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COMMENT DUE DATE:  

February 15, 2018

DATE: 

January 16, 2018

Laura Brown Adult and Family Services 405-521-4396

Dena Thayer, Programs Administrator 405-521-4326

RE:  

APA WF 18-65

It is very important that you provide your comments regarding the DRAFT COPY of policy by the comment due date. Comments are directed to *STO.LegalServices.Policy@okdhs.org

The proposed policy is  Permanent .  This proposal is subject to Administrative Procedures Act

A public hearing is scheduled for 10:00 a.m. on February 21, 2018, at DHS, Sequoyah Memorial Office Building, 2400 N. Lincoln Boulevard, Oklahoma City, Oklahoma 73105, Room C-48.Anyone who wants to speak must sign in at the door by 10:05 a.m.

SUBJECT:CHAPTER 65. PUBLIC ASSISTANCE PROCEDURES

Subchapter 5. Procedures Relating to Case Changes

Part 1. General Provisions

340:65-5-1 [AMENDED]

Subchapter 9. Overpayment Claims and Fraud in Temporary Assistance for Needy Families and State Supplemental Payment Benefits

340:65-9-1 through 340:65-9-2 [AMENDED]

340:65-9-4 through 340:65-9-7 [AMENDED]

(Reference WF 17-18 AND 18-04)

SUMMARY:The proposed revisions to Chapter 65, Subchapter 5 amend the rules to:(1) add taglines and rule citations; (2) update change reporting requirements for Child Care Subsidy and Supplemental Nutrition Assistance Program (SNAP); (3) update reasons advance notice is not required for a Child Care Subsidy closure; (4) update information regarding when Child Care Subsidy and SNAP benefits may be reduced; and (5) add clarifying information.

The proposed amendments to Chapter 65, Subchapter 9 amend the rules to:(1) update, separate, and clarify Temporary Assistance for Needy Families (TANF) and State Supplemental Payment (SSP) overpayment claims, classifications, and procedures; (2) update overpayment repayment procedures, options, and terminology; (3) add:(a) policy citations; (b) taglines; (c) case retention information; (d) fraud definitions and penalties; (e) notice receipt time frame; (f) information regarding repayment suspension when the client requests a fair hearing; (g) monthly overpayment statements; (h) repayment plan reconsideration; (i) information regarding when the Oklahoma Department of Human Services (DHS) begins collection action on overpayments held in suspension; and (j) clarifying information; and (4) remove: (a) a form; (b) duplicative information discussed in another policy Section; and (c) incorrect information regarding overpayment decision appeal rights.

PERMANENT APPROVAL:Permanent rulemaking is requested.

LEGAL AUTHORITY:Director of Human Services; Sections 162, 168, 171, 185, 186, and 230.63 of Title 56 of the Oklahoma Statutes, CCDBG Act of 2014, P.L. 113-186,and Section 98.21 of Title 45 of the Code of Federal Regulations.

Rule Impact Statement

To:Programs administrator

Legal Services - Policy

From:Patrick Klein,Director

Adult and Family Services

Date:December 18, 2017

Re:Chapter 65. PUBLIC ASSISTANCE PROCEDURES

Subchapter 5. Procedures Relating to Case Changes

Part 1. General Provisions

340:65-5-1 [AMENDED]

Subchapter 9. Overpayment Claims and Fraud in Temporary Assistance for Needy Families and State Supplemental Payment Benefits

340:65-9-1 through 340:65-9-2 [AMENDED]

340:65-9-4 through 340:65-9-7 [AMENDED]

(Reference WF 18-04 and WF 17-18)

Contact:Laura Brown 405-521-4396

A.Brief description of the purpose of the proposed rule:

The proposed revisions to Chapter 65, Subchapter 5 amend the rules to:(1) add taglines and rule citations; (2) update change reporting requirements for Child Care Subsidy and Supplemental Nutrition Assistance Program (SNAP); (3) update reasons advance notice is not required for a Child Care Subsidy closure; (4) update information regarding when Child Care Subsidy and SNAP benefits may be reduced; and (5) add clarifying information.

The proposed amendments to Chapter 65, Subchapter 9 amend the rules to:(1) update, separate, and clarify Temporary Assistance for Needy Families (TANF) and State Supplemental Payment (SSP) overpayment claims, classifications, and procedures; (2) update overpayment repayment procedures, options, and terminology; (3) add: (a) policy citations; (b) taglines; (c) case retention information; (d) fraud definitions and penalties; (e) notice receipt time frame; (f) information regarding repayment suspension when the client requests a fair hearing; (g) monthly overpayment statements; (h) repayment plan reconsideration; (i) information regarding when the Oklahoma Department of Human Services (DHS) begins collection action on overpayments held in suspension; and (j) clarifying information; and (4) remove: (a) a form; (b) duplicative information discussed in another policy Section; and (c) incorrect information regarding overpayment decision appeal rights.

Strategic Plan Impact. The proposed rules achieve DHSgoals by continuously improving systems and processes and improving communication with DHS clients and staff.

Substantive changes.

Subchapter 5. Procedures Relating to Case Changes

Part 1. General Provisions

Oklahoma Administrative Code (OAC) 340:65-5-1 is amended to:(1) add taglines and rule citations; (2) update change reporting requirements for Child Care Subsidy and SNAP; (3) update reasons advance notice is not required for a Child Care Subsidy closure; (4) update information regarding when Child Care Subsidy and SNAP benefits may be reduced; and (5) add clarifying information.

Subchapter 9. Overpayment Claims and Fraud in Temporary Assistance for Needy Families and State Supplemental Payment Benefits

Oklahoma Administrative Code (OAC) 340:65-9-1 is amended to:(1) update TANF and SSP overpayment claims procedures and terminology; (2) add policy citations, taglines, and case retention information; and (3) reorder and clarify overpayment claim information for enhanced understanding.

OAC 340: 65-9-2 is amended to:(1) add a policy citation and clarifying information regarding TANF and SSP overpayment classifications; (2) separate procedures for how TANF and SSP overpayment classifications change to fraud or an intentional program violation; (3) remove a form; and (4) update terminology.

OAC 340:65-9-4 is amended to:(1) add a fraud definition and penalties; (2) separate and expand on fraud determination procedures for TANF and SSP as they are handled differently; (3) remove duplicative information discussed in OAC 340:65-9-1; (4) add taglines and reorder and clarify information for enhanced understanding; and (5) update terminology.

OAC 340:65-9-5 is amended to:(1) remove incorrect information regarding overpayment decision appeal rights; and (2) add a notice receipt time frame.

OAC 340:65-9-6 is amended to:(1) update and clarify overpayment repayment procedures, options, and terminology; and (2) add information regarding repayment suspension, when the client requests a fair hearing, monthly overpayment statements, repayment plan reconsideration, and policy citations.

OAC 340:65-9-7 is amended to:(1) add information regarding when DHS begins collection action on overpayments held in suspension; and (2) update terminology.

Reasons.The proposed amendments update overpayment processes, highlight differences in handling TANF and SSP overpayments, add taglines, reorder information, and clarify information to provide clients and staff with clear, concise, and updated rules to facilitate the accurate delivery of benefits and services to persons in need.

Information regarding the Child Care Subsidy Programs change reporting requirements and when benefits may be reduced is updated to align with Child Care Subsidy emergency rule revisions.Child Care Subsidy rules are updated to comply with provisions in the Child Care and Development Block Grant (CCDBG) Act of 2014, Public Law (P.L.) 113-186.

Repercussions.If the proposed amendments are not implemented, rules will not be updated to reflect current processes, will not align with Child Care Subsidy rule revisions, and may affect the accuracy of eligibility determinations and service delivery.

Legal authority. Director of Human Services; and Sections 162, 168, 171, 185, 186, and 230.63 of Title 56 of the Oklahoma Statutes,. CCDBG Act of 2014, P.L. 113-186,and Section 98.21 of Title 45 of the Code of Federal Regulations.

