Wednesday, July 16, 2008
I just wanted to remind anyone reading that while there can be plans for rollouts, there can be a "wait and see" attitude- through WHP (Women's Health Program), cases (I'd venture to say 100's per day) are pushed into TIERS DAILY.
So Hawkins can talk all day about all these plans, however he is "back door" rolling out TIERS as. we. speak.
Think about this- when W.H.P. was created, what was the real motivation? What does WHP really pay for, in the long run? Birth Control? It's not "Medicaid". So who thought up the WHP program? Who decided that this program should be done exclusively in TIERS- even when it was common knowledge that TIERS was having major problems in the Pilot Area?
How much easier than to sell a program that "helps poor women in Texas" and decide that TIERS would be how it was done. And what happens once in TIERS? Always in TIERS. Remember?
It seems, upon thinking about it, that WHP was the PERFECT vehicle to get as many cases in TIERS.
Who gets WHP? Women, right?
Who are most of our clients? Child-bearing age women. What faster, easier way to do it?
What about the fact that clients, once they realized what getting on WHP did to their case- BEGGED to be put back in the "old system"?
I've seen it personally. Clients who got on WHP through somewhere like Planned Parenthood thinking that it was a form of "Medicaid"- find out it wasn't really, then they would literally say to local office staff "never mind that program then, put me back in the old system". This at a time when those in the "old system" were still being done timely (and still are), and those in TIERS were waiting up to 45 days just to get an APPOINTMENT to apply for Food Stamps.
Is it any wonder the clients might have felt duped by this?
There was no major "outcry" when WHP was created, as anything Hawkins could do that made it appear that he cared about client services was what he needed at the time it was done. Right?
WHP serves many women. It provides birth control (that was, by the way, given at PP on a sliding scale based on income anyway, meaning many didn't pay in the first place- and it's not like Planned Parenthood *for example* wasn't receiving funding to pay for these services already), and well women checkups, as well as various screenings- however, what people do not realize is if a woman goes for that screening and something is WRONG- WHP does NOT pay for the treatment of that issue. So a woman can get a preliminary diagnosis, but not help to take care of the problem.
Nevermind the fact that the spenddown program was virtually eliminated for all but pregnant women and children (most of which qualify for either Pregnancy Medicaid or for kids- Medicaid or CHIP).
Just think on the relationship between WHP and TIERS.
Back. Door. Rollout.
Tuesday, July 15, 2008
Joint Committee on Oversight HHSC Eligibility System
July 14, 2008
My name is Derrick Osobase, I am here representing the Texas State Employees Union. We represent over 12, 000 state agency and university employees across Texas.
The Texas State Employees Union is very concerned for the future of services administered by the Health and Human Services Commission. We ask that the legislature continue to direct HHSC to rebuild the eligibility program that’s been plagued since HB 2292 with the dismantling of the Health and Human Services workforce, the use of a new eligibility system that has proven not ready for statewide rollout, and the use of costly and ineffective private call centers.
We acknowledge the effort that the Commission has put forth in attempting to rebuild the workforce and encourage them to continue. The legislature in the last session made great gains to stem some of the problems that agency was experiencing, such as giving the Commission the authority to hire 10% more staff above its FTE cap. We are pleased to hear that’s what the agency plans on doing. However 10% is not enough, rider 54 explicitly gives HHSC permission to hire additional state staff to replace work being done by private contractors. In light of past failures by private contractors and taxpayer money wasted on these endeavors, we believe that most efficient and reasonable course of action is to forgo private contracting and use the money rebuild state staff.
Currently, staffing levels are still clearly inadequate to properly administer services to Texans in need. Caseloads for eligibility workers have exploded in recent times; the average caseload before regional rollout of TIERS was about 150 to 250 cases per worker and now its 500 to 900 cases per worker. Customer service has been adversely affected by these high caseloads, which translate into clients not receiving their benefits. This is compounded by trying to navigate TIERS, which workers describe as “inefficient” and “cumbersome”. Many state employees are overwhelmed by their workload and see little indication that the situation will get better in the near future, so they leave, which contributes to 20.9% turnover rate statewide.
We have a major concern with the amount of time it takes to process TIERS cases. HHSC reports that 1914 state eligibility staff processed a Food Stamp case in the month of June. We know that there are approximately 4000 HHSC employees with the job title Texas Works Advisor. That suggests that nearly half of all staff worked at least one TIERS case last month. Some of those workers do all their cases in TIERS. Yet, according to HHSC, only 12% of all Food Stamp cases are in TIERS currently. This suggests that a significantly disproportionate amount of staff are working TIERS cases. Plus, the vast majority of cases worked by vendor staff are in TIERS. We would like to see an analysis of how much overall staff time is being spent on the entire TIERS caseload compared to the entire SAVERR caseload. Without this analysis and simply based on what we see right now, a statewide roll-out of TIERS would necessarily require one of two changes: TIERS would have to be much quicker or HHSC would have to hire significantly more staff.
The TIERS program continues to fall short of expectations. Timeliness of cases in TIERS for the month of May in the rollout region was 69 %, an improvement from 49% in February, but still well below federal timeliness standards. Recipient are experiencing delays and even the highly trained TIERS workers are having trouble processing cases within the 45-day time period. Recipients literally flood local state offices asking to be placed back into the older system.
Compared to SAVERR timeliness on average is about 92% statewide. This is not a call to get rid of TIERS, but before the State of Texas fully commits to a system on which the taxpayers have already spent 420 million dollars and counting, we need to be sure it works. We're asking this committee to direct HHSC to take the following steps to ensure that Texans continue to get the services that need in a timely fashion.
1. Stop putting new cases into TIERS until backlog is cleared. This means putting new women’s health, CHIP, and foster care cases into SAVERR, not TIERS.
2. Conduct an independent analysis of the TIERS system with an assessment of its strength and weaknesses compared to the SAVERR system. Also, explore the cost benefits to converting SAVERR to a web base system.
3. Get pilot area into compliance with Federal timeliness standards.
Finally, stop the continued use of privatized call centers for service delivery. Making recipients fax their documentation to a call center that is not connected with a state office in their area just places another obstacle in the way of getting services. Clients report many other problems such as lost paper work or paper work that was improperly scanned, which results in the eligibility worker essential redoing intake. The approach has been both very costly and has caused problems for recipients. It increases the number of people with whom the clients need to communicate and, as a result, delays the final disposition of the case. This notion that private call centers save taxpayers money and make access easier for clients is false.
