10-148-6 Me. Code R. § 12

Current through 2024-25, June 19, 2024

Section 148-6-12 - IMPROPER PAYMENTS

When a Parent or Child Care Provider receives more or less benefits than they should have received, an improper payment is deemed to have occurred.

A.Underpayments and Overpayments

1. If the improper payment results in less benefits than should have been granted, the result is an Underpayment.

2. If the improper payment results in more benefits than should have been granted, the result is an Overpayment.

3. The Department shall take prompt action in accordance with the requirements of this section whenever an improper payment occurs.

B.Underpayments

1. Agency Administrative Error will be addressed by the Department on a case-by-case basis. The Department must receive written notification of any administrative errors by the Parent or Child Care Provider within thirty (30) calendar days of the date payment is issued to the Child Care Provider.

C.Overpayments

No Overpayment shall be established if the difference between the benefits paid on behalf of the Parent and the correct benefit amount is less than ten dollars ($10).

D.Errors Caused by Parents and Providers

1. Overpayments that are not caused by Agency Administrative Errors shall be classified as caused by the Parent or Child Care Provider.

2. Overpayments caused by the Parent shall include, but not be limited to:

a. Errors caused by reporting false information; and

b. Errors caused by reporting inaccurate information.

3. Overpayments caused by the Child Care Provider shall include, but not be limited to errors caused by:

a. Inaccurate reporting of licensing status, age of the Child, or other Child Care Provider eligibility requirements;

b. Inaccurate reporting of the Child Care Provider's relationship to the Child or the location at which Child Care Services are provided;

c. Inaccurate reporting of household circumstances;

d. Committing an illegal act, such as cashing a replacement check after falsely claiming that the original check was lost, stolen or destroyed;

e. Inaccurate reporting of actual charges or a Child's attendance; and

f. Any other false claim for Child Care Services provided.

4. The Overpayment shall be considered as both Parent and Child Care Provider caused if the Parent and the Child Care Provider both participated in the action that caused the Overpayment to occur.

5. The Department shall make a preliminary determination of whether the Overpayment was caused by a Misrepresentation based on the information and evidence and pursuant to these rules. Overpayments shall be considered and pursued if the Parent or Child Care Provider withheld or provided false information on matters affecting eligibility, benefits or a claim for services.

6. Where the Department makes a preliminary determination that a Parent or Child Care Provider may have committed a Misrepresentation, the case may be referred to the DHHS Fraud Investigation Unit pursuant to 22 M.R.S. §13 and the Department may pursue establishment of a Misrepresentation against the Parent and/or Child Care Provider administratively.

7. A final determination that a Misrepresentation occurred shall be made only as the result of a decision by an Administrative Hearing, a court, or waiver of the Administrative Hearing by the Parent and/or Child Care Provider. Failure to request an Administrative Hearing constitutes a waiver.

E.Calculating the Improper Payment

1. Improper Child Care Subsidy Payments shall be calculated by comparing the Child Care Subsidy Payment during the applicable benefit month to the Child Care Subsidy Payment that would have been payable if eligibility and Child Care Subsidy Payment had been calculated correctly. The difference between the correct Child Care Subsidy Payment and the amount of the Child Care Subsidy Payment paid shall be the amount of the monthly improper Child Care Subsidy Payment.

2. The monthly calculation is applied on a month-to-month basis for the improper payment period. The aggregate sum of the monthly improper Child Care Subsidy Payments within the improper Child Care Subsidy Payment period is the net amount of the improper Child Care Subsidy Payment or the Overpayment/Underpayment amount.

3. If Child Care Subsidy benefits are underpaid, the amount owed shall be paid within sixty (60) calendar days of the date the error was discovered, unless information needed to calculate the improper Child Care Subsidy Payment is inadequate or has not been received. If the Parent or Child Care Provider has an outstanding Overpayment, the amount of the Underpayment shall be used to offset the outstanding Overpayment and any remaining balance of the Underpayment shall then be payable to the Parent or Child Care Provider.

