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HomeMy WebLinkAboutEI-116 Fiscal Procedure1 FRANKLIN/FULTON COUNTY MENTAL HEALTH/INTELLECTUAL & DEVELOPMENTAL DISABILITIES/EARLY INTERVENTION 425 Franklin Farm Lane Chambersburg, PA 17202 (717) 264-5387 MH/IDD/EI PROCEDURE STATEMENT PROCEDURE SUBJECT: Fiscal Procedure PROCEDURE NUMBER: EI-116 Effective Date: September 22, 2008 Date Revised: September 27, 2023 References: - IDEA 34 CFR §303.510 and §303.520 - Title 55 PA Code §4226.11, §4226.13-15, §4300 and §4600 - Medical Assistance 837 Handbook - Announcement: EI-08 #10 Eligibility for the Infants, Toddlers and Families Medicaid Waiver - Announcement: EI-07 #04-. Infants, Toddlers and Families Medicaid Waiver - Operating Agreement - County/Provider Contract POLICY: Franklin/Fulton Early Intervention program maximizes the use of funds through discussions with families about the system of payment and available sources of funding by:  Discussing funding sources during the intake/initial meeting with the family.  Reviewing the Insurance Verification Form with the family to confirm if the family has private insurance, Medical Assistance (MA), or no insurance.  If the family confirms that the child has MA health benefits, permission from the family to bill MA will be confirmed on the Insurance Verification Form.  If the family confirms that they have private insurance or no insurance and they do not have MA health benefits for the child, the service coordinator (SC) will inform the family about MA and provide an application for MA. The SC will assist the family with the application process as needed. Applications for Medical Assistance are voluntary; a family may choose not to enroll the infant/toddler in Medical Assistance. Families are informed that enrollment in Medical Assistances is required for infants/toddlers to be eligible to receive waiver funding for Individual Family Support Plan (IFSP). Families are also informed that there is other non-medical 2 assistance funding sources for IFSP services that can still be utilized. Termination of the toddler’s Medical Assistance benefits cannot affect the infant/toddler’s receipt of services authorized on the IFSP; however, another source of funding needs to be applied. Franklin/Fulton Early Intervention Program has the following procedures for obtaining medical necessity: 1. Medical necessity will be obtained for all children whose families participate in at least an intake/initial meeting. 2. A release of information for a child’s pediatrician or primary care physician will be obtained during the initial meeting with the family. The Service Coordinator will explain the reason for the request and the type of information that will be obtained from the physician. 3. After obtaining the release of information, the Service Coordinator will submit the information needed to the Service Coordinator Supervisor who will mail the request for medical necessity to the physician. The physician will be requested to complete and sign the letter of medical necessity and return to Service Access and Management Inc., Attention: Service Coordination Supervisor along with a copy of the child’s most recent medical records. 4. At or before the child’s Annual IFSP review and Re-Evaluation, the Service Coordinator will request an updated release of information for the child’s pediatrician or primary care physician. The Service Coordinator Supervisor will send an updated medical necessity request to the physician for them to sign and return along with current medical records. Franklin/Fulton Early Intervention Program has strategies in place for identification of infants/toddlers eligible for the Infants, Toddlers, Families, Medicaid Waiver. The first step in the process is the determination of the infant or toddler's eligibility for Medical Assistance. This needs to precede eligibility for waiver-funded IFSP services, although applications for both Waiver and Medical Assistance can be submitted to the County Assistance Office (CAO) simultaneously. The infant or toddler is also required to satisfy financial and level of care eligibility requirements before waiver-funded IFSP services. Level of care eligibility is based on the infant/toddler being determined eligible to receive Early Intervention services by the independent evaluation team. Financial eligibility is based on the infant or toddler’s eligibility for Medical Assistance that is determined by the CAO. Franklin/Fulton Early Intervention also utilizes the data on the ITF Waiver Eligibility Report found in HCSIS/PELICAN web-based system to check waiver numbers. If the child’s eligibility meets any of the following criteria, the Service Coordinator will review the Infant/Toddlers/Family (ITF) Waiver eligibility information with the family: a. Diagnosis with a high probability of resulting in a developmental delay 3 b. A minimum of 33% delay or 2.0 standard deviation below the mean (-2.0 SD) in at least two areas of development c. A minimum of 50% delay or 3.0 standard deviation below the mean (-3.0 SD) in at least one area of development If a child is determined to be eligible for Early Intervention services during the Initial Multidisciplinary Evaluation (MDE), the Service Coordinator will once again review funding sources with the family. If the child’s eligibility meets criteria for the ITF Waiver and the family has MA, the Service Coordinator will offer the family the choice of enrolling their child in the ITF Waiver and will complete the appropriate waiver paperwork. If the child’s eligibility meets criteria for ITF Waiver and the family does not have MA, the Service Coordinator will review the MA application process with the family. The Service Coordinator staff will confirm funding sources on a regular basis with families and during reviews of the IFSP. This would include: 1. The Service Coordinator will review the Insurance Verification Form with the family during quarterly IFSP reviews as well as the Annual IFSP/Re-Evaluation meeting to confirm if the family’s insurance information collected initially is still correct. 