Finance Systems

Building a systemic approach to financing a statewide system of services is a complex process that includes the identification, understanding, and full utilization of all existing funding resources. The following are examples of ways that states have been successful at forming a framework for a financing system that is based upon a common vision of a community-based, family-centered, and culturally competent foundation of services and supports to meet individual needs.

Framework

PDF: A Framework for Developing and Sustaining a Part C Finance System (2007) summarizes the fiscal challenges that this legislation presents and proposes a framework for analyzing, adjusting, and maintaining a flexible and self-regulating finance system to support Part C early intervention services for infants and toddlers and their families. The framework design features four phases of work to help agencies understand the issues and make informed decisions for on-going development and support of a Part C finance system.

Medicaid Waiver

A Medicaid waiver is when the Federal Government allows or grants States permission to waive certain Federal requirements in order to operate a specific kind of program. In general, Federal law allows States to enact two types of Medicaid waivers - Program waivers and research and demonstration waivers.

Program Waiver - Home and Community Based Waivers

  • PDF: Maryland - House Bill 99 - Services for autistic children and seriously emotionally disturbed individuals
  • WWW: Montana -§1915(c) HCB Waiver designed to serve young children aged 15 months through seven years who are diagnosed with Autism Spectrum Disorder and who have deficits in adaptive behaviors (2012)
  • PDF: North Dakota waiver for case management, homemaker service, personal care, respite care, habilitation.
  • PDF: Pennsylvania
    • WWW: CMS Waiver to provide community habilitation, respite, service management, transportation, therapy and visiting nurses, permanency planning service, and physical adaptations.
  • Texas - EPSDT Developmental Rehabilitation Services include diagnostic, evaluative and consultative services for the purposes of identifying or determining the nature and extent of, and rehabilitating an individual's medical or other health-related condition.
  • PDF: Wisconsin - Payment by Medicaid for eligible children when use of private insurance is denied by the parent.

Centralized Billing and Reimbursement Systems

Centralized billing and reimbursement systems allow for a centralized pooling of funds to maximize utilization of multiple fund sources and lowers distribution cost, and eliminates distribution formulas and other grant contracting difficulties.

  • Florida - Children's Medical Services (CMS) contracts with MED3000, a division of McKesson, to serve as the Third Party Administrator to facilitate provider information, client information, service authorizations and claims payment.
  • WWW: Illinois - Early Intervention - Central Billing Office (CBO)
  • Indiana - Central Reimbursement Office (CRO) is designed to manage the finances and data collection for Indiana's First Steps System. The CRO receives and dispenses all relevant state and federal resources for early intervention services by reimbursing providers from a revolving fund as invoices are submitted. The CRO is also responsible for WWW: enrolling service providers, maintaining the WWW: online provider matrix and maintaining the WWW: Central Directory.
  • Kentucky's Central Billing and Information System - KY provides an electronic billing system for early intervention providers through the data system, WWW: TOTS. The system bills Medicaid on behalf of the providers and plans are underway to add an insurance billing feature to the system.
  • Louisiana - Early Steps uses the services of the WWW: Central Finance Office contract agency for its provider enrollment, central directory (service matrix), service authorizations, claims submission and claims payment functions.
  • Missouri - WWW: Central Finance Office (CFO) details on HIPPA, schedules and guidelines, and an authorized units calculator tool
  • West Virginia - WWW: Central Finance Office (CFO) Practitioner Information

Financial Case Management

As states become increasingly invested in assisting families in all aspects of accessing the system of services, more states are finding that financial case management is key to successfully paying for a given type or category of services.

Early Childhood Technical Assistance Center

  • CB 8040
  • Chapel Hill, NC 27599-8040
  • phone: 919.962.2001
  • fax: 919.966.7463
  • email: ectacenter@unc.edu

ECTA Center is a program of the FPG Child Development Institute of the University of North Carolina at Chapel Hill, funded through cooperative agreement number H326P170001 from the Office of Special Education Programs, U.S. Department of Education. Opinions expressed herein do not necessarily represent the Department of Education's position or policy.

Project Officer: Julia Martin Eile

  • UNC Frank Porter Graham Child Development Institute
  • IDEAs that Work: Office of Special Education Programs, U.S. Department of Education