Introduction:

The responsibilities for managing the entirety of the Early Intervention Services Trust (EIST) program resides with the Colorado Department of Early Childhood Accounting Unit’s EIST Program Accountant positions (formerly Southern District Accounting). Local Early Intervention Programs were previously responsible for entering required data needed to create a child’s "Trust Program" within the Early Intervention (EI) data system. The updated EIST process which is reflected in this guide will allow the EIST Program Accountant (EISTA) to fully manage the program for which they have oversight and will relieve Local EI Programs of the burden of data entry in relation to children covered under the EIST.

DETERMINING EIST ELIGIBILITY

1. Health Insurance Authorization Form

   1. The Local EI Program will complete, obtain parent signature, and send the Health Insurance Authorization (HIA) to the insurance company

   2. The Local EI Program will be responsible for sending the HIA and the IFSP to the individual insurance company to confirm EIST eligibility

   3. Verify email on the HIA form is listed as EISTA [email protected]

   4. The EISTA office will receive the HIA back from the insurance company and verify the child is EIST Eligible

   5. Insurance Verification (if needed)

      1. The EISTA will contact the insurance company to verify coverage/discrepancies

   6. A copy of the HIA will be uploaded as an attachment to the Client Case (if not eligible for EIST) or to the Trust Program (if eligible for EIST) in the EI Data System.

      The Local EI Program will be notified by email if the child is not eligible for the EIST

   7. Health Insurance Authorization Form Date - object located on Client Case Details tab, Insurance Information section, and may be used by Local EI Programs to track the process of receiving the HIA form in office and sending it to the insurance company

2. EI Trust Eligible Checkbox

   1. The Local EI Program will check the EI Trust Eligible box on the client case for children they expect to be EIST Eligible. This will indicate to the EISTA they should expect to receive the HIA from the insurance company

TRUST PROGRAM (ALLOCATION)

1. Creating a New Trust Program

   1. Once coverage is verified, the EISTA will create a Trust Program in the Trust Program section on the Related tab of the Client Case

   2. A new Trust Program (Allocation) is created in a ‘New’ Status

   3. An email communication is sent to the Email listed under the EIST Communications Email field on the Local EI Program (CCB) Account with the following message:

      “Hi, A new Trust Program has been created. Access it here [hyperlink to Trust Program] Thanks!”

      Note: EIST Communications Email field on the Local EI Program (CCB) Account should be used for email communication specific to the EIST. This field is only editable by the Local EI Program Manager Supervisor.

   4. Insurance Invoice Batch process - 1st of the month

      1. The batch process will look for any Client Case with EI Trust Eligible=True and a Trust Program Status=New. If both of these are true, an Insurance Invoice billing is created

   5. Once the Insurance Invoice is approved by the insurance company, the Trust Program Status will be updated to ‘Waiting on Funding.’ Once the insurance company pays the Insurance Invoice, the Trust Program Status will be updated to ‘Funded’. All EIST allowable activities created on a Trust Program that is in status ‘Funded’ will be associated with the Trust Program Allocation

2. Trust Program - Details

   1. The Trust Program Allocation captures all the details of a client’s Trust Program(s) and replaces the previous Early Intervention Trust Details (#1-#5) on the client case

      1. All sections of the Trust Program Allocation are Read Only for Local EI Program Users and may only be modified by the EISTA

   2. Details- Main Section

      1. Client Demographic section includes the main information about a Trust Program Allocation, such as Allocation Name, Client Name, Related Client Case(s), Local EI Program Account, Trust Transfer details

   3. Trust Program Detail

      1. Trust Program Detail includes specific information about the Trust Program which includes Trust Program Start and End Dates, Trust Program Status and Reconciliation Dates

   4. Trust Program Visits

      1. The visit count is located in the Trust Program Visits section of the Trust Program on the client case

         1. The system will count in real time (right side of section)

            1. Number of Visits Used: Visits entered and allocated to the EIST allocation minus invoiced credits (i.e., visits still in Pending or Ready for  Invoicing, as well as those already paid)

            2. Number of visits Left: 45 visits minus Number of Visits Used

            3. Average Number of Monthly Visits

            4. Average Cost per Visit

         2. The system will count only after the EISTA pays CCB/EIB Invoice (left side of section)

            1. Number of Visits Paid: Visits entered and allocated to the EIST allocation minus invoiced credits (Activity Status=EIST Paid)

            2. Number of Visits Left (based on paid): 45 visits minus Number of Visits Paid

               Note: When EIST Accounting attaches the Trust Exhausted Letter to EI Case and email is generated to the email listed in the EIST Communications Email field on the Local EI Program Account: “Trust Fund has been exhausted for this child, letter attached to client case 00000.”

