Thursday, January 8, 2009
9:00 a.m. - 2:30 p.m.
Crowne Plaza - 3000 Dirksen Parkway, Springfield, Illinois
- Gerri Clark, Division of Specialized Care for Children
- Bob Cammarata, ICG Health Care Services
- Beatrice Nichols, IICEI Chairperson, Head Start
- Mary Peterson, DFPR, Division of Insurance
- Karrie Potter, parent, Neoga
- Deanna Pratscher, parent, Thonton
- Dorelia Rivera-Martinez, Melrose Park
- David Rubovits, PhD, Jewish Child and Family Services
- Sandy Ryan, IL Council on Developmental Disabilities
- Julie Doetsch on behalf of Deborah Saunders
- Kathy Schrock, Easter Seals DuPage and Fox Valley
- Connie Sims, DHS, Division of Developmental Disabilities
- Myrtis Sullivan, M.D., DHS, Division of Community Health and Prevention
- Gail Tanner, AuD, IL Department of Public Health
- Therese Wehman, PhD, Elmhurst College
Absent - Excused
- Diane Blythe, parent, Crystal Lake
- Sheena Coleman, parent, Naperville
- Andria Goss, IL Department of Children and Family Services
- Janet Gully, DHS, Bureau of Early Intervention
- Representative Julie Hamos
- Kay Henderson, IL State Board of Education
- Linda Saterfield, DHS, Bureau of Child Care and Development
- Deborah Saunders, IL Dept of Healthcare and Family Services
- Joyce Smith, Lessie Bates Davis Neighborhood House
- Constance Williams, PhD, DHS, Division of Mental Health
Contents of Council Packet
- Lead Agency Report - January 8, 2009
- Draft Report from October 2, 2008
- Finance Workgroup Reports
- Service Delay Workgroup Reports
- Draft Annual Performance Report
- Mission, Vision and Principles
1) Call to Order
The meeting was called to order at approximately 9:00 a.m.
2) Introduction of Council Members
3) Lead Agency Report
- Rule changes - Small changes have been made to 89 Illinois Administrative Code 500 which includes language related to family outcomes and interpreter proficiency testing and training. There was no comment to the proposed language during the public comment period. The document is now moving through the DHS internal process.
- RFP process - We are still in process of writing and getting the RFP language approved.
- EI payments - We are about 2 weeks behind in payment to EI providers. A transfer was received this week and we are now in process of paying the December 17, 2008 voucher.
- CFC Noncompliance Findings - It was explained that items of CFC noncompliance have been identified via data from April 2008. This is the 2nd round of this process. CFCs previously received non-compliance items via the 1st round of this process and were required to document correction. There are a number of CFCs with findings in compliance/improvement areas. Service delays are not improving, transition is better, 45-day problem is almost non-existent, and the natural settings has improved. The CFCs with the worst service delays are numbers 1 & 3.
4) EI Central Billing Office
Troy Alim from the Early Intervention Central Billing Office presented an overview of the program areas administered by the CBO. He also provided a look at the organizational chart of the CBO. The CBO program areas include the following: Medicaid, Coordination of Benefits (COB), Family Fee, Collections, Claims, Technical Assistance, Project Management, and Insurance Billing.
- Medicaid - The CBO submits claims to the Illinois Department of Health Care and Family Services for Federal Financial Participation (FFP) reimbursement of services, which have been paid by the EI system for dually enrolled All Kids recipients. The FY08 FFP reimbursement was $33,828,216. This is approximately $2.4 million less than the FY07 FFP reimbursement. This is the 2nd time that EI has experienced a decrease in reimbursement. The decrease is due to a delay in FFP deposits. EI has recouped the FY08 delayed dollars. The FY09 FFP year to date outpaces FY08 by $6.2 million and FY07 by $11.6 million. There are 1.5 FTEs dedicated to the Medicaid projects.
- Coordination of Benefits Unit - The CBO provides data to assist CFC's in their service coordination duties by providing a preliminary assessment of third party financial responsibility to ensure the EI program's role as payer of last resort. Benefit verification has increased from 14,035 verifications in FY07 to 15,833 verifications in FY08. Turn around time for benefit verifications are within 5 business days. There was a decrease in CFC requests for waivers of more than 900 for FY08. The reason for the decrease is due to changes in DHS policy that allows the CBO to recognize the need for waivers up front at the time of benefit verification.
- Family Fee Unit - The CBO is responsible for the accounting, invoicing and distribution of family fee invoices to families as well as managing the accounts, providing technical assistance to families and initiating collection activity when warranted. The CBO received 3072 calls from families in FY08. An increase of 903 calls from the previous year.
