CHAPTER 111. QUALITY CONTROL Sec.
111.1. Policy.
111.2. [Reserved].
111.3. Requirements.
111.4. Procedures.§ 111.1. Policy.
(a) General. Quality Control (QC) is a system of continuing Commonwealth review designed to operate an effective measurement of the accuracy of decisions on eligibility and extent of entitlement for assistance payments, Food Stamps and eligibility for MA. A review will also be made to assure compliance with Title VI of the Civil Rights Act of 1964 (42 U.S.C.A. § § 2000e—2000e-17).
(b) Administrative responsibility. Administrative responsibilities in the QC area are as follows:
(1) The Division of Quality Control will have the responsibility for administration and supervision of the Federal Quality Control System for the Commonwealth.
(2) The Division of Quality Control will operate out of field offices in each of the four regions of this Commonwealth. Each field office will be staffed with an office supervisor, reviewers and clerical support. Staff members will be State office personnel who are assigned to the offices to meet workload demands. No part-time review staff will be employed.
(c) Purpose. The purpose of QC is as follows:
(1) As an instrument for corrective and remedial action, the focus of QC will be on identifying the types of error that occur with such frequency as to cause error levels in excess of tolerance limits, and determining why they occur so that action may be taken to reduce errors to a minimum by eliminating their causes.
(2) The system will also support program development and will be a measure of the efficiency of State-county operations. It will help to test the effectiveness and clarity of policies and procedures, and to provide information for use in strengthening State and county office staff training and supervision.
§ 111.2. [Reserved].
§ 111.3. Requirements.
(a) Analysis of and action on findings. The following is an analysis and summary of action on Quality Control (QC) findings:
(1) Periodic reports on QC review findings will be submitted by the Chief, Division of Quality Control, as follows:
(i) Findings regarding assistance payments—cash grant and MA—will be sent to the Assistance Payments Administration, United States Department Human Services.
(ii) Findings regarding the Food Stamp Program will be sent to the Program Development Branch, Food Stamp Division, Food and Nutrition Service, United States Department of Agriculture.
(iii) Within the Department, findings will be sent to the Deputy Secretary, Office of Income Maintenance.
(2) These reports will be analyzed to determine if eligibility errors or payment errors exceed the prescribed tolerance limits. From this analysis, the State office and county office will develop appropriate measures to improve administration and program operations.
(3) The following is a summary of corrective action to prevent future defects:
(i) State and county offices will undertake appropriate remedial action to strengthen policies, regulations and methods of operation to reduce or prevent future recurrence of the kinds of defects revealed by reviews.
(ii) Remedial action will be discussed with the Executive Director by the regional office representative when defects in local performance indicate a need to modify local policies, or improve supervisory or worker training and performance in aspects of regulation or procedure.
(iii) Immediate action will be taken regarding specific eligibility factors, or subfactors, identified as substantially contributing to an unacceptable error level. This means putting into effect whatever changes are adequate to reduce error rates within tolerable levels. These changes will be applicable to the specific program or geographical area, or both, in which the errors are found to be occurring.
(b) QC process. The following is a summary of the QC process:
(1) The system will be applied through a sampling of the active Medical Assistance, Food Stamps and AFDC caseload, and of county office decisions regarding ineligibility of Food Stamp cases.
(2) The Quality Control process includes the following steps:
(i) Selection of sample cases to be reviewed which are representative of caseloads and provide statistical validity.
(ii) Review by QC Field Staff of the cases selected.
(iii) Analysis of findings to identify the sources and causes of the problems found.
(iv) Corrective measures by State and county offices appropriate to the problems found.
(v) State office reporting to the Federal Government on the steps delinated in this paragraph.
(3) The review will include coverage of the elements of Commonwealth regulations related to any of the following:
(i) Determination of eligibility and the amount of the assistance grant.
(ii) Determination of eligibility and client liability for Medical Assistance.
(iii) Determination of eligibility and correctness of purchase price for participation in the Food Stamp Program.
(4) The review will also include the adequacy of each step taken in the process of making the determination, the adequacy of the application of regulations to the facts obtained, and how well clients meet their responsibility for eligibility requirements.
(c) Sampling process. The following is a summary of the sampling process:
(1) Source of sample. Cases to be reviewed will be selected from cases in the following categories:
(i) Active cash grants in AFDC.
(ii) Medical Assistance cases (P and T with the A, B, C, CU or J symbol).
(iii) Food Stamp cases, both active cases and negative actions (PA, NonPA and SSI)
(2) Method of selection. The method of selection will be as follows:
(i) Cash grant program sample. Selection of cash grant program sample will conform with the following:
(A) The central disbursing office will maintain a computer tape record of persons receiving cash grants. This will be the universe from which the sample of active cases will be selected.
