Chapter 34: Case Reviews

34.1 Overview

The purpose of a case review is:

  • to determine whether a case complies with federal requirements and CRS policy;
  • to assess the quality of decision making, understanding of the vocational rehabilitation process, and ability to explain a consumer's progress clearly and concisely in the case record;
  • to help counselors and support staff members improve their decision making about the rehabilitation process, increase their use of community resources, and improve how well they manager their casework and caseload; and
  • to help managers develop performance management information.

34.2 Key Terms

Case Reading Review – A review that allows users to quickly review a case, or a specific aspect of a case, when a more detailed case review is not necessary. Refer to the TxROCS User’s Guide for instructions on entering a case reading review in TxROCS.

Compliance – Adhering to the federal and state laws, regulations, guidelines, and specifications that are outlined in this manual and in the CRS Standards for Providers Manual, Contracting Processes and Procedures Manual, and DARS Procurement Manual. A case is compliant if it meets all of the requirements. For information about evaluating compliance, refer to the MOSAIC Process Guide, Appendix C: Compliance and Quality Case Review Guide, Section III: MOSAIC - Case Review Guide.

Compliance and Quality Review (C&Q) – A review of the compliance and quality aspects of a vocational rehabilitation case. C&Q reviews can be completed using an entire or partial approach. Refer to the TxROCS User’s Guide for instructions on entering a C&Q review in TxROCS.

Entire Review Approach – A case review approach that requires the reviewer to answer all questions in the review before the review can be considered complete. The approach can be used for compliance and quality reviews, technical and purchasing reviews, and full reviews.

Full Review – A review that includes both a technical and purchasing (T&P) review and a compliance and quality (C&Q) review of a case that is started as a single full review in TxROCS. The reviewer must answer all questions in both the T&P and C&Q sections of the review before the review can be considered complete. Refer to the TxROCS User’s Guide for instructions on entering a full review in TxROCS.

Monitoring, Oversight, and Internal Controls (MOSAIC) Process Guide – A guide that describes the quality assurance system and monitoring processes. The MOSAIC guide provides information about the risk assessment model. It explains how reviewers use the model to develop quarterly monitoring plans and how regions use it to develop and report on action plans to address monitoring results.

Partial Review Approach – A case review approach that allows the reviewer to complete and finalize a case review without answering all of the questions in the review. The approach can be used for compliance and quality reviews or technical and purchasing reviews. It cannot be used for full reviews.

Quality – An assessment of the level of service and other forms of support provided to a consumer throughout the consumer’s case. Quality casework is demonstrated by values- based decision making, active participation by the consumer, and compliance with all required policies and standards. Quality is assessed based on a thorough review of all related casework and documentation. Quality is rated as exceeds expectations, meets expectations, or needs improvement. For more information about quality assessments, refer to the MOSAIC Process Guide, Appendix C: Compliance and Quality Case Review, Section III: MOSAIC - Case Review Guide.

Technical and Purchasing Review (T&P) – A review of the technical and purchasing aspects of a vocational rehabilitation case. T&P reviews can be completed using an entire or partial approach. Refer to the TxROCS User’s Guide for instructions on entering a T&P review in TxROCS.

TxROCS Users Guide – A technical guide that explains how to navigate through the TxROCS application. The TxROCS User’s Guide is not a policy manual.

TxROCS User Role – Distinct roles that define what the user is allowed to use in TxROCS. User roles prohibit reviewers from viewing case reviews and reports that are not within the reviewer’s assigned management unit. For more information on user roles, refer to the TxROCS User’s Guide.

Validate – To verify that required corrective actions have been completed appropriately. When the validator is satisfied that the corrective actions have been completed appropriately, he or she selects the "Completed Validation" button on the Actions page in TxROCS. When the validation is complete, the case review is final and no further changes may be made to the case review.