2. If there are no changes to insurance information, the Service Coordinator will note this on the original Insurance Verification Form with the date of the meeting with the family. 3. If insurance information has changed, the Service Coordinator will complete a new Insurance Verification Form with the family to document the new information and confirm the family’s permission to bill MA if applicable. 4. Alerts from the Pelican system will be reviewed for information when children start to receive MA benefits. If there is notification of any changes, management staff will notify the Service Coordinator in order to review this change with the family and discuss funding sources with the family. 5. Service Coordination staff will meet with families when notified that a child is now receiving MA benefits in order to obtain parent permission for billing MA and to offer ITF Waiver choice when applicable. Service Coordination staff will complete the Insurance Verification Form and Waiver paperwork as appropriate. Franklin/Fulton Early Intervention Services has the following procedures in place for monitoring local contracted providers for timely billing: Per the county contract, all billings must be submitted by the 15th of the following month, unless otherwise specified. Early Intervention contracted Providers must submit billing through PROMISe. Providers may bill weekly but must bill at least monthly. PROMISe billing will be downloaded from SeGov weekly and imported into the Early Intervention Tracker (the county billing software). Infants/toddlers who are funded by County Maintenance funds are entered into the Early Intervention Tracker. The infants/toddler’s Individual Family Support Plan (IFSP) is reviewed to ensure Pelican and Early Intervention Tracker reflects the same service provisions. Once this has been completed, a Remittance Advice (RA) is generated from Early Intervention 4 Tracker, printed and authorized for payment. The Early Intervention Fiscal Officer & Early Intervention Program Specialist review RAs on a weekly basis and enters the billing into provider billing verification spreadsheet. If the provider has not billed for services by the 15th of the following month they will be notified by email or phone call. Franklin/Fulton Early Intervention Services has the following procedures in place for distribution of funds to local contracted providers: PROMISe billings are downloaded from SeGov and imported into the Early Intervention Tracker. A Remittance Advice (RA) will be printed and authorized by the Program Specialist and coded by the Fiscal Officer for payment. The RA information is entered into a provider verification spreadsheet. The provider verification spreadsheet summarizes the payments on a monthly basis. This spreadsheet allows the Early Intervention Fiscal Officer to track how much has been paid to the Provider and the amount of funds remaining in the fiscal year contract. Once it has been determined there are sufficient funds within the contract to pay the Provider for services rendered, the RA is sent to Accounts Payable (A/P) for payment processing. Notification of any billing issues or discrepancies should be sent to the Early Intervention Fiscal Officer and Program Specialist. A copy of the RA is securely emailed to the Provider for payment verification. For any Early Intervention services not billable through PROMISe, a Services Rendered Report will need to be completed. Franklin/Fulton Early Intervention program uses PELICAN data and additional fiscal reports to analyze encumbered funds and review overall utilization percentage to manage Early Intervention funds. The program uses PELICAN status reports and child enrollment reports to ensure that Medical Assistance billing is occurring. Data analysis is used to manage the program and improve program performance. All Early Intervention staff and providers will review the information included in this policy and procedure regarding the Fiscal Policy Procedure checklist. Training resources related to the Fiscal Policy Procedure Checklist can be found on the HCSIS Learning Management System (https://www.hcsis.state.pa.us/hcsis-ssd). Trainings will occur for all staff including administrative, Service Coordination and fiscal staff as needed. Any change or update to any policy or procedure statement will be sent immediately upon receipt to the provider agencies and all changes will be reviewed at the next scheduled Early Intervention provider meetings for further review and discussion. The Fiscal staff will also contact the Office of Child Development and Early Learning with questions regarding fiscal issues.