Permanent rulemaking approval is requested.OAC 340:65-5-1 was submitted as an emergency rule on August 2, 2017 and approved by the Governor on August 28, 2017.The rule was revised as an emergency to align with federally mandated Child Care Subsidy rules.No additional revisions were made to this Section during permanent rulemaking.

B.A description of the classes of persons who most likely will be affected by the proposed rule, including classes that will bear the costs of the proposed rule, and any information on cost impacts received by the Agency from any private or public entities:The classes of persons most likely to be affected by the proposed amendments are clients receiving benefits administered by Adult and Family Services (AFS) and AFS staff.The affected classes of persons will bear no costs associated with implementation of the rules.

C.A description of the classes of persons who will benefit from the proposed rule:The classes of persons who will benefit are clients receiving benefits administered by AFS and AFS staff.

D.A description of the probable economic impact of the proposed rule upon the affected classes of persons or political subdivisions, including a listing of all fee changes and, whenever possible, a separate justification for each fee change:The proposed amendments do not have an economic impact on the affected entities.There are no fee changes associated with the revised rules.

E.The probable costs and benefits to the Agency and to any other agency of the implementation and enforcement of the proposed rule, the source of revenue to be used for implementation and enforcement of the proposed rule and any anticipated effect on state revenues, including a projected net loss or gain in such revenues if it can be projected by the Agency:The probable cost to DHS includes the cost of printing and distributing the rules, which is estimated to be less than $20.The proposed amendments will result in enhanced delivery of services for clients.

F.A determination whether implementation of the proposed rule will have an impact on any political subdivisions or require their cooperation in implementing or enforcing the rule:The proposed amendments do not have an economic impact on any political subdivision, nor will the cooperation of any political subdivisions be required in implementation or enforcement of the rules.

G.A determination whether implementation of the proposed rule will have an adverse economic effect on small business as provided by the Oklahoma Small Business Regulatory Flexibility Act: There are no anticipated adverse effects on small business as provided by the Oklahoma Small Business Regulatory Flexibility Act.

H.An explanation of the measures the Agency has taken to minimize compliance costs and a determination whether there are less costly or nonregulatory methods or less intrusive methods for achieving the purpose of the proposed rule: There are no less costly or non-regulatory methods or less intrusive methods for achieving the purpose of the proposed amendments.

I.A determination of the effect of the proposed rule on the public health, safety, and environment and, if the proposed rule is designed to reduce significant risks to the public health, safety, and environment, an explanation of the nature of the risk and to what extent the proposed rule will reduce the risk: Implementation of the proposed overpayment amendments are not intended to reduce risks to the public health, safety, and environment.The proposed Child Care Subsidy change reporting requirement and prohibition to decreasing child care benefits when the renewal is not due rule protects the health and safety of children by allowing children to remain eligible for subsidized child care for longer periods of time.This may prevent some children from being left at home alone or with unsuitable caregivers while their parents work.

J.A determination of any detrimental effect on the public health, safety, and environment if the proposed rule is not implemented: If the proposed overpayment amendmentsare not implemented, no detrimental effects on public health, safety, or the environment are anticipated.If the proposed Child Care Subsidy rule revisions are not implemented, DHS will be out-of-compliance with federal requirements, which may result in penalties that further exacerbate limited child care funding and will not decrease safety risks to children who lose stable and licensed child care.

K.The date the rule impact statement was prepared and, if modified, the date modified:Prepared April 25, 2017; modified December 18, 2017.

SUBCHAPTER 5. PROCEDURES RELATING TO CASE CHANGES

PART 1. GENERAL PROVISIONS

340:65-5-1. Case changes

Revised 10-1-2017

(a) Change reporting requirement for Temporary Assistance for Needy Families (TANF), State Supplemental Payment (SSP), and SoonerCare (Medicaid).TheclientRecipients of TANF, SSP, and SoonerCare (Medicaid) for the aged, blind, and disabled must report within 10-calendar days any changes in his or her circumstances that would result in an increase or decrease inincreases, reduces, or closes benefits.For the Supplemental Nutrition Assistance Program (SNAP), refer to OAC 340:50-9-5 for reporting exceptions.

(1) The worker:

(A) gives the client 10-calendar days to provide any required proof to verify the reported change.The workerpromptly; and

(B) acts on changes that increase, reduce, or decreaseclose benefits or result in benefit closure.To be considered prompt, the change must be made within 10-calendar days of the date the change wasis reported and required proof wasis received.¢ 1

(2) Failure to report changes timely may result in ana client error overpayment assessment against the client.¢ 2

(3) Examples of changes the client must report include:

(1)(A) household income;¢ 3

(2)(B) household resources;¢ 4

(3)(C) household composition;¢ 5

(4)(D) the client's address or telephonephone number;¢ 6

(5)(E) legal alien status of non-citizens;¢ 7

(6)(F) insurance coverage per Oklahoma Administrative Code (OAC) 317:35-5-43;and

(7)(G) in addition, for the Temporary Assistance for Needy Families (TANF) program:

(A)(i) deprivation of parental support, per OAC 340:10-10-1 through 340:10-10-4;

(B)(ii) when thea TANF Work activity stops or starts, per OAC 340:10-2-1 through 340:10-2-8; and

(C)(iii) when a child in the assistance unit stops attending school, per OAC 340:10-13-1; and

(8) in addition for the Child Care Subsidy program the:

(A) names of household members in child care;

(B) reason child care is needed;

(C) the parent's or caretaker's work or school schedule or any other change affecting the days and hours child care is needed; and

(D) name of the child care facility the child is attending.

(b) Change reporting for the Supplemental Nutrition Assistance Program (SNAP).SNAP has three categories of households with different change reporting responsibilities; annual reporters, semi-annual reporters, and change reporters.Refer to OAC 340:50-9-5 for change reporting requirements.¢ 8

(c) Change reporting for the Child Care Subsidy Program.Child care subsidy recipients must report income changes within 10-calendar days when the household's gross income exceeds federal income guidelines for the household size per OAC 340:40-9-2(a).Refer to Oklahoma Department of Human Services (DHS) Appendix C-4, Child Care Eligibility/Copayment Chart, Schedule II for the federal exit income threshold.¢ 9

(b)(d) Change processing deadline.After certification, all reported changes, except those reported prior to certification, must be processed by deadline dates shown onper Oklahoma Department of Human Services (OKDHS)DHS Appendix B-2, Deadlines for Case Actions, to be effective the first day of the month following the deadline date.

(1)(e) Notices.A computer-generated notice is sent to advise the client of any increase or decrease inwhen the action taken increases, reduces, suspends, or closes benefits.A computer-generated notice is not sent when the action taken does not affect the benefit level.

(2)(1) Advance notice is required when the action taken reduces, closes, or suspends benefits for a reason other than those listed under (b)(3)per (2) of this Sectionsubsection.When advance notice is required, refer to DHS Appendix B-2 for advance notice deadline dates shown in OKDHS Appendix B-2, Schedule I apply.

