That's All Folks!

Presently sitting at the airport awaiting my flight.  It was a great conference and I hope that by following this blog, you gained something from it as well.  I would love some feedback!!

Closing - W.H.I.S.T.L.E. While You Work - Wednesday - 9:45

Closing Speaker - W.H.I.S.T.L.E. While You Work

Wednesday - 9/12/12  9:45

LaWayne Salter - Florida 

Whistle while you work song

7 key strategies to improve performance and release your potential

3 types of individuals in the world -make things happen, watch things happen, wonder what happened

#1 - win big - celebrate your success - go to person - make things happen but sometimes forget to make things happen for yourself

changes your mood

if we don't celebrate ourselves, who will?

challenges your personal expectations

inspires others

#2 Harness the greatness within you

acknowledge and embrace it

find your niche

open your own "me market"  - be the resource everyone else requires - being marketable - be the problem solver

#3 Inventory and invest 

Look at the knowledge, skills and abilities we have and invest in what we need

#4 strengthen your weaknesses

A.C.T. - acknowledge, confront, train

everyone has weakness - acknowledge don't hide - confront the fear/ situation - train your weakness 

#5 trust your failures

opportunity to begin again more intelligently

it's an event and NOT a person

not failing - Not growing

learn from mistakes

#6 lose the excuses and leverage opportunities

tools of incompetence

devised to camouflage the real issues

un-ending possibilities

wants the day to say "he's up"

#7 evaluate and adjust your F.O.C.U.S.

Fear

Opportunities

Commitments

Understanding

Strategies

Fear motivates you to make a change - where are your opportunities? - are you overcommitments (first word for child is typically "no") people have a way to make us feel guilty for saying "No" - do we really understand what we are involved in  - have to have goals and roadmap for getting there

Maintain the momentum

stay in the stream of things (nemo and turles in the gulf stream) we should never be surprised by new things coming out

change lanes as needed - don't want people in front of you putting on the brakes unnecessarily - habital breakers - you have to be able to change lanes as needed

monitor your cruise control - don't get comfortable with what you are doing - life always has a way to throw things in front of us

 

Cee Candy Winners!!

Q5i Chocolate Winners!!

Congratulations to the winners of the Cee Candies which were awarded by the great folks at Q5i!!  Larry Goolsby of APHSA, Bertha Levin of APHSA, Jean Ryan from Kentucky and Terri Wilkerson from Florida will be bringing home a one pound box of chocolates!!!  Congrats!!

Nevada utilizes Q5i for SNAP QC reviews, TANF Data Reporting and Administrative Hearings.  Please contact me if you would like details on this robust application!!

QC Integrity - Completion Rates and Likely Conclusion - Tuesday 1:30

SNAP Program and QC Integrity - Completion Rates and Likely Conclusion

Tuesday 9/11/12  1:30

Fran Heil and Dave Young (FNS)

Completion rates should be at 98% or above.  

FNS has been monitoring this rate for some time and is concerned about the increases with the drops.  They are trying to figure it out.  And they have discovered multiple reasons.  Staff turnover contributes.  They have instructed regions to complete reviews to determine what the problems with completion rate are.  These QC ME reviews are often welcomed because information is shared about improving the completion rate.  FNS is always willing to provide technical assistance.

The FNS Office of Research and Analysis will be examining the issue of completion rates.  They will be conducting a study as to the who, what, when, where, how and why of the existing completion rate issue.

Dave -( PowerPoint will be added to the PartnerWeb soon)

Required at 98% minimum - if 95% or below, requires data analysis and corrective action plan.  In FY11, the national average was 92.84%. 

There is an adjustment to the regression rate if completion rate below 95%

In last 5 years there has been an improvement in the national average.

For States with a large sample size (1080 annual reviews), 2 cases per month will place you at 98% and 5 cases per month will place you below 95%.

NSTR versus Incomplete - difference is in attempts to locate the client.  For NSTR you must make 2 attempts to locate.  These attempts must be made with contacts who are likely to know the location of a client.  In order to qualify, there must be feedback from the source.  Therefore, documentation of the reviewer is critical.  Automation can assist in these location attempts.

Likely conclusion can be a great source to complete a case missing minimum information.  But you must follow the rules to get there.  

Regulations for NSTR are located at 310 Section 330-338 & 7 CFR 275.12(g)(2) -  If clients have moved out of state, the case is NSTR.  If client is hospitalized, the case is NSTR.

Unable to Locate NSTR - HB 310, 442.1 - rarely seen anymore because of electronic case records.  Usely a falsified case in today's world.  

UTL - you must be abel to document 2 elements of eligibility and have 2 attempts to loccate for NSTR to apply.  

What is difference between UTL for NSTR and Incomplete?  creating confusion, FNS is looking at 310 modification to clarify.

There can be no direct client contact in a NSTR disposition.  

If case is NSTR, cannot be completed.

If incomplete, contact with the state eligibility staff is allowed in efforts to locate the client and to advise them on the client's non-cooperation.  In all cases where the client has refused to cooperate or failed to cooperate, the SAQC MUST attempt to complete the case.  Example case where client had completed a recert and 15 days later was pulled for QC.  Client refused to cooperate but all asects of eligibiilty was verified at recent recert.  Case can be completed with likely conclusion.

Verifications must be reviewed to determine if it meets the verification requirement and it does not conflict with any other evidence.  

Example:  Case was incomplete due to missing rent verification.  However, the rent in and of itself doe not change the outcome of the allotment when a budget is completed.  Therefore, likely conclusion could be utilized to complete the case.

