Delaware Medicaid Cuts For Day Treatment Centers Will Make Schools A “One Size Fits All” Band-Aid

The root of the State of Delaware cutting day treatment centers that have state contracts lies with Medicaid.  The federal government issued guidance in 2011 urging states to look at their state Medicaid plans.  As a result of Delaware’s plan, it has been determined that day treatment centers can no longer be reimbursed for education through Medicaid as of June 30th, 2016.  The news coming out about the state closing these centers has not been officially released yet but something is supposed to come out from the Division of Services for Children, Youth and Their Families this evening.

What this means is day centers can no longer provide any education services for children under the age of 21.  They can only provide direct treatment or counseling.  Many students that currently attend these centers receive both.  It will force these centers to essentially shut down.  So far, it has been confirmed that the two most impacted day centers will be the Terry Center in New Castle and Seaford House in Sussex County.  But there are others, and this will impact a lot of children.

So where will these children go?  Many parents of these students fear they will be placed in their district Intensive Learning Centers (ILC).  I have found these ILCs to be more like a boot camp than a place where students with disabilities or troubled youth can get the true help they need.  The ILCs tend to treat all problems as behavior, but most severe disabilities are neurologically based.

All of this was reported by the State of Delaware through the regulatory process, but the language used in the writing is somewhat vague and never once mentions the words “day treatment center” which is the commonly used terminology for these places.  This is from Regulation 763 which was finalized on February 1st, 2016:

5. Other EPSDT Services

Reimbursement for services not otherwise covered under the State Plan is determined by the Medicaid agency through review of a rate setting committee. Non-institutional services are paid on a fee-for-service basis. Institutional services are per diem rates based on reasonable costs. These services include:

(a) Prescribed Pediatric Extended Care – see ATT. 4.19-B, Page 7

(b) Inpatient and Partial Hospital Psychiatric Services – reimbursed on a per diem basis

(c) Outpatient Psychiatric Facility Services – fee-for-service

(d) (b) School-Based Health Service (SBHS) Providers:

School based health service providers include Delaware school districts and charter schools and may provide the following Medicaid services per Attachment 3.1-A, Page 2 Addendum:

•	EPSDT Screens

•	Nursing Services

•	Physical Therapy

•	Occupational Therapy

•	Speech Therapy, Language and Hearing Services

•	Psychological and Developmental Treatment Assessment

•	Counseling and Therapy

•	Residential Mental Health or Developmental Disability Treatment

•	Specialized Transportation Services

19 DE Reg. 763 (02/01/16) (Final)

 

As I feared, they are taking out services that are necessary for students with disabilities and attempting to replace those with either in-home services or school-based services.  I’m sorry, but even with the strides some schools have made with special education, these students are not meant to be in an inclusive setting at times based on their disabilities.  And ILCs are a prison for these kids.  They are psychological torture.  This is very bad.  Delaware will say they went through all the proper channels, but if the Regulation was finalized in February, why are parents just finding out about this now? Why didn’t they send something to parents that have their child in the state Medicaid program to let them know of these HUGE changes?  Writing about regulations with all their confusing jargon and legalese is not the same thing as making sure that information gets disseminated to citizens in a clear and coherent way.  This is how both state and federal government get away with things.

But who is going to pay for these increased services in our schools?  We don’t have enough money now to properly service public education.  Will this mean more federal grants tied to the Every Student Succeeds Act?  Or will we start to see the slow invasion of non-education entities coming into our schools?  Is this just Delaware or will other states go through this process?  These are burning questions I mean to find the answers to.

Unless the legislators don’t check their state email, they should all know about this by now.  I emailed every one of them, along with Governor Markell, Attorney General Matt Denn, DHSS Secretary Rita Landgraf, Secretary of Education Dr. Steven Godowsky and several others about this today.  But this information regarding the regulation and the Medicaid situation I just found out about in the past few hours.  In reviewing the FY2017 Budget Proposal by the DSCYF to the Joint Finance Committee this year, this plan wasn’t clearly laid out to the General Assembly.  But the timing on this, when these day treatment centers would close, would be after the General Election even though Medicaid stopped reimbursing for these services as of 6/30/16.  How many people knew about this?  Did John Carney?

