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MA/FS Second Party Review Overview

MA/FS Second Party Review Overview. March, 2006. This presentation is intended to be used as an optional supplement to the information communicated through the Operations Memo 06-05 and the Administrator’s Memo 06-02 on this topic. Second Party Review Process Changes .

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MA/FS Second Party Review Overview

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  1. MA/FS Second Party Review Overview March, 2006

  2. This presentation is intended to be used as an optional supplement to the information communicated through the Operations Memo 06-05 and the Administrator’s Memo 06-02 on this topic

  3. Second Party Review Process Changes • Beginning March 2006, a combined process for second party reviews will be implemented that includes both Medicaid (MA) and FoodShare (FS). • The IMQA system is being changed to accommodate MA second party reviews, and will be easier to use for both MA and FS reviews.

  4. Implementation Timeline • February 2006 • Communication/Staff Awareness • Administrations Memo • Message to CARES and Policy Coordinators • March 2006 • Implementation • Enhanced IMQA available for MA and FS Second party reviews • Release of new IMQA Second Party Review Manual • New MA Second party review processes in place • April 2006 • Agency Compliance monitoring in effect

  5. Overall Goals • Establish baseline data to more effectively implement and measure program improvements. • Identify areas for cost savings and program improvement. • Maintain a focus of payment accuracy on IM programs. • Minimize workload by combining both processes.

  6. Background: FoodShare Second Party Reviews • Wisconsin’s FS error rate has exceeded the national average for many years which has resulted in the state remaining in sanction status from 1994 to 2002. • The FS federal oversight agency, USDA/FNS, has long recommended second party reviews as a proven error reduction initiative. • Over the past three years, Wisconsin’s error rate has decreased by 42% (from 9.32% to 5.38%). • This reduction is due, in part, to improved accuracy because of second party reviews. About 10% of the QC sample contains cases that have been part of the second party review process. • FS second party reviews will continue as an effective error reduction strategy.

  7. Background: Medicaid Second Party Reviews • While some IM agencies have been conducting informal MA second party reviews, the Management Evaluation Reviews (MER) found that MA case reviews were not being completed by a majority of the agencies surveyed. • Input from the Income Maintenance Advisory Committee (IMAC), the Medicaid Eligibility Quality Control (MEQC) project and the Legislative Audit Bureau (LAB) resulted in the decision to implement a uniform method for IM agencies across the state to complete MA second party reviews. • The 2006 state and county contract that includes IM contains language requiring second party reviews of Medicaid cases.

  8. Background: IMQA • The web-based IMQA system (formerly known as “FSQA or “Newman” has been used successfully for the FS second party review process, as well as PAC and FS state quality assurance reviews. • Functions in the IMQA system include selecting cases for review, entering review findings, and monitoring individual workers

  9. Changes to IMQA • The IMQA system has been enhanced to include the ability to use it for MA second party reviews, and to streamline the process for both FS and MA second party reviews.

  10. Access to IMQA • You must have a DWD/Wisconsin (WIEXT) Logon and password to get access to IMQA. • Once you have registered for (or if you already have) a DWD/Wisconsin Logon, go to the website below to obtain the IMQA Access Request Form: http://dhfs.wisconsin.gov/forms/DHCF/HCF16083.pdf

  11. Getting into IMQA • Once you have received access to the system, log in to IMQA using your logon ID and your password. • To access IMQA via the Eligibility Management web page: http://dhfs.wisconsin.gov/em/ • First click on Systems, next click on Systems Gateway and finally, click on IMQA. Note: you may also go directly to IMQA using the following link: https://www.dwd.state.wi.us/dwsfsqa/

  12. Second Party Review Requirements The number of case reviews that must be completed is based on a percentage of an agency’s caseload: Temporarily, until new IMQA programming work is completed to allow cases outside the sample to be entered manually: • 0.5% of the agency’s caseload (two thirds will be FS and MA cases, one third will be MA only). • Small agencies (500 cases or less) must review a minimum of two cases per month, one FS and MA case and one MA only case. The requirement after the new programming is completed will be • 0.9% of the agency’s caseload (two thirds will be FS/MA cases, one third will be MA only). • Small agencies (500 cases or less) must review a minimum of two cases per month, one FS and MA case and one MA only case.

  13. Second Party Review Requirements, con’t • Cases identified for review can be selected from a list generated from CARES. The case review sample will be produced on the first Saturday of the month and will be available the following Monday. • In the future, local agencies may also enter cases manually that are considered problem cases (e.g. fair hearing, client complaints, etc.). These are cases that someone may already be looking at for other reasons, and can count toward the required review percentage. • The FS sample case selection criteria will be the same as the 2005 second party reviews (applications and reviews with household size greater than 2 and issuance greater than $100).

  14. Second Party Review Requirements, con’t. • Second Party reviews are to be done by a county/tribal agency worker who is not the assigned worker for the reviewed case. • The deadline to complete all case reviews is the end of the month following the review month • A review is considered complete when the case is correct and case specific corrective action has been taken on the case. • For more information on requirements, see DHCF Administrator’s memo 06-02 and Operations Memo 06-05.

  15. IMQA Second Party Review Manual • On March 8, 2006,the IMQA Second Party Review Manual will be available via the DHFS EM web site at http://dhfs.wisconsin.gov/em/ • Click on “Handbooks and Manuals”, then click on IMQA • This manual has been developed to assist local county/tribal agencies in using the IMQA system, and includes step by step processing guidelines for the second party review process. • The IMQA Second Party Review Manual should always be the primary reference for the second party review process.

  16. IMQA Second Party Review Manual Use • It is recommended that any agency staff who will be conducting second party reviews become familiar with the IMQA Second Party Review Manual priorto conducting any second party reviews using the new process and IMQA tool. • The IMQA Second Party Review Manual can also serve as an ongoing resource available any time anyone wants to know more about the second party review process or the IMQA tool.

  17. Questions and Feedback • General technical assistance with the second party review process will be provided primarily by the CARES Call Center.

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