State Survey Analysis Report
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APPENDIX 1. DEFINITION OF IMPROPER PAYMENTS
1. How does the CCDF Lead Agency define improper payments?
24 State agencies responded to Question 1 (Appendix 1: pp. 39–43) |
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| State | Definition of Improper Payments |
|---|---|
| Alabama | Improper payments result from an intentional or unintentional violation of subsidy policy by the parent/provider or misapplication of subsidy policy by the agency. |
| Arizona | ARS § 46-213.BStates “If a recipient is overpaid for whatever reason, the recipient is liable for the amount of the overpayment. The department with the concurrence of the department of law shall determine the method of securing repayment which is most appropriate to the particular situation. If there are insufficient assets or resources to justify collection, if the recipient has not obtained assistance or services by intentional misrepresentation or if the overpayment was due to an error on the part of the department, the department may waive a repayment by the recipient. The department, with the assistance of the department of law, may institute appropriate court proceedings to recover overpayments.” State policy defines an overpayment as the payment of funds to a provider on behalf of a client who: Was not eligible for assistance; Did not have an eligible activity/need; Used more assistance than they were eligible for; or Payments were made for days/hours in which the children were not in attendance with the child care provider. Overpayments may be client, provider, or agency caused. |
| California (DE) | California distinguishes between improper payments attributable to errors and improper payments attributable to the intentional provision of inaccurate or incomplete information by program beneficiaries (parents) or child care providers. |
| California (DSS) | According to California’s Code of Regulations (hereinafter referred to as “CCRs”), improper payments are defined as follows: CCR 47-110(o) (1) "Overpayment" means payments for child care services in excess of the amount which either the client or the child care provider is eligible to receive. CCR 47-110(u) (1) "Underpayment" means payments for child care services that are less than the amount which either the client or the child care provider is eligible to receive. For the California Code of Regulations, please go to: http://www.cdss.ca.gov/ord/CDSSManual_240.htm |
| Connecticut | Underpayments occur when the parent does not receive all the benefits to which the family is entitled due to an administrative error made by the department, the Care 4 Kids (C4K) administrator or upon submission of satisfactory documentation of an error made by the Department of Labor or its designee for a family participating in an employment services activity. The evidence must clearly demonstrate that an administrative error occurred. Errors caused by the family or the provider are not be considered underpayments, except when a provider makes a billing error on an invoice and the C4K administrator is notified of the error within thirty days of the date the payment is issued to the provider. Overpayments occur when the amount paid exceeds the benefit that would have been paid if the payment had been calculated correctly based on accurate information that was reported, verified and acted on in a timely manner. Overpayment are classified as administrative, parent or provider caused. Parent and provider caused overpayments are further classified as intentional or unintentional (fraud). The agency makes a “preliminary” determination of whether the error was intentional or unintentional. Errors are considered intentional if the parent or provider knowingly withheld or provided false information on matters affecting eligibility, benefits or services provided. Only a court of law or an administrative hearing official can determine if fraud occurred. No overpayment exists if the difference between the benefits paid on behalf of the family and the correct benefit amount is less than ten dollars in any month. |
| District of Columbia | Improper payments are generally defined as overpayments or underpayments to providers on behalf of children and families. An overpayment is payment made to a provider for services that were not performed or for services when correct eligibility has not been established. Underpayments to providers occur when correct eligibility has been established and payment is not made during the regular payment cycle. Improper payments may also be payments made at the incorrect rate. Note: Information from the D.C. CCDF Plan FY 2006-2007. |
| Georgia | “A client overpayment occurs when a client fails to report accurate information during the application process; when a client fails to report changes that affect eligibility in a timely manner; and/or when the agency miscalculates benefits. Overpayments to providers occur when a provider receives payments for care not received, when a provider receives payment for times care is not authorized, when a provider receives payments for care when the provider did not meet CAPS requirement, etc. Overpayments to providers occur when the agency makes a payment/reimbursement error. Underpayments exist when agency’s portion of the cost of care was not correctly calculated.” |
| Kansas | Kansas defines improper payments in the same manner as federally defined on page 1 of this document. |
| Kentucky | “Improper Payment” means any payment that should not have been made or that was made in an incorrect amount (including overpayment and underpayments) under statutory, contractual, administrative, or other legally applicable requirements; and includes any payment to any ineligible recipient, any payment for an ineligible service, any duplicate payment, payments for services not received, and any payment that does not account for applicable discounts. |
| Maryland | Improper payments are payments that the customer or provider received, but were not entitled to receive. |
