Virginia Interagency Coordinating Council (VICC) Meeting ...Virginia Interagency Coordinating...

1 Final VICC Minutes, December 12, 2012, KW

Virginia Interagency Coordinating Council (VICC) Meeting

Hanover DSS December 12, 2012

Draft Minutes

The December 12, 2012 Virginia Interagency Coordinating Council Meeting was called to order by Lissa Power-deFur. The role was called by Karen Durst. There were eighteen (18) VICC members in attendance. Please see the attendance list following the minutes. The September 12, 2012 VICC minutes were corrected and approved with Rick Beaman making the motion to approve and Barbara Barrett seconding the motion.

Agency Reports The ARC of Virginia, Family Involvement Project The following ARC of Virginia update was given by Debra Holloway. The following italicized report is verbatim from a written report that was provided. Our staff continues to participate in committees and work groups as requested. Including the Virginia Autism Council, ITC, EI Task Force, VCPD, regional meetings, Insurance Committee and Regulations Workgroup to name some. The Arc of Virginia staff continues to provide technical assistance for families this quarter including assisting families with referral to services, transition and request about waiver information. We continue in development of the Early Intervention Family Support Network and met once this quarter. This network is made up of families and VICC parent representatives and they will be our local connection as we are identifying one parent or board member of each of our 25 local Arc Chapters to be a part of this network. This network of families will be able to provide support to local families, provide quality assurance feedback and participate on workgroups and committees. The Arc of Virginia hosted a fall webinar series targeted for families that have children receiving early intervention services that included:

Introduction to Part C Early Intervention Part C Regulation Changes, How Families are Affected Private Insurance Medicaid Waiver Supports Early Intervention Advocacy

All of these webinars were well attended and have been recorded and available on our website www.thearcofva.org - Help for Families for viewing. Four Medicaid Waiver Trainings were hosted two in collaboration with Blue Ridge Care Connection, EIPD, Talks on Tuesday Webinar and a training was held at the Glen Allen Children’s hospital Therapy Center for staff. Staff attended the Arc of the U.S. conference in October and a staff meeting to speak with the Infant and Toddler Connection of Prince William to discuss helping families to access resources and advocate for EI services/funding.

http://www.thearcofva.org/


Advocacy tools and Rights information was developed and shared with families and are also available on our website. Virginia Department for the Blind and Vision Impaired (VDBVI)-No Report

Virginia Department for the Deaf and Hard of Hearing (VDDHH) -No Report VA Department of Behavioral Health & Developmental Services (DBHDS) -No Report

Virginia Department of Education (VDOE) Phyllis Mondak reported that the Department of Education is still currently working on the Annual Performance Report for the Office of Special Education. Phyllis also reports that the VDOE is advocating for Early Intervention and preschool children. Phyllis informed everyone that she and the Virginia Department of Education are working with Part C on transitioning from Part C to Part B. Virginia Department of Education-Project HOPE-Virginia Patricia Popp reported that the number of children and youth identified as homeless enrolled in public school has increased by 9%. The number of children enrolled went from 16,420 in the SY 10-11 to 17,900 in the SY 11-12. The economy has been very challenging. Pat feels this is the reason for the increase in the number of children and youth identified as homeless. Virginia Department of Health Joanne Boise reported that the Department of Health has had some leadership changes and also a number of employees to retire. The Department of Health is awaiting the announcement of the Governor’s budget to understand the potential impact of requested budget reduction plans. Virginia Department of Medical Assistance Services (DMAS) Jeff Beard informed us that the Department of Medical Assistance is awaiting the release of Early Intervention Case Management Regulations which has already been approved in the first phase. Jeff also noted that the Emergency Regulations have been fast tracked and are expected to be ready by October 7, 2013. Virginia Department of Social Services (VDSS) Lynne Edwards informed us that she is a part of a newly formed Early Prevention Unit. The Early Prevention Unit has developed/created: • Practice Guidelines •State wide Dialogues •Strength based Family engagement practice model •Self Assessment The Early Prevention Unit is reaching out to other organizations to discuss the impact of early trauma and how to prevent it. The VICC is invited to participate in an Early


Prevention Group. April is National Child Abuse Prevention (NCAP) Month and there will be a Statewide Child Abuse Prevention Month conference held on April 15, 2013. In honor of National Child Abuse Prevention Month, people across the country come together to raise awareness about child abuse and neglect prevention. PCAV spearheads Child Abuse Prevention Month activities for Virginia annually. The theme adopted for 2013 is, “Insure Their Future: Invest in Children.”

