10-148-6 Me. Code R. § 11

Current through 2024-51, December 18, 2024

Section 148-6-11 - IMPROPER PAYMENTS

A.Underpayments and Overpayments

1. An improper payment occurs when a Parent or Child Care Provider receives more or less benefits than they should have received.

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

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

4. 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 sixty (60) calendar days of the date payment is issued to the Child Care Provider.

C.Overpayments

1. 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 include, but are not limited to:

a. Errors caused by reporting false information; and/or

b. Errors caused by reporting inaccurate information.

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

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

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. Accepting duplicate payments or any payments issued in error;

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

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 Affordability Program payments shall be calculated by comparing the Child Care Affordability Program payment during the applicable benefit weekly to the Child Care Affordability Program payment that would have been payable if eligibility and Child Care Affordability Program payment had been calculated correctly. The difference between the correct Child Care Affordability Program payment and the amount of the Child Care Affordability Program payment paid shall be the amount of the weekly improper Child Care Affordability Program payment.

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

3. If Child Care Affordability Program 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 Affordability Program payment is inadequate or has not been received.

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

F.Responsibility for Repayment

1. Parent Responsibility for Repayment: If the Parent is responsible for the error, the Parent who is the Primary Applicant 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 and will terminate the Parent's participation in CCAP, as applicable, pending repayment. If the Parent is not currently participating in CCAP, and applies again for CCAP, the Parent's application will be denied until the Overpayment is repaid to the Department in full.

2. Child Care Provider Responsibility for Repayment. 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 recovery may be initiated by reducing the monthly Child Care Affordability Program payments if the Child is still attending. 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 last known address of the Parent and/or Child Care Provider, by U.S. Postal Service first class mail and email, as applicable.

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 reduction in Child Care Affordability Program Payments (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 Child Care Affordability Program Payment amount to the Child Care Provider and that the Child Care Provider cannot require the Parent to pay the difference.

H.Methods of Repayment

1. The Department shall 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 Affordability Program payments, the Department may then reduce the Child Care Provider's monthly payment until the Overpayment has been fully recovered if the Child is still in attendance.

3. Child Care Affordability Program may withhold income from federal or state grant payments to offset Child Care Affordability Program repayments until Overpayment has been fully recovered.

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

5. Written request for an Administrative Hearing on establishment of the Overpayment must be received by the Department within ten (10) calendar days of the notice date. Such written requests shall stay recovery actions until issuance of a decision as a result of the Administrative Hearing. Full repayment of the Overpayment is due within thirty (30) days of any final decision that the Department was correct when it determined a Parent or Child Care Provider was subject to recoupment of an Overpayment.

6. If the Child Care Provider does not actively receive Child Care Affordability Program payments, the Department shall recover the Overpayment through the quickest means possible and through those mechanisms available by law as with other program Overpayments.

7. If the Parent or Child Care Provider does not comply with any repayment plan, the Department may, to the extent allowed by law, take appropriate action to recover such Overpayment, up to and including termination from the Child Care Affordability Program.

8. If the Parent is unable to make a lump sum repayment but is otherwise eligible for the Child Care Affordability Program, the Department may approve a repayment plan with the Parent or Provider of up to twenty percent (20%) of the amount owed paid weekly until the Parent or Provider has repaid the Overpayment.

9. The repayment plan is subject to income eligibility review at any time.

10-148 C.M.R. ch. 6, § 11