DSL MEMO SERIES 2001-19
ACTION MEMO

 September 21, 2001

STATE OF WISCONSIN
Department of Health and Family Service
Division of Supportive Living

To:
Area Administrators/Assistant Area Administrators
Bureau Directors
County Birth to 3 Program Coordinators
County Birth to 3 Administrative Lead Agency Directors
County Departments of Community Programs Directors
County Departments of Developmental Disabilities
Services Directors
County Departments of Human Services Directors
County Departments of Social Services Directors
Licensing Chiefs/Section Chiefs
Tribal Chairpersons/Human Services Facilitators

From:
Sinikka McCabe, Administrator
Division of Supportive Living

Re: Implementation Of The Revised Birth To 3 Program Parental Cost Share System

Background Information
The Department of Health and Family Services has been reviewing possible action steps to address financial problems of the Birth to 3 Program. The two strategies that the Department considered to address this issue included: 1) increasing revenue to the program by revising the parental ability to pay system and 2) decreasing program costs by making the Birth to 3 Program eligibility criteria more strict. At this point we are moving ahead with a change for the Birth to 3 Program’s Ability to Pay system. There are positive outcomes in the budget, including increased GPR funding for the Birth to 3 Program and the enhanced Medicaid rate that we anticipate will start in January 2002 for providers serving in natural environments. However, the fiscal issues will not be completely alleviated as some county Birth to 3 Programs will be receiving funding increases and others will receive minimal increases. The parental cost share remains an important part of the Birth to 3 Program funding structure.

The Department is proceeding with an emergency rule change to ch. HFS 90 to create a Parental Cost Share System for the Birth to 3 Program. The Department felt that it was important, for fiscal reasons, to allow counties to implement the parental cost share process as soon as possible. Due to fiscal restrictions, last year some children in the Birth to 3 Program had services discontinued for over a month. Given the negative effect such service cessation could have on children with disabilities, the Department needs to immediately alleviate the cost burden on counties by increasing the share of service costs parents must bear. In doing so, the Department will preserve the continuity of early intervention services. The emergency rule will help alleviate fiscal pressure on county programs and assist counties to keep the Birth to 3 Program functioning. Based on the projections from the Department's study of the new system, there will be increased revenue from the parental cost share system while the administrative costs will decrease.

The emergency rule creates a revised Parental Cost Share System to replace the current Ability to Pay System. The method of determining parents’ share of the costs of needed services is simplified and standardized statewide. It is based on the relationship of families’ incomes to the federal poverty threshold. The changes reduce the administrative costs associated with the program. Under the current Ability to Pay System, counties must perform complex calculations to determine each family’s liability for sharing in the cost of providing early intervention services to their child. In addition, the turnover of families in the Birth to 3 Program makes the current system’s complex calculations relatively onerous on counties.

 The emergency rule also assures that the Parent Cost Share System will be equitable for families statewide. Currently, a family with a lower income in one county may be required to pay more for the same services than a relatively high-income family in another county due to inconsistent adjustments to income and variable implementation of the Ability to Pay System. Additionally, some counties are exempt from implementing the Ability to Pay System because they proved that participating was administratively unfeasible. The dual payment system in the state creates unnecessary inequities for families depending on their county of residence. Moreover, federal policies require participating states to administer a uniform program statewide.

Overview of the Revised Parental Cost Share System
The revised Parental Cost Share System uses the federal poverty threshold, as revised annually, as a benchmark against which families’ adjusted incomes are compared to determine the parental cost share liabilities. Families with incomes above 200% of the federal poverty level will be billed for a fair share of the early intervention services their children receive. Families with adjusted incomes below 200% of the federal poverty threshold will be exempt from cost sharing. Parental cost shares will range from $25 to $150 per month per family.

The annual income of the parent(s) is determined and the annual income is adjusted by subtracting $3,300 for each member of the family participating in the Birth to 3 Program and for each child under 19 years of age with a disability as defined in s. HFS 65.02 (5) (the rules for the Family Support Program). The family's adjusted income and family size is used to determine the parental cost share. The text of the emergency rule is attached and includes the chart for Assignment of Parental Cost Share.

Implementation of the Revised Parental Cost Share System
Although the Parental Cost Share System is effective October 1, 2001, the cost share determinations will be phased in. That is, the cost share determination will affect all Individualized Family Service Plans (IFSPs) developed or reviewed on or after October 1, 2001. Counties will use this revised system for all new children and families entering the program after this date. For families currently in the Birth to 3 Program, the parental cost share will be determined at the time of next review of the IFSP, which may be the six month review or annual review, whichever is first. The parental cost share determination is applicable to the service period following the IFSP development. This means that the parental cost share will be determined for all families by April 1, 2002.

The county administrative agency may not assess a parental cost share for early intervention services if the parents have financial liability for other services subject to the uniform fee system that are provided to the child in the Birth to 3 Program. This acknowledges the complex needs of some children in the Birth to 3 Program.

Implications for Counties
The Department feels it is important for the integrity of the Birth to 3 Program and for compliance with federal regulations that the Parental Cost Share System be administered statewide. County participation in administering the Birth to 3 Program Parental Cost Share System is now required. The county administrative agency is responsible for billing and collection of the parental cost share unless it delegates responsibility to a service provider through a written agreement. The county administrative agency may determine how income information is collected and verified.

As before, the county administrative agency may waive or reduce the parental cost share for individual families. However, a parent who is informed of his or her rights and who knowingly refuses to provide full financial information is liable for the maximum parental cost share.

Promulgation of the Permanent Rule
The Department is proceeding with the promulgation of permanent rules for the Parental Cost Share System. This process began in August 2001. Hearings have been scheduled to gather public comment about the emergency rule and the proposed permanent rule. The public hearings will be held:

• October 16, 2001
  3:00 p.m. to 5:00 p.m.
  Room 950A
  1 W. Wilson Street
  Madison, WI
• October 17, 2001
  2:30 p.m. to 4:30 p.m.
  State Office Building
  610 Gibson Street
  Eau Claire, WI

The text of the proposed rule and the hearing announcement is published on the Department's website. You may also request a copy of the proposed rule and hearing announcement from Donna Miller, (608) 267-5150, milledm@wisconsin.gov

Training and Materials
The Birth to 3 Program will provide administrative guidance for the Parental Cost Share System, including a detailed assignment chart based in the current Federal Poverty Thresholds, a sample form for the declaration of parental income, and a brochure for parents regarding the Parental Cost Share System. These materials will be distributed to counties by October 1, 2001. For additional information, contact David Sorenson, 608 267-3270, sorendm@wisconsin.gov .

Initial training will be provided a the upcoming Birth to 3 Program regional meetings:

• NERO October 4 Appleton 
• SRO October 9 Spring Green
• SERO October 10 Waukesha
• WRO October 17 Chippewa Falls
• NRO October 18 Lac du Flambeau

ACTION SUMMARY
County administrative agencies for the Birth to 3 Program are required to implement a Parental Cost Share System October 1, 2001.

REGIONAL OFFICE CONTACT:
Assistant Area Administrator - Birth to 3 Program Contact

CENTRAL OFFICE CONTACT:
Donna Miller, Birth to 3 Program and Policy Specialist
Bureau of Developmental Disabilities
PO Box 7851
Madison WI 53707
(608) 267-5150
E-mail: milledm@wisconsin.gov

Attachment:

1. Emergency Rule By the Department of Health and Family services Regarding HFS 90 - The Birth To 3 Program

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