La. Admin. Code tit. 48 § V-4507

Current through Register Vol. 50, No. 9, September 20, 2024

Section V-4507 - WIC Transaction Processing and Reimbursement and Claims by LA WIC

A. Only authorized WIC vendors may transact WIC benefits.

B. LA WIC will establish a vendor peer group system, place vendors into peer groups, and set allowable reimbursement levels for each peer group for the purpose of cost containment. If an above-50-percent (A-50) vendor is needed for participant access, LA WIC will place the A-50 vendor into a peer group for vendors designated as A-50.

C. A vendor shall process WIC transactions as outlined in the vendor guide and policy manual. LA WIC shall reimburse a vendor in accordance with its peer group, making adjustments as required by WIC federal regulations.

D. A vendor shall maintain and operate its WIC EBT system in compliance with the USDA/FNS's WIC operating rules for EBT, the technical implementation guide, the vendor rules and regulations and any changes thereto.

E. If a vendor submitted a claim for reimbursement that was rejected or the payment amount for the claim for reimbursement was adjusted by the LA WIC-contracted EBT processor or bank with which the vendor disagrees, the vendor may submit its dispute of the rejection of (or adjustment to) the reimbursement according to the process outlined in the vendor guide and policy manual. Any dispute submitted untimely shall be denied. Disputes that exceed the federal monetary threshold are subject to USDA approval. Vendors shall be notified of adverse reimbursement decisions.

F. LA WIC shall establish a claim against the vendor for any amounts owed to the program (e.g., overcharges, unauthorized items, excess WIC approved food items, excess payments, deficiencies identified during an inventory audit, and adjustment to the vendor's claim for reimbursement). Disqualification and/or termination of the vendor agreement or payment of a civil money penalty (CMP) does not relieve the vendor of the obligation to repay any monies claimed by and owed to LA WIC. LA WIC may refer debts to the Louisiana Department of Revenue, Office of Debt Recovery and/or commence action in the 19th Judicial District Court to recover the outstanding claim amount and/or pursue any other remedies allowed to LA WIC by law.

La. Admin. Code tit. 48, § V-4507

Promulgated by the Department of Health and Human Resources, Office of Preventive and Public Health Services, LR 13:246 (Apri11987), Amended by the Department of Health, Office of Public Health, LR 43338 (2/1/2017), Amended LR 491406 (8/1/2023).

AUTHORITY NOTE: Promulgated in accordance with R.S. 46:972 and R.S. 47:1676.