The original authorization for call centers in HB 2292 required that HHSC make a convincing cost benefit analysis for call centers. In light of the lack of cost saving for private call centers and the frustration they cause our citizens, it is our position that private call centers should be abandoned. HHSC, under the direction of the legislature should plan and operate any facilities where applicants and recipients communicate by telephone. The successful children Medicaid center in El Paso is one example of a state run call center that is fully integrated into their program components.In conclusion, we ask that the committee and the legislature act quickly to stabilize the workload by hiring more staff, freezing further roll out until TIERS is fully ready, and making service delivery more unified and effective, by eliminating the role of vendors making contact with clients. The best way to insure accountable and timeliness would be to have one entity, HHSC, being responsible for all client contact with adequate staffing and a computer system that works.
Contact: Derrick Osobase, TSEU Legislative Director,
512-468-3018 or email@example.com
I got an email from a reader in April 2006.....which reflects on this...and now I find that it's appropriate.......here is part of it...........and this is the truth. Believe it.
When this rolls out for the NH (nursing home) cases, then you will see
some organized, active, and vocal public complaints. “Our” clients may be
poor, (although with spousal impoverishment, many aren’t) but their relatives
aren’t. The responsible parties are usually younger, more educated, and
more motivated to complain than FS clients. After all, a monthly NH bill
and medications are very expensive. Waiting around for an answer, or being
lost in the shuffle, just won’t cut it with those folks.
By KAREN BROOKS / The Dallas Morning News firstname.lastname@example.org
AUSTIN – Skeptical legislators on Monday directed Health and Human Services Commission chief Albert Hawkins to bring them a detailed plan for how he would put nearly 1 million elderly and disabled Texans through a new application process that has been plagued with problems.
At a meeting of a House and Senate joint committee to discuss the embattled TIERS – the Texas Integrated Eligibility Redesign System, a private computerized system used to enroll clients in state programs – members grilled the commissioner about those plans and expressed anger that the state had made that decision without consulting them.
"I am absolutely shocked and dismayed at what has happened and cannot believe that there is such an obvious attempt" to get around legislative oversight, said Sen. Judith Zaffirini, D-Laredo, former chairman of the Senate Health and Human Services Committee.
The panel was formed in response to dismal performance by TIERS pilot programs rolled out in 2003, including high staff turnover as well as wait times for food stamp applications that were three times longer than the federal mandate.
House Human Services Committee Chairman Patrick Rose, D-Dripping Springs, said it is "critical" that high standards are established before any expansions of the program.
Mr. Hawkins agreed to return with specific criteria that would have to be met before TIERS was expanded, saying the system is being improved and more workers are being hired.
The agency said Friday that it would add 953,000 elderly and disabled Medicaid patients to TIERS by September 2009, on top of the 288,000 food stamp recipients it already plans to add by then. Of the 3.8 million Medicaid, food stamp and welfare recipients in the HHS system, about 15 percent are on the TIERS system
By Corrie MacLaggan
Tuesday, July 15, 2008
Members of a legislative panel on Monday sharply criticized a plan to nearly triple the number of Medicaid and food stamp cases handled by a troubled computer enrollment system.
Under the plan, Health and Human Services Executive Commissioner Albert Hawkins proposed adding about 953,000 elderly and disabled people to the system between December 2008 and September 2009. Some lawmakers and advocates for people with disabilities called that reckless because the state has had problems processing cases in the system as quickly as the federal government requires.
"If this conversion is not totally successful, people will be without services — this is probably the most vulnerable population we have," Colleen Horton of the University of Texas Center for Disability Studies told lawmakers. "It's really unfair to place the burden of the consequences of such a massive, untested conversion" on this group.
The expansion plans for TIERS — Texas Integrated Eligibility Redesign System — comes at a time when the agency is struggling with worker shortages and high turnover. The state has had trouble getting enough workers trained in TIERS, which was designed to modernize the enrollment system.
Several lawmakers said they were surprised to learn of the plan last week from an early copy of Hawkins' testimony Monday to a joint House-Senate committee looking at the enrollment system.
"I'm absolutely shocked and dismayed at what has happened," said state Sen. Judith Zaffirini, D-Laredo, "and cannot believe that there is such an obvious attempt to go counter to what I consider legislative intent."
Texas received federal approval to expand TIERS in a limited manner starting this month, but Hawkins said he won't do so until the commission meets a series of benchmarks.
Hawkins said that the agency is working to smooth the conversion and that he will continually evaluate the conversion plan and will not move forward if there are problems. The bulk of the change, which requires approval from the federal agency that oversees food stamps, is set to begin in March.
"It's not etched in stone," Hawkins said of the plan. "It's the plan to guide our efforts, but we're not going to be bound to it."
Additionally, he plans to expand TIERS to other Medicaid and food stamp recipients in Central Texas and the El Paso and Lubbock areas.
The Center for Public Policy Priorities, which is an advocate for low- and middle-income Texans, warned in a report Monday that the state should halt plans to convert any more cases to TIERS until there are enough trained workers to process applications quickly enough to meet federal standards: 30 days for food stamps and 45 days for Medicaid.
In June, Texas completed more than 70 percent of food stamp applications on time in TIERS — an improvement since January but short of the more than 90 percent that were completed on time in the old system in June. Most public assistance enrollment in Texas is still processed using the old system.
Kalese Hammonds of the Texas Public Policy Foundation, which is an advocate for limited government, told lawmakers that delaying TIERS expansion is not the solution — in part because of what keeping two systems is costing taxpayers.
The state spends $1.6 million a month to maintain the system that TIERS was designed to replace, agency spokesman Geoffrey Wool said.
