Business Case
While all states work hard to provide Early Intervention (EI) services to children with special needs, many states have fragmented and/or proprietary EI systems that oftentimes do not identify these children early enough to make treatment efficient.
Or these systems fail to provide the coordination necessary to identify and attain the best services for the special-needs child. The systems may be unable to provide equal, quality, and consistent access to the available Early Intervention services, or do not have access to historical data for predictive analysis and reporting.
New York needed a centralized, Web-based, state-of-the-art system that electronically manages Early Intervention Program (EIP) administrative tasks and provides for information exchanges. This system needed to support the EIP’s service delivery, financial, administration, and management activities at both the local and state levels.
These activities include initial intake, evaluation, eligibility determination, Individualized Family Service Plan development, service provision, and all financial aspects including insurance, claiming, payments, and Medicaid reimbursement.
The Solution
CMA provided a full project team including project management, technical and business analysis leads, data conversion, testing, reporting and training and documentation specialists.
This team designed, built, tested, and deployed a Curam based solution entitled the New York Early Intervention System (NYEIS). This multi-year project included extensive requirements validation and verification, reporting and data conversion/migration as well as training and help desk services for all counties in New York State. CMA continues to maintain and support operations of NYEIS today.
The system provides many enhanced features, designed to help Early Intervention workers optimize their daily and long-term objectives. CMA’s single sign-on, browser-based solution is supported by role-based and fully configurable security. Its task-driven workflow allows authorized users to easily identify and complete their required tasks.
The Business Rules engine ensures the system will adhere to each state’s rules and the built-in activity and audit logging will track all updates to the system. The data model is designed to maintain all historical and current data for a member under a single integrated case and the system further enhances a user’s experience by providing the ability to store and access attachments online and to temporarily reactivate closed cases for re-referral or update.
Another improvement is to reduce costs. CMA’s COTS-based solution will minimize costs by providing a configurable and scalable solution that receives regular product upgrades. CMA’s Data Center, EI Customer Care Center, and EI Datamart, with over 100 available reports, provide additional opportunities for cost savings as these existing resources can be leveraged by other states.
CMA’s solution is compliant with security requirements for HIPAA/HITECH, and meets the CMS Critical Success Factors for Federal Funding. The system also meets the federal standards for HL7/HIPAA transactional processing and includes automated adjustment processing for retroactive insurance changes. CMA provided training to each county and help desk support for the NYEIS application at our dedicated help desk facility.
The Results
By consolidating all these systems with CMA’s solution, New York was able to achieve many advantages and improvements for over 13,000 users, who serve 225,000 enrolled children. The New York State Early Intervention System (NYEIS) adjudicates over 150,000 new day Early Intervention claims per week while providing the ability to directly bill Medicaid/commercial insurance organizations for these services.