113-3          REVIEW OF QUALITY ASSESSMENT FEEDBACKS

After reaching a decision on a review (error or no error), the QA Quality Assurance Reviewers complete the electronic Q-Form to notify the field staff of the review findings.  The Q-Form is transmitted to the QA Quality Assurance Supervisor for distribution to the appropriate regional representative for no error cases and error cases are distributed to the Quality Assessment Review Committee (QARC).

For child care reviews, the entire review form for both no error and error cases are sent to the Child Care Program Office for distribution.  A Child Care Quality Assessment Review Committee (CC-QARC) has been established for the errors pertaining to child care reviews.  The CC-QARC Child Care Quality Assessment Review Committee is held separately from the other QARC Quality Assessment Review Committee .

A regional representative, usually the case reader or a supervisor, distributes the Q-Form to the appropriate field supervisor and caseworker or case manager.

For a no-error review, the supervisor and caseworker or case manager review the Q-form for other information found during the review process.  The caseworker or case manager makes the case corrections as needed.  The supervisor follows up on the review to ensure the caseworker or case manager takes appropriate action on ”other information”.

For an error finding, the QA Quality Assurance Field Manager distributes the Q-form to the core membership of the QARC Quality Assessment Review Committee and the regional designee.  The field supervisor and caseworker or case manager research the error and the cause of the error.  In the process of researching the error, the agency must have no communication with any collateral contact regarding the error.  Any follow-up conducted by any staff other than QA Quality Assurance is considered to promote bias in the review and is therefore unacceptable.  In preparation for the QARC Quality Assessment Review Committee meeting, staff may contact the Quality Assessment office or the Policy Specialists for clarification.

The supervisor provides the pertinent research information to the regional manager or their designee for presentation at the next monthly QARC Quality Assessment Review Committee meeting.  It is not recommended to have the worker who processed the case attend the QARC Quality Assessment Review Committee .

This information for review should include:

• The error cause,
   

• New or overlooked information,
   

• Clarifications received from policy,
   

• Corrective action for the specific case, to fix the benefit, if appropriate, and
   

• Corrective action plans to prevent the recurrence of the error.

The field staff processes claims, restored benefit payments, fraud referrals and other corrections to the sample month after review and discussion by the QARC Quality Assessment Review Committee .

113-3 A.     CORRECT CASE FEEDBACK

Staff do not need to respond to a ”No Error” QA Quality Assurance finding.

During the review process, the QA Quality Assurance Reviewer may discover information that changes benefits for months before or after the review month, and will report this on the Q-Form.  Caseworkers must follow-up on this information to correct the case, however, they do not respond to the Q-Form.

Payment errors of $25 or less will be reported as ”correct”.  These errors do require case corrections and corrective actions by the field.  They do not require a response to the Q-Form nor will the QARC Quality Assessment Review Committee address the error.

113-3 B.     ERROR FEEDBACK

The regional manager forwards the Q-Form to the field staff for review and response.  Regional responses vary greatly; some regions require a response from the supervisor while others designate a lead worker.  The regional manager provides further instructions for presenting the information to the QARC Quality Assessment Review Committee .

Field staff must respond to QA Quality Assurance eligibility and payment error findings by e-mailing their supervisor and regional manager (or their designee) with their response, including forwarding copies of relevant verifications.

Note:

Wait to complete a claim determination (Gen 95) or fraud referral (Gen 40) form or issue a restored benefit on the actual sample month benefit until after you hear the final determination from the QARC Quality Assessment Review Committee .

When challenging the findings, the caseworker must clearly state all pertinent facts and issues related to the challenge and include supporting documentation and policy manual sections.  The district office manager or unit supervisor reviews the challenge for validity and content.