New Mexico Register / Volume XXXII, Issue 4 / February 23, 2021
This is an Amendment to 8.15.2 NMAC, Sections 7 through 21, effective 3/1/2021.
8.15.2.7 DEFINITIONS:
A. “Attending a job training or educational
program” means actively participating in [a job] an in-person or
online job training or educational program.
B. “At-risk child care” means a program
for families at-risk [of child protective services involvement] as
determined by the department.
C. “CACFP” means the child and adult care food program, administered by the children, youth and families department.
D. “Child with a disability or special needs” means a child with an identified disability, health, or mental health conditions requiring early intervention, special education services, under an individualized education plan (IEP) or an individualized family service plan (IFSP), or other specialized services and supports; or children without identified conditions, but requiring specialized services, supports, or monitoring.
[E. “Child support
enforcement division” means the child support enforcement program
administered by New Mexico’s human services department, which collects child
support from non-custodial parents.]
E. “Client” means the parent or legal guardian of the child that the department has determined is eligible for child care assistance benefits.
F. “Closure” means the client’s child care case is closed with the department.
G. “Co-payment” means the portion of the approved and agreed upon monthly child care cost for clients receiving child care assistance that the client is required to pay to the child care provider. The department’s payment to the provider is reduced by the co-payment amount.
H. “Demonstration of incapacity”
means written documentation that an individual is unable to fulfill an
eligibility requirement, such as work, school, or the ability to provide child
care, and should otherwise be excluded, in whole or in part, from the
determination of eligibility. Written
documentation of incapacity includes, but is not limited to, the
following: statements or letters on a
physician’s/medical professional’s/treatment provider’s letterhead stationary;
statements, records or letters from a federal government agency that issues or
provides disability benefits; statements, records or letters from a state
vocational rehabilitation agency counselor; records or letters from a treatment
facility/counselor; certification from a private vocational rehabilitation or
other counselor that issues or provides disability benefits.
[H.] I. “Department” means the New Mexico
children, youth and families department (CYFD).
[I.] J. “Earned income” means income received
as gross wages from employment or as profit from self-employment.
K. “Fluctuation of earnings”
means a family with inconsistent or variable income throughout the year. To calculate fluctuation of earning the
department may:
(1) average family earnings over a period of time (e.g., 12
months); or
(2) choose to discount temporary increases in income provided
that a family demonstrates an isolated increase in pay (e.g., short-term
overtime pay, temporary increase to pay, etc.) and is not indicative of a
permanent increase in income.
[J.] L. “Homeless children and youth” means
individuals who lack a fixed, regular, and adequate nighttime residence, which
includes:
(1) Children and youth who are temporarily sharing the housing of other persons due to loss of housing, economic hardship, or a similar reason; are living in motels, hotels, trailer parks (excludes mobile homes), or camping ground due to the lack of alternative adequate accommodations; are living in emergency or transitional shelters; are abandoned in hospitals; or are awaiting foster care placement;
(2) children and youth who have a primary nighttime residence that is a public or private place not designed for or ordinarily used as a regular sleeping accommodation for human beings;
(3) children and youth who are living in cars, parks, public spaces, abandoned buildings, substandard housing, bus or train stations, or similar settings; and
(4) migratory children who qualify as homeless for the purposes of this subtitle because the children are living in circumstances described in Paragraphs (1) through (3) of this subsection.
M. “Household” means the household as defined below in Paragraph (1) of Subsection C. of 8.15.2.11 NMAC.
N. “Household
income” means household income as defined below in Paragraph (3) of
Subsection C. of 8.15.2.11 NMAC.
[K.] O. “Incidental money” means earnings of a
minor child for occasional work performed such as baby-sitting, cutting lawns,
and other similar activities.
[L.] P. “Infant, toddler, preschool, school age”
means the age categories used for assigning child care provider reimbursement
rates, defined as follows:
(1) infant: zero - 23 months;
(2) toddler: 24 -35 months;
(3) preschool: three to five year olds; and
(4) school age: six year olds and older.
[M.] Q. “Job
training and educational program” means participation in a short or long
term educational or training program, including online programs [which
provides] that provide specific job skills which allow the participant
to enter the workforce and directly relates to enhancing job skills, including
but not limited to the acquisition of a general equivalency diploma (GED),
English as a second language, literacy training, vocational education training,
secondary education including adult basic education and accredited high school
programs, and post-secondary institutions.
[N.] R. “National accreditation status” means
the achievement and maintenance of accreditation status by an accrediting body
that has been approved by CYFD. CYFD
determines the program criteria and standards to evaluate and approve
accrediting bodies.
(1) The following are the only national accrediting bodies that are approved by CYFD:
(a) the association of Christian schools international (ACSI);
(b) the council on accreditation (COA) for early childhood education and after school programs;
(c) the international Christian accrediting association (ICAA);
(d) the national accreditation commission for early care and education programs (NAC);
(e) the national association for the education of young children (NAEYC) academy for early childhood program accreditation;
(f) the national association of family child care (NAFCC); or
(g) the national early childhood program accreditation (NECPA).