- Collections - The CBO is responsible for preparing certain delinquent debt for collection to the DHS Bureau of Collections, providing reports and debt repayment activity to the EI Monitoring team and DHS staff.
- Claims Processing Unit - When it is determined that no other payer is responsible for the costs of service delivery, the CBO applies DHS rules to determine if state funds will be used to cover those costs. Traditional claims processing represents about 20 % of overall CBO work. Payer of last resort takes precedence. In FY07 and FY08 the CBO completed more than a million claims for each year. Completed means that the claim was paid.
- Technical Assistance - In FY08, the calls received were broken out into the following categories and percentages. 54% families; 2% provider enrollment; 12% COB; 25% claims; and 7% requests for EOB/Provider Claim Summary reprints.
- Insurance Billing Unit - Two hundred payees have registered with the CBO Insurance Billing Unit. Payees include both agencies and independent providers.
- 2009 and Beyond - The CBO will focus on the following activities for 2009 and beyond. Staff Training: Each staff employed by the CBO will receive a minimum of 100 hours of training. Upgrades to technology: In order to increase efficiency of CBO operations, the CBO will continue to upgrade/update its technology. Insurance billing expansion: The CBO will have the ability to allow providers to submit forms to register with the CBO Insurance Unit via a secure website and to also accept insurance information for billing purposes via the same mechanism. Trained staff that know how to bill insurance have been employed to work with the different insurance companies. At this time there are three certified insurance coders on staff and the CBO is interviewing to hire a fourth. Offset system: The CBO is working with EI staff to develop the offset process for implementation. Once the process is implemented, debt owed by providers will be resolved prior to payment being made. Expansion of Qclaims (electronic billing): The CBO is working to be able to accept resubmissions of claims and paid insurance claim information electronically.
5.) EI Clearinghouse
Illinois has one of the largest and most comprehensive libraries for children in the country. There has been a change to the Clearinghouse website and it is now targeted to families. Clearinghouse staff continues to work to make the site as family friendly as possible. There is still a basic link on the site that will take you directly to the library. All newsletters and new materials are found on the site. There is an emphasis in the library section of the site for parents as well. The Clearinghouse does not carry as many periodicals as it used to now that they are easy to access via the Internet. This has freed up dollars for use in other areas. The Clearinghouse has about 10,000 books and 1,700 videos. Close to half of request for materials come via inter-library loans. It is not known who is requesting the materials, parents or providers. So that limits the ability for the Clearinghouse to determine users. We do have some CFCs that use videos for in services and some videos are also used for training credit.
The Clearinghouse feels that there is a need to reach out to CFC's and tries to attend CFC fairs and continues to speak at CFC meetings when asked. Chet spoke about how important it is for providers to visit the library and read current materials so that they can keep up on what's new in the Early Childhood field, especially in the area of evidence based practice. The Clearinghouse has both professional and parent list serves. If you are not on a list serve and want to be, you can drop an email to the Clearinghouse to sign up to be on a list serve.
6) Interpreter Testing and Training
Interpreter training was created in response to the many requests of CFC managers for interpreter standards. We begin to meet to develop the training and testing about 2 years ago. Help was provided from entities within DHS and external to DHS to put together the testing procedures. We were looking for a minimal bar of competency. Interpreters needed to be able to demonstrate the ability to both speak and understand the language and interpret it to English. The Spanish test was developed first and piloted in Feb/March, 2008. Once the pilot was complete the testing went statewide. The tests have been translated into other languages. Some of the written tests were not translated in this country. We will look at the need for tests to be translated into additional languages, based upon the numbers of children with that language need. We will also look at the available technology to determine if testing modules can be developed and taken via a computer. Providers will still have to come to a site for proctoring.
We have trained 512 interpreters and tested 491. Of the 491 tested, only 412 have trained. Some of the training has now been incorporated into systems training. Providers are given the option to test for either oral interpretation or written translation only, or may test for both. A provider may take each test two times during a six-month period. We will look at using a translator or interpreter via the provisional authorization process on a rare occasion only. Testing is very stressful and some good interpreters have failed, but passed on their 2nd try. The written test is 20 questions and there are two passages that must be translated into both English and the other language. The oral testing is much more simple.
There was a concern raised about dialect. Some of the interpreters feel that the test distorts dialect and that is causing interpreters to fail. Some good interpreters may never pass the test due to dialect, even though those interpreters are highly competent. The validity and reliability of the testing was questioned. Ted stated that changes have been made to the testing process due to some of those concerns. Providers now have to fill out a cover sheet that asks questions such as where did the provider learn the language? Ted stated that if there is movement to standardize testing statewide for all programs, we want to be a part of that.