(3)(2)When advance notice is not required, refer to DHS Appendix B-2 non-advance notice deadline dates shown in OKDHS Appendix B-2, Schedule II apply.Advance notice of action is not required when the action taken does not suspend, close, or reduce benefits, or is because ofwhen:

(A) the death of all members included in the benefit die;

(B) the death of the TANF payee whendies and there is not a relative available to serve as a new payee;

(C) transfer of benefits are transferred from one category of assistance to another without a resulting decreasereduction or interruption in benefits, such as changing from disability to aged benefits;¢ 10

(D) approval of care is approved in a skilled nursing facility or an intermediate nursing care facility resulting inthat requires closure of the person's State Supplemental Payment (SSP) benefit or the SoonerCare (Medicaid) Qualifying Individuals - group 1 (QI-1s) benefit;

(E) the household moves out of state;

(F) an automatic increase in income occurs because of federal legislation, such as a cost-of-living increase to all beneficiaries of Social Security, Supplemental Security Income, Railroad Retirement, or Veterans' benefits;

(G) admission of the client is admitted to a public institution where his or her needs are fully supplied;

(H) receipt of athe client provides a signed, written statement signed by the client:

(i) stating he or she no longer wisheschooses to receive assistance; or

(ii) requesting closure or reduction of benefits to avoid or repay an overpayment;

(I) the client's whereabouts beingare unknown.and OKDHSThis may occur when DHS mail directed to him or her has beenthe client is returned by the post office indicating no known forwarding address.for all Adult and Family Services (AFS) programs except the Supplemental Nutrition Assistance Program (SNAP)and Child Care Subsidy benefits are not closed for this reason;¢ 11

(J) a TANF child beingis removed from the home as a resultbecause of a judicial determination or voluntarily placed involuntary foster care placement by the legal guardian for a period in excess ofmore than 30-calendar days;

(K) a change occurs in federal or state or federal law;

(L) a reduction in SSP benefits necessarymust be reduced to comply with federal law pertaining to maintenance of effort or a state mandate; ¢ 12or

(M) a verbal request, child care services no longer being used, a child reaching the maximum allowable age,the client requests a reduction in or closure of the child care benefit or a change in child care provider for the Child Care Subsidy program per OAC 340:40-9-2 and 340:40-9-3.

(c)(f) Reinstating or reopening benefits.Following theWithin 30-calendar days of notice issuance of a notice, the client may present proof to show the action is incorrect and request reduced benefits be reinstated or closed benefits be reopened at the previous benefit level until the last calendar day of the month of closuredue to an incorrect action or a change in circumstances.¢ 13

(1) When information showsbenefits were reduced and the worker determines the client remains eligible at:

(A) the previous benefit level, the worker restores benefits to the previous benefit level for all Adult and Family Services (AFS) programs.;

(2)(B) When information shows the client remains eligible at an increased benefit level, benefits are increased based on specific program rules.; or

(C) a reduced level than the last action taken, the worker reduces benefits further:

(i) effective the next advance notice deadline date for TANF, SSP, and SoonerCare (Medicaid);

(ii) when the renewal is due for Child Care Subsidy and SNAP.When the renewal is not due:

(I) benefits are not reduced for Child Care Subsidy, per OAC 340:40-9-2(a); or

(II) reduced in limited circumstances for SNAP.Refer to OAC 340:50-9-5 for appropriate circumstances.

(3)(2) WhenFor TANF, SSP, and SoonerCare (Medicaid), when benefits were closed or suspended and proof provided shows the client remains eligible, but at a reduced benefit level, benefits are reopened using current eligibility information. ¢ 14

(4) When benefits were reduced and proof provided shows the client is eligible, but at a reduced level than the last action taken, the worker reduces benefits further using deadline dates shown in OKDHS Appendix B-2, Schedule I.

(3) When Child Care Subsidy benefits are reopened and the renewal is not due, benefits are not reduced below the benefit level at closure.Child care benefits may only be reduced at renewal, per OAC 340:40-9-2(a).

(4) When SNAP benefits are reopened and the benefit renewal is not due, benefits may only be reduced in limited circumstances.Refer to OAC 340:50-9-5 for appropriate circumstances.

(d)(g) Fair hearing information.When the client requests a fair hearing at the same time he or she requests benefits be reinstated, or requests a hearing at a later datewithin 90-calendar days of the date action is taken for SNAP or 30-calendar days for all other AFS programs, the worker follows fair hearing procedures per OAC 340:2-5 and explains if benefits are continued and the appeal is not decided in the client's favor, he or she is expected to repay the benefits.

(1) When the client requests a fair hearing within 10-calendar days following the notice issuance date of the notice and requests benefits be reinstated at the same benefit level pending the outcome of the hearing, the worker reopens benefits at the same benefit level and explains to the client if the appeal is not decided in the client's favor, he or she is expected to repay the benefits.Benefits remain open unless another change occurs before a hearing decision is made that requires benefits be reduced or closed.¢ 15

(2) When the client requests adoes not request the fair hearing regarding the action more thanwithin 10-calendar days following the issuanceof the notice date of the notice, the worker does not restore benefits unless the client provides information provided showsverifying the client remains eligible at the previous benefit level, the worker determines an incorrect action was taken, or if the hearing is decided in the client's favor. ¢ 16

(3) Per OAC 340:2-5, the OKDHSDHS Legal Services Appeals Unit makes a decision regarding the fair hearing and sends a decision letter of decision to the client and the county office.

(A) The worker is responsible for taking the action needed to carry out the hearing decision of the OKDHS Appeals Unit.¢ 17

(B) If the OKDHS Appeals Unit denies the appealWhen benefits were reinstated or reopened and the hearing decision is not in the client's favor, benefits are continued through the end of the month in which the final decision on the fair hearing is reached and an overpayment referral is sent to AFS Benefit Integrity and Recovery, when appropriate.

INSTRUCTIONS TO STAFF 340:65-5-1

Revised 10-1-17

1.The worker is responsible for updating the applicable Family Assistance/Client Services (FACS) tabs and recording a brief explanation of the action taken and reason for taking the action in FACS Case Notes.In addition to rules in this Section, refer to Oklahoma Administrative Code (OAC) 317:35-7-36 for SoonerCare (Medicaid) case changes.

2.Overpayment procedure rules are located at:

(1) OAC 340:65-9 for the Temporary Assistance for Needy Families (TANF) and State Supplemental Payment (SSP) programs;

(2) OAC 340:40-15 for the Child Care Subsidy program;

(3) OAC 317:35-13-5 for the SoonerCare (Medicaid) program; and

(4) OAC 340:50-15 for the Supplemental Nutrition Assistance Program (SNAP).

3.Refer to income rules at:

(1) OAC 340:10-3-26 through 340:10-3-40 for the TANF program;

(2) OAC 340:15-1-4, 340:15-1-6, and 317:35-7-38 for the SSP program; and

(3) OAC 317:35-5-42 for the populations related to the aged, blind, and disabled (ABD), including long term care (LTC).

4.Refer to resource rules at:

(1) OAC 340:10-3-1 through 340:10-3-10 for the TANF program;

(2) OAC 340:15-1-14 and 317:35-7-38 for the SSP program; and

(3) OAC 317:35-5-41 through 317:35-5-41.11 for populations related to ABD and OAC 317:35-17-10 and 317:35-19-20 for the (LTC) population for the SoonerCare (Medicaid) program.

5.(a) Refer to household composition rules at:

(1) OAC 340:10-3-56 and 340:10-3-57 for the TANF program;

(2) OAC 340:15-1-5 and 317:35-7-36 for the SSP program; and

(3) OAC 317:35-7-36 for the population related to ABD and OAC 317:35-17-9 and 317:35-19-20 for the (LTC) population for the SoonerCare (Medicaid) program.

(b) For TANF, when the client requests benefits for an additional person prior to certification, a new application is not needed.The client must complete a new application when he or she requests benefits for an additional person after certification.

(1) To evaluate an additional person's eligibility, the worker first determines if the person is required to be included in the assistance unit per OAC 340:10-3-56.

(A) When the person must be included, the worker completes the TANF renewal for the rest of the assistance unit at the same time.

(B) When the person is not required to be included in the assistance unit and including the person will reduce the TANF benefit, the client may choose not to include the person.The worker is responsible for informing the client of his or her options.

(C) After certification, when the client chooses not to include the person or the person is not eligible for another reason, the worker sends Form 08MP038E, Client Notice of Action Taken, to inform the client of the denial.

(2) When the additional member is eligible, the worker adds the person to the TANF benefit effective the date of request.

