Second Error Rate Pilot Report
Download this document in Word (1,076 KB) or PDF (1.28 MB)
Appendix B. Kansas
A. Organizational Structure
The Division of Economic and Employment Support within the Kansas Department of Social and Rehabilitation Services (SRS) administers the Child Care Subsidy Program. In six regional offices and 39 county offices, SRS provides eligibility services to the State’s 105 counties. In FY 2005, average per month assistance was provided through 6,450 providers to over 18,800 children in 10,200 families.
Kansas has processes in place at both the Central and Regional level to handle improper payments. At the Central Office level, the Economic and Employment Support section provides supervision and oversight of Quality Assurance and Performance Improvement functions. At the Regional Office level, both the Economic and Employment Support and the Performance Improvement divisions are tasked with the responsibility to identify and correct improper payments.
B. Overview of the Child Care Eligibility Process
The Kansas Child Care Subsidy Program allows families the choice to select the child care provider that best meets their needs. Parents may use licensed centers, licensed family childcare homes, and group homes as well as license exempt centers and homes.
To be eligible for child care assistance, families must have an income less than 185 percent of the Federal Poverty Level (FPL), be a resident of the State, have children under the age of 13 (or age 19 for special care needs), be employed or in an approved education or training activity, and, when applicable, cooperate with child support enforcement. A monthly family payment is assessed to income eligible clients with income at or over 70 percent of the FPL. Kansas does not have a resource limit as a condition of eligibility.
The basis of the child care payment is the hours of need. Payment rates vary from county to county (excluding the In-Home care rate) and for special needs. Benefits are determined prospectively, i.e. for the upcoming month. Reauthorization of eligibility is on an annual basis. Clients are responsible for reporting specific types of changes (household composition, income, residence, and provider changes) within 10 days of the change. With some exceptions for changes requiring verification, the change takes effect the following month.
C. Improper Payment Process
Kansas defines an underpayment as the amount a provider was due but did not receive and an overpayment as either assistance to a client or a payment to a provider over the entitled amount. Overpayments are also classified according to cause: agency, client, or provider. Client and provider overpayments may be further categorized as fraudulent if a court of appropriate jurisdiction determines that the actions or omissions have been willful.
Kansas identifies improper payments through a variety of methods listed below:
- The automated eligibility system, KSCARES, contains a number of edits that identify anomalies dealing with income, hours, duplicate eligibility, and multiple providers.
- The system generates reports that identify cases reporting excessive hours or providers whose capacity exceeds their licensing.
- Kansas staff members currently complete the following audits and quality assurance reviews designed to improve payment accuracy:
- Targeted reviews on specific populations and/or portions of eligibility and payment such as attendance records, in-home child care cases, special needs, and child welfare cases;
- General statewide quality assurance reviews initiated in October 2005 on a randomly selected sample of 80 cases per month; and
- Provider audits involving reviews of 10 randomly selected providers per month, initiated with EBT in June 2005, to audit hours of care charges against attendance records and contracts.
- Kansas contracted with a firm to develop software, which would track all case review findings and provide aggregate review data. The system, which is web based, provides detailed tracking information on all reviews, including the child care reviews. The software costs $75,000 with an 18 percent maintenance costs agreement.
D. Case Reviews
Kansas Performance Improvement staff completed two targeted child care quality assurance reviews over the past two years. One focused on in-home care as it was believed to be more error prone than other types of care. The review findings did not support this belief. The second review focused on field staff adhering to State policy and procedures in the area of social services child care. The review tool was a version of the Food Stamp quality control review sheet. The review began with a reading of the case record. All aspects of eligibility were reviewed. Each element was re-verified with collateral contacts (customer, employers, providers, etc.) All relevant data bases were queried (CSE – Child Support, EBT, FACTS – Child Welfare, BARI/BASI – wages and unemployment, KDHE – vital records, EATTs – licensing, KAECSES – TANF, Food Stamps, General Assistance, Medicaid). The information was compared to the customer’s June 2006 child care payment.
Kansas chose to participate in the pilot in order to learn the error rate review methodology undergoing a pilot test. From the Kansas perspective, because the pilot error rate review model was limited to a desk audit it was less involved than the most recent State child care review, which involved contacting employers and verifying income.