State Corporation Commission (CSS), Bureau of Insurance-No Report

Part C Update The following Part C update was given by Catherine Hancock. Fiscal Challenges

• In SFY 2012, 25 of 40 local systems requested additional funds in the amount of $7,633,159 in order to meet compliance requirements.

• DBHDS was able to award $4 million in one-time funding due to state fund savings (from vacant positions, efficiencies in operation at DBHDS).

• Twenty-three of the 40 local lead agencies expect a financial shortfall for SFY 2013. Two expect the expenditures to be close to budget, 12 do not expect a deficit and one is unknown at this point. Two systems did not report in the October 2012 informal survey.

• At least four of the local lead agencies are currently out of compliance due to anticipated budget shortfalls.

• The most frequent form of non-compliance is having a waiting list or putting limits on the number of services allowed.

• If services are not in compliance with federal requirements, families may file a complaint or request mediation and/or a due process hearing.

• DBHDS estimates that the deficit is $8.5 million for SFY 2013. This amount was determined based on the average cost of providing services, the number of children in the system, and available funding streams.

• One reason for the deficit is the growth of the program.


The following information relates to Child Find Data: Indicator 5 – Child Find, Birth to 1

Actual FFY 2011 data = 1.02% Trend data over last few years = .70%, .67%, .59%, .93%, 1.02% Average of states with broad eligibility criteria* = 1.17% Median of states with broad eligibility criteria* = 1.03%

Indicator 6 – Child Find, Birth to 3

Actual FFY 2011 data = 2.77% Trend data over last few years = 1.92%, 1.99%, 1.95%, 2.43%, 2.77% Average of states with broad eligibility criteria* = 3.11% Median of states with broad eligibility criteria* = 2.88%

* There are 16 states considered to have broad eligibility criteria. The one state that also

includes at-risk children was deleted when calculating the average and median.

0.70 0.67 0.59

0.93

1.02

1.92 1.99 1.95

2.43

2.77

0.00

0.50

1.00

1.50

2.00

2.50

3.00

2007 2008 2009 2010 2011

Child Find Trends

Birth to 1

Birth to 3


Activities to Address Fiscal Situation 1. Budget Request 2. Efforts to Assist with local management 3. Work with National Consultants on insurance, fiscal management

Total Revenue to Support Part C Early Intervention Services

Revenue Source FY12 Revenue Amount

Federal Part C Funds $ 9,545,592

State Part C Funds $ 10,020,426

Federal ARRA Funds $ 2,251,526

Other State General Funds $ 712,630

Local Funds $ 7,992,093

Family Fees $ 702,005

Medicaid $ 15,230,981

Targeted Case Management $ 3,986,948

Private Insurance $ 5,096,825

Grants/Gifts/Donations $ 12,472

In-Kind $ 322,604

Other $ 1,575,081

Total $ 57,449,183

10,330 11,351

11,766 12,234

14,069

15,676

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

2007 2008 2009 2010 2011 2012

Children Served

# of Children


Professional Development Deana Buck and Cori Hill provided information related to professional development. They reported that Rebecka, the e‐learning specialist who put together the info graphics, will be leaving and Dana Childress will be taking lead on blogging. Blogs are short articles where people can ask questions and provide feedback. The latest blog was titled “Strategies for Rescuing a Shaky First Visit”. New postings to the blog are made 1-2 times a week. Deana and Cori also informed us that four new data modules (Autism, Prematurity, Social Emotional, and IFSP module) have been developed with the Data Accountability Center and was launched December 11, 2012. Illinois is willing to share the modules they have developed; this will provide a great example to follow.