(A) When the additional person increases the TANF benefit, the worker prorates the initial month's supplemental benefits per OAC 340:65-3-5(5).

(B) When the additional person must be included and has countable income that reduces the TANF benefit, the worker adds the person and reduces the TANF benefit effective the first day of the month following the advance-notice deadline date per Oklahoma Department of Human Services (DHS) Appendix B-2 Deadlines for Case Actions.

(C) When the additional person must be included and causes the assistance unit to no longer be eligible for TANF benefits, the worker closes the TANF benefit effective the first day of the month following the advance-notice deadline date per DHS Appendix B-2.

(3) The worker is responsible for updating the applicable FACS tabs and recording in FACS Case Notes the date the client requested benefits for the additional person, when the person moved into the household, details about the person's eligibility, and how the person affects the benefit amount for the assistance unit.

(c) For TANF, when the client reports that a person included in the assistance unit left the home, the worker removes the person's needs effective the first day of the month following the advance-notice deadline date per DHS Appendix B-2.When the person dies, the worker removes the person effective the date of death, using reason code 01 and sends Form 08MP038E when other household members are included in the benefit.

(d) For all programs, when the client reports a household member's name changed, the worker updates the person's name in FACS after the client provides the person's Social Security card showing the correct name.

(e) When after certification a person not included in the assistance unit asks to be made payee for the TANF benefit, the person must complete a new application and the worker must review household eligibility before making the change.The worker documents the new circumstances in FACS Case Notes, including why the current payee must be removed.The new payee must have a certain degree of relationship to the child for whom benefits are requested, per OAC 340:10-3-56 and 340:10-9-1.

(f) For rules regarding who can be payee for programs other than TANF, refer to:

(1) OAC 340:65-3-2 for the SSP program;

(2) OAC 340:40-3-1 and 340:65-3-2 for the Child Care Subsidy program;

(3) OAC 317:35-7-15 and 340:65-3-2 for the SoonerCare (Medicaid) program; and

(4) OAC 340:50-3-1 and 340:65-3-2 for SNAP.

6.When the client moves to another county, refer to OAC 340:65-1-3 Instructions to Staff # 1(e) for transfer procedures.

7.For rules regarding legal alien status of non-citizens, refer to:

(1) OAC 340:65-3-1 for all programs;

(2) OAC 340:10-15-1 for the TANF program; and

(3) OAC 317:35-5-25 for the SoonerCare (Medicaid) program.

8.For SNAP, refer to:

(1) OAC 340:50-7-22 through 340:50-7-29 for income rules;

(2) OAC 340:50-7-1 for resource rules;

(3) OAC 340:50-5-1 through 340:50-5-10.1 for household composition rules; and

(4) OAC 340:50-5-67 for legal alien status of non-citizens rules.

9.For Child Care Subsidy, refer to:

(1) OAC 340:40-7-10 through 340:40-7-13 for income rules;

(2) OAC 340:40-7-5 for resource and legal alien status of non-citizen rules; and

(3) OAC 340:40-7-6 for household composition rules.

10.When a person transfers from a TANF benefit to SSP, an advance notice is almost always required because the public assistance benefit for that person reduces.An advance notice is not required when the TANF cash assistance amount remains the same or increases.

11.Per OAC 340:50-9-5 for SNAP and OAC 340:40-9-2 for Child Care Subsidy, the worker does not close benefits because of returned mail between renewal months.The worker enters a FACS case note regarding the returned mail and inquires about the client's current address at renewal.

12.DHS may adjust the SSP benefit one or more times during the year to ensure DHS does not spend more or less on the program than was spent the previous year.DHS sends a special notice to the client and a broadcast message to staff when an adjustment is made.

13.For rules regarding reopening or reinstating benefits, refer to:

(1) OAC 340:65-5-6 for the TANF and SSP programs;

(2) OAC 340:40-9-2 for the Child Care Subsidy program; and

(3) OAC 340:50-9-5 for SNAP.

14.Using current eligibility information means the effective date of the reopen action that reduces benefits is the same effective date as would have occurred had the benefit remained open.

15.The worker notifies the hearing officer of actions taken while a hearing decision is pending.

16.When, within 30-calendar days of closure, the worker reopens the client's benefit without a gap in benefits because of a reconsideration of administrative action, per OAC 340:65-5-6, the worker attaches a cover letter to the fair hearing request to notify the DHS Legal Services (LS) Appeals Unit that benefits were reopened.Per OAC 340:2-5-70(c), the DHS LS Appeals Unit dismisses the fair hearing request when DHS withdraws the action the client appealed and restores benefits.

17.When the appeal is not decided in the client's favor, the worker sends Form 08MP038E to the client explaining the action taken.

SUBCHAPTER 9. OVERPAYMENT CLAIMS AND FRAUD IN TEMPORARY ASSISTANCE FOR NEEDY FAMILIES AND STATE SUPPLEMENTAL PAYMENT BENEFITS

340:65-9-1. Scope and applicability

Revised 6-1-119-1-18

(a) Scope and applicability.The scope and applicability of overpayment procedures contained in this Subchapter apply to Temporary Assistance for Needy Families (TANF) and State Supplemental Payment (SSP) recipients.

(b) Overpayment claim definition.An overpayment claim occurs when a household receives more benefits than it is entitled to receive.Overpayments may be classified as inadvertent household errors (IHE), agency error (AE), willful misrepresentation, or intentional program violation (IPV), or fraud.

(c) Overpayment referral.When Oklahoma Department of Human Services (DHS) staff suspects an overpayment occurred, he or she sends an overpayment referral to Adult and Family Services (AFS) Benefit Integrity and Recovery (BIR) for an overpayment determination and claim establishment.

(1) Instances whichReasons DHS staff may result insend an overpayment referral to AFS BIR for an overpayment determination include, but are not limited to, when the:

(A) the household:

(i) failed to provide the Oklahoma Department of Human Services (OKDHS) DHS with correct or complete information;

(ii) failed to report changes in its circumstances; or

(iii) elected to receive benefits pending a fair hearing decision, whichthat subsequently found the family ineligible or eligible for fewer benefits; or

(B) the worker:

(i) failed to take prompt action on a change reported by the household;

(ii) incorrectly computed the household's income,and/or deductions, or both; or

(iii) incorrectly authorized issuance of benefits to a household; or

(C) any overissuance is discovered as a result of a Quality Control Reviewan audit or review.

(2) When theThe worker determines that an overpayment claim has occurred, he or she documentsincludes in the overpayment referral, the circumstances leading to the overpayment, if the overpayment occurred because of household or agency error, and computes the amount ofhow he or she computed the overpayment amount.¢ 1When applicable, the overpayment referral may cover up to six years prior to the date the worker discovers the over-issuance.

(A) IfFor TANF, when an over-issuance occurs because the client does not report earned income in a timely manner for Temporary Assistance for Needy Families (TANF) overpayment claimswithin 10-calendar days per Oklahoma Administrative Code (OAC) 340:65-5-1, the client is not allowed an earned income deductionworker calculates the overpayment based on the client's gross earned income without the earned income deduction per OAC 340:10-3-33.

(B) IfFor SSP the client does not report earned income timely for State Supplemental Payment (SSP) overpayment claims, the client is allowed the earned income deduction per OAC 317:35-5-42(d) even when the earned income is reported untimely.

(C) Overpayments may cover up to six years prior to the date the overissuance was discovered.

(d) Overpayment claim establishment.AFS BIR staff is responsible for evaluating overpayment referrals, establishing overpayment claims, and referring overpayment claims to the Office of the Inspector General (OIG) when appropriate per OAC 340:65-9-2 and OAC 340:65-9-4.An overpayment claim is considered established on the date AFS BIR staff sends the overpayment notice to the household.