Here are some comments posted regarding the article on the website (click title of this post):
TIERS WILL LITERALLY LEAVE YOU IN TEARS! IT'S A MESS! THE PEOPLE NEEDING THESE PROGRAMS/SERVICES ARE GOING TO BE THE ONES TO SUFFER. I KNOW THERE IS MUCH MORE INVOLVED THAN ANY ONE OF US COULD IMAGINE. BUT WHEN YOU WORK FOR THE STATE YOU KNOW WHAT MAKES SENSE ISN'T WHAT ALWAYS HAPPENS. STAFF ARE JUMPING- NO ONE WANTS TO BE FORCED INTO TIERS! THERE IS NO WAY POSSIBLE TO QUICKLY AND EFFECIENTLY PROVIDE SERVICES IN TIERS WHEN YOU CAN WORK TWICE AS MANY AND 10 TIMES AS FAST IN THE CURRENT PROGRAM. AS A TAX PAYER I'M HIGHLY PISSED OFF THAT MORE AND MORE MONEY IS BEING THROWN INTO THIS PLAN. THE TRAININGS, THE TRAVEL INVOLVED FOR THE TRAINING, THE EFFECTS THE STRESS IS HAVING ON EMPLOYEES HEALTH. THE MORE IT SEEMS IMPOSSIBLE THE MORE IT IS PUSHED TO "ROLL OUT" GIVE ME A BREAK ALREADY! YES STATE EMPLOYEES ARE PAID TO DO THEIR JOB- BUT THERE IS NOT ENOUGH MONEY ANY WHERE THAT WOULD MAKE ME WANT TO WORK CASES IN TIERS!! WE ARE DROWNING IN CASES AS IT IS - YOU CAN'T EFFECIENTLY WORK IN BOTH PROGRAMS AT THE SAME TIME! HOW MUCH MORE MONEY ARE WE GOING TO THROW INTO A PROGRAM THAT DENIES BENEFITS FOR THOSE THAT NEED IT AND GIVE EXTRA TO THOSE THAT AREN'T ELIGIBLE. OUR TAX DOLLARS AT WORK????
7/15/2008 7:50 PM CDT on Statesman Staging
jUST THINK IF THEY ALL QUIT JUST HOW MANY TAX DOLLARS THEY WILL SAVE AND WITHOUT A CLIENT LIST AND A COMPUTER WE WILL NOT NEED SALES TAX MUCH LONGER AND PERHAPS WE CAN GET RID OF HIGH WAY TAX. THE OLD AND SUPPOSELY HANDICAPED OR WHAT HAVE YO WILL ALL BE GONE AND WE WILL NOT NEED ANY TAX IN THE STATE OF TEXAS THEN PERHAPS WE CAN GET RID OF THE IDIOT CALLING HIMSELF GOVERNOR PERRY AND THE CONGRESS; PEOPLE JUST THINK OF THE MONEY WE CAN SAVE FOR THE WORKERS THEMSELVES TO USE RATHER HAVE IT THROWN TO ANCHOR KIDS AND WELFARE FOLKS.. FRANK BOWERS
7/15/2008 1:34 PM CDT
If the agency doesn't do something about workload, there won't be any staff left to work in either system!
7/15/2008 12:00 PM CDT on Statesman Staging
Many of us in Texas believe that our tax dollars should be used as a collective expression of our values. Ever more often that means ensuring that all Texans have access to adequate food, shelter and health care. TIERS is an effort by the Republican Legislature and administration of the state to reduce the care we offer to individuals so they can continue their personal slush funds to deliver cash to private entities, foreign and domestic (economic development incentives, privatization and toll road contracts to name three vehicles). In the name of updating our technology and being more efficient, we have created the TIERS system to frustrate those applying for help so that more and more just give up or do without for months. How much money has the state "saved" and then delivered to private contractors hands in the name of this efficiency and how many Texans have suffered? To expand this program before the bugs are worked out simply extends the cold shoulder we started in 2003 giving Texans who need help with drastic budget cuts. It is unconscionable to expand implementation of this system before we can make it work for those it should serve.
7/15/2008 10:21 AM CDT on Statesman Staging
Here we go again......the shredding facility in Washington state must need something to do(the DHS contractor in Midland "accidentally" shredded 10,000 active case files 2 years ago leaving 10,000 households with no food, health care and/or TANF).
7/15/2008 1:37 AM CDT on Statesman Staging
900 Lydia Street • Austin, Texas 78702-2625 • T 512/320-0222 • F 512/320-0227 • www.cppp.org
ELIGIBILITY SYSTEM PROGRESS REPORT
Legislative Oversight Committee to hold hearing on Monday, July 14
Access to health care, good nutrition, and cash assistance is vital to low-income Texas families who don't earn enough to make ends meet, particularly during economic downturns. Yet, enrolling in programs like Food Stamps and Medicaid has gotten harder over the last year due to problems with TIERS.the new computer system.and a shortage in state workers that
resulted from the Legislature.s failed attempt to privatize the system in 2006.
Rebuilding and sustaining a viable eligibility system promises to be one of the most important challenges facing Texas in the years to come. Today, the Legislative Oversight Committee overseeing efforts to rebuild the eligibility system will hold a public hearing. The Health and Human Services Commission (HHSC) will provide a progress report and present the benchmarks that will be used in determining whether to continue implementing TIERS.
When Texans seek assistance from the state to support themselves or their families, they generally need help fast.whether to pay their rent, put food on the table, or take a sick child to the doctor. It is the states responsibility to figure out whether an applicant is eligible and enroll that person as fast as possible. This is why it is so important to have a system in place that can of
process applications for assistance timely and accurately.
Federal law requires that most applications be processed within 30 days for Food Stamps and 45 days for Medicaid and TANF (cash assistance).
Applications that take longer to process are considered untimely.
Timeliness in application processing has been below these federal standards since January 2006, though some improvement occurred over the last several months. The delays are most severe in applications processed in TIERS, the new computer system currently being used for approximately 13% of families receiving assistance.
Several staffing factors are contributing to these delays: worker shortages, high turnover, reduced tenure, and problems training staff quickly enough to work cases in TIERS. Thus, the first step HHSC must take to rebuild the eligibility system is to stabilize the workforce. In support of this effort, HHSC should postpone any additional expansion of TIERS and hold off on awarding a new contract to expand the call centers until there are enough trained workers to
meet the federal standards for timeliness in application processing.
Staffing Levels Plummet and Workload Skyrockets
Ten years ago, roughly 10,000 workers handled a caseload of approximately 4.1 million clients. Since then, the Texas Legislature has cut the number of eligibility staff at HHSC by almost 40%, despite a 50% increase in the number of clients served by the system. As a result workload has more than doubled and client services have suffered.
