Phase II Findings: Error Rate Methodology Pilot
Executive Summary, I. Introduction, II. Methodology, III. Measuring Improper Payments in Nine States, IV. Findings and Next Steps, V. Recommendations, Appendices: Appendix A: Arkansas, Appendix B: Colorado, Appendix C: Illinois, Appendix D: Ohio, Appendix E: Record Review Worksheet, Appendix F: Data Entry Form, Appendix G: Telephone Discussion Guide, Appendix H: Arizona, Appendix I: California, Appendix J: Kansas, Appendix K: Nebraska, Appendix L: New Hampshire
New Hampshire is a highly centralized, State-administered State with 12 district offices. These offices take applications, determine eligibility, and provide services for all of the assistance programs. New Hampshire contracts with 36 centers, which are monitored once every 2 years, unless a problem arises.
Improper Payments Process
New Hampshire has a task force for improper payments that crosses program areas in the Department of Health and Human Services. The task force began after the State’s chief policy staff attended the State Advisory Meeting in 2004. The State is developing rules within the Office of Special Investigations to cover improper payments, but does not feel that the statutes that are in effect apply specifically to child care, but apply more generally. The State plan does have a definition for improper payments: “Improper Payments are defined as payments that should not have been made and payments that were made for the incorrect amount under statutory, contractual, administrative, or other legally applicable requirements.” Fraud is defined as “intentional improper billing or payment.”
Current policies and practices to identify and verify improper payments are being formalized. Information on improper payments comes from a variety of sources:
- Educating the provider community to encourage referrals;
- Conducting a front-end prevention effort to identify training needs;
- Establishing Internet billing to reduce error and potential fraud in the provider billing process;
- Developing queries of the automated system for error-prone profiling; and
- Developing automated exception reports to identify potential areas where improper payments may be occurring.
Funding to address improper payments comes from the State’s high performance bonus and the program’s cost allocation plan to pay for an Improper Payments Coordinator for the department.
An adjustment process for both underpayments and overpayments allows the client or provider to return the check, write a reimbursement check, or deduct the amount out of the next check. Recovered improper payments are returned to the General Fund and are not returned to the program.
Automation
The New Heights system is a Windows-based system activated in 2000 that integrates all programs in the Division of Family Assistance, including Temporary Assistance for Needy Families, Food Stamps, Medicaid, and child care agencies. The system captures family data and automatically determines eligibility. The case file is fully integrated and a single query can determine if a client is receiving services in another program.
Currently, licensing is not integrated with the New Heights system. Providers and payments are housed within the Statewide Automated Child Welfare Information System, New Hampshire Bridges. This system is a transfer system and has undergone considerable modification. The New Heights system uses the New Hampshire Bridges provider number when authorizing service for a child within the New Heights system. The information is passed through the interface during a nightly batch run, which initiates and completes the process.