Presentation on theme: "EEC FINANCIAL ASSISTANCE REGULATIONS AND POLICIES"— Presentation transcript:
1EEC FINANCIAL ASSISTANCE REGULATIONS AND POLICIES January 2011
2EEC Financial Assistance Program Governance EEC’s Financial Assistance Program is governed by federal and state laws and policies:The Child Care and Development Block Grant Act (42 USC 9858), as amended, and section 418 of the Social Security Act (42 USC 618), as amendedFederal Regulations CFR Parts 98 and 99Federal Policies, Program Instructions and Other Guidance:(http://www.acf.hhs.gov/programs/ccb/law/index.htm#guidance)EEC Subsidy Regulations CMR et alEEC Policies -- EEC Financial Assistance GuideAdd the reasons we edited the Subsidy Regulations in November 2006 (to go to one year reassessments and ____)
3EEC Financial Assistance Regulations and Polices EEC Subsidy Regulations last updated in November 2006Policy Guide developed and released in July 2007“Question and Answer” document added to the Guide in 2008,Several updates issued through EEC Management Bulletins (EMBs) and messages from the Commissioner reflecting new or edited policies and instruction for providers to “reprint” selected chapters.Access limitations to Income Eligible financial assistance (November 3, 2008), Access opening last fiscal year have resulted in a number of other EMBs and memos to clarify and revise policies.Add the reasons we edited the Subsidy Regulations in November 2006 (to go to one year reassessments and ____)
4Table of Contents: EEC Regulation Table of Contents: EEC Policy Guide Financial Assistance – Table of Contents for both EEC Regulations and Policy GuideTable of Contents: EEC RegulationTable of Contents: EEC Policy Guide10.01: IntroductionChapter 1: Eligibility10.02: Definitions10.03: General ProvisionsChapter 2: The EEC Centralized Waiting List for Financial Assistance10.04: Income Eligible Child Care Subsidy10.05: Employment Services ProgramChapter 3: Documentation of Eligibility10.06: Supportive Child Care10.07: Teen Parent Child Care ServicesChapter 4: Service Need10.08: Trial Court Child Care10.09: Child Care for Special PopulationsChapter 5: Parent Co-Payments10.10: CaregiversChapter 6: Reassessment10.11: Reimbursement10.12: Termination and Reduction of ServicesChapter 7: Terminations and Reductions10.13: Review Process10.14: ApplicabilityChapter 8: EEC Financial Assistance Complaint and Investigation ProcessWe are Updating existing language to comply with licensing regulation changesAlign current full time care definition with the current part time care definition language.Full Time Care. Care for not less than 30 nor more than 50 hours per week during the hours when the parent(s)' service need activity occurs, unless otherwise approved by EEC.Full time Service Need. Service need of 30 hours or more per week.Part Time Child Care. Care up to 30 hours per week.Part Time Service Need. Service need between 20 and up to 30 hours per week.“Protective services” is discussed later in presentation under the discussion of special needs of child– we are ali
5EEC Financial Assistance Regulations and Policies DRAFT 9/17/08EEC Financial Assistance Regulations and PoliciesMany factors contribute to the need to update the Guide and Amend the Regulations including:Improper Authorizations for Payment (IAP) exercise resultsResponse from ACF regarding our State PlanUnique challenges/ weaknesses identified due to recent fiscal constraints/ system restructuring(e.g., ongoing closure of, or limited access to, EEC financial assistance and CPC transition)Capability to monitor programs’ determination of financial assistance eligibility (fraud/waste/abuse)Recent GAO Report Identified Fraud, Waste and Abuse findings in Head Start programsCommunicationEECDTADCFWaitlistRequest for review processRecoupmentsClarify Required DocumentationChild support, residency (second parent in household, employment verification and special need forms1. Communication:EEC – Bulletin board: CCRR staff need more timely responses when seeking policy clarifications to avoid delays in subsidies for clients.Suggested Action:-Identify appropriate EEC staff to work with CCRR staff around policy questions.-Define the expected turn around time for answers so that we can give them a time period of when they can expect us to get back to them.DTA & DCF: CCRR’n need alternate lines of communication for workers in the field to help with clarifying questions on referrals (ie: s on DTA child care referrals)Commissioners to work on the notification process from DTA to CCRR when cases are closed (ie: DTA is unaware of recoupment for clients with closed cases who don’t notify us).2. Waitlist – e-CCIMS FunctionWhen running renewal and confirmation letters the system pulls individual letters by child, not family – requires sorting mail – too much paper etc.We need an “activity history” for families to identify who sent letters – many calls come to the CCRR when we have not sent the available funding letter. (this has been discussed at PUG meetings).Suggested Actions:-Fix e-CCIMS to run renewal and confirmations by family. Available funding letters needs to have an option to run letter by family or child.-Allow for running list of who has made changes on the waitlist so when families call we can identify who has tried to contact them.-Eliminate confirmation letters. Eliminate renewal letters while the waitlist is closed for vouchers.5
