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Payments

NOTICE:   ITEMS SHADED IN BLUE ARE A RESULT OF THE COLLECTIVE BARGAINING AGREEMENT (CBA) WITH STATE AND THE UNION REPRESENTING THE FAMILY HOME AND IN-HOME/RELATIVE PROVIDERS EFFECTIVE 7/1/07.

L.  PAYMENT REDUCTIONS AND TERMINATIONS

Revised:  July 1, 2007

In this section:

  1. Terminations and Denials

  2. When Advance and Adequate Notice of Payment Changes is Required

  3. When Advance and Adequate Notice of Payment Changes is not Required.

A. Terminations and Denials

Effective May 28, 2004

WAC 170-290-0110 What circumstances might affect my eligibility for WCCC benefits and when might I be eligible again?

  1. We stop your eligibility for WCCC benefits when you do not:

    1. Pay copayment fees assessed by us and you do not make mutually acceptable arrangements with your child care provider to pay the copayment;

    2. Complete the requested reapplication before the deadline noted in WAC 170-290-0105 (2) (a);

    3. Meet other WCCC eligibility requirements; or

    4. Cooperate with the quality assurance review process or with the division of fraud investigations.

  2. You might be eligible for WCCC again when you meet all WCCC eligibility requirements, and:

    1. Back copayment fees are paid,

    2. You make mutually acceptable payment arrangements with your child care provider; or

    3. You cooperate with the quality assurance review process or with the division of fraud investigations.

Note: This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

Effective May 28, 2004

WAC 170-290-0107 When do I receive a denial letter?

We send you a denial letter when you have applied for child care and you:

  1. Withdraw your request;

  2. Are not eligible due to your;

    1. Family composition;

    2. Income; or

    3. Activity.

  3. Did not provide information necessary to determine your eligibility according to WAC 170-290-0012.

Note: This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

Effective May 28, 2004

WAC 170-290-0108 What happens if I meet eligibility requirements after I receive a denial letter?

If you turn in information or otherwise meet eligibility requirements after we send you a denial letter, we determine your benefit begin date by:

  1. WAC 170-290-0095 if you are TANF; or

  2. WAC 170-290-0100 if you are non-TANF.

Note: This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

B. When Advance and Adequate Notice of Payment Changes is Required

Effective May 28, 2004

WAC 170-290-0115  When does the WCCC program provide me with advance and adequate notice of payment changes?

  1. The WCCC program provides you with advance and adequate notice for changes in payment when the change results in a suspension, reduction, termination, or forces a change in child care arrangements, except as noted in WAC 170-290-0120.

  2. "Advance and adequate notice," means a written notice of a WCCC reduction, suspension, or termination that is mailed at least ten days before the date of the intended action which includes the Washington Administrative Code (WAC) supporting the action, and your right to request a fair hearing.

Note: This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

clarifying information

  1. We consider payments to be overpayments if they are made after the consumer's change in circumstances and during the advance notice period if the consumer is not eligible. See Overpayments.

  2. Notice to the consumer may be required when a reduction in payment is due to:

    1. The consumer requesting the change,

    2. Household changes and there is a someone else available to provide care, or

    3. Activity schedules of either the adult or child changing and fewer child care hours are needed.

  3. Family Home and In-Home/Relative providers must receive the DEL 5-15-247B WCCC Termination Notice to Provider when you send consumers the 15-247 10-day Termination Notice. The consumer 10-day notice is required if the consumer is no longer eligible for WCCC or if specific children are no longer eligible (per WAC 170-290-0015 or 170-290-0020(2)). If the child is still eligible for care but does not need care due to the consumer's schedule, a notice is not required. The WCAP will also send the 5-15-247 to Centers.

    (Refer to WAC 170-290-0120 for when notice is not required)

  4. The Social Services Notice does not replace the DEL 5-15-247B notice. The provider receives advance notice via the Social Services Notice when service lines on the SSPS authorization are closed, terminated, or changed immediately following the change.

  5. When the DEL 14-430 WCCC Child Care Reapplication is sent to the consumer the WCAP generates the DEL 14-430A Child Care End Date Reminder for the provider. This gives a courtesy advance notice to the provider.

worker responsibilities

  1. Send a 10-day termination notice when care is terminating before the set end date and:

    1. The consumer is not eligible for WCCC benefits OR

    2. Specific children are no longer eligible for WCCC benefits per WAC 170-290-0015 or 170-290-0020(2).

NOTE:

It is not a new requirement to provide a 10-day termination notice to a consumer for specific children no longer eligible for WCCC. Offices handled these terminations differently. Family Home and In-Home/Relative providers must receive the DEL 5-15-247B notice every time the required 10-day termination notice to consumers is sent. Sending the DEL 15-247 for all required 10-day termination notice situations and having WCAP auto-generate the new DEL 5-15-247B WCCC Termination Notice to Providers standardizes and automates this process as much as possible.

  1. When terminating or reducing WCCC benefits:Notify the consumer at least ten days in advance per WAC 170-290-0115. Use the DEL 15-247 WCCC Termination Notice (for terminations) or the DEL 15-001 WCCC Notice of Change (for reductions). Include the appropriate WAC reference for the action if it is not already on the form.

    1. Inform the consumer about other child care subsidy programs if necessary.

    2. Give the child care provider advance notice of reductions whenever possible. Although it is not required, advanced notice fosters good working relationships with the provider.

  2. The WCAP automatically sends the provider the DEL 5-15-247B when you send the 15-247. Choose the appropriate option in WCAP, either:

    1. Terminate Case or

    2. Terminate Specific Children and choose the:

      1. Children from the list provided in the WCAP.

      2. "Other" box and explain which children are terminating and why (include the WAC reference).

