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Centralized Facility Eligibility Unit
Applications Design Event Report Out
“Making History”
The Opportunity
Jaili Cunningham Department of Human Services Income Maintenance Administrator
Team Making History CFEU Applications Design Kaizen Team
3
Team Making History
Lean Co-Facilitators Matt Haynes Ann Hogle
Iowa Department of Human Services
Team Members Jaili Cunningham, DHS CCA
Amie Schippa, DHS CFEU Erica Fitch, DHS CFEU Dawn Helm, DHS CFEU
Elaine Walker, DHS CFEU Kimberly Anderson, DHS DM SA
Patsy Walker, DHS CFEU
4
Scope Amie
• This event will design a standardized, efficient, and clear method of processing CFEU applications from the time an application is received by CFEU to the time it is completed and forwarded for ongoing case maintenance.
5
Objectives Amie
• Design a process that includes clear and efficient utilization of ECF.
• Create a process flow map for the new process.
• Document the new process in text to use for training staff and reference immediately after the event (Mon. 3/7/11)
• Streamline any and all processes/procedures we can and clearly detail standardized steps (i.e. attributions, Miller Trust, burial contracts, application form to be utilized, narrative section, use of addendum, etc.)
• Establish comfortable case load levels
• Establish better communication with facilities
• Create standardized resource list for staff reference
• Establish a sense of a “single team” between Apps and Ongoing staff & determine best way to share resources
• Clearly define the appeals process
• Test the new process prior to training all staff
6
Goals Amie
• Reduce lead time for pending applications to within 1 working day of receipt of the application
• Reduce lead time for completing RFIs by app workers to w/in 1 working day of the app being pended
• Ensure application decisions are made within 60 days of the application date, meeting the established KPM.
• Improve the work environment as measured by a 50% reduction of overtime.
• Determine a reasonable carryover case load for CFEU app workers.
Kaizen Methodology Ann
• Clear objectives • Team process • Tight focus on time • Focus on reducing steps, reworks,
duplications • Necessary resources immediately available • Immediate results (new process designed
by end of 3-days)
8
Trends Elaine
– Baby Boomers getting older & have more resources – Most Baby Boomers are still married and may enter facility
together – State cut-backs/Layoffs/Hiring freeze – Healthcare Reform – Potentially more centralization/smaller government – Move from more direct service contact we provide much
lighter & remote touch – Facilities more stringent on accepting individuals – Facility staff turnover is increasing, staff not trained or
knowledgeable – Supervisor ratio worse – less time (quality) with staff – Iowa has higher percentage of elderly population
9
SWOT Erica
• Some of the Strengths of the CFEU – Intake workers, ongoing workers, all facility
resources together “centralized” – One program “Facilities” – Smart, hardworking, dedicated, GREAT staff – Less staff can process apps when working
with one program – Info to one place rather than across the state – Policies can be consistently applied more
easily
10
SWOT Erica
• Select Weaknesses
– Not fully staffed at 20, until January 16/18 workers new to facilities, 8-9 new to DHS
– Not enough tools, resources, etc capabilities, ISIS not ready
– Rollout – Less client contact, no interviewing required – Less communication with clients, no time – Unable to get files/attributions from local
offices 11
SWOT Erica
• Select Opportunities
– Model for centralization, example for others – Policy change to serve all parties – Standardize/streamline processes – Better communication with facilities – Process with less staff – Help to develop other centralized units – Develop process that will help throughout the
state
12
SWOT Erica
• Select Threats – The feeling if we do not succeed – the unit will
be discontinued – Layoffs/cutbacks – the effect on caseload and
supervisor/employee ratio – Systems down – Higher caseloads/applications – Facility turnover – Budget cuts
13
Brainstorming Kim
• Revise the Application • Develop case face sheet for Facility/Waiver
cases • Revise other necessary forms • Support staff pending applications • Increase communication • Increase training based upon needs • New process for ECF • Revise imperative policies • Delete the Application Register
• Identifies – Impact to
customer – Difficulty
implementing
• Helps to rate/rank solutions to resolve issues while identifying ease of implementation
De-Selection Process Kim
I III
II IV
I
M
P
A
C
T
D I F F I C U L T Y