6DRAFT 9/17/08User FeedbackAs EEC providers, CCR&Rs and internal staff have used the Guide, issues have been identified, including:Ability to update and communicate changed or new policiesStructure of and clarity of policy informationDocumentation of eligibility requirementsOutdated, confusing policiesExisting policies outside of the Guide (recently added as “appendices”)Missing policiesEase of finding needed informationCCR&R and Provider FeedbackConfirms need to improve Financial Assistance Polices, including the Request for Review process, Recoupment procedure, and Documentation requirementsRaises other concerns regarding improving Communication (w/ EEC, DTA and DCF staff)6
7Status of policy updates requested DRAFT 9/17/08Status of policy updates requestedQuick Fixes – Policies UpdatedLong Term Fixes – Regulation Changes or Data Exchanges NeededBreak in service need of parentEligibility self reporting “significant changes” in income (20% rule)Travel time for calculation of service needWaitlist management enhancementsRedraft Provider voucher manual and agreement (Jan roll out)Identity/ legal immigration status documentationCodified Variance ProcessSpecial Need Forms (Child/Parent)Self Employment VerificationSpecial Need Access RegulationsStreamline Review ProcessChild Support RequirementSecond parent in HouseholdClarify Recoupment ProcessRedraft Financial Assistance agreement/ termination noticesExcessive Absences of ChildrenSchedule of CareInterfaces with other agencies: RMV, DOR (wage matches) or other agency systemsClarify Required Documentation Needed to Establish Financial Assistance EligibilitySpecial Needs Verification FormsResidency (i.e., second parent out of household)Employment Verification FormSelf Employment DocumentationExcessive Absences - why change?:Current Rule allows for up 10 absences every monthData from both Contracts & Vouchers indicates EEC is paying between $35-40M/yr for absences – some families are “regularly absent” for 5-10 days per month;Evidence related to attendance in pre-k and achievement gapSuggested changes – allow for an average of 5 absences per month; enforce over a specified timeframe (i.e., 30 every 6 months; 60 every 12 months); eliminate current practice of “regularly scheduling absences (i.e., out every Friday, but given FT slot); eliminate “types” of absences – no more explained vs. unexplained; only allow providers to “bill” EEC for the maximum amount of absences.Travel Time ClarificationTravel time is not an EEC approved activity to establish a service need; can 5 hours of travel time be counted to establish threshold minimum service need requirementsBreak in Service-- We implemented approved break in service– 90 days for sick families, traveling/ custody issues, seasonal employment,Key= Policy issue reviewed and updated= Policy issue reviewed and requires regulation change to update7
8Highlights of Proposed Regulation Changes While many of the issues identified to date have been addressed by revising the Policy Manual, and improving the process for updating policies, some revisions are necessary to EEC’s Financial Assistance regulations, including:Redefine Special needs of parent/ childReduce Allowable AbsencesStreamline Review Process and recoupment processRedefine Self EmploymentAllow for eligibility verifications through inter-agency data matchesWhile many of the identified issues have been addressed by revising the Policy Manual, and improving the process for updating policies, some revisions are necessary to EEC’s Finacial Assistance regulations.Redefine Special needs of parent/ childwhy? comply with CCDF regulations/ ACF comments; address access equity issueReduce Allowable Absenceswhy? Accountability (waste/ abuse); target limited resources; research-based good for kidsRedefine Self Employmentwhy? Reduce cumbersome eligibility process for both parents and providers/ CCR&Rs; accountability; target limited resourcesStreamline Review Process and recoupment processwhy? Streamline and improve administrative functions; accountabilityAllow for eligibility verifications through inter-agency data matcheswhy? Streamline and improve administrative functions; accountability; reduce cumbersome documentation requirements for both parents and providers
9Summary of Proposed Changes to Subsidy Regulations Redline version of the regs will be provided to Board Members. Many of the redline changes that you’ll see will just be tightening up existing language, reorganizing sections or codifying/ clarifying existing practice.This Powerpoint is intended to highlight some of the more contentious/ challenging issues.
