After a CAO scans or sends the case record to QC and the review is completed, QC will notify the CAO and the Area Manager electronically if an error is found. Any supporting documentation will be electronically attached. Upon receipt of the message, the CAO will:
Access the document through the hyperlink provided in the email or through DocuShare's BPE folder to review the QC error findings. A program specific folder will contain the findings;
Review the information in the findings memo or deficiency memo to determine whether QC's determination is correct according to current policy and verification of the facts;
Decide whether it agrees or disagrees with the QC findings; and
Respond to the findings memo within 10 business days of its receipt.
Participate in the Error Review Committee (ERC) process if the CAO disagrees with the finding. See Section 900.41, Error Review Committee.
NOTE: QC Memo Reports are available monthly for TANF demographic and work participation deficiencies and a Daily Status is posted about the 21st of each month when the reports are available.
The CAO's position regarding the QC finding(s) will be stated in response to a QC finding or deficiency memo prior to being schedule for ERC.
Documentation to support the CAO's disagreement must be scanned to the appropriate QC Program Manager and can be forwarded either before or after the meeting.
The CAO must address the factual data presented by QC and the applicable policy. If the CAO determines that QC used an incorrect policy, it must identify the appropriate policy reference or submit additional clarification if QC is believed to have misinterpreted the cited policy. The CAO must also provide verification to dispute the QC findings.
QC will determine which agency is responsible for the finding based on information available in the case record. The identified agency will be expected to respond to the finding issued. If the agency or area management disagrees that the agency to which the finding is attributed is correct, communication should be sent by email to the appropriate QC Program Manager as soon as possible after the issuance of the finding memo.
All error cases that the county assistance offices disagree with for SNAP, SNAP Timeliness, TANF, Medicaid, and Presumptive Eligibility (PE) are addressed by the Error Review Committee (ERC).
NOTE: As of November 17th, 2014, EBT, FTI and findings with which the CAO agrees are no longer discussed at ERC.
The committee is made up of members from the Bureaus of Policy, Operations, Program Evaluation and Program Support who meet as needed to discuss both positive and negative review findings and deficiencies that are challenged at the CAO level. Meetings are held in Harrisburg and staff members attend in person or participate via speakerphone. The functions of the ERC are to discuss the circumstances surrounding each finding or deficiency and develop corrective action plans. This includes, but is not limited to:
Policy
Computer systems
Training
QC procedures
CAO procedures
The purpose of ERC is to create changes that would improve payment accuracy and benefit timeliness. The sessions provide a means to examine the various systems which contribute to the eligibility and allotment process and aid in the identification and implementation of ways to prevent future errors. All who participate have an opportunity to offer suggestions for system-wide changes that may help reduce the state’s payment error rate.
The basic steps of the ERC processes are as follows:
1. The CAO receives a QC Review Findings Memo or QC Memo List Report. The Findings Memo, formatted in Excel, contains a Findings Memo tab and a CAO Response tab.
2. The CAO responds to the finding within 10 days to either agree or disagree by selecting the appropriate radio button.
3. QC Memo List Reports have a CAO Response column which should be completed for cases that require a corrective action response and QC Memo Reports should be returned to the PW, TANF sample mailbox by the 20th of each month.
4. If the agency agrees with the finding, the finding is adjudicated and an Error Prevention Plan is generated based on the given root cause of the finding.
5. For findings where the agency either disagrees or has not responded within 10 business days, the Division of Quality Control (DQC) e-mails a list of cases to be discussed with the CAOs along with the date of the ERC meeting.
6. At the meeting, the ERC members will contact the CAO representative to obtain the CAO’s position on the review and to supply any additional information about the review and their basis for disagreeing with the finding. The ERC and the CAO will discuss the issues of the case. As needed, requests for or discussion of corrective action plans and strategies will be made.
7. ERC makes a decision to affirm, withdraw, or pend each error finding for further discussion.
8. If the QC representative or the Area representative disagrees with the ERC decision, an Area Manager challenge can be initiated. To initiate an Area Manager’s challenge, both the QC and the Area representative must notify and provide supporting documentation for discussion to the Area Manager and the BPE director within 5 days of the notification of the ERC decision. A decision on the final review results will be made by the BPE Director and the Bureau of Operations Director or the Area Manager.
9. DQC issues ERC Summaries by benefit program which recapitulate the decisions made on each week’s reviews completed as of the monthly issuance.
Reminder: If QC does not find an error, it will notify the CAO via Clean Case Letter for SNAP and TANF reviews. The letters are transmitted automatically on a monthly basis via e-mail to CAOs and Area Managers. Also, if there are no QC Memo Reports for a county or district for a particular month, the QC Memo Report will display "No Data Found."
Reissued November 13, 2015, replacing January 30, 2015