Ted reports that the training and testing has caused the interpreters to begin to talk and that some have formed groups that have began to meet monthly. The formation of the groups may help us to develop better training in future.
7) Work Group Reports
The Finance Workgroup has met three times since the last Council meeting. Much work has been done in preparation for each meeting. We have been trying to come up with answers to identified problems. The most pressing issues include the following.
- Payment Delays - We have discussed how important it is that EI make sure that a consistent message is being shared statewide by entities such as the Bureau of EI and CFCs. We understand that we cannot do anything about the payment delays. This is a situation that is impacting all state programs, not just EI. We have discussed the status of providers. We have no hard data to determine if they are leaving the system or not enrolling due to payment delays.
- Insurance Legislation - Senate Bill 101addresses payments by insurance companies for habilitative services provided to children with disabilities and delays. This bill passed the House in November 2008. It was hoped that this bill would go before the Senate the week after it passed. However, other priorities took precedence. Now that new members have been seated in the House, the House will have to pass it again before it can be sent to the Senate.
It was thought that if this legislation passed, it would be of great benefit to EI until the following was explained to the Workgroup: More than 50% of insurance plans are large employer self-insured group plans. These plans are covered under the Federal ERISA Act which pre-empts state law. So a state mandate for insurance to pay for EI services would not apply to self-insured groups. But it would still apply to children who are not insured under a self-insured plan.
The Workgroup has struggled with how to support/get support for this bill statewide. The IICEI as a whole cannot generate a letter of support with recommendations to legislators or to providers and others because about one-half of the members are state agency employees. And state ethics would prevent them from making recommendations to support. After discussion among the Council members it was determined that the Finance Workgroup could generate a letter that provides information on the legislation without recommending any action.
How to Maximize Insurance - Information that was provided by the CBO shows that one third of all authorizations are covered by waivers or exemptions. The number one reason is that the service is not covered by insurance. The second reason is that there is not an insurance provider available or enrolled. The provider issue was discussed at length. The CBO Insurance Unit was also discussed. For providers who do not want to spend the time chasing insurance, they should register with the CBO Insurance Unit so that the Unit can bill and chase on their behalf. Providers will receive 100% of the reimbursement received by CBO.
Service Delay Workgroup
The Service Delay Workgroup has met three times since the last Council meeting. On 1/5/09 the Workgroup held an interactive forum in Rockford to look at different approaches/methods of service delivery that may help to address the service delay problems. The target groups for this forum were CFCs 1 and 3. Larry Eddleman, Senior Instructor in the Department of Pediatrics at the University of Colorado and Health Sciences Center, was brought in as a consultant in instructional design and training to facilitate the forum. The OT, DT, ST and PT Associations were represented. Five Council members, four EI Bureau staff, two EI monitors, CFC representatives and training staff also attended. It was stated that these issues impact the entire state, not just in CFCs 1 and 3. It was also stated that Council members need direction from Janet to know how involved they can be with groups in the field. Provider consultation time was discussed. It was stated that providers in the field do not understand how to bill for consult time.
It was suggested that there should be an FAQ on the Clearinghouse website, or maybe some webinars that would allow folks to chat with Council members about issues and concerns at the local level. A statement came from the audience that there is already a network at the local level. It is the LICs and CFCs. But the members of the Council do not access the local networks for input. It was suggested that the Council extend seats to LIC and CFC members to allow for local input.
8) Overview of Annual Performance Report
Nyle gave a presentation on the APR. He spoke of the possibility of an ombudsman position to work directly with CFC's and providers from a technical assistance perspective in concerns to following existing EI rule and law during eligibility determination and the IFSP process. He stated that eligibility is not being determined uniformly across the state based upon the existing eligibility criteria. It was stated that this concept has been sent to OSEP for review and approval. If this concept is approved by OSEP, EI can move forward with implementation. Nyle stated that our participation rate continues to increase, which impacts the service delay problem. Nyle stated that an appeal should be made to providers to follow the existing eligibility guidelines and to follow the "Principals of Early Intervention" when determining eligibility and frequency and intensity of service provision.
9) Discussion of Vision and Mission Statements
Due to the length of today's Council meeting the discussion of the Vision and Mission statements was tabled until the next meeting, when Janet can be present. Or possibly Janet could schedule a date to meet on the Vision and Mission statements before the next meeting.