10Child Care Educator/Provider Contracted Child Care Educator/Provider 10.02: Definitions: The addition of new or revised definitions are needed to aid in the interpretation of the regulations.Child Care Educator/ProviderContracted Child Care Educator/ProviderExcessive AbsenceExplained AbsenceFull Time CareProtective ServicesWe are Updating existing language to comply with licensing regulation changesAlign current full time care definition with the current part time care definition language.Full Time Care. Care for not less than 30 nor more than 50 hours per week during the hours when the parent(s)' service need activity occurs, unless otherwise approved by EEC.Full time Service Need. Service need of 30 hours or more per week.Part Time Child Care. Care up to 30 hours per week.Part Time Service Need. Service need between 20 and up to 30 hours per week.“Protective services” is discussed later in presentation under the discussion of special needs of child– we are ali
1110.03(1): General Provisions, Eligibility Family Size and Household Composition (codifies existing practice)Clarifies verification of household members is necessary for purposes of determining eligibility and establishing parent fees.Identity, Residency & Citizenship Status (codifies existing practice)Requires verification of applicant’s identity and residency, as well as the citizenship or immigration status of each child seeking child care financial assistance.Child Support Enforcement Requirement (new)Requires single parent applicants to submit evidence of child support and/or cooperation with the Commonwealth’s Child Support Enforcement agency, as a condition of eligibility.Child Attendance/ Reimbursment Requirements (amends current requirements)Requires children to regularly attend early education and care programs subsidized by the Commonwealth or risk terminationData Sharing - to streamline, enhance and create efficiencies in the application process and to assist EEC’s efforts to institute front end detection to combat fraud, waste and abuse in child care, the Department is seeking to establish legal authority to establish interfaces with other government agencies and/or the right to conduct data matches with other government agencies to ensure consistency related to income and household composition – specifically, EEC anticipates seeking cooperative arrangements with the RMV, MassHealth, DTA and any other agencies, as deemed necessary. Current practice allows data matches/sharing, but through contract law – language on vouchers and EEC applications.
12Identity, Residency & Citizenship Status EEC seeks to formally codify the Citizenship and Immigration Status policy issued in April 2010, in order to:Address the deficiency in EEC’s regulations and policies identified by ACF the Federal Improper Authorization for Payment reviewMassachusetts, along with all other Year 2 States, were given a one time exemption to implement this requirementAchieve consistency between regulations and policies and to ensure efficient and uniform outcomes for familiesCitizenship and/or Immigration Status – During EEC’s Federal Improper Authorization for Payment review, ACF cited the Department for failing to verify the citizenship and/or immigration status of the children receiving EEC subsidies. However, EEC and all other Year 2 States, were given an exemption related to this requirement based on conflicting and/or confusing federal guidance/policy in this area. This exemption was contingent on ACF’s understanding that EEC would be working towards developing and implementing a citizenship verification process by the next IAP cycle, which will occur inNote: To address the IAP findings, EEC issued a Citizenship policy on April 2, 2010 and now seeks to formally codify this requirement in the regulations.
