2023-036 Department of Early Learning and Care
Improve controls over family copay and child care hour calculations
MANAGEMENT RESPONSE:
We partially agree with this recommendation.
DELC does not concur with the finding regarding a case with the copay amount not reflected in reimbursement between ...
2023-036 Department of Early Learning and Care
Improve controls over family copay and child care hour calculations
MANAGEMENT RESPONSE:
We partially agree with this recommendation.
DELC does not concur with the finding regarding a case with the copay amount not reflected in reimbursement between multiple providers.
DELC sends out billing forms in advance of the month and providers are allowed to bill for anticipated hours of attendance. We do not require that the primary provider bill, nor can we retroactively reduce the secondary providers payment amount by the copay amount if the primary provider does not bill. DELC has the following language in our ruleset (5b) reflected below, which allows the copay to be zero if the provider to whom the copay is designated does not submit a billing for the month.
414-175-0051
Requirement to Make Copay or Satisfactory Arrangements
1) The Need Group must use a child care provider who meets the requirements in OAR 414-175-0080 and 414-175-0085.
2) The caretaker is responsible for paying the copayment to the primary provider of child care unless the Child Care Billing form was sent to the provider showing no copayment.
3) If the caretaker has only one provider during a month, that provider is the primary provider. If the caretaker uses more than one provider, the caretaker must designate one as the primary provider. Notwithstanding any designation by the caretaker, the Department considers a provider having the copayment amount (not to exceed the caretaker's established copayment amount) deducted from its valid billing statement the primary provider for that period.
4) If the copayment exceeds the amount billed by the primary provider, the Department may treat a different provider as the primary provider or split the copayment among the providers who bill for care.
5) The copayment amount due from the caretaker to the provider is the lesser of:
a. The copayment amount determined by the Department based on family size and income.
b. The total amount allowed by the Department on a provider claim.
DELC does not concur with the finding regarding the overpayment for the months of January, February, and March when the parent changed providers. An overpayment referral was made to the Overpayment Writing Unit in the Oregon Department of Human Services when the new provider was set up. The provider in question did submit billing forms for payment for January, February, and March 2024. When the parent called in late March to end the previous provider, she gave the end date of 1/16/23. The provider was allowed to bill for absent days for the rest of January and the full month of February as absent days. The provider was unable to bill for March since it doesn’t not fall within OAR 414-175-0075 and is considered abandonment of care. DPU made an overpayment referral to the Overpayment Writing Unit when the new provider was set up. The provider was written up for an overpayment for March in the amount of $1,395.00.
DELC concurs will all other findings in this area.
DELC agrees with stated recommendations and will take the following corrective action steps:
• The Child Care Assistance Program team will develop a training partially focused on error trends found in this report to educate staff on findings and preventative measures.
• The Child Care Assistance Program team will provide case finding information to OPAR for recoupment purposes.
• DELC will reimburse the federal agency for unallowable costs.
Anticipated Completion Date: December 31, 2024
Contact person: Regina Siefert, Childcare Policy Analyst