Child Care Assistance

Transcription

1 Montrose County Department of Health & Human Services Policy/Procedure Director (Signature) Recovery of Overpayment Child Care Assistance Effective Date: 9/1/2008 Last Revised Date: 11/1/2013 Page 1 of5 1. Purpose Montrose County Health & Human Services (MCHHS) has established a policy for recovery of overpayments made to child care providers on behalf of households participating in the Colorado Child Care Assistance Program (CCCAP). 2. Responsibility Child Care Assistance Technicians, and program Supervisor. 3. Background Colorado Department of Human Services (CDHS) Staff Manual, Volume 3, Section ("Child Care and Recovery") states that when an overpayment is discovered, counties are to determine if a recovery should be attempted, and to recover if so determined. 4. References CDHS Staff Manual, Volume 3, Section 3.9 Montrose County Child Care Assistance Plan (MCCCAP) 5. Definitions CCCAP - Colorado Child Care Assistance Program CDHS - Colorado Department of Human Services ChATS - Childcare Automated Tracking System Qualified Family Child Care Home - Non-licensed provider MCHHS - Montrose County Health & Human Services POS - Point of Service CCAP Title Page (8/06)

2 CCCAP: Recovery of Overpayment Page 2 of 5 6. Policy Upon determination that an overpayment of CCCAP funds has been made, ivlchhs staff will review the circumstances to determine if a recovery of overpaid funds is required, per CDHS Rules, Volume 3, Section Required Recovery Circumstances Recovery may be required ifthe following is determined: Family's income exceeds 85% of the State Median Income (SMI), or Family's qualifying eligible activity has changed, and either were not reported within 4 weeks of occurrence, OR A child care provider has received child care payments for which they were not eligible. 6.2 Exceptions to Recovery If recovery is indicated by the above, MCHHS staff should determine if an exception to recovery exists per CDHS Rules, Volume 3, Section Exceptions to overpayments to be recovered are as follows: Recipient household is without fault in the creation of the overpayment Recipient household reported change in circumstances, that affect eligibility, in a timely manner When the identified overpayment(s) have been made within the prior 12 months to discovery and total less than $50.00 State System Overpayment Errors Substantial system error overpayments, overpayments with unusual circumstances such as those related to child support issues, and any other exception to this policy will be evaluated on an individual basis by the CCCAP Supervisor, the Technician, and the MCHHS Fraud Investigator. The Supervisor will make a recommendation to the MCHHS Director, or designee, as to whether or not these overpayments should be recovered. 6.3 Suspicion of Fraud If no exception to recovery is determined, MCHHS staff will review to determine if the cause of overpayment is suspected fraud. If fraud is suspected, staff should complete a referral for investigation to the agency investigator, and notify the CCCAP supervisor. Staff will not take further immediate action to recover until the investigation is complete.

3 CCCAP: Recovery of Overpayment Page 3 of 5 When investigation determines that overpayment occurred due to willful misrepresentation or withholding ofinformation, recovery will be pursued regardless of when overpayment occurred. In cases of overpayment through willful misrepresentation or withholding of information, and in which MCHHS is unable to determine income or activity eligibility criteria for child care assistance previously provided, recovery will be established for the entire benefit for the affected time period. Overpayments based on criminal acts that are referred to the District Attorney for prosecution shall wait for a court-ordered judgment for recovery/repayment. 6.5 Barring exceptions, MCHHS will recover CCCAP assistance overpayments from involved parties, as follows: A) Determine/verify the amount of overpayment. B) Enter the amount of overpayment and other specific factors of the situation into the case record and ChATS, including the calculation used to determine the amount to be recovered. C) Notify the household or child care provider ofthe amount due and the reason for the recovery per proper prior noticing rules 7. Procedure 7.1 Calculating overpayment Technicians will first complete an overpayment calculation report before proceeding to take any action Technicians will print a copy of the Payment Detail screen from ChATS for payments by case to document the actual paid amounts versus the amounts that should have correctly been paid. Technicians should include the following in their calculations: Ensure accounting for any periods when the parent fee covered the full cost of care, when determining proper adjustments If payments were made for a child who became ineligible, when household remained eligible, use the Payment Detail screen payments by SID (State ID), to determine correct overpayment amount (will normally occur as provider errors) Calculations must show the original basis of benefit coverage as well as the correct calculation «CDHS CCCAP Rules Manual References reflecting the specific responsibility or error shall be included on the overpayment calculations document

4 CCCAP: Recovery of Overpayment Page 4 of5 Connplete form "Low Income Child Care Recovery Statement" Complete narrative report of findings for Supervisor, which will have attachments of calculations and Recovery Statement Make clear in report which party is responsible to make repayment Review overpayment report with Supervisor Retain copy of report in Participant or Provider case records, 7.2 Initiating Recovery of Overpayment Technicians will coordinate actions with the Business Office and Fraud Investigator to ensure that withholdings are completed based on current state and county practices Business Office staff will enter the recovery into the ChATS which will generate a Notice of Established Recovery letter (CR207) to be printed and mailed to the provider that was overpaid When a completed and signed Repayment Agreement is received from an overpaid provider. Business Office staff will enter the details of the Repayment Agreement into ChATS Repayments shall be addressed to Montrose County Health & Human Services Ifthe Repayment Agreement is not completed, signed, and received back from the overpaid provider within 60 days of creation ofthe recovery in ChATS, Business Office staff will create a Default Recovery in ChATS, along with justification case notes in ChATS. Default Recoveries will be established for repayment of $25.00 or 5% of total overpayment per week, whichever amount is greater Records of Repayments will be maintained in ChATS by Business Office staff.

5 CCCAP: Recovery of Overpayment Page 5 of5 7.3 Recovery Completed When the amount overpaid has been successfully repaid and recorded in ChATS, ChATS will generate a Recovery Completed letter (CR212) to be printed and mailed to the provider that completed the repayment. 7.4 Records Retention Afterthe repayment is completed, MCHHS staff will retain case record and recovery/repayment records for 3 years plus current year. 8. Inquiries Please direct questions about this policy / procedure to the Child Care Assistance Program supervisor, Montrose County Health & Human Services.