13Child Support Enforcement Requirement EEC proposes a requirement to mandate “cooperation” with the MA Child Support Enforcement (CSE) agency OR other proof of child support as a condition for child care assistance for single parent familiesAt least 20 States currently impose a CSE requirementBenefits of instituting a Child Support Enforcement policy:Keep families out of povertyProvide adequate food, shelter and clothingIncreased access to medical services & sense of securityAdd to the overall stability, security and well-being of families and childrenIntended to lessen the existing burdens of second parent in the household documentationKey issues to consider during implementation of policy:How many families seeking assistance are currently enrolled – avoid duplicationIdentify exceptions (i.e., domestic violence or child protection)Required documentationMonitoring and evaluation of effectivenessChild Support –to streamline, enhance and create efficiencies related to EEC’s efforts to institute front end detection to combat fraud, waste and abuse in child care, the Department has been working with the Department of Revenue’s Child Support Enforcement Unit. The joint effort supports the mission of DOR-CSE, which seeks to support the best interests of children in the Commonwealth by assisting families in obtaining financial support for children from both parents. Consistent with the regulations and policies of DTA, EEC is seeking to require single parents seeking child care assistance to demonstrate child support orders and/or efforts to secure child support orders, including cooperating with DOR-CSE, as a condition of child care eligibility. The regulations will recognize exemptions, including the health and safety of the parent and/or child.
14Strengthen Child Attendance Requirement Current Regulatory Definitions, 606 CMR 10.02:Excessive absence = more than 3 consecutive unexplained absences or 11 or more explained absences w/in a 30 day period.Explained absences = any absence due to illness, emergency, or max. of 10 days vacation/ year.EEC’s regulations related to absences give rise to potential abuse/waste. EEC’s annual billing for FY08-10 shows:Average annual billing by the CCR&Rs - $18.5MAverage annual billing by contract providers - $18.5MOver each of past 3 years, providers have billed EEC for over $37M related to absent daysAbsence rates for some children approach 50%Providers acknowledge billing for “regularly scheduled” absences, such as families that only need 4 days/week
15Strengthening Child Attendance Requirement In preparing its recommendations, EEC reviewed research which shows that chronic absenteeism in the early years, such as kindergarten, predicted continuing absences in latergrades.In addition, we looked at other states to identify best practice:Ohio – limits absences to 10 in 6 monthsMaryland – limits absences to 60 in 12 monthsDelaware – limits absences to 5 per monthMA public schools limit absences to 7 in 6 monthsThese examples have ramifications on both families (termination) and providers (billing) giving incentive for proper use of funds and encouraging attendance/ good outcomes for childrenMissing school early, when pupils are learning th e most basic skills, can hamstring them later in grades and contribute to poor attendance throughout their academic career. The National Center for Children in Poverty found in 2008 that on average, pupils who missed 10 percent or more of school in kindergarten scored significantly lower in reading, math, and general knowledge tests at the end of 1st grade than those who missed 3 percent or fewer days. Moreover, researchers found chronic absenteeism in kindergarten predicted continuing absences in later grades
16Strengthening Child Attendance Requirement Options for implementation – excused absences:Limit absences to 5 per monthLimit absences to 15 per 3 monthsLimit absences to 30 per 6 months*Limit absences to 60 per 12 monthsLimit absences to 7 in 6 months, in accordance with ESE policies*The Recommendation above reflects an average of 5 absences per month enforced over a 6 month period.EEC does not propose any changes related to the definition of “excessive” absence.Excessive absence = more than 3 consecutive unexplained absences or 11 or more explained absences w/in a 30 day period.Explained absences = any absence due to illness, emergency, or max. of 10 days vacation/ year.
17Amendments to Financial & Service Need Eligibility Criteria, 606 CMR 10.04(1) Special Needs (Protective Services) (amends current requirements)New definition of protective services to include parents and children with documented disability and/or special need.Eliminates child with special need as a single service need.Limitations on Self-Employment (amends current requirements)Imposes restrictions on certain work-related service need activities, in particular “at home” self-employmentChanges methodology for calculating service need – total earnings divided by minimum wage to establish amount of care needed.Travel Time (codifies existing practice)Requires applicants to present a minimum of 20 hours of service need before allowing travel time to be factored in.
18Special Needs – Protective Services In order to be eligible for CCDF-funded child care services, children must:Reside with a family whose income does not exceed 85% of SMI; andReside with parent(s) who are working, or participating in job training or an education program, or are receiving or need to receive protective services.See 45 CFR § 98.20(a)(2) – income threshold.See 45 CFR § 98.20(a)(3) – employment/training/education or protective services.