Judging the reliability of the evidence - Recently a case was re-reviewed where a homeless client was being dropped as incomplete.  One of the contacts was a priest in charge of a local homeless shelter.  QC asked him to let the client know that QC was looking for him.  Priest got back to QC that he had passed on the message and QC had documented this.  Changed the outcome from UTL to refusal to cooperate.  QC staff must use prudent judgment and clearly document.

Waivers have been creating problems for the QC review process.  State waivers are for the benefit of eligibility processing usually.  QC has their own verification standards which must be adhered to.

The worksheet is required for dropped cases.  It is part of the review process.  The 380 worksheet documents the work SAQC did to attempt to complete the review for both internal state staff and FNSQC.  Document the worksheet clearly.

Likely conclusion - must attempt to verify all elements - document all efforts to verify elements - cannot use likely conclusion for non-citizen status, IEVS bank accounts and employment, vehicles, SSNs and work requirements.

Always use what information is available to you. 

Questions:

Q:  Gary from Minnesota - Homeless ABAWDS what would you suggest be used as a second contact if they have general address as a postal address.  A: Dave - NY has a homeless department.  Use a local homeless shelter contact, soup kitchen, use relative contact identified in the case record.  Last resort, use the local certification office to determine if they have had any recent contact with the client.  

Q:  NSTR - did not access benefits in review month in 2 following months, what about $16 households who stockpile their benefits.  Are they still NSTR?  A:  Dave - Yes

Q:  Coment about EBT benefits and access - if clients don't access EBT within 90 days, the account goes off line and the EBT card had to be reactivated.  

Q:  Mentioned about the rent and could not verify but did not make a difference in the allotment, what about income.  We have been told that if the income could not be verified, the case could not be completed.  seems like a double standard. A:  You must be able to complete a comparison 1.  Bottom line.

Q:  Gary from Minnesota - follow up with likely conclusion - they were told by their regional re-reviewer that likely conclusion could not be used for comp I.  A:  Fran - comp I must be completed.  Not trying to get into dispute about what they were told by regional staff.   

Fran is trying to determine what prevents state staff from being able to complete a case.  He needs to know what is preventing cases from being completed so they can adjust policy is needed.

Completion of comp I is critical for ability to complete a review.  You must be able to complete comp I for case to be completed.  

Q:  Bob from Alaska - states are in a catch 22 situation.  If they don't complete, the FNSQC could complete with likely conclusion and regress the finding.  A:  Dave - yes.  That is why you should arbitrate the FNSQC finding if necessary.  (Side note - in these types of disagrees, you can only arbitrate the disposition on the case.  You cannot arbitrate the error finding amount.) 

Q:  Collins from Arkansas - States would love to have a committment that something will be send to the regions to ensure that everyone is on the same page.  Arbitration is a labor intensive process.  A:  Fran will commit to having a conference call with regional FNS staff.  

SNAP Technical Advisory Group (TAG) - Tuesday 3:30

QC Technical Advisory Group (TAG) Meeting

Tuesday, 9/11/12   3:30

FNS Headquarters staff

Timeliness of Recertifications, Error Coding, Open forum for raising issues and asking questions

Liz Weber - Recertification Timeliness Coding -  Update - FNS will measure effective 10/11.  Had 14 states participate in pilots.  They conducted surveys and made adjustments along the way.  Feedback was that it wasn't that bad.  Training was less than a day.  Saw room for improvement due to completion of the pilot.  Handout is new page for the recert timeliness codes.  Limit review to the previous 12 months prior to the sample date.  Will be released on PartnerWeb.  

Fran Heil - Training materials will be released before the end of September.  5 tools and one of them is the 310 update page.  Will be posted to PartnerWeb.

Clarification - Code 30 on the 310 update draft indicates a case was issued benefits outside of the approved certification cycle.

Q:  Will this information be part of the June notification letters to the Governors?  A:  No, the letters to the Governors announce the error rates which this has nothing to do with.  Until it becomes a issue, it will not be updated with the Governors.

Q:  Is code 68 and 70 required for all reviews.  A:  Yes.  Both deal with the timeliness measure.  Be sure to follow the directions carefully.  It is possible that both measures will be coded for the same action.

A webinar will be scheduled for training on this in October.

Nancy Baca-Stepan - Arbitrations 

Fran Heil- Nancy has the right to talk to any FNS staff for clarification on policy based issued.  They are not making decisions.  They are trying to ensure that she has the support from FNS she needs.  And Nancy added that if a State feels they need to talk to her about an arbitrated issue, they need to contact her to schedule a time to do so.  But everyone needs to understand that she will not make a decision on the fly or over the phone.

She wants us to know that she does not know your State.  When you submit a arbitration packet, you must explain your acronyms, codes, etc.  When you submit a packet, explain a little bit about your State.  For example, if the issue involves income, explain what your conversion calculation is.

Also, explain what your policy references indicate.  

Chapter 14 is your friend when submitting an arbitration packet.  The format for QC cases clarification memo should be followed also.  Even when cases are electronic.  

If there is something confusing to you, please contact her.

Q:  Fran from FNS - Is there anything additionally which needs to submitted with the negative review packets?  A:  She has seen two things - is the notice clear and understandable? and is there a procedural issue?  