   5. Financial Information

      1. Financial Information section includes financial information for Local EI Program in real time on the right side of the section (Trust Program Ready to Invoice Amount (activities in Pending or Ready for Invoicing); Trust Program Balance Remaining; Trust Program CCB Invoice Paid(only updated when the CCB Invoice has been paid), as well as Insurance Invoice payment

   6. Insurance Detail

      1. Insurance detail section includes insurance plan information specific to the Trust Program Allocation. This includes Insurance Company, Subscriber ID, Policy Start, End and Renewal Dates and other specific policy details (i.e High Deductible, Grandfathered, etc.)

3. Ending a Trust Program

   1. The EISTA will update the Trust Program status when it is closed due to a child losing coverage, funds or visits being depleted, or the child exiting the EI program. When a Trust Program is closed the system will automatically allocate activities to the next funding source following the funding hierarchy.

   2. The EIST Accounting Office will update the Trust Program Status when ending a Trust Program in the following scenarios:

      1. Ready to reconcile

         1. This indicates a Trust Program is currently in the process of reconciliation. This status will ensure activities created allocate to the ‘AO (Accounting Office) Temp’ allocation in preparation for a potential new Trust Program as long as the EI Trust Eligible checkbox on the client case remains checked and the dates of service for the activities are after the Trust Program end date. If the dates of service for the activities fall within the Trust Program dates or IF the EI Trust Eligible box is unchecked, all activities will then allocate to EI Direct Services OR Previous Fiscal Year (FY) Credits & Denials (if applicable)

      2. Reconciled

         1. This indicates a Trust Program is Reconciled and is closed and unused funds have been returned to Insurance Company. This status will ensure activities created allocate to the ‘AO Temp’ allocation in preparation for a new Trust Program as long as the EI Trust Eligible checkbox on the client case remains checked and the dates of service for the activities are after the Trust Program end date. If the dates of service for the activities fall within the Trust Program dates or IF the EI Trust Eligible box is unchecked, all activities will then be allocated to EI Direct Services OR Previous FY Credits & Denials (if applicable).

      3. Closed

         1. This indicates a Trust Program has closed a trust program was not invoiced to the insurance carrier

         2. EIST Accounting will update the Trust Program Allocation to Closed AND uncheck the EI Trust Eligible checkbox on the client case. All activities will then allocate to EI Direct Services OR Previous FY Credits & Denials (if applicable)

4. Trust Program Renewal

   1. Follows the same process of a New Trust Program

   2. The Local EI Program is responsible for monitoring the renewal date of the Trust Program and is required to submit a new HIA and a copy of the most current IFSP to the insurance company

   3. EI Data System Report Trust Program w/ End Date Next Month can be used to determine when a new HIA is required for a child’s renewal trust program

5. Transferring a Trust Program

   1. The EI Data System can Transfer a Trust Program from one Local EI Program to another

   2. EISTA runs a report each month to find client cases that have been transferred between Local EI Programs and will transfer the trust program based upon the CCB Transfer Date on the sending Local EI Program’s client case

      1. Transfer Trust Allocation is only used by the EISTA

         1. The EI Data System has the ability to Transfer a Trust Program from one Local EI Program to another

      2. EISTA runs a report each month to find client cases that have transferred between Local EI Programs and will transfer the trust program based upon the CCB Transfer Date on the sending Local EI Program’s client case

         1. Transfer Trust Allocation is only used by the EISTA

         2. The Trust Transfer Date is the exact date the Trust Program will ‘end’ for the old Local EI Program and will ‘start’ for the new Local EI Program

      3. NEW Local EI Program - Transferred TO Local EI Program: A ‘copy’ of the Trust Program Allocation with the SAME Allocation Name will be created on the client case the child is transferring TO and be visible in the Trust Program section on the Client Case

         1. The Transfer date will now act as the ‘Trust Program Start Date’ for the transferred TO Local EI Program and will run through Trust Program End Date

         2. This will ensure the transferred TO Local EI Program can:

            1. View all Trust Program Details for the Trust Program

            2. Create and invoice new activities between the Transfer Date (which acts as the Trust Program Start Date for billing purposes) and the Trust Program End Date

               1. The system will automatically look to the Transfer Date and Trust Program End Date to correctly allocate an activity to the correct funding source

               2. NOTE: Transferred TO Local EI Program will only see new activities starting from the Transfer Date and will not see any previously created activities from the OLD Local EI Program

