Quality Assurance / Quality Control
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Quality Assurance / Quality Control


Revised June 27, 2011



Purpose:

Quality Assurance Criteria and Food Regular Sample Activities

 

Quality Assurance Food Management Evaluation Sample Selection Criteria

 

Quality Assurance Payment Error Rate Measurement (PERM) Sample Activities


Quality Assurance Criteria and Food Regular Sample Activities

What is a quality assurance food regular sample selection?

 

How is a food regular quality assurance sample report generated?

 

How is a quality assurance food regular sample selection modified?

 

How can a food regular sample draw request be voided/cancelled?

 

How are regular positive and secondary food samples collected?

 

How are food regular samples selected?

 



NOTE:

Currently KMEN Option B – QC Sample ID Detail Inquiry and Option C - QC Sample ID Detail Update is accessed using function keys thru KMEN Option A – QC Sample ID Selection List.


What is a quality assurance food regular sample selection?

 

·         This is federally funded Basic Food (BF) Assistance Unit data collected from ACES issuance’s to create a report used by Quality Assurance to draw monthly sample reports for United States Department of Agriculture (USDA) Food & Nutrition Service (FNS) auditing purposes.

 

How is a food regular quality assurance sample report generated?

 

·         ACES generates a food regular Quality Assurance/Quality Control sample on a monthly basis, which consists of a single review month for all CSOs. This report runs on the 5th business day of the month. Once posted these reports can be found in Cypress.

 

How is a quality assurance food regular sample selection modified?

 

·         Take the following steps to access the QC Sample ID Selection List: See <F2> Help.

 

1.    From WMEN, select Option K – QA/QC in the Selection field.

 

o    <TRANSMIT> and the KMEN screen displays.

 

2.    On the KMEN screen:

 

o    Enter Option [A] – QC Sample ID Selection List, in the Selection field.

 

o    <TRANSMIT> and the QCSL screen displays.

 

3.    On the QCSL screen:

 

o    Enter a [Y] in the S – Selection field to view a list of sample ID data that is contained in the QA/QC database.

 

o    Enter <F13> to access the QCSD screen.

 

o    This screen displays a detailed view of the sample ID data in either INQUIRY or UPDATE access mode. See <F2> Help.

 

o    If the control data needs to be modified for a food regular request <F13> QCSD should be used on the QCSL between month-end and the 5th business day. 

 

    The SAMPLE DRAW CONTROLS area is protected with the exception of the following fields: Sample Starting Point, Sample Interval Quantity and Starting Review Number. If needed these fields can be modified.

 

o    If the control data does not need to be altered <F14> should be used between the 5th business day and month-end. 

 

o    <TRANSMIT> to update and return to the QCSL screen or <F3> to cancel.

 

o    If the food regular Sample ID already displays on the QCSL list, then edit it using <F13>.

 

o    If an attempt is made to create the next food regular Sample ID and it already exists then Edit – 0387 THIS UPDATE IS ALREADY ON THE DATABASE will appear.

 

o    The SAMPLE ID Type reflects a food regular (Positive Primary (F), Positive Secondary (H), Negative (G)), and a report is generated in batch on the 5th business day of each calendar month.

 

o    The food regular sample request will automatically carry forward at month-end. 

 

4.    On the QCSL screen:

 

o    Enter <F14> to access the QCSD Rglr New screen (manual regular food control data carryover process). This functionality is used if QA/QC staff wish to manually create a food regular sample earlier than when the system automatically does it at month end.  Users can save the sample which then tells the system not to create another one at month end or they can <F3> cancel the manually created sample and the system will create the regular food sample at month end as usual.

 

5.    On the QCSD screen:

 

o    <TRANSMIT> to accept the FOOD REGULAR POSITIVE PRIMARY control data that appears on Page 1 or <F3> to cancel the manual control data carryover process.

 

o    <TRANSMIT> to accept the FOOD REGULAR POSITIVE SECONDARY control data that appears on Page 2.

 

o    <TRANSMIT> to accept the FOOD REGULAR NEGATIVE control data that appears on Page 3 and return to the QCSL screen.

 

·         A food regular sample report is generated in overnight batch on the 5th business day of each calendar month.

 

How can a food regular sample draw request be voided or cancelled?

 

·         To void or cancel a sample draw request, take the following steps:

 

1.    On the QCSL screen:

 

o    Enter a [Y] in the S – Selection field to view a list of sample ID data that is contained in the QA/QC database.

 

o    Enter <F13> to access the QCSD screen.

 

    If the user does not have update security access to the QCSD screen, then the QCSD screen automatically displays in inquiry mode.

 

2.    On the QCSD screen:

 

o    Enter a [Y] - Yes in the Void/Cancel the Sample Draw Request? field.

 

o    <TRANSMIT> to update and return to the QCSL screen or <F3> to cancel.

 

How are regular positive and secondary food samples collected?

 

·         Sample data is collected daily using a batch process developed to capture daily, monthly and emergency issuances and then are loaded into the Quality Assurance/Quality Control database.

