QC State Reviews

This is a federally mandated type of case review which is integrated by a random sample of households (HHs) selected by the State. This sample is pulled from the universe of HHs, which participated in the CalFresh Program during the sampling month. The QC sampling month is a prior month (two to three months in the past).

Note: The QC reviews require a response within 5 working days. The CF sanction requests must be completed prior to NOA Cut Off day.

In the event of a QC suspension, reprieve, or other reasons for a QC case to be dropped where the review is not completed, an “RTF-QC” review will be completed in CARMA to ensure case accuracy and address any corrections needed by the district office. A task will be generated for any cases with errors found to notify the district office of the review.

State Sanctions

Any State whose error rate percentage is higher than the federal tolerance level is sanctioned by the federal government. The State then sanctions those counties whose error rate was above the federal tolerance level. This can easily equate to millions of dollars.

Example Example The federal tolerance level is 5.5%. California’s total error rate is 7.8%. The State will be sanctioned by the federal government for being over the federal tolerance level by 5.5%. All counties whose error rate was over 5.5%, will also have to share in the sanction.

QC State Review Step Chart

There are several instances where a QC EE will create a task requesting action on the case, depending on the status of the case review. All instructions will be provided to the EW on the form attached to the task (for example, the SCD 1194 or the SCD 1449A).

The following procedures apply to QC State Reviews:

Step	Who	Action
1	QC Eligibility Examiner (EE)	Based on QC Review findings, the EE will create a new task request with the following attributes: Requestor: Client associated with the case reviewed by the EE Category: "Case Corrections.CA" Status: Assigned Received Date: Date that the review was conducted, and Quality Control Review with attachments Attach SCD 1194, and SCD 1194A for QC "State Review Quality Control Findings" Saves the new task.
2	Eligibility Worker	Receives the task. Opens and views attachments from QC. If the EW: Agrees and all required forms and verifications are on file: Makes the corrections for the month of review and any other month involved by the due date. Documents any necessary clarifications/corrections in the case journal. Completes comments section of the SCD 1194. Attach or email copies of all supporting documents. Note: The EW should discuss with the supervisor if the error/problem cannot be corrected by the due date and contact the QC unit for further discussion. Agrees, but verification is needed from the client in order to make the correction: Generates and mails CW 2200 "Request for Information" in CalSAWS requesting missing verifications from the client. Journals missing verification and due date in the case. Disagrees: Discusses reasons for disagreement with the supervisor. If Disagreement is: Valid: Completes the comments section of the SCD 1194, describing the reasons for disagreement and attaches any supporting evidence. Updates task in CalSAWS. Invalid: Continues with QC review correction. Note: There is not as much room for disagreement as this is a State or Federal review and reviewed with the FNS 310 Handbook processes. This review differs from that of QA. Receives an SCD 1449- Request for Case Action Follows instructions on SCD 1449 to sanction/SCD 1449A to lift sanction Updates task.
3	EWS	Reviews task to ensure corrections were completed. If actions are: Accurate and complete: Signs the SCD 1194 and retains a copy. Ensures all relevant documents are imaged. Email is sent to CATR.WEBB@ssa.sccgov.org or assigned EE, attaches SCD 1194. Not accurate or complete: Informs EW task is not accurate or complete and continues to monitor task until accurate and complete.
4	ASB Clerical	Monitors and updates QC Transmittal log for completed tasks. Notifies EE of completion.
5	ASB EE	Reviews case corrections If all case corrections are accurate, will notify clerical to update spreadsheet to complete. If all case corrections are not made, will go back to Step 1. Note: EE may also elect to discuss with EW or EWS prior to going to Step 1.

Client Refuses to Cooperate with QC

When a determination is made that an applicant or recipient failed to cooperate with QC without good cause, CalFresh must be discontinued. Ineligibility begins the first of the month after the month in which the non-cooperation with QC occurs.

If a client refuses to cooperate with the QC process by not providing verification, not completing the required QC interview, etc., then the QC EE will request a CF Sanction. The QC EE will send the Eligibility Worker the “Quality Control Request for Case Action Do Not Restore/Pay Case Until Cleared with Quality Control” (SCD 1449) form with instructions.

When an individual has refused to cooperate with QC, a request for a restoration or reapplication may be made, but eligibility cannot be determined until:

The applicant/recipient subsequently cooperates and meets all eligibility conditions, or
State Sanction: The applicant/recipient reapplies for aid (i.e., CalFresh) at least 125 calendar days after the end of the “Annual Review Period” in which the refusal to cooperate occurred and meets all eligibility conditions. (For example, the “Annual Review Period” ends September 30, 2021, the household can reapply on or after February 3, 2022, which is 125 days after September 30, 2021.)
Federal Sanction: The applicant/recipient reapplies but will not be determined eligible until at least nine (9) months from the end of the “Annual Review Period” in which the household refused to cooperate with Federal QC. (For example, the “Annual Review” period ends September 30, 2021, the household can reapply on or after July 1, 2022, which is 9 months after September 30, 2021.)
The QC EE will send form “Quality Control Request For Case Action QC Sanction Lift - Client Cooperated with QC” (SCD 1449A) to the EW with instructions when the client has cooperated.

Example 1

State Sanction: A recipient refuses to cooperate with QC on July 7, 2021. The EW is notified by the QC reviewer via SCD 1449 with instructions and the case is discontinued through February 2, 2022.