For the pilot, the Kansas Review Team consisted of three Quality Assurance supervisors (Topeka, Wichita, Kansas City) and three Quality Assurance Specialists. The team also conducted a re-review of all cases by having a second team member conduct the review. When both team members agreed on an error, they sent a notice to the local Social Rehabilitation Services (SRS) office for corrective action. The Review Team reviewed all records centrally in Topeka. Kansas modified the Record Review Worksheet to include “Yes” or “No” questions to reduce the amount of written narration for the reviewers.
Prior the pilot, the Quality Assurance Specialists had conducted two reviews of child care cases in 2006. These reviews were more extensive, involving re-verification of all elements of eligibility, queries of relevant State databases, and follow-up contacts with clients, employers, and providers.
E. Automation
The Kansas System for Child Care and Realizing Economic Self Sufficiency (KsCARES) has played a significant role in preventing and identifying improper payments in the subsidized child care program. Kansas obtained the system from Wyoming and then modified it extensively to fit its policy requirements.
KsCARES has extensive edits that help enforce policies and perform the calculations used for eligibility determination, including:
- Indicating whether income is countable based on income type;
- Enforcing maximum hours for child care service plans during a month;
- Preventing duplicate benefit issuances; and
- Determining the reimbursement rates automatically, based on the child's age, provider's individual rate, and the State’s maximum rates.
KsCARES is a mainframe system that Kansas has modified extensively since the 1990’s. Some of the modifications enhance the sharing of information with the systems supporting Temporary Assistance for Needy Families, Food Stamps (KAECSES) and child care licensing (KDHE/CLARIS). KsCARES processes all eligibility determinations automatically, but workers may perform some eligibility calculations off-line and enter the results into the system. However, KsCARES computes rates to ensure accuracy. The system will pay the lesser rate between the provider maximum, State, and private pay rates.
KsCARES has many system edits that improve payment accuracy including: case record search when entering application information, “215” hour block, duplicate plans, automatic income eligibility test, the number of placements and maximums for licensed home, child on more than one case, automation of provider rates, and provider rates automatically pay lesser of provider/SRS rate. Also, Kansas has recently changed the child care payment system to automatically deduct a percentage of the overpayment from each monthly payment.
Kansas installed a new Electronic Benefits Transfer (EBT) system in June, 2005 that handles all aspects of billing. Providers no longer send in attendance sheets but use a point-of-service (POS) system or a 1-800 number to submit attendance records electronically. Kansas plans to establish a system of random audits of providers.
F. Next Steps
Based on the experience with the error rate pilot Kansas took the following actions:
- Prior to the pilot, Kansas had completed child care quality control (QC) reviews for the month of October 2005, the second month of statewide payments using the new child care EBT payment system. Kansas was already aware of the error causes found in the pilot and had conducted statewide refresher training in June 2006 to address these errors. The training focused on hours of care, use of child care plan hour worksheets, computation of income, use of income worksheets to document computations, and general case documentation.
- Kansas continues to complete monthly Child Care QC reviews and uses the results of these reviews to inform training needs. Kansas is updating the Child Care Personnel Trainer and Training Academy to emphasize case documentation and computation of hours of care needed and income. Kansas requires this training for all new workers and for others as needed. Supervisors now complete monthly case reviews for the Child Care Assistance Program.
- Kansas hired a child care trainer in July 2006 to revise training materials and conduct several training sessions for eligibility staff. The QC unit compiles results monthly for regional administrators to keep them informed about findings and areas needing improvement. Supervisory case reviews at the regional level now include child care cases.
- Kansas contracted with a firm to develop software to track all case review findings and provide aggregate review data. The web based system tracks aggregate case review data for the mandatory Food Stamp reviews and the child care reviews. The child care reviews began in July 2006. The software costs $75,000 with an 18 percent maintenance costs agreement.
