By Amy Feiereisel (Community Engagement Reporter)

January 9, 2025

On January 1, 2025, New York State submitted paperwork to instate a long awaited 5% rate increase for Early Intervention, the federally mandated program that provides therapy to babies and toddlers with developmental delays.

That increase was hard-won and passed in the 2024-25 NYS Budget last April. It was the first pay increase for therapists since 1994; a fact that many point to as the reason New York ranks last in the nation for delivery of Early Intervention services.

With that 5% raise, New York also requested something else: a 20% decrease in Early Intervention teleheath therapy rates.

Providers and advocates say it was completely unexpected, and will have devastating consequences on an already struggling system.

5% increase long overdue

Last spring, Early Intervention providers lobbied for an 11% increase in their reimbursement rates, which is essentially how much the state pays them for their services.

Those rates have stayed the same for three decades now, with no cost-of-living increases.

They didn’t get the 11%, but a 5% raise in rates was passed with the budget in April. Providers expected the eagerly awaited change to come within a few months, and be retroactive.

“That money was allocated, so we assumed that we were going to get it sometime. But that’s not what happened,” said Traci Harris, an Early Intervention therapist and the owner of a therapy agency called Building Blocks, in Watertown.

Harris said as the months passed, and no increase came, frustration mounted within the Early Intervention community.

That frustration was on display in December, during a quarterly meeting of the Early Intervention Coordinating Council, the state advisory board to New York’s Bureau of Early Intervention. Several advocates and providers expressed their dismay at the delay, and urged the Bureau of Early Intervention to submit the necessary paperwork to enact the raise.

One of those people was Bridgit Hurley, from the ‘Kids Can’t Wait’ campaign, which advocates for young children with developmental delays and disabilities.

“The stalled implementation of a 5% rate increase is the latest evidence of the need for a thorough study of how to build a strong and effective EI program,” said Hurley, pointing out the fact that New York ranks 50th, last in the United States, for delivery of Early Intervention services.

Unexpected dates and add-ons that providers call ‘devastating’

Then, on January 1, 2025, the state formally requested a 5% rate increase from Medicaid, through a Medicaid State Plan Amendment.

That should have been a moment of celebration and relief for providers.

But it wasn’t, said Traci Harris, in Watertown. Firstly, the rate increase was retroactive to October, instead of April. Harris said that came as a total surprise.

“We thought that it was going to go retroactive from April,” said Harris, “that’s what’s been historically done.” According to Harris, many Early Intervention agency owners, including herself, passed on a rate increase to their therapists, and essentially ate the cost, expecting for retroactive reimbursement.

“I spoke to many agency owners and we all kind of passed that increase on to our providers [back in the spring and summer],” said Harris. With the retroactive date set to October, that’s five months of rate increases lost, and Harris said it leaves agency owners in a tough place.

October also lines up with something else. “The bigger issue with this, is that October is when they implemented the Early Intervention Hub,” said Harris.

The EI HUB is a new software system the state rolled out to manage all of NY’s Early Intervention on October 15, 2024.

The trouble is, the system doesn’t fully function, and since October 15, therapists and agencies haven’t been getting reimbursed for a lot of their work. Some providers have reported up to 90% of their claims being rejected. That means therapists are working but not getting paid.

“The week before Christmas I had therapists reach out to me,” said Harris, “saying that they were not reimbursed what they were expected to be reimbursed, and that they did not have money for their holidays.”

Shocking cut to telehealth rates

So the amendment, and its surprises, comes on the heels of a lot of frustration, heartbreak, and some therapists choosing to leave a field that’s already suffering a worker shortage.

In the amendment, there’s also no mention of a 4% increase for therapists working in underserved areas, like rural locations or in languages other than English, which was also included in last April’s budget.

Instead, there’s something else that providers say they had no idea was even being considered: an overall 20% cut in the rate for telehealth therapy.

Stefanie Burgio lives on Staten Island and provides Early Intervention therapy in New York City. She’s a speech pathologist and special education instructor.

In New York City, the proposed cut to telehealth therapy rates is 22%. She said this will be the end of Early Intervention telehealth visits.

“Who’s going to work with a 22% decrease?” asked Burgio. “That’s a big cut! That’s nearly a quarter of your pay.”