 

How are food regular samples selected?

 

·         For the food regular sample, ACES:

 

o    Checks the regular universe.

 

o    Checks the duplication rules.

 

o    Checks the regular universe sort rules.

 

o    Then checks the regular universe control data (starting point, and interval quantity) against the universe data that has been collected on a daily basis over the past 7+ weeks.

 

o    Then stores this data with the appropriate QA/QC review month that it pertains to.

 

·         There are three types of regular food samples:

 

o    Food Regular Positive Universe Samples:

 

    Positive Primary Universe issuances contain all federally funded Basic Food Assistance issued benefits with a payment service date range within the benefit month that pertains to monthly issuance processing.

 

o    Food Regular Secondary Universe Samples:

 

    Positive Secondary Universe issuances contain federally funded basic food assistance cases for benefits issued after monthly issuance and through the last day of the sample review month.


EXAMPLE

Monthly issuance is 03/27/09 for 04/09 benefits. Positive Secondary Universe cases are cases that are issued benefits for April from 03/28 (after monthly issuance) through April (04/30/09) month-end.


o    Food Regular Negative Universe Samples:

 

    Federally Funded Basic Food Assistance applications denied, suspended, zero benefit issuances or withdrawn by the client.

 

    Basic Food Assistance in the ongoing month where the AU closed in the previous month, with an effective date of the following month.

 

    New application denial when state funded BF is approved instead of federally funded BF; and

 

    Active termination when a federally funded BF AU remains active but data changes cause it to issue state funded benefits.

 


Quality Assurance Food Management Evaluation Sample Selection Criteria

What is a food management evaluation sample selection?

 

Who can request a food management evaluation sample?

 

How do I request a food QA/QC management evaluation sample selection?

 

How can a food management evaluation sample draw request be voided or cancelled?

 

How is a food management evaluation sample collected?

 

How are food management evaluation samples selected?

 


 

What is a food management evaluation sample selection?

 

·         This is a manually requested report for a specific date range span, region and CSOs within the selected region. The report is printed by the CSOs selected for review and sorted by AU. This request can be made at any time as the program is run in overnight batch.

 

Who can request a food management evaluation sample?

 

·         Authorized users from Quality Assurance/Quality Control can request sample selections by CSOs within a region.

 

How do I request a food QA/QC management evaluation sample selection?

 

·         Take the following steps to access the QA/QC Replacement Management Evaluation Sample Selection:

 

1.    From WMEN, select Option K – QA/QC in the Selection field.

 

o    <TRANSMIT> and the KMEN screen displays.

 

2.    On the KMEN screen:

 

o    Enter Option [A] – QC Sample ID Selection List, in the Selection field.

 

o    <TRANSMIT> and the QCSL screen displays.

 

3.    On the QCSL screen:

 

o    Enter <F15> to access the QCSD ME New screen.

 

4.    On the QCSD screen:

 

o    Enter the [region number] into the Region Code field.

 

o     Enter the [CSO] into the CSO number field.

 

o    Enter the [year and month] into the Highest YYYYMM field.

 

o    Enter the [year and month] into the Lowest YYYYMM field.

 

o    <TRANSMIT> to activate the Region, CSO, Highest YYYYMM and Lowest YYYYMM data fields. See <F2> help.

 

o    The QCSD screen will then reappear with Edit – 1715 PRESS <TRANSMIT> TO SET SAMPLE FRAME REQUEST OR <F3> TO CANCEL.

 

o    Review the results of the Sample Draw Controls and make any necessary adjustment to the Review Month span to preview the impact that the change will have upon the auto derived sample draw control numbers.

 

o    To set the sample frame request and generate the report in overnight batch <TRANSMIT>. To cancel the request <F3>.

 

How can a food management evaluation sample draw request be voided or cancelled?

 

·         To void or cancel a FSME sample draw request, take the following steps:

 

1.    On the QCSL screen:

 

o    Enter a [Y] in the S – Selection field next to the sample ID to be Voided/Cancelled.

 

o    Enter <F13> to access the QCSD screen.

 

    If the user does not have update security access to the QCSD screen, then the QCSD screen automatically displays in inquiry mode.

 

·         The QCSD  screen then displays a detailed view of the sample ID data in either Inquiry or Update access mode. See <F2> Help.

 

2.    On the QCSD screen:

 

o    Enter a [Y] - Yes in the Void/Cancel the Sample Draw Request? field.

 

o    <TRANSMIT> to update and return to the QCSL screen or <F3> to cancel.

 

How is a food management evaluation sample collected?

 

·         Sample Universe data is collected daily using a batch process developed to capture daily, monthly and emergency issuances and then loaded into the internal ACES Quality Assurance/Quality Control database.

 

·         ACES calculates the sampling interval for each CSO (from a table of sample sizes according to universe size), picks random starting points, draws the samples, and produces the sample lists of no more than 280 cases.