 Dave Young - FNS is coming up with a new option for completing the clint interview.  Effective FY13, by waiver, States will be allowed to conduct video interviews in leu of face-to-face interviews.  There will be no restriction on the case allotment value.  Fran does not intend to make States submit anything to apply for this.  Rather codes will be added to the schedule to capture this as an interview type in field 69 and the 310 will be updated.

Oregon has had a waiver since 2007 and recently Pennsylvania was approved for this waiver.   However, the following parameters must be adhered to: (1) state agency must have a secure link for the video conference.  (2) if clients prefer a face-to-face interview that must be made available and a client's failure to agree to a video conference cannot be perceived as a refusal to cooperate.

Draft policy will be provided to states for comment and feedback soon.  But Fran suggests that States carefully consider this practice and roll it out over time.   

Congress wants to know the difference in error rates under the tolerance levels and between the $25 and $50 tolerance levels.  That's why there was a recent rush to provide the data to FNS.   They are trying to gather information so they can fight to keep the $50 threshold.  

Fran has been shifted into a new position at FNS and will no longer be the National Headquarters QC Chief.  He will be responsible for moving QC projects along rather than supervising the QC staff.  However, he will continue to work with the new QC Chief daily.  The position is presently announced on USAJobs.  Anyone who is interested should apply.

APHSA President's Message - 9/12/12

APHSA president - Tracy Wareing

Tuesday General Session 9/11/12 - 8:30

Pathways to the Future

What is the next generation of human services?  What will future look like?  

Pathways involves presenting the opportunities ahead for human service agencies.  It involves using capital wisely. And is built on members input.  Focus is on promoting sound efficient, workable and sustainable solutions to the needs of low income populations and those served by social service programs. 

Today's reality present challenges - growing needs and less resources - rigid oversight - volatile political environment - unsustainable path presently - what should we look at changing in national policies?

Pathways is an action agenda of policy and practice reforms designed to help secure the next generation of health and human services delivery.

It is an ongoing effort & movement, not just documents or corrective action plans. 

It is about the integration and alignment of programs and services within and across government and private sectors.  It is about shared government moving beyond traditional lines and advancing a shared agenda with other public sector partners, the private non-profit sector and businesses.  It is about deliberate experimentation allowing for research and development that fosters innovation.  It is about elevating existing practices.  

Accomplishments which are noteworthy which involve SNAP, TANF and other programs, clear impacts on federal policies record achievements in program integration.  SNAP is presently experiencing historically low Active error rates.   Budget outlook remains stagnant - caseloads could keep raising, narrow focus on accountability for process rather than results may continue.   

Outcomes sought - gainful employment and independence, stronger families and communities, healthier families and communities, sustained families and communities

key elements which are preventative, collaborative and strategic - prevention, early intervention, bridge supports, capacity building and sustainability.

foundational tools - flexible financing, technology infrastructure, a prepared workforce, client engagement, accountability - think through projects 

pathways - what are we doing?  published documents- policy briefs setting policy priorities for four outcomes; specific policy recommendations - raise the locals voice initiative - launch innovation center 

national workgroup on integration - APHSA led collaboration with federal and vendor partners to identify opportunities and practical solutions for integrating human services and health programs - exemplifies the type of partnerships desired to transform the health and human services system -focused on providing practical, real-time guidance for states/localities - website

innovation center - launching pad for emerging issues and breakthrough innovations - supports transformation to an integrated outcome-focused model - four initial focus areas - alternative financing of human services, adaptable leadership, government's role in the 21st century, social return on investment.

What lies ahead?  dissemination of Pathways statements on core vision, principles, and recommendations - specific policy recommendations - website

where are key opportunities for change?  where can policies be aligned?  Let APHSA know if you feel something is missing in their policy briefs/ recommendations

Tuesday Opening Session - 8:30

Perspectives on the Roadmap from Today to 2015:  Federal Panel

Tuesday, 9/11/12  8:30

Kay Brown (GAO), Andrew Feldman (OMB), Jessica Shahin (FNS) and Michelle Dilks (ACF)

 Kay is Director ...  Andrew is .... (on phone)  Jessica is ... Michelle is ....

Kay - thanks for good work you do - GAO legislative branch agency reports to congress and reviews federal funds - 2 challenges presently are increasing needs and increase in aging populations which in turn create need for additional services. In '11, 7,600 individuals per day turn 65.  There are significant fiscal constrains with present practices being unsustainable over long term.  There was a total of 493 billion awarded  in grants last year.  The focus over the  next few years: effectiveness, efficiencies, integrity.  The SNAP program is gaining attention in the areas of fraud, waste and abuse.   Also,  duplication of services and program overlap study will be their upcoming 3 yr project.  Programs are too complex to clients, the program administrators and agencies who monitor.  Programs must gain administrative efficiencies through application process, alignment of policies, and other fragmentation issues.  Key factors for success in collaboration - strong leadership and agreement on goals along with results oriented decision making. Does data measure what we want measured?  For example, the TANF WPR is flawed.  There are better measures for performance.  What should be monitored and measured and still keep the focus on work?    Support policy alignment, innovative practices.

Andrew (via phone connection) Has tracked historical initiatives and elements.  How do we balance the need to put money into things which work while at the same time investing in innovations?  Suggests tiered investment opportunities:  what works?   what could work?  Proof of concept tier using the least amount of money available.  How do we harness private investment?  Suggests modeling from the social impact bonds from England which is used in current grant innovations.  How do we work across agencies for better outcomes and provide opportunities for cross funding?   Recently the director of OIB issued memorandum m-12-14 (which is available on the OIB website) Challenges agencies to prepare new ways to do things in next budget through waivers and partnerships. Develop technological investments.  And use grants to do what works for agencies during tough budget times. 

