CICRF Did Not Process Applications in a Timely Manner.

As a result of these processing delays, families seeking reimbursement for medical expenses might incur financial hardship.

Table of Contents

Overview

CICRF did not process applications for financial assistance in a timely manner. Our sample test of 60 case files (consisting of 62 applications5) out of 363 showed that the 62 applications were idle for an average of 170 days before CICRF assigned them to staff members to begin reviewing and processing. Once applications were assigned, CICRF took an average of 140 days to approve them for payment. Finally, CICRF took an average of 300 days from receiving an application to approving the reimbursement.

Many families applying for financial assistance have incomes near or below the federal poverty level. As a result of these processing delays, families seeking reimbursement for medical expenses might incur financial hardship.

Authoritative Guidance

According to its website, CICRF’s purpose is as follows:

[CICRF] provides financial assistance to qualified families caring for children with special health needs and disabilities. The CICRF can help families with certain medical and related expenses that are not covered by insurance, public benefits or other financial source[s].

If CICRF does not process and review applications in a timely manner, it prolongs families’ financial hardship, which is contrary to its purpose.

Reasons for Issue

CICRF management stated that they had not yet developed formal performance standards for employees, including attainable, time-based goals for processing and reviewing applications.

Recommendation

CICRF should develop formal performance standards for employees, including attainable, time-based goals for processing and reviewing applications.

Auditee’s Response

CICRF aims to provide timely assistance to families while adhering to all Fund policies and procedures.

Since FY2018, CICRF has leveraged technology, quality improvement tools and additional staffing to streamline the application review process. Given this audit period covers FY2018 and FY2019, the results of these efforts are not fully evident.

The audit calculated the time from the date the application is received to the date the application is opened by CICRF staff (the “queue”); and the time from the date the application is opened to the date a payment is made. The backlog accumulated over many years, starting when there were no transfers from the Medical Security Trust Fund (MSTF) to the CICRF Trust from the 4th quarter of FY2009 through FY2013. During that time, funds were preserved for families instead of backfilling staff positions.

Since FY2018, CICRF has been increasing staffing capacity, and [the Executive Office of Health and Human Services’ Information Technology Office] has identified a customer relationship management (CRM) software solution that will improve the timeliness of applications and has engaged in quality improvement processes to identify delays and inefficiencies in workflow to improve processes at CICRF, and identified the challenges posed in getting timely documentation from families. The development phase began in Feb 2022, and it is anticipated that it will take at least 3 months to build the system. The goal is that families would be able to apply . . . online and submit information online, follow-up [on their applications via a] tracking system, reduce / eliminate paper files, make it easy for families to email material on a secure platform versus mail-in and reduce processing time.

CICRF offers families ample time and flexibility to submit required documentation given ongoing stressors and demands on families caring for children with medically complex conditions. The workflow analysis revealed one example of an application that took 130 days between the date the application was opened and date of payment. A single mother with limited income applied for family support reimbursement for her child who was born prematurely at 23 weeks with [multiple diagnosed medical conditions]. Staff worked closely with the parent for months until all the required documentation from multiple sources were collected. Once staff received all required document[s], the payment was approved the next day.

Given that CICRF cannot finalize a determination on a family’s eligibility for Fund reimbursement until all necessary income and expense documentation is received, CICRF has implemented strategies to collect as much paperwork from families before the application is opened. CICRF is confident that continuing efforts to engage with families upon application receipt, leveraging technology (state mobile phones to text families and receive documentation, eFax [a program that allows faxes to be sent online with a computer], and secure email) and implementing the new CRM system will further reduce processing time so that eligible families receive financial assistance more quickly.

Auditor’s Reply

OSA acknowledges that CICRF faces a number of challenges in processing applications; however, we are concerned about the fact that the time CICRF takes to process applications has increased since our last audit (No. 2016-0292-3S, issued in June 2017). Since then, the number of days it takes CICRF to assign a case to a staff member for review and processing has increased from 158 days to 170 days, and the average time CICRF takes to process an application has increased from 289 days to 300 days. Although we recognize that CICRF may not be able to effectively control some aspects of the application process, OSA believes CICRF can make its application process more efficient. For example, it is unclear why CICRF took an average of 170 days to assign an application to a staff member for processing. OSA believes that developing formal performance standards for employees, including attainable, time-based goals for processing and reviewing applications, would address many of the application processing issues.

Based on its response, CICRF is taking measures to address our concerns on this matter. We urge CICRF to implement our recommendation.

5.    There were 62 applications in the 60 case files in our sample because a family can apply for reimbursement multiple times.

Date published: April 20, 2022

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