| Massachusetts | The Department of Early Education and Care (formerly The Office of Child Care Services under the Executive Office of Health and Human Services) of the Commonwealth of Massachusetts defines improper payments as: Any payment to a child care provider that is incorrect and/or is not authorized under applicable laws, contract terms, policies and/or procedures. This includes any payments to providers for families who are ineligible for subsidized services, payments for care that was not provided, or payments made in error by the purchasing agency. |
| Minnesota | An amount of child care assistance paid to a recipient, or child care provider in excess of or an amount that is different from the payment due even when the improper payment was caused by agency error or circumstances outside the responsibility and control of the family or provider. |
| Mississippi | See attached response |
| Missouri | Improper payments for the child care program are defined as any payments made in error to a child care provider on behalf of families receiving child care assistance. Improper payments are identified as the result of intentional program violations (fraud) or inadvertent errors made by child care providers, families utilizing child care subsidy, and/or the agency responsible for determining eligibility. |
| Montana | An improper payment is a payment requested or made to a parent or provider in error. |
| Nebraska | We do not have a formal definition, but our working definition would be any payment: a. For care not rendered; b. For care for non-allowable purpose; c. For an ineligible child; d. Billed at an incorrect rate; e. That fails to deduct the family's fee. |
| New Hampshire | Improper payments are defined as payments that should not have been made and payments that were made for the incorrect amount under statutory, contractual, administrative, or other legally applicable requirement. |
| North Carolina | An improper payment occurs when a recipient (usually child’s parent) or provider receives subsidy services or a payment for which they were not eligible. This includes administrative errors made by the local purchasing agency (LPA) that result in improper payments to providers. |
| Ohio | Ohio Administrative Code Section 5101:2-16-73 “(A) Child care overpayment is defined as follows: (1) Child care benefits which the recipient received but for which the recipient was not eligible and for which the CDJFS has reimbursed the child care provider. Benefits may include child care services received by the recipient, or the portion of the recipient's monthly child care co-payment paid by the CDJFS but owed by the recipient. The recipient is responsible for repayment of the overpayment to the CDJFS. (2) Child care payments which the provider received from the CDJFS but for which the provider was not entitled. The provider is responsible for repayment of the overpayment to the CDJFS.” |
| Oklahoma | Improper payments are those child care payments which are not correct with respect to the care authorized, age of the child, star status “quality level” of the provider, geographic rate area or payment rate for the care provided. The family must also meet the “need factor” in order to receive proper child care benefits. |
| Utah | • The customer receives a payment for which he/she is not eligible. • The customer receives a payment he/she is eligible for, but in the wrong amount. • The customer should have received a payment, but was denied or closed in error. |
| Washington | Any payment that should not have been made, or any payment made in the incorrect amount (including overpayments and underpayments). |
| West Virginia | Improper payments are defined as payments that should not have been mad, or that were made in an incorrect amount due to worker error in determining and verifying eligibility, and/or calculation and input of information into the Family and Children's Tracking System (FACTS). Incorrect amounts include overpayments, underpayments, and inappropriate denials of payment. |
| Wisconsin | Improper payments is defined in terms of an overpayment. When an underpayment occurs, the local agency is able to make a positive adjustment in order to pay the provider. Overpayment is defined in Wisconsin Administrative rule DWD 56.04 (5): A child care administrative agency or the department shall take all reasonable steps necessary to recover from a parent funds paid to a child care provider or to that parent when the parent was not eligible for that level of child care benefit and the overpayment benefited the parent by causing the parent to pay less for the child care expensed than the parent otherwise would have been required to pay under child care assistance program requirements, regardless of whether overpayment was the result of administrative error, client error, or intentional program violation. Section DWD12.23 shall apply to overpayment collection from a parent under this section. An overpayment shall include excess child care funds paid when there was a change in family eligibility circumstances that was significant enough that it would have resulted in a smaller child care benefit or ineligibility for child care benefit due to any reason, including the following: 1. The parent failed to report a change in circumstances that may affect his or her eligibility within 10 days after the change. 2. The parent was absent from an approved activity without good cause while the child was in the care of the provider. A child care administrative agency shall take all reasonable steps necessary to recoup or recover from a provider any overpayments made for child care services for which the provider was responsible or overpayments caused by administrative error that benefited the provider. A provider shall be responsible for an overpayment if both of the following criteria is satisfied: 1. The overpayment benefited the provider by causing the provider to receive more child are assistance than otherwise would have been paid on the family’s behalf under child care assistance program requirements. 2. The overpayment did not benefit the parent by causing the parent to pay less for child care expenses than the family otherwise would have been required to pay under child care assistance program requirements. |
| Those that did not provide an answer: | |
| Puerto Rico | |
Appendix 2 >>