Michelle - ACF vision for Child Care is that more children in low-income families are able to access high quality child care.  Their goals include strengthening program integrity, building a child care subsidy system that can support child development, ensure the health and safety of children, build quality rating and improvement system and  build strong professional development and workforce initiatives.  CCDF funds require an application for funds, application approval and fund allocation, states are required to submit  data reports and required amendments, conduct quality activities, submit fiscal reports, participate in audits, and complete error rate reporting.  Recent developments in technical assistance launched the National Center on Child Care Subsity Innovation and Accountability.  This will integrate program integrity and provide enhanced technical assistance. Recently there has been a national conference call series on Fraud Prevention (200+ participants).  There are also requirements to conduct internal controls through self-assessment tools.  Changes to the error rate methodology  is presently in clearance process (first year impacted will be 2014) There will also be an error definition workgroup established.  This group will also issue informational memos and data reports will include information on the quality of childcare.  The goal is to create balance between access to services and quality of care. 

Jessica -Thanks!  The work we do  makes a difference every day.  Presently, SNAP is under a lot of scrunity but thanks to the QC process, we have data to support the integrity of the program.   We have  proven that the program can have both access and integrity.  Customer service, integrity and access is a three legged stool. FNS tries to provide the tools States need.  Take advantage of PartnerWeb.  Share good practices.  She tries to talk to commissioners, administrators and program leaders.  Encourages us to talk all the way through our organizations.  Participate in state exchange program sharing.  She believe there probably needs to be more clearity  with communications. Iimproper payments, fraud and abuse are firmly established. Presently the administration of program involves a focus on integrity. For example, they are presently working on rules for receiptants EBT card replacement guidance.  And they actively fight fraud on their website and fight fraud on social media sites. FNS has built a tool to manage searches of social media websites which will search via a e-mail notification process. This was developed with  partnership funds.   There are also plans for a national clearinghouse project which will check for dual participation across states.  A pilot of this revealed a "hit" response of  less than 1% in the 10 state pilot. Success creates new challenges. How can you get the rate lower?   Upcoming focus will be to examine the  complexity and possible integration with other federal programs.  This will involve using administrative process improvements.   Idaho is already strong in this - using technology in process improvements.  There are  $5 million in grants available each year and business process re-engineering awards are available for states which are having difficulties.  We also need to improve access to healthy foods. The farm bill may continue for another year.  Congress is looking to save money on the program not spend more money.  Recognized states who have achieved good program delivery through high completion rates (law requires 95%) - Virgin Islands 99.3%, Wyoming 99.29%, North Dakota 98.87%, North Carolina 98.75%, Mississippi 98.6%, Kentucky 98.28%, Idaho 98.125%, Rhode Island 98.07%  

Swamped!!!

I have been busy today attending workshops and keeping notes along the way.  It may be tomorrow before I can update with the workshop details...but stayed tuned.  I will wap up the blog with the workshop details by the end of the day tomorrow.  Promise!!

Balance of Integrity & Access - SNAP QC Negatives - Monday 1:30

Balance of Integrity and Access - SNAP Negative Reviews

Monday 9/10/12 - 1:30

Fran Heil, Lana Rae Tapia, Dave Young - FNS

(PowerPoint will be added to PartnerWeb soon)  Fran - USDA promotes easy access to SNAP.  Need to ensure individuals who need the program have access to it.  Also, need to ensure that there is integrity within the program.  Focus of the presentation will be on negatives.  The switch in the focus of negative reviews was done intentional.  FNS needs to monitor that programs are delivered with a high degree of customer service.  This new process is simply a road to get us to a better place.  

Pulled most recent data reveals these estimates based on State Reported data as submitted through 9/6/12. The SNAP negative error rate is approximately 22%. Based upon this, there is not a single state who is except from submitting a negative correction action plans.  The following figures are based upon an analysis of reported error case:  60% of the problems are related directly to the notice being insufficient as described in the 310 Handbook (either the reason stated on the notice for the action is not specific, or the notice i not clear or the notice is not understandable or any combination of the three.  About  12% of the errors are missing notices completely.  About 29% of error cases had notices which were sufficient.   Based on information from Item J codes, which does not include timeliness, about 82% of the errors stem from notices that are not meeting notice of adverse action (NOAA) requirements.   About 8.5% stem from incorrect notice of missed interviews (NOMI).  About 6.5% of error cases occured despite notices being completely correct.  Looking closer at NOAA cases, about 10% of NOAA errors were missing notices or the notice was sent to an incorrect address.  About 19% of NOAA notices did not comply with appropriate timeframes.  About 37% of NOAA were not accurate or did not comtain the correct reason for the action.  About 7.5% of NOAA notices were not clearly understandable.  Proud to announce that NOMIs are no longer a problem which they have been in the past.  About 2% of notices lacked the required regulatory statements.  (Thanks to Jackson Crockett with FNS for providing verification/ clarifications on these statistics!)

This data supports that we still have a lot of system work to do.

Lana - Most of what she is saying, we already know.  Effective 10/11,  the review process for negatives changed.  Basically the focus in on looking to see if agency's notice was valid.  Expanded reviews have been elimanated and sampling is completed based upon the effective date.  Valid negative actions require the notice be correct and action is valid.  