Public Comment Public Comment was submitted by Alison Standring on behalf of the Infant and Toddler Connection of the Rappahannock Area. The following italicized report is verbatim from a written report that was provided. My name is Alison Standring. I am the Local System Manager for the Rappahannock Area and a member of the CoCoA Steering Committee. I am speaking today on behalf of the CoCoA Steering Committee. We welcome staff from Voices for Virginia’s Children and thank them for their support of early intervention. Voices facilitated drafting a Unified Early Childhood Legislative Agenda earlier this year; Part C funding is one of their top priorities. We appreciate all they are doing to support the advocacy efforts for increased funding. We, CoCoA Steering Committee members, on behalf of all local system managers, are concerned that infants and toddlers in Virginia are not receiving needed early intervention services due to funding constraints. In this room we all know the value of identifying and serving infants and toddlers as early as possible to maximize the opportunity to positively impact their developmental trajectory. It is critical that we continue to educate the administration, the Governor, and elected officials about the benefits of early intervention and the need for additional funding to support services. The Governor’s budget will be released next week. We hope to see an increase in Part C funds. No matter how much is – or is not - in the Governor’s budget we must continue education with elected officials to either support the Governor’s budget or increase it. Long-range planning is essential to the sustainability of our system. Continued uncertainty about funding leaves local lead agencies hesitant to continue in that role, creates great stress among those who are trying to manage systems on a shoestring with increasing demands, and ultimately leaves infants and toddlers waiting for services. We can and we must do better. Finally, we thank the members of the VICC for their continued support.


Annual Performance Report Kyla Patterson submitted the following talking points regarding the Annual Performance Report. The italicized report is verbatim from a written report that was provided.

As a quick refresher … every state was required by the US Dept. of Education to develop a State

Performance Plan in 2004 that identified annual targets for the state’s performance on a set of federally required indicators for the next 6 years. That plan has since been extended for 2 more years, through June 30, 2013. Each year we must submit an Annual Performance Report (APR) that specifies our actual performance on each of those indicators compared to the target we established in the State Performance Plan. Today we’ll be talking about our 7th APR.

As you might have seen if you reviewed the full draft of the APR that we sent with the summary, this is a lengthy report that includes data on Virginia’s performance, activities that we’ve completed to maintain/improve our performance, and new improvement activities that will improve our performance on any indicators where we are below the target.

Hopefully you had a chance to review at least the APR Summary sent to you last week.

Page 1 of the summary we sent had a table showing the state target for this year for each of the indicators and how we actually did this year.

We thought you also would be interested in seeing how Virginia has done over the entire 7-year period so we also sent you a table with the trend data. We didn’t include the targets here, except to asterisk those that are federally-required to be at 100%, because we wanted to just give a picture of progress. It’s important to remember that each of indicators represent requirements and outcomes that are important in ensuring quality services to children and families. This overview of progress allows us to see how well we’re doing in certain areas and reminds us that there’s still room for improvement in some other areas. I’ll just briefly highlight a few points:

o Our performance on Indicators 2, 7, 8b and 14 has been consistently very high over the last 5 or more years. Children are being served in their natural environments, they’re getting into the system and having an IFSP written quickly (within 45 days of referral), they’re having information sent to their local school division to assist with transition.

o After being at 94% on Indicator 1 for 3 years, we finally moved to 95% this year, now putting us in what USDOE considers substantial compliance. 95% of children are receiving all of the services on their IFSP in a timely manner, which means all services start within 30 days of the family signing the IFSP

o Next, let’s take minute to look at and celebrate this year’s numbers for Indicators 5 and 6, the percentage of the 0-1 and 0-3 population served in Part C. We have seen a substantial increase in these percentages for the second year in a row and met the state target for each of these indicators. This is very exciting news!

o We also met the state target for all 3 parts of Indicator 4 (a,b,c) this year. These are the family outcomes, measuring the impact of EI on families. We’re making some changes to the statewide family survey that we use to measure these indicators, and I’ll talk more about that in a minute.


o On Indicators 8a and 8c, related to transition, you’ll see that we rebounded to a very high level of compliance (98%) after 2 years of lower performance. Children and families are receiving support for a smooth transition as they exit early intervention.