      4. OLD Local EI Program - Transferred FROM Local EI Program: Once transferred, the system will retain a ‘copy’ of the Trust Program allocation. This will move the Trust Program Allocation from the ‘Trust Program’ to the ‘Transferred Trust Program’ section on the client case the child transferred FROM

         1. This will ensure the transferred FROM Local EI Program can:

            1. View all Trust Program Details for the Trust Program

            2. Retain all activities associated with the Trust Program through the Transfer Date

               1. NOTE: The Transferred FROM Local EI Program will ONLY see their own Local EI Program activities through the Transfer Date

            3. Create and invoice new activities between the Trust Program Start Date and the Transfer Date (which acts as the ‘Trust Program End Date’ for billing purposes)

               1. The system will automatically look to the Trust Program Start Date and Transfer Date to correctly allocate an activity to the correct funding source

CHANGES OR UPDATES TO A TRUST PROGRAM:

1. The Local EI Program will notify EISTA when there are changes or updates to a child’s trust program. EISTA will then make all applicable changes directly in the Trust Program Allocation and notify Local EI Programs when these updates have been made

2. The Local EI Program will notify EISTA by email if any of the following has occurred:

   1. The child is no longer receiving EI services

      1. The EISTA will start the trust program reconciliation process

   2. The child’s insurance policy has been terminated or changed

      1. The Local EI Program will complete a new/updated HIA form (if applicable) AND the most current IFSP and notify the EISTA

      2. The EISTA office will then determine if the Trust Program must be reconciled, if a new Trust Program should be created, or if the child is no longer eligible for a Trust Program uncheck the EI Trust Eligible box

         Note: When the Trust Eligible Box is Unchecked by EIST Accounting, an email notification will be sent to the email listed on the EIST Communications Email field under the Contact Details section of the Local EI Program Account.

   3. Declination form signed

      1. The EISTA needs to be notified when a declination form has been signed and the date the declination takes place to know when the trust program is to end. The EISTA will first determine if there are any activities that must be paid for services completed prior to the date the Declination form was signed and process any payments necessary. Once all payments have been completed the EIST Accounting office will reconcile the Trust Program and update the Status to ‘Ready to Reconcile’, then ‘Reconciled’

      2. The EI Trust Eligible checkbox on the client case will be unchecked

ALLOCATIONS, UTILIZATIONS & ACTIVITIES

1. Trust Program Allocations

   1. EIST Allowable activities created on a client case that is EI Trust Eligible will associate to one of two new allocations, ‘EIST-#####’ OR ‘AO Temp’.

      1. EIST Allocation: There is now a new trust program allocation created for each child who has a Trust Program. This replaces the previous ‘Trust’ Allocation in the EI Data System and there is no longer one large ‘bucket’ for trust activities

         1. Activities will associate to EIST (allocation) IF:

            1. The Client Case is EI Trust Eligible; and,

            2. The Trust Program is in a status of ‘Funded’; and,

            3. The Trust Program is ‘Active’; and,

            4. The Activity Date of Session falls within the Trust Program Start and End Dates; and,

            5. There are unpaid visits remaining on the Trust Program (if non- grandfathered program); and,

            6. There are enough unpaid dollar amount remaining on the Trust Program (if grandfathered program)

         2. AO Temp: This allocation is a “placeholder” allocation used for activities that cannot yet be associated directly to a Trust Program Allocation.

            1. Activities will associate to AO Temp (allocation) IF:

               1. The Client Case is EI Trust Eligible AND;

                  1. A Trust Program Allocation has not yet been created; or,

                  2. A Trust Program is in a status of ‘New’; or,

                  3. A Trust Program is in a status of ‘Waiting on Funding’; or,

                  4. A Trust Program is in a status of ‘Ready to Reconcile’

2. Trust Program Activities

   1. EIST Allowable activities created from a client case or service plan element for a client case that is EI Trust Eligible will create a new ‘Trust Program Activity’ record that operates like the existing ‘EI Services’ activity

      1. The Local EI Program will enter activities following the existing steps in EI Data System User Guide

      2. An activity created from either the Client Case OR the Service Plan Element that is Allowable on the Trust and is Paid by Trust=Yes will automatically create a Trust Program Activity

   2. Trust Program Activity Fields

      1. The Trust Program Activity has new fields for tracking Trust Program related information

   3. Trust Program Activity Statuses

      1. Trust Program Activities have the following Status options:

         1. Pending: Trust Program activities are automatically created in a status of ‘Pending’

         2. Ready for Invoicing: The Local EI Program will update Trust Program Activity Status to ‘Ready for Invoicing’ to be included in the 3rd of the month Local EI Program Invoice Batch