There are 4 steps to the completion of a negative review. 1st step is to determine if the action is reviewable based on the 310 section 1332 - NSTR. Make sure you use this step and evaluate the case for NSTR.  Step 2 is to determine if the action under review was valid.  Ensure there something in the case record to support the action.  Notices impact this step.  Also, the timeiiness of the notice is evaluated.  This is required under the Food Stamp Act of 1977  specifically 7 CRF 273.13 (a)(2).  Is the notice easily understandable?  Step 3 is optional.  Involves making  collateral contacts to support case determination.  If utilized, make sure this step/action is well documented within the review file.  Step 4 requires you to determine if the reviewable action  was  valid or invalid. 

Always document the 245 so the person reviewing it can easily understand the case issues. And  include corrective actions references.  

Coding for the 245 was developed and expanded at request of state agencies to better determine root causes and error trending.

Questions:

Q:  Dave Young indicates that PowerPoint will be on the PartnerWeb shortly.

Q:  Sara from Wisconsin - Concerned about increase in their state error rate.  Will there be information sharing for corrective action planning purposed esp. on late notices? A: Fran - He is taking the position that problems being identified by States are problems for the entire SNAP program.  There is a payment accuracy workgroup which is meeting to discuss and refine this review process.  Everyone needs to take look at what the SNAP regulations have always required.  Identified problems will be resolved in multi-facet manner between States and FNS.  

Q:  Regarding the properly pended process from a State with a  60 days pending  period.  What is a possible improper pending error?  A: Fran - In properly pended situations, a state agency has taken an action to request valid  information necessary to determine SNAP eligibility.  If state has allowed 10 days to return information,  you should be in position to process the case within 30 days.  If a case is properly pended, it is possible to have a valid negative action which exceeds the 30 days.

Q:  If the stated income amount on a notice is incorrect, is there a variance tolerance allowed?  A:  Fran - The answer is no.  FNS doesn't tell you that the amount of income has to be on the notice.  But if it is, it must be correct.  Per regulations, the notices must be correct, clear and understandable.  "Clear and understandable" is subjective.  His advise is that States not be too specific but be specific enough with their language on their notices.  Clients should be able to understand the notice and why they are denied from program participation.   The notices should contain sufficient information to reflect if it is something that they can do something about it to fix it or is it something they can control.

Q:  Is it possible for FNS to publish income policy changes? Is there a set income calculation standard? A: Fran - States need to ask themselves if they are they doing it right?  There are set standards in regulations.  There may be options.  Annual Thrifty Food Plans are published by FNS.  There are general guidelines including conversion strategies and rounding methods. But there are also State options available.  Regulations also allow for the TANF income determination standard to be used for the SNAP program.  However, if federal staff determine differences, then there are problems for States

Q:  Delaware - How are federal reviewers maintained between regions?  Fran - He believes we are all on the same page.  Regional reviewers have conference calls where questions were discussed and everyone is provided with same answers.  There is consistency.  FNSQC will be publishing a Q&A on PartnerWeb shortly which addresses questions which have come in from all States.  Currently undergoing FNS management concurrence.  Contains 38 questions with very specific answers.  Open communication is most important thing through all of this.  But doesn't want FNS to be dictatorial to States.  

Q:  Guidance is helpful with allocation of IS resources into the correct areas of concern.

Fran - FNSQC only 1/4 way through the analysis of federal re-review data for FY12  presently.  Fran believes these negative review processing issues will be discussed for years.

Q:  Will there be guidance in negative coding?  We believe there are coding inconsistencies among States with how they are being applied and applied.  Requests FNS use associated analysis with caution.  A:  Fran - Jessica Shehin has declared FY12 to be the base year.  And FNS will approach cautiously.  There will be no bonuses for FFY12 for most improved performance.   It is a huge change for everyone.  He understands that everyone may not be reporting in the same manner.  

He asks States to use the FNSQCS data being provided.  New negative reports are being offered.  Use them.  Wants states to improve and offer future best practices to everyone.

Q:  Regarding coding on the 245,  how to code when the reason on notice is correct  but the timeliness is problematic.   A:  Fran - FNS has worked hard on coding.  If you have situation which you think are insufficient with existing codes, please share them.   Share with Fran and another panel member so your e-mail is not lost lost.

Q:  Virginia from California - Has FNS thought about making FY12 a "hold harmless" period?  What about batch printing which shows a 31st date when action was actually taken on the 30th day?  A:  Fran - FY12 is a base year.  Keep in mind that there are no sanctions in place for negatives. Q: What about a corrective action plan exception for FY12?  A: Fran - Let's work on getting it fixed.  We try to see what can be done but plans are important sources of information.  From Feds perspective they are not done until states are 9 months into the next FY.  Afraid of overall impact if there is not a corrective action requirement.  Customer service is important.  Need to try to get everyone to a better place - clients and staff.

Q:  Rosie from Idaho -Tragedy is that we can no longer identify the true "ineligibles" from the flawed notice events.   This makes corrective action planning difficult.  Workers may be processing correctly and cannot control the notice language.   A:  Fran - The old way didn't provide true data either.  There could have been circumstances where client was in fact eligible but was told otherwise.  Negative sampling was inconsistant and depending on how it was sampled, a State could get different results.  There might be a way to determine these types of occurrences if coding was broken apart better.  As discussed earlier, we need to figure out if codes does what we want it to.  Send him examples and suggestions.  

Q:  Rosie from Idaho - All State IS resources are currently devoted to Health Care Reform.  States have competing interests with limited resources.  FNS needs to understand this when recommending system enhancements.