(2) Effective July 15, 2014 accrediting bodies that have been previously approved by CYFD that are not on the above list will no longer be CYFD approved national accrediting bodies.
[O.] S. “Non-temporary
change in activity” means the family has experienced a change in activity
that does not meet the definition of a “temporary change in activity” as
defined in Section [CC] HH below.
[P.] T. “Non-traditional hours of care” means
care provided between the afterhours of 7:00 p.m. and 7:00 a.m. Monday through
Friday or care provided during weekend hours between 12:00 a.m. Saturday
morning and 12:00 a.m. Monday morning.
[Q.] U. “Open case”
means a case that has not been closed as a result of a failure to recertify, or
that has not been closed due to becoming otherwise ineligible for child care
assistance benefits.
[R.] V. “Overpayment” means a payment of child
care assistance benefits received by a client or provider for which they are
ineligible based on incomplete or inaccurate information provided by either the
client or the provider, or agency error.
[S. “Child Protective
services (CPS) child care”
means child care services for children placed in the custody of the child
protective services of the department.]
[T.] W. “Provider types” means the
characteristics of child care providers, which determine their approved
reimbursement rate, capacity, staffing levels etc. as follows:
(1) “In-home” care means care provided in the child’s own home.
(2) “Registered home” means child care provided in the home of a provider who is registered with the department to care for up to four children. All registered homes receiving child care assistance subsidies must be enrolled and participate in the child and adult care food program (CACFP), unless they are exempt.
(3) “Licensed family child care home” means child care provided in the home of a provider who is licensed by the department to care for up to six children.
(4) “Licensed group child care home” means child care provided in the home of a provider who is licensed by the department to care for up to 12 children.
(5) “Licensed center” means child care provided in a non-residential setting, which is licensed by the department to provide such care.
(6) “Out-of-school time care” means child care provided to a kindergartner or school age child up to age 13 immediately before or immediately after a regularly scheduled school day or when regular school is not in session.
(7) “Friend,
family, or neighbor (FFN)” means care to be provided temporarily in a home
to be self-certified by the parent or legal guardian and registered by the
department, not to exceed six months. In
the case of a public health emergency, the department may extend the temporary
status.
[U.] X. “Recertification” means the process by
which a client’s eligibility to continue to receive child care assistance
benefits are determined.
[V.] Y. “Registration/educational fee” means a
fee charged to private pay and families receiving child care assistance for
materials and supplies.
Z. “Sanctions”
means a measure imposed by the department for a violation or violations of
applicable regulations.
[W.] AA. “SNAP” means the supplemental nutrition
assistance program administered by the U.S. department of agriculture, which
helps low-income families purchase healthy food. SNAP was previously referred to as food
stamps employment and training program.
BB. “Special supervision” means the special supervision for child(ren) as defined below in Subsection G of 8.15.2.11 NMAC.
[X.] CC. “Star level” means a license indicating the level of quality of an
early childhood program. A greater
number of stars indicates a higher level of quality.
[Y.] DD. “Suspension” means [that the child
care case remains eligible, but benefits are not paid to the provider] the
voluntary cessation of child care benefits at the client’s request, during
which the client remains eligible.
[Z.] EE. “TANF” means the temporary assistance
to needy families program administered by the U.S. department of health and
human services. TANF is the successor to
the aid to families with dependent children (AFDC) program and provides cash
assistance to qualified low-income families with dependent children.
[AA.] FF. “Teen parent” means a biological parent
under the age of 20 who is attending high school, working towards a general
equivalency diploma (GED) or attending any other job skills training or
educational programs directly related to enhancing employment opportunities.
[BB.] GG. “Termination” means the client’s child care case will
be closed due to cause.
[CC.] HH. “Temporary change of activity” means
one of the following events that does not exceed three months:
(1) limited
absence from work for employed parents or legal guardians for periods of
family leave (including parental leave) or sick leave;
(2) interruption
in work for a seasonal worker who is not working between regular industry work
seasons;
(3) student
holiday or break for a parent or legal guardian participating in
training or education;
(4) reduction
in work, training or education hours, as long as the parent or legal
guardian is still working or attending training or education; and
(5) cessation
of work or attendance at a training or education program less than [90 days]
three months.
[DD.] II. “Underpayment” means a payment made by
the department for services provided which did not fully reimburse the client
or provider.
[FF.] KK. “Working” means employment of any type, including self-employment and
teleworking. For TANF recipients,
this includes work experience or community service or any other activity that
meets the TANF work activity requirements.