4. Improper Child Care Subsidy Payments shall be corrected regardless of whether the Parent's case is active or closed. The Parent and Child Care Provider shall be notified of the determination.

5. Repayment of Overpayments shall begin on the first day of the month following the month in which the circumstances that caused the Overpayment occurred.

6. Repayment of Agency Administrative Overpayments shall begin on the first day of the month following the month in which the circumstances that caused the Overpayment occurred, unless a notice of Adverse Action is required.

7. If the Department fails to take timely action following discovery of the issue to correct the issue causing the Overpayment to accrue any subsequent subsidy benefits overpaid as the result of the delay, this shall be considered an Agency Administrative Error.

F.Responsibility for Repayment

If the Parent is responsible for the error, the Parent shall repay the Overpayment. If the Parent is responsible for the Overpayment, the Department shall require restitution by billing when the Overpayment is due and again on the 30^th and 60^th day if the Parent fails to pay. Thereafter, the Department may pursue collection in the appropriate venue. If the Child Care Provider is responsible for the error, the Child Care Provider shall repay the Overpayment. If the Child Care Provider is responsible for the Overpayment and recovery is initiated by reducing the monthly Child Care Subsidy Payments, the Child Care Provider shall not require the Parent to pay the difference by increasing charges to compensate for the loss of income due to the recovery of an Overpayment.

G.Notice of Overpayment

1. The individuals responsible for the repayment of the Overpayment shall be provided with written notice of Overpayment.

2. The written notice of Overpayment shall be sent to the Department's last known address of the Parent and/or Child Care Provider, by U.S. Postal Service first class mail.

3. The written notice of Overpayment shall contain:

a. Name(s) of the individual(s) responsible for repayment;

b. Last known address of the individual;

c. Amount of the Overpayment;

d. Period of the Overpayment;

e. A statement that the Overpayment will be considered payable in full thirty (30) calendar days from the date of the notice;

f. Explanation of why the Overpayment occurred;

g. Responsibility for repayment by recovery through Child Care Provider payment reduction (if applicable);

h. Responsibility for repayment when billed (if applicable);

i. Responsibility for repayment through Maine Revenue Services Tax Setoff (if applicable);

j. Administrative Hearing Rights and Appeal Rights; and

k. Selection of repayment method.

4. If the Child Care Provider is solely responsible for repaying the Overpayment, the Parent shall be notified in advance of the proposed change in Subsidy amount to the Child Care Provider and that the Child Care Provider cannot hold the Parent responsible for paying the difference.

H.Methods of Repayment

1. The Department shall attempt to recover Overpayments by a lump sum repayment or the quickest means possible.

2. If the Child Care Provider does not agree to a lump sum repayment and continues to receive Child Care Subsidy Payments, the Department shall then reduce the Child Care Provider's Child Care Subsidy Payments by twenty percent (20%) of the Child Care Provider's monthly Child Care Subsidy Payment until the Overpayment has been fully recovered.

3. Recovery by benefit reduction shall be initiated if the Child Care Provider does not respond to the advanced notice or request an Administrative Hearing.

4. Written request for an Administrative Hearing on establishment of the Overpayment must be received by the Department within thirty (30) calendar days of the notice. Such written requests shall stay recovery actions until issuance of a decision as a result of the Administrative Hearing.

5. If the Child Care Provider does not actively receive Child Care Subsidy Payments, the Department shall attempt to recover the Overpayment through the quickest means possible and through those mechanisms available by law as with other program Overpayments.

6. If the Parent or Child Care Provider does not comply with any repayment plan, the Department may, to the extent allowed by law, take any action deemed appropriate to recover such Overpayment.

7. If the Parent does not agree to a lump sum repayment and continues to be eligible for Child Care Subsidy, the Department may approve a repayment plan with the Parent of up to twenty percent (20%) of the amount owed paid weekly until the Parent has repaid the Overpayment.

10-148 C.M.R. ch. 6, § 12