Q:  Vesta from Maryland- The hard work of staff is lost in the details of error trending.  There will be political fallout with the releases of the FY12 error notification letters to the Governor.  Wants to be reinsured that the FNS letters next year will fully explain the true situation.  A:  Fran states everyone is aware and "gets it".  FY12 FNS notification letters will explain the major change in the negative review perspective. 

Maryland's PIRAMID Review Process - Monday 3:30

PIRAMID Pre-review:  Better than 'Pay and Chase' Case Reviews

Monday - 9/10/12 - 3:30

Vesta Kimble - Maryland - Deputy Executive Director 

Description:  Pre-review can prevent improper payments of SNAP and TANF and improper certification for Medicaid/CHIP.  Maryland has created an easy-to-use, 5 minute pre-review system that has quadrupled the number of case reviewed vs.  supervisory case reviews because it has a limited set of questions that trained peer pre-reviewers and supervisors answer after the eligibilty has been determined but before the benefits are issued.

Maryland's SNAP rates 7.68% in 10 to 3.37% in 12. Presently in sanction status for FY11.  Ranked #2 in most improved for FY12.  The SNAP caseload has doubled in last six years due to active outreach.  306,002 participants in '07 to 702,604 participants in '12

Meanwhile, staffing levels reduced by 12% in last 6 years.  1,841 FTE in '07 to 1,626 FTE in '12

Through QC reviewes, it was discovered that 2/3 of payment errors are related to staffing rushing through cases.  FY11 Breakdown: 37% worker, 6% due to data entry,  7% wages/SSA not checked, 11% case not updated timely, 17% policy errors and 22% were customer errors.

 Developed multiple strategies for reducing errors in FFY11 and FY12.  1) Mandatory on-line training and refresher quiz, 2) gold fork competitive awards for good performance with managers in attendance and 3) 12/11 Rushmore Consulting for QC made recommendations which were adapted.  Trianing modules are visually pleasing and  provide instantious results to the trainee.  Called "Get your SNAP on"

Comparison to old process "Pay & Chase"

Who does the reviews - Pay & Chases - only supervisrs/PRE reviews - peers, clerical leads, teams

Volume - Pay & Chase - tied to quota per staff / PRE reviews -expectation linked to volume of applications approved and RDs/changes processed 

Method - Pay &Chase - assumes reviewer knows their stuff / PRE reviews  - asks question which require an answer based upon policy

Useful - Pay &Chase - personnel evaluations / PRE reviews - drill down to error details, can be used not only for performance evaluations but also for program performance/corrective action 

Flexability - Pay &Chase - tied to legacy system which requires IS intervention for adjustments/updates / PRE - programmed in Excel - changes can be made overnight by non-IS staff

Mechanism for cleansing errors hiding in caseload. 

Recruited PRE review  workgroup to design comprised of field, program and QC.  Work group began meeting in  2/11 and designed review questions between March and July 2011. 194 specific questions were developed by the group for SNAP, TANF, Medicaid.  The questions are color coded by program on excel spreadsheet and goes through all elements of eligibility. 

This was trimmed down to 19 mandatory questions for all SNAP reviews with others optional based on local office desires/clientele, etc.  If some offices didn't expand the questions but trending patterns indicated they should,  they were politely invited to expand.

The process was reviewed by management in 7/11 and was up by 10/11.  It has an excel/visual basic front-end with SQL back end.  It has a devoted SQL server.  

Active Directory is on shared drives with controlled access rights. 

Each office has individual folder - Generator v 2007 runs reports and selects samples of active, closures, etc. optional for offices to use.

Starts with blank review form.  The review is posted with a specific title which contains details which identify case, results (labeled "efinal" if an error) Once a disposition is determined, the case "hops" automtically into folders such as "completed clean", "pending correction", "corrections updated", etc.  The review doesn't count in overall results until the correction are completed on the case.

Data elements automatically load into SQL server from which reports are drawn.

Training occured in local offices in 9/11.  A total of 326 reviewers were trained and  PIRAMID liaisons were developed. The training lasted for 1/2 day.

(PowerPoint of training module displayed) 

Main points of displayed trining module:  1) reviews are conducted on cases prior to posting cases for benefits, 2)  demographics auto fills from eligibility system to begin the PIRAMID review, 3) reports of final reviews list error cases first, 4) automatically e-mail errors to offices for correction, 5)auto saves each step in process and 6) produces a  top 10 list of errors identified. 

The initial goal was relayed to complete as many reviews as possible before an application is finalized or immediately after a RD or interim change is processed.  However, it was assigned that a minimum would be 10% of applications and 15% of RDs with efficiency measured  by QC reviews and ME results, OIG audits and program appeal requests.

The results of these reviews are also used for personnel evaluations as well as policy updates and the development of training for the on-line modules.

They are starting to see shift in ME adverse findings.  And as performance improves,  changes can be made to the questions on the Excel spreadsheet for the specific program under review.

To date, a total of 121,919 cases have been reviewed in FFY12. 

The lapsed time for reviews is under 10 minutes (11,327 in 2/12) with an average time per review of 5 minutes.

Improvement is also noted in reduced QC errors.  3,237 in FY11 to 2,078 in FY12 (but not all federal errors - some are informational processing errors such as an unsigned application)

The application allows for the tracking of the number of errors by specific questions posed on the spreadsheet and offices can pull up specifics in real time data.

