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Nevada hearing exposes deep divisions over proposed early intervention payment change
Summary
State officials defended a planned shift from a gross monthly capitation model to a fee-for-service approach for Nevada’s Early Intervention (IDEA Part C) services; community providers and parents warned the cutbacks and an unclear billing transition would force many providers to close and send children back to a state wait list.
Administrators from the Nevada Aging and Disability Services Division (ADSD) told the Joint Subcommittee on Human Services that a planned change in how early intervention services are paid is intended to bring the program into compliance with federal Medicaid rules, but community providers, business owners and parents said the specific cuts would destabilize the system and reduce access.
Dina Schmidt, administrator for ADSD, described the proposed change during the division’s budget presentation. She said the division aims to transition community provider payments to a fee-for-service model and to “ensure compliance with payer of last resort requirements” while maximizing federal funding. Ricky Robb, deputy administrator, told legislators the change is compliance-driven and that the state is required not to maintain a wait list under federal law.
The move would replace the longstanding gross capitated payment model (frequently discussed as about $795 per child per month in testimony) that community providers received with a smaller supplemental payment plus billing of insurance. Agency staff said a temporary add-on sourced from opioid settlement funds (the Fund for Resilient Nevada) would be available to transition providers; the administration said that temporary payment would flow through the director’s office rather than ADSD’s program budget.
Community providers and parent advocates warned the proposed amounts and implementation plan are inadequate. Mike Wheldon of the Perkins Company told the committee, “The $7.95 should be considered as, like, an managed care payment. ... If we go to the other model, the fee for service, and where they get paid $1.99, there's a $600 gap between $7.95 and $1.99.” Robert Burns, president of the Nevada Early Intervention Community Providers Association, said past independent studies recommended keeping a gross rate until a plan for fee-for-service exists and called for restoring community-provider funding.
Providers gave concrete cost examples in public comment. Dana Aronson of TheraPlace Solutions said her company’s figures for 182 children showed the proposed fee-for-service supplemental would not cover payroll and operating costs and that shifting children back into state programs would, in her analysis, increase monthly state costs compared with retaining current community-provider funding.
ADSD officials urged continued work with Medicaid, community providers and the director’s office to streamline claims and minimize administrative burden. Ricky Robb said the division and Medicaid are meeting regularly and that ADSD maintains a log of system tickets from NEIDS, the new Nevada Early Intervention Data System, which went live in December 2023 and remains under active vendor support.
Legislators pressed both sides for additional detail. Questions focused on whether the insurance billing assumptions used to justify a reduced supplemental rate were realistic, how denials and high deductibles would be handled, and whether the temporary opioid-settlement add-on would be continued beyond the biennium; administrators said the opioid add-on is intended as a temporary transition and that the ongoing structure would be part of the main budget request.
The committee heard multiple requests from providers for a further independent analysis before the state implements a fee-for-service model. Providers sought: (1) restoration of the community-provider supplemental payment to the level recommended in the earlier independent rate study, (2) continued improvement and vendor support for NEIDS to reduce denials and administrative burden, and (3) a new study assessing cost, billing realism, and access impacts before the payment model is changed.
No formal vote or final decision on the payment model occurred at this hearing. Agency staff said they would continue to coordinate with providers, Medicaid and the legislature on implementation details and on streamlining invoicing so providers would not have to submit requests to multiple offices.
The public comment period featured multiple community-provider owners and advocates from both northern and southern Nevada who described business and clinical operational details and argued a rapid transition would reduce provider capacity and create new wait lists for children at a critical developmental stage.