 

·         The Primary Positive and Secondary Food Sample Universe data is collected daily using a batch process developed to capture daily, monthly and emergency issuances and then loaded into the internal ACES Quality Assurance/Quality Control database.  The negative food sample universe data is collected from negative actions taken by both the individual workers and from nightly batch processes.

 

How are food management evaluation samples selected?

 

·         The FSME selection process for a food positive events and food negative events that pertain to a review month span specified in the request that pertains to the CSO.

 

·         Multiple FSME requests can be made for the same region and or same CSO during the same business day.

 

·         The Sample Size is restricted to a maximum of 280 cases.  Therefore, for each FSME request, the Universe Size is automatically determined by ACES, depending upon the CSO and Review Month span.  Then the Interval and Starting Point are automatically determined by ACES, depending upon the respective FSME Universe Size, to accommodate the maximum Sample Size. The date span can be adjusted to reach 280 cases if needed.

 

·         Additional QA/QC Universe data could potentially be collected for that business day during overnight batch, after the FSME request is submitted online.  Therefore, for each non-voided FSME request submitted online on that business day, ACES will re-calculate the universe counts, sampling control data [Starting Point, Interval Quantity] and the Sample Size, prior to actually creating the FSME report data and FSME electronic file sample data, that is associated with that FSME request.

 


Quality Assurance Payment Error Rate Measurement (PERM) Sample Activities

What is a PERM report?

 

How is a PERM report generated?

 

How are PERM universe samples collected?

 

How are PERM universe samples selected?

 


 

What is a PERM report?

 

·         This report is used by Quality Assurance to draw monthly sample reports to meet the auditing requirements for the Center for Medicare and Medicaid Services (CMS).

 

·         A PERM report is created using client and assistance unit level data to build a sample universes for   Medicaid medical programs.

 

How is a PERM report generated?

 

·         The data collected by ACES from the daily batch process, data collected at Month Begin and also from the first business day after Month Begin is used to generate the monthly PERM Universe report. ACES transfers the monthly PERM Universe files to the QA/QC unit through an automated File Transfer Protocol (FTP) process prior to the 15th of every month.

 


EXAMPLE

Month Begin scheduled for 09/08/09. QA/QC PERM universe data to be reviewed is for the prior month August (08/31/09) through Month End.


How are PERM universe samples collected?

 

·         PERM universe sample data is collected using the batch process developed to capture daily and monthly issuances. Also at Month Begin any sprouted AUs or spenddown AU that changed from M – MA Spenddown status to A - Active during the system month are loaded into the Quality Assurance/Quality Control database.

 

How are PERM universe samples selected?

 

·         For the PERM monthly universe sample, ACES applies:

 

o    The PERM regular universe criteria.

 

o    The duplication rules.

 

o    The PERM regular universe sort rules.

 

o    Then the system applies the regular PERM universe control data (starting point, and interval quantity) against the universe data that has been collected on a daily basis over the past 7+ weeks.

 

o    This data is then stored with the appropriate QA/QC review month that it pertains to.

 

·         Within the PERM Medicaid and SCHIP universe files there are four separate PERM stratums:

 

o    Stratum 1 – Positive Applications:

 

    New applications, re-opened applications and add-a-person with a positive issuance.

 

    Spenddown Medical Assistance Units that have gone from M – MA Spenddown status to A – Active status at the end of the same day within the review month.


EXAMPLE

Application is finalized 05/25/09 and approved with a begin date of 05/01/09. The QA/QC Review month is May.

 

Application is finalized 05/25/09 and approved with a begin date of 06/01/09. The QA/QC review month is May.

 

These AUs were active at the end of the processing day.


o    Stratum 2 – Medicaid / SCHIP Re-determination Reviews:

 

    Review is initiated and completed and case remains active at the end of the day and through the last day of the sample review month.

 

o    Stratum 3 – All other active Medicaid / SCHIP clients:

 

    Active Medicaid/SCHIP Assistance on the last business day of the month.

 

     Assistance Units that sprouted from a new Assistance Unit.

 

    Spenddown Assistance Units that went from M – MA Spenddown status to A – Active status during the review month.

 

o    Stratum 4 – Negative Medicaid / SCHIP

 

    Case action that results in termination or denial of benefits.

 

    Historical changes. (Example: Change of Circumstance.)

 

    Parameter adjustments. (Example: Cost of Living Adjustment (COLA).)

 

    Automated processing that results in termination or denial of benefits. (Example: Non-compliance for Standard of Promptness (SOP).)

 

    Data changes cause an active Federally Qualified recipient to remain an active Non-Qualified recipient. Unless the Assistance Unit closes at the end of the day due to one of the following reason codes:

 

235 – Review Not Completed

550 – Voluntary Withdrawal 

555 – Application Opened in Error – For Administrative Use Only

561 – Screened in Error – For Administrative Use Only

572 – User Voided Application – For Administrative Use Only

575 – Not Receiving Cash Assistance – For Administrative Use Only

 

Modification Date: June 27, 2011