19Special Needs – Protective Services In reviewing the MA CCDF State Plan, ACF identified two instances where EEC regulations and policy may not align with these mandatory requirements:Children with Special Needs – 1) allowing children to remain in care up to 100% SMI and 2) allowing a categorical waiver of the work, education and training requirement for families w/ children with special needs.See 606 CMR 10.04(1)(a)1 and (b)Parents with Special Needs – 1) allowing children to remain in care up to 100% of SMI, and 2) not clearly defining such families “in need of protective services.”See 606 CMR 10.04(1)(a)1See 45 CFR § 98.20(a)(2) – income threshold.See 45 CFR § 98.20(a)(3) – employment/training/education or protective services.
20Special Needs – Protective Services CCDF regulations do allow states some flexibility for families receiving or at risk of receiving protective services:Children residing in a family that is receiving or needs to receive protective intervention services may be eligible for CCDF-funded child care, if they remain in the home, even if the parent(s) is not working or in an education or training program. See 45 CFR 98.20(a)(3)(ii).Additionally, states have the discretion to waive the 85% SMI limitation if a child is residing in a family that is receiving or needs to receive protective intervention services if determined necessary on a case by case basis. See 45 CFR 98.20(a)(3)(ii)(A)EEC must review and update the Special Needs policies and regulations to ensure alignment with Federal law.In addition, EEC will be updating the Verification of Special Needs Form, to ensure that it aligns with the changes, and separating out the forms (one for parents, one for children)
21Special Needs of Children– Protective Services Current practice:Parents are not required to engage in work, education and/or training activitiesFamilies may enter care at 85% SMI and exit at 100%Children are eligible for full-time care regardless of needIssues:Exemption was originally based on assumption special needs children are “educationally at risk”Misaligned with federal exemption definition of “in need of protective services”Research based risk factors show that ALL low-income children are “educationally at risk”Streamlining and coordinating resources:Other agencies are charged with providing services to special needs children -- ESE (IEP) or DPH (IFSP)EEC should support ESE and/or DPH with wrap-around services, for otherwise eligible childrenNumber of children qualifying for EEC $$$ with at least one parent identified as special needsContracts: 1,377Vouchers: 468Number of children qualifying for EEC $$$ based on their own special needsContracts: 541Vouchers: 361Additionally, 95 children have qualified for EEC $$$ with both special needs of parents and children – contracts only.In total, Contacts have authorized 2,013 children, while Vouchers have authorized 829.*This data was pulled on October 29, 2010
22Special Needs of Children – Protective Services Proposed change:Align EEC regulations with Federal regulations and require parents of children with special needs must participate in work, education or trainingNo Change:Families will continue remain eligible at the 85%/100% income levelsEligible children may continue to qualify for full-time care, regardless of their parents service needEEC will continue to work with other state agencies to provide the necessary wrap around support for eligible childrenNumber of children qualifying for EEC $$$ with at least one parent identified as special needsContracts: 1,377Vouchers: 468Number of children qualifying for EEC $$$ based on their own special needsContracts: 541Vouchers: 361Additionally, 95 children have qualified for EEC $$$ with both special needs of parents and children – contracts only.In total, Contacts have authorized 2,013 children, while Vouchers have authorized 829.*This data was pulled on October 29, 201022
23Special Needs of Parents – Protective Services The Department has identified the following concerns when reviewing its child care subsidy regulations and policies and makes the following findings/observations – for Parents:In practice, “special need of parent” definition misaligned with federal “in need of protective services” intention.Examples identified through central office review: headaches, backaches, carpal tunnel syndrome.Data shows inordinate number of special need of parent service needs approvals in contract slotsSpecial need of parent service need currently approved for indefinite time period irrespective of the stated needFederal laws prohibit use of CCDF funding for respite careIf MA continues to eliminate the “service need” requirement for families’ that have children with special needs from the assessment process, the definition of “protective services” will need to change. Political correctness – does MA want to link special needs/disabilities with protective services in ALL cases?Concerns – examples of special need requests that “prevent families from working or entering education/training” include: parents with carpal tunnel syndrome, parents with constipation or parents with limited vision and/or physical restrictions (may limit some activities, but no rendering them totally disables/unable to work, educate or train). Changing regulations to align with federal law (ensuring compliance and no audit findings) does not minimize the aforementioned diagnoses. But, whole-sale exemptions for required eligibility factors inevitably result in abuses.