Kansas Site Visit Participants
Alice Womack – Program Administrator SRS
Sally Hargis – Kansas SRS, Family and Children Programs, Policy
Darlene Kinion – Kansas SRS, Quality Assurance Specialist
Dennis Priest – Kansas SRS, Program Administrator
Diane Dykstra – Kansas SRS Performance Improvement Manager
Tonie Dugan – Kansas Quality Assurance Supervisor (Topeka Unit)
Diane Britton – Kansas Quality Assurance Supervisor (Wichita Unit)
Cindy Barshesky – Kansas Quality Assurance Supervisor (Kansas City Unit)
Kelly Ross - Kansas Quality Assurance Specialist
Cletus Linenberger – Kansas Quality Assurance Specialist
John Gibson – Kansas Quality Assurance Specialist
Allen Mossman – Kansas SRS, Training
Rachel Katuin – Kansas SRS
Jean Morgan – Kansas SRS, Policy
Nancy Caudle – Kansas EES, Management Evaluation
Exhibit B-1. Kansas Record Review Worksheet
| 7-31-06 WORKSHEET FOR Child Care QUALITY CONTROL REVIEWS |
||||||||
|---|---|---|---|---|---|---|---|---|
| A. IDENTIFYING INFORMATION | B. PERSONS LIVING IN THE HOME | |||||||
| 1. Region | NAME | BIRTH DATE | AGE | RELATIONSHIP OR SIGNIFICANCE |
SOCIAL SECURITY NUMBER | Sample child | ||
| 2. CASE NAME | 1 | | | | ||||||
| 3. ADDRESS | 2 | | | | ||||||
| 3 | | | | |||||||
| 4. PHONE NUMBER | 4 | | | | ||||||
| 5. Child’s name | 5 | | | | ||||||
| 6. Child’s ID number | 6 | | | | ||||||
| 7. Case Number | 7 | | | | ||||||
| 8. Review Number | 8 | | | | ||||||
| 9. REVIEW DATE | 9 | | | | ||||||
| 10. Date of Most Recent child care plan | 10 | | | | ||||||
| 11. Most Recent Action | C. SIGNIFICANT PERSONS NOT LIVING IN THE HOME | ||||||
| A. DATE | NAME | RELATIONSHIP OR SIGNIFICANCE |
SOCIAL SECURITY NUMBER | ADDRESS | PHONE NUMBER | FINANCIAL SUPPORT | |
| B. TYPE | |||||||
| 12. Reviewer | 11 | | | | |||||
| 13. Date Assigned | 12 | | | | |||||
| 13 | | | | ||||||
| D. REVIEW FINDINGS | |||||||
| 14. Date of Case reading | Child Care | |
| CASE Eligibility | PAYMENT FINDING | |
| SRS Payment under Review ____________ | ||
| c Correct c Improper Payment Amount $______ | ||
| 18. DATE COMPLETED | c Drop | c Underpayment $ ______ |
| 19. SUPERVISOR | Drop Reason | c Overpayment $ ______ |
| 20. DATE CLEARED | c Ineligible $ ______ | |
Coding on worksheet
1 = Correct
C= Case error
2= Agency caused error
P= Payment error
3= Customer caused error
ELEMENTS OF ELIGIBILITY AND PAYMENT DETERMINATION Review No
| ELEMENTS OF ELIGIBILITY AND
PAYMENT DETERMINATION |
QC ANALYSIS OF CASE RECORD (Pertinent facts, sources of verification, reliability, gaps or deficiencies) |
FINDINGS OF FIELD INVESTIGATION (Facts obtained, verification and substantiation, nature or errors) |
CC |
(1) |
(2) |
(3) |
(4) |
|
SECTION I. STATE CHILD CARE PROGRAM FORMS |
|
|
100 APPLICATION FORMS
|
Date of Application: _______________
Date Child Care Plan approved: _______________
Child Care Plan from ____________ to ____________
First Month of Plan: _______________
Income worksheet: ___ Yes ___ No
Hours of Care worksheet: ___ Yes ___ No
|
Case reviewed in last 12 month: ___ Yes ___ No ___N/A
Most recent application approved within 30 days: ___ Yes ___ No ___ Unable to determine
Approval Notice sent to consumer: ___ Yes ___ No Reporting requirements notice sent to consumer: ___ Yes ___ No Copy of case plan sent to consumer: ___ Yes ___ No
Verification of income in record: ___ Yes ___ No Verification of work hours in record: ___ Yes ___ No
|
C
1 2
3
|
|
SECTION II. PRIORITY GROUP PLACEMENT |
|
|
200 PRIORITY GROUP PLACEMENT |
Case was set up under what subtype.
