Identifying the Services, Costs, and Reimbursements for Young Children with Disabilities Through Data Collected by Tennessee Part H IDEA Program. RESULTS

04/01/1996

A total of 550 charts were reviewed. Fifty-five charts in the Greater Nashville Region were reviewed prior to the realization that it would not be possible to review all the children. Only those cases that coincided with the specified timeframe and odd-number designation were included. The numbers of cases for the eight districts are presented in Table Six. These were reduced to four regions (East, Middle, Greater Nashville, and West) for purposes of analysis. One hundred-ninety-eight were from the 1993-94 year and 297 from 1994-95

  TABLE SIX. Number of Children Per District  
  District/Region     Frequency     Percent  
East 108 21.8
  First Tennessee 53 10.7
  East Tennessee 55 11.1
Middle 149 29.9
  Southeast Tennessee 59 11.9
  Upper Cumberland 49 9.9
  South Central 40 8.1
Greater Nashville 174 35.2
West 65 13.1
  Northwest Tennessee 26 5.3
  Southwest Tennessee 39 7.9

 

TABLE SEVEN
Diagnosis   Frequency     Percent  
Congenital Defects 99 19.9
  Down Syndrome 16 3.2
  Cerebral Palsy 24 4.8
  VATERS Syndrome 2 0.4
  Spina Bifida 7 1.4
  Cleft Lip or Palate 5 1.0
  Congenital Heart 9 1.8
  Congenital Other 36 7.3
Developmental Delays 205 41.4
  Speech, Language, or Feeding   131 26.5
  Autism 4 0.8
  Developmental Delays 62 12.5
  Pervasive Delays 8 1.6
Prematurity (Premie) 97 19.7
  7 weeks or less premature 32 6.5
  8 to 12 weeks premature 37 7.5
  13 or more weeks premature 28 5.7
Other/Missing 94 19.0

The number of children with each of the diagnoses are presented in Table Seven. These were reduced to the most common diagnostic categories (Congenital Defects, Developmental Delay, Prematurity, and Other/Missing)'for purposes of subsequent analyses.

The demographic information is present in Table Eight and Table Nine.

TABLE EIGHT. Demographic Information
    Female  
(%)
  Male  
(%)
  Afr-Amer  
(%)
  Asian  
(%)
  Cauc  
(%)
  Hispanic  
(%)
  Mixed  
(%)
REGION
East 45 55 11 0 89 0 0
Middle 35 67 10 1 87 0 2
Greater Nashville 43 57 31 1 65 1 1
West 31 71 31 0 68 2 0
p value 0.03 0.001
CHILD'S DIAGNOSIS
Congenital defects 41 59 14 2 83 0 1
Developmental delays   31 69 21 0 77 1 1
Premie 45 55 24 1 73 0 2
Other/missing 44 56 24 0 75 1 0
p value 0.03 0.39
ALL 38 62 21 1 77 1 1

 

TABLE NINE. Age at Intake
    Female  
(%)
  Male  
(%)
  Afr-Amer  
(%)
  Asian  
(%)
  Cauc  
(%)
  Hispanic  
(%)
CHILD'S DIAGNOSIS
Congenital defects 26 21 12 14 17 9
Developmental delays   6 11 12 17 29 25
Premie 28 24 16 9 13 9
Other/missing 17 14 14 12 20 23
p value 0.21
REGION
East 19 20 13 10 22 16
Middle 20 15 14 12 26 14
Greater Nashville 13 13 13 16 21 25
West 14 22 14 18 15 17
p value 0.001
ALL 16 16 13 14 22 19

The information about the education level of the parents and their occupations was too incomplete to be meaningful.

The remaining results are presented in reference to the questions presented in the proposal:

  1. In a six-month period, what services do children with disabilities receive? How many of those services do they receive?

    The percentage of children receiving each of the evaluations or therapeutic services are presented in Table Ten and Table Eleven.

    TABLE TEN. Percent Receiving Each Type of Evaluations
        Sp & Lang  
    (%)
      Psychology  
    (%)
    PT
      (%)  
    OT
      (%)  
      Pediatrics  
    (%)
      Audiology  
    (%)
      Education  
    (%)
    REGION
    East 36 7 23 29 5 19 44
    Middle 43 2 29 9 10 26 47
    Greater Nashville 51 6 14 8 25 42 13
    West 49 0 38 32 9 11 80
    p value* 0.07 0.04 0.001 0.001 0.001 0.001 0.001
    CHILD'S DIAGNOSIS
    Congenital defects 40 4 42 25 20 20 37
    Developmental delays   65 6 15 13 12 38 40
    Premie 24 2 30 18 9 24 41
    Other/missing 28 3 17 12 18 20 33
    p value** 0.001 0.44 0.001 0.03 0.07 0.001 0.59
    ALL 45 4 24 16 14 28 39
    * p value pertains to a test of the hypothesis that there are no differences by region
    ** p value pertains to a test of the hypothesis that there are no differences by diagnosis
    The sum of the rows is greater than one because children received more than one evaluation (as discussed below)

