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2014 Quality Management Review Tools and Instructions

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Core Tool - Items in This Tool Apply to All DSHS Contactors
BCCS
CSHCN
DSHS Family Planning
Genetics
MCH Title V – Prenatal Medical, Prenatal Dental, Child Health Medical and Child Health Dental
Primary Health Care (PHC)
Expanded Primary Healthcare (EPHC)
Texas Health Steps
WIC

Program tools are used to review contractors monitored by the Quality Management Branch. Instructions are provided for each program tool. The instructions follow the number sequence of the appropriate program tool. Please utilize these tools for self-assessment of your agency.


For information on downloading any of the documents on this page please visit the 
DSHS File Viewing Information Page.


Core Tool (2014) - Items in this tool apply to all DSHS contractors.

Core Tool
Core Tool Contractor Instructions
Child Abuse Record Review Tool 
Completing Surveys for Core Tool Review Instructions
Limited English Proficiency Policies and Procedures Survey        
ADA/Section 504 Policies and Procedures Survey                        
Non-Discrimination Policies and Procedures Survey
For more information visit the QMB Contractor/Provider Information page.   

BCCS (2014) - Items in this tool apply to all Breast and Cervical Cancer Screening (BCCS) contractors. For more information visit the BCCS website.

BCCS Tool
BCCS Tool Contractor Instructions
BCCS Clinical Record Review Tool
Eligibility and Billing Record Review Tool

CSHCN (2014)- Items in these tools apply to Children with Special Health Care Needs (CSHCN) Case Management and CSHCN Specialty Services. For more information visit the CSHCN website.

CSHCN CASE Tool 
CSHCN CASE Contractor Instructions 
CSHCN CASE Record Review Checklist 

CSHCN -CLIN Tool 
CSHCN -CLIN Contractor Instructions
CSHCN -CLIN Record Checklist

CSHSN FSCR Tool 
CSHSN FSCR Contractor Instructions        

DSHS Family Planning (2014) -  Items in this tool apply to all DSHS Family Planning contractors. For more information visit the DSHS Family Planning website.

DSHS Family Planning Clinical Record Review Tool                    
DSHS Family Planning Contractor Instructions Tool - revised August 2014                 
DSHS Family Planning Review Tool                                  

Genetics (2014) - Items in this tool apply to all Title V-Genetics contractors. For more information visit the Genetics Program website.

Title V Genetics Services Tool
Title V Genetics Contractor Instructions
Title V Genetics Clinical Record Review Tool
Title V Genetics Prenatal Clinical Record Review Tool
Eligibility and Billing Record Review Tool

Primary Health Care (PHC) (2014) - Items in this tool apply to all PHC contractors. For more information visit the Primary Health Care website.

PHC Tool
PHC Tool Contractor Instructions
Eligibility and Billing Record Review Tool
Clinical Record Review Tool

Expanded Primary Health Care (EPHC) (2014) – Items in this tool apply to all EPHC contractors.  For more information, visit the Expanded Primary Health Care website. 

EPHC Tool
EPHC Tool Contractor Instructions
Eligibility and Billing Record Review Tool
Clinical Record Review Tool

Texas Health Steps (2014) - Items in this tool apply to all Texas Health Steps providers reviewed by QMB. For more information on Targeted Case Management for Pregnant Women and Infants and Texas Health Steps Medical Case Management, visit the Texas Health Steps website.

Texas Health Steps Review Tool
Texas Health Steps Tool Contractor Instructions
Texas Health Steps Clinical Record Review Tool & Instructions

MCH Title V – Prenatal Medical, Prenatal Dental, Child Health Medical and Child Health Dental (2014) - Items in these tools apply to all Title V Prenatal and Child Health contractors. For more information visit the Title V website.

Title V Prenatal Medical Tool
Title V Prenatal Medical Tool Contractor Instructions
Eligibility and Billing Record Review Tool
Title V Prenatal Medical Clinical Record Review Tool & Instructions

Title V Prenatal Dental Review Tool
Title V Prenatal Dental Tool Contractor Instructions
Prenatal Dental Clinical Record Review Tool
Eligibility and Billing Record Review Tool

Title V Child Health Medical Tool
Title V Child Health Medical Tool Contractor Instructions         
Eligibility and Billing Record Review Tool
Title V Child Health Medical Clinical Record Review Tool & Instructions

Title V Child Health Dental Review Tool
Title V Child Health Dental Tool Contractor Instructions
Child Health Dental Clinical Record Review Tool
Eligibility and Billing Record Review Tool


WIC - (2014) Items in these tools apply to all Special Supplemental Nutrition Program for Women, Infants and Children (WIC) contractors.
Core Tool
Core Tool Contractor Instructions
Child Abuse Record Review Tool 
WIC Clinical Tool
WIC Fiscal Tool
WIC Fiscal Checklist
Fiscal Self-Audit Contractor Instructions
EBT Food Delivery System Self-Audit Form
504 Checklist

Explanation for WIC Worksheets (2014):
These worksheets apply to all WIC contractors. Record reviews must be documented and include all areas described below. The Recap worksheet is not required as part of the self-audit. Foxfire reports can be used to obtain participant's names and ensure compliance in the different review criteria.

Eligible Records
Midpoint Screening
Noncontract Formula
Exclusively Breastfeeding  
Employees/Relatives/Friends
Ineligible Records
Health Care Referrals
Date of First Visit 
Records Not Available
Child Abuse
High Risk Referrals
Midcertification Assessment
Records Recap

Additional resources to help prepare for a WIC QA on-site monitoring visit:

http://www.dshs.state.tx.us/wichd/WICdirPlanningCal.pdf

http://www.dshs.state.tx.us/wichd/WICReqLAPolicies.pdf

Last updated January 06, 2015