Fiscal 1998 Fiscal 2008
Average number of workers 10,404 7,136
Number of cases per worker 389 756
Total clients (recipients may receive more than one
4.1 million 6.1 million
Turnover rate NA 23.9% (year to date, FY 08)*
Percent of staff with less than 3 years experience 4% (Sep. 04) 23% (Sep. 07)
*The statewide turnover rate for classified employees was 17.4% in fiscal 2007.
HHSC Takes Steps to Increase Staff and Stabilize the Workforce
The original staffing target for fiscal 2008 was 7,136. However, the 80th Legislature authorized HHSC to increase eligibility staffing levels up to 10% over the agency.s cap for the 2008-2009 biennium, increasing authorized staffing level to 7,438.
HHSC had made progress toward reaching this staffing level, increasing the number of eligibility workers from 6,343 in September 2007 to 7,027 in June 2008, for a net gain of 684 eligibility staff.
Despite this growth, high turnover and decreased tenure continue to complicate efforts to rebuild the workforce. In fiscal year 2008 (YTD), the average turnover rate for eligibility workers was 20.9%, higher than the 2007 state average of 17.4%, but down from 28.8% in 2006. The tenure of staff also has fallen dramatically over the last four years. In 2004, only 4% of eligibility workers had less than 3 years experience. By 2007, 23% of eligibility workers had less than 3 years experience.
HHSC has taken numerous steps to stabilize the workforce, including:
. Converting 2,000 temporary jobs to permanent status;
. Actively hiring qualified candidates for vacant positions,
. Conducting outreach to retirees and former eligibility staff,
. Implementing improvements to reduce overtime and divert work from local offices to specialized teams and centralized units,
. Assuring state staff that no reduction in force or office closures will occur (despite ongoing plans to privatize the eligibility system see Call Center Procurement Plans below), and
. Increasing salaries.
These efforts have started to pay off. As of March 2008 there were 756 clients for every worker, down from 816 recipients per worker in December 2007. However this is still almost double the workload per worker 10 years ago, when workers handled fewer than 400 cases. Moreover, timeliness still remains below federal standards, particular for those cases processed in TIERS.
The good news is that TIERS timeliness has improved dramatically since December 2007, when it hit an all-time low of 47.2%. In June 2008, 71.2% of Food Stamp applications were processed timely. However, this is still far worse than a year ago, when 92.6% of Food Stamp cases in TIERS were processed on time.1 The decline in TIERS timeliness is the result of a
sharp increase over the past year in the volume of cases processed in TIERS, without a corresponding increase in the number of staff trained to work cases in TIERS. In other words, the number of cases in TIERS has been growing faster than HHSC can train workers to use the system. This growth in TIERS and its impact on timeliness is discussed below.
The Impact of Uncontrolled Statewide TIERS Growth on Application Delays
The original TIERS implementation plan called for a geographical rollout, starting with two counties in July 2003. Confining TIERS cases to the pilot area proved impossible, however, as clients moved from the pilot counties to other parts of the state.
However, the vast majority of the growth in TIERS cases over the last year was not caused by this movement; it is the direct result of HHSC's decision to put both new enrollees and denied applicants for the Women.s Health Program (WHP) (a Medicaid-funded program that provides family planning services) into the TIERS system, along with any family members with
open Food Stamp, Medicaid, or TANF cases. The addition of the WHP and associated cases to TIERS has caused the number of TIERS cases to almost triple statewide over the last year. It also has led to a diffusion of TIERS cases throughout the state.
In December 2006, the month before WHP implementation, approximately 150,000 total cases (all programs) were in TIERS, representing 5% of the statewide caseload. Roughly one-third of TIERS cases were located outside of the TIERS pilot area. As of May 2008, approximately 469,000 total cases were in TIERS, with more than twice as many TIERS cases outside of the pilot area as inside the pilot area. (See chart above.)
The three-fold increase in TIERS cases over the last year has strained the capacity of local offices, particularly outside the pilot area where many offices lack enough TIERS-trained staff to handle the increased volume of cases. This haphazard expansion of TIERS is driving the serious delays in application processing as well as limiting access to competent workers able to assist
TIERS clients. HHSC should put further expansion of TIERS on hold until timeliness in both SAVERR and TIERS meets federal standards.
HHSC’s Plans to Expand TIERS Despite Timeliness Problems
HHSC recently received federal approval for a limited geographic expansion of TIERS to additional offices in Regions 7 (Central Texas), 10 (El Paso), and 1 (Lubbock) that would occur between October 2008 and February 2009. HHSC also plans to convert all .MEPD. (Medicaid for the elderly and people with disabilities) cases to TIERS over an 8-month period beginning in December 2008.
HHSC has developed certain benchmarks that must be met before proceeding with the geographic rollout or MEPD conversion. Prior to each conversion, HHSC will use these benchmarks to determine if the office is prepared for the conversion. The chart below shows the .pre-conversion. benchmarks:
Benchmarks to Determine Readiness for Conversion Measure
Adequacy of staff trained in TIERS and available to process cases-500 cases per TIERS trained worker
Capacity of on-site support to assist the office Minimum of 1 per office/1 on-site support worker for every 30 eligibility workers
Capacity of TIERS mentors to assist the office Minimum of 1 per office/1 TIERS mentor worker for every 30 eligibility workers
Availability of Assistance Response Team (ART) staff to assist with conversion corrections. (As evidenced by prior conversions, a proportion of cases will require manual processing and/or correction.
SAVERR continues to issue benefits until the case is successfully converted into TIERS.)
1 ART staff per 2,500 cases converted
Stable and appropriate call center performance measures-Call abandonment rate of 10% or less for 4 of the 6 weeks prior to conversion / Average Speed to Answer of 180 seconds or
less for 4 of the 6 weeks prior to conversion
Appropriate and stable TIERS server utilization levels (lower levels ensure better system performance)
Server utilization at or below 80% during business hours in the month prior to conversion
Appropriate and stable TIERS transaction response times (the most commonly used transactions are monitored to ensure better performance)
In the month prior to conversion, inquiry/query transactions are completed within 4 or fewer seconds; and update/save transactions are completed in 5 or fewer seconds
Consistent TIERS system uptime (to ensure availability of the system during business hours)
In the month prior to conversion, the system is available a minimum of 99% during business hours
In addition, HHSC has developed a .post-conversion. benchmark to determine if and how conversion to TIERS is affecting clients. HHSC will monitor the post-conversion performance of offices recently converted to TIERS by looking at timeliness.
