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Early Intervention Reimbursement Rates Create Financial Challenges for Clinical Professionals

Updated: Mar 27

--Edited 3/27/24-- Further highlighting the need for increased funding for Early Intervention, Spectrum News Rochester interviewed RHSC's Director of Education & Clinical Services, Beth McLellan and Occupational Therapist, Carrie Pfluke to discuss how low EI reimbursement rates affect not only EI service providers, but our children as well. This interview aired on March 26th, and can be viewed by clicking on the video below.

We're focusing once again on the ongoing challenges that many in the Early Intervention (EI) program face in regard to the state's low reimbursement rates for EI providers, which are currently lower than they were 30 years ago.

Carrie Pfluke, MS, OTR/L, has been with RHSC since 2015, the year that she graduated with her Master's as an Occupational Therapist from Keuka College. Carrie decided to pursue Occupational Therapy after watching her grandfather receive OT at home after a series of strokes when she was a kid. Her cousin, also an OT, was further inspiration in her chosen field. 

A therapist working with child
Carrie Pfluke, MS, OTR/L, an Occupational Therapist at RHSC works with Timothy who received services through RHSC..

Carrie currently works four jobs to make ends meet; not only due to the low reimbursement rate that she gets as an Early Intervention provider, but also because of her student loan debt that is equivalent to what she describes as what could be a mortgage payment. 

Her position as an OT in the Early Intervention program at RHSC has her working with children for 23-25 hours and doing two 1-1.5 hour preschool evaluations each week. This doesn't include time spent doing daily notes, reports, and additional paperwork for each child. Along with that, she works a 5-8 hour shift as an OT at Monroe Community Hospital on Saturdays; provides respite care 4-5 hours each week for a family with three children, two of whom are Autistic and need to be driven to classes around the community; and also babysits an additional 3-4 hours each week for much needed extra income. 

Therapist working with a child during occupational therapy
Carrie and Timothy during an Occupational Therapy session.

"Emotionally and physically, it's a draining schedule", says Carrie who finds it difficult to have down time, not to mention a social life. "For me, there's just no end in sight."

Currently, Early Intervention advocates are trying to get legislators to not only increase the EI reimbursement rate by 11% in this year's upcoming budget, but also reform the methodology for EI reimbursement rates, reworking its formula that has been in place since the mid-1990s to determine payment for all evaluations, services, and service coordination. Additionally, they are asking for the creation of a student loan forgiveness program to attract new Early Intervention providers to the field. An incentive is needed to recruit new professionals who are willing to provide in-person EI services in medically underserved and/or healthcare provider shortage areas. The shortage of EI providers has reportedly left over 500 children in Monroe County on the waitlist to receive Early Intervention services for over 30 days, which is the deadline for children to receive the services they are legally entitled to. 

Want to make your voice heard before the upcoming NYS budget? Please use the form below provided by nonprofit organization, The Children's Agenda, to contact your Assemblymember and State Senator and encourage them to support the 11% increase for Early Intervention services.


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