24Special Needs of Parents– Protective Services EEC will seek to amend current policies related to Child Care Financial Assistance eligibility requirements for families with special needs Parents to:Only allow for new access through vouchersHeighten the bar on what is deemed “at risk of needing protective service”Only allow these to be short term vouchers 12 months, renewable once– with the intended purpose of helping to serve as a bridge while parents seek other resources to address the “protective service” issue and/or become employable.
25Special Needs – Protective Services States are required to define “protective services” in the CCDF State Plan, if they choose to fund services to this population. See 45 CFR 98.16(e)(7)Currently, Massachusetts defines “protective services” as:“Families are eligible for supportive child care services when they have active protective needs documented in a supported report of abuse or neglect within the previous 12 months or when there is a determination of need to begin or continue supportive child care at a Department of Children and Families Progress Supervisory Review.”Proposed definition:“Families, who have active protective needs documented in a supported report of abuse or neglect within the previous 12 months or when there is a determination of need to begin or continue supportive child care at a Department of Children and Families Progress Supervisory Review, will be deemed to be in need of protective services. Additionally, children may be deemed at risk of needing protective services in special circumstances, wherein families are unable to provide child care for any portion of a 24 hour day due to a crisis situation of domestic violence or homelessness, a physical, mental, emotional or medical condition, or participation in a drug treatment or drug rehabilitation program, or court-ordered community service.”If MA continues to eliminate the “service need” requirement for families’ that have children with special needs from the assessment process, the definition of “protective services” will need to change. Political correctness – does MA want to link special needs/disabilities with protective services in ALL cases?Concerns – examples of special need requests that “prevent families from working or entering education/training” include: children with ear infections, lactose intolerance, exotropia (cross-eyed), etc. Changing regulations to align with federal law (ensuring compliance and no audit findings) does not minimize the aforementioned diagnoses. But, whole-sale exemptions for required eligibility factors inevitably result in abuses.
26Limitations on Self-Employment EEC proposes to limit the types of work-related activities that satisfy the service need requirement:No home-based self-employment, unless the work performed:creates a clear and present danger to childrenrequires regular face-to-face meetings or appointments with clients, which prevents direct supervision of childrenPropose a launch/grace period for new self-employment business – 3 month start upImplement new mechanism for confirming minimum wageCurrent practice – divide gross income by estimated hours to determine hourly rateProposed practice – divide gross income by MA minimum wage rate to determine hours
27Eligibility Determinations – Documentation Requirements The following new or revised provisions are required to respond to comments and/or feedback from internal and external stakeholders.Additional documentation (clarifies existing practice)Authorizes providers and/or CCR&Rs to request additional documentation related to the residency of unreported parents, if file indicates application inaccuracies/ contradictions.Data Sharing and/or Interfaces (new requirement)Authorizes EEC to request and/or provide information to/from other government agencies, contracted providers, other states and banks or other financial institutions for purposes of verifying eligibility.
28OVERVIEW OF REVIEW PROCESS Parent submits a Request for Review after Termination, Reduction or Denial of SubsidyEEC Financial Assistance Specialist reviews Request and makes Determination to Uphold or OverturnIf upheld, Parent submits Request for Hearing and EEC Hearing Officer conducts informal hearing and issues a Written DecisionReview process is a three part process. If a parent receives notice of termination, reduction or denial of a subsidy, the parent has the right to request a review of this decision from an EEC Financial Assistance Specialist. The parent must submit a written request for review, explaining how the subsidy agent (i.e. the CCR&R or contracted provider) either failed to follow or improperly applied EEC policies or regulations. The EEC Financial Assistance Specialist will then review this request for review, determine if the parent’s child care can be continued during the review period, and may contact the parent for further information/documentation regarding the request for review. The EEC Financial Assistance Specialist will then make a written determination to uphold the termination, reduction or denial or will overturn the decision. If the determination is made to uphold a termination, reduction or denial, the parent may have the right to file a Request for an Informal Hearing to appeal this decision. A written request for hearing must be submitted to General Counsel. It is then assigned to one of three assistant general counsels to act as the assigned hearing officer. The hearing officer schedules the informal hearing with the parent and hears testimony from the EEC Financial Assistance Specialist who made the determination and the parent.