If timeliness drops more than three percentage points below the office.s average timeliness in the three months prior to conversion, HHSC.s Independent Validation and Verification (IV&V) vendor will do a .root cause. analysis to identify the factors contributing to the decline. HHSC will evaluate timeliness at 30, 60, and 90 days post-conversion. If the IV&V vendor identifies changes necessary to prevent future conversions from delaying services to clients, then HHSC will develop a remediation plan and reassess its roll-out schedule.
Benchmarks Must Be Revised to Include Timeliness Measure
Though we heartily support the use of benchmarks to determine readiness for a TIERS rollout, there are several flaws in HHSC.s approach that must be addressed to ensure that expansion of TIERS does not undermine the significant progress made in rebuilding the state workforce and reducing the delays in application processing:
. No Real Limit on TIERS Expansion. USDA.s Food and Nutrition Service (FNS), the federal agency that oversees Food Stamps, approved an expansion of TIERS to up to 22% of the Food Stamp caseload. However, the limits on geographic expansion only apply to Food Stamp cases currently in the system and those added during the geographic rollout. The limits do not include cases that are converted to TIERS through the WHP,2 which is driving the rapid increase in TIERS cases and causing a much larger volume of cases to enter the TIERS system than would occur under the limited geographic rollout approved by USDA. In other words, FNS. limit will do little to control the rapid increase in TIERS cases that is straining the workforce and causing delays in services to needy families.3
. No Real Timeliness Goal; Improvements in One Region May be at Expense of Others. The benchmarks include a workload measure, which is good, but fail to include timeliness as an indicator of system readiness. Yet, timeliness is the best indicator of a system and a workforce that is stable enough to weather the strain that is inevitable in the conversion to a new computer system. The workload measure alone does not accurately assess performance. For example, there may be enough bodies in an office to reach 500 cases per worker, but not enough tenured workers to ensure the timely and accurate processing of applications. Moreover, the workload measure by itself only captures the circumstances in that particular office. It does not capture what is happening in other offices, which may be struggling as a result of losing staff who have been sent to support the TIERS rollout. Any further expansion of TIERS before the current
workforce is capable of processing all applications timely and accurately4 in both SAVERR and TIERS will only rob Peter to pay Paul.
MEPD Rollout Poses Risks to Vulnerable Population
HHSC is proposing to convert all cases for Medicaid for the Elderly and Persons with Disabilities (MEPD) in four phases, currently scheduled to begin in December 2008. The proposed conversion schedule is as follows:
Proposed MEPD Conversion to TIERS
December 2008 . Approximately 13,000 cases. This will convert MEPD cases currently in SAVERR for clients with existing Medicaid, Food Stamp, and TANF cases already in TIERS. This will not add new Medicaid, Food Stamp, and TANF cases to TIERS.
March 2009 . Approximately 300,000 cases. This will convert SAVERR cases to TIERS for MEPD clients who do not receive Supplemental Security Income (SSI).
June 2009 and September 2009 . Approximately 320,000 cases for each conversion. This will convert SAVERR cases to TIERS for the remaining MEPD clients who do receive Supplemental Security Income (SSI).
Note: The conversion of MEPD cases scheduled for March, June and September 2009 will also result in an increase in the number Medicaid, Food Stamp, and TANF cases in TIERS. This is because many MEPD clients also receive, or have family members who receive, these benefits. Once the MEPD client is converted to TIERS, their family members. cases would be converted as well. HHSC does not yet have an exact number for how many Medicaid, Food Stamp, and/or TANF cases will be converted in conjunction with the scheduled MEPD conversions.
Before converting any MEPD cases to TIERS, HHSC must make certain enhancements to TIERS. These changes are planned for August 2008 and are intended to simplify data entry for MEPD cases and allow data to be transferred electronically between HHSC and the Department of Aging and Disability Services (DADS), the agency that determines .functional eligibility..the medical necessity for MEPD services.
We have several grave concerns with the proposed MEPD conversion:
. The pre-conversion benchmarks developed for the geographic expansion are not appropriate to determine readiness to convert the MEPD cases. They should be revised to address the specific concerns associated with adding these programs and population to TIERS. As with the geographic conversion, the benchmarks must include a timeliness measure in addition to a workload measure to ensure that the conversion of MEPD cases does not result in delays in application processing in other programs or areas of the state.
. MEPD clients are among the most vulnerable served by HHSC. Many have cognitive impairments such as dementia that interfere with their ability to understand or communicate effectively. Moreover, any disruption in their Medicaid benefits could have dire consequences for their health and well-being. HHSC should take extra care before converting any MEPD cases to TIERS to ensure that it will not cause disruptions in services and that enough staff are available to assist clients when problems occur.
. It is unclear why HHSC is planning to convert such large numbers of the MEPD caseload at one time. A more rational and cautious approach would be to convert only a small number of cases at a time. This would allow HHSC to maintain close control over the conversion and ensure they have the resources needed to intervene when problems arise.
We recommend HHSC halt all plans to convert any MEPD cases to TIERS until they have implemented more meaningful benchmarks and thoroughly tested the new functionality being added to TIERS to ensure that the interface between DADS and HHSC works smoothly. The legislative oversight committee as well as stakeholders and advocates should be given the
opportunity to comment on the revised conversion plan prior to implementation.
Call Center Procurement Plans
HHSC continues to forge ahead with its plan to use privately run call centers to modernize the eligibility system. In October 2007, HHSC released two draft Requests for Proposals (RFPs) related to the development and operation of an eligibility system for Food Stamps, Medicaid, TANF, and CHIP. Similar to the original, now defunct contract with Accenture, the RFPs asked vendors to submit their proposals for operating a system of call centers to provide .eligibility support services. for Food Stamps, Medicaid, and TANF; determine eligibility for CHIP-only cases; and provide document-processing services through a centralized mail center. Last week, HHSC received the federal approvals needed to release final RFPs and move forward in the
CPPP has always supported the general concepts and goals behind the state.s plans to modernize its eligibility system. We share HHSC.s vision of a system that is easier for clients to use and more economical for the state to administer. We agree that better technology, more efficient processes, and the right mix of call centers, online tools, and local eligibility offices could produce a state-of-the art eligibility determination system for these programs. However, we strongly urge the Legislature and HHSC to learn from the painful experience with the Accenture contract.which caused harm to thousands of Texas families and cost taxpayers millions.and proceed with great caution before entering into any new contracts.
