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______________________________________________________________________ DIVISION OF WELFARE AND SUPPORTIVE SERVICES Child Care Policy Manual The calculation of any subsidy claim requires a comparison of benefits already received by the child care household minus benefits to which the household was retrospectively entitled. The difference is the claim amount. Determine the child care claim amount for each month incorrect benefits may have been paid. Budgeting procedures and policy in effect at the time the claim was incurred must be used in the determination of the claim amount. Note: If a Quality Control claim is identified, staff must expand the claim review to the entire certification period to be able to determine the total amount of the claim. 784 Claim Referral to I&R Following the calculation of a customer error claim, the debt must be referred to DWSS Investigations & Recovery (I&R) Unit via the Investigations and Recovery Information System (IRIS) for pursuit and collection. Use the Child Care Referral form (2154-WC/A) for the claim to be established in the AMPS. Child Care staff shall compile a “claim packet”. The packet must include: 1. Copy or original of all pertinent documents (application, service agreement, picture ID, etc.) contained within the case file; 2. Copy or original of substantiating documentation relative to the claim; 3. A case narrative containing at a minimum how the claim occurred; 4. Documentation of the claim calculation; and 5. A copy of the referral form The packet must be sent to the I&R Unit responsible for their program office as soon as possible for review and establishment. Note: Claims for active providers are not referred to DWSS. Provider claims are pursued by the Child Care Contractor in accordance with their individual contracts with the child care providers. If a provider is not active, and retention of future payment is not possible to recover a debt, then the case must be referred to I&R for collection, as with a customer claim. All supporting evidence of the provider must also be provided in the “claim packet” (see manual section 656 for details). Exception: The Child Care and Development Program Agency Manager or their designee may refer a Provider to DWSS for investigation. Subsequent actions related to the investigation (i.e. prosecution, debt recovery etc.) will be performed by I&R staff. Reimbursement for Contractor and DWSS caused claims will not be pursued from the customers except where the error was the result of: • An action resulting in a benefit which the customer should have reasonably known was an error or mistake; or • The Child Care case manager and customer took action enabling the customer to receive benefits he/she was not entitled to. Contractor and DWSS errors resulting in a claim must be reported quarterly to the Child Care and Development Program Agency Manager. 790 HEARINGS 700- Program Violations, Overpayments, Hearings [14] MTL 01/24 July 1, 2024