o Indicator 9 reflects the number of findings of noncompliance that are corrected within 1 year of being identified. We were at 76%, which is lower than we (or the USDOE) would like. I can report, though, that the findings that were not corrected within 1 year have since been corrected, and our performance for next year already shows improvement. I’ll give you more information about that in a few minutes.

o Indicator 3, which addresses child outcomes, is not included in this table since we have only had to report data for the last 3 years and we still have a lot of work to do to ensure that we understand what the data is telling us. That’s true not just in VA but nationally. Indicator 3 looks at children’s progress compared to their same age peers, but we don’t have a way right now to tie that progress data to the reason for eligibility, length of time in EI, types of services, etc. We can assume, though, that there’s always room for improvement in our service delivery practices so we’ve been designing state-level improvement activities to support improved child outcomes and I’ll talk more in a minute about some of the efforts that are underway.

As I discussed the data, I mentioned a few indicators we’d like to discuss further. There are also 3 indicators where we’ll need to set new targets for next year because we did so well this year.

Indicator 3 (Child Outcomes) – I want to mention 2 major activities that we started in 2012 and that will continue into 2013:

o Established Child Indicators Work Group to determine how Virginia can fully integrate the child outcome indicators into the IFSP process. The work group recommended changes in the IFSP form and process to address this goal, and a cadre of early implementers was selected to begin implementing the changes proposed by the Workgroup. Feedback from the early implementers will be used to finalize the IFSP revisions and to develop training and technical assistance materials and activities to support statewide implementation beginning on July 1, 2013

o Began year-long focus on coaching with a full-day institute presented by national experts at the statewide Creating Connections for Shining Stars Conference in July 2012. The Early Childhood Coaching Handbook has been purchased for every local system manager; and additional work will include intensive training of and technical assistance follow-up for 20 master coaches who will each then mentor 2 colleagues, training for 30 additional local providers who are members of the master coaches’ local teams, development of additional resources and materials for providers, expansion of the coaching section of the early intervention professional development website, development of videos, and regional book studies

Indicator 9 (Timely Correction of Noncompliance) o Already showing improvement: 93% of the next set of findings were corrected within 1

year o Have implemented a number of improvement activities, including:


Added a monitoring team leader position at DBHDS to ensure that both Medicaid Quality Management Review (QMR) and Part C monitoring and supervision responsibilities are fulfilled in a timely manner.

Worked with a national consultant to review the monitoring and supervision system with a focus on streamlining data collection and verification procedures and ensuring timely correction of noncompliance. In fall/winter of 2012, DBHDS began implementing the streamlined procedures and began requiring local systems with noncompliance to check monthly for correction to ensure correction of noncompliance is documented and verified more quickly.

In an effort to streamline general supervision and monitoring and assist local systems in identifying systemic strengths and issues, moved to using one document, an Improvement Plan, that will contain improvement strategies for any compliance and/or results indicator in which a local system did not meet the state target instead of having separate Corrective Action Plans for compliance indicators and Service Enhancement Plans for results indicators. The new single Improvement Plan document will also include any improvement planning that is needed as a result of Medicaid QMR findings.

Indicator 4 (Family Outcomes) – Need to set new targets o As you saw in the APR Summary, we did a study in 2012 on a new family survey. When we

did our 2012 statewide family survey, half of the families got the old survey and half got the new survey; and we were able to analyze the differences in responses and measurement between the two.

o We found out that the new survey gives us more valid data, which is exactly what we had hoped. Because the new survey is not completely equivalent to the old survey, we’re using the results we got from the families who completed the new survey this year as a new baseline for our performance on Indicator 4.

o So we need to set new targets based on that new data. Our results from this year on the new survey already exceeded the targets we had set for next year.

o Let’s take a look at the handout we sent last week called Information to Consider When Setting FFY 2012 Targets…

o Actual FFY 2011 data from new survey

4a = 75.4%

4b = 72.2%

4c = 84.2% o Trend data over last few years (from old survey)

4a = 69.5%, 70.1%, 72.3%

4b = 66.8%, 67.6%, 70.3%

4c = 80.3%, 80.0%, 81.9% o Previous plan for targets was to raise target by 1% each year for 4a and 4b and by 0.7% for

4c o From last year’s Indicator Analysis Report, based on the 15 states using the NCSEAM survey

and standards, the results on Indicator 4 were as follows:

4a = 75%

4b = 71%

4c = 85% o Staff recommendation: New targets …


4a = 76.4%

4b = 73.2%

4c = 84.9% Because the new baseline data is based on a relatively small sample this year, follow the

previous plans for rate of improvement.

