1. State Initiatives Shared with EI Providers November 5, 2015

2. Purpose for Meetings 2  CCBs provide different interpretations of state guidance  Many changes, both in this year’s State Plan and proposed changes to next year’s State Plan  Want providers to know about current SSIP initiatives  Want providers to know how to be more actively involved in the process

3. Program Overview 3  We provided an overview of the structure of the EI system in Colorado  We listed the state Team and how we’re structured  We showed data of referrals and number of active children to give them some perspective:  Referred – 12,897 (final count)  Evaluated – 9,192 and 80% eligible (? Is this correct?)  Unduplicated Count – 13,316  Average Monthly Enrolled Count – 7,340  Total Budget $48,167,964

4. What Regulations Drive EI? 4  We went through the State Plan:  Policies and Procedures Page at www.eicolorado.orgwww.eicolorado.org  Colorado Code of Regulations (CCR) 2509-10, Sections 7.900-994 at sos.state.co.us  Fiscal Management and Accountability Procedures (FMAP) at www.eicolorado.org Policies, Fiscal Managementwww.eicolorado.org  Medicaid Billing Manual

5. Future EI Rules and Part C Grant Timelines Revised EI Rules 1 st Board Hearing April 2016 Revised EI Rules 2 nd Board Hearing May 2016 Effective July 1, 2016 Application, Budget & Revised Policies & Procedures public review January 20 – March 20, 2016 Public Comment and Hearings February 19 – March 20, 2016 Application due to Office of Special Education Programs April 21, 2016 Policies and Procedures Effective July 1, 2016 5 State Systemic Improvement Plan (SSIP) Phase II: Implementation and Evaluation Plan September 2015 – February 2016 Public Engagement January – February 2016 SSIP Phase II due to Office of Special Education Programs April 1, 2016 Implementation Effective July 1, 2016

6. Organization of the EI Colorado State Plan 6  Overall template is:  Title of subsection  Federal and State authority reference  Rule number  Rule language  Procedure(s), if necessary  Other related documents, if necessary, in text box

7. EI Colorado State Plan Changes  7.901 Definitions  Created new definitions and revised current definitions  Revised definitions for:  Abuse and/or neglect  Assessment  Added definitions for:  Coaching  Evidence-based practices  Evidence-informed strategies 7

8. EI Colorado State Plan Changes (cont.)  7.901 Definitions  Added definitions (cont’d…):  Family Assessment  Frequency  Intensity  Method  Model  Multidisciplinary  Multidisciplinary Service Providers Model  Primary Service Provider Model  Single Provider Model  Telehealth 8

9. EI Colorado State Plan 7.901 Important New Definitions  “Coaching” means a relationship-based strategy used by appropriately trained personnel with a family member, other caregiver, or another provider to support what is already working to help a child develop and to increase their knowledge and use of new ideas to achieve child or family outcomes.  “Evidence-based practices” mean practices that integrate research that has demonstrated efficacy and with consideration of the situation, goals, and values of the child, family and professionals.  “Evidence-informed strategies” mean the use of nationally recognized recommended practices to inform the effective delivery of early intervention services. 9

10. EI Colorado State Plan 10 7.901 Important New Definitions  “Multidisciplinary Service Providers Model” means a model in which two (2) or more qualified providers who have different training and experience provide ongoing services as identified in an IFSP. In this model the providers work independently of each other with minimal interaction with other team members, and perform interventions separately from others while working on discipline-specific goals.

11. EI Colorado State Plan 11 7.901 Important New Definitions  “Primary Service Provider Model” means a model of service delivery that utilizes one main qualified provider from any discipline that is the best fit to address the child and family outcomes as identified in an IFSP. Other team members support the primary service provider through teaming and may provide co-visits under this model.  “Single Provider Model” means a model of early intervention service provision in which one provider is utilized to meet the child’s and family’s needs as identified in an IFSP.

12. EI Colorado State Plan 12 7.901 Important New Definitions  “Telehealth” means a form of service provision that utilizes secure interactive videoconferencing to deliver early intervention services.