Above all, the draft RFPs outline an enormous undertaking that will require years to accomplish and require extraordinary additional resources from HHSC at a time when HHSC is struggling with the limited resources it has. A project of this magnitude will change the fundamental role of HHSC in providing these services. Even if it chooses to outsource to private companies certain tasks related to the eligibility and enrollment process, HHSC remains responsible for ensuring that eligible families receive timely and accurate benefits in accordance with federal law. This creates new responsibilities for HHSC.
Where previously HHSC was required to administer the system, now it is responsible for developing requests for bids, negotiating contracts, monitoring performance, and enforcing compliance. HHSC needs to determine whether it has the capacity to play this role and include the costs of contract monitoring and enforcement when determining whether the bids that result from the final RFP are truly cost-effective.
We further recommend that HHSC do a new cost-benefit analysis to determine whether privately operated call centers are the best approach to improving services and achieving greater efficiencies. The assumptions in the .business case. analysis developed in March 2004, which ultimately served as the basis for the Accenture contract, have since been proven wrong. A rational approach to contracting must begin with a new set of assumptions, including a valid staffing analysis that determines how many workers are needed, and the right mix of workers (public vs. private; skilled vs. unskilled), to operate an effective eligibility system. HHSC should then test these assumptions in a controlled pilot experiment that allows the state to compare
the .old. system to the new and determine which works best before entering into any long-term, high-dollar contracts.
Summary of Recommendations
. HHSC should postpone any additional rollout of TIERS until it has hired and trained enough workers to meet the federal standards for timeliness in application processing.
. HHSC should devise an alternative to putting Women.s Health Program (WHP) and associated cases into TIERS to slow the rapid increase in TIERS cases and ensure enough trained workers are available to handle the volume of TIERS cases.
. HHSC should revise its pre-conversion benchmarks for TIERS expansion to include a meaningful timeliness measure. Timeliness statewide for cases processed in both SAVERR and TIERS should meet federal standards prior to adding any new cases to TIERS.
. HHSC should halt all plans to convert any MEPD cases to TIERS until they have developed and implemented more meaningful benchmarks and thoroughly tested the new functionality being added to TIERS to ensure that the interface between DADS and HHSC works smoothly. The legislative oversight committee as well as stakeholders and advocates should be given the opportunity to comment on the revised conversion plan prior to implementation. Before eleasing a call center RFP, HHSC should determine whether it has the capacity to rigorously oversee a large contract and include the costs of contract monitoring and enforcement when determining whether the bids that result from the final RFP are truly cost-effective.
. Before entering into any contract for call center services, HHSC should perform a new cost-benefit analysis to determine whether privately operated call centers are the best approach to improving services to clients and achieving greater efficiencies for the state. This exercise must include a .baseline. staffing analysis that determines how many workers are needed, and the right mix of workers (public vs. private; skilled vs. unskilled), to operate an effective eligibility system.
. HHSC should test its assumptions about the benefits of privately run call centers in a controlled pilot experiment that allows the state to compare the .old. system to the new before entering into any long-term, high-dollar contracts.
Sunday, July 13, 2008
Texas Legislative Committee on Human Services can be seen HERE
House Committee on Appropriations-S/C on Health & Human Services is HERE
Saturday, July 12, 2008
Thursday, July 10, 2008
Texas' Trouble with Timeliness
For those following the slow-motion implementation of TIERS, Texas' new social services enrollment system, yesterday was another step forward - although not a wholly positive one, according to the Dallas Morning News.
Since its introduction, 217,000 hungry Texans in need of food stamps have been transferred to TIERS, whose privatized, high technology was supposed to make life easier for everyone.
Last winter, however, half of new food stamps cases in the system were not resolved in the federally mandated 30 days, stranding hundreds of hungry families without food around the holidays and putting HHSC on the wrong side of the law.
Yesterday, after state lawmakers demanded accountability from the system before approving an expansion, HHSC released a set of nine measures designed to improve TIERS' performance. Not on the list? Timeliness.
"The test is whether you're processing cases in a timely way, and that's not in here," said food policy expert Celia Hagert of the Center for Public Policy Priorities.
Timeliness is a key aspect to fighting hunger. What would you do if your local firemen only showed up in time to fight half the fires?
Posted by jc at 8:25 AM
By ROBERT T. GARRETT / The Dallas Morning News
AUSTIN – State social services officials now plan to switch 1 million or more needy people in the next year to a different application process for benefits, including Medicaid and food stamps.
The state says it intends to shift 953,000 elderly and disabled Medicaid patients into its problem-plagued "integrated eligibility" system by September 2009 – on top of its previously stated goal of moving in 288,000 more food stamp recipients by August 2009.
The state's decision, tucked into an advance copy of Health and Human Services Commission chief Albert Hawkins' planned testimony to a legislative panel next week, caught advocates for the poor, state employee groups, and a veteran Democratic lawmaker by surprise Friday.
They expressed alarm that Mr. Hawkins would so greatly accelerate the rollout of TIERS – the Texas Integrated Eligibility Redesign System – to aid recipients statewide.
"I'm concerned that the commission is going to take one of the most vulnerable populations, the elderly and disabled, and convert these extremely complicated cases into TIERS so quickly," said Rep. Elliott Naishtat, D-Austin. He said the Medicaid recipients are "most likely to have problems" and there could be "dire consequences."
The Texas State Employees Union, which has said an old mainframe-based system works much better than TIERS, denounced the plan.
"It borders on irresponsible behavior," said union spokesman Will Rogers. "They haven't worked out all the bugs with TIERS. You're playing with people's lives by doing that."
Mr. Hawkins has said the mainframe computer used for Texas benefit applications is one of only seven of its type left in existence. The old approach is outmoded and costly, while TIERS is being improved, he has said.
Commission spokesman Geoff Wool, when asked whether the state was expanding TIERS too fast, said: "This proposal reflects a measured approach. We're going to monitor very closely the benchmarks that have been established and if there are indications of problems, we'll adjust the rollout."
