La. Admin. Code tit. 67 § VII-1127

Current through Register Vol. 50, No. 11, November 20, 2024

Section VII-1127 - Violations, Penalties, and Reasons for Closure

A. The following may result in termination of services or other penalties:

1. the individual no longer meets eligibility criteria;

2. the individual falsified information (time sheets, signed personal assistance provider's name to check and/or time sheets, etc.);

3. the individual failed to meet the contractual agreement with the fiscal agent's requirements;

4. the individual is unable to be contacted and/or whereabouts unknown for 90 days or more and no response after an attempted home visit and certified letter;

5. any other reason which is contradictory to policy and procedures for the SPAS Program.

B. Definitions

Fraud-use of trickery or deceit to receive benefits. For fraud to exist:

a. misrepresentation of fact affecting eligibility, amount of benefits, and/or use of SPAS Program funds. The burden of proof that fraud exists is on the fiscal agent;

b. the misrepresentation must have been made knowingly and with deceitful intent.

Intentional Program Violation-made a false or misleading statement, or misrepresented, concealed or withheld fact; or committed any act that constitutes a violation of the SPAS Program or SPAS policy and/or procedures. Also, a consumer/recipient who repeatedly fails to comply with the policies and/or procedures of the SPAS Program would be in violation of §1127

C. Warning. The contractor/fiscal agent should issue a "warning" to consumer/recipients who commit a violation of policy, such as failure to comply with terms of the service plan between the consumer/recipient and fiscal agent. The fiscal agent will determine if the violation was intentional. If the violation is not intentional, written notice of the violation and action to correct the violation is to be given to the consumer/recipient. A copy of the notice to the consumer/recipient is to be placed in the consumer/recipient's case record. Repeat of the violation should be brought to the attention of the LRS Program Coordinator for consideration of termination.

D. Recoupment

1. In lieu of termination, the contractor/fiscal agent can demand that a consumer/recipient refund the SPAS Program for all benefits received because of a violation as listed above.

2. If the contractor/fiscal agent rules that the consumer/recipient must repay the amount in question, the contractor/fiscal agent will determine the repayment schedule. Consumer/recipient can remain eligible as long as recoupment is made and a willingness to comply with policies and procedures set forth in the SPAS Program are shown. The contractor/fiscal agent shall maintain close monitoring of the consumer/recipient until such time the contractor/fiscal agent determines consumer/recipient is complying with the policies and procedures.

3. Recoupment is required from fraudulently received benefits as well; however, the consumer/recipient will not be eligible for further services.

E. Termination. The contractor/fiscal agent may terminate an individual who violates the policy and/or procedures of the SPAS Program. The determination to terminate will be based on the severity of the violation(s) and/or continued violation(s).

La. Admin. Code tit. 67, § VII-1127

Promulgated by the Department of Social Services, Rehabilitation Services, LR 21:1251 (November 1995), amended LR 33:1149 (June 2007).

AUTHORITY NOTE: Promulgated in accordance with R.S. 49:664.6 and R.S. 36:477.