A new billing procedure for early intervention services in New York state is causing a headache - and a lack of payments - for local therapists.
Providers, including those working in speech, physical, and occupational therapy, and itinerant special education, have not received full payment for services in several months.
Under a new state proposal involving an escrow account, the county may have to pay if local therapists do not get paid.
Individual counties were responsible for service reimbursement until New York state took over on April 1.
Chautauqua County Director of Health and Human Services Christine Schuyler said the county, as previous administrator, took care of billing. The state hired an outside fiscal agent to help with the billing as a way to provide mandate relief, Schuyler said.
In the previous billing system, providers would submit payment to the county and receive the funds. With New York state taking over the billing, service providers are required to log on to a website and submit the bills electronically. According to Audrey Buck of Occupational Therapy & Hand Rehabilitation Services, there was no instruction on how to utilize the website.
"We got absolutely no instruction on how to do the billing, what codes we're supposed to use," she said. "There was no training. It was just dropped in our laps."
Once the bills are submitted, the state will forward any bills to private medical insurance companies, if applicable.
The private insurance companies are then responsible for reimbursing the providers. The problem providers are seeing with private insurance companies is they are not paying.
"One of the major bumps in the road has been with commercial insurers. A large payment has not been paid," Schuyler said. "Un-fortunately, the bottom line is we have many providers who are not being paid."
Providers working in early intervention are assigned cases to work on. These cases involve young children who are in need of services to meet developmental milestones. Buck, along with many other providers in the area, work with these children in the child's own home. By providing early intervention services, it eliminates the need for services needed later on in a child's life; the earlier services start, the more successful the outcome.
"Services (are) for children who have developmental delays, whether it be a birth defect, birth injury or failure to thrive. It's usually a medical condition of some sort that prevents them from meeting their development milestones," Buck said.
The state did try to offer temporary relief for the lack of payment. It allowed providers to prove economic hardship through bank and credit card statements. The paperwork had to be in to the state a few days prior to Memorial Day, only giving providers a short period of time to submit the paperwork.
Another option the state gave providers such as Occu-pational Therapist Cathy Dorman was a letter she could send to her creditors explaining the current situation. She said this was three weeks ago and still has not received any form of a letter.
According to Schuyler, the state has put forth a new proposal to ensure payment for providers. The proposal is subject to county approval. The state is proposing municipalities and counties front 75 percent of the money owed to providers to be placed in an escrow account. According to Schuyler, this money would have to come from taxpayers. The providers would have to pay back the money given to them or face a penalty of the state withholding 25 percent of future payments.
"The state has come up with this plan and rolled it out to municipalities and providers without ever discussing it with the municipalities," Schuyler said.
Each county throughout the state has an obligation to partially pay for early intervention programs. The escrow account is already set up where counties pay their portion and the state takes the money out bi-weekly. The unpaid amounts to providers is in the thousands; both Buck and Dorman said they are owed thousands for services. Another local speech pathologist, who asked to not be named by the OBSERVER, said she is owed $8,000.
In order for this proposal to be effective, local providers have to agree to be paid by this account. Schuyler said only a few local therapists have agreed to be paid out of the escrow account. For those who do not agree, the money paid into the escrow account would sit stagnant. Schuyler is currently in the process of researching if the county could only pay those who agree to this proposal or if they would have to pay all providers, even if they did not agree.
"We really are stewards of the taxpayers' dollars. I don't think it's appropriate to advance substantial amounts of money to the state if it isn't going to go to the providers," Schuyler said.
Schuyler said this proposal is a "Band-Aid" to the problem and called the entire situation frustrating.
Dorman echoed Schuyler's comments by saying it's a "short-term fix for a long-term problem."
The county would have to make the decision to accept the proposal, which has not been made yet. Some counties have opted in favor while others have dismissed the proposal.
"Chautauqua County hasn't really decided if we're going to participate in the escrow payment. That money would have to come out of the county's overall budget," said Schuyler. "Our number one priority is making sure the children get the services. In order to do that, we need to make sure we maintain excellent providers."
Even if the providers are not getting paid, they are continuing to provide services. This lack of payment is making things difficult for providers.
"When you're used to a certain income and it comes regularly, that's how you live. When that's pulled out from under you ... you can't do it," Dorman said.
Another speech pathologist, who also wished to not be named, said this is a frustrating time for all providers. When providers give 100 percent to the families and the children, they should not be worried about receiving payment for those services.
When they take on a case, providers enter into a contract with the state for a pre-determined amount of visits. Both Buck and Dorman said the state would take action against providers for being in breach of contract.
"If we were to all stop, don't you think Albany would be breathing down our backs for breach of contract? What about our breach of contract for getting paid," said Buck. "I worry every week how I'm going to meet my payroll."
Providers and the county have reached out to elected officials, including State Sen-ator Catharine Young. Elect-ed officials have been supportive of the situation, but they are having no luck getting in touch with the state. The United New York Early Intervention Providers and Parents as Partners will host a press conference Wednes-day on Capitol Hill in Albany to address this matter.
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