He referred to measures, such as reduced caseloads and caller hold times, that the state plans to use to determine if the 331 eligibility field offices can be switched to the Web-based TIERS software technology. Only six, all in the Austin area, have been fully converted.
Celia Hagert /(512) 320-0222 x110
July 11, 2008
Contact: Celia Hagert, email@example.com
LEGISLATIVE OVERSIGHT COMMITTEE ON TIERS/ELIGIBILITY
SYSTEM TO HOLD HEARING ON MONDAY, JULY 14
Access to health care and good nutrition is vital to low-income Texas families who don’t earn enough to make ends meet. Yet, enrolling in programs like Food Stamps and Medicaid has gotten harder over the last year due to problems with TIERS—the
new computer system—and a staff shortage that resulted from a legislatively-mandated attempt by the state to privatize the system in 2006, which failed. Rebuilding a viable eligibility system promises to be one of the most important challenges facing
Texas in the years to come.
On Monday, July 14, the Legislative Oversight Committee overseeing efforts to rebuild the eligibility system will hold a public hearing. The Texas Health and Human Service Commission (HHSC) will provide a progress report and present the benchmarks that will be used in determining whether to continue implementing TIERS.
The hearing is scheduled for Monday, July 14, 2008, at 10:00 a.m., Capitol Extension, E1.028, Austin, Texas. The committee will hear invited testimony from HHSC on their efforts to rebuild and enhance the eligibility system including:
• Stabilizing the workforce (increasing staff, reducing turnover, and training staff to use TIERS);
• Expanding TIERS; and
• Awarding a new call center contract.
The committee will also take public testimony. We encourage stakeholders to attend and provide input.
Issues of Concern
• Timeliness in application processing is still below these federal standards, with the most severe delays occurring in applications processed in TIERS. Several factors are contributing to these delays: staffing shortages: high staff turnover rates, reduced staff tenure, and problems training staff quickly enough to work cases in TIERS. HHSC should postpone any additional rollout of TIERS or entering into any new contracts until the system is meeting the federal standards for timeliness in application processing for all clients already in TIERS, and has enough workers to meet those standards for new rollout populations as well.
• HHSC is planning several significant expansions to TIERS, yet the proposed benchmarks for determining readiness to expand do NOT include timeliness as a measure of system readiness. HHSC is planning a limited geographic expansion
of TIERS as well as conversion of all of the “MEPD” (Medicaid for the elderly and people with disabilities) over the course of eight months beginning in December 2008. HHSC has developed certain benchmarks that must be met before proceeding with these expansions. Though we support the use of benchmarks to determine readiness for further TIERS rollout, several flaws in HHSC’s approach must be addressed first. Most significant, the benchmarks fail to include timeliness as an indicator of system readiness, despite timeliness being the best indicator of a system and a workforce that is stable enough to weather the strain that is inevitable in the conversion to a new computer system. We also have serious concerns about the decision to convert all of the MEPD cases to TIERS, as well as with the proposed timeline for the implementation.
Friday, July 11, 2008
The state's main social services agency, trying to stabilize a troubled enrollment system for aid programs, said Thursday it will increase the eligibility determination workforce this summer by several hundred people.
"We're hiring as many people as the Legislature will allow us to hire," said Health and Human Services Commission spokesman Geoff Wool.
Lawmakers, foreseeing the need after what critics say was a botched privatization experiment, gave the commission flexibility to go over a payroll cap.
Since September, the number of state eligibility workers has climbed to 7,027, a gain of 684 employees.
However, in a report this week to a legislative oversight panel, the commission said problems remain.
"Despite the increase in net staffing levels, turnover continues to be an issue," it said.
This year, 21 percent of the state's eligibility caseworkers, clerks and supervisors are expected to quit – only a "modest reduction" from last year's 22 percent turnover, the commission said.
To halt the flight, Health and Human Services Commission chief Albert Hawkins announced last winter an unusual set of midyear raises for eligibility workers. Last month, most received at least a 5 percent raise. Last fall, entry-level workers were paid an average annual salary of $26,100.
But Mr. Hawkins has conceded there's much work to do.
On Thursday, the commission announced it lifted this year's target for eligibility staff to 7,438, from 7,136.
Mr. Wool said if the goal can be reached, the commission will have used up all the flexibility lawmakers permitted
Thursday, July 10, 2008
Have you seen the Health and Human Services Eligibility Transition Plan July 2008 Update? The link is this (but it's not working right now?)
Anyway, some highlights are as follows:
Rollouts are coming folks.....no matter what they might be telling you in the offices.
Region 7 is first- and this will start October 2008 with the following offices:
LaGrange, Bastrop, San Saba, Hamilton, Elgin, Lampasas, Llano, Marble Falls, and Goldthwaite (9,000 SAVERR Cases)
November '08(with approx 19,500 SAVERR Cases):
Temple, Killeen, Copperas Cove, and Gatesville
January '09(with approx 22,500 SAVERR Cases):
(I'm going to tell you what is really going to hurt here....the cases they are currently "bumping" certifications on? This is when they will all be coming in for recertifications after going an entire 12 months without an interview....for you workers out there, think about this....you are now in TIERS, and you will be interviewing clients who have not had an interview in a year. Think of the changes you will have to put in, the updates you will have to make. For those who are not yet on TIERS, ask some of your fellow co-workers who ARE on TIERS how horrible this will be)
Bryan, Centerville, Madisonville, Navasota, Giddings, Hearne, Caldwell, Brenham, Rockdale, Marlin, and Cameron
February '09 (with approx 29,000 SAVERR Cases- this will complete Region 7):
Waco, Hillsboro, Meridian, Mexia, Teague, Luling, and Lockhart.
April '09 (with approx 54,300 SAVERR Cases)
Canutillo, Yandell (Midtown), Diana (Mountain View) and ElPaso Drive
May '09 (with approx 32,300 SAVERR Cases)
Edgemere (Eastside), Lomaland, and Alameda (Riverside)
June '09(approx 22,100 SAVERR Cases- Completes Region 10):
Fabens, Socorro (Mission Valley), Alpine, Marfa, Van Horn, and Presidio
July '09 (approx 30,700 SAVERR Cases):
Amarillo, Perryton, Borger, Dalhart, Dumas, Pampa, Childress, Memphis, Plainview, Muleshoe, and Tulia
August '09(Approx 33,500 SAVERR Cases-Completes Region 1):
Lubbock Parkway, Levelland, Lorenzo, Post, Brownfield, Hereford, Denver City, Littlefield, Tahoka, and Dimmitt
Tuesday, July 01, 2008
By Corrie MacLaggan Tuesday, June 17, 2008, 01:04 PM
Accenture spokesman Jim McAvoy apologized for the heavily redacted document the company's lawyers sent me earlier this month.
