, this (autistic support) will overtake special education budgets."
Complicating matters, school systems lack personnel specifically trained to work with children with autism, as well as policies defining what are considered appropriate services, Mandell said.
"The school system - like other systems that are handling the needs of these kids - is completely unprepared," he added.
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Finance : Advocates want more even distribution of state funds to help people with autism
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Posted by Sylvia on Friday, April 30, 2004 (14:51:49)
Sun-Sentinel 20/04/2004
By Jennifer Peltz
In a rural part of North Florida, the state is spending an average of $1,085 per client this year on advice and encouragement for autistic people and their families.
In South Florida, it's spending $340, according to a South Florida Sun-Sentinel analysis of state statistics. In Broward County, the average is $160 per client; in Palm Beach County, $308.
The difference is the outcome of a Tallahassee balancing act that often pits sheer numbers against scarcity.
For Florida Atlantic University's Center for Autism and Related Disabilities, the outcome is this: Two full-time staffers provide more than 500 autistic clients and their relatives with free help that's hard to label but that participants call invaluable. Support groups. Workshops. A professional advocate at a school meeting. An expert eye on a behavioral problem. A sympathetic ear for a distressed parent.
The autism center and some South Florida legislators are making progress to change that. Initially reluctant counterparts around the state now are backing the FAU program's bid for more support, as part of a push for more money for all of them. In what's seen as an important symbolic step, state budgeters have agreed to give money directly to the FAU group rather than considering it a satellite of the University of Miami's autism center.
FAU's autism center relies almost entirely on state money. It ultimately hopes for $750,000 a year, up from $157,000 now, according to lobbyist David Mann.
More money would mean more autism experts and a small corps of parents of autistic people working part time to help other parents, Director Jack Scott said. Broward County's autism center, at Nova Southeastern University, also is stretched thin. It has two full-time staffers to work with more than 1,000 families but often taps UM colleagues, according to Director Robin Parker. The NSU group has asked state legislators to raise its budget from $182,000 to $282,000 a year but isn't pursuing expansion on the same scale as FAU, Parker said.
Autism is a disorder that affects behavior, communication and social skills, usually by age 3. Estimates of its prevalence range as high as 1 in 250 births, according to the Autism Society of America.
Symptoms and their severity vary widely, but autistic people can be distant, volatile or both. Some never talk.
Scientists haven't pinpointed a cause or a cure, but medications, behavior coaching and specialized education can help.
The state's other autism centers raised eyebrows when FAU broached the idea of expansion two years ago. Some said it would increase the FAU program's administrative costs, draining some of the new money. And some took umbrage at the notion that South Florida wasn't getting its share. Together, the UM, NSU and FAU autism centers got nearly $992,000 this year, more than any other.
North Florida's autism programs may count fewer people, but they're farther apart, notes Paul Wharton, who runs a University of Florida-related autism center in Jacksonville. Staffers have to spread themselves out across the countryside, often to places that don't have as many other autism services as South Florida does, he said.
Just "getting parent groups together in rural Florida is a challenge," Wharton said.
Still, the other autism centers agreed in January to back a $128,000 boost for FAU, as part of asking state leaders for a total of $1.6 million more for all of them, according to a memo from the UM program's director, Peter Mundy.
"[Having a child with autism] is something nobody chooses," said one of the lawmakers championing FAU's plan, state Senate Democratic Leader Ron Klein of Delray Beach. "It's something the state should provide support for."
For more information on South Florida's Centers for Autism and Related Disabilities, see www.umcard.org or call 800-928-8476 .
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Finance : Payments on hold while state sorts out therapy rates
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Posted by Sylvia on Thursday, April 15, 2004 (14:17:10)
Lancaster Eagle Gazette 26/03/2004
By CARRIE SPENCER
COLUMBUS — The state is withholding some $13.5 million in Medicaid payments from hundreds of programs that provide therapy to disabled people while the state works to correct billing problems, officials said Friday.
This is the second week money is being withheld by the Department of Job and Family Services, which oversees all payments from the federal insurance program for the poor.
Emergency rules will allow payments to resume late next week, while the Department of Mental Retardation and Developmental Disabilities revamps its newly adopted payment rates for various services and ensures all participants are complying with federal law, said Greg Schneller, MR/DD’s interim finance director.
“The services are absolutely being provided,†he said. “What is being affected is the reimbursement.â€
The problems arose in January as the state switched the way it pays therapists and others, for the first time allowing the possibility of profit.
The changes are attracting more private companies to a $360 million state and federal program providing nursing, psychological care, and physical and other therapy for Ohioans with problems such as mental retardation and autism. The program works through all 88 county MR/DD boards, 220 school districts and about 45 private companies.
The private providers were first allowed in 2001, but the state and Medicaid then covered only direct expenses such as salary, overhead and equipment, Schneller said. As of this year the state pays standard fees for each 15 minutes of a service such as counseling or speech therapy.
Those new rates, however, were based in part on past payment records, so they varied widely from county to county and didn’t meet guidelines for what Medicaid is willing to pay for services, officials said.
In one case, 15 minutes of psychological service jumped to $59 from $39, an $80 hourly raise, said MR/DD spokesman Robert Jennings.
“It immediately became clear that some smaller counties could not sustain those rates,†Jennings said.
The state is trying to adopt uniform rates that meet Medicaid guidelines.
Meanwhile, as more private companies enrolled, the department discovered not all are following state law, which requires them to enter contracts with either with a county or a school district. The local governments must pay for 42 percent of a service before Medicaid pays.
The state is investigating the contract status of 32 such companies, Schneller said.
If none exists, the state will cover the local payments due those companies until a county or school district can take over, said Debbie Hoffine, MR/DD’s assistant fiscal director.
Also, the state in January found possible double-billing by the state to Medicaid for some administrative fees, requiring the cash-strapped state to front $10 million for the programs. Medicaid is expected to repay most of that, Schneller and Jennings said.
It is not yet known how much of the administrative costs the state might have to repay, if any, they said.
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