Indicator 5 (Child Find, 0-1) o Why we need to revise target: We already met next year’s target o Actual FFY 2011 data = 1.02% o Trend data over last few years = .70%, .67%, .59%, .93%, 1.02% o National average = 1.02% o Average of states with broad eligibility criteria = 1.17% o Median of states with broad eligibility criteria = 1.03% o Staff recommendation: New target – 1.03%.

Target to reach the average percentage of children served by states with broad eligibility

criteria that do not serve at-risk children (1.17%) within 3-5 years and set the FFY 2012

target at the median of those states. The rate of increase on this indicator is expected to

level off in FFY 2012 now that the new eligibility criteria for premature infants have been in

place for two years and because economic factors have resulted in fewer dollars for public

awareness and child find activities.

Indicator 6 (Child Find, 0-3) o Actual FFY 2011 data = 2.77% o Trend data over last few years = 1.92%, 1.99%, 1.95%, 2.43%, 2.77% o National average = 2.79% o Average of states with broad eligibility criteria = 3.11% o Median of states with broad eligibility criteria = 2.88% o Staff recommendation: New target – 2.88%.

Target to reach the average percentage of children served by states with broad eligibility

criteria that do not serve at-risk children (3.11%) within 3-5 years and set the FFY 2012

target at the median of those states. The rate of increase on this indicator is expected to

level off in FFY 2012 now that the new eligibility criteria for premature infants have been in

place for two years and because economic factors have resulted in fewer dollars for public

awareness and child find activities.

Sending the draft out to all local system managers and other stakeholders by the end of the week.

Written comments from VICC members and other stakeholders are welcome through December 31st.

A discussion of the APR occurred following the VICC meeting and the following action was taken by

the VICC:

Rick Beaman made a motion that the target be set at 1.03% for Indicator 5. Dr. Patricia Popp

seconded the motion. The motion was approved.


Rick Beaman made a motion that the target be set at 2.88% for Indicator 6. Joanne Boise seconded

the motion. The motion was approved.

Hearing Video Joanne Boise shared an awesome video about a sweet little boy named Micah and his family’s journey to get him the help he needed to be able to hear. The video is titled “Cochlear Implant 7 months and counting for MICAH”. The video can be found on YouTube.

Recommendation of the Lead Taskforce

Phyllis Mondak and Patricia Popp provided information on the progress of the Lead Task Force. They reported the following: The group had a meeting September 13, 2012 in order to develop a recommendation for

the VICC related to whether to include an elevated lead level as an automatic qualifier for

Part C services for children ages birth to three. The Lead Task Force provided a

recommendation to the VICC that an elevated lead level should not be an automatic

qualifier for Part C services. The recommendation was based on information indicating

that there are many things that must be considered with lead poisoning. Two children may

have the same elevated level and one has no effects and the other has problems. Nutrition

is a major factor. Additionally, many children do not exhibit problems until first or even

fourth grade where critical thinking skills are being used.

The consensus of the Task Force was that prevention is the route to take. It was stressed

that the Task Force recommended that all Part C providers should have an awareness and

knowledge related to lead exposure and know how to guide families to resources. The

suggestion was that either a module be developed on lead exposure and the potential

impact and/or a Talks on Tuesday presentation that focuses on lead exposure.

Those serving on the Lead Task Force include Brian Campbell, Karen Durst, Catherine Hancock, Debra Holloway, Phyllis Mondak, Dr. Patricia Popp and Nancy Van Voorhis.

