QA Review Procedures

A. Each month a statistically random sample of active and negative cases is selected for QA review. The sampling of both active and negative cases is accomplished through the master file from the automated system. B. Case records for the monthly selected sample may be reviewed by QA in the local office, or the local office may be requested to forward the case recrods to the appropriate state QA office for review prior to the field reviews and verification of eligibility factors. Local offices shall make case records available for review no later than seven (7) business days from the date that the request is received by the local office. C. When the local office receives a request for one or more cases for QA review, the following steps shall be taken in preparing the case record: 1. All documents and notes supporting eligibility decisions and/or basis of issuance related to the case and actions taken by the local office that apply to the sample/review month shall be included in the case record. 2. Accomplishment of the objectives of QA depends upon the successful operation of all aspects of the sampling system, including the elimination of bias to prevent bias, the local office shall not take any action that might alter the findings or misrepresent the household’s circumstance including, but not limited to: a. Making changes that would affect eligibility and payment; b. Adding or removing documentation/verification from the official case record; or, c. Contacting the household sampled, the QA reviewer, or making collateral contacts to obtain additional information to clarify the household’s circumstances, obtain statements or coerce the household into saying or doing anything that might alter the findings or misrepresent the household’s circumstances for the review month. D. These provisions do not apply to routine case management such as acting on reported changes, completing recertifications, or issuing a notice of expiration.