     

    TABLE ELEVEN. Percent Receiving Services by Type
      Sp & Lang
    (%)
    OT
    (%)
    PT
    (%)
    Vision
    (%)
    Nursing
    (%)
    Transport
    (%)
    Home EI
    (%)
    Center EI
    (%)
    REGION
    East 42 27 34 6 6 7 23 3
    Middle 32 9 32 1 5 11 22 3
    Greater Nashville 33 10 13 3 5 9 5 3
    West 28 25 26 0 5 14 35 8
    p value* 0.24 0.001 0.001 0.04 0.93 0.50 0.001 0.30
    CHILD'S DIAGNOSIS
    Congenital defects 29 30 44 3 5 13 25 6
    Developmental delays   49 10 18 1 3 10 17 3
    Premie 20 16 31 5 11 7 18 4
    Other/missing 21 11 15 3 4 7 13 2
    p value** 0.001 0.001 0.001 0.33 0.02 0.45 0.13 0.45
    ALL 34 15 25 3 5 10 18 4
    * p value pertains to a test of the hypothesis that there are no differences by region
    ** p value pertains to a test of the hypothesis that there are no differences by diagnosis
    The sum of the rows is greater than one because children received more than one evaluation (as discussed below)

     

    TABLE TWELVE. Average Number of Hours/Miles of Services
    Units/Hr or Mile Sp & Lang
      (Mean Hours)  
    OT
      (Mean Hours)  
    PT
      (Mean Hours)  
    Vision
      (Mean Hours)  
    Nursing
      (Mean Hours)  
    Transport
      (Mean Hours)  
    Home El
      (Mean Hours)  
    Center El
      (Mean Hours)  
    REGION
    East 45 51 65 13 565 1157 40 102
    Middle 34 24 41 14 1229 3096 52 156
    Greater Nashville 52 29 43 41 384 414 33 113
    West 23 33 28 NA NA 1064 35 87
    p value 0.04 0.07 0.02 0.73 0.53 0.003 0.19 0.07
    CHILD'S DIAGNOSIS
    Congenital defects 42 41 43 60 1765 805 44 149
    Developmental delays   37 39 59 8 158 951 39 121
    Premie 66 37 46 13 57 695 55 99
    Other/missing 41 26 41 NA 1032 249 31 92
    p value 0.07 0.79 0.42 0.07 0.05 0.81 0.29 0.24
    ALL 41 38 48 30 741 774 43 121
    NOTE: Mean calculated using only individuals who received that particular service.

    This is organized by region and diagnosis, and is the percentage of children receiving the evaluation or service. Of 17 possible therapeutic services, only the eight presented occurred with greater than 2% frequency. Those services occurring less frequently included psychology, pediatrics, nutrition, social work, developmental pediatrics, or medical specialists. Table Twelve presents the extent of services provided. These figures represent the average number of hours or miles each child received based on those children who received any of that particular service.

    1. Are some combinations of services more common than others?

      The percentage of children receiving zero to five services are presented in Table Thirteen divided by regions and diagnosis. Those receiving no services, received evaluations only.

      TABLE THIRTEEN. Number of Types of Services Received
          0 Services  
      (%)
        1 Service  
      (%)
        2 Services  
      (%)
        3 Services  
      (%)
        4 Services  
      (%)
        5 Services  
      (%)
      REGION
      East 33 28 15 14 8 2
      Middle 33 40 20 5 2 1
      Greater Nashville 53 34 6 4 3 1
      West 42 15 22 18 3 0
      p value 0.001
      CHILD'S DIAGNOSIS
      Congenital defects 31 24 24 12 6 2
      Developmental delays   34 43 13 7 2 0
      Premie 42 32 11 8 5 1
      Other/missing 66 15 7 7 4 0
      p value 0.001

      It was not possible to determine when services began so that we could not determine sequences.

  2. What are the costs of providing services to the average child? How does this vary by type of service?

    The cost divided by region and diagnosis are presented in Table Fourteen.

    TABLE FOURTEEN. Average Cost of Each Service for Each Child Receiving That Service
      Sp & Lang
      (Mean Dollars)  
    OT
      (Mean Dollars)  
    PT
      (Mean Dollars)  
    Vision
      (Mean Dollars)  
    Nursing
      (Mean Dollars)  
    Transport
      (Mean Dollars)  
    Home El
      (Mean Dollars)  
    Center El
      (Mean Dollars)  
    REGION
    East 3601 2247 3305 484 33713 278 1432 3498
    Middle 1709 1583 2620 490 55313 681 1789 4425
    Greater Nashville 2665 3055 3385 1496 14649 99 1263 3160
    West 1078 2053 1792 NA NA 255 1232 2539
    p value 0.001 0.60 0.40 0.73 0.65 0.006 0.35 0.13
    CHILD'S DIAGNOSIS
    Congenital defects 2574 2837 2489 2207 88800 193 1543 4284
    Developmental delays   2116 1823 3362 282 7863 219 1341 3524
    Premie 3937 1944 2861 484 2631 167 2023 2805
    Other/missing 2454 1259 3013 0 39216 60 1107 2952
    p value 0.06 0.39 0.67 0.06 0.08 0.81 0.20 0.30
    ALL 2435 2217 2871 1092 36147 182 1500 3536
  3. Do some combinations of services produce better progress toward treatment goals?

