H11- 009– Procedure

February 16, 2011
TO: / Home and Community Services (HCS) Division Regional Administrators
Area Agency on Aging (AAA) Directors
FROM: / Bill Moss, Director, Home and Community Services Division
SUBJECT: /
Participation Reimbursements
Purpose: / To inform staff of the revised procedure for processing participation reimbursements to clients who have incorrectly overpaid participation.
Background: / The participation reimbursement process is used to reimburse a COPES, MPC, MNRW, MNIW, New Freedom, RCL or Chore client who has incorrectly overpaid participation to their provider. Participation overpayments most commonly occur when the client reports a change in circumstances or finances that decrease the preceding month’s(s’) participation calculation.
The current reimbursement process requires the SW/CM to complete a reimbursement packet and send it to HQ for processing. Recent audit findings indicate that this process is not always followed and instead some workers are incorrectly issuing reimbursements to providers and instructing the providers to reimburse the client.
What’s new, changed, or
Clarified / In order to reduce the time spent on completing the reimbursement packet and to address the audit findings related to non-compliance with the current process, this revised policy transfers the participation reimbursement process to the local level.
The following participation reimbursement codes are now published in Appendix A of the SSPS manual:
Chore / 4299
MPC / 4598
COPES / 5299
MNIW / 5599
MNRW / 5499
New Freedom / 5799 (Unpublished)
RCL / 5899
ACTION: / Effective immediately, to reduce the occurrence of participation overpayments, verify and update any participation amounts at yearly review or when changes are made in payment authorizations. Act immediately when notification from Financial is received regarding a change in participation.
This participation process is not subject to Exceptions to Rule (ETRs).
PROCESSING PARTICIPATION REIMBURSEMENTS
Errors for small amounts of money may be corrected by adjusting or suspending the client’s participation for a limited period of time, generally one or two months. Document these adjustments or suspensions by completing the Participation Reimbursement Form 07-081 (see link, below) and by entering an SER in the client file.
When an error cannot be corrected by adjusting or suspending the client’s participation for a limited period of time, process a participation reimbursement directly to the client or the client’s estate if the client is deceased. Complete the following steps:
  1. Complete Participation Reimbursement Form, 07-081.
  2. Verify the client’s payment of the incorrect participation amount for each month included on the Participation Reimbursement Form. Adequate verification includes:
  3. Copies of the client’s canceled checks (front and back); or
  4. Signed copies of accounting statements from Home Care Agencies or residential providers; or
  5. Signed monthly receipts from the provider; or
  6. An attestation signed by the provider stating that the payment was received from the client and an attestation signed by the client or the client’s representative stating that the client made the payment to the provider.
NOTE: SERs documenting conversations in which the provider or client states that participation was paid are not adequate payment verification.
  1. Submit the Participation Reimbursement Form and the verification that participation was paid to your supervisor for approval and signature;
  2. Supervisory review includes review of applicable ACES letters/narratives and SSPS payment information.
  3. Upon supervisory review and approval, request and obtain a SSPS provider file number for the client, (CL code);
Note: if the client is deceased, the reimbursement must go to the client’s estate. Obtain a provider number for the client’s estate.
  1. Authorize payment to the client(Never authorize payment to the provider):
  1. Enter the SSPS provider file number for the client or client’s estate.
  2. Complete one line for each month in the retroactive reimbursement period.
  3. Use the SSPS participation reimbursement code listed in Appendix A of the SSPS manual for the program the client was on in the month(s) the overpayment occurred.
  4. Generate a one-time payment for each month of reimbursement.
  5. Open and close each line on the first of the month using termination code 1B.
  6. Rate = the amount of the reimbursement for the month you are authorizing
  7. Unit = “Each”
  8. Number of Units = 1
  1. A one-time payment in the amount of the incorrectly paid participation will be generated. The payment warrant will be sent directly to the client.
  2. Send a 14-443 to notify Financial of the date and amount of the reimbursement.
  3. Notify the client or the client’s representative of the following and document in an SER:
  4. The amount of reimbursement that is being sent to the client;
  5. The months for which participation is being reimbursed;
  6. The money is not owed to the provider but is the client’s to keep;
  7. The provider is not entitled to additional payments for the time period covered by the reimbursement;
  8. The payment will not be reported to the Internal Revenue Service as client income nor as provider income.
  9. File the signed Participation Reimbursement Form and the documentation verifying the client’s payment of the incorrect participation in the client’s case file.

Related
REFERENCES: /
ATTACHMENT(S):
CONTACT(S): / Debbie Johnson, HCS Waiver Program Manager
(360) 725-2531

1