(1) When AFS BIR staff determines an OIG referral is not appropriate, AFS BIR staff:

(A) establishes the overpayment claim;

(B) classifies the overpayment claim as an IHE, AE, or willful misrepresentation, per OAC 340:65-9-2;

(C) sends the:

(i) Notification of Overpayment, Form 08OP011E, Repayment Agreement and, when appropriate, Form 08OP025E, Chart of Temporary Assistance for Needy Families and State Supplemental Payment Overpayments, to the debtor(s); and

(ii) Notification of Overpayment with supporting documentation to the DHS county office or support center; and

(D) assigns recoupment of the overpayment per OAC 340:65-9-6.

(3)(2) When the worker suspects fraudulent intent but has insufficient information to complete an overpayment referral, he or she sends Form 19MP019E19MP001E, Referral Form, to the Office of the Inspector General (OIG)OIG.

(A) When OIG staff determines thatsuspects an overpayment occurred but a fraud determination is not needed, it is sentOIG staff sends the findings to the Family Support Services Division (FSSD) Benefit Integrity and Recovery Section (BIRS) whereAFS BIR to calculate and establish the claim is calculated.¢ 2

(4) Once the overpayment claim has been calculated and notices sent, the overpayment is considered to be established.The establishment of an overpayment claim is made by the worker's supervisor or staff in FSSD BIRS.¢ 3Notices sent include:

(A) Notification of Overpayment to the client; and

(B) Notification of Overpayment and Form 08OP025E, Chart of Temporary Assistance to Needy Families and State Supplemental Payment Overpayments, to the local human services center (HSC).

(5)(B) The FSSD BIRS staff postpones notification to the client on cases referredWhen OIG staff determines fraud occurred, OIG staff may:

(i) refer a TANF or SSP overpayment claim for a judicial court decision until after a court decision has been made.regarding fraud per OAC 340:65-9-4;

(6)(ii) Forfor TANF overpayment claims, OIG staff may make a referral to the Legal DivisionServices Appeals Unit for an administrative disqualification hearing instead of a court referral; or

(iii) for SSP, send the findings to AFS BIR to calculate and establish the overpayment based on willful misrepresentation.

(e) Case record retention.DHS is mandated to retain case records containing overpayments for three years from the date:¢ 3

(1) the overpayment debt is paid in full; or

(2) AFS BIR staff determines the debt to be uncollectable.This may occur when the debtor(s) dies or files bankruptcy and discharges the debt.

INSTRUCTIONS TO STAFF 340:65-9-1

Revised 6-1-119-1-18

1.(a) When the worker determines that an overpayment claim has occurred, he or she documents the circumstances leading to theThe overpayment andcomputes the amount using the Oklahoma Program Integrity (OPI) system within 30 days of discoveryreferral consists of a memo with supporting documentation that may include, but is not limited to:

(1) Form 08OP025E, Chart of Temporary Assistance for Needy Families and State Supplemental Payment Overpayments;

(2) pay stubs;

(3) an employer statement;

(4) an award letter;

(5) financial institution records;

(6) a deed;

(7) a vehicle title; or

(8) data exchange screen.

(b) The OPI system retrieves paid benefits information and calculates the

overpayment amount based on information provided by the worker.The worker submits the overpayment referral to Adult and Family Services (AFS) Benefit Integrity and Recovery (BIR) by interoffice mail, email to overpayments@okdhs.org, or faxes it to 405-522-0952 within 30-calendar days of discovery, when possible.

(c) DocumentationThe worker includes in the memo the:

(1) the circumstances whichthat caused ineligibility for benefitsthe overpayment including if the:

(A) client reported changes within 10-calendar days; and

(B) overpayment is due to a household or agency error per Oklahoma Administrative Code (OAC) 340:65-9-2;

(2) date the worker discovered an overpayment may have occurred;

(3) dates and months the worker believes the household was completely or partially ineligible for benefits;

(2)(4) monthly gross earned and unearned income and allowable monthly deductionsdeduction calculations used to determine the correct benefit amount, when the overpayment is due to income or deductions.When the income is from a new source, the worker includes the:

(A) date employment began and receipt date of first check; and

(3)(B) receipt date of the first payment for unearned income and receipt date of first payment; and

(4)(5)resources, whichresource amount and thedate resources exceeded allowable standards,and amount of highest known resource during the overpayment periodwhen the overpayment is due to excess resources;

(5) the exact date the worker learned that a possible overpayment occurred, the months there was complete ineligibility, and those months in which there was partial ineligibility; and

(6) a specific statement whether the overpayment was a result of household or agency error (AE) per OAC 340:65-9-2.

2.Office of Inspector General (OIG) staff documents the circumstances leading to the overpayment, including income, resources, or other necessary verification, and sends the information to the Family Support Services Division (FSSD) Benefit Integrity and Recovery Section (BIRS) staff who computesAFS BIR staff to compute the over-issuance amount using the OPI system.

3.Prior to completion, the overpayment claim is shown in pending status in OPI.The establishment of an overpayment is made by the worker's supervisor or staff in the FSSD BIRS within the OPI system.

(1) The worker and supervisor establish any overpayment under $500 due to inadvertent household error (IHE) and any AE overpayment regardless of the amount.

(2) FSSD BIRS staff establish all overpayments $500 and over not due to AE, all overpayments referred by OIG, and all overpayments due to fraud after a determination of fraudulent intent has been made by OIG through the judicial system, an administrative disqualification hearing (ADH), or a signed Form 19MP002E, Disqualification Consent Agreement, or Form 08OP002E, Affidavit of Acknowledgement of Indebtedness.

(3) OPI forwards pending overpayments that are not established by HSC staff to the FSSD BIRS.FSSD BIRS staff reviews these overpayments and, if appropriate, forwards them for investigation to OIG through the OPI system.Once OIG staff completes the investigation, the overpayment is sent back to the FSSD BIRS through OPI to establish the overpayment.

To ensure the Oklahoma Department of Human Services meets the federal requirement, local county office staff must image all overpayment documents submitted to AFS BIR and all documents AFS BIR staff returns to the local county office in the client's case record and annotate within the imaging record details OVERPAYMENTS/DO NOT DELETE.

(1) Examples of documents the worker submits to AFS BIR that must be imaged in the overpayment packet include, but are not limited to:

(A) Form 08OP025E, Chart of Temporary Assistance for Needy Families and State Supplemental Payment Overpayments;

(B) Form 08TW013E, Time and Progress Report; or

(C) paystubs and resource information used to calculate the overpayment.

(2) Examples of documents AFS BIR staff returns to the local county office that must be imaged in the overpayment packet include, but are not limited to:

(A) Form 08AD019E, Program Penalty/Disqualification Notice;

(B) Notification of Overpayment; or

(C) Form 08OP025E when AFS BIR staff make changes to the form.

(3) The case is maintained until three years after the overpayment is fully repaid or deemed uncollectable.The worker checks with AFS BIR staff to make sure these requirements were met.

340:65-9-2. Overpayments by classification

Revised 6-1-119-1-18

(a) Overpayments classified as inadvertent household error (IHE).AnAdult and Family Services (AFS) Benefit Integrity and Recovery (BIR) staff classifies a State Supplemental Payment (SSP) or Temporary Assistance for Needy Families (TANF) overpayment is classified as IHE if the overissuance is caused by a misunderstanding or unintended error on the part of the householdwhen intent to misrepresent cannot be established.Instances of IHE whichthat may result in an overpayment claim include, but are not limited to, when the household unintentionally:

(1) failsfailed to provide the Oklahoma Department of Human Services (OKDHS)(DHS) with correct or complete information;

(2) failsfailed to report changes in household circumstances; or

(3) receiveselected to receive benefits or more benefits than it was entitled to receive pending a fair hearing decision and the fair hearing decision found the family ineligible or eligible for fewer benefits.