Future enhancements include: 1) real time review log, 2) hyperlinks to program policy, 3) CARES 2.0 (eligibility) system incorporate the pre-review functionality into the business process thereby eliminating the PIRAMID application.

The spreadsheet contains a column with specific instructions on how to fix the error.  This is what the eligibility worker follows in making case corrections.

Eligibility staff voiced concerns about QC seeing the PIRAMID spreadsheet and case narrations.  The result was that they were trained on proper documentation/case narration.  (detailing what was fixed on a case not what the identified problems were) 

The spreadsheet filters each review template to match program and certification cycle under review.

  

Monday afternoon

The first full day has ended and it was hectic!!  Seeing friends and peers, meeting new people, trying to decide which workshop will be of the most benefit, sharing common concerns and seeing that ultimately we are all working on the same issues (modernization, staffing, growing caseloads).  WOW!!  What a day!  I will post the afternoon 3:30 session on the Maryland PIRAMID reviews immediately after this one.  The 1:30 SNAP negative review session will be posted as soon as I receive confirmation from FNS that the percentages are accurately described.  Please post any questions that come up!  Happy reading....

Workshop - QC Automation - Monday 10:30

QC Automation/SharePoint 9/10/12 10:30

Jean Ryan - Kentucky

Kentucky had done QC business the old fashioned way with old paper worksheets and case files.  Started looking for a way to automate the process.  In the past, supervisors had no way to review work other than wait on mail runs and pen and ink changes.  There was a postage expense related to moving hard copy materials around the state.  They were using a tremendous amount of paper.  42 file cabinets. When they relocated, the floor had to be reinforced to accommodate.  Presently down to 8 file cabinets.  Looked to IS staff for solution.  Now using SharePoint as a tool.

(Powerpoint)  Built folders on a shared drive. these folders contain the assigned review worksheets/schedules.  Analysts can only see the folders to what they are assigned but supervisors can see all folders.  This is based on permission levels.  Supervisors can go in at any time and look at their work.  They can answer processing questions in real time.  Notes are kept on case details as well as re-review findings.  Policy is also shared via SharePoint.  Files can be renamed by users.  Meeting notes are built and shared on this drive also.  Clerical support needs for QC teams were reduced and staff were reassigned to other areas.

QC reviewers can only see their folder.  They cannot see their peers.  But supervisors can see all staff assigned under them.  There is also a assignment tracking system which monitors case processing and compliance to processing timeframes.  (Excel document)  

When review is completed,  the file is moved to a closed file folder and is no longer contained in the reviewer's personal folder.  When cases are pulled for re-review, the case is copied from the closed case folder.  Cases are stored by active and negative.  The system has a robust search engine.  

Analysts create a snapshot of the screen print of the eligibility system material.  Other documents are scanned into the SharePoint file.  There are no paper QC review files created.  

Under a given review, the analyst creates a file containing eligibility screen prints, worksheets, verifications, etc.  The naming of the pieces of a review file have consistent naming structures for consistency.   That way, the federal re-reviewer can locate the various pieces of a review case easily.

They also keep separate notes such as client's non-cooperation folders were an analyst can keep processing notes to refer back to for efficiencies.  They can also double check their original assignments to ensure that they did not overlook something. 

To partner with regional staff, the offices have access to folders which provide error memorandums and other QC related communications.  These folders are also built with security structure similar to the QC staff structure.  This method allows the offices to review and respond to QC errors.  Additionally it allows a location point for an office to conduct analysis of their office's past errors when developing a corrective action plan.  

Management Evaluations are also stored in these regional folders.  This helps everyone in working through problems within a regional office.

QC findings are added regardless of dispositions.  Clean cases as well as those with significant findings are added under the regional office folders.  These folders are build by month under a master FFY.  They do not see the dropped case findings.  Under this approach, regional offices respond to the QC error within the same folder.  Responses are available to QC as well as policy.  Compliance to error responses  can be easily tracked.  

Questions:  

Q: Can you show us how the reviewer uses the 380-1?  A:  Worksheets are developed in an Excel program.  Jean is willing to share this workbook if you would like to see it.  Her e-mail address is j.ryan@ky.gov 

To address analyst training needs, there is a training folder with example workbooks set up for examples.  

Talk to your techs and see what solutions may be available to you.  

Q:  What are the costs associated with electronic storage?  A:  Not sure

Q:  If verifications come back in which require some type of comment, can the QC reviewer add some type of sticky note?  A:  Yes, but documentation through the workbook, not on the verification which was scanned into the review record.

Q:  Can the supervisor use this for other issues such as case management feedback?  A:  Yes but you need to build it.  Spreadsheets can be developed to address and track the various aspects of case processing.

Q:  What columns are on your case tracking spreadsheet?  A:  Case assignment date, date interview letter is sent, date of interview, date completed, etc.  

Q:  Do you have reviewers who enter into QCS themselves?  a:  Yes.  Supervisors clear the case for entry into QCS system.  

Q:  When supervisors clear the case, do they create the PDF file?  A:  Yes, they move the case into the FFY closed folder.  For re-review, the closed case is copied and moved into another folder from which a CD is burnt.  For FNS timeliness reviews, only the relevant documents are captured and shared.  If any additional documents were needed, they were provided as a hard copy.

Q:  Fran asked Jean to share what she has done with him.  He indicates that this is the direction that they are moving toward on a Federal level.  His vision is that all reviews will be built this way in the future.

Jean believes the process is very user friendly and people adapt to it easily.

Jean is willing to provide more specifics and answer any questions.  Just contact her.