Application, Appeals & Attribution Dawn
16
New Applications CFEU
Ap
plica
tion
Wor
ker
Job
Sear
chAp
plica
tion
Wor
ker
Clie
ntSc
an C
ente
rSu
ppor
t Sta
ff
Send in Application
Receive Application
Index Application
with 00
Delay2 days
Open Process LIst
Sort by document type
Clear app by checking ABC
NIs this a Y CFEU App
YDenied past 30 days N
or dup
NIs it a Y
redert
NIs this a Y
Review
Assign to appropriate
county process list
Assign to Rev. worker alpha split – put in process list
Assign to alpha-split
redert worker process list
Log App into App Log
Assign to previous App
worker
Log app into App Log
Assign App to intake worker TPQ2 Request
Add Case # & State ID into
ECF Document
Put into assigned workers
process list
Pend spouse on 55-FBU w/
143-643 A type
Y
Spouse N
TPQ2 Request
Pend Application
Check ECF process list
Assess App and attached
info
NKnow
Facility Y Name
RFI requests name of facility
Fax CAR/LOC form to Facility& upload ECF
Upload App and info to
catalog
Complete Face Sheet
RFI? NY
Type RFI Letter
Set Tickler 3 days after due date in LF01- (due on this
date, deny on this date)
Print 2 copies Upload to ECFKeep 1 copy
with face sheet in 1-31 file
Mail copy to client/POA with
Packet
YExtension N Requested
YExtension N
Granted
Delete previous tickler
and set new tickler
Make RFI to new due date
in 1-31 fileDelay
Document in OLN missing information
Set tickler for 17th day
N Client info rec. by Y
day 17
Re-pend application
Answer ISIS Milesones
NICF? Y
Decision from IME via ISIS
milestone
Answer ISIS milestone
Process Application
Put case in ongoing
worker # TDO1
Upload face sheet to ECF
NAll req. info Received Y from client
Shred RFI Upload face sheet End
End
Delay0-30 days
Fax CAR/LOC form to Facility
– upload in ECF
Additional Info NNeeded
from client
Receive faxed CAR/LOC form
Send CAR to App worker
Send LOC assessment to
IME
Review Face Sheet
Approve Y
N
Deny case in ABC
Upload Face Sheet
NICF? Y
YCase
Activity N Report
IME Delay
Decision from IME via ISIS
milestone
Answer ISIS MIlestone
Process Application
Send IS Intent to Transfer
Letter in cases of CS
Set Tickler for due date if IS
intent to transfer CS
Put case in ongoing
worker # TD01
Upload Facesheet to
ECFEnd
Facility Delay
Send Second CAR/LOC to Facility – no earlier than 1
week from first request
Note on initial request form if this is second
request
Receive CAR
Facility Delay
Delay14 days
Delay 1day
DelayIME
Send IS intent to transfer letter if CS
Set tickler due date of IS
Intent Letter for CS
3 out to Attribution
4 in from Attribution
End
2 out
2 in
Deny apps for not providing info in ABC
Appeals
Superv
isor
Polic
yA
pplic
ation W
ork
er
Appeals
Clie
nt/P
OA
Client receives NOD
Appeal in writing
AppWorker Y
N
Receive Req for Appeal in
writing
Receive Request for Appeal from
client in writing
E-Mail Appeal to Appeals Department
Receive e-mail from Appeals Department
Worker go to AIS and check appeal request
If necessary e-mail NOD to appeals Dept
Print information on
AIS
Complete appeal
summary – within 10 days
Fax to Appeals Dept
Mail copy to Client/POA File
Delay
Receive E-mail from AIS re:
Notice of Telephone
Hearing
Print Notice for File
Enter hearing date into Outlook
Send e-mail invitation to
Amie of hearing
Attend Hearing
Review Desired N
Y
Receive e-mail re: proposed
decision
Take necessary
action
NAction Y Required
Send packet to scanning
Send packet to scanning End
End
RequestReview N
Y
Policy manager reviews requests
Supervisor sends request
to Policy Manager
Receive Appeal request
from App worker
Delay Delay
Receive e-mail regarding proposed decision
Print for file
Delay
Print for file
Attribution
Applic
ation W
ork
er
Pull up Resources
Upon Entering Medical Facility
Complete Attribution Worksheet
Complete Notice of
Attribution of Resources
Upload to ECF
3 in
Mail copy to client
4 out
Application Process Highlights Patsy
• Consistent work practice, with training manual
• New fax sheet to communicate with health facilities
• New Face Sheet for workers to use • Support Staff pending applications and
assign to workers • Daily priority order for all app workers
18
Homework Patsy
Item Item Description Person Responsible Due Date
1 Turn process map into text for training manual Matt, Amie 3/7/11
2 Training on new process to Application Workers Dawn, Erica 3/10/11
3 Create transition plan and roll out of new process Jaili, Elaine 3/9/11
4 Schedule Training for ECF for all CFEU application employees – in Training Room 1 Patsy, (John Tvedt), Jaili 3/9/11
5 Monthly Training for CFEU scheduled Topics based upon suggestion box or if data shows an area declining (First training – appeals process – exhibits, etc.)