         3. Invoiced: Trust Program activities with zero system errors will update to Invoiced automatically in the 3rd of the month Local EI Program Invoice Batch

         4. EIST Paid: Trust Program activities in a status of Invoiced will then run in the EIST Invoice Batch and EIST Accounting will review activities for payment and update to ‘EIST Paid’ to indicate Trust Program payment to the Local EI Program

         5. Pending Rejected: EIST Accounting will update a Trust Program status to ‘Pending Rejected’ if it has been INVOICED and upon review there are errors (ex. incorrect units entered as 40 instead of 4) OR the EIST Accounting determines the Trust Program Activity will not be paid by the Trust and needs to be reallocated to Direct Services

            1. If the Trust Program Activity will not be paid by the Trust, EIST Accounting will notify the Local EI Program AND will update the activity to Paid by Trust=No which will automatically allocate the activity to EI Direct Services or Previous FY Credits & Denials (if applicable)

         6. Unable to Pay: Activities in a status of ‘Unable to Pay’ is used to indicate a Trust Program Activity cannot be paid by the Trust Program OR Direct Services. This is mostly likely for previous fiscal year activities in which the deadline to bill CDEC for previous fiscal year activities has passed and the Trust can also not pay

ACTIVITY INVOICE BATCHES

1. Local EI Program Invoice Batch

   1. Local EI Program invoicing will continue to run at midnight the 3rd of each month

   2. EI Services Activities associated with Direct Services Allocations AND Trust Program Activities associated with Trust Program Allocations will all run in the Local EI Program invoice batch

   3. Trust Program Activities will then LOCK and update the Record Type to ‘Trust Program Activity-Invoiced’ and the Status will update to ‘INVOICED’

      1. Trust Program Activities update to Record Type ‘Trust Program Activity LOCKED’ and Status ‘EIST Paid’ after the EISTA has updated the associated Local EI Program invoice to be paid.

2. AO Temp Nightly Batch

   1. A nightly batch job that updates activities based on Trust Program Status and Trust Program details

      1. The Nightly Batch Job  looks for all Trust Program Activities that are associated with AO Temp Allocation and update the activity IF:

         1. Trust Program Status is updates from ‘New’ or ‘Waiting on Funding’ to ‘Funded

            1. Trust Program Activity allocation updates from AO Temp to the active Trust Program Allocation (EIST-#) when the status is updated to ‘Funded’

         2. Trust Program Allocation has exceeded 45 visits. The Trust Program Activity updates from EIST-# to AO Temp

         3. Trust Program Status updates to ‘Ready to Reconcile’

            1. Trust Program Activity allocation updates to Direct Service Allocation when Trust Program status is updated to ‘Reconciled’

         4. Trust Program Status is updated to ‘Closed’ or ‘Reconciled’

            1. Trust Program activity will be updated to Direct Service allocation

3. EIST Invoice Batch

   1. Runs immediately after Local EI Program Invoice Batch to create a Local EI Program EIST Invoice for invoiced activities associated with Trust Programs

      1. This process will replace the previous process of EIST Accounting pulling an EIST Extract from the EI Data System and manually reviewing and processing payment outside of the EI Data System

   2. EISTA will review the Local EI Program EIST Invoice for accuracy and after making any needed adjustments will proceed with payment

      1. The Local EI Program EIST Invoice is then Marked Paid and all associated activities are updated to EIST Paid and updated with the Date Paid and the Remittance ID of the Local EI Program EIST Invoice

PAYMENT TO Local EI Program

1. Process for EIST payment/Changing EIST activity status to EIST Paid

   1. The EISTA is responsible for all EIST payments to Local EI Programs

   2. The EISTA will update the Local EI Program EIST Invoice to be paid which will then cause each Trust Program Activity to reflect funding and payment

   3. After the Local EI Program EIST Invoice is set for payment a report will be created to be used for entry into the CORE system (State of Colorado payment software/system) in order to process the payment to the Local EI Program

   4. Local EI Programs will continue to be provided with the detailed payment report for each monthly payment but they are also able to view in the system when an activity status is changed to ‘EIST Paid’

PAYMENT TO INSURANCE COMPANY

1. Process for EIST payment for Trust Program Reconciliation

   1. EISTA will complete analysis of payments/fees associated with each eligible Trust Program and will set the program to ‘Ready to Reconcile’ status

   2. The Reconciliation process will be run and all Trust Programs in ‘Ready to Reconcile’ status will be allocated to an Insurance Invoice for each insurance company. Trust Program status will be changed to ‘Reconciled’ and record type will update to Trust Program-LOCKED

   3. EISTA will process payments and provide reports to insurance companies for Trust Program reconciliations