    Direct analysis of this question was limited because the majority of the charts (55%) did not report on progress toward goals. The distribution as to who had notes about progress towards goals, and the data about progress on those children where goals were written is presented in Table Fifteen.

    TABLE FIFTEEN
        Progress Status Recorded  
    (%)
      Made Progress When  
    Status was Reported
    (%)
    REGION
    East 35 21
    Middle 47 42
    Greater Nashville 45 32
    West 55 53
    p value 0.07 0.02
    CHILD'S DIAGNOSIS  
    Congenital defects 59 41
    Developmental delays   52 34
    Premie 35 41
    Other/missing 23 32
    p value 0.01 0.68
    ALL 45 37
  4. Who bears the cost of treatment? Do families depend on more than one source?

    The percentage of children with each of 5 sources of funding are provided in Table Sixteen. Many children had services funded by more than one source. The columns in Table Sixteen represent the most common combinations.

    TABLE SIXTEEN. Payment Sources
      Child's Diagnosis
    Congenital Defects
    (%)
    Developmental Delays
    (%)
    Premie
    (%)
    Other/Missing
    (%)
    ALL
    (%)
    TEIS only 6 22 14 13 16
    TEIS + PRIV 22 23 14 16 20
    TEIS+ 35 27 25 34 29
    MDCAID only 7 8 16 16 10
    MDCAID + 14 8 9 13 10
    PRIV only or + 4 1 4 0 2
    MHMR, CSS + 13 11 19 9 13
    ALL 100 100 100 100 100
    p value 0.18
      Region
    East
    (%)
    Middle
    (%)
    GN
    (%)
    West
    (%)
    ALL
    (%)
    TEIS only 11 22 13 10 16
    TEIS + PRIV 10 25 25 13 20
    TEIS+ 34 26 21 46 29
    MDCAID only 24 8 3 3 10
    MDCAID + 11 5 14 15 10
    PRIV only or +   3 5   2
    MHMR, CSS + 9 10 20 13 13
    ALL 100 100 100 100 100
    p value 0.001
    • TEIS only
    • TEIS + PRIV: TEIS and private insurance
    • TEIS+: TEIS and something other than private insurance
    • MDCAID only: Medicaid
    • MDCAID +: Medicaid and something other than TEIS
    • PRIV only or +: private insurance and not TEIS and not Medicaid (in some cases includes other)
    • MHMR, CSS +: Dept. Mental Health and Mental Retardation) and/or CSS (Children's Special Services) and other state sources other than TEIS

    Because we could not determine when services started, we were unable to determine changes overtime.

  5. Do individuals with different means of paying for those services differ in the types and amounts of services they receive?

    The percent of services provided by the different funding sources is presented in Table Seventeen.

    TABLE SEVENTEEN
        MDCAID  
    (%)
      PRIV INS.  
    (%)
    CSS
      (%)  
      MHMR  
    (%)
      TEIS  
    (%)
    SPEECH & LANG
    Received the service   39 15 8 54 51
    Funded the service 36 28 16 40 70
    OT
    Received the service 32 19 12 47 62
    Funded the service 53 33 13 46 59
    PT
    Received the service 27 16 12 45 60
    Funded the service 53 31 13 48 65
    VISION
    Received the service 36 22 12 45 61
    Funded the service 57 21 29 71 71
    NURSING
    Received the service 34 23 12 47 63
    Funded the service 73 15 19 46 42
    HOME EI
    Received the service 34 24 13 42 61
    Funded the service 44 17 10 57 63
    CENTER EI
    Received the service 37 23 13 45 62
    Funded the service 44 11 11 72 61
  6. How have reimbursement patterns been influenced by the introduction of managed care?

    We addressed this by comparing the first year of analysis under Medicaid with the second year under TennCare. The differences between the two fiscal years (before and after TennCare) are presented in Table Eighteen.

    TABLE EIGHTEEN
        1993  
    (%)
      1994  
    (%)
    ALL
      (%)  
    TEIS only 17 15 16
    TEIS+ priv 14 25 20
    TEIS+ 38 23 29
    mdcaid only 7 12 10
    mdcaid + 10 11 10
    priv only 1 3 2
    mhmr and/or css only   14 12 13
    p value 0.03
    ALL 100 100 100

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