FEEA Introduction

Facilitated Enrollment (FE) was implemented in June 2000 to combine the eligibility screening and enrollment process for three state-subsidized health insurance programs—Medicaid Managed Care, Child Health Plus (CHP), and the Woman, Infant, and Children programs (WIC). FE is the means by which millions of New Yorkers gain access to essential health care services, provided they qualify on the basis of documented need. Family Health Plus (FHP) was later added to the FE process.

The eight-page Access NY Health Care application form used to enroll individuals in these programs requires complex eligibility calculations and extensive supporting documentation. Once a form has been completed, manually transcribed data must be entered into computer systems numerous times — at the managed care organization, at the local Medicaid agency, and for use by the State. Illegible entries, miscalculations, and missing documentation lead to rejected applications and delays in approval. The current application and enrollment process is paper-driven, time-consuming, error-prone, and costly. Recertification procedures are just as inefficient because they are also paper-driven and redundant.

This makes the enrollment process a daunting one for applicants, who may be deprived of necessary medical care while awaiting approval or recertification. In New York State each year, 40 percent of adults and children enrolled in publicly funded programs lose their coverage through involuntary disenrollment and over 1.3 million adults and children who could be covered by state programs, simply are not.

The Facilitated Enrollment Electronic Application (FEEA) was originally developed by Hudson Health Plan (HHP), a not-for-profit 501(c)(3) managed care organization that serves the health care needs of low-income individuals and families in six counties in the Hudson Valley. As one of New York’s first Prepaid Health Services Plans, HHP has long been a leader in advocacy, operational effectiveness, and clinical quality in New York State-sponsored managed care programs. HHP realized that information technology was the key to improving the FE process and in 2000 began the development of FEEA. FEEA is now developed, distributed, and supported through the Hudson Center for Health Equity & Quality (Hcheq).

FEEA’s primary purpose is to automate the eligibility verification, enrollment, and recertification processes for subsidized managed care programs in New York State. To ensure that community-wide needs were met, FEEA was developed for use by any FE agency, regardless of size, and with minimal resource requirements.

FEEA is easily interfaced with other systems and networks, and can be used in small PC-based environments. FEEA was conceived to address processing barriers in the FE system, to reduce costs and to ensure that all eligible individuals are added to the health insurance rolls quickly and efficiently.

FEEA revolutionizes the way Access NY Health Care applications are processed. By using an automated e-application process that is simpler, quicker and more efficient, enrollers can focus on getting families the health care they need. The improvement to the enrollment and recertification process will lead to substantial administrative cost savings to FE agencies, County and State government.

FEEA is designed to streamline the Medicaid managed care application enrollment process for any Facilitated Enrollment agency, including lead agencies, health plans, and community based organizations, and it can expedite the transfer of these applications into local social service agencies and the State. Functionality enhancements are made to on a frequent basis and it is kept current with respect to all State guidelines pertaining to Medicaid eligibility.

ΔTop

---

What Does FEEA Do?

• FEEA replaces the manual, paper-driven application process with a simplified electronic application.
• FEEA automatically performs all calculations and determines the eligibility of a household based on the information entered.
• FEEA retains information from households so future applications are generated without re-entering data.
• FEEA generates an Access NY Application that can be printed or sent electronically to any agency.

ΔTop

---

Summary of FEEA Functionality

FEEA was designed by health informatics professionals trained in the facilitated enrollment process. FEEA automates the intake of information necessary to enroll someone in Medicaid Managed Care, CHP, or FHP. It enables the enroller to interview the applicant while simultaneously entering his/her responses into the system. FEEA also makes it possible to scan supporting documents into the system and have these linked to the applicant’s record. FEEA is easy to use and supports the enroller throughout the application process.

Here are examples of some of the most convenient features of FEEA:

• Drop down menus and pick-lists offer the enroller the option of locating existing enrollment records or choosing standardized information for given fields (e.g., County, preferred language), thereby eliminating typographical errors and speeding data entry.
• Rules are built into the system, preventing calculation errors (e.g. maximum allowable childcare credit may not be exceeded).
• Summaries of New York State FE rules for each field are detailed at the bottom of the screen to ensure that the enroller has immediate access to regulatory information.
• Redundancy has been removed from the data entry process; applicant’s name is entered only once and is used to populate all appropriate fields.
• Salary information is accepted in multiple formats (weekly, biweekly, monthly, or yearly) and is automatically re-calculated on a monthly basis.
• Eligibility calculations are automatically and immediately generated for Medicaid, CHP, and FHP.
• Premiums due from the applicant are automatically calculated and displayed.
• Supporting documentation may be scanned and stored with applicant record.
• Primary Care Professionals (PCPs) and FEs active in a given coverage area can be uploaded into FEEA for easy selection.
• PCP selections may be automatically applied to the entire family, if desired.
• Recertification application is automatically populated with information collected from the prior year.
• FEEA records the date of enrollment and important enroller information on each application, and tracks status.

