welcome to the pending guideline accuracy lab pending pme (009 qa... · welcome to the pending...

Welcome to the Pending Guideline Accuracy Lab

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ACCURACY-West Region:

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Year of 2018

Brought to you by Quality Assurance and Program Management Evaluations

How to reducere-pending

At the intake follow these five steps!

Review past narratives back to the last certification.

Review the current application, verification and check all IEVS.

Compare the verification, application, IEVS screens against what the participant reported.

Address any found discrepancies with the participant. If questionable, request additional verification.

Narrate the steps that were taken to clear up the discrepancies. This includes the conversation with the participant, employer, additional verification, or collateral statement(s).

Soft Skill Tips for Effective Interviewing

• Make the person or family feel welcome.

• Build a good rapport.

• Listen effectively - Listen for discrepancies and resolve them with the Participant in a respectful and courteous way.

• Review or summarize - Ensures accurate understanding of the person or family’s situation.

• Maintain professional boundaries when asking questions;

• Be aware of your body language, tone of voice, and other non-verbal cues.

Effective NarrationSeven Elements of an Eligibility Narrative:

Narrative Heading

Situation HH Comp. Non-financial Eligibility

FinancialEligibility

DeductionsEligibilityDecision

Tell a story that someone can understand.

Narrate how you resolved any discrepancies.

A good narration provides, clear and complete information pertaining to the decision on a case. This can make a difference when your coworker needs to respond in your absence,

to support continuity of service when the case is transferred to a new office, and can be a major factor in the outcome of quality assurance reviews, hearings, and audits.

Pending occurs when we need to request verification or additional information before making an eligibility decision.

Verification may be required for any information that is questionable.

When you are not sure if you need to verify or not, check the FSM Multiple Program Worker Guide #2, and OAR 461-115-0610.

Most often the actual pend issues can be clarified on the system, with a phone call and/or does not need to be verified.

What about IEVS Verification?

You can verify with The Work Number, ECLM, SMUX, DPPL, SPVF, online SSA records or other screens listed on the mainframe.

Do not pend for information that we’ve already verified or that is unnecessary to verify.

Don’t forget to have a conversation with the participant and always narrate the conversation to support your eligibility decision.

Yes we can accept an Employer Statement.

If gathering an employer statement to verify questionable or missing information you must document:

• name of person providing the information,

• position or title along with the name of their organization,

• specific information received, and

• protect the participant’s confidentiality.

What about an Employer Statement?

Employer statements can be provided by letter or phone.

Be courteous when requesting an Employer Statement. Please check with the participant first to make sure we are not compromising their employment.

When is it questionable?

Information is considered questionable when it is inconsistent or there is a discrepancy with:

• Other reported information (verification received and/or IEVS),

• Other information on the application,

• Other information received by the branch,

• Information on prior applications or narration, or

• The participant tells you something that conflicts with information

on the application or during the interview itself (a discrepancy).

Processing the Return Pended Information

• Re-review IEVS prior to taking an eligibility action.

• There are times when re-pending is unavoidable. When this occurs, be sure to narrate what documents were received and the reason for additional verification.

• Send an amended pending notice when re-pending, along with “amended to include” and list the new information needed. It is not necessary to list the previously requested information if those previously requested items have been provided.

Situations Where You Do Not Need to Pend (not limited to this list)

Accept the participant’s statement for:

• Seasonal employment —about a reduction in hours as long as it is an expected change and in line with the industry.

• Marginal income — if it would be a hardship for an individual to get or keep documentation then it is not required.

• Excluded income — educational income that is deducted from the cost of attending school when the cost of attending is more than the income that is received.

• Terminated source of income (for an ongoing case).**

• Identity of other persons in the filing group.

• Household composition.

• Student status.

• Shelter and utility cost.

To document the need for the verification, you must:

• Complete and give the appropriate request for information (487, 210, or 210a).

• Narrate why the information is needed or questionable.

• Narrate how you requested it and when it is due.

Example:

Lucy had no income verification at the time of intake, not available via IEVS, therefore pending for proof of gross wages. DHS 210 NOTM sent and due March 20th.

Quiz time!

Jeff is a new applicant and reports his social security number on the application. Social Security Records do not verify the number and you’ve checked to make sure the number was entered correctly.

Is this questionable? YES or NO

Write your answer in this box:

This is Sally’s third recertification. Sally is doing odd jobs, each certification she reports around $200.00 for income SEN. She has rent of $550.00 per month along with separate heating FUA. No other household members reported.



Nancy has an ongoing case. She reports that her job with Old Navy ended because the holiday season is over. Her last date worked was Jan. 13th and final pay will be received on the 20th.



Gloria is applying for herself and three children. She reports one roommate (no name listed). Gloria has no income and reports no housing costs. Gloria tells you that she and the children P&P separate from the roommate because he works full time. On the SMUX screen an inactive case shows that the absent father has the same address as Gloria and past child support notes on SMCL indicate that they live together.



When should I pend during an ongoing

certification?

