The DHS Bureau of SNAP Integrity (BSNAPI) and HFS Bureau of Medicaid Integrity (BMI) base findings on the information current for the review month shown on Quality Control Report - BSNAPI Findings/FCRC Action (Form 263), or Quality Control Report - BSNAPI Findings/FCRC Action - Negative Case Action (Form 263N), even though the error may have happened some time before the review date. The error will still be cited even if the FCRC has corrected it after the first day of the month under review.
BSNAPI/BMI sends Form 263/263N to the Family Community Resource Center (FCRC) and Regional Office when a Quality Control review is completed. The form indicates QC findings and the action the FCRC needs to take.
If the review indicates that the FCRC does not have to reply to BSNAPI/BMI:
1. (FCRC) Take immediate action, as necessary, based on the information reported on the 263/263N.
2. (FCRC) File Form 263/263N in the case record.
If the review requires a reply to BSNAPI/BMI, the FCRC:
1.Replies to Form 263/263N by the due date. Takes action by the due date to correct current benefits on the case, if applicable.
- For BSNAPI reviews, takes action by the due date to file any overpayment referrals or to authorize past month benefits due to any
- agency cause under issuance:
- if a negative action error is cited because of a lack of documentation in the case record, check that the negative action was correct and document the circumstances of the denial or termination in the case record. if the Form 263N shows that timely notice requirements were not met, send a correct timely notice.
- if the client appeals the new timely notice, follow appeal procedures. If the decision requires the restoration of medical benefits for a prior period, send the request to the Bureau of Policy Development.
2. Complete Section IV of Form 263/263N:
- include a detailed explanation of what caused the error; and
- a description of the actions taken to correct the case, including computations, dates and dollar amounts. For BSNAPI findings, include copies of Overpayment Referral (Form 2404) and Notice of Overpayment (Form 2404x). If an agency caused under issuance occurred, refer to WAG 23-01-02-b regarding required steps to follow prior to authorizing past month benefits.
3. Email/contact BSNAPI for an extension if the reply and/or the required follow up actions will be late.
4. Email Form 263/263N reply to BSNAPI/BMI and file a copy in the case record.
5. (BSNAPI) Follows up with the FCRC to ensure appropriate case actions are completed.