How telehealth therapy is being used to help underserved families

Burgio provides both in-person and telehealth services. The way telehealth visits work is that therapists like Burgio coach parents through providing the therapy themselves.

“So that the parents get to learn these fundamental skills,” said Burgio, “and not just [rely on] the therapist to do it.” She said it works really well getting parents more involved, sometimes even better than in-person therapy “A lot of times it’s really, really beneficial for the parent and the child,” said Burgio.

Initially, Early Intervention telehealth visits were an alternative during the height of the COVID-19 pandemic.

But since then, Burgio says they’ve become standard practice for medically fragile children, families with challenging work schedules, and children who live in remote or hard to reach areas.

Telehealth allows therapists to work with kids when they themselves are ill, or their family members are sick. Burgio gave an example of her own son getting sick with RSV. In that scenario, “I can cancel or give a telehealth option” said Burgio. “Most parents take telehealth because it’s better than not missing an appointment, but they also don’t want their their kid getting RSV.”

It allows for the continuity of care in the face of emergencies. “There’s a snowstorm. My son has RSV. The child [recieving therapy] is sick,” said Burgio. “It’s better than the alternative, which is a child having a two-week gap in services.”

Telehealth therapy reaches children who are otherwise not receiving care

Burgio said telehealth has also been a crucial solution for families on waitlists. Most of her telehealth clients waited for months because of the therapist shortage, and she took them on because she knew they were waiting.

“So now what happens to those families that were waiting and waiting and waiting? Now there’s going to be virtually no telehealth providers,” she said, if the rate is cut by 22%. “So now they’re just going to wait and wait and get absolutely no one.”

Traci Harris in Watertown employs two telehealth therapists who see children in Lewis and Jefferson counties. That’s helped her agency reach children who are far away, and it’s also helped her with a staff shortage; those therapists live on Long Island and see clients in the North Country.

Harris said a rate cut will mean that fewer children are helped, in some of the areas where therapy is the scarcest.

I reached out for comment to both Governor Kathy Hochul’s office and the NYS Department of Health, which oversees the Bureau of Early Intervention.

The DOH responded via a written statement. It called the 20% telehealth reduction an “administrative savings” decision that would “refocus the program to more personal, direct care.” It also said that in-person care is being requested over telehealth services.

Traci Harris said there’s one big problem with reducing telehealth rates to incentivize in-person therapy.

“The issue with that theory is that the places where we’re doing the telehealth [like rural areas of Northern New York] and the reason why we’re doing the telehealth [because it’s the only option] is because there’s already a provider shortage!”

Fewer choices in an environment of lack

Both Burgio and Harris said they won’t abandon the children they’re already seeing via telehealth, but they won’t be taking on any new ones if the rate is cut.

Harris said the cut devalues therapists’ work, and takes choices away from families.

Burgio said to cut telehealth rates in the current environment of delayed paychecks and a therapist shortage is “horrible.”

“You’re going to cut telehealth on top of already not being paid, on top of having paychecks [from NYS] being delayed, and agencies having to take out loans to pay providers,” she said. “It’s just a recipe for disaster and a recipe for the whole system to crumble, because therapists are not going to want to work under these circumstances.”

Bigger ramifications for families and taxpayers

And there’s a bigger consequence to nickel and diming Early Intervention providers, said Bridgit Hurley, the advocate from the ‘Kids Can’t Wait’ campaign.

“Early Intervention improves outcomes for children,” she said in the December meeting. “One in three infants and toddlers will receive Early Intervention services do not later present with a disability or require special education.”

When families and children do not receive Early Intervention services, more children go into kindergarten with unaddressed delays and disabilities.

Hurley said taxpayers then pay a much bigger bill for years of in-school therapy and teacher’s aides. She gave an example of children with autism. “Early Intervention results in reduced special education costs by 55 to 100% for autistic children,” said Hurley.

There are 90 days available for public comment on the submitted State Plan Amendment. Comments can be sent to spa_inquiries@health.ny.gov.

Traci Harris says she’s hoping if there is enough pushback from the public and Early Intervention providers, there’s a chance the amendment could be changed.

Original article here: https://www.northcountrypublicradio.org/news/story/51039/20250109/despite-slight-pay-raise-therapists-say-a-bigger-cut-to-telehealth-will-hurt-developmentally-delayed-kids