Proposed changes to the Birth to 3 program have parents and service providers nervous about what those changes will mean for kids like David Drolc, as well as what effect they'll have on the pocketbooks of the speech, occupational and physical therapists who work with them.

David is a 15-month-old toddler with Down syndrome whose mother, Mona, credits the various therapies he receives weekly through Part C of the Birth to 3 Connections program for the rapid progress he has made to date.

Birth to 3 is a state-run, federally funded early-childhood intervention program for infants and toddlers whose developmental delays aren't significant enough to qualify them for services through a school district.

"First of all, he walks. That wouldn't have happened without this program," Mona Drolc said as she watched speech therapist Amanda Heilbut work with her son on the floor of her Robbinsdale living room. "At 15 months, many Down syndrome kids are just learning to crawl. The average age that kids with Down (syndrome) learn to walk is between 20 and 24 months."

Drolc ticks off a list of current skills that David possesses, including his ability to drink from a regular cup despite the poor muscle control and thicker, flatter tongue characteristic of Down syndrome. That accomplishment is due to the oral motor activities that Heilbut has worked on weekly with David since he was 5 months old.

No one doubts the value of the early childhood intervention program, or its popularity with parents and educators as a tool for improving the abilities and outcomes of children like David who face special challenges. Certainly not Dick Gowen.

Gowen, of Rapid City, is a member of the South Dakota Board of Education and the grandfather of a special-needs grandchild who received Birth to 3 services.

"We have a grandson with Down syndrome, so we know exactly how valuable this program is. We've watched the effectiveness of this program firsthand," Gowen said. "No one wants to do away with the program. The issue is, what are appropriate charges for services rendered?"

In fact, it is the program's popularity that has caused its current funding crisis, said Bridget Stone, a Birth to 3 caseworker in Pennington County. When she started with the Part C program 14 years ago, Stone had to seek out children to enroll. Now, new referrals to the popular program are constant.

"That's another reason our coffers are empty," Stone said.

Initially paid for with 100 percent federal funds, the Birth to 3 program's budget has, in recent years, been balanced by a transfer of other state funds to cover deficit spending. Next fiscal year, the program's 2009 budget of $4,371,542 will be paid for through 58 percent federal funds and 42 percent state general funds.

This past session, the legislature charged the state DOE with cutting $546,000 in Birth to 3 expenses to bring it in line with its approved 2009 fiscal-year budget.

"We must meet the will of the Legislature on this," Gowen said.

But at the board's July 21 meeting, the DOE staff's recommendations for doing that - through changes to eligibility guidelines, reimbursement rates and travel expenses - didn't match what an advisory group of therapists thought they had agreed on at a meeting between service providers and the DOE, Heilbut said.

Drolc and Heilbut were among the contingent of service providers and parents attending the July 21 board of education meeting in Pierre to express dismay at the changes they said they weren't informed of. The board deferred action any changes.

"Listening to providers and their concerns, the board thought we needed to give it more time to find a more equitable way of handling this issue," Gowen said. "That's when I said, 'I don't think we're ready to vote on this.'"

Those proposed changes to the administrative rules that govern the Birth to 3 program included:

* Bringing therapist payments in line with Medicaid reimbursement rates, and requiring all providers to bill through Medicaid.

* Travel-time reimbursement rates would change from 60 percent of service rates to some other formula.

* Changes to eligibility guidelines that would eliminate some children from the program entirely or shift others to early childhood intervention services offered through school districts.

Currently, speech, occupational and physical therapists are paid $18 per 15-minute unit of service. Medicaid reimbursement rates for speech, occupational and physical therapists vary according to what services are offered, but they are much lower than current Birth to 3 rates.

Heilbut estimates 60 percent of her workload is Birth to 3 Part C clients. If all those clients also begin to reimburse at the lower Medicaid rates, she estimates her income would drop by as much as 40 percent.

"That's a hard one," Heilbut said when asked if she would continue as a Birth to 3 provider under the new rates.

Children are evaluated for deviations from the standard test scores to determine whether they qualify for early intervention services because of developmental delays. The main change proposed for Birth to 3 eligibility would come from the elimination of the "6-month delay" or the "25 percent below normal age range" as standards for qualifying for Part C services. Stone said those two changes would not affect many children already enrolled in Pennington County. Statewide, it would result in an estimated savings of $98,000 to the program.

Drolc questions the financial savings of moving children out of a federally funded program and onto school rolls, creating a financial hardship on already overburdened local school districts.

"Early intervention saves money in the long run for schools by reducing the need for in-school therapy," Drolc said.

Her son's therapy through Birth to 3 costs as much as $20,000 per year. He sees a physical therapist and an occupational therapist monthly and a speech therapist twice a month.

She knows some cuts need to be made to the program. She would prefer to have therapy times reduced equitably for all participants rather than have some children eliminated from the program.

DOE staff was encouraged to meet again with a work group of service providers before the board's next meeting Sept. 16-17 in Watertown. As of Aug. 5, no date had been set for that meeting. Once that work group meets again, the proposed solutions will be brought before the board, perhaps by teleconference. The DOE hopes to have new rules and reimbursement rates in place by Oct. 1.

Gowen said the board is anxious to approve an accord that treats providers and children fairly.

"It's their livelihood and, as I look at the children involved, it's their future," he said.

How many children?

Statewide, the Birth to 3 program counted 1,132 children on its rolls on Dec. 1, 2007. In Pennington County, the program served 160 children that day, but its census changes constantly as children age out of the program at 3 years old, and new children enroll daily.