2016 Quality Management Review Tools and Instructions

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 (2016) - Items in this tool apply to all DSHS contractors. 8590004495

Core Tool
Core Tool Contractor Instructions
Child Abuse Record Review Tool 
Self-Assessment for Civil Rights Compliance

For more information on The HHSC Civil Rights Office requirements and the Self-Assessment for Civil Rights Compliance, please visit their website at: http://www.hhsc.state.tx.us/about_hhsc/civil-rights/

For more information visit the QMB Contractor/Provider Information page.

BCCS (2016) - 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 (2016)- 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
CSHSN FSCR Tool
CSHSN FSCR Contractor Instructions

DSHS Family Planning (2016) - 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
DSHS Family Planning Review Tool
Eligibility and Billing Record Review Tool


Genetics (2016) - Items in this tool apply to all Title V-Genetics contractors. For more information visit the Genetics Program website.

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

Primary Health Care (PHC) (2016) - 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) (2016) – 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 (2016) - 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

MCH Title V – Prenatal Medical, Prenatal Dental, Child Health Medical and Child Health Dental (2016) - 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
Title V Prenatal Dental Clinical Record Review Tool & Instructions
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
Title V Child Health Dental Clinical Record Review Tool & Instructions
Eligibility and Billing Record Review Tool

WIC - (2016) 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
Clinical Worksheet Instructions*
Record Review Worksheets*
EBT Food Delivery System Self-Audit Form
504 Checklist
WIC Fiscal Self-Audit Instructions and Worksheet
Records Recap

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

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 February 27, 2017