[8.15.2.7 NMAC - Rp, 8.15.2.7 NMAC 10/1/2016, A, 2/1/2017; A, 10/1/2019, A/E, 9/18/2020; A, 3/1/2021]
8.15.2.8 TYPES OF CHILD CARE: These policies apply to child care assistance benefits provided to eligible children for the following types of child care to ensure that parents or legal guardians have a variety of child care services from which to choose:
A. licensed child care programs administered by public schools and post-secondary institutions that provide on-site care for the children of students;
B. licensed child care programs administered by tribal entities;
C. licensed child care programs administered by church or religious organizations;
D. in-home care;
E. licensed child care centers;
F. registered family childcare homes;
G. licensed family and group childcare homes;
H. licensed
out of school time programs; [and]
I. licensed
programs operated by employers for their employees[.]; and
J. FFN.
[8.15.2.8 NMAC - Rp, 8.15.2.8 NMAC, 10/1/2016; A, 3/1/2021]
8.15.2.9 PRIORITIES FOR ASSISTANCE: Any funds received by the department under the child care development fund and other sources are expended for child care assistance pursuant to the following priorities:
A. Priority one: Clients receiving temporary assistance to needy families (TANF) benefits to include TANF diversionary payment, are considered priority one clients.
(1) Participation exemption: The human services department (HSD) grants participation exemptions to TANF clients who cannot locate child care. The children, youth and families department is responsible for the verification of the TANF participant’s inability to locate child care. Reasons for a participation exemption due to lack of child care are as follows:
(a) the unavailability of appropriate child care within a reasonable distance from the individual’s home or work site;
(b) the unavailability or unsuitability of informal child care by a relative or under other arrangements; or
(c) the unavailability of appropriate and affordable formal child care by a relative or under other arrangements.
(2) A
person who applies for participation exemption for any or all of the above
reasons is referred to the children, youth [&] and families
department child care resource and referral.
The child care resource and referral assists the client with location of child care. The final validation/verification of a
client’s inability to locate child care is determined by the child care services
bureau supervisor in conjunction with his/her supervisor. A client who receives a participation
exemption due to lack of child care is required to re-apply for the exemption
every six months. If a person disagrees
with the determination of their eligibility for a participation exemption, they
may apply for a fair hearing with [the human services department (HSD)] HSD. HSD is responsible for providing notice of
the approval or denial of a participation exemption.
B. Priority one A: [RESERVED]
C. Priority one B: Child care assistance for income eligible families whose income is at or below one hundred percent of the federal poverty level, adjusted annually in accordance with federal guidelines. The department prioritizes child care services within priority one B for children with special needs, disabilities, homeless families, and for teen parents.
D. Priority two: Families transitioning off TANF and clients who have received a TANF diversionary payment. Clients must have received TANF for at least one month, or a diversionary payment, in the past 12 months in order to qualify for priority two. Only clients transitioning off TANF whose TANF cases are closed at least in part due to increased earnings or loss of earned income deductions or disregards are eligible for priority two. Priority two clients do not have to meet income eligibility requirements during their 12 consecutive month period of eligibility for priority two child care.
E. Priority three: [RESERVED]
F. Priority four: Child care assistance for families whose income is above one hundred percent of the federal poverty level but at or below two hundred percent of the federal poverty level, adjusted annually in accordance with federal guidelines. These families are certified for a 12 month block of time and will remain eligible at or below two hundred fifty percent of the federal poverty level. Exceptions to the 12 month certification period are included in 8.15.2.11 NMAC. The department prioritizes child care services within priority four for children with special needs, disabilities, homeless families, and for teen parents.
[G. Child
protective services (CPS) child
care: The department pays for CPS child
care as determined by the protective services of the department. Income requirements and copayments are
waived for clients in this priority.]
[H.] G. [At-risk child care] Priority five: In addition to these priorities, the
department pays for at-risk [protective services] child care as approved
by the department. Child care benefits
are provided for a minimum of six months to support the family. Income, work and education
requirements and copayments are waived for clients in this priority.
[8.15.2.9 NMAC - Rp, 8.15.2.9 NMAC, 10/1/2016; A; 10/1/2019; A/E, 9/18/2020; A, 3/1/2021]
8.15.2.10 APPLICATION PROCESS:
A. Clients
apply for child care assistance benefits by presenting the following documents
to establish eligibility [in person at the local child care office. Upon a need or request by the client, the
department may approve a client to submit their initial application by fax,
email, or mail. Clients shall have 14
calendar days after initial submission of an application to submit all other
required forms. Under documented
extenuating circumstances and with approval from the early childhood services
director, clients may be given longer than 14 days but no more than 30 days to
submit required documentation]:
(1) a completed signed application form;
(2) [current
proof of earned income or participation in the temporary assistance to needy
families (TANF) program; social security numbers or assigned TANF
identification numbers may be used to verify TANF participation or receipt of
child care support] documentation of current countable earned and
unearned income as listed below and defined in Paragraph (5) of Subsection C of
8.15.2.11 NMAC;
(3) documentation of the applicant’s TANF
eligibility or participation, if applicable, and can include applicant’s social
security number or assigned TANF identification number;
[(3)] (4) school schedule or
verification of educational activity, if applicable;
(5) demonstration of incapacity for parent or legal guardian, if applicable;
[(4)] (6) verification of
birth for all applicant’s household children;
(7) documentation of qualifying
immigration status, as defined by the United States department of health and
human services, administration for children and families, office of child care,
for all children requesting child care assistance;
[(5) proof
of unearned income;]
[(6)] (8) [proof] documentation
of New Mexico [home address] residency; and
[(7)] (9) [CYFD] department
approved provider.
