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Audit: First Steps program has improved, could do more

By Marshall Griffin, KWMU / AP

Jefferson City, MO – An audit of a state-run program that serves developmentally-delayed kids up to three years old finds that improvements have been made over the past year, but there are still some unmet needs.

State Auditor Susan Montee says The First Steps Program is not serving enough children, and part of the reason why is that the program is underfunded: "We are unable to get enough providers, we're not able to get the people to do the evaluatations because we're not paying enough."

The audit also finds Missouri's criteria for treating kids is more restrictive than most other states, and that service managers' caseloads are still too high. The Missouri Department of Elementary and Secondary Education, which oversees the program, said it would analyze the impact of easing eligibility.

But Montee says delays in handling new cases have been addressed, and The Dept. of Elementary & Secondary Education has eliminated the risk of fraud by providing more direct oversight of contractors.

The state revamped the First Steps program following 2005 legislation by requiring many families to contribute to the cost of the service, such as physical and speech therapy, and by requiring private health insurers to cover some costs.

The audit said the program went from serving 3,004 children in the 2004 fiscal year to 2,563 in the 2006 fiscal year, which ended June 30, but does not draw conclusions on why the number dropped.

Montee blamed fewer referrals from doctors, while noting the audit didn't determine why recommendations were down. Whatever the reason, it appears short-lived.

Department spokesman Jim Morris said enrollment had bounced up to 3,350 children as of December and the agency expects 6,700 referrals to the program this year more than in any of the three years covered by the audit. Not everyone referred to the program is approved to participate.

The audit also found the program's expenses rose from $19.2 million in the 2002 fiscal year to $25.5 million in 2005, then dropped to $22.9 million last year.

Morris said the program is budgeted to receive more than $28 million in the 2007 fiscal year, a period not covered by the audit.

The state now handles services through 10 regional offices run by private contractors, down from 24 offices before the program was revamped.

But the audit criticized the state's approach, saying children should be evaluated by a team of experts to best determine what help they need. State auditors also found that the state's bid requests for regional office contractors did not adequately predict the workload of service managers, so some have caseloads of 60-1, far exceeding the state target of 40-1.

Also, some children aren't getting services the program determined they need because some areas, especially in rural Missouri, lack enough providers, a problem caused largely by low payment rates and not reimbursing enough for travel costs, the audit found. About 1.9% of authorized services weren't provided last year, the audit said.

The education department said it's discussing whether to change its payment rates and policy.