Amie 3/14/11
6 Create a Face Sheet to be used by all Application Workers Dawn, Erica, Marcy O., Patsy, Kim 3/4/11
7 Create Attribution Worksheet form for app workers to use for attribution cases Elaine, Marcy O, Patsy, Kim 3/4/11
8 Guidance and develop standard RFI Language (cut and paste language) for burials, VA Dawn 3/7/11
9 Create an info sheet regarding burial contracts to be used with clients and funeral homes. Amie 4/7/11
10 Design and implement fax for LOC to send to facilities 1st and 2nd notices – make part of ECF – include
stronger language Elaine (Kim) 3/7/11
11 Create OLN guidance document – consistent practice – i.e. document phone calls, etc. Jaili 3/7/11
12
Develop protocol for handling case phone calls after the case is handed off to on-going and communication plan, include a couple examples (no RFI or extensions by CSC on app cases)
Develop protocol (recommendation) for Customer Service interaction with applicants
Dawn, Erica, Veronica 3/7/11
13 Develop a new Facility assistance questionnaire Amie, Jaili, Dawn, Erica 3/7/11
14 Train Julie on her new process Elaine, Amie, Kim Grasty 3/8/11
15 Develop a new facilities application and follow protocol to get application updated Denise, Jaili, Amie, Dawn, Erica 9/1/11
16 Develop a daily priority order Jaili, Dawn, Erica 3/3/11
17 Develop organization of workspace - Develop Tickler process & 1-31 filing process (define how to
calculate the actual tickler dates) Jaili, Dawn, Erica 3/3/11
18 Identify process for duplicate applications Kim 3/3/11
19 Process to assign applications to workers for the support staff & Create Application Log Matt, Julie, Teresa, Amie 3/4/11
20 Determine what goes out in packets – process Denise, Amie 3/4/11
21 Create internal tracking for case reading Elaine 4/3/11
Homework Patsy
Homework Patsy
22 Determine process for CAR’s received before application – communicate plan to
eliminate Amie 3/14/11
23 Grace Period Clarification – communicate clarification Kim, Dawn, Erica 3/9/11
24 Determine process for Miller Trust Elaine, Amie 3/8/11
25 Develop a resource list of other agencies such as VA, SSA, etc. Jaili 3/11/11
26 ISIS/IABC Logout Times Extended (Research other systems logout times, Get SAMs support for extending logout times, IABC/CWIS Approval, Implementation
Jaili 6/1/11
27 Create SharePoint and identify information needed Matt, Jaili, Amie 3/4/11
28 Clarify intent to transfer process assets (approval needed by Denise) Amie 3/4/11
29 Training for facilities Jaili, Denise 6/1/11
30 Timeline for taking applications back from field – anything we need to do prior to March 14th. Jaili, Kim 3/3/11
31 Identify process to ensure scanning/faxing is current in ECF (Jaili will print out e-mails and bring to 30-day, etc.) Matt, Jaili Revisit at 30-60-90 day follow-ups
32 Develop protocol and guidance for assessing application Amie 3/10/11
Team Members Experience
Comments
Matt Haynes Lean Co-Facilitator, Iowa Department of Human Services
Ann Hogle Lean Co-Facilitator, Iowa Department of Human Services
WE WELCOME YOUR QUESTIONS AND COMMENTS!
Thank you for attending.
23
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