B. The
department may approve a client to submit their initial application by fax,
email, electronic submission, or mail. Clients
shall have 14 calendar days after initial submission of an application to
submit all other required forms. Upon
approval from the child care regional manager, clients may be given longer than
14 calendar days, but no more than 30 calendar days, to submit required
documentation.
[B.] C. Assistance is provided effective the first
day of the month of application if all of the following apply:
(1) the client is utilizing child care services;
(2) the client is employed, attending school or a training program. In the case of a public health emergency, the department secretary may waive the requirement for employment, attending school or a training program; and
(3) the
[eligible] provider is eligible to be paid [was providing care
from the first day of the month forward].
[8.15.2.10 NMAC - Rp, 8.15.2.10 NMAC, 10/1/2016; A/E, 03/16/2020; A, 8/11/2020; A/E, 9/18/2020; A, 3/1/2021]
8.15.2.11 ELIGIBILITY REQUIREMENTS: Clients are eligible for child care assistance benefits upon meeting the requirements for eligibility as determined by the department and federal regulation.
A. Child
care staff will initiate communication at the initial [eligibility]
determination of their eligibility period to provide outreach and consumer
education with a case management approach and coordination of services to
support families.
B. Eligibility
period: Based upon the client meeting
all eligibility requirements, a 12-month certification period will be granted.
(1) Eligibility
may be granted for less than 12 months at the parent or legal guardian’s
request.
(2) [Eligibility
for CPS and a at] At-risk child care may be granted for less than 12
months as determined by the department.
(3) Eligibility may be granted for up to
three months for seeking employment. The
eligibility may be closed if the client fails to obtain a qualifying activity
within three months. The department has
the discretion to extend the job search period.
[(3)] (4) The client will remain
eligible if a temporary change of activity occurs.
[(4)] (5) If a client experiences a
non-temporary change in activity, the client will no longer be eligible to
receive assistance if another activity is not obtained within the three-month
grace period.
C. Income
eligibility determination:
(1) The
household: The household includes
biological parents, stepparents, [and] legal guardians of the
child(ren) for whom child care assistance is sought, and any legal dependents
of the aforementioned, living in the
household, thereby constituting an economic unit[, and any dependents of the
aforementioned who are under 18 years of age.
Grandparents will be considered household members only if they are legal
guardians of the children, are providing for the physical and emotional needs
of the children, and are applying for child care benefits on behalf of the
children]. Grandparents who are
not legal guardians living in the household are counted as members of the
household, but their earned and unearned income is excluded from the
eligibility calculations. Periods of
absences: A household member may be
absent from the home and will be considered as living in the home and be
counted in the household composition as long as the absent household member
plans to return to the home. Any parent
or legal guardian who remains in the home must be working, attending school, or
participating in a job training or educational program. Temporary absence may include, but are not
limited to, attending school, working, training, medical or other treatment, or
military service.
(2) [Allowed exclusions from the household for co-payment
calculation only: Excluded from the
household for co-payment calculation purposes only are grandparents or legal
guardians who have taken custody/guardianship of children due to circumstances
such as but not limited to death of biological parents or other documented
circumstances such as mental or physical incapacity of biological parents to
care for the child or children.
Grandparents or legal] Legal guardians who are not the
parents of the child(ren) for whom child care assistance is sought, in
this situation are required to qualify for child care assistance as per
Paragraph [(4)] (3) below and, upon qualification, have the
required co-payment waived.
[(3) Adult dependent children:
18 year old dependent children must be attending school to be counted in
the household. Incidental money earned
by dependent children is not to be counted as household income.]
[(4)] (3) Household
income: [Income eligibility for
benefits is determined by the number of members in the household and the total
countable gross earned and unearned income.
Eligibility determinations will take into account irregular fluctuations
of earnings to income based on the client’s individual circumstances.] The
household’s gross monthly or annual average countable earned and unearned
income, taking into account any fluctuation(s) of earnings, and will always be
calculated in favor of eligibility.
Household income does not include any earned and unearned income
received by grandparents who are not legal guardians, and any legal dependents
of the biological parents, stepparents, or legal guardians of the child(ren)
for whom child care assistance is sought, living in the household.
[(5)] (4) Family
assets: A family’s assets may not exceed
one million dollars.
[(6)] (5) Countable earned
and unearned income: The following
sources of income are counted when computing a family’s eligibility for
assistance and for determining the co-payment (if applicable): income from employment by working for others
or from self-employment; [child support payments;] alimony payments;
veterans administration (VA) payments except VA payments [for educational
purposes and disability] that are specifically exempted in Paragraph (6)
of Subsection C of 8.15.2.11 NMAC; [union payments; unemployment or]
workman’s compensation; railroad retirement benefits; pensions; [TANF
benefits, including diversion payments;] royalties; income from rental
property; social security benefits except social security payments that are
specifically exempted in Paragraph (6) of Subsection C of 8.15.2.11 NMAC; [work
study income;] overtime shall be counted at CYFD’s discretion if CYFD
determines that the applicant is paid overtime on a regular basis.