34.3 Compliance and Quality Reviews

The compliance portion of a compliance and quality (C&Q) review is used to evaluate whether specific elements of a case adhere to the federal and state laws, regulations, guidelines, and specifications that are outlined in the this manual and in the CRS Standards for Providers Manual, Contracting Processes and Procedures Manual, and DARS Procurement Manual.

The quality portion of a C&Q review is used to assess the level of service and other forms of support provided to the consumer throughout the consumer’s case. Quality casework is demonstrated by values-based decision making, active participation by the consumer, and compliance with all required policies and standards. It is based on a thorough review of all related casework and documentation.

C&Q reviews are documented by completing DARS3456, Compliance and Quality Case Review in TxROCS. Only managers, program specialists, and their designees may complete a C&Q review. C&Q reviews cannot be completed by administrative support staff members.

For help when completing a C&Q review, see the MOSAIC Case Review.

34.4 Technical and Purchasing Review

The technical portion of a technical and purchasing (T&P) review is used to evaluate whether all required information is included in the electronic and or paper case file.

The purchasing portion of a T&P review is used to evaluate whether the appropriate purchasing policies and procedures were followed and documented, as required by the applicable federal and state laws, regulations, guidelines, and specifications that are outlined in the CRS Standards for Providers Manual, Contracting Processes and Procedures Manual, and DARS Procurement Manual.

T&P reviews are documented by completing DARS3399, Technical and Purchasing Review in TxROCS. Managers, program specialists, and their designees may complete T&P reviews. Designees may include management support staff members; however, managers must review a designee’s work to ensure that the designee accurately represents the findings.

All managers are required to monitor the operation of their units. Case reviews are a required part of monitoring. To identify the type and quantity of required reviews, managers refer to the unit’s monitoring plan for the current fiscal year. The regional director and designated regional office staff members oversee each unit in their region, including monitoring of activities related to case review.

The program director or program manager of Consumer Services Support (CSS) manages and oversees the case review process statewide to ensure that the process is applied consistently. Direct all questions about the case review process and unit monitoring plan to the CSS program director or a designee.

Refer to the MOSAIC Case Review Guide for information on the unit monitoring plan and the reporting requirements and other roles and responsibilities of unit, regional, and central office staff members.

34.5 TxROCS

The CRS program uses TxROCS to capture and organize data from case reviews that are conducted statewide.

The CRS program uses the data captured in TxROCS to:

  • examine statewide activity and trends; and
  • respond to ad-hoc requests requiring case review data.

Using TxROCS allows the CRS program to:

  • record case review data efficiently and accurately;
  • create one repository for data, in place of many repositories;
  • provide timely and accurate reporting, at all organizational levels; and
  • provide auditors, quickly and accurately, with a comprehensive list of the vocational rehabilitation cases that have been reviewed.

Responsibilities and Roles in TXROCS

All reviews of vocational rehabilitation cases must be entered into TxROCS. The reviews are maintained in TxROCS for a minimum of two state fiscal years. The review process is audited each year.

The supervisor:

  • determines the appropriate user role for all staff members based on the standard descriptions in the TxROCS User’s Guide; and
  • submits a completed DARS1260, Service Request for an Individual.

Exceptions to a standard user role require the approval of the regional director.

Reviewers (or their designees):

  • document the case review in TxROCS;
  • identify areas of non-compliance (if applicable);
  • establish the corrective actions to be taken;
  • notify staff members about their reviews and assigned corrective actions;
  • monitor the progress made on taking corrective actions;
  • validate that corrective actions have been completed;
  • document the validation in TxROCS; and
  • report serious findings (that is, illegal, immoral, or unethical practices) immediately to the regional director.

After completing a review, the reviewer enters a case note in the consumer's electronic file to document the type of review conducted. Specific findings and assigned corrective actions are not entered in the case note.

Caseload carrying staff members (or their designees):

  • review completed case reviews;
  • complete all assigned corrective actions; and
  • acknowledge that they have completed these steps of the review in TxROCS.