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SPECIAL INVESTIGATIONS ADVISORY COMMITTEE
August 12, 2003
DMA Cabarrus Building, Raleigh NC
Shelia Dorsett, back-up for Paul Burge, Co-Chair of SIAC, called the meeting to order. The minutes for the July meeting were approved as written.
Shara Britt gave the DMA updates. She stated the Medicaid collections for July were $152,217.61. She discussed Family and Children’s Medicaid Change # 04-04 regarding the end of the Earned Income Disregard. A “cheat sheet” with Medicaid EPICS Tips was given out, and Shara reviewed those. She also mentioned Medicaid TE claims and explained that investigators should never close a Medicaid claim without reducing the balance to zero. She reviewed the procedures for requesting a debtor be deleted, and for requesting a claim be deleted by the state office. She reminded everyone that Medicaid does not allow claims to be compromised. Brenda Porter asked that when claims are closed or requested to be deleted that they enter an explanation in the Referral Detail Allegations notepad. Shara explained when and how to use AJCD, and AJCI. She reminded everyone that the cash portion of an SA overpayment does not go in EPICS, only the Medicaid portion. She also asked that they not use the “Civil Judgment Date” or “Criminal Judgment Date” space on the Claim Detail screen to enter hearings dates. This is misleading and may create accounting problems for the controllers’ office in the future when billing will be done by EPICS.
Suzanne Marshall, now the project Manager for NC Fast gave a NCACDSS Technical Committee Status Update. She stated there are three units of work they plan to implement by June 30, 2004. They are On-line Verification, Systems Interface, and Client Relationship Management (CRM) Tool Evaluation and Recommendation. She asked for volunteers to participate in the workgroup for all three, but needs the names of those who wish to work on the On-Line Verification unit by August 20, 2003. She needs an email from each volunteer’s Director, giving permission to participate. She stated most of the work will be done via email and conference calls, with possibly one or two meetings in Raleigh. She stated the state will not be able to provide money for transportation.
Debbie Knowles and Donna Smith gave the updates for DSS PI. Debbie stated that they are currently under Adult Services, but have been told that effective September 1, 2003 Adult Services will be under the Division of Aging. She stated she has no idea what will happen to Food Stamps; whether they will also go under the Division of Aging or some other section/division or stay under DSS. She stated that she and Donna no longer handle Work First issues, as that position has now been placed under Families and Children Services. She stated they will not delete claims in EPICS when someone dies. Investigators need to go to the Referral Detail screen and close with a “Y” if the only debtor dies. This will put the claim in TE status. If there is more than one debtor and one dies, send a letter to DSS PI to request the deceased debtor be deleted from the claim.
Donna states she is planning to attend the National UCOWF Conference. Her main reason for attending is the forum being held on TOP for Work First (Cash Assistance).
Donna stated that the State FS Program is under USDA Corrective Action for Claims Management issues. Some are due to automation problems in EPICS. Donna has drafted a letter with a Plan of Corrective Action that will go to all counties. Also there are five counties that were studied in more detail by USDA. Those counties will receive individual letters as well, addressing corrective action for the problems that were found.
Donna stated that counties will soon be required to track claims from the Date of Discovery. This is important since they will be required to key in the referral within 30 days from the date of discovery to assure timeliness. She stated that TOP gross collections for the Fiscal Year were $2,180,440.04. The net was $1,878,140.12.
Marilyn Carpenter stated there were no updates. They do have a new investigator, Calvin Bullock. Calvin Thompson is in Princeville for the year.
Shelia Dorsette stated that John Shore is the new President of the Director’s Association. They are changing some of the requirements for requests for Board action. They now must be submitted in writing in triplicate. Also they want reports from committee meetings sooner.
Diane Daniel reported that the Planning/Site committee for the State PI Training Conference in 2004 will visit the Ramada in Asheville within the next month or two. They are also reviewing proposals from sites for the 2005 conference.
Vi Simmons from DCD reports that at this time the policy stands that overpayments for child dare care that are established by the county must be repaid to the state up front.
She states they are still looking at it, but that it stands for now. She stated that the reason overpayments are required to be repaid immediately to the state is that 57% of the funds are federal, and that it is a subsidy instead of a benefit. She addressed the Day Care sanction policy, and said that an attorney DCD had to sit in on the review panel for their sanctions stated that DCD is required to apply the sanctions instead of the county. It was brought up that if that was so, why would the county be required to handle appeals for any sanctions the DCD approved. Vi made the comment that the appeal process will be different and they have not developed all of the hearings procedures.
Sheila Wood and Sherry Arnold stated the DCD policy is too open to interpretation when it comes to verifying employment and income. They stated that Social Workers are not trained to question income issues. For example, they stated that clients pick the lowest dollar amount pay stubs to provide to the Social Worker. The Social Worker may not think to question why they have skipped around, or to question whether these pays are representative of what a client normally earns. If there was a base period requirement for income when authorizing day care, this would prevent a lot of overpayments. They also stated they have found Social Workers are geared to process applications on the date of application, when they have 30 days. If they would not rush it, and verify income properly they could avoid a lot of overpayments.
Shelia Dorsett led a discussion of repayment of Day Care overpayments. Vi stated that if an overpayment is discovered during the current obligation period the money repaid by the county to the state “could” be re-obligated to that county. Someone asked what report the county would receive to know the money was re-obligated, and how would this work if the county later collected from the client or provider, since they were the ones who would actually have to repay the county? There was a lively discussion with no real resolution or understanding on how this all really works. Vi stated the people in the county who do the keying into the reimbursement system would probably be able to explain it. She stated there are instructions in their system manual telling them how to make the needed adjustments when this occurs.
Sherry Arnold stated that she has researched the issue of how other states interpret the Federal guidelines on repayment of Day Care overpayments, and has found that no other state requires repayment up front. Shelia Dorsett stated she has given Vi a written list of questions her county needs answered in writing before they can proceed with old DCD cases. Also a show of hands was asked for of counties that are now working Day Care overpayment referrals. Only three raised their hands. Several commented that since Day Care overpayments can go back past the current period of obligation that their counties cannot afford to repay “misspent monies” when they had not yet collected it from the providers or clients who misspent it.
Reports were given by each SIAC sub-committee. The meeting was then adjourned.
Respectfully submitted by:
Brenda Porter
