§ 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.
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