(B) To obtain the cash grant program, or active sample, the Division of Statistical Analysis will estimate the number of cases needed for review in accordance with Federal requirements; determine the selection interval which will provide that number of cases; and select from Standard Statistical Tables the beginning numeral. This information will be given to the central disbursing office and will be used to select from their records the cases to be reviewed.
(ii) Food Stamp Program sample—PA, NonPA and SSI. For the Food Stamp Program, the active case sample will be selected from the central disbursing office record of households that were issued food coupon authorizations during the month, using the same method as for the cash grant sample.
(iii) Medical Assistance Program Sample. In accordance with Federal sampling guidelines, the Office of Income Maintenance will select the required sample site each month from claims data available in the State Office.
§ 111.4. Procedures.
(a) Data reported by county office on Form PA 96 and Form PA 96-S. To provide State Office with data needed, the County Office will prepare a Form PA 96 or Form PA 96-S, Quality Control Card, for Food Stamp cases. Each reporting office will assign a staff member to act as a liaison between the county office and Office of Inter-Program Planning and Evaluation with respect to the collection and submittal of QC data. The name of the person, phone number and county name will be submitted when necessary to keep a current listing in the State Office.
(1) Negative action cases. The following will apply to negative action cases:
(i) Application not authorized. Form PA 96 cards for applications not authorized will be submitted to the Office of Inter-Program Planning and Evaluation at the end of each week. Requests for information, where eligibility is not determined, will not be included. For the Food Stamp Program, a Form PA 96 will be prepared for each assistance and nonassistance application not authorized when an agency determination was made that a household failed to meet eligibility requirements. These will be arranged chronologically by date of decision before being submitted. No card may be submitted for failure for a household to keep an appointment for scheduled application interview.
(ii) Cases closed. Form PA 96 cards for Food Stamp cases closed will be submitted to the Office of Inter-Program Planning and Evaluation at the end of each week. A Form PA 96 ( ) will be prepared for each assistance and nonassistance case determined ineligible. These will be arranged chronologically by date of decision before being submitted. No card may be submitted for households which fail to appear for an interview. For QC purposes, the following discontinuances will be arranged chronologically by date of decision before being submitted and will not be reviewed and no card will be submitted.
(A) Closure of a case due to the death of all members of a household.
(B) Closure of a case due to a household moving from this Commonwealth.
(C) Failure of household to report for recertification interview, and certification period expires.
(D) Closure due to failure to cooperate with QC review.
(E) Lapses, that is, automatic discontinuance because the household fails to purchase coupons for 3 months.
(b) QC Review System. Arrangements for QC reviews will be made with the County Office by the QC Field Office Supervisor.
(1) The county office will send the case records requested for review to the QC Field Office within 5 work days. If the county office needs any part of a record while the QC field office has it, the field office will temporarily return the material requested.
(2) In reviewing sample active cases, the reviewer will have a personal interview with clients and make necessary collateral contacts.
(3) On home visits to clients, the reviewer will identify himself by an Employee Identification Card. He will explain that he is not acting for or in place of an employe of the County Board of Assistance and make clear the responsibility of the client for reporting changes in his circumstances to the county office.
(4) In reviewing sample closed cases and applications not approved, direct client and collateral contacts will be made only if the case record does not provide all the information needed to establish clearly whether or not the county office action was correct.
(5) A recipient who refuses to participate in the review will be ineligible for participation in the program being reviewed and his eligibility for participation in other programs must be redetermined immediately by the County Assistance Office. Upon notification by quality control division that a recipient refuses to participate in the review, the County Assistance Office will take the following action immediately:
(i) Contact the client to determine his reason for refusing to participate.
(ii) If, after an explanation, the client agrees to participate, arrange for an appointment with the QC reviewer.
(iii) If the client persists in refusing to participate, follow the procedures in § 133.24 (relating to procedures) regarding written advance notice of proposed discontinuance.
(6) If the case record has been reviewed, the reviewer will stamp the case record narrative immediately below the most recent entry, insert his name and the date and return the record to the county.
(7) The findings of the reviewer in each individual case will be recorded on prescribed schedules and transmitted promptly on completion through the QC field office to the division of quality control.
(8) If, during a direct or collateral contact, the reviewer obtains new information on circumstances that are related to eligibility or amount of payment, he will report this information directly to the county office. This information will not be included on the prescribed schedules.
(9) The county office will receive a summary of any defects in each case. A copy of the summary will be sent to the appropriate regional office.
(c) Correction of defects. Action will be taken by the county office to correct reported defects and a report on the action taken will be sent to regional office within 30 days.
APPENDIX A
[Reserved]
Source The provisions of this Appendix A reserved July 11, 1986, effective July 12, 1986, 16 Pa.B. 2524. Immediately preceding text appears at serial page (28894).
APPENDIX B
[Reserved]
Source The provisions of this Appendix B reserved July 11, 1986, effective July 12, 1986, 16 Pa.B. 2524. Immediately preceding text appears at serial page (28895).
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