May 15, 2012

CalFresh_Color_Eng.jpg Program Guide Letter #572

 

Subject

UPDATES AND REVISIONS TO THE CLAIMS AND ADJUSTMENTS CHAPTER 63-450

 

Reference

Manual of Policies and Procedures (MPP) 63-801, 63-802 and 20-300; All County Letters No. 12-06 and 11-26 and various All County Information Notices.

 

Effective Date

Upon receipt.

 

Purpose

The purpose of this letter is to inform staff of the revisions and updates to the Claims and Adjustments Chapter 63-450 and to implement procedures relating to Intentional Program Violations (IPVs) as specified in the settlement for the Lopez v. Wagner lawsuit.

 

Summary of Changes

The following sections of the CalFresh Claims and Adjustments chapter 63-450 have been updated and/or revised:

Section

Updates/Revisions

63-451

·     Changed section title from “Claim Determination Requirements” to “Establishment of CalFresh Claims.”

·     Added the following information:

o  Clarification and examples related to overissuance evaluations when a change, which is reported timely by the household, cannot be implemented because of the ten-day notice requirement.

o  CalFresh claim repayments cannot be demanded from the SSI/SSP grant.

o  Definition of “Establishment of a Claim.”

o  Clarified timeframes for establishing a claim; three years to establish and six years to calculate.  Added example.

o  Establishment of claims against categorically eligible households.

o  Noncitizen household’s claims and sponsor responsibilities.

o  Type of claims that can be compromised pursuant to the Lomeli v. Saenz court settlement agreement.

63-452

·     Deleted Benefit Recovery (Recoupment of Claims) information from this section.  Recoupment of non-fraud and fraud claims are now included in section 63-454.

·     Added the following information:

o  The twenty (20) percent earned income deduction shall not apply to the portion the household failed to report.

o  Lost benefits cannot be offset against administrative error claims.

o  Determination of categorically eligible household claims.

o  Determination of overissuances in CalWIN.

o  Non-System Determined Claims (NSDC).

63-453

·     Deleted Benefit Recovery (Recoupment of Claims) information from this section.  Recoupment of non-fraud and fraud claims are now included in section 63-454.

·      Updated the following information:

o  The worker is now responsible for computing all Inadvertent Household Error (IHE) overissuances.

o  IHE claims referrals guidelines to the Overpayment Specialist (OSU) unit or Public Assistance Fraud Division (PAFD) according to current business process.

o  IPV Disqualification Procedures and Timeframes according to current business process.

·     Added:

o  Definition of Administrative Disqualification Hearing (ADH).

o  Lopez v. Wagner requirements according to ACL 12-06.

63-454

·     Added the following information:

o  Recoupment notice and budget requirements according to Heathcock v. Allenby lawsuit (ACL 11-26).

o  Explanation of the choices CalFresh households have to repay overissuances.

o  Quarterly Reporting Recoupment regulations.

o  Recoupment of claims from separate household information.

o  Benefit offset exception due to Lopez v. Glickman court order.

o  Recoupment procedures for noncitizen households with sponsors.

·     Updated the following procedures:

o  Claims recoupment of non-fraud and fraud claims; sending overissuance notice and repayment agreement, and worker action after receiving the agreement.

o  Collection of closed cases claims.

o  Reopened cases with outstanding claim balances.

63-455

·     Changed section title from “Revised Rescinded Claim Determination” to “Management of Claims.”

·     Added recoupment of inter-county and interstate claims.

·     Added the following information pertaining to the Office of Revenue and Recovery (ORR):

o  Criteria for recouping claims after a case is discontinued.

o  Suspending Recoupment of Claims;

o  Action against individuals failing to respond to collection letters;

o  Determining delinquency of Claims.

63-456

Changed the section structure and expanded disputed benefits information.

63-457

The Overpayment Specialist Unit Procedures section has been deleted.

 Changes are noted with highlighted text.

 

ACCESS Call Center Impact

When there is an overissuance or underissuance due to a change in a quarterly report, the ACCESS agent will follow up the necessary steps to complete the overissuance/underissuance process. Internal protocols will be issue to make sure agents are following all necessary steps and send a communication to the FRC if needed.

 

Automation Impact

In order to track and identify the IPV disqualified individuals ending disqualification period, the Human Service Specialist shall follow the instructions for registering an IPV as shown in link below:

http://10.176.128.93/Process_Sanction_POI_Penalty.htm

NOTE: For an IPV a beginning and end date must be entered on the “Collect Sanction/POI/Penalty Detail” window> “Sanction Begin Date and End Date” fields.

Family Resource Center staff need to ensure that all claims are created with the appropriate:

·         Liable Individuals

·         Claim Type

·         Claim Reason

·         Claim Period

·         Claim Balance

·         Notices of Actions / Repayment Agreements &  / or Demand Letters.

 

Forms (Client Correspondence Impact)

NOTICE OF ADMINISTRATIVE DISQUALIFICATION (DFA 377.7A) has been updated in CalWIN to provide additional information on how a disqualified household member may resume his or her benefits upon expiration of the IPV disqualification penalty.

In addition, a new form REQUEST FOR RESTORATION OF CALFRESH AFTER ADMINISTRATIVE DISQUALIFICATION (DFA 377.7A1) is attached to the DFA 377.7A in CalWIN.  This form is for the disqualified household member to request restoration of benefits following an IPV.

Human Service Specialists need to ensure that all related Client Correspondence:

·         Is reviewed for accuracy

·         Has correct reason populated on the NOA

·         Has manual variables completed

·         Is mailed timely to the assigned Liable Individual

·         Is mailed prior to CalWIN initiating recoupment activity

·         Is mailed prior to sending referral to ORR on closed/ discontinued programs.

The 09-95 HHSA form could be accessed from Section 63-650, County Forms.  FRC’s can order print stock from the XEROX Print Center in the usual manner.

 

Management Reports Impact

Strategic Planning and Operational Support (SPOS) is creating a monthly report that identifies the disqualified individuals ending the disqualification period. 

 

Other Programs Impact

CalWORKs

CalWORKs Program issuing CalWORKs Program Guide Letter No. 266 to inform staff of the updates to the Overpayments and Underpayments chapters.

Medi-Cal

No impact.

 

Quality Assurance (QA) Impact

Quality Assurance (QA) shall cite the appropriate error when instructions in Chapter 63-450 are not followed or are followed incorrectly.

 

Manager Approval

 

SYLVIA MELENA, Assistant Deputy Director

Self-Sufficiency Programs

Strategic Planning & Operational Support

 

OA