Benefits pending appeal

In some cases, families or providers may choose to continue receiving benefits at the same level during the appeal process.

Continuation for families

Do not terminate a family’s child care assistance or take the adverse action, if:

· The family appeals before the effective date of the adverse action, or within 10 days of the date the on the notice, whichever is later

AND

· The family chooses to continue receiving benefits.

If a notice period ends on a Saturday, Sunday or holiday, consider an appeal request made on the next working day to be timely.

If a change not related to the issue under appeal occurs while benefits are continuing, notify the family of any adverse action. Take the action unless it is also appealed timely.

The family continues to receive benefits until the Appeals Division issues a hearing decision, another change occurs which requires an adjustment, or the family requests to stop receiving benefits, whichever occurs first.

Notification of potential overpayment for families

Families receive Appeal rights (DHS-3353) with termination and adverse action notices for actions taken against them. These appeal rights notify the family that child care assistance paid pending an appeal will be an overpayment if the appeal finds that the family was not eligible for the amount of child care assistance paid.

A family may choose not to continue receiving benefits pending appeal, even if they appeal timely.

See Chapter 15.18 (Effect of Appeal Decision) for information on when a family who continued to receive benefits during the appeal process loses the appeal.

Continuation for providers

Payments pending a fair hearing

If a provider is entitled to a fair hearing and the provider appeals an adverse action before the effective date, postpone the action until after the hearing, unless:

· The provider chooses not to receive child care assistance pending appeal.

· The provider is appealing the basis for an overpayment, the amount of an overpayment, and/or the level of recoupment or recovery. Recovery of a provider overpayment, including recoupment for active providers, must continue pending appeal. See Chapters 14.9 (Recovery Methods) and 14.9.9 (Recoupment – Providers).

· The provider’s registration was closed or denied based on a licensing action. When this happens, the provider’s:

· Registration must stay closed, and payments cannot continue for service dates after the registration closes, while an appeal is pending; and

· Child care assistance appeal will happen after a final decision is reached about their license or certification.

· The adverse action entitles the provider to an administrative review or administrative reconsideration. If an agency issues a payment stop in combination or conjunction with an administrative disqualification notice, the provider may request a fair hearing for the disqualification, but the provider cannot receive payments pending appeal (see below).

See Chapter 15.6 (Family and Provider Appeal Rights) for a list of adverse actions that entitle a provider to fair hearing.

NOTE: Child care assistance paid pending an appeal will be an overpayment if the appeal finds that the provider was not eligible for the amount of child care assistance paid.

Payments pending an administrative review or administrative reconsideration

A provider whose payments are immediately suspended or withheld pending an investigation under Minnesota Statutes 142E.17, subdivision 9, paragraph (d), clauses 1 or 2; 142E.51; 245.095, subdivision 5; or 142A.12, subdivision 5 cannot receive payment even if they request an administrative review or administrative reconsideration, whichever is applicable. This includes payments for service dates before the payment stop took effect.

For more information about administrative review and administrative reconsideration processes, see Chapters 12.6.6 (Adverse Action Notices – Provider), 12.6.9 (Termination Notices – Provider), 15.6 (Family and Provider Appeal Rights), and 15.9 (Appeal Requests).

See Chapter 15.18 (Effect of Appeal Decision) for information about on what happens with a provider’s payments after a decision is reached about the provider’s appeal.

Legal authority

Minnesota Statutes 142A.12
Minnesota Statutes 142E.17, subd. 9(d)
Minnesota Statutes 142E.18
Minnesota Statutes 142E.19
Minnesota Statutes 142E.51
Minnesota Statutes 245.095
Minnesota Rules 3400.0230