At the conclusion of the enrollment process, an exact replica of the Access NY Health Care application is generated, complete with all enrollee information. This information is stored electronically and may be printed at any time.

With FEEA the auditing function is completely streamlined:

• No calculation errors.
• No illegible applications.
• Documentation review simplified through on-line auditing.
• Quality returns automatically posted for follow-up.

FEEA has a built-in reporting function that enables management to view aggregate information regarding status of applications by any number of different criteria, including by enroller, team and regional reports. The system can also report on applications relative to enrollee information, e.g. by ethnicity, by county and by product line. FEEA also makes it possible to build custom reports using an ad hoc reporting tool that is part of the reporting system.

ΔTop

---

Summary of FEEA Benefits to Facilitated Enrollers

• FEEA reduces enroller application processing time by about 40% per application.
• FEEA increases the accuracy of the applications, completely eliminating quality returns for legibility and calculation errors, which are two significant causes of rejections. There has been an actual reduction in quality returns at HHP from 30% to 13%.
• FEEA increases the accuracy of the applications forwarded to the Department of Social Services, virtually eliminating quality returns.
• FEEA increases employee and enrollee satisfaction by reducing question redundancy and increasing the amount of time an enroller can spend on enrollee education and personal interaction.
• FEEA increases efficiency by providing pre-populated recertification applications, completely eliminating the need to re-enter data annually.

A standardized transaction file has been developed so that any Local Department of Social Service (LDSS) using FEEA can accept the transmission of information from other electronic application products that can produce a compliant transaction file.

FEEA tracks enrollment, eligibility and application status by improving communication among Medicaid agencies, health plans, and enrollers. Individuals and families will be better served as the total number of uninsured and the churning of enrollees on state health insurance rolls are reduced.

ΔTop

---

FEEA on a PC, Laptop, or in a Network Environment

FEEA can be run as a stand-alone application on a single computer or in a network environment. All FEEA implementations benefit from the use of a powerful relational database that facilitates data entry, application generation, application tracking, and the ability to facilitate electronic application transmittal. The FEEA database stores all enrollee data for retrieval at any time, which is particularly important for recertification. Electronic application retrieval improves enroller productivity and facilitates improved client interactions. FEEA reporting functions enable management to assess enroller productivity and ensures applications are error free and completed on a timely basis.

In a stand-alone environment, FEEA can also be configured to print a completed application for signature by the client, which can then be forwarded to the lead agency for processing. A scanner may be added to the configuration to enable electronic storage and retrieval of all documentation used in the eligibility assessment.

FEEA can be configured to run in a network environment to promote centralized storage of all applications by multiple enrollers within a given organization. In this environment, FEEA applications are transmitted to a central server at predetermined times. Applications may then be forwarded to staff designated to perform an auditing function. Incomplete applications are held as pending, and completed applications are then forwarded to the appropriate lead agency, either in hard copy or as electronic files, as determined by prior agreement between the respective organizations. Pending applications may be returned to the original enroller or forwarded to a resolution unit as determined by organization policy.

ΔTop

---

FEEA Integration

FEEA is built using an open architecture that makes it accessible to integration with existing in-house systems. FEEA can also be programmed to receive information from a claims adjudication system.

ΔTop

---

The Access NY Health Care Application

The State of New York currently offers a variety of health insurance programs to individuals and families who qualify based on income, expenses, current coverage, and other eligibility requirements. The types of health insurance programs include:

• Medicaid
• Medicaid Managed Care
• Child Health Plus A (formerly Children’s Medicaid)
• Child Health Plus B
• Family Health Plus
• WIC (Women, Infants, Children Program)
• PCAP (Prenatal Care Assistance Program)

The Access NY Health Care application (DOH 4220) is divided into 12 sections that ask for information that is used to determine the applicant’s eligibility for a health insurance program:

• Contact information
• Household information
• Health Insurance
• Citizenship
• Household income
• Housing expenses
• Illness/injury
• WIC status
• Resources (for people 19 to 64 years old only)
• Absent parent/spouse (for people 19 to 64 years old only)
• Managed Care plan selection
• Terms, rights, responsibilities, and signature line

FEEA cycle begins with the Facilitated Enroller who works with applicants to gather and enter information in FEEA to determine eligibility for health insurance programs.

Using FEEA, the 12 sections outlined above are combined into easy-to-use screens. Once the enroller has finished entering all the applicant’s information, FEEA calculates a summary or worksheet that tells the enroller what health insurance plans the applicant is eligible for. The application is then automatically submitted for auditing with a status of complete. The next step is for the auditor to review the newly submitted application for accuracy and completeness.

If the application is completed and all supporting backup documentation scanned, the auditor approves it with a status of Audit-approved. If the application is not complete or all supporting documentation has not been provided, the auditor marks the application with a status of Audit-Quality Return.

Once the missing or inaccurate information is corrected, the application is resubmitted with a status of Corrected–Quality Return. The auditor then reviews the application again. If approved, the application and supporting documentation is either transmitted electronically or printed and sent to the appropriate Social Services district for review.

ΔTop