/ Texas Workforce Commission
Vocational Rehabilitation Services
Compliance and Quality Case Review
General Information
Consumer last name: / Consumer first name: / Case ID:
CCS name: / Case status at time of review:
Reviewer name: / Reviewer title: / Review date:
Enter X to select review types C&Q Only Full (both C&Q and T&P) Case Reading
Enter X to select review approach, if applicable: Partial Entire
Review Reasons
Approval
Consultation
Case Transfer
Formal Inquiry
Performance Management
Data Correction
Risk Assessment
DBS RISK ASSESSMENT:
Successful closure
Yes No
Unsuccessful closure
Yes No
Case Cost > $20,000
Yes No
Case Length > 2 years for adult VR only
Yes No
Case Length > 5 years for Transition only
Yes No
90 days to IPE
Yes No
No counseling and guidance > 180 days
Yes No
DRS RISK ASSESSMENT:
One-time maintenance total >$300
Vacant caseload or change in CCS
Unsuccessful closure by strategic populations
Successful Closure
Case cost >$25,000
Case length >5 years
Presumptive eligibility (SSI/SSDI)
Application phase >60 days
>90 days to IPE
No Counseling and Guidance >180 days
Application and Diagnostic Interview / Preliminary Assessment
Compliance—Application and Diagnostic Interview / Preliminary Assessment
Compliant?
Yes No NA / Reason for “No” rating:
Corrective actions required:
Quality—Diagnostic Interview / Preliminary Assessment Case Notes
Exceeds
Meets
Needs improvement / Discussion:
Pre-Eligibility Trial Work
Compliance—Pre-Eligibility Trial Work
Compliant?
Yes No NA / Reason for “No” rating:
Corrective actions required:
Quality—Pre-Eligibility Trial Work Case Notes
Exceeds
Meets
Needs improvement / Discussion:
Determination of Eligibility
Compliance—Determination of Eligibility
Compliant?
Yes No NA / Reason for “No” rating:
Corrective actions required:
Quality—Eligibility Documentation
Exceeds
Meets
Needs improvement / Discussion:
Consumer Eligibility
Was the correct decision made regarding the consumer’s eligibility for VR services?
Yes No NA
Reason for “No” rating:
Corrective actions required:
Level of Significance
Compliance—Level of Significance
Compliant?
Yes No NA / Reason for “No” rating:
Corrective actions required:
Assessment and Planning for Comprehensive Assessment
Compliance—Assessment and Planning
Compliant?
Yes No NA / Reason for “No” rating:
Corrective actions required:
Quality—Comprehensive Assessment
Exceeds
Meets
Needs improvement / Discussion:
Original Individualized Plan for Employment
Compliance—IPE
IPE Content Compliant?
Yes No NA / Reason for “No” rating:
Corrective actions required:
Quality—IPE
Exceeds
Meets
Needs improvement / Discussion:
IPE Amendments and/or Joint Annual Reviews
Compliance—Amendment and/or JAR
Compliant?
Yes No NA / Reason for “No” rating:
Corrective actions required:
Quality—Documentation
Exceeds
Meets
Needs improvement / Discussion:
Counseling and Guidance
Compliance—Counseling and Guidance
Compliant?
Yes No NA / Reason for “No” rating:
Corrective actions required:
Quality—Counseling and Guidance Documentation
Exceeds
Meets
Needs improvement / Discussion:
Planned Services
Compliance—Planned Services
Compliant?
Yes No NA / Reason for “No” rating:
Corrective actions required:
Quality—Planned Services Delivery
Exceeds
Meets
Needs improvement / Discussion:
Closure
Type of Closure Unsuccessful before IPE Unsuccessful after IPE Successful
Compliance—Closure
Compliant?
Yes No NA / Reason for “No” rating:
Corrective actions required:
Quality—Closure Documentation
Exceeds
Meets
Needs improvement / Discussion:
Overall Comments, Corrective Actions Required, and/or Coaching Notes
(Required)
CCS Feedback
CCS feedback:
Additional Reviewer Feedback (if returned)
Reviewer feedback:
Date Acknowledged:
Name of person validating corrective action: / Date validated:
Name of person finalizing review: / Finalized date:

DARS3456 (07/16) A+ Compliance and Quality Case Review Page 1 of 5