(b) Overpayments classified as agency error (AE).AnAFS BIR staff classifies a SSP or TANF overpayment is classified as an AE ifwhen DHS action or failure to take action causes the overissuance is caused by OKDHS action or failure to take action over-issuance.Instances of AE whichthat may result in an overpayment include, but are not limited to, when OKDHS staff:

(1) failsAFS staff failed to take prompt action on a change reported by the household;

(2) AFS staff incorrectly computescalculated the household's income or deductions, or otherwise assignsissued an incorrect benefit amount or benefits to an ineligible household;

(3) the computer system incorrectly issuesapplied benefits to a household, including errors caused byduring an overall updatesupdate or because of other system problems; or

(4) AFS staff incorrectly appliesapplied policy or procedures.

(c) Overpayments classified as willful misrepresentation.Overpayments classifiedAFS BIR staff classifies a SSP or TANF overpayment as willful misrepresentation result from deliberate concealment ofwhen the household deliberately conceals information whichthat, had it beenthe household reported the information, would have initiated case closure or benefit reduction.Willful misrepresentation may be oralverbal or written and may include under reporting of the amount of income or resources or other pertinent information.Debts classified as willful misrepresentation may change in the event they are referred for judicial prosecution or an administrative disqualification hearing (ADH).

(1) When the human services center (HSC) receives the Notification of Overpayment, on debtsnon-exempt resources are known and a debt is classified as willful misrepresentation, but not referred to the Office of Inspector General (OIG), the worker contacts the client andDHS staff requests the client to voluntarily sign Form 08OP002E, Affidavit of Acknowledgment of Indebtedness.If the client refusesRefusal to sign Form 08OP002E, his or herdoes not affect the client's eligibility is not affected.

(2) IfWhen the client voluntarily signs Form 08OP002E and owns real property other than the declared home property, the worker files the signed form with the county clerk of the county in which the real property is located.Filing Form 08OP002E with the county clerk places a lien on the real property.¢ 1

(d) OverpaymentsTANF overpayments classified as intentional program violation or fraud(IPV).An overpayment is classified as intentional program violation or fraud when it is determined that a client has intentionally given false information or withheld facts in order to receive benefits.This determination is made by the Office of the Inspector General (OIG) throughA TANF debt classified as IHE, AE, or willful misrepresentation may change to IPV following an administrative disqualification hearing (ADH)decision, signing Form 08OP016E, Administrative Disqualification Hearing Waiver or Form 19MP002E, Disqualification Consent Agreement, or by judicial court decision.

(e) SSP overpayments classified as fraud.A SSP debt classified as IHE, AE, or willful misrepresentation may change to fraud only after a judicial court decision.Refer to Oklahoma Administrative Code 340:65-9-4 for additional fraud information.

INSTRUCTIONS TO STAFF 340:65-9-2

Revised 6-1-119-1-18

1.(a) Before filing Form 08OP002E, Affidavit of Acknowledgment of Indebtedness with the county clerk's office, the worker checks the legal description of the property to ensure it conforms with the property deed.After filing, the worker sends the original and one copy of the signed Form 08OP002E to theAdult and Family Support Services Division (FSSD)(AFS) Benefit Integrity and Recovery Section (BIRS)(BIR).The remaining copies are filed in the case record.

(b) Refer alsoAlso refer to OACOklahoma Administrative Code 340:65-9-4 and Instructions to Staff.

(c) When the debt is paid in full, the FSSD BIRSAFS BIR or the Legal DivisionServices staff prepares a "Release of State's Lien" and mails it to the appropriate county clerk for filing.The FSSD BIRSAFS BIR staff mails a copy of the lien release of lien to the client or other concerned party, such as a caretaker or legal guardian.

340:65-9-4. Fraud

Revised 6-1-119-1-18

(a) Fraud definition.The term fraud is defined as an intentional false representation of a truth or matter of fact, whether by words or conduct, false or misleading allegations, or concealment of that which should have been disclosed, for the purpose of inducing another to part with something valuable or surrender a legal right.The penalty for fraud is provided in the Oklahoma Social Security Act,Per Section 185 of Title 56 of the Oklahoma Statutes.(56 O.S. § 185), fraud in obtaining public assistance occurs when a person:

(1) obtains or attempts to obtain, or aids, abets, or assists any person to obtain, by means of a false statement or representation, by false impersonation, by a fictitious transfer, conveyance or encumbrance of property or income, by a knowing and willful failure to report to the Oklahoma Department of Human Services (DHS) income, personal property, real property, household members, or other material eligibility factors at the time of application or during the receipt of assistance, or by other fraudulent device, assistance to which an applicant is not entitled or assistance greater than that to which an applicant is justly entitled; or

(2) by sale, barter, purchase, theft, acquisition, possession or use of any electronic benefits or debit card or any other device authorizing participation in the Temporary Assistance for Needy Families (TANF) or other DHS program, knowingly obtains, aids, abets, or assists any person to obtain or attempt to obtain assistance to which a person is not entitled.

(b) Fraud penalty.The penalty for fraud is set forth in 56 O.S. § 185.Under thePer statutes, only courts can determine guilt and impose a legal penalty for fraud.

(b)(c) Office of Inspector General (OIG) referral by AFS BIR staff.TheAdult and Family Support Services Division (FSSD)(AFS) Benefit Integrity and Recovery Section (BIRS)(BIR) staff refersmay refer household error overpayments of $500 or more to the Office of Inspector General (OIG)for a determination of fraud and whetherto determine if a referral for judicial court action is feasiblewarranted.

(c)(d) OIG referrals by workers.Workers use Form 19MP001E, Referral Form, to make aan investigative referral directly to OIG using Form 19MP001E, Referral Form, when they suspect fraudulent intent, but there is not sufficientinsufficient information to calculate an overpayment or itthe referral involves a state employee and/or his or her relatives.

(e) OIG findings.OIG staff submits their findings to FSSD BIRSAFS BIR for final overpayment calculation and establishment of the overpayment.When OIG returns the overpayment to AFS BIR and a fraud determination is not made per (f) or (g) of this Section, the AFS BIR staff proceeds to collect the debt.¢ 1

(f) Fraud determination for State Supplemental Payment (SSP) overpayments.

(1) Overpayments classified as For SSP, a fraud are overpayments that have been referred fordetermination is made when the local, state, or federal court official agrees to pursue judicial prosecution and the court finds the debtor(s) guilty of fraud.The debtor(s) is not subject to disqualification when the court determines fraud occurred; however, he or she may be subject to some or all of the fraud penalties in (b) of this Section.

(g) Intentional program violation (IPV) determination for TANF overpayments.For TANF, an IPV determination is made, when:

(1) the local, state, or federal court official agrees to pursue judicial prosecution and the court finds the debtor(s) guilty of fraud.When the court decision is a deferment, the prosecutor asks the accused person to sign Form 19MP002E, Disqualification Consent Agreement;

(2) Legal Services Appeals Unit staff holds an administrative disqualification hearing and, as a result, have been determined as fraudulentand determines intentional program violation; or

(3) when the clientdebtor(s) signs Form 08OP016E, Administrative Disqualification Hearing Waiver, or Form 19MP002E, Disqualification Consent Agreement.

(h) TANF program penalty for overpayments classified as an IPV.ClientsDebtor(s) with TANF overpayments classified as fraud arean IPV may be subject to the actions described in (A) through (C) of this paragraph.

(A) Notification Program Penalty/Disqualification Notice is sent to the penalized Temporary Assistance for Needy Families (TANF) client.The notice informs the TANF client of a 25%percent payment standard reduction penalty per Oklahoma Administrative Code 340:10-3-57(g) in addition to the requirement to repay the overpayment.

(B)(1) Penalty period.A TANF client is penalized with aAFS BIR staff applies the 25%percent payment standard reduction penalty period for:

(A) 12 months for the first violation,;

(B) 24 months for the second violation,; and

(C) permanently for the third violation.

