Agency Requirements and Sample Criteria

Income Maintenance agencies are required to conduct second party reviews for a sample of their total caseload.  The sample size will be determined once per year and remain the same throughout the year.  The required sample size for each agency will be communicated through an Administrator’s Memo each year.  DHFS reserves the right to re-determine the sample size within the year if there are circumstances, such as a major policy change, that could significantly affect caseload(s).  
 

Cases are randomly selected from CARES and relevant case data populated into IMQA the first Saturday of each month.  The cases are available for agencies on the following Monday.  The sample cases were confirmed in the month immediately preceding the month in which the sample was pulled.  Any cases from the sample list that are not selected for review will be purged 60 days after the sample was pulled.   
 

• The sample will include 10% more cases than the minimum number required for each agency for each case type (FoodShare/Healthcare The term "Healthcare" includes: BC+, EBD-MA, Institutional, and Community Waivers. and Healthcare-only).  

• The total sample can be distributed at agency discretion.  However, reviews may not be completed by the worker originally assigned to the case.  
  
  Note: Although sample cases can be selected by supervisory unit, the sample itself is not selected according supervisory unit or worker.  For example, if an agency is required to conduct 100 reviews and has five supervisory units, the sample will not consist of twenty cases per unit.
   

• DHFS generated reviews and manually generated reviews must be completed by the end of the following month. Sample pull, purge and review completion dates are listed in the table below.
   

Sample Detail

For the 2008 contract year, agencies are required to conduct second party reviews for 0.9% of their FoodShare and Healthcare caseload.  The sample consists of:

1. Two-thirds or 0.6% of the reviews will be combined Food Share/Healthcare cases.   

and

2. One-third or 0.3% of the reviews will be Healthcare -only cases.  
    

The FoodShare/Healthcare cases selected for the review sample:

1. Have had an application or review in the last month,

2. May have both programs open or only FoodShare open,

3. Have a household size greater than two, and

4. FoodShare allotment amount of at least $100
    

If an agency doesn't have enough cases with a minimum allotment of $100 and household size greater than two, the sample will select cases without those parameters.  Further, if an agency still does not have enough cases to meet their requirement then the sample will select ongoing cases.  

The Healthcare-only cases selected for the review sample:
 

1. Have had a confirmed review in the last month,
    

2. Include all Healthcare case types except those that are only extensions, continuously eligible newborns, and premium assistance cases,
    

3. Do not have any other assistance programs open, and
    

4. Consist of case types proportional to the percentage of case types in an agency's entire Healthcare caseload.    

For purposes of the second party review DHFS has collapsed Healthcare benefit categories so that the case types fall into one of four categories.  The categories are as follows: BC+,  EBD, Institutional, and Community Waivers.  

Agencies with a monthly caseload of 500 or less are required to review a minimum of two cases per month consisting of one FS/Healthcare case and one Healthcare only case.

Case reviews not in DHFS sample
 

Cases not included in the DHFS-generated sample may be counted toward meeting the total required case reviews.  Agencies may use the following types of cases toward their review requirement:

• Client complaint cases

• Fair hearing cases,

• New worker cases, or

• Complicated or problem cases reviewed by a supervisor,

This page last updated in Release Number: 08-01

Release Date: 03/03/08

Effective Date: 02/01/08