PDFWAC 110-15-0268

Payment discrepancies—Provider overpayments.

(1) An overpayment occurs when a provider receives payment that is more than the provider is eligible to receive. Provider overpayments are established when that provider:
(a) Bills and receives payment for services not provided;
(b) Bills without attendance records that support the billing. Beginning July 1, 2018, attendance must be recorded using DCYF's electronic attendance system or a DCYF-approved electronic attendance system. Any other format for recording attendance will not be considered valid support for a provider billing and may result in an overpayment;
(c) Bills and receives payment for more than the provider is eligible to bill;
(d) Routinely provides care in a location other than what was approved at the time of authorization;
(e) With respect to license-exempt in-home/relative providers, bills the state for more than six children at one time for the same hours of care; or
(f) With respect to licensed or certified providers:
(i) Bills the state for more than the number of children in the provider's licensed capacity; or
(ii) Is caring for a child receiving WCCC benefits outside the provider's licensed allowable age range without a DCYF-approved exception; or
(g) With respect to certified providers caring for children in a state bordering Washington:
(i) Is determined to not be in compliance with the state's licensing regulations; or
(ii) Fails to notify DSHS within ten days of any suspension, revocation, or change to the provider's license.
(2) DCYF or DSHS will request documentation from a provider when preparing to establish an overpayment. The provider must provide requested information within twenty-eight consecutive calendar days from the date of the written request.
(3) A provider must repay any payments that the provider was not eligible to receive.
(4) A provider must repay any overpayment, even if the overpayment is the result of a DCYF or DSHS error in issuing payment the provider was not eligible to receive.
[Statutory Authority: RCW 43.216.055, 43.216.065 and 42 U.S.C. 9858, et seq. WSR 19-08-020, § 110-15-0268, filed 3/26/19, effective 4/26/19. WSR 18-14-078, recodified as § 110-15-0268, filed 6/29/18, effective 7/1/18. Statutory Authority: RCW 43.215.060, 43.215.070 and 2017 3rd sp.s. c 1 § 615. WSR 17-23-033, § 170-290-0268, filed 11/7/17, effective 12/8/17. Statutory Authority: RCW 43.215.060, 43.215.070, and chapter 43.215 RCW. WSR 17-12-035, § 170-290-0268, filed 5/31/17, effective 7/1/17; WSR 12-11-025, § 170-290-0268, filed 5/8/12, effective 6/8/12. Statutory Authority: RCW 43.215.060, 43.215.070, 2006 c 265, and chapter 43.215 RCW. WSR 09-22-043, § 170-290-0268, filed 10/28/09, effective 12/1/09.]