218 R.I. Code R. 218-RICR-20-00-2.24

Current through November 7, 2024

Section 218-RICR-20-00-2.24 - Error Cases

2.24.1Types of Error Cases

A. Agency Error. An agency error is any overpayment caused by the agency's action or failure to take action. Overpayments caused by agency error are considered non-fraud. Instances of agency error which may result in a claim include, but are not limited to, the following:

1. The agency failed to take prompt action on a change reported by the household;

2. The agency incorrectly computed the household's income or deductions, or otherwise assigned an incorrect allotment resulting in an incorrect benefit; or

3. The agency continued to provide a household benefits after its certification period had expired without benefit of a reapplication determination.

B. Client Error. Overpayments caused by, but not limited to, the following household errors are considered non-fraud (inadvertent):

1. A payment was issued pending a fair hearing decision adverse to the recipient;

2. A payment was issued solely due to ten (10) day notice requirements even though the recipient was ineligible for the assistance; or

3. An overpayment resulting from a misunderstanding or unintended error on the part of the household.

2.24.2Establishing Claims Against Households

A. Instances of errors which may result in a collection include, but are not limited to, the following:

1. The household unintentionally failed to provide the agency with correct or complete information;

2. The household unintentionally failed to report to the agency changes in its household circumstances; or

3. The household unintentionally received benefits, or more benefits than it was entitled to receive, pending a fair hearing decision because the household requested a continuation of benefits based on the mistaken belief that it was entitled to such benefits.

B. The following individuals are responsible for paying a claim:

1. Each person who was an adult member of the household when the overpayment occurred.

2. If a change in household composition occurs, the agency may pursue collection action against any household which has a member who was an adult member of the household that received the overissuance;

C. DHS may also offset the amount of the claim against restored benefits owed to any household which contains:

1. A member who was an adult member of the original household at the time the overissuance occurred;

2. A sponsor of a non-citizen household member if the sponsor was at fault; or

3. A person connected to the household, such as an authorized representative, who actually caused the overpayment.

2.24.3Underpayments

A. Correction of Underpayment. The appropriate agency representative corrects the underpayment as soon as possible, but not later than thirty (30) days after discovery of the underpayment, to a current recipient or one who would be a current recipient had the error causing the underpayment not occurred.

B. Underpayments Discovered After Case Closure

1. Past RIW recipient currently active in another DHS program will receive a supplement through a DHS worker.

2. Past recipients closed to DHS will receive a letter from DHS addressed to the head of household known to DHS at the time the underpayment occurred requesting response to correct the underpayment.

C. Retroactive Corrective Payment. A retroactive corrective payment is not considered income, nor is it considered a resource in the month received or in the following month.

D. Current Recipients. The correction of underpayment errors to current recipients is required regardless of when the underpayment occurred. There is no time limit for correcting an underpayment.

E. Underpayment and Overpayment in Same Month. In cases involving an underpayment and an overpayment in the same month, the agency representative must factor in both in determining what the correct payment should have been. If an underpayment still exists, it is promptly corrected.

F. Method of Payment. An underpayment is corrected by first entering the correct information in the electronic case record to reflect the actual income, resources, or household circumstances during the period of the underpayment. The agency representative then approves the deficit payment through the eligibility system.

2.24.4Overpayments

A. Recovery of Overpayments

1. Recovery of overpayments from current or former recipients is required regardless of when the overpayment occurred.

2. An overpayment may result from either an agency or a client error. To determine the net overpayment amount, the gross overpayment must be reduced by the amount of any child support collected and retained by the Office of Child Support Services, over and above the payment the recipient should have received (see § 2.15 of this Part).

B. DHS must initiate collection action against the household on all client or agency error claim referrals unless the claim is collected through offset, or one (1) of the following conditions applies:

1. The amount of the claim referral is less than thirty-five dollars ($35.00), and the claim cannot be recovered by reducing the household's allotment. This threshold does not apply for overpayments discovered through Quality Control.

2. The agency has documentation which shows that the household cannot be located.

2.24.5Underpayment and Overpayment in Same Month

A. In cases involving an underpayment which has not yet been restored and an overpayment in the same month, the agency representative must factor in both in determining what the correct payment should have been. If an underpayment still exists, it is promptly corrected.

1. The amount of the underissuance must be used to offset the claim.

2. If an overpayment still exists, the referral is made to the Collections, Claims and Recoveries Unit (CCRU) to institute collection for the remaining balance.

