Family appeals

When a family chooses not to receive child care assistance pending an appeal and then wins the appeal, reinstate the family’s eligibility back to the date of termination. Payment to an eligible provider for child care expenses incurred pending the appeal can be made retroactively. However, see Chapter 9.1 (Child Care Authorizations) for information about the earliest date care can be paid if a provider provided care without receiving a Service Authorization and billing form.

When a family who continues to receive benefits during the appeal process loses an appeal, send a 15-day notice of termination or reduction in benefits to the family and the child care provider. Send the notice as soon as possible after the appeal decision has been received to lessen any family overpayment. Note: Due to MEC2 functionality, eligible results may continue to generate when the family is actually ineligible. Contact your Policy Specialist if assistance is needed to close the case.

If the appeal decision finds the family to be ineligible or that the family received more child care assistance benefits than they were eligible to receive, calculate the amount(s) that were determined overpaid and assess an overpayment. See Chapter 14.6 (Amount of Overpayment) to determine when to assess an overpayment.

Provider appeals

Fair hearings

Human Services Judge reverses an action following a fair hearing, and the provider chose to continue receiving payments pending appeal

If a provider chose to continue receiving benefits pending appeal, and it wins its appeal, no further action is needed. See Chapter 15.15 (Continuation of Benefits) for information about when a provider could choose to continue receiving payments pending appeal.

For example, no action is needed if:

· A provider’s registration was set to close due to failure to complete the registration process.

· The provider appealed timely and chose to keep its registration open continue receiving payments pending appeal;

AND

· A Human Services Judge reverses the agency’s action to close the registration following a fair hearing.

Human Services Judge reverses an action or reduces an overpayment that already taken effect

If a Human Services Judge reverses or reduces an overpayment that has been partially or fully collected:

· Follow procedures in the MEC² User Manual – Appeals for Claims Recoupment.

· Refund the provider. Contact your Policy Specialist if you need assistance.

NOTE: Recovery and recoupment of an overpayment must continue pending appeal. A provider cannot request that recoupment stop pending appeal, even if the provider appeals timely. See Chapter 15.15 (Continuation of Benefits).

If a Human Services Judge reverses an action to disqualify a provider or close or deny a provider’s registration, and the provider’s registration is closed, the provider must complete a new registration to receive CCAP again.

Assuming all registration requirements are met, the new registration may be retroactive. Depending on the provider’s specific circumstances, registration may not go back to the original closure date. See Chapter 11.12 (Provider Registration).

To determine whether to make payments for retroactive service dates while the appeal was pending, standard eligibility, authorization, and payment policies for families apply. See:

· Chapter 4.18 (Date of Eligibility) for retroactive eligibility limits.

· Chapter 9.1 (Child Care Authorization) for information about the earliest date care can be paid if a provider provided care without receiving a Service Authorization and billing form.

· Chapter 9.3 (Payments to Providers) for information about billing timelines.

Human Services Judge affirms an action, and the provider is not continuing to receive benefits pending appeal

Typically, no action is needed if provider loses its appeal, and the provider was not continuing to receive benefits pending appeal.

Human Services Judge affirms an action, and the provider chose to continue receiving payments pending appeal

If a provider chose to continue receiving benefits pending appeal, and loses its appeal:

· Use the CCAP Providers Communications Form on SIR and select “Other concern or inquiry” from the drop down to notify the DCYF CCAP Provider Support Team immediately. DCYF will close the provider’s registration after the appeal decision is received to reduce any possible overpayment;

AND

· Calculate and assess any overpayment(s) for periods of time when the provider was ineligible or overpaid. See Chapter 14.6 (Amount of Overpayment).

See Chapter 15.15 (Continuation of Benefits) for information about when a provider could choose to continue receiving payments pending appeal.

Administrative reviews and payment stops

An administrative review is a process that allows a provider whose child care assistance payments are temporarily suspended to submit written proof and argument for consideration by the Minnesota Department of Human Services (DHS) or DCYF. See Chapter 15.6 (Family and Provider Appeal Rights).

If DHS or DCYF determines during the administrative review process that there is insufficient evidence to continue an action and that a payment stop can be lifted:

· Payments may be made for services provided before the payment stop took effect, if the provider bills timely and accurately.

· The provider must complete a new registration to receive CCAP again. See Chapter 11.12 (Provider Registration). Registration does not guarantee a child’s authorization or payment.

Assuming all other registration requirements are met, the new registration may go back to the later of:

· The date the registration closed previously

OR

· The date set in a legally binding settlement agreement.

For service dates after the new registration opens, standard eligibility, authorization, and payment policies for families apply. For example, see:

· Chapter 4.18 (Date of Eligibility) for retroactive eligibility limits.

· Chapter 9.1 (Authorizing Child Care) for information about the earliest date care can be paid if a provider provided care without receiving a Service Authorization and billing form.

· Chapter 9.3 (Payments to Providers) for information about billing timelines.

If a provider is subject to a payment stop and has a disqualification for wrongfully obtaining assistance, an administrative disqualification, or a termination, then the Child Care Assistance Program retains any payments suspended or held during a fraud investigation. See Chapter 13.9.3 (Administrative Disqualification-Provider).

Legal authority

Minnesota Statutes 142A.12
Minnesota Statutes 142A.20
Minnesota Statutes 142E.01, subd. 24
Minnesota Statutes 142E.16, subd. 1
Minnesota Statutes 142E.17, subd. 9
Minnesota Statutes 142E.18
Minnesota Statutes 142E.19
Minnesota Statutes 245.095
Minnesota Rules 3400.0120, subp. 1
Minnesota Rules 3400.0187
Minnesota Rules 3400.0230