Requirement to cooperate with quality assurance. WAC 388-464-0001
CLARIFYING INFORMATION
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As a condition of receiving federal funds for the administration of the food assistance program the federal government requires states to maintain a Quality Assurance system. The QA section must:
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Review a statistically valid statewide sample,
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Compile and analyze review findings semi-annually to determine numbers and types of errors, and;
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Aid in establishing corrective action plans.
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Review sampling:
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The Review Sample Time Period covers the federal fiscal year which runs from October 1st of one calendar year through September 30th of the following year.
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Cases are selected for review at random from active recipients of public assistance benefits. This is identified as the positive sample.
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A random negative sample is also drawn from denied, withdrawn, and terminated case actions.
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Case review process:
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The QA review process typically includes:
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An electronic file and case record review.
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A field investigation consisting of a visit to the home of the recipient and any collateral contacts necessary to establish payment accuracy.
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Verification of all eligibility factors.
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A determination of the correctness of payment and benefit eligibility.
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A report of the findings to the Community Services Office (CSO) and where appropriate to the federal government.
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Federal re-review:
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Federal reviewers conduct a re-review of a sub-sample of cases previously reviewed by state QA to validate the review findings.
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If re-review results in a variance from original state findings, QA will send the re-review findings to the CSO for any necessary action.
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Exempt errors: Food stamp errors that are discovered and are less than $6.00 are reported to the CSO on a DSHS 05-012A(X) but are not counted in the federal QA error rate.
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WORKER RESPONSIBILITIES
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Non-cooperation:
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The QA reviewer will notify the CSO immediately upon determining a client's refusal to cooperate in the QA review process. The notice will contain:
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The specific reasons for the non-cooperation findings.
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The period of ineligibility;
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What the client can do to end the disqualification; and
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The phone number and reviewer name for future contact.
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Upon receipt of the notice of non-cooperation the FSS must take the following action:
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Notify the client immediately that the entire TANF/SFA assistance unit or food assistance household benefits will be terminated. The effective date of termination is the first of the month following the end of the 10 day advance notice period. The notice should contain the following:
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The specific reason for the non-cooperation finding,
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The sanction time period and if the client is non-cooperating for both TANF/SFA and food assistance, include both time periods,
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What the client must do to end the disqualification,
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That an overpayment may have occurred, and;
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The phone number of the QA unit.
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The FSS must terminate benefits unless QA notifies the FSS the sanction is lifted.
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If unable to terminate benefits prior to the first of the month, the FSS should take the following action for TANF/SFA assistance units:
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Establish an overpayment from the first of the month following QA's determination of non-cooperation, and;
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Include the advance notice time period.
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For food assistance household's, the FSS must terminate benefits effective the first of the month following the end of the 10 day advance notice period.
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Re-application after termination due to non-cooperation:
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If an applicant that has been terminated from assistance reapplies before the end of the QA sanction period, review the case record for a notice of cooperation from QA. If there is none, notify the QA field unit the client is reapplying and document the response from QA on the narrative screen in ACES.
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If the applicant has cooperated, determine eligibility in accordance with the procedures found in the Applications category of this manual.
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If the applicant has not cooperated
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Pend the application for cooperation with QA but request the necessary verification of current circumstances.
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Refer the applicant to QA to reinstate the review process.
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Authorize assistance effective the date all eligibility factors are met, including cooperation with QC. For food stamps issue benefits according to instructions found in the Issuance category.
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If the applicant continues to not cooperate, deny the application no later than 30 days from the date of application.
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For an applicant who reapplies after the sanction period expires, verify all eligibility requirements. No referral to QA is necessary.
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Processing QA case file requests:
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The CSO receives requests for case files for both state QA and federal re-reviews by electronic mail fax or phone. These requests originate from the QA office responsible for completion of the QA review or coordinating the federal re-review.
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CSO's are responsible for:
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Sending case records to the originating QA office within 5 days of the date requested.
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If the record is unavailable, the originating QA office is to be notified immediately.
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Quality Assurance Responsibilities
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QA units are to provide sufficient lead time to allow CSO's to find records; and,
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Restore records to their proper order prior to returning them
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Quality assurance review findings:
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Quality Assurance reviews focus on correctness of eligibility and payment in a specific review month. The findings from the review are reported via the DSHS 05-012A(X).
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For correct cases, no action is required by the CSO unless other information is supplied which affects the client's eligibility. The CSO is responsible for evaluating the information and taking appropriate action.
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For error cases, the CSO must evaluate and respond by following procedures specified in subsection 5. of this section.
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The error findings report from QA should contain information specifying;
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The type (overpayment or underpayment) and dollar amount of the error
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The applicable rule citation
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A narrative explaining how the error was found
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A listing of Federal reporting codes indicating;
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Element and nature codes (program requirements)
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Type of error (agency or recipient responsibility)
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Discovery (how the error was identified)
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Verification (how the information
supporting the error finding was
verified i.e.: from what source)
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Occurrence (relationship between error and most recent action on case).
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Filing a concurrence or non-concurrence:
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If concurring with QA's findings, the CSO completes the bottom portion of the DSHS 05-012A(X) indicating concurrence, routes pink copy to QA; and
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Takes appropriate action on the case, including computing and establishing an overpayment where necessary
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Initiates corrective action, including;
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Error analysis,
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Changing procedures where appropriate, and;
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Providing training.
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If nonconcurring, the CSO must complete a DSHS 05-012C(X) by the date specified in order to affect findings reported to the federal government. The non-concurrence must contain information:
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Explaining the non-concurrence
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listing manual references, and;
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supporting documents.
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Administrative review:
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In some cases, after completion of the non-concurrence cycle, the CSO, Regional office and QA are in disagreement over the error findings. Once the CSO issues a notice of non-concurrence QA will issue a supplemental report to either agree or disagree with the non-concurrence. If a resolution cannot be reached, either the CSO or the QA supervisor may initiate an administrative review by calling or faxing a request to the Chief of the Division of Program Research and Evaluation or the designee.
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The Administrative Review process consists of a review of the issue by a headquarters management team. If no resolution is reached, the director of Community Services Division becomes responsible for issuing a final decision.
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