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Personal Care Assistance

Quality assurance (QA)

Page posted: 11/04/13

Page reviewed:

Page updated:

Legal Authority

Minn. Stat. § 256B.0651 subd. 15 and subd. 16, and Minn. Stat. §256B.0652

Definition

Quality assurance: Guarantee program integrity through review of the services that are reimbursed by Medicaid/Medical Assistance, a combination of state and federal government funds.

Background

State and federal legislation provides DHS the authority and responsibility to:

  • • Safeguard the health and welfare of Medicaid recipients
  • • Oversee and monitor the program
  • • Be accountable for the Medicaid spending
  • QA is a support and assistance process to identify areas that need improvement in order to provide the most effective and efficient services to individuals.

    The ongoing QA process monitors standards through a use of a variety of tools including but not limited to training and testing, surveys, data collection and scheduled and random reviews of records.

    Numerous methods are utilized such as requesting information to be sent to DHS, visiting sites, using self-reports and analyzing data available from various sources.

    Cooperation from those providing direct services is essential for this compliance

    DHS Responsibilities

    DHS is responsible to develop and implement a system for continuous performance measurement regarding the assessment and delivery of services to assure specific technical and/or procedural requirements are being met.

    DHS will monitor, review and measure the following:

  • • Individual’s need for services
  • • Service delivery
  • • Policies, procedures and business practices
  • • Recruitment, wages and benefits
  • • Provider agency integrity including evaluations
  • Lead Agency Responsibilities

    The lead agency is responsible to:

  • • Provide access to individual files, documentation and services
  • • Demonstrate compliance with all laws, rules and policies
  • MCO Responsibilities

    The managed care organization (MCO) is responsible to establish an internal quality assurance program

    PCA Provider Agency Responsibilities

    The PCA provider agency is responsible to provide access to all agency records and documentation including:

  • • Employment files of all staff
  • • Client files and all required service information
  • • Policy and procedure manuals
  • • Accounting, payroll and billing records
  • • Documentation of all training requirements
  • The PCA provider agency must demonstrate compliance with all laws, rules and policies

    Additional Information

    Minnesota Office of the Legislative Auditor report on PCA, January 2009
    Recommendations for Minnesota's Personal Care Assistance Program (PDF)
    , Lewin Group, July 2009

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    Updated: 11/8/13 3:23 PM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 11/8/13 3:23 PM