[(7)] (6) Exempt
income: The types of income not counted
when computing eligibility or co-payments include but are not limited to: earnings of [a] household [dependent]
dependents [child who is under 18 and in school]; earnings of
household grandparents who are not the legal guardians of the child(ren) for
whom child care assistance is sought; SNAP; TANF benefits, including
diversion payments; supplemental security income (SSI); social security
disability insurance (SSDI); social security benefits received by household
children; any VA payments made on behalf of the child(ren); VA benefits for
educational purposes or for disability; unemployment benefits; work study
income; child support payments; military food and housing allowances; an
increase in military salary or allowances due to “temporary national emergency
status beginning September 11, 2001”; third party payments; energy assistance
benefits; foster care payments; adoption subsidies; [VA payments for
educational purposes and disability;] loans; child or adult nutrition
programs; income tax refunds; payments for educational purposes; compensation
under the Domestic Volunteer Services Act and the volunteers in service to
America (VISTA) program or [Americorp] AmeriCorps; Work
Investment Act (WIA) payments made to dependent children; relocation payments;
department of vocational rehabilitation (DVR) training payments; in-kind gifts;
cash gifts; employer reimbursements; overtime, unless CYFD determines that the
applicant is paid overtime on a regular basis; payments from special funds such
as the agent orange settlement fund or radiation exposure compensation
settlement fund; lump sum payments such as those resulting from insurance
settlements and court judgments; or other resources such as savings, individual
retirement accounts (IRAs), vehicles, certificates of deposits (CDs) or
checking accounts. In the case of an
emergency, or under extenuating circumstances, the department secretary may
disregard certain temporary income, such as federal stimulus payments or hazard
pay.
[(8)] (7) Verification of household
countable earned and unearned income:
Clients applying for child care assistance benefits are required to
verify household countable earned and unearned income by providing
current [proof] documentation of income for [all members of
the household] biological parents, stepparents, and legal guardians of
the child(ren) for whom child care assistance is sought, living in the
household, who receive such income.
[Self-employed clients must show proof of business expenses in order
for the countable self-employment income to be determined.] A self-employed individual who does not show
a profit that is equal to federal minimum wage times the amount of hours needed per week within 24 months from the
start date of receiving child care assistance will be evaluated by the child
care assistance supervisor, at which point services may be reduced or
discontinued.
(8) Calculating income:
(a) Current
income provided to determine eligibility shall be used as an indicator of the
income that is and shall be available to the household during the certification
period. Fluctuation(s) of earnings may be taken into account as specified in
Paragraph (3) of Subsection C of 8.15.2.11 NMAC
(b) Conversion
factors: When income is received on a weekly, biweekly, or
semimonthly basis, the income shall be converted to monthly amount as follows:
(i) Income
received on a weekly basis is averaged and multiplied by four and three-tenths.
Weekly income is defined as income received once per week.
(ii) Income
received on a biweekly basis is averaged and multiplied by two and fifteen one-hundredths.
Biweekly income is defined as income received once every two weeks. Income is
received on the same day of the week each pay period, therefore receiving 26
payments per year.
(iii) Income
received on a semimonthly basis is averaged and multiplied by two. Semimonthly
income is defined as income received twice per month every month of the year.
Income is received on specific dates of the month, therefore receiving 24
payments per year.
(iv) Income received on a monthly basis is
averaged and multiplied by one. Monthly income is defined as income
received once per month.
D. Residency requirement: An applicant of child care assistance and a child care provider must be a resident of the state of New Mexico. Proof of residency is required.
E. Citizenship
and eligible immigration status:
Any child receiving child care assistance must be a citizen or legal
resident of the United States; or a qualified [alien] immigrant
as [determined by applicable federal laws] defined by the United
States department of health and human services, administration for children and
families, office of child care. [If a child is determined to be a
citizen of the United States or a qualified alien, as approved by the New
Mexico human services department, the child will be eligible provided all other
eligibility requirements are met regardless of the citizenship or alien status
of the child’s parent or parents.]
F. Age
requirement: Child care benefits are
paid for children between the ages of six weeks up to the day in which the
child turns 13 years old. Eligibility
determinations made prior to a child turning 13 years old may be granted a
12-month eligibility period or a lesser period of time as determined by the
department for [CPS or] at-risk child care.
[G. Failure to use authorized child care: If authorized child care has not been used
for five consecutive scheduled days without a reason such as illness, sudden
death, or family medical emergency, payment may discontinue to the provider and
the client will remain eligible for the remainder of their eligibility
period. The provider or the client shall
notify the department within three business days after the fifth day of non-attendance. Upon receiving notice from the provider or
the client within the prescribed timeframe, the department shall issue a notice
to the client stating when the client’s placement will be closed and shall simultaneously
issue a notice to the provider stating when the last date of payment will be
made. Providers shall be paid through
the 14th day following the first day of nonattendance provided that the
department was notified within the timeframe prescribed above. If the department is not notified within the
prescribed timeframe, the provider shall be paid through the last date of
attendance.