Opening Session Monday 8:30

9/10/12 - General Session

Relentless  pursuit of programmatic efficiencies through innovation of Florida's central region ACCESS program - Panel Discussion

William D'Aiuto - central region headquarters in Orlando - 16 counties - 4.4 million in population - 1700 staff - 1.1 million clients in region - 

Phillip Scarpelli - 6 regions statewide - diverse populations - tourist based economy - June 2012, state has 3.4 million clients - 12th highest in nation for unemployment at 8.5% - 3rd highest in foreclosure rate - In '03-'04 reduction in staff to 817 FTE and at the same time had significant caseload growth

Jorge Martinez - aggressive modernization with standardized processes statewide.  Required changes to policies.  Was a transition to process center & store fronts which established a paradigm shift with establishment of community partners which created a network. 

applications accepted at store fronts then shifted to processing center - community partners established which assisted clients with applications

Sharron Washington - 65% of staff telecommute through Adobe connect software product online meetings & training - Have virtual policy consultants which were created in 2006 who answers questions for front line staff who use Adobe connect via chat rooms - ask questions and gain answers - Also have virtual intake units with standardized process & consistent practices - able to gain efficiencies in that staff were redirected to processing - reduced customer service call time - repurpose 20% of intake staff - reduced hold time by 72% - reduced call abandonment rate by 64% - reduced telephone interview time by 23% - $167,000 projected annual cost savings 

William D'aiuto- community partner enhancements  - community partner with a shared vision - awarded a 3 yr grant with FNS - State provided technological resources - collaborated with 2 partners with mobile units - developed operations manual with resources - trained a diverse group of volunteers - special unit for partners to call in for technical support needs - 

9.5 days application average turn around - QC error rate dropped from 7% to less than 1%

Brian Donohoe - Alaska - has been involved in lean and case management work - focus how to do a lot more with a lot less - process mgm't was way to go - 530 staff - caseworkers 300 statewide - legacy system  for eligibility 3 days for 80% of cases - 

Jeri Flora - Florida - central region is shining star of state - loves to do new things - She started in 2007 in Florida - believes Florida is a progressive state - revamped QC - corrective action involves examining data - understanding it and taking action - solutions can create new problems - constant work - goal is to provide good customer service

Kaye Craft - south carolina - SNAP and TANF only - not medical programs - regionalized specialist work - high caseload growth and reduction in staff - developed efficiencies to improve service delivery - SCOSA system is universal caseload system - cases were scanned into virtual case files developed in 2009 and rolled out in 2010 - casework was equalized - 2012 regionalized specialized casework - applications, recertifications, semi-annual reports - has masters who specialize in one area available for assistance and training -  responsible management is a "must" at all levels - QC is working on ways to assign responsibility for problems - 

Larry Goolsby - questions - 

Q: Julie from Michigan - more info about community partners.  do you pay them? -A:  William from Florida -  750ish partners - vary - faith based, pantries, etc.  work form small mom and pop to very large groups - Jorge from Florida - some are paid/reimbursed.  may fund internet access or provide a computer 

Jean from Maine - training for community partners?- A: Jorge from Florida - yes, make sure they have tools and contact details - usually about a day but may be longer - has liaisons for community who recruit and train - A: Jeri from Florida -serve as primary contact for community partners - keep them informed of program changes - will be introducing scanners for community partners and will be providing conversion training for them

Q:Chris from Illinois - waiver for community partners in order to determine eligibility? A: Jeri - community partners only take application but merit staff determine eligibility - community partners interview clients following template and ask clients to provide verifications

Q:Carol from Iowa - reduced time for telephone interviews, how did you determine?  looking for tips on how it as reduced - A:Sharron from Florida - staff are very flexible with an interview script - tracked by software - can shift staff as needed based upon demand - supervisors can monitor calls to ensure quality

Q: what program is used for call system? A: William from Florida - vive call system - has 3 call systems presently -  Wayne is contact point for Florida - 450 -500 staff total - pat live is contract vendor - automated voice software for basic inquires - tracks calls by client's SSN and phone numbers - 3.6 million calls per month with 65% handled by VRU.  is developing a new system where call will interface with legacy system to provide basic case details.  

A:Kaye from South Carolina - call center was overwhelmed - last week they developed a system were the client was provided with a pass code when calling in to more readily identify the reason for the call and to sort interviews from inquiries from change reporters

Q:  Rosie from Idaho - streamlining of policy? A: Jeri - always looking for ways to simplify policy - Presently they align TANF and SNAP certification periods and auto close refugee cases (8 month program) - working through legislature to align TANF and SNAP disqualification process -

Q:Larry from APHSA - where are you with aligning with HCR? A:Brian from Alaska - so much being discussed right now - 

A: Jeri from Florida - there are more questions than answers right now

Q: Virginia from CA - percentage of TANF clients on SNAP? A: Brian from Alaska - thinks it is about 30% - A: Kaye from SC- SC is less due to reduction of TANF caseload - A:  Jeri from Florida - agrees with kaye

Q:  Larry from APHSA - where is Alaska in automation? A: Brian from Alaska - bandwidth is an issue for Alaska due to remote locations - there is no resolution for this and is a huge challenge - partnering with university system who has best network.

Monday Update

Sitting poolside presently at the Rosen Center.  It is humid and 90 degrees.  The morning has been spent in a general session and my first workshop.  I am attaching my notes as seperate posts.  Please comment any questions you may have as you read along.