3. When there is any restoration of lost benefits which is used to offset an established claim, the balance of the claim is reduced by the amount of the offset through the eligibility system.

4. CCRU will initiate underissuance payments identified while researching a claim for overpayment.

5. All actions pertaining to the collection of outstanding claims in the TANF Program are handled by the Collections, Claims and Recoveries (CCRU) Unit of the Department of Human Services.

2.24.6Determining Initial Month of Over-Issuance

A. In all inadvertent household error or agency error claims, the first (1st) month of overissuance is the month the change would have been effective had it been reported in a timely manner with allowance for the adverse action timeframes. In no instance, however, is the first (1st) month of over issuance any later than two (2) months from the month in which the change in household circumstances occurred.

B. Determining Initial Month

1. Failure to Report Change Within Ten (10) Days. If the household failed to report a change in its circumstances within ten (10) days of the date the change became known to the household, the first (1st) month affected by the household's failure to report is the first (1st) month the change would have been effective had it been reported in a timely manner.

2. Change Reported Timely

a. When a household reports the change on time, but the agency representative does not act on the change in a timely manner, the first (1st) claim month is still the first (1st) month the change would have been effective.

b. If the Notice of Action was required but not sent, the agency representative assumes, for the purpose of calculating the claim, that the maximum advance notice period would have expired without the household requesting a hearing.

3. Benefits Issued Pending Hearing Decision. If a household requests the continuation of benefits pending a fair hearing decision, and receives an overissuance because its position is not sustained by the hearing decision, the first (1st) month of overissuance is the month that the change would have been effective had the household not asked for the continuation of benefits.

2.24.7Calculation of the Claim Referral

A. The field representative determines the correct amount of benefits the household should have received for those months the household participated while the overissuance was in effect.

B. The agency representative determines that amount for active cases as follows:

1. The correct information is entered in the appropriate months in the electronic case record to reflect the actual income, resources, or household circumstances during the period of the overpayment;

2. The retroactive eligibility is approved for the month(s) affected; and

3. The circumstances pertaining to the overissuance is recorded in the electronic case record.

2.24.8Reasonable Effort to Pursue Recovery

A. If the amount of the overpayment is more than thirty-five dollars ($35.00) and owed by a former recipient (§2.24.1 of this Part) in a non-fraud case, the Collections, Claims and Recoveries (CCRU) Unit determines by a reasonable effort if it is cost effective to pursue recovery efforts.

1. "Reasonable effort" requires minimally that a repayment request be sent to the former recipient.

2. If s/he fails to respond, CCRU must consider if the cost of collecting the overpayment is likely to equal or exceed the amount of the overpayment, and what degree of effort is within the bounds of cost effectiveness.

3. If a former recipient subsequently becomes active within three (3) years, recovery is initiated regardless of the overpayment amount.

B. Every effort must be made to recover any overpayment amount in cases of court-determined fraud. The agency must take all reasonable steps necessary to promptly correct any overpayment.

C. Prompt recovery of an overpayment means the agency representative must initiate action by the end of the quarter following the quarter in which the overpayment is first identified to recover the overpayment from an active recipient.

D. In closed cases, the CCRU must initiate action to locate a former recipient and/or recover the overpayment from him/her.

E. Mandatory recovery of overpayments includes an overpayment resulting from assistance paid pending a hearing decision where the recipient receives an adverse hearing decision. Only the portion of cash assistance paid relating to the disputed issue is recoverable.

F. Any recovery of an overpayment to a current assistance unit must be made through repayment (in part or in full) by the following:

1. through the individual recipient responsible for the overpayment;

2. by reducing the benefit amount of assistance payable to the assistance unit of which s/he is a member; or both.

G. If recovery is not possible from the individual responsible, the CCRU representative determines whether to recover from:

1. Any assistance unit which has a member who was an adult member of the assistance unit that received the overpayment (was age eighteen (18) or older - excluding minor heads of households); or

2. Any individual members of the overpaid assistance unit, who were adults at the time the unit received the overpayment, whether or not current recipients.

218 R.I. Code R. 218-RICR-20-00-2.24

Adopted effective 1/6/2019
Amended effective 2/16/2020
Amended effective 2/27/2022
Amended effective 11/11/2022
Amended effective 8/26/2023
Amended effective 11/4/2023