H. Change
in Provider: If the parent or guardian
changes providers, the provider shall be paid through the 14th day following
the first day of nonattendance provided that the department was notified within
the timeframe prescribed. If the
department is not notified within the prescribed timeframe, the provider shall
be paid through the last date of attendance.]
G. Special supervision: Children between the ages of 13 and 18 who
are under the supervision of a court of law, or who are determined by a medical
or treatment professional to require supervision.
H. Children enrolled in head start,
kindergarten, school or other programs:
Child care benefits are not paid during the hours that children are
attending head start, kindergarten, New Mexico pre-K, school or other programs.
I. Work/education
requirement: Child care benefits are
paid only for families who are working, attending school or participating in a
job training or educational program and who demonstrate a need for care during
one or more of these activities. Clients
who are receiving TANF are required to participate in a TANF-approved activity
unless they are exempt by TANF. Clients
and caseworkers shall negotiate a reasonable amount of study and travel time
during the application or recertification process. [Child care will not be paid during the
hours in which a parent or guardian is attending graduate or post-graduate
courses. Child care benefits for clients
who are preparing for the acquisition of a GED shall be limited to one year.] The department may, in its discretion,
exempt a client or applicant from the work/education requirement upon
submission of a demonstration of incapacity.
[J. Periods of absences:
A household member may be absent from the home and will be considered as
living in the home and be counted in the household composition as long as the
absent household member plans to return to the home. Any parent or guardian who remains in the
home must be working, attending school, or participating in a job training or
educational program. Temporary absence
may include, but are not limited to, attending school, working, training, or
military service.
L. Children
enrolled in head start, kindergarten, school or other programs: Child care benefits are not paid during the
hours that children are attending head start, kindergarten, New Mexico pre-K,
school or other programs.]
[8.15.2.11 NMAC - Rp, 8.15.2.11 NMAC, 10/1/2016; A/E, 9/18/2020; A, 3/1/2021]
8.15.2.12 RECERTIFICATION: Clients must recertify for services at the
end of their eligibility period by complying with all requirements of initial
certification. Clients who recertify
will qualify at or below two hundred fifty percent of the federal poverty level. If recertification is not completed in a
timely manner, the case may be closed on the last day of the month for which
assistance is provided under the previous child care placement
agreement. At time of recertification,
clients must provide [proof] documentation of income, or proof of
school enrollment. Changes in income,
household size, employment, training or educational status are noted in the
client’s record. Co-payment, if applicable,
is re-determined at the time of recertification. A 12-month certification period will be
granted in accordance with eligibility requirements outlined in Subsection B.
of 8.15.2.11 NMAC.
[8.15.2.12 NMAC - Rp, 8.15.2.12 NMAC, 10/1/2016; A, 10/1/2019; A/E, 9/18/2020; A, 3/1/2021]
8.15.2.13 CLIENT RESPONSIBILITIES: Clients must abide by the regulations set forth by the department and utilize child care assistance benefits only while they are working, attending school or participating in a training or educational program.
A. Co-payments: Co-payments are paid by all clients receiving
child care assistance benefits, except for [CPS child care,] at-risk
child care and qualified grandparents or legal guardians [as defined in
Paragraph (2) of Subsection C of
8.15.2.11 NMAC]. [In the case of
a public health emergency, the department secretary may waive co-payments for
families receiving child care. The
department will pay providers the client’s approved rate, to include required
co-payments, during the time of the public health emergency.] Co-payments are determined by income and
household size. The co-payment schedule
is published yearly at [https://cyfd.org/child-care-services]
https://www.nmececd.org/child-care-assistance/. In the case of an emergency, or under
extenuating circumstances, the department secretary may waive co-payments for
families receiving child care, during which period, the department will pay
providers the client’s approved rate, including required co-payments.
B. Co-payments
described in Subsection A of 8.15.2.13 NMAC, are used for determining the base
co-payment for the first eligible child.
The formula for [calculating] determining the co-payment amount
based on the co-payment schedule for the first full time child is (low end
of the monthly income bracket on the co-payment schedule ÷ 200 percent of
annual federal poverty level for household size) X (low end of the monthly
income bracket on the co-payment schedule) X 1.1 = monthly copayment for first
full time child. Base co-payments for
each additional child are determined at one half of the co-payment for the
previous child.
(1) The first child is identified as the child requiring the most hours of child care.
(2) Each additional child will be ranked based on the most number of hours needed for child care to the least number of hours needed for child care.
C. Each child’s co-payment will be adjusted based on the units of services described in Subsection E of 8.15.2.17 NMAC, as follows:
(1) full time care will be based on one hundred percent of the base co-payment;
(2) part time 1 care will be based on seventy-five percent of the base co-payment;
(3) part time 2 care will be based on fifty percent of the base co-payment; and
(4) part time 3 care will be based on twenty-five percent of the base co-payment.
D. Clients pay co-payments directly to their child care provider and must remain current in their payments. A client who does not pay co-payments may be subject to sanctions.
E. The co-payment for a child shall not exceed the monthly provider reimbursement rate. If this situation arises, the co-payment may be reduced in the amount by which it exceeds the monthly provider reimbursement rate.