Lead Dust buster Kit Liz Tuck from the Virginia Department of Health reported on Childhood Lead Poisoning Prevention. Liz also performed a demonstration with a Lead Dust buster Kit that is sent out to families with children that have tested positive for elevated lead levels. The kit included a mop, a mat, cleaning materials, a bucket, hand soap, gloves, sponges, industrial strength trash bags, a spray bottle, and goggles. Below are facts about lead and lead poisoning.


Lead Poisoning: Facts For Parents What is lead? Lead is a soft, dense metal used to make many products. It may be found in fishing weights, bullets, ceramic dishes, glassware, car batteries, electronics, and old plumbing, among other things. Years ago, it was added to gasoline and to paint. (Lead was banned from gasoline in 1995 and from paint in 1978.) Lead is toxic, or poisonous, to people if it gets inside the body. How does lead make children sick? Lead can damage many organs, especially the nervous system, brain, and kidneys. It can interfere with normal brain development, causing reduced IQ, learning disabilities, behavior problems, and hearing problems. This damage is permanent. At very high levels lead can cause seizures, coma, and even death. What causes lead poisoning? The biggest source of childhood lead poisoning is paint in homes built before 1978 (before lead paint was banned). As the paint ages, it may chip and peel, or form invisible lead dust. Lead dust can also form when painted surfaces are rubbed together, scraped, or sanded, like in a window frame or while a home is being renovated. The dust settles on places where babies and young children crawl and play. They swallow lead when they put dust-covered surfaces, like their hands and toys, in their mouths. They may also eat visible chips of paint.

Is my child at risk? Lead poisoning can affect any child, but children under age 6 are at the greatest risk because:

• Children under age 6 normally put their hands and other objects in their mouths.

• Children under age 6 are growing so fast, any lead that gets into their bodies is absorbed very easily.

Are there other sources of lead poisoning? Below is a list of items that may contain lead. These items could cause lead poisoning if swallowed or if children put them in their mouths: • Toy jewelry • Fishing weights or lures • Bullets, buckshot, and musket balls • Imported or antique toys with painted surfaces


• Some Mexican candies • Certain folk medicines or remedies, like azarcon, pay-loo-ah, or ayurvedic medicines • Water from old plumbing • Soil near a road or near a house painted with lead paint • Vinyl mini-blinds made before 1997 • Handcrafted or foreign-made ceramic dishes may contain lead

that can get into food or drink. Adults can bring invisible lead particles into a home if they have a job or a hobby that exposes them to lead. These include:

• House painting or renovation • Furniture refinishing • Stained glass • Firearms • Recycling or making automobile batteries

How do I know if my child has lead poisoning? Sometimes children with lead poisoning have stomach aches or irritability, but most of the time there are no symptoms at all. Your child’s doctor can do a blood test. That is the only way to be sure whether or not there has been an exposure to lead. Young children enrolled in Medicaid can get free tests. Children at risk for lead poisoning should be tested even if they do not appear sick. Can I protect my child from lead? Lead poisoning is completely preventable! These steps can help keep your child safe from lead:

1. If you live in a building built before 1978, the paint may contain lead. Often the soil around the building also contains lead. Use lead-safe work practices if performing any renovations or maintenance and keep bare soil covered with mulch or vegetation.

2. Damp mop floors and surfaces like windowsills often to remove lead. Frequently wash your child’s hands, toys, and pacifiers.

3. Discourage your child from playing in bare soil. 4. Feed your child a healthy, low fat diet with plenty of calcium and iron. Their bodies

will be less likely to absorb lead. 5. At this time, children and pregnant women should avoid candy from Mexico. 6. Don’t eat or drink from ceramic dishes that are hand crafted or not officially

imported into the U.S. 7. Avoid using folk or ayurvedic medicines. 8. Stay alert to recalls of toys or products that may contain harmful amounts of lead.

The U.S. Consumer Product Safety Commission (CPSC) keeps a list on their website: www.cpsc.gov. The list is updated often.

9. Don’t allow a child younger than 6 to wear or play with imported toy jewelry.

Who can help me if I have questions or concerns?


For concerns about someone who may have been exposed to lead, contact your doctor, your local health department or your regional poison center:-1-800-222-1222. For information about working safely with lead paint, how to have your home tested for lead, or for more information on having a lead safe home, contact Lead-Safe Virginia: 1-877-668-7987. Visit their website: www.vahealth.org/leadsafe/.

