(a) Goal of a quality control review. ARU completes its review responsibility through a system of quality control and conducts field investigations on each program. Randomly selected sample cases are studied and analyzed to determine whether errors have occurred through client or Department failure to comply with program policy. All reviews are conducted for a point in time. ARU reviewers analyze sampled cases to determine whether:
(1) Medicaid recipients are eligible, and if any spend-down computations, claims processing, and third party liability considerations are accurate. The correctness of termination or denied actions on Medicaid cases is assessed by ARU reviewers.
(2) Food Stamp sampled cases are issued correct benefits as of a point in time. The correctness of termination or denied actions on Food Stamp cases is also assessed by ARU reviewers.
(3) persons receiving TANF are eligible for assistance and, if so, whether the work requirements and outcomes of that program have been met. Also, a determination is made as to whether terminated or denied cases were handled in accordance with Department policy.
(4) persons receiving Day Care assistance are eligible and, if so, whether the prescribed policy and procedure of the Department was correctly applied.
(b) General parameters of a quality control review. The USDHHS and USDA Federal QC policies mandate acceptable parameters for the QC processes and specify procedures for conducting household interviews, such as who can be interviewed, location of the interview, form of reviewer inquiries, method of verification, and appropriateness of collateral contacts. For the Food Stamp and Medicaid programs, ARU reviewers conduct QC reviews in accordance with these federally prescribed policies. For the TANF and Day Care programs these policies and procedures are state modified to address the program data and monitoring needs of the Department.