The new agreements, set to take effect July 1, laid out new reimbursement rates for preschool special education services. The county sets these rates, and pays the providers, to ensure that children receive the services they’re entitled to under the law.
These contracts, for the first time, included group rates, which the county said is an effort to increase capacity for services that are chronically overburdened.
The group rates were set lower than individual rates, which county spokesperson Jesse Sleezer said is common across counties in New York, because they allow providers to earn reimbursements for multiple children per session.
But a key hangup arose around the issue of what the county calls “groups of one,” which occur when a specialist determines that a child is best treated in a group setting, but there’s no group available.
The county had initially planned to reimburse groups of one at the lower group rate, but after a meeting with providers in April, the public health department decided to treat groups of one as individual therapy sessions, with a corresponding higher reimbursement rate.
Still, providers remained unsure. Public health commissioner Michael Mendoza sent out an email to clarify the April decision Thursday afternoon. Therapists hailed it as “a big win” and “a victory,” and said they had not realized the clarification reflected a decision already made months ago.
At another meeting in May, county officials heard concerns from therapists that its newly established group rates were set too low, and that they appeared out of sync with a promise of a 15 percent “across-the-board” rate increase that County Executive Cheryl Dinolfo made in March.
Those proposed group rates, in fact, represented “a cut to rates that have not changed in 10 years,” said Heather Hanson, chief operating officer at Step-by-Step Pediatric Services.
The county responded with new group rates that were more similar to the old individual rates, and reiterated its proposed increases to individual rates, which are either “at or above the 15 percent mark,” said Sleezer.
The uncertainty has left advocates for early intervention wishing for more definitive answers from the county.
“All I want to see is, you know, in writing, the actual rate increase written into the contracts with providers,” said Brigit Hurley, advocacy director at The Children’s Agenda, a Rochester non-profit.
Hurley said without raising rates across the board, including for group therapy providers, the county risks falling short of its obligation to get interventions to children who are entitled to them under state and federal law.
“The reality is that, if the rates are not corrected, there are children who will wait – continue to wait – for the services that they really need,” Hurley said. “Their brains are developing, changes are taking place, and this is the opportunity we have to really help that child reach his or her full potential.”
Brett Dahlberg is health reporter for WXXI News.