I have wondered over the past two years, as I fell deeper into the corporate education reform rabbit hole, how students with disabilities, especially those with the most severe, could ever survive in the upcoming personalized learning/competency-based education world.  The answer is becoming very clear: they can’t.  I believe the intent is to push them out of public education.  To force parents into homeschooling their children with moderate to severe disabilities.  The problem becomes the affordability of this.  That would mean one parent can’t work a normal 9-5 job.  It means less revenue for the state.  But these families will still be expected to pay property taxes to pay for our schools.  How is that just in any way?  I have always spoken out against voucher programs.  But if our state wants to force the hand of families of disabled children, perhaps it is time a new conversation started.

 

State Rep. Kim Williams Informed Closure Of Day Treatment Centers Will Happen

Delaware State Rep. Kim Williams let me know she was informed the closure of out-patient intensive servicees, otherwise known as day treatment centers, will occur in the next sixty days.  This decision was made through the Division of Prevention and Behavioral Health which is part of the Department of Services for Youth, Children and Their Families (DSCYF).  One parent found out that local school districts or charter schools will be expected to pick up the tab for these types of services in private settings.  Which is in sharp contrast to existing Delaware state code which indicates the state picks up 70% of these bills and the local districts pay 30%.  These placements are deciding by a group called the Interagency-Collaborative Team.

The ICT and what they do is this, from Title 14 of Delaware code:

(b) Before the Department of Education can authorize expenditures for new placements according to this section, the case must be reviewed by the Interagency Collaborative Team (ICT).

(1) The ICT shall consist of:

a. Division Director, Division of Prevention and Behavioral Health Services of the Department of Services for Children, Youth and Their Families (DSCYF);

b. Division Director, Family Services of DSCYF;

c. Division Director, Division of Youth Rehabilitation Services of DSCYF;

d. Division Director, Division of Developmental Disabilities Services of the Department of Health and Social Services (DHSS);

e. Division Director, Division of Substance Abuse and Mental Health of DHSS;

f. Director of the Office of Management and Budget or designee;

g. The Controller General or designee;

h. Director, Exceptional Children’s Group, Department of Education (DOE), who will serve as Chair; and

i. Associate Secretary, Curriculum and Instructional Improvement, DOE.

(2) A director assigned to the ICT may designate staff to represent the director on the ICT only if these designated representatives are empowered to act on behalf of the division director, including commitment of division resources for a full fiscal year.

The Delaware Department of Education needs to share the blame for this.  They have set up a pressure cooker for students with disabilities.  While Autism rates have soared in the past decade, so has the test, label, shame, and punish atmosphere set up by the DOE.  While much of this was set up through federal mandate, Delaware has consistently failed in being able to “get” special education.  Inclusion does not work in the modern era of Common Core standards and the Smarter Balanced Assessment.  When the DOE started setting up “standards-based IEPs” they missed the whole point of special education.  Is it any wonder students can’t function in these types of environments?  It is toxic to them. It is toxic to all students, but more for the most challenged.

Special education in Delaware is horrible.  I am not disparaging the teachers in the classroom who attempt to deal with these issues, but the psychological toll on these students is more clear than ever.  What we are doing now isn’t working.  What they are planning won’t work.  It is past time for parents to begin rising in protest like they never have before and demand change.

 

State Rep. Mike Ramone Is Going To Ignite An All-Out Charter-District War With House Bill 261

Delaware State Representative Mike Ramone’s House Bill 261 may cause even more controversy than the war of the charter school audit bills!  Ramone’s proposed legislation would protect charter schools if they don’t get timely records from school districts when an expelled student or a student who was placed in an alternative school setting for disciplinary reasons choices into a Delaware charter school.  The bill would make it so the local school district would have to pick up any costs for that student.  This bill is assuredly in response to what happened at Delaware Met.  Many students who went to the school were alleged to have been either expelled or came from an alternative school setting.

I see red flags all over this bill.  I am already picturing charters not taking these students based on this information.  The key word in this legislation is “applies”.  How would a local school district know when a student applies to a charter?  Of course it is the burden of the charter to request that information.  It would be like applying for a new job and my old job would be responsible for proactively sending my references to the new job, prior to my even being accepted at the new job.  Using the word “burden” in the synopsis of this bill makes it look like “Oh, the poor charters. The problems they have with those bothersome districts.”

Ramone, you are letting your charter bias shine through with this bill.  This could put the stigmatism of “cherry-picking” to a whole new level!  I understand the intent here, but this is NOT the way to do it.  As well, the proof is in the pudding on whether or not records are sent.  This is also a two-way street.  Local districts do not always get records from charters in the allotted time period.  If you want to further the tensions between districts and charters, this is a great way to go about it.  I hope this bill dies a quick and sudden death in the House Education Committee…