Department of Health

Early Intervention Program Reimbursement Methodology Study

The Department of Health administers the Early Intervention Program, in which children up to three years of age may be tested and treated for developmental disabilities. Program services are delivered by authorized service providers; the providers are reimbursed by the counties, which are in turn reimbursed by Medicaid, third-party payers and New York State. Providers are paid a certain amount for each service provided (the fee-for-service reimbursement methodology). We considered whether the providers should instead be paid on the basis of a capitated reimbursement methodology (a fixed amount for each Program participant) or a partially capitated reimbursement methodology (which combines features from the fee-for-service and capitated methods). We conclude that there are advantages and disadvantages to each reimbursement methodology, but believe a partially-capitated method, as is used by the Office of Mental Health in its Intensive Case Management Program, may be the best way of controlling costs without compromising the quality of the services provided.

For a complete copy of Report 95-D-37 click here.
For a copy of the 90-day response click here.