The household reapplies on August 23, 2021, but is still ineligible as the household refuses to cooperate. The household will remain ineligible as long as the HH refuses to cooperate with QC. The HH may reapply on or after February 3, 2022 and have the eligibility determined without agreeing to provide QC with the items needed (this is 125 days after the end of the Annual Review Period).

Example 2

Federal Sanction: A recipient refuses to cooperate with QC July 3, 2020. The EW is notified by the QC reviewer via SCD 1449 with instructions and the case is discontinued July 31, 2020.

The client reapplies (CalFresh) August 12, 2020, but is still ineligible as the client refuses to cooperate. The client will remain ineligible as long as the client refuses to cooperate. The client may reapply on July 1, 2021 and have the eligibility determined without agreeing to provide QC with the items needed (this is 9 months after the end of the Annual Review Period.)

Note: The definition of the “Annual Review Period” is the FFY, October 1st through September 30th, which corresponds to the review date. This is a set time frame, regardless of when application is made for CalFresh.

Important: It is the EWs responsibility to ensure CF Households reapplying after being sanctioned for refusing to cooperate with a QC EE, shall provide verification of ALL eligibility requirements, including items that would normally only be verified if questionable. EWs may contact the ASB QC unit if there are any questions regarding the CF Household’s eligibility status prior to granting eligibility on a CalFresh case.

Procedures for QC Disagreements

There is not as much room for disagreement on a QC State or Federal review as it is reviewed using the Federal FNS 310 Handbook processes. The QC review differs from that of a QA review.

The following occurs when an EW disagrees with an error cited in a QC State Review by a QC EE:

Who	Action
Eligibility Worker	Discusses the case with his/her supervisor, indicating the reasons for the disagreement. Completes the bottom section of the SC 1194, describing the reasons for the disagreement, and attaches any supporting evidence.
Eligibility Work Supervisor	Establishes a system for follow-up. Forwards the SC 1194 stating disagreement to the QC Lead and/or QC Supervisor. Forwards copy to the DEBS Manager.
DEBS Manager	Maintains copy of SC 1194 to reference monthly report.
QC Supervisor/ QC Lead	Reviews the disagreement and discusses it with the QC Reviewer. If the disagreement is: Accepted: Notifies the State to return the review, and has the original QC State Reviewer re-complete the review. Not accepted: Will notify the EW Supervisor that the disagreement was not accepted, and consult with the Program Coordinator, if appropriate.

QC Case Disposition Letters (CDL) Step Chart

Every State QC case that is reviewed will have a CDL created and sent to the EW. A CDL is a requirement by the USDA, FNS on ALL QC case reviews, regardless of the outcome of the case.

Each month, the ASB clerical team will email the CDLs to the following DEBS staff: EW, EW Supervisor, district office SSPM, Corrective Action Coordinator, ASB SSPM, ASB Program Control Supervisor, and QC EE. It is imperative that the CDL is returned to the ASB Clerical team by the due date due to QC regulations.

Who	Action
QC EE	Creates and completes the CDL with the appropriate QC error findings and case information Sends a copy of the CDL to the ASB Clerical team at CATR.WEBB@ssa.sccgov.org
ASB Clerical	Edits/updates the CDLs with current information before sending to district offices Sends out the CDLs to the appropriate staff with a request for the EWS to complete within 10 business days (EW, EWS, SSPM, CA Coordinator, ASB SSPM, ASB Supervisor, QC EE) Updates QC CDL log with cases sent out and due dates Sends CDLs to the State QC Sharepoint site on a monthly basis Follows up on any CDLs that are not returned by the due date and informs the CA Coordinator of any outstanding CDLs that have not been returned
EWS	Discusses QC error case (with EW, unit, CA Committee, SSPM, etc.) to develop a Corrective Action Plan EWS and EW completes, signs, and dates page 2 of the CDL with the Corrective Action Plan and sends back to ASB Clerical by the due date.
EWS and QC Program Control Supervisor	If there is any disagreement with the QC error on the CDL, the EWS will need to discuss the case with the QC Program Control Supervisor If the disagreement is: Accepted: The QC Program Control Supervisor or QC EE will notify the State to return the review, and has the original QC State Reviewer re-complete the review. Not accepted: Will notify the EW Supervisor that the disagreement was not accepted, and consult with the Program Coordinator, if appropriate.
ASB Clerical	Updates the QC CDL log and emails any “Error CDL” responses to the CA Coordinator for further review Sends all CDLs to the State QC Sharepoint site
CA Coordinator	Reviews all Error CDLs and develops: corrective action strategies, adds to monthly CA Dash- board for discussion, and adds to review at QC Error Prevention Discussion meeting

Time Lines

A reply is required to the SCD 1194 or SCD 1449A (whether the EW agrees with the error cited or not) for all QC cases that have an error cited, and must reply within 10 working days. Additionally, a task will be generated for any SCD 1194s or SCD 1449As that are sent to the EW.

For CDL’s: the reply MUST be received within 10 working days from the date the CDL is sent to the EWs corresponding district office, EW Supervisor, and SSPMs. Due to strict time lines imposed by the state and federal guidelines, it is imperative that EWs meet this 10 day requirement.

Any instructions will be provided by the QC EE on the CDL, SCD 1194, or SCD 1149A form with a due date.