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FY12 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- Part A & Dental 
Primary Health Care (PHC)
School Health
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 (FY12) - 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

BCCCS (FY12) - Items in this tool apply to all Breast and Cervical Cancer Control (BCCCS) 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 (FY12)- Items in this tool 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 

CSHSN FSCR Tool 
CSHSN FSCR Contractor Instructions

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

Genetics
 (FY12) - 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

Primary Health Care (PHC) (FY12) - 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

School Health (FY12) - Items in this tool apply to all School Health (SH) contractors. For more information visit theSchool Health website.

Texas Health Steps (FY12) - 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 Record Review Tool
Texas Health Steps Clinical Record Review Tool & Instructions

Title V - Part A & Dental (FY12) - Items in this tool apply to all Title V-Part A and Dental contractors. 
Title V Part A Tool
Title V Part A Tool Contractor Instructions
Eligibility and Billing Record Review Tool
Clinical Record Review Tool

Title V Dental Review Tool
Title V Dental Tool Contractor Instructions
Dental Clinical Record Review Tool


DSHS Family Planning (FY12) Items in this tool apply to all Family Planning contractors. For more information visit the Family Planning website.
DSHS FP Tool
DSHS FP Tool Contractor Instructions
Eligibility and Billing Record Review Tool 
Clinical Record Review Tool

WIC - (FY12) Items in this tool 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 (FY12):
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. These reports can be found at http://www.dshs.state.tx.us/wichd/default.shtm

Child Abuse
Date of First Visit 
Eligible
Exclusively Breastfeeding
Employee
Formula
HR Referrals
Ineligible
Midpoint
Record Not Available
Records Recap
Referral
WIN Appts

Explanation for WIC Clinical Checklist:
The WIC Checklist applies to all contractors who have a WIC site-monitoring visit scheduled. To expedite the review, please have the documents that are listed on the checklist available at the time of the Entrance Conference. 

Clinical Checklist

Last updated June 12, 2014