Helpful tip:

Get to know the Program Reporting Requirements!

SNAP ERDC TANFChange Report System

(CRS): Participants are given

a Change Report DHS 943.

Simplified Reporting

System (SRS): Participants

are given the Simplified

Reporting System DHS

853/854.

Transitional Benefit

Alternative (TBA):

Participants in TBA do not

need to report any changes.

Change Report System (CRS): Participants are given a Change Report for Employment Related Day Care (ERDC) DHS 862.

Change Report System (CRS): Participants are given a Change Report DHS 943.

Quiz time!

Susan was approved for SRS SNAP and TANF. What reporting requirements does Susan need to adhere to?

A.) SRS for SNAP and CRS for TANF

B.) CRS for both SNAP and TANF

C.) SRS only because SNAP trumps TANF

D.) CRS only because TANF trumps SNAP


Larry just got a job and is applying for new ERDC benefits. He already has open TANF and SRS SNAP. He is not over the countable income limit for his filing group and he does not know when he will receive his first pay check. No verification was turned in.

Do we need verification of the income and what should we give to Larry for further verification?

A.) Send a DHS 210 for ERDC.

B.) Send a DHS 210a for TANF.

C.) No pending notice is needed for SNAP because of SRS reporting.

D.) All of the above.


Kate is receiving only SNAP SRS benefits. She reports that she just won a scratch it last week and was paid one lump sum of $4,500.

What do you do?

A.) Thank her for the timely reporting, remind Kate of her SRS reporting requirements, narrate the reported information, and take no other action on her case.

B.) Send a DHS 210a for SNAP & request verification.

C.) Nothing, due to SRS reporting.

Yes!I won!


Pending Forms &

Time Frames

New/Redetermination (Intake)

Notice of Pending Status - DHS 210 or NOTM GS00210

Used when requesting additional verification for an initial certification or a re-certification for all program benefits (SNAP, ERDC and TANF).

If requesting income verification try to get verification by calling the employer.

Also be sure to check The Work Number before pending for income verification.

Interim Change Report (DHS 852)

Notice of Incomplete Information -

DHS 487 or NOTM GS00487

Used when a DHS 852 Interim Change report is submitted and additional verification is required to complete the 852.

When a participant reports a change

Notification of Information or Verification Needed- DHS 210A or NOTM GS0210A

Used when something is reported during the ongoing certification that has to be acted on and verification is needed.

Allow the participant at least 10 days to provide requested verification.

If participant fails to return requested information by the due date then the case may need to be closed. Be sure to send timely notice.

Pending Due Dates

SNAP – 30 days from Filing Date TANF – 30 days from Filing Date

ERDC – 45 day from DOR

852/487 – Give at least 10 days. If less than 10 days are remaining to process the DHS 852, let the participant know they will need to reapply if you do not receive the information by that date.

210A – at least 10 business days from processing date

PendingDo’s and

Don'ts

A Message from our Oregon PME ReviewersFor the complete article see the September 2017 On Target Newsletter.

Two errors most cited were asking the participant to provide proof for items which are not required to be verified and limiting the individual's option for how to provide the verification. We need to pay attention to what we are asking for and how we are asking for it. Workers are encouraged to consider if the verification is necessary and required by policy and narrate why the information is needed.

The second most common pend error is LIMITING. That is requiring one document that will satisfy the pend. A common example is the employment verification forms we give the participant who starts a new job. Participants can verify their anticipated hours and rate of pay in other methods. We can’t require them to have only that form filled out. Many pending notices state this is the only way to verify the new income. When writing a pend notice, think to yourself, “Have I given this individual some options to provide the requested information?”

Pending with Fabulous ServiceA Notice sent for a Pending Status is a form of written communication that we use with our participants.

When communication is unclear it can create a barrier to successfully completing a task.

The same goes for our notices; if we fail to communicate to our participants what we are needing on the DHS 210, 210a or 487, it can create a barrier for our participants and may lead to a delay in potential benefits.

Do’s vs Don’tsDo’s: Don’ts:

• Use proper grammar, check your spelling,

capitalization, punctuation…etc.

• Include full address and phone number –

Why, you might ask? Lack of proper contact

information can be cited as a Federal Review

error as a barrier to applying for services.

• ALWAYS sign the hard copy of the DHS 210

and keep a copy in the file (EDMS). The copy

must include your signature.

• Remember the Notice of Pending Status DHS

210 is also available on Notice Writer (aka

NOTM).

• Scan Forms Server Pending notices to EDMS

• Use abbreviation

• Lump dates together: use 02/02/2016 vs

02022016

• Lump the phone number 503-378-6327 as

3786327. 3786327 is not a valid number.

• Use only 2401 as the Branch name and

address: Spell it out and include the address.

• Do not use limiting language.

• Request more information than is federally

required.

• Do not pend for future pay dates.

What happens when we request proof for items which are not

required?

Great Question! Let me tell you what

happened in my office.