Blood Lead Levels in Children What Do Parents Need to Know to Protect Their Children? Protecting children from exposure to lead is important to lifelong good health. Even low levels of lead in blood have been shown to affect IQ, ability to pay attention, and academic achievement. And effects of lead exposure cannot be corrected. The most important step parents, doctors, and others can take is to prevent lead exposure before it occurs.

Update on Blood Lead Levels in Children Children can be given a blood test to measure the level of lead in their blood. Until recently, children were identified as having a blood lead level of concern if the test result is 10 or more micrograms per deciliter of lead in blood. Experts now use a new level based on the U.S. population of children ages 1-5 years who are in the top 2.5% of children when tested for lead in their blood (when compared to children who are exposed to more lead than most children). In the past, blood lead level tests below 10 micrograms per deciliter of lead in blood may, or may not, have been reported to parents. The new, lower value means that more children likely will be identified as having lead exposure allowing parents, doctors, public health officials, and communities to take action earlier to reduce the child’s future exposure to lead. What has not changed is the recommendation for when to use medical treatment for children. These new recommendations do not change the recommendation that chelation therapy be considered when a child is found with a test result of greater than or equal to 45 micrograms per deciliter of lead in blood.

Actions for Parents Parents can take simple steps to make their homes more lead-safe. Talk to your local health department about testing paint and dust in your home for lead if you live in a home built before 1978. Common home renovation activities like sanding, cutting, and demolition can create hazardous lead dust and chips by disturbing lead-based paint. These can be harmful to adults and children. Renovation activities should be performed by certified renovators who are trained by EPA-approved training providers to follow lead-safe work practices. Learn more at EPA's Renovation, Repair, and Painting rule Web page: http://www.epa.gov/lead/pubs/renovation.htm. If you see paint chips or dust in windowsills or on floors because of peeling paint, clean these areas regularly with a wet mop. Wipe your feet on mats before entering the home, especially if you work in occupations where lead is used. Removing your shoes when you are entering the home is a good practice to control lead. Remove recalled toys and toy jewelry from children. Stay up-to-date on current recalls by visiting the Consumer Product Safety Commission’s Web site: http://www.cpsc.gov/.

http://www.vahealth.org/leadsafe/

http://www.cpsc.gov/


Background Effect of a Different Blood Lead Level In the past, blood lead level tests below10 micrograms per deciliter may, or may not, have been reported to parents. Identifying a child’s blood lead equal to or above 5 micrograms per deciliter means more parents should learn that their child has an elevated blood lead level. Even though no medical treatment is recommended for children with blood lead levels lower than 45 micrograms per deciliter, parents will know they need to learn about sources of lead exposure and find out if one or more unrecognized sources of lead are present in their home. Parents then can follow the Centers for Disease Control and Prevention (CDC)’s recommendations to control exposure to lead. No changes are recommended to the existing CDC guidelines for the evaluation and treatment of children requiring chelation (those with BLLs ≥ 45 micrograms per deciliter). New Recommendations to Define Elevated Blood Lead Levels In January 2012, a committee of experts recommended that the CDC change its “blood lead level of concern.” The recommendation was based on a growing number of scientific studies that show that even low blood lead levels can cause lifelong health effects. The committee recommended that CDC link lead levels to data from the National Health and Nutritional Examination Survey (NHANES) to identify children living or staying for long periods in environments that expose them to lead hazards. This new level is based on the population of children aged 1-5 years in the U.S. who are in the top 2.5% of children when tested for lead in their blood. Currently, that is 5 micrograms per deciliter of lead in blood. CDC’s “blood lead level of concern” has been 10 micrograms per deciliter. The new value means that more children will be identified as having lead exposure earlier and parents, doctors, public health officials, and communities can take action earlier. The committee also said, as CDC has long said, that the best way to protect children is to prevent lead exposure in the first place.

Insurance Committee Update Kelly Hill provided the following information on behalf of the Insurance Committee: A Tot Webinar was presented in October for LSA's and providers on understanding private

insurance, billing, coding, documentation, and handling denials and appeals. A similar webinar was

presented with Debra Holloway of ARC later in October.

