2007 OSEP National Early Childhood Conference December 2007

2007 OSEP National Early Childhood Conference December 2007 1

NJEIS CENTRAL MANAGEMENT Finance, Billing, Data Collaboration 2

NJEIS FUNDING TRENDS 3

NJEIS INFRASTRUCTURE • Lead Agency-Quality Assurance Team § Contracts § Procedural Safeguards § Central Management Office § Monitoring § Personnel Development • Regional Early Intervention Collaboratives (REIC) (4) • Service Coordination Units (SCU) (21) • Early Intervention Program Provider Agencies (EIP) (80+) / Practitioners (3600+) § Targeted Evaluation Teams § Comprehensive Programs § Service Vendors 4

CENTRAL MANAGEMENT OFFICE (CMO) 5

COVANSYS CMO • The Covansys System is designed specifically for early intervention. • It has been in use for over 10 years. • Currently there are 4 states using the system who are actively developing and making improvements to the software. 6

CMO FEATURES • • • Child Specific Data Collection State access to timely statewide data Local Access to Data Verification (Accuracy) Provides Accountability Timely system of payment Maximization of funding resources Supports Monitoring Personnel Enrollment/Matrix Reports 7

CHILD SPECIFIC DATA COLLECTION 45 days 1 year Exit Entry Timely Services Referral Timely Services Initial Annual IFSP Transition 8

ACCOUNTABILITY FEATURES • Child must be eligible for Early Intervention • Child must have an Active IFSP to receive • • • authorization for services Practitioners must pass a credentialing process where their experience and licenses are verified Explanation of Benefits sent to family Billing authorizations are created based on a completed IFSP and ensure services are being provided according to the IFSP 9

Denied and Disallowed • Practitioner must have the correct specialty for • • the service type in order for a authorization to be created Claims are verified against the authorizations before payment is issued. Claims payment is denied/disallowed if: – The date of service was not authorized – A duplicate claim is being submitted. – Service hours exceed the “bucket” of time authorized – Practitioner claimed is not the practitioner assigned to provide the service. 10

DATA VERIFICATION • REICs are responsible for entering the IFSP • • • information into SPOE which provides on going accountability (Oops tickets). Paperflow REIC Data entry Funky Data Inquiry Process Service and practitioner’s specialty is matched to ensure practitioner is qualified Data Verification On-site Visit 11

MAXIMIZING FUNDING SOURCES • Claims from agencies are used to generate • Medicaid Claims and maximize reimbursement. The SFY 2007 Medicaid reimbursement was $14. 2 million. The CMO billed and collected $3, 900, 000 Family Cost Share revenue for SFY 2007 12

CMO SUPPORTS MONITORING • The CMO provides standard and customized reports that support: § Federal reporting requirements including 618, SPP, and APR § Quality assurance of Federal and State performance and compliance requirements § Analysis of child outcome data § Tracking progress improvement and correction § Reporting to state, stakeholders and public 13

CMO Reports • Reports for the SPP indicators: – Timely Services – Child Count – 45 Days – Service Location – Transition Planning Conference 14

Fiscal Reports • Service intensity • Bi-weekly check run • Family Cost Participation – Monthly Collections – Exiting – Suspensions (Approaching Suspension Notice and Suspension of Services) • Fiscal Forecasts 15

PRACTITIONER VERIFICATION & ENROLLMENT 16

PRACTITIONER ENROLLMENT PROCESS • Agency is responsible for sending original • • • signature forms and practitioner credentials to CMO trained personnel review and match to NJEIS standard CMO enrolls or denies practitioners within 24 -48 hours Agencies may appeal practitioner decisions to NJEIS Personnel Coordinator 17

Data Analysis 18

Service Intensity Analysis • Over 8 hours of service in a day • Reassessment within 3 months of Initial IFSP • Over 20 hours of service in a week • Drill down on individual counties, EIPs, or practitioners 19

Fee for Service Transition Challenges • NJEIS went live in May 2004 with no child records, and no authorizations • It took until December 2004 to achieve real time data entry. • NJEIS provided multiple advance payments to assure that agencies had sufficient cash flow • Recovery of advanced payment 20

NJEIS Profile • December 1, 2006 Child Count - 9, 310 • Cumulative for SFY 2006 - 17, 472 children with IFSPs 21

CMO Data • Since May 2004: § 61, 500 child records with 1, 300 records added a month § 591, 701 Authorizations § 6, 627 practitioners records with 3, 011 providing services § $293, 755, 974 in Direct Service and Evaluation claims paid through the CMO 22

Financial Forecast 23

Forecast Direct Services Costs • Prior to the CMO a budget projection was obtained by multiplying the December 1 count by an average cost per child. • The CMO provides the data to allow timely and current calculations of the potential financial liability to the state based on the services authorized on the IFSP. 24

Fiscal Year Forecast • During SFY 2007 the CMO was required to prepare • and submit to the Office of Management and Budget (OMB) a monthly SFY forecast, a bi-weekly claim report, and a monthly family cost participation revenue report. Annual budget forecasts are now requested and prepared for the next 2 -3 fiscal years. 25

CMO Fiscal Information Used to Forecast SFY Budgets • Claims submitted and paid by service month • Authorized service costs calculated for each service • • month Regression analysis of authorized funds to forecast future claim payments Service Coordination, REIC, and system component expenses provided through grants The percentage of Medicaid funds recovered against the total direct service costs is applied against future direct services costs to forecast ongoing Medicaid fund recovery. (13% for SFY 2008). Family cost share collections 26

Child Count Forecast 27

Child Count • In addition to the December 1 Child Count, NJEIS generates a monthly child count and forecast to monitor growth and resource needs. 28

Actual and Forecasted Child Counts § Referral § Evaluation § Initial IFSPs § Children Receiving Direct Service 29

Actual and Forecasted Child Count 30

Data Collaboration 31

Data Sharing/Matching • Special Child Health Services Birth Registry § Universal Newborn Hearing Screening/Diagnosis/early identification § Analysis to determine if children are appropriately identified to NJEIS and Birth Registry § Determine accuracy of diagnosis information across programs • Data sharing of early intervention exiting data with Department of Education by school district • Electronic Birth Certificate § To determine if children with at risk conditions are known to or eligible for early intervention (i. e. extremely low birth weight babies) • Maternal Child Health projects 32