"I am really sorry, deeply sorry that this happened, and it shouldn't have happened," McAvoy said. "It was outrageous."
I wrote last week about how Accenture is trying to keep me from getting access to documents I requested from the Health and Human Services Commission regarding negotiations to unravel a major contract to enroll Texans in public assistance. The deal was originally worth $899 million, and the state has paid some $243 million.
The heavily blacked-out document I got from Accenture's lawyers was a legal brief the company sent Attorney General Greg Abbott explaining that the documents contain trade secrets and should remain private.
Today I got a "revised redacted copy" of the legal brief from the Accenture lawyers. This time, instead of blacking out the information they view as trade secrets, the redacted words are just blank spaces. So the revised version is a little less jarring to look at. And more importantly, there are fewer words redacted.
For example, page 6 of the brief as originally redacted was almost entirely blacked out, but in the new version of the same page, I can read about how Accenture is concerned about releasing trade secrets involving a system called the Rapid Transition Suite.
So the fact that I can read more of this brief is good news. But the brief just explains why the documents I requested should remain private. Frankly, I'm not that interested in all of Accenture's trade secrets.
What I really want is what I requested in the first place: the documents detailing Accenture's negotiations with the state of Texas. A lot of taxpayer dollars are at stake.
My comments in RED
Despite federal OK, Texas delays computer system expansion
Legislature increasing oversight of TIERS system used to enroll Texans in food stamps, Medicaid.
Texas recently got federal permission to expand use of a controversial public assistance enrollment system beginning this month, but Health and Human Services Executive Commissioner Albert Hawkins has agreed not to do so — at least for now.
Shock! Stop the PRESSES! Is this the SAME Mr. Hawkins that has DEFIED instructions in the PAST to not continue putting clients in this system? Really? All of a sudden, now that the Women's Health Program has thrown THOUSANDS of households in TIERS, he's willing to not "expand"? I'm dumbfounded. And curious- what "politics" are at play here?
Hawkins said this week that he'll abide by a legislative request that the commission first establish — and meet — a series of goals before expanding use of the computer system known as TIERS. That stands for Texas Integrated Eligibility Redesign System.
Of course! Now that the state is in TURMOIL with TIERS. Very interesting INDEED.
Federal officials have been concerned about expanding TIERS, in part because Texas has struggled to process food stamp cases as quickly as required.
No, really? It's been like that since DAY ONE. Of COURSE food stamp cases take longer. The system itself is long. Laborous. What used to take a worker 30 minutes to do can take HOURS to do if TIERS isn't cooperating. That is NO exaggeration.
"No expansion of TIERS will be undertaken prior to the benchmarks being established," Hawkins wrote in a letter to lawmakers this week. "As a result, we will not begin rollout in July 2008."
So am I to assume that the State will ALSO stop loading clients into this system via WHP?
The request to Hawkins from state Rep. Patrick Rose, D-Dripping Springs and chairman of the House Committee on Human Services, stems from a new law requiring legislators to more carefully scrutinize the state's work enrolling Texans in programs such as food stamps and Medicaid.
The legislation created a committee "to maintain oversight, hold the commission accountable and ensure to Texans that TIERS was being expanded in a prudent manner," Rose said. "It's important for Texas taxpayers and to those eligible for all critical services."
Rose has asked Hawkins to propose specific benchmarks later this summer to the oversight committee. The goals may include ensuring that there is adequate staff trained in TIERS, according to a letter Hawkins wrote to Rose.
Adequately trained? What does that mean exactly? You mean, more workers ON PAPER that have BEEN to training? Because that does not equate "adequately trained". No. It takes at LEAST 6 months of WORKING on TIERS to fully grasp alot of the nuances that go with the system. Mind you, the training is TWO WEEKS LONG and does NOT cover things that happens in the "real world". Training in TIERS is a BREEZE because hey! all the cases work like they are supposed to!
The state has had trouble processing food stamp applications in TIERS as quickly as required by the U.S. Department of Agriculture — 30 days — in part because there aren't enough workers trained in TIERS. Texas has struggled to retain employees who enroll Texans in public assistance.
Yes, and you know why? Because for too long, no one has ever listened to the actual people in the field that have to do these cases. Too many chiefs, not enough indians. Period.
"The combination of not enough staff trained well enough and too many cases coming into TIERS and the fact that it takes longer to process a case in TIERS than (the old system) is a recipe for disaster when it comes to timeliness," said Celia Hagert of the Center for Public Policy Priorities, which aims to help low- and middle-income Texans. "The whole reason we have a standard is that people who go to get food stamps are people in an emergency situation."
In April, 49.2 percent of Texas food stamp applications processed using TIERS were completed on time, compared to 92.6 percent processed in the old system in the same period.
Anyone in the field could have told you this. We've been screaming about this since all this started. Is it any wonder that there is a difference? The old system, "old" as it may be, got the JOB DONE.
This week, USDA officials gave final approval to the state's plan to expand TIERS. They told Hawkins in May that Texas could expand it, but only to 22 percent of food stamp cases because "far too many approvals remain untimely."
About 9 percent of cases are now in TIERS, agency spokeswoman Stephanie Goodman said. About 2.3 million Texans are on food stamps.
I find that 9% questionable. There are offices that haven't "rolled out" that are closer to 30%. Austin is 100% TIERS and the timeliness there is beyond bad. Not the fault of the workers at all, it's the system. It's double edged, because you throw workers through basic policy training, then give them TIERS for 2 weeks, then they go to the field. Depending on the state of the office they are in, they may get to gradually amp up to full caseload, but in many offices the need is too great to do that slowly, the way it should be. So you fully schedule them, it becomes impossible to keep up with and they quit. Sad thing is, it's the "worker" that gets all the heat when it comes to timeliness. It's never ever because the expectation is too high. You know why? Because the "decision makers" have NEVER EVER BEEN A FULLTIME CASEWORKER IN TIERS. They simply do NOT know.
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