N.M. Admin. Code § 8.2.2.15

Current through Register Vol. 35, No. 21, November 5, 2024

Section 8.2.2.15 - CLAIMS AGAINST INSTITUTIONS

A CYFD shall recover any payment made to an institution for disallowed claims. CYFD identifies disallowed claims during program reviews and considers payments made for such claims as over payments. CYFD shall notify all institutions of the reasons for the disallowed claim and demand reimbursement. The institution may request an administrative review of CYFD's decision as provided in Paragraph (11) of Subsection A of 8.2.2.9 NMAC.

B. Disallowed claims include the following for independent centers:

(1) lack of documentation to verify sufficient milk purchases to meet the required portion size for each age group, as documented in the menu record book and claimed for any month reviewed;

(2) reimbursement for meals, or snacks, claimed which lack required components;

(3) reimbursement for meals or snacks claimed which include non creditable foods as one of the required meal components;

(4) reimbursement for meals claimed when food production observed or recorded indicate there was not enough food prepared to provide the minimum serving size for the meals claimed for eligible children; food production is calculated using the USDA food buying guide;

(5) reimbursement for meals claimed when there is insufficient, or lack of, documentation to support the quantity and types of foods served;

(6) reimbursement for meals claimed in excess of two main meals and one supplement, or two supplements and one main meal per child, per day;

(7) reimbursement for meals claimed when meal count records do not support the meals claimed, or when any other required documentation to support the meals claimed, is not available;

(8) reimbursement for meals served during unapproved meal time periods;

(9) reimbursement for individual meals claimed in excess of recorded attendance or authorized capacity;

(10) reimbursement for all meals claimed for any month by for-profit Title XX centers when less than 25 percent of enrolled participants are Title XX beneficiaries or eligible for free or reduced price meals.

C. Disallowed claims for sponsoring organizations of day care homes include the following:

(1) reimbursement paid for meals served to ineligible children;

(2) reimbursement paid for ineligible meals or meals served during unapproved time periods;

(3) reimbursement paid for meals served that do not follow the USDA meal pattern as described in 7 CFR 226.20, and the state agency non creditable foods list;

(4) reimbursement for meals served to children not properly enrolled;

(5) reimbursement paid for meals served to providers' own children without current and complete income eligibility applications on file;

(6) reimbursement paid for meals at Tier 1 rates to providers who are incorrectly classified as Tier 1; the difference between Tier 1 and Tier 2 reimbursement paid to providers, is considered an over payment;

(7) reimbursement paid for meals at Tier I rates served by Tier II providers who do not have adequate Tier I eligibility documentation for non resident children.

D. Sponsoring organizations of day care homes shall recover payments from family day care home providers for the following disallowed claims:

(1) failure to maintain daily menu and attendance records;

(2) claiming meals when eligible enrolled children are not present;

(3) claiming meals which do not meet meal pattern requirements;

(4) claiming more than 2 main meals and a snack or two snacks and a main meal per child per day;

(5) claiming provider's own children when non resident children are not present at the meal service;

(6) program participants not found at the family day care home during stated hours of care on two consecutive visits; in such cases, the sponsoring organization shall dis-enroll these participants from the program and shall disallow any future claims concerning such participants until the sponsor verifies attendance.

E. Sponsoring organizations of family day care homes shall notify providers of disallowed claims and afford an opportunity for an administrative review in accordance with 7 CFR Part 226.6(l)(2).

N.M. Admin. Code § 8.2.2.15

8.2.2.15 NMAC - Rp, 8 2.2.15 NMAC, 06-15-09