F. In-home providers: Parents or legal guardians who choose to use an in-home provider become the employer of the child care provider and must comply with all federal and state requirements related to employers, such as the payment of all federal and state employment taxes and the provision of wage information. Any parent or legal guardian who chooses to employ an in-home provider releases and holds the department harmless from any and all actions resulting from their status as an employer. Payments for in-home provider care are made directly to the parent or legal guardian.
G. Notification
of changes: [Clients must notify the
department of changes that affect the need for care, which include but are not
limited to any non-temporary change in activity, or household members moving in
or out, within five business days of the change. Clients who do not comply with this
requirement may be sanctioned.] Clients must provide notification of
changes via fax, e-mail, or telephone that affect the need for care to their
local child care assistance office.
(1) A client must notify the
department of any non-temporary change in activity or changes to household
composition. Notifications must be
provided within 14 calendar days of the change.
(2) A client who changes a provider must
notify the department and the current provider 14 calendar days prior to
the expected last day of enrollment. If
this requirement for notification is met by the client, the current provider
will be paid through the 14th calendar day.
If this notification requirement is not met, the current provider will
be paid 14 calendar days from the last date of nonattendance. The child care placement agreement with the
new provider shall become effective when payment to the previous provider
ceases. The client will be responsible
for payment to the new provider beginning on the start date at the new provider
and until the final date of payment to the former provider.
(3) If the client has not used the authorized provider for 14 consecutive calendar days, the child will be disenrolled from that provider and the client will remain eligible for the remainder of their eligibility period.
(4) Clients who do not comply with this requirement may be sanctioned.
[H. Required application with New Mexico human services
department’s child support enforcement division (CSED):
(1) When
one or both of the child’s parents are absent from the home, the client shall
apply for child support though CSED within 12 months of initial application with the child care assistance
program.
(2) The
following exceptions include but are not limited to: the client is receiving TANF; the client is
already receiving child support; the client is receiving financial support,
including but not limited to housing, clothing, food, transportation and funds,
from the non-resident parent; there is a joint custody agreement and neither
parent is ordered to pay support; parental rights have been terminated; the
parent is a foster parent to the child; the parent is an adoptive parent and provides proof of a
single parent adoption; at-risk child care; a parent is temporarily out of the
home and is still considered part of the household; the client is a teen
parent; the client is a grandparent; guardian; parent is deceased or when good cause exists.
(3) Good
cause for refusal to apply may be granted when such application is not in the
best interest of the child or parent, including but not limited to the
following circumstances:
(a) there
is possible physical or emotional harm to the child, parent or guardian;
(b) the
child was conceived as a result of incest or rape;
(c) legal
proceedings for adoption of the child are pending before a court; or
(d) the
client is currently being assisted by a public or licensed private social agency
to resolve the issue of whether to keep the child or relinquish the child for
adoption.
(4) The
applicant or recipient who makes a claim for good cause shall supply written
documentation to establish the claim.
The caseworker shall not deny, delay, or discontinue subsidized child
care benefits pending a determination of good cause if the applicant or
recipient has complied with the requirements to furnish information.
(5) If
the client is not exempted from applying with CSED and has not applied within
the required timeframe, the client’s case will be closed.]
[8.15.2.13 NMAC - Rp, 8.15.2.13 NMAC, 10/1/2016; A, 10/1/2019; A/E, 03/16/2020; A, 8/11/2020; A/E, 9/18/2020; A, 3/1/2021]
8.15.2.14 CASE SUSPENSIONS AND CLOSURES:
A. A case may be suspended by the client if child care benefits are not being utilized for a period not to exceed three months with payment being discontinued to the provider. The client will remain eligible for child care assistance through the remainder of their eligibility period.
B. If the client experiences a non-temporary change of activity including the loss of employment, no longer attending school, or no longer participating in a job training or education program, the client will be granted a three-month grace period in which the client will remain eligible. This three-month grace period is for the purpose of giving the client an opportunity to secure new employment or another approved activity. The three-month grace period will start on the date of required notification for the non-temporary change of activity pursuant to section 8.15.2.13 G NMAC.
C. A case will be closed if the following conditions apply:
(1) any non-temporary change in activity and failure to obtain an activity after the three-month grace period;
(2) income
in excess of two hundred and fifty percent federal poverty level [or
eighty-five percent state median income, whichever is greater];
(3) moving out of state;
(4) failing to recertify at the end of approved eligibility period;
(5) at the option of the client;
(6) being disqualified from participation in the program; or
(7) failure to use authorized child care.
[8.15.2.14 NMAC - Rp, 8.15.2.14 NMAC, 10/1/2016; A, 3/1/2021]
8.15.2.15 PROVIDER REQUIREMENTS: Child care providers must abide by all department regulations. Child care provided for recreational or other purposes, or at times other than those outlined in the child care placement agreement, are paid for by the client.
A. All child care providers who receive child care assistance reimbursements are required to be licensed or registered by the department and meet and maintain compliance with the appropriate licensing and registration regulations in order to receive payment for child care services. Beginning July 1, 2012, child care programs holding a 1-star license are not eligible for child care assistance subsidies. The department honors properly issued military child care licenses to providers located on military bases and tribal child care licenses properly issued to providers located on tribal lands.