(2) AFS BIR mails the Program Penalty/Disqualification Notice to the debtor(s).The notice informs the debtor(s) of the:

(A) IPV determination;

(B) 25 percent payment standard reduction penalty; and

(C) date the penalty period starts and ends.

(C)(3) Penalty effective date.The 25%percent payment standard reduction penalty begins on the date shown on the notice.Once the payment standard reduction penalty begins, it runs continuously until the end of the period imposed regardless of whether the debtor(s) receives TANF benefits during the penalty period.

(2)(i) When a court finds the debtor(s) guilty of fraud.If the case is prosecuted, OIG notifies the human services center (HSC) and the FSSD AFS BIR of the disposition of the case.IfWhen the court finds the clientdebtor(s) guilty of SSP or TANF fraud, the court may order a fine, restitution, imprisonment, or any combination of the three per (b) of this Section.The Oklahoma Department of Human Services (OKDHS)DHS abides by the court decision.¢ 2

(3)(1) Court-ordered restitution does not relieve the clientdebtor(s) of any overpayment amount in excess of thatthe judgment.

(2) When the court stipulates a repayment plan, DHS does not renegotiate the repayment plan with the debtor(s) unless the debtor(s) sentence expired and the court has no action pending against the debtor(s).¢ 3

(A)(3) IfWhen the clientdebtor(s) defaults on court-ordered restitution, the court may accelerate the sentence,may be accelerated.

(B) If the sentence is accelerated and which may include the client servesdebtor(s) serving a prison term,.serving theServing a prison term does not satisfy repayment of the debtor(s)’ responsibility to repay the monetary portion of the debt.At that point the debt may be subject to civil prosecution.

(C)(4) The fact that a client is making restitution payments does not relieve the client of the obligation to sign Form 08OP002E, Affidavit of Acknowledgment of Indebtedness.Home property and personal property are exempt from this process.A lien may also be filed on declared real property ifwhen Form 08OP002E indicates property is owned.¢ 34

(4) If OIG releases the case without a court decision or Form 08OP016E signed by the client, the FSSD BIRS staff proceeds to collect the debt.In some instances, OIG discovers additional information that affects the overpayment.The OIG gives this information to the FSSD BIRS so staff can adjust the overpayment.

INSTRUCTIONS TO STAFF 340:65-9-4

Revised 6-1-119-1-18

1.The Family Support Services Division (FSSD) Benefit Integrity and Recovery Section (BIRS) makes referrals to the Office of Inspector General (OIG) using the Oklahoma Program Integrity (OPI) system.

(a) Office of Inspector General (OIG) findings include:

(1) a description of the investigation;

(2) documents acquired in the course of the investigation that prove the overpayment amount or that the client intentionally withheld information that would have reduced or closed the client's benefits; and

(3) Form 08OP016E, Administrative Disqualification Hearing Waiver, when signed by the debtor(s).

(b) When OIG staff discovers additional information after releasing the overpayment, he or she sends the information to Adult and Family Services (AFS) Benefit Integrity and Recovery (BIR).AFS BIR staff reviews the information to determine whether to adjust the overpayment.

2.(a)Oklahoma Department of Human Services (OKDHS)Only AFS BIR or OIG staff MUST NOTmay discuss the overpayment with the clientdebtor(s)until court action is completed or the FSSD BIRSAFS BIR staff notifies the local human services center (HSC)DHS county office or support center of any action to be taken.All other staff MUST NOT discuss the overpayment with the client while court action is pending.LocalDHS county staff forwards further information or directs client inquiries to the FSSD BIRSAFS BIR or the OIG.

(b) The court may stipulate a repayment plan.The repayment plan cannot be renegotiated.

3.The Office of the Inspector General (OIG) staff may refer the case back to the district attorney's office ifwhen the clientdebtor(s) fails to comply with the repayment plan and the debtor(s)' sentence has not expired.

34.Filing Form 08OP002E, Affidavit of Acknowledgment of Indebtedness, with the county clerk places a lien on the real property.Before filing Form 08OP002E, the worker checks the legal description of the property to ensure it conforms with the property deed.After filing, the worker sends the original and one copy of Form 08OP002E to the FSSD BIRSAFS BIR.The remaining copies are filed in the case record.In all other situations, if the client voluntarily signs Form 08OP002E, the worker sends the original and one copy of the signed Form 08OP002E to the FSSD BIRS and files the remaining copies in the case record.

340:65-9-5. Right to appeal

Revised 6-1-119-1-18

If there is a disagreementWhen the household disagrees with the overpayment decision and the client has not signed Form 08OP16E, Administrative Disqualification Hearing Waiver, the household may request a fair hearing within 30-calendar days of the date on the Notification of Overpayment.Per Oklahoma Administrative Code 340:2-5-63, an item mailed by the Oklahoma Department of Human Services is presumed received on the second day mail is delivered following the date on the notice.¢ 1

INSTRUCTIONS TO STAFF 340:65-9-5

Revised 6-1-119-1-18

1.When the clientdebtor(s) disputes the overpayment decision, the client and worker complete Form 13MP001E, Request for a Fair Hearing, and the worker sends the form to the Legal Services Appeals Unit.ThePrior to the hearing, the worker also completes Form 13MP002E, Hearing Summary, and provides all necessary information for the hearingsends the form and applicable documentation to the Legal Services Appeals Unit and the debtor(s).TheAdult and Family Support Services Division (FSSD) Benefit Integrity and Recovery Section (BIRS) staff is available for consultation as needed.Refer to OACOklahoma Administrative Code 340:2-5 for fair hearing procedures.

340:65-9-6. Development of repayment

Revised 6-1-119-1-18

(a) Repayment of established overpayments.Households must make repayment on all established overpayments regardless of the reason for theoverpayment.

(1) Adult and Family Support Services Division (FSSD)(AFS) Benefit Integrity and Recovery Section (BIRS)(BIR) staff initiates collection efforts against all adult household members who were included in the benefit at the time the overpayment occurred except members who have filed bankruptcy or are deceased.

(2) Collection may be received from two separate householdsmore than one household for the same claim when responsible debtors separate.The FSSD BIRSAFS BIR staff sends the clientdebtor(s) the Notification of Overpayment that explains the acceptable methods of repayment for the debt classification.¢ 1

(3) When the debtor(s) requests a fair hearing regarding the overpayment within 30-calendar days of the Notification of Overpayment issuance date, collection is suspended until after the hearing decision is made.

(b) Repayment options.The debtor(s) may repay an overpayment:¢ 1

(1) Payment in full.The client may repay an overpayment in one lump sum by personal check, money order, or cashier's check.; ¢ 2

(2) Monthly payments.The client may repay an overpayment in regular monthly installments by personal check, money order, or cashier's check.; or¢ 2

(3) Benefit reduction.by benefit reduction, also known as recoupment.¢ 3

(A) Agency error (AE).The FSSD BIRS When the debtor(s) continues to receive State Supplemental Payment or Temporary Assistance for Needy Families (TANF), AFS BIR staff processes arecoups the debtor(s)’ monthly benefit by 10% reduction in the client's monthly allotmentpercent, rounded up to the nearest dollar, for all overpayment classifications.

(B) Inadvertent household error (IHE), willful misrepresentation. The FSSD (BIRS) staff processes a 10% reduction in the client's monthly allotment.

(C) Fraud.The FSSD BIRS staff processes a10% reduction in the client's monthly allotment as well as the When a TANF overpayment is due to an intentional program violation, in addition to recoupment, AFS BIR staff also applies a 25%percent, rounded up to the nearest dollar, payment standard reduction penalty for Temporary Assistance for Needy Families (TANF) benefitsper Oklahoma Administrative Code 340:10-3-57(g).

(c) Monthly statement.When the debtor(s) does not repay the overpayment in full, a monthly statement is computer-generated around the 20th of each month and sent to the debtor(s) when appropriate.¢ 4

(4)(d)Recoupment rate changes.