29Review Process: Issues Caseload volume (by calendar year)2008 = Requests for Review2009 = 1,438 Requests for Review2010 = to date, 829 Requests for ReviewIncomplete documentationSignificant lag times within caseload processingAppellants have several “bites of the same apple”Child care may continue for several additional weeks or months pending the outcome of the review and/or the informal hearing
30Review Process: Proposal Proposed updates to EEC Review Process regulations include:Dismissals for failure to prosecuteClarify appropriate grounds for appealClarify documentation timelinesGrant opportunity for appeal related to recoupment amounts
31GOALS FOR THE REVIEW PROCESS EEC seeks to revise the Termination and Reduction of Services and the Review Process sections to:Streamline and Manage EfficienciesAddress Federal and State Mandates to Recoup FeesParent recoupments (by calendar year)2008: 4 repayment agreements; 7 referrals to BSI/ AGO referrals.2009: 196 repayment agreements; 5 BSI/ AGO referrals.2010: to date, 336 repayment agreements; 1 BSI/AGO referralProvide clarification for Parents, CCR&Rs and Contracted Providers
3210.12 Termination and Reduction of Services Reasons for Denial or Termination: Currently, there are 6 reasons for issuing a denial or termination of subsidized child care:Lack of continuing service needLack of financial eligibilityNon-payment or late payment of feesUnexplained or excessive absenceFailure to submit the required documentation at reassessmentFailure to comply with EEC’s, CCR&R’s or contracted provider’s policiesEEC seeks to add two additional reasons:Submission of False or Misleading Information and/or Documentation to the contracted provider, CCR&R or EECOutstanding child care debt owed to the Commonwealth“Denial” has always been included but was not listed a particular reason for refusing child care. Most common instance of denial is when a parent who is on the waitlist receives a funding availability letter, is then assessed for eligibility and is found not to be eligible due to service need, employment, over income, etc. Added in “debt amount” to reflect recoupment process.Reasons for Denial or Termination: added in two new reasons that encompass scenarios regularly encountered by contracted providers, CCR&Rs and EEC. These include: submission by a parent of false and misleading information and/or documentation to obtain or continue a subsidy; outstanding child care debt owed which has been assessed to the parent but remains unpaid and the parent now seeks to obtain a new subsidy (e.g. parent leaves a program with a debt owed, goes back on the waitlist to obtain a new subsidy).
3310.12 Termination and Reduction of Services (cont’d) (2) Reasons for Reduction: EEC seeks to modify the existing reason for reduction:Parent(s)’ service need changes from full time to part timeand add a new reason for reduction:If a change in the total household income results in an increase to the parent(s)’co-payment fee, in accordance with EEC’s fee scheduleReasons for Reduction: Streamlined this section and added “change in household income results in increased parent fee.” This could occur when a parent changes jobs and receives more income. This additional income will increase the parent’s co-pay and will “reduce” the subsidy amount that he/she receives.
34Review ProcessReasons for Review: EEC seeks to add an additional reason for review:assesses a fee or an outstanding child care debt that the parent believes is not in accordance with EEC policy(2) Scope of Review: EEC seeks to clarify scope of review by adding a new scope to reflect recoupment:Requests for Review that are solely related to the existence and/or the amount of a debt owed are outside the scope of the review process, if: (a) the parent(s) has already entered into an agreement to repay the outstanding debt; or(b) the parent(s)’ claim is limited to financial hardship imposed by the agreement to repayAgain, to reflect the recoupment process, we have added the assessment of an outstanding child care debt as a reason for review.The scope of review has been changed to streamline the review process and weed out meritless appeals. The addition of “fairness” to the instances when a parent may not challenge state, federal law or EEC policy is to cut down on the many requests for review that are received by EEC in which a parent states nothing more than that the termination, reduction or denial was unfair. Requests for review that only relate to a debt will be outside of the review process if the parent has already entered into a repayment agreement or does not dispute the debt but merely claims that he/she cannot pay the debt due to financial hardship.
