1. Provider enters monthly case notes for each participant 2. DSHS CSO checks to ensure Providers are entering monthly case notes 3. Provider (in some cases DSHS) updates activity components based on participant activity 4. DSHS CSO closes components that have been expired for more than 30 days or if participant no longer eligible for BFET PARTICIPANT
ACTIVITY TRACKING (MAINTENANCE)
1. Provider checks Basic Food status and BFET eligibility of prospective participants in e-JAS system
2. Provider sends list of eligible participants to DSHS CSO staff OR (as of January 2014) directly enrolls them in BFET using the e-JAS system
3. DSHS CSO staff verify participant eligibility lists and enroll participants in BFET, OR confirm eligibility of participants directly entered by Providers PARTICIPANT ENROLLMENT MONTHLY BILLING 1. Provider sends billing roster (list of participants receiving BFET services that month) to DSHS CSO staff for approval
2. DSHS CSO reviews and sends approved roster back to Provider 3. Provider completes invoice, submits with approved roster to DSHS HQ (CBOs) or SBCTC (colleges). SBCTC submits combined quarterly billing to DSHS HQ 4. DSHS HQ processes invoices within 60 days of the end of each billing period
At the close of each month (or each quarter in the case of SBCTC), BFET contractors submit reimbursement requests to DSHS for services provided to BFET clients during that month. With their invoices, contractors are again required to attach a list (billing roster) of those individuals earlier deemed eligible for BFET services upon whom their expenses are based. The list must have again been reviewed by DSHS to ensure eligibility. It occasionally happens that an individual earlier deemed BFET-eligible by DSHS, and thus receiving BFET services from a contractor, will be later deemed ineligible for BFET upon DSHS’ review of the billing roster, perhaps due to previous error, fraudulent claims, etc. This has been an ongoing challenge for providers because the result is that they do not get reimbursed as anticipated for services provided. Providers may and often do challenge the DSHS ruling of ineligibility. Once local FSS staff approves the invoices and billing rosters, these are sent to DSHS headquarters in Olympia (or to SBCTC in the case of the colleges) for processing and reimbursement.
DSHS’ process of 100 percent eligibility review for both new BFET enrollees and those individuals submitted by providers on billing rosters is ultimately intended to avoid disallowed costs and to minimize the risk to providers. It has proved staff intensive for both DSHS and providers, and has had the effect of limiting how fast the program could grow. On the positive side, it has provided DSHS leadership as well as FNS a high degree of confidence with the level of program oversight. Due to the complexities of the reverse referral model, the need to verify eligibility whenever a service is provided, and the allowed levels of support services, a Partner Handbook was developed by DSHS early in the pilot to ensure consistency with program rules. The Handbook continues to be a key component for the BFET’s success and is updated on a regular basis.
DSHS Local Staffing for Eligibility, Billing & Other Functions
The staffing model DSHS developed to administer BFET fit well with the agency’s concurrent efforts to centralize eligibility work that did not require face-to-face interactions into a call center model. The primary work at the centralized Whiter Center CSO unit is done by FSS staff. The basic FSS work includes reviewing and determining eligibility for the participants submitted on the provider enrollment rosters, sending reviewed lists back to the providers so they know who is approved for services, opening up initial e-JAS component codes for each participant, updating and changing component codes based on provider requests, reviewing cases to determine if 30-day notes are current, resolving issues with other DSHS staff not part of the BFET program (such as student eligibility and WCCC issues), reviewing and approving billing rosters, and providing some onsite services.
As the BFET program expanded beyond the White Center CSO, the centralized unit for the program continued at that location for consistency and effectiveness. Like other DSHS call center models, it became a virtual office that could cover statewide work for the BFET program. When additional staffing was approved for BFET administration, the White Center CSO expanded its role to provide some onsite services
primarily to community-based organizations and colleges within King County and Snohomish County. DSHS leadership was able to project the workload that could be covered by each FSS and this became of factor each year with both staffing the BFET program and with determining the level of program growth each year. At one point it was determined that each White Center FTE could cover 400 BFET clients. Moving forward, the aforementioned efforts to streamline e-JAS should allow for greater caseloads.
Additional work by local DSHS staff includes reviewing BFET contractors’ case notes for accuracy, and communicating impending case actions affecting participant eligibility to contractors. It also includes some level of partner and community outreach around the BFET program, including program assistance and consultation to contractors on DSHS programs, training for CBO BFET staff, coordinating local BFET partner meetings, and promoting BFET services to community stakeholders and the general public.