(A) The recoupment rate cannot be changed unless the overpayment or the benefit received by the client is less than the recoupment amount.

(1) IfWhen the benefit amount is less thanequal to the specified percentage recoupment amount specified, athe full benefit is not issued howeverrecouped and the case remains active and a medical card is issued.¢ 5The client may request recoupment not be initiated ifWhen the client requests a fair hearing regarding the overpayment is filed within 30-calendar days of the issuance date of the Notification of Overpayment, recoupment is suspended until a hearing decision is made.

(B)(2) When AFS BIR staff initiates or terminates recoupment is initiated or terminated, the client is notified by a computer-generated notice is sent to the client stating the new benefit amount and its effective date.

(d) Repayment plan reconsideration.The debtor(s) may request reconsideration of the repayment plan by submitting changes in family and financial circumstances directly to AFS BIR.AFS BIR staff makes adjustments to the repayment plan when circumstances warrant.¢ 6

INSTRUCTIONS TO STAFF 340:65-9-6

Revised 6-1-119-1-18

1.(a) Human services center (HSC) procedures for maintaining cases with established overpayments.

(1) Upon notification by Family Support Services Division (FSSD) Benefit Integrity and Recovery Section (BIRS) of the establishment of a debt, the case record is marked with “DO NOT DESTROY.”The case is maintained in the active case files until the debt is paid in full.Restitution cases are never destroyed.

(2) Until the overpayment is paid in full, the case record must have an OVERPAYMENT SECTION in the working case that includes:

(A) a copy of the original referral memorandum or a copy of the Case Comments in the Oklahoma Program Integrity (OPI) system;

(B) Form 08OP025E, Chart of Temporary Assistance to Needy Families and State Supplemental Payment Overpayments;

© any documentation and verification used to determine the overpayment; and

(D) completed forms that established the overpayment, including the copy of the Notification of Overpayment, that was sent to the client.

(3) It is recommended that the HSC have a system for identifying Temporary Assistance for Needy Families (TANF) households that are assessed with a payment standard reduction 25% penalty income.

(b) Types of repayment.

(1) Recoupment.Recoupment is coded by the OPI system at the time the client is notified of the overpayment.The Notification of Overpayment advises the client of any change in benefits at the beginning of the recoupment process.The person responsible for repayment is the debtor(s) which may include the payee of the case,and any other adult who was included in the benefithousehold at the time the overpayment occurred, and any other adults deemed responsible for the incident of the overpayment.Examples of adults not included in the household who may be responsible for repayment include adults that trafficked the household's benefits or a person acting as an authorized representative for the household.

2.(2) Monthly payments.Repayment of an overpayment may be madeThe debtor(s) may choose to make a voluntary payment in one lump sum by personal check, money order, or cashier's check, or make monthly payments.Monthly payments do not necessarily absolve the debtor(s) of other collection actions that may be warranted.Payment may be submitted any date after the overpayment is established.

(A)(1) Clients are instructedForm 08OP011E, Repayment Agreement, instructs the debtor(s) not to send cash through the mail.

(B) The HSC or FSSD may accept cash if it is impossible for the client to make payments by personal check, money order, or cashier's check.

(C) A receipt is given to the client if cash payment is received.

(D)(2) Any money received isPayments may be sent to the Oklahoma Department of Human Services Finance DivisionFinancial Services, P.O.PO Box 53306248893, Oklahoma City, OKOklahoma73152-911673124-9914.

3.Adult and Family Services (AFS) Benefit Integrity and Recovery (BIR) staff enters the recoupment code in the system to reduce the client’s monthly benefit and a computer-generated notice is sent to notify the client of the new benefit amount.

4.(c) Collection notice.Monthly statements are computer-generated on approximately the 20th day of each month.For example, a monthly statement does not computer-generate when the debtor(s) moves and does not inform DHS.The information contained on these statements includesmonthly statement includes the:

(1) statement date;

(2) clientaccount identification number;

(3) overpayment case number(s);

(4) clientdebtor(s) name and address;

(5) new overpayment amounts;

(6) itemized payment amount, payment dates, and new overpayment amounts since the last billing cycle;

(7) billing date;

(8) account balance; and

(9) overpayment balances by program.

(d) HSC staff notifies the FSSD BIRS of any address change or case number assignment for a client having an established overpayment.

5.Because the specified percentage recoupment amount is rounded up to the nearest dollar, it may be equal to the benefit amount.For example, when the benefit amount is one dollar and the specified percentage is 10 percent, the specified percentage would be 10 cents if not for rounding.Because of rounding, the specified percentage is one dollar which reduces the benefit amount to zero.

6.Per Oklahoma Administrative Code 340:65-9-4(i), AFS BIR staff does not renegotiate the repayment plan with the debtor(s) when the court stipulates a repayment plan unless the debtor(s) sentence expired and the court has no action pending against the debtor(s).

340:65-9-7. Suspension of collection efforts

Revised 6-1-089-1-18

(a) TheAdult and Family Support Services Division (FSSD)(AFS) Benefit Integrity and Recovery Section(BIR) suspends collection noticeefforts on cases no longer receiving benefits, when the:

(1) head of household is deceased and there are no remaining household membersdebtors responsible for the overpayment;

(2) household cannot be located; ¢ 1

(3) cost of further collection action is likely to exceed the amount that can be recovered; or

(4) client notifies the FSSD Benefit Integrity and Recovery Sectiondebtor(s) provides verification to AFS BIR, that bankruptcy proceedings have been initiated; or

(5) debtor(s) requests a fair hearing.

(b) FSSD Benefit Integrity and Recovery SectionAFS BIR may begin collection actions held in suspension based onwhen changes in household circumstances.The FSSD Benefit Integrity and Recovery Section initiates reduction in the benefit ifoccur, such as:

(1) AFS BIR staff locates the household when the client reapplies and becomes eligible in the future;

(2) the court dismisses instead of discharging the debt through bankruptcy; or

(3) the fair hearing decision is not in the debtor(s)' favor.¢ 2

INSTRUCTIONS TO STAFF 340:65-9-7

Issued 9-1-18

1.This occurs when the United States Postal Service returns the monthly account statement to the Oklahoma Department of Human Services with no forwarding address and Adult and Family Services (AFS) Benefit Integrity and Recovery (BIR) staff is unable to find another address for any responsible household member.

2.When the appeal is found in favor of the debtor(s), Financial Services staff reimburses owed direct payments and AFS BIR staff reimburses owed recoupment.

340:65-9-8. Termination of collection of debt (Instruction to staff only)

Revised 6-1-11

In the case of repayment in full, the household is notified that the debt has been satisfied by a monthly overpayment account statement showing a zero balance owed.¢ 1

INSTRUCTIONS TO STAFF 340:65-9-8 [REVOKED]

Revised 6-1-11

1. (a) Collection statements are suspended:

(1) when the Family Support Services Division (FSSD) Benefit Integrity and Recovery Section (BIRS) staff is unable to locate any responsible household member;

(2) after the monthly account statement is returned by the United States Postal Service; or

(3) by a decision of FSSD BIRS staff.

(b) When the client requests a fair hearing, BIRS staff enters information in the Oklahoma Program Integrity (OPI) system to suspend all collection activity, including recoupment.If the appeal is found in favor of the client, the Finance Division reimburses any collected direct payments and BIRS staff reimburse any collected recoupment.

(c) Upon notification by FSSD BIRS of the establishment of debt, human services center (HSC) staff labels the case record with "DO NOT DESTROY."

(1) The case is maintained in the active case files until repayment has been made in full.The worker checks the OPI system to determine whether the overpayment has been paid in full before destroying a case record.

(2) When the overpayment has been paid in full, HSC staff pulls the case record, removes the "DO NOT DESTROY" label, and handles the case in the usual manner.

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