Self–insured group coverage in which the employer acts as its own insurer. The Employer uses an

administrator to administer the plan. This includes establishing a provider network, processing

claim payments, and conducting other tasks necessary to run the plan. There is no insurance

contract between the employer and the administrator because the employer bears the risk for

payment of claims. This type of coverage usually occurs with larger companies. Companies with


Self–insured coverage and policies owned by companies in other states do not have to include

Virginia’s Early Intervention Private Insurance Mandate, although many choose to do so. Kelly

reported that all insurance companies (self-insured, out of state owned, etc.) will have to pay for

habilitative services beginning in 2014 as part of the Affordable Care Act Essential Benefit

Provisions. How these services will be covered is still unknown but the Federal Workers Anthem

Policy is slated to be the blueprint. Laura Lee Viergiver reported at a meeting in November that

companies say that they are covering EI as mandated. We know this is not the case. There is a

possible disconnect between the Medical Management Dept. of insurance companies that handle

"exclusions" and their representatives who report benefits and coverage to billing parties.

The Early Intervention Mandate is treated as an exclusion in a policy and people don’t know what

questions to ask and to whom to ask them. Beth Tolley and Catherine Hancock will meet to discuss

and come up with a plan of action to address this issue.

Kelly also informed the VICC that AETNA and Anthem sent out a letter to their in network providers

stating that as of September 26, 2012 they will no longer cover any of the315 codes which are the

developmental and expressive language delays, codes 317-319 which cover intellectual disabilities,

and code & (781.3) which covers the lack of coordination. These insurance companies have given

the in network providers 30 days to decide if they will stay in network or get out of network.

Child Find Information and Data Please see attached handouts presented by Allan Phillips.

VICC Vacancies and Reappointments Karen Durst reported that communication was received from the Governor’s Appointment Office of reappointments as representatives on the Virginia Interagency Coordinating Council for Angela Leonard and Dr. Corey Herd Cassidy. Both of their reappointments are effective as of 10/01/11 and expire 09/30/14. Information was also sent to the Appointment Office regarding the upcoming expiration, as of September 30, 2012, of the VICC seats for the Legislative Representative and the Local System Manager. The current Legislative Representative, Delegate Anne Crockett-Stark, has stated that she will be unable to accept a reappointment. Mr. Allan Phillips, the representative for the Local System Managers is available for reappointment. The position of Head Start Representative is currently vacant.

Other VICC Bussiness Allan Phillips expressed his worries about the Infant and Toddler Online Tracking System (ITOTS). Allan recognizes how important ITOTS data is to the State, but has concerns about data entry. He expressed that every time ITOTS makes a change, the local systems have to make changes to their system as well. Allan expressed his hardships of having to hire a temp agency just to keep up with data entry.


The following Action Items were identified: Writing the Delegates regarding funding issues. The following are agenda items for the March VICC meeting: Staff request permission from Gov. McDonell regarding VICC appointments. Signing of the APR on behalf of the VICC. Kelly Hill will work with Cori Hill to develop fact sheets for Talks on Tuesdays. The next meeting of the VICC will be held March 13, 2013. The location is the:

Twin Hickory Area Library 5001 Twin Hickory Road

Glen Allen, VA 23059-2509 (804) 290-9200

The meeting was adjourned. VICC Members Present: VICC Members Absent: Family Representative: Barbara Barrett Delegate Anne Crockett-Stark Debra Holloway

Rick Beaman Dr. Corey Herd Cassidy

Jeff Beard Leslie Hutcheson Prince

Joanne Boise Kate McCauley

Cathy Cook Edwin Scott Moran

Lynne Edwards Glen Slonneger

Kelly Hill

Virginia Heuple

Angela Leonard

Sonia Lopez

Janet Lung

Phyllis Mondak

Jeannie Odachowski

Allan Phillips

Dr. Patricia Popp

Dr. Lissa Power-deFur

Yolanda Tennyson

Sandra Woodward

Virginia Interagency Coordinating Council (VICC) Meeting ...Virginia Interagency Coordinating...

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