Jack

Jack applied for SNAP w/ filing date of July 14th for his family of 5. He had a few no shows and the SNAP intake was completed on August 4th . We received two pay stubs, and Jack reported he is paid the first of each month and works 30-40 hours per week at $10.75 per hour.

Pay dates include:

June 1st $984 gross, non-representative because this is the first pay check.

July 1st $1,665 gross, is representative and the hours reflect 30-40 hours per week at $10.75/hour.

We gave Jack a DHS 210 with a due date of August 14th, requesting the August 1st pay stub.

Jack (Part 2)

The receptionist received a call on August 11th and Jack requests more time to turn in the pay stub. He tells them he works full time and it is difficult for him to take time off to come back during office hours.

The information is passed to the Worker of the Day, who adds an EAT code to the case and allows up to September 12th which is the 60th day to turn in the needed information.

On September 5th the agency receives the August 1st pay stub showing $1,763.00 gross. Jack leaves a voicemail explaining they had a family emergency and need food benefits right away.

Jack (Part 3)

Management receives a call, and discovers that this was a pender offender situation. We had received the most recent and representative pay stub dated July 1st according to Jack’s filing date of July 14th .

The case is given back and processed along with the Notice of Income and Benefit Calculation (DHS 7294) which allows the agency to use the actual July gross income for the month of application and anticipate using the average of July and August income effective August 1st (this change will reduce the SNAP allotment).

SNAP benefits were issued for July, with a reminder to issue August and September SNAP benefits the next business day(s). With another reminder to issue JPI supplements for the same months.

Whoa!!!!! That’s was a lot of extra work for the

Participant and Staff!

What could we have done better?

What Could Have Gone Better• Ask if there are any hardships to coming into the office and share the office

hours and the option of phone appointments for future scheduling needs.

• Inform the Participant of the different ways they can submit verification.

• Thank the participant for turning in their proof of income.

• Ask if the July 1st pay stub represents the normal ongoing income.

• Explain SRS Reporting Requirements.

• Offer referrals and resources.

If all other Eligibility factors were met at the time of intake:

Approve with the July 1st check using the $1665 gross per month to anticipate ongoing income.

When you request a particular item such as a pay stub or a letter from someone, you are creating a potential barrier to completing a request from a participant’s point of view. This is also known as limiting language.

How do you ask for what you really need?

Think about which eligibility element you really need to verify, not how the client can prove it.

Example: You need proof of income but you don’t need a paystub.

Have your Employer complete the Employment Verification form. Copy enclosed.

Not LimitingLimiting

All of April Paystubs

We need your Schedule C.

VA Award Letter

Picture ID

Proof of your most recent month’s worth of income.

Provide a copy of your most recent Federal Tax Return and all schedules.

Proof of Veterans benefits.

Proof of gross wages such as expected hours and hourly wages.

Proof of identity.

The MSC223 is a general information form that you can give to the Participant. This form lists the required proofs for each program.

https://apps.state.or.us/cf1/DHSforms/Forms/Served/de0223.pdf?CFGRIDKEY=MSC 0223,0223,Proof For Eligibility (Can use prior version),,de0223.pdf,,,,,,https://apps.state.or.us/cf1/DHSforms/Forms/Served/-,,https://apps.state.or.us/cf1/DHSforms/Forms/Served/-,

Quiz time!


Faith and Tim received a pending DHS 210 notice in the mail. She calls your office number because it’s the first one listed in the phone book. Faith is very upset and concerned about the benefits she applied for. The letter includes the due date for SNAP and for the listed item needed, it states “POI” and no other information.

What could we have done better?

A.) It’s okay that the Pending Notice is incomplete because we

covered everything at intake.

B.) Complete all areas on the DHS 210 including Branch contact

information, case information, mark the appropriate program box,

What is needed, and we should not use acronyms or abbreviations.


What is “POI”?

We find the shelter cost questionable due to the applicant listing one rental amount on the application, and giving a very different rent amount during the intake. The worker is requesting: Complete copy of rental agreement.

Is this language limiting? (Yes or No)

ANSWER:

YES – Limiting Language.

The option for non-limiting language: Proof of rent amount.


We are requesting: Copy of the front and back of your LPR card.


ANSWER:


The option for non-limiting language: Proof of your legal status, such as your legal status papers or lawful permanent resident card.


We are requesting: Proof of your out of pocket medical expenses. For example: over the counter medications, annual appointments, copays, or medical insurance premiums.


ANSWER:NO


We are requesting: Copy of your September 5th and August 20th paystubs.


ANSWER:


The option for non-limiting language: Proof of gross wages earned in the most recent month or a statement from your employer of your gross earning (hourly wage and weekly hours scheduled and any other pay (bonuses, etc)).


Question and Answer Session

Contact us at:PROGRAM ACCURACY-West Region

[email protected]

PROGRAM ACCURACY-South [email protected]

PROGRAM ACCURACY-East Region [email protected]

PROGRAM ACCURACY-North Region [email protected]

THANK YOU!





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