Quality Control (QC) is a division of the Bureau of Program Evaluation that reviews the state’s performance in determining the accuracy of eligibility determinations and benefit amount. QC also examines adherence to policy and regulations. Federal regulations mandate QC review of the Temporary Assistance for Needy Families (TANF), Medicaid and Supplemental Nutrition Assistance Program (SNAP) programs and monitoring of LIHEAP. QC assures compliance with the Civil Rights Act of 1964.
QC examiners review eligibility for the following programs:
TANF – active cases only.
Medicaid – active cases, closed cases, and rejected applications.
Supplemental Nutrition Assistance Program – active cases, closed cases, rejected applications and suspended cases.
QC examiners review adherence to policy and procedures for LIHEAP: Most counties are reviewed in a two year rotation period.
As of November 2014, QC examiners no longer review EBT and FTI.
NOTE: QC refers to active cases as positive reviews and closed cases and rejected applications as negative reviews.
The QC eligibility review focuses on how accurately County Assistance Offices (CAOs) determine eligibility and give benefits for randomly selected cases. Using QC review findings, management can develop corrective action initiatives to reduce error rates and improve accuracy.
The goals of Quality Control are:
to provide data on the accuracy of eligibility and payment determination, so management can take corrective action to improve the error rate;
to support program development;
to measure the efficiency of state and county operations; and
to test the effectiveness and clarity of policies and procedures.
Quality Control uses four systems to manage the data involved in the review process. The Quality Control Information Exchange System (QCIES) is a MAPPER file that contains information on cases QC selects for review. The Quality Control Management Information System (QCMIS) is an Access database produced to capture, maintain and retrieve QC data. The Federal TANF Reporting FTR Intranet Website is an SQL database produced to capture and report demographic information and employment and activity hours to the federal government for the TANF work participation calculation for Pennsylvania. The OIM QC Sampling Website is an application used for the assignment and review of SNAP cases.
Information available in QCIES includes:
The monthly sample of active cases selected for review;
The monthly sample of active and closed Medicaid cases selected for review.
Information available in QCMIS includes:
The case data from which QC monthly, quarterly and annual reports are compiled.
Clean case letters.
Information available in FTR includes:
The monthly sample of active TANF cases selected for review.
Information available in the QC Sampling Website includes:
The monthly sample of active SNAP cases selected for review.
CAOs may access the Bureau of Program Evaluation (BPE) website to view QC reports such as the Monthly Trend Report and the Early Error Identification Report (EEIR), which are completed quarterly, to review its performance and that of other CAOs. Notification is sent via e-mail when the updates to the reports are posted.
The Bureau of Information Systems (BIS) generates monthly sample lists of cases selected for QC review by program. These lists are available at specific times and QC will notify each CAO by email that a sample list is available. CAOs are responsible for accessing the corresponding system to view the sample lists and to determine which cases to either send to the indicated QC office or scan and notify QC that the case is ready to review.
Federal regulations specify the method that QC uses to select a statistically valid random sample.
QC reviews each case that appears in the monthly sample only for the month in which it is selected.
For example, if a case appears on the sample list for May, the QC reviewer will examine eligibility and benefits for the month of May. If QC finds the case to be correct for May, it will record clean case findings, even if the reviewer finds a discrepancy at some other time. If QC finds the case to be incorrect for May, based on timing and effect, a time frame prior to the review month is examined. Changes which occur during the review month or the period prior to the review month are considered and do not necessarily result in a recordable finding.
The timeframes examined in the review period can be:
|
From |
To |
Program |
|
Application |
The review month |
TANF, SNAP |
|
The last SAR review, |
The review month |
TANF, SNAP,Medicaid-MNO |
|
Two months before the review month |
The review month |
TANF, Medicaid - NMP |
If a finding is recorded, QC will notify the CAO of the finding so that the CAO can take corrective action.
The review period coincides with the federal fiscal year. For SNAP and TANF eligibility, the review period begins October 1st and ends September 30th of the following year. For Medicaid eligibility, there are two review periods which run from October 1st to March 31st of the following year and from April 1st to September 30th.
QC sends the following types of memos and materials on case findings to the CAO:
QC Finding Memos and Deficiency Memos for recordable discrepancies.
Information Only Memos for information about the review which does not adversely affect the review month payment or circumstances.
Preliminary Information Memos for information which clarifies the case or supplies information that is missing.
QC Memo Reports through the Federal TANF Reporting System (FTRII) for TANF demographic discrepancies and work participation deficiencies.
Memos requesting the CAOs assistance in getting the recipient to cooperate with the QC review. If the client refuses to cooperate, QC will send the CAO a memo requesting that the CAO contact the client to secure cooperation. For the Medicaid and TANF program, QC requests that the CAO close the budget under review, if the client still fails or refuses to cooperate. For the Medicaid and SNAP programs, a distinction is made between failing to cooperate and refusing to cooperate. The chart below shows the difference between the two determinations.
|
Determination |
Result |
|
Failure to cooperate |
QC request for CAO action |
|
Refusal to cooperate |
QC request for mandated CAO budget closure |
Clean Case Letters to inform the CAO that the review was found to be correct.
Documentation obtained through the review process, such as copies of letters from landlords, etc.
Untimely issuance memos (SNAP only)
After a state completes its reviews of sampled SNAP cases, the federal government selects certain cases from the same sample and re-reviews those cases to check QC compliance with policy and the QC review requirements. The re-reviews may consist of an examination of the case record and collateral contacts. On rare occasions, the re-review may consist of interviewing the client.
The CAO may be required to send the case record materials for the cases selected for re-review to Quality Control.
Reissued January 30, 2015, replacing September 20, 2012