3510.13 Review Process (cont’d) (6) Termination of Continued Subsidized Child Care: Currently there are 3 bases as to when subsidized child care can be terminated during the review process or subsequent appeal:a determination is made that the sole issue is a challenge to the validity of a particular law or regulationa change affecting the parent’s subsidy occurs subsequent to the filing of the request for review that makes the previously filed request mootthe parent fails to comply with the requirements for continuing subsidized child care.EEC seeks to add the following as an additional basis:a determination is made that there is no genuine issue of material fact as presented by the parent in his/her request for reviewEEC seeks to implement efficiencies in the review process. One area that requires modification is the bases for termination of continued subsidized child care. EEC seeks to add in two bases to terminate continued child care that are frequently abused in the review and appeal process. First, a parent’s subsidized child care will not continue if a determination is made that the sole issue is a challenge to the validity or fairness of a particular law or regulation. Secondly, child care will be terminated if there is no genuine issue of material fact as presented by the parent in his/her request for review. This last category, no genuine issue of material fact, is regularly observed by the Financial Assistance Specialists who receive numerous requests for review that state that the parent knows that he/she failed to report a loss of employment, reduction in hours, etc. and then asks for forgiveness and reinstatement of the subsidy.
3610.13 Review Process (cont’d) (7) Preliminary Review:(d) Decisions:1. How Made. Currently the EEC Review Officer reviews all information submitted by the parent and the provider or CCR&R and seeks clarification from the parties, if necessary. The Review Officer may take administrative notice of general, technical or scientific facts within his/her specialized knowledge and may use his or her experience and specialized knowledge in the evaluation of the evidence presented.EEC seeks to add the following provisions:The Review Officer may take administrative notice of public records or any information provided by other state agencies, the State Auditor’s Office and/or its Bureau of Special Investigations. If during the evaluation of the evidence presented, the EEC Review Officer determines that additional reasons for termination/reduction as enumerated in 606 CMR (1) and (2) are supported by the evidence, the Review Officer will identify these in the written decision.Under preliminary review, the Financial Assistance Specialists would continue subsidized child care services pending the outcome of the review by notifying the CCR&R or the contracted provider and usually, by notifying the parent. Now, the Financial Assistance Specialist will be obligated to notify the parties of continuing child care.For clarity, EEC is defining the case record for requests for review. The case record will now consist of evidence submitted by the provider or CCR&R and any evidence submitted by the parent. The provider or CCR&R will have an affirmative obligation to provide the case file to support its decision to issue a termination, reduction or denial of child care.
3710.13 Review Process (cont’d) (8) Informal Hearing:(e) Reasons for Dismissal: Currently there are 2 reasons as to when a request for informal hearing may be dismissed. EEC seeks to modify this provision and add two more reasons for dismissal as follows:1. fails to appear at the informal hearing;2. fails to prosecute his/her claim;3. has already agreed in writing to repay the debt at issue; or4. withdraws the request for Informal Hearing in writing or on the record at the hearing.EEC Financial Assistance Specialists are often required to seek additional information from public records to support or dispute the termination, reduction or denial of a subsidy. Resources utilized for this purpose are RMV records, Registry of Deed records, and town/ municipality assessment records. EEC has also a pilot program with the Bureau of Special Investigations from the State Auditor’s Office to research instances of suspected fraud. The Bureau of Special Investigations has the ability to review other databases such as MassHealth, DTA, etc. to verify such matters as household composition and income.Often, when reviewing a request, the EEC Financial Assistance Officer may determine from the information contained within the parent’s file or from evidence provided by the parent that there are additional reasons for termination or reduction. Rather than require that the first matter be amended and a second notice of termination or reduction be issued to the parent with another two week notice, the Financial Assistance Specialist may identify these as additional reasons for termination or reduction in her written decision.
38Proposed Regulation Promulgation Timeline DRAFT 9/17/08Proposed Regulation Promulgation TimelineTasksDateVet Regulation Changes with Providers/ CCR&Rs; continue to make policy changes/ clarifications that do not require regulation changesFall 2010Board reviews first draft of proposed regulation changes; Committee discussionsJan/Feb 2011Board vote to put regulations out for public commentPublic comment period; meetings with providers/ advocatesBoard vote to promulgate regulations;Roll out implementation/ trainings38