___ JO ___ MO ___SS
__ N/A see element 320 |
Child care type correct: ___ Yes ___ No
If no, explain:
__ N/A see element 320 |
C
P
1 2 3
|
|
SECTION III. GENERAL PROGRAM REQUIREMENTS |
|
|
300 QUALIFYING HEAD OF HOUSEHOLD |
___ Parent ___ Other (list) ___ Step-parent
___ Legal Guardian
___ Needy Caretaker Relative
___ Spouse of Needy Caretaker Relative
Cooperating with CSE: ___ Yes ___ No
If not cooperating with CSE, is there good cause: ___ Yes ___ No
|
Were all family members properly included in the household and listed on CAMA? ___ Yes ___ No explain
Was a CSE referral found in KsCARES, KAECSES, or by paper in the case record? __ Yes __ No explain
|
C
P
1 2 3
|
310 RESIDENCY |
Residents of Kansas: ___ Yes ___ No |
Child met residency requirement: ___ Yes ___ No explain
|
C 1 2 P 3 |
320 HOUSEHOLD MEMBERS |
N/A ______ See element 200 The customer is employed by (the employer of record) or in school (record States) _____________
Case was set up under what subtype ___ EM ___ ET |
N/A ______ See element 200
Child care type correct: ___ Yes ___ No If no, explain:
|
1 2 C 3 P |
330 QUALIFYING CHILD |
Age of child: ________ Under 13 age ___ Yes ___ No go to next question Between 13 & 18 (under 19) is the child physically or mentally incapable of self care or under court supervision: ___ Yes ___ No ( Ineligible) Child is a special needs child: ___ Yes ___ No There is a need for child care: ___ Yes ____ No ( Ineligible) |
Child eligible to received child care assistance: ___ Yes ___ No If no, explain: All documentation for special needs in case record. __ Yes __ No Child is citizen of the United States: ___ Yes ___ No ( Ineligible if alien not met)
Child is resident Alien: ___ Yes ___ No
If not citizen or resident alien, Social Services involvement: ___ Yes ___ No
|
1
2 C
3 P |
340 QUALIFYING CARE |
________ Hours of Care Authorized
Calculation of hours:
|
CASE RECORD INCLUDING TAF AND FS CASES IF ANY.
|
1
2 C
3 P |
| 350 QUALIFYING PROVIDER ARRANGEMENT | 1 st Provider Name: ___________________________________
Provider Address: ___________________________________
___________________________________ PLHC/CHCP Provider Type: ___ LIC ___ REG ___ REL ___ INH ___ CCC
2 nd Provider Name: ___________________________________
Provider Address: ___________________________________
___________________________________
Provider Type: ___ LIC ___ REG ___ REL ___ INH ___ CCC |
Was the provider listed on KSCARES also the provider paid (provider on sample assignment list) by the client: ___ Yes ___ No Explain: |
1
2 C
3 P |
360 PROVIDER REQUIREMENTS
|
Provider on PRLI (enrolled as qualified provider). __ Yes ___ NO
PRR2 is another helpful screen |
Provider requirements were met: ___ Yes ___ No If no, explain:
Child with in home provider and provider was enrolled for that child (see memo from Regional provider manager) _ Yes _ No _ NA
Child in the home of a relative provider and is related to that provider (verified ) ____ Yes ____ No ___ NA |
1
2 C
3 P |
|
SECTION IV. INCOME AND PAYMENTS |
|
|
400 INCOME |
EMPLOYMENT
#___ Employer of Record:________________________________
#___ Employer of Record:________________________________
Calculation: CHILD SUPPORT
Budgeted: _______ Calculation:
___ No changes AORD
___ Change reported on ____________ acted on ____________
|
Case record |
1
2 C
3 P |
410 INCOME ELIGIBILITY |
Household financially eligible: ___ Yes ___ No
Family Fee: _______ |
Financial eligibility & family fee were determined correctly: ___ Yes ___ No
Corrected family fee: _______
Explain:
|
1
2 C
3 P |
420 PAYMENTS, GENERAL |
Payments made on CHCP: __________ |
Payments were made correctly: ___ Yes ___ No
If no, explain:
|
1
2 C
3 P |
430 PAYMENTS / COMPUTATIONS |
Case manager used conversion 4.3, 2.15, ?, : Comments: |
___ Correct
___ Overpayment of: ____________
___ Underpayment of: ____________
|
1
2 C
3 P |
June, 2007