13. EI Colorado State Plan 13  7.930 Service Coordination  B.9. Removes requirement to provide open choice of providers in order to meet the requirement to follow the funding hierarchy  7.940 IFSP  I.1. Adds that model is included along with method as required content on the IFSP service page

14. July 1, 2015 Changes in FMAP  Pages 18-24:  Removes the personnel from service descriptions and revises the descriptions of the methods (description of qualified personnel is now an attachment)  Adds Teaming, Evaluation and Assessment to all appropriate services and uses the definitions in the State Plan  Adds supervision where it is allowable under the service descriptions and adds the requirement for an Assistive Technology (AT) evaluation to be conducted prior to an AT device being purchased 14

15. Changes in FMAP  Page 26, footnote 8: Clarifies that the only plans that must meet a deductible are HSA tax-qualifying plans.  Page 31: Clarifies the relationship between Medicaid (HCPF) and Denver Health HMO, as well as Medicaid’s relationship with the Behavioral Health Organizations (BHOs) 15

16. Changes in FMAP  Page 32: Clarifies that if a family has Medicaid as a secondary plan and declines use of their primary insurance, then they are also declining the use of Medicaid  Page 35: Clarifies how CHP+ (Colorado Access) must be billed 16

17. Other EI Colorado State Plan Appendices 17  A – Memorandum of Understanding  B – State Transition Interagency Agreement  C – General Supervision and Monitoring Procedures  D – Fiscal Management and Accountability Procedures  E – A Family Guide to the Coordinated System of Payments for Early Intervention Services  F – Personnel Standards  G – Colorado Interagency Coordinating Council

18. State Systemic Improvement Plan Overview 18  Indicator 11: The State’s State Performance Plan (SPP)/Annual Performance Report (APR) includes a State Systemic Improvement Plan  Measurement: The State’s SPP/APR includes a comprehensive, multi-year State Systemic Improvement Plan (SSIP), focused on improving results for infants and toddlers with disabilities and their families

19. SSIP Process 19 FY 2013-18  Phase I – Analysis  Phase II – Plan  Infrastructure Development  Support for EIS Program and/or EIS Provider Implementation of Evidence-based Practices  Evaluation  Phase III – Implementation and Evaluation

20. SSIP 20  Phase I – Analysis - submitted 4/1/15  Phase II – Plan – due 4/1/16  Infrastructure Development  Support for EIS Program and/or EIS Provider Implementation of Evidence-based Practices  Evaluation  Phase III – Implementation and Evaluation – due 4/1/17-19 Focus for improvement: Evidence-based practices consistently implemented from referral through transition

21. Colorado SSIP Improvement Activities 21  Develop a CDHS/DCFS EI Program data system to ensure that data will be available for monitoring, evaluation, and improvement planning for both compliance and quality indicators  Integrate the Individualized Family Service Plan (IFSP) Process with the Child Outcomes Summary (COS) Process  Implement a Statewide System of Family Assessment, Using Department-Approved Family Assessment Tools and Provide Training, Technical Assistance and Quality Assurance Monitoring

22. Highlighted Our Other Initiatives 22  Telehealth Pilot and Policies and Procedures Task Force  Provider shortages  Part C – Early Start Denver Model (C-ESDM)  UNC Project TREE  Early Childhood Mental Health (ECMH) endorsement  Neonatal Intensive Care Unit (NICU) Project  Marsico Study and Gap Analysis of Early Care and Learning Settings and Infants and Toddlers with Special Health and Developmental Needs

23. Next Steps 23  What’s going well in the EI system?  Are there system challenges that EI Colorado needs to be aware of?  What is the best format to disseminate information to EI providers?  What are additional topics of interest?

24. Provider Response to the Meetings 24  While most providers appreciated having a better understanding of the EI system, they had specific questions that they wanted to discuss – the first meeting, they wanted to talk about billing and the second meeting, they wanted to talk about teaming  There was a great deal of interest in telehealth  At the second meeting, we mentioned that we are working with higher education to put together training for an EI Certificate and providers were very excited about that

25. Provider Response (cont.) 25  They like in person meetings and suggested that we look into having regional meetings  They thought that posting the slides for those who couldn’t attend would be a good first step, but would like to see webinars, or in-person meetings  They are hungry for information about the PSP model

26. What We Learned 26  We will need to have regular meetings with providers, possibly quarterly or three times a year  We need to have targeted meetings – some on billing, others on a variety of topics  We need to include CCB representatives in these meetings, so that they are hearing the same information that we are telling providers

27. Questions 27

28. State Updates 28  Process for filling EI Program Director position  Fill quickly, but thoughtfully  Internal posting only  Getting the support of a national consultant to ensure that we have the correct structure for our work  Ashley will be handling verifications of provider credentials  Beth moving forward the work of both the Alliance/OEC Task Force and the Telehealth Work  Christy is the interim Colorado Part C Coordinator and contact for national partners  Christy and Beth will be participating in the CCB Executive Directors’ meetings  Amended contracts coming

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