Tracking# 2012-00391 
FA/P 6/1/12, eff. 8/1/12 

I:/11081102.rtf 
(I:/11081102.doc)

(10 CCR 2506-1)

[Instructions:  insert before line 1514142.] 
Revisions of Sections B-4010.42 through B-4010.424 were final adoption following publication at the 6/1/2012 State Board meeting (Rule-making# 11-8-11-2), with an effective date of 8/1/2012. Statement of Basis and Purpose and specific statutory authority for these revisions were incorporate by reference into the rule. These materials are available for review by the public during normal working hours at the Colorado Department of Human Services, Office of Enterprise Partnerships, Division of Boards and Commissions, State Board Administration.

********************

[Instructions:  replace lines 937398 through 937422.] 
B-4010.42  Quality Assurance Reviews [Rev. eff. 8/1/12] 
The reviews are conducted during the annual federal quality assurance review period, which is the twelve month period from October 1 of each calendar year through September 30 of the following calendar year. A statistically random sample of households is selected from two different categories: households that are participating in the Food Assistance Program (active cases) and households for which participation was suspended, denied or terminated (negative cases). 
A.  Quality assurance reviews are federally mandated to provide: 
1.  A systematic method of measuring the validity of the Food Assistance Program caseload; 
2.  A basis for determining error rates; 
3.  A timely continuous flow of information on which to base corrective action at all levels of administration; and, 
4.  A basis for establishing liability for errors that exceed the federal error rate target and the state's eligibility for an increased share of federal administrative funding and/or federal high performance bonuses. 
B.  Reviews are conducted on: 
1.  Active cases to determine if the household is eligible and, if eligible, whether the household is receiving the correct Food Assistance benefits. 
2.  Negative cases to determine if households which were suspended, denied or terminated were, in fact, not eligible to participate in the Food Assistance Program. 
C.  Definitions 
1.  An “active case” means a household that was certified prior to or during the sample month and issued Food Assistance Program benefits for the sample month. The review of an active case includes: a household case record review, a field investigation, an error analysis, and the reporting of review findings. 
2.  A “negative case” means a household which was denied certification to receive Food Assistance Program benefits in the sample month or which had its participation in the Food Assistance Program suspended, denied, or terminated during a certification period effective for the sample month. The review of a negative case includes: a household case record review, an error analysis, and the reporting of review findings. 
B-4010.421  Quality Assurance Review Procedures [Rev. eff. 8/1/12] 
A.  Each month a random sample of active and negative cases is selected for quality assurance review. Sampling of both active and negative cases is accomplished through the master file from the Department’s automated system. 
B.  Case records for the monthly selected sample may be reviewed by Quality Assurance in the local Food Assistance office, or the local office may be requested to forward the case records to the appropriate State Quality Assurance office for review prior to field reviews and verification of eligibility factors. Local Food Assistance 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 Food Assistance office.
C.  When the local Food Assistance office receives a request for one or more cases for quality assurance 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 Food Assistance office that apply to the sample/review month shall be included in the case record. 
2.  Accomplishment of the objectives of quality assurance depends upon successful operation of all aspects of the sampling system, including the elimination of bias. In order to prevent bias, the local Food Assistance 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 in an attempt 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. 
These provisions do not apply to routine case management such as acting on reported changes, completing a recertification, or issuing a notice of expiration.
B-4010.422  REFUSAL TO COOPERATE [Rev. eff. 8/1/12] 
Households selected for review are required to cooperate with federal and state quality assurance review. 
A.  Households that refuse to cooperate in a quality assurance review shall be declared ineligible for Food Assistance Program benefits. The State Quality Assurance reviewer shall notify the local Food Assistance office of the household's refusal to cooperate in the review process, including each individual who refused, on the State prescribed Quality Assurance reporting forms(s). 
1.  Within ten (10) calendar days from the date of receipt of Quality Assurance's notification of the household's refusal to cooperate, the local Food Assistance office shall take action to disqualify or terminate the entire household from participation in the Food Assistance Program and each household member who refused to cooperate shall be entered into the Colorado Benefits Management System (CBMS) with a period of ineligibility. 
2.  If a member or members who refused to cooperate with a quality assurance review leaves the household, the ineligibility period shall follow the household member(s) who refused to cooperate. The period of ineligibility is as follows: 
a.  For refusal to cooperate with a state quality assurance review, the period of ineligibility is one hundred and twenty five (125) days from the end of the annual federal quality assurance review period. 
b.  For refusal to cooperate with a federal quality assurance review, the period of ineligibility is nine (9) months from the end of the annual federal quality assurance review period. 
B.  If a household is disqualified or terminated for refusal to cooperate with a quality assurance review, the household may reapply. The household cannot be determined eligible until it cooperates with the quality assurance review and provides verification of all eligibility factors. 
C.  If a household which has refused to cooperate with a state quality assurance review reapplies more than one hundred and twenty five (125) days after the end of the annual federal quality assurance review period, or refused to cooperate with a federal review and reapplies more than nine (9) months from the end of the annual federal quality assurance review period, the household shall not be determined ineligible for its refusal to cooperate and is required to provide verification of all eligibility factors before it can be approved for benefits. 
B-4010.423  Quality Assurance Findings and Required Responses [Rev. eff. 8/1/12] 
Quality Assurance shall notify local Food Assistance offices on State prescribed forms of the review findings for each sampled active and negative case. Brief descriptions of the review findings shall be given with references to applicable rule sections.
A.  When the review findings document no error and/or only other observations have been noted, no further action is required by the Food Assistance office The report of review findings shall be retained in the case record. 
B.  When the review findings document that an error resulted in ineligibility overissuance, underissuance, or an incorrect negative action, the local Food Assistance office shall respond to the review findings by completing the State prescribed form documenting the corrective action taken or rebutting the amount or finding of error. The response shall be forwarded to the Food Assistance Program Division within ten (10) working days from receipt of the Quality Assurance review finding notification. 
C.  Upon receiving the Food Assistance office's response to the quality assurance review findings, the Food Assistance Program Division shall review the action taken by the local Food Assistance office and either concur with the quality assurance findings; concur with the Food Assistance office rebuttal; or concur/disagree with the corrective action taken by the Food Assistance office. 
1.  The Food Assistance office shall be notified of the final quality assurance review findings. 
2.  Upon receipt of final notification of the findings results, the county must take corrective action to terminate ineligible households within ten (10) working days, restore lost benefits or establish a claim in accordance with Sections B-4410.4 and B-4430.1. 
B-4010.424  Federal Quality Assurance Reviews [Rev. eff. 8/1/12] 
For purposes of validating the State's Quality Assurance findings, the Food and Nutrition Service (FNS) Federal Regional Office conducts a sub-sample re-review of the state's sample. As part of this re-review process, the Federal Regional Office will conduct case record reviews to the extent necessary to determine the accuracy of the State’s Quality Assurance findings. The FNS Regional Office may request case records and/or verify any aspects of the State’s Quality Assurance findings. The local Food Assistance offices shall forward case records in their entirety as outlined in B-4010.421, C, that are selected to be sub-sampled by Federal Quality Assurance to the Regional Office within ten (10) days of the request. 

********************