11

2007 OSEP National Early Childhood

ConferenceDecember 2007

22

NJEIS

CENTRAL MANAGEMENT

Finance, Billing, Data Collaboration

33

NJEIS FUNDING TRENDS

State Versus Federal Funding SFY 2000 to Present

$0

$20,000,000

$40,000,000

$60,000,000

$80,000,000

$100,000,000

$120,000,000

STATE/OTHER $23,594,659 $25,465,874 $30,188,494 $43,363,647 $49,373,064 $59,554,937 $80,771,564 $99,064,939

MEDICAID $4,356,848 $6,772,579 $4,839,491 $4,402,745 $6,408,003 $5,127,681 $14,175,803 $17,590,447

FEDERAL $9,865,491 $9,965,995 $10,193,673 $11,405,544 $11,876,542 $11,773,206 $11,779,984 $11,904,582

2000 2001 2002 2003 2004 2005 2006 2007

44

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

55

CENTRALMANAGEMENT

OFFICE(CMO)

66

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.

77

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

88

CHILD SPECIFIC DATA COLLECTION

45 days 1 year 1 year 1 year

Referral Initial

IFSP

Annual

IFSP

Annual

IFSP

Transition

Entry Exit

Timely Services

Timely Services

Timely Services

99

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

1010

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.

1111

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

1212

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

1313

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

1414

CMO Reports

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

1515

Fiscal Reports

•Service intensity

•Bi-weekly check run

•Family Cost Participation– Monthly Collections– Exiting– Suspensions (Approaching Suspension

Notice and Suspension of Services)

•Fiscal Forecasts

1616

PRACTITIONER VERIFICATION

& ENROLLMENT

1717

PRACTITIONER ENROLLMENT PROCESS

• Agency is responsible for sending original signature forms and practitioner credentials to CMO

• 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

1818

Data Analysis

1919

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

2020

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

2121

NJEIS Profile

•December 1, 2006 Child Count - 9,310

•Cumulative for SFY 2006 - 17,472 children with IFSPs

2222

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

2323

Financial Forecast

2424

ForecastDirect 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.

2525

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.

NJEIS Annual Direct Service Expense

$0

$50,000,000

$100,000,000

$150,000,000

$200,000,000

2007 2008 2009 2010

2626

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

2727

Child Count Forecast

2828

Child Count• In addition to the December 1 Child Count,

NJEIS generates a monthly child count and forecast to monitor growth and resource needs.

7,000

7,500

8,000

8,500

9,000

9,500

10,000

Jul-0

4

Nov-0

4

Mar

-05

Jul-0

5

Nov-0

5

Mar

-06

Jul-0

6

Nov-0

6

Mar

-07

Jul-0

7

Nov-0

7

Actual

Monthly Forecast

2929

Actual and Forecasted Child Counts

ReferralEvaluation Initial IFSPsChildren Receiving Direct Service

3030

Actual and Forecasted Child Actual and Forecasted Child CountCount

Mar-07 Apr-07 May-07 Jun-07 Jul-07 Aug-07 Sep-07 Oct-07

Current Forecast (Child Count)Referrals (Monthly Regression) 1,550 1,451 1,326 1,363 1,249 1,352 1,337 1,384 Evaluations 1,331 1,283 1,320 1,376 1,127 1,344 1,284 1,346 Initial IFSP 946 785 875 804 735 806 816 836 Children Receiving Direct Service 8,695 8,690 8,853 8,909 8,840 8,885 8,931 8,976 Percentage Growth in Children receiving services

Actual (Child Count) Mar-07 Apr-07 May-07 Jun-07 Jul-07 Aug-07 Sep-07 Oct-07Referrals 1,409 1,372 1,323 1,281 1,297 1,358 1,201 397 Evaluations (by month of referral) * 1,230 1,159 1,282 1,106 1,226 1,190 1,107 181 Initial IFSP (by month of referral) * 904 861 815 753 647 212 4 - Eligibility Rate 64% 63% 62% 59% 50% 16% 0%Children Receiving Direct Service 8,492 8,419 8,606 8,540 8,454 8,373 8,268 7,494

3/2007 4/2007 5/2007 6/2007 7/2007 8/2007 9/2007 10/2007Referrals (141) (79) (3) (82) 48 6 (136) (987) Evaluations (by month of referral) * (101) (124) (38) (270) 99 (154) (177) (1,165) Initial IFSP (by month of referral) * (42) 76 (60) (51) (88) (594) (812) Children Receiving Direct Service (203) (271) (247) (369) (386) (512) (663) (1,482)

Difference of Actual and Current Forecast

3131

Data Collaboration

3232

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