  1. Using correct dates per policy, close/terminate/change the SSPS authorization lines of service the same day the consumer is notified of the action. This action sends a Social Services Notice to the provider and alerts them to the termination or change in services. Do not reduce or terminate authorizations with a past effective date.

  2. Document your actions in the WCCC case notes and close the WCAP case if appropriate.

Example 1

On 6/8, a provider reports her last day of service to a consumer was 5/31. The AW is unable to verify the consumer's need for ongoing care. WCAP will ask you if this is a "Terminate Case" or "Terminate Specific Children" situation. This is a "Terminate Case". Send the consumer DEL 15-247 with an end date no earlier than 6/18 to allow for advance and adequate notice. WCAP will auto-generate the DEL 5-15-247B to the provider. Terminate all lines on the authorization with an end date from the termination notice. Remind the provider they should bill zero for June since they reported care was last used 5/31.

EXAMPLE 2

On 7/15 the worker discovers and verifies a consumer last worked on 5/25. Applying the advance and adequate notice rule, a termination letter is sent to the consumer with an effective date no earlier than 7/25. WCAP will ask you if this is a "Terminate Case" or "Terminate Specific Children" situation. This is a "Terminate Case". Terminate all lines on the authorization effective the date from the termination notice. Set a 'tickle' in WCAP or Track-It for August to check the billing. Follow the overpayment procedure to determine if an overpayment occurred between 5/26 and the date from the termination notice.

In this example, the July invoice has not been sent. Do not terminate care effective before July 25th to stop the payment.


EXAMPLE 3

On August 3 you receive information that Mary's child Billy is no longer in her home. Mary's WCCC eligibility continues for her 2 other children. WCCC child care benefits for Billy are terminating earlier than his original end date. Send a 10-day termination notice to the consumer. WCAP will ask you if this is a "Terminate Case" or "Terminate Specific Children" situation. This is a "Terminate Specific Children". Choose Billy from the list of children. Make sure the termination date is at least 10 days in the future.

Describe in the "other" box that Billy is terminating and the reason, including the WAC reference. WCAP will auto-generate the DEL 5-15-247B to all providers authorized to care for Billy.

C. When Advance and Adequate Notice of Payment Changes is not Required.

Effective May 28, 2004

WAC 170-290-0120  When doesn't advance and adequate notice of payment changes apply to me?

We do not give you advance and adequate notice in the following circumstances:

  1. You tell us you no longer want WCCC;

  2. Your whereabouts are unknown to us;

  3. You are receiving duplicate child care benefits;

  4. Your current eligibility period is scheduled to end;

  5. Your new eligibility period results in a change in child care benefits;

  6. The location where child care occurs does not meet requirements under WAC 170-290-0130(2); or

  7. We determine your in-home/relative provider:

    1. Is not of suitable character and competence;

    2. May cause a risk of harm to your children based on the provider's physical or mental health; or

    3. Has been convicted of, or has charges pending for crimes posted on the DSHS secretary’s list of permanently disqualifying convictions for ESA. You can find the complete list at  http://www1.dshs.wa.gov/esa/dccel.

Note: This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

clarifying information

Advance and adequate notice for terminations or reductions in benefits is not required when:

  1. The department receives a written or verbal statement from the consumer asking for termination or reduction of benefits. If it is a verbal statement, inform the consumer of the change effective date and their right to waive the 10-day notice (the effective date cannot be prior to the date the consumer is told of the effective date). Document verbal notification well in the case notes. Confirm with the provider the consumer's last day of care or reduction in payments when the consumer is requesting termination or a reduction.

  2. Department mail to the consumer has been returned by the Post Office indicating no known forwarding address;

  3. The consumer is receiving child care assistance in another catchment area or another state.

Worker Responsibilities

  1. Do not send a DEL 15-247 when the notice is not required or is waived by the consumer. Sending the DEL 15-247 generates the DEL 5-15-247B to providers which is only used for required 10-day notice situations. Terminate care as appropriate. In some situations the provider may have provided care up to the date you become aware of the termination. Contact the provider and allow for enough days on the authorization for the provider to bill if the consumer used care.

  2. Do not use termination effective dates that are earlier than the date the change or termination is made.

  3. Document the situation and close the WCAP case if appropriate.

EXAMPLE 1

Alex calls on 8/25 to report his school-age children will change from full to part-time care on 9/1. You tell Alex you can reduce the authorization effective 9/1 but making that change does not allow 10-day advance notice. Alex understands but is OK with allowing the change effective 9/1. Document the changes and Alex's agreement to waive the DEL 15-001 10-day WCCC Notice of Change in the case notes.

(Best Practice: Full-Day authorizations for summer can be open until 8/31 reducing these situations.)

EXAMPLE 2

The department receives written notice on 8/15 from Angela that her husband's work hours have changed as of 7/31. They state they no longer need care for their school-age child. You verify through the provider that the last day of care was on 7/31 and make appropriate changes to the authorization with effective dates no earlier than 8/15. Document the request for change and do not send the 15-001. Remind the provider to not bill for August if the child does not attend in August.

  1. At reapplication, the consumer receives the DEL14-430 Reapplication Letter which serves as notice of benefits ending on a specific date. There is no need to send a 10-day termination notice per WAC 170-290-0120 (4) above.

EXAMPLE

A consumer is authorized for care from 1/1-5/31. The consumer became ineligible on 4/25 but the AW discovers it on 5/22. There are not enough days between 5/22 and 5/31(the scheduled eligibility end date) to give 10-day advance notice. No termination notice is required as the consumer's eligibility will naturally end before the 10 days expire. Terminate the authorization effective 5/31.

For a more complete description of advance and adequate notice, refer to EA-Z Manual (Letters, and Change of Circumstances).
 

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