B. Signed child care placement agreements (including electronically signed child care placement agreements) must be returned by hand delivery, mail, email, fax, or electronic submission to the local child care office within 30 calendar days of issuance. Failure to comply may affect payment for services and the child care placement agreement will be closed. The department will provide reasonable accommodations to allow a client or provider to meet this requirement.
[B.] C. Child care
providers collect required co-payments from clients and provide child care
according to the terms outlined in the child care placement agreement.
[C.] D. [Child care
providers must notify the department within three business days after the fifth
day of non-attendance if the child is disenrolled or is absent for five
consecutive scheduled days. Providers
who do not comply with this requirement are sanctioned and may be subject to
recoupment or disallowance of payments as provided by Subsection G of 8.15.2.11
NMAC] Notification of changes:
Child care providers must notify the department if a child is
disenrolled or child care has not been used for 14 consecutive calendar days
without notice from the client.
(1) If the above notification was met, the
provider will be paid through the 14th calendar day
following the first date of nonattendance.
(2) If a provider does not notify the
department of disenrollment or of non-use for 14 consecutive calendar
days, the provider will be paid through the last date of attendance.
(3) If a child was withdrawn from a
provider because the health, safety, or welfare of the child was at risk, as
determined by a substantiated compliant against the child care provider,
payment to the former provider will be made through the last day that care was
provided.
(4) Providers who do not comply with this requirement are sanctioned and may be subject to recoupment or disallowance of payments as provided in 8.15.2.21 NMAC.
[D.] E. Child care
providers accept the rate the department pays for child care and are not
allowed to charge families receiving child care assistance above the department
rate for the hours listed on the child care placement agreement. Failure to comply with this requirement may
result in sanctions [or suspension of the child care assistance agreement].
(1) Providers are not allowed to charge clients a registration/educational fee for any child who is receiving child care assistance benefits as listed under 8.15.2 NMAC. The department shall pay a five dollar monthly, not to exceed sixty dollars per year, registration/educational fee per child in full time care, on behalf of department clients under 8.15.2 NMAC. Adjustments to the five dollar registration/educational fee will be made based on units of care.
(2) In situations where an incidental cost may occur such as field trips, special lunches or other similar situations, the child care provider is allowed to charge the child care assistance family the additional cost, provided the cost does not exceed that charged to private pay families.
(3) Child care providers are allowed to charge child care assistance families the applicable gross receipts tax for the sum of the child care assistance benefit and co-payment.
[E.] F. Under emergency
circumstances, when CYFD has reason to believe that the health, safety or
welfare of a child is at risk, the department may immediately suspend or
terminate assistance payments to a licensed or registered provider. The child care resource and referral will
assist clients with choosing another CYFD approved provider.
[F.] G. Providers who are
found to have engaged in fraud relating to any state or federal programs, or
who have pending charges for or convictions of any criminal charge related to
financial practices will not be eligible to participate in the subsidy program.
[8.15.2.15 NMAC - Rp, 8.15.2.15 NMAC, 10/1/2016; A, 10/1/2019; A, 3/1/2021]
8.15.2.16 DEPARTMENT RESPONSIBILITIES:
[A. The department will initiate mid-certification
communication with the client to provide outreach and consumer education with a
case management approach and coordination of services to support families.]
[B.] A. The department pays child care providers who
provide child care services to department clients in a timely manner.
[C.] B. Child care
assistance workers perform all casework functions in a timely manner, including
the processing of payments and notifications of case actions.
[D.] C. Child care
assistance workers will perform all eligibility and recertification determinations
within 10 working days upon receipt of all required documentation from the
client.
[E.] D. Child care
assistance workers notify clients and providers in writing of all actions,
which affect services, benefits, or provider payments or status, citing the
applicable policy.
[F.] E. Child care
assistance workers determine eligibility for all child care assistance programs
except for TANF. Eligibility for TANF is
determined by the New Mexico human services department.
[G.] F. Child care
assistance workers must inform parents or legal guardians of their right
to choose their child care providers and provide information on how to look for
quality child care in a provider.
[H.] G. The department and other organizations
approved by the department provide information and orientation programs
regarding child care assistance benefits, quality child care issues, and the
impact of child care on the child’s physical, mental, social and emotional
development to parents or legal guardians and providers.
[I.] H. The department
and other organizations approved by the department offers provider education
programs consisting of training on program participation requirements, parent or
legal guardian and provider responsibilities, licensing and registration
requirements, payment issuance and background check processing, the competency
areas for child care providers as outlined by the office of child development,
or the department, the importance of providing quality child care, and other
topics of interest to parents or legal guardians and providers. These education programs count toward the
continuing education hours required of providers by registration and licensing
regulations.
[8.15.2.16 NMAC - Rp, 8.15.2.16 NMAC, 10/1/2016; A/E, 9/18/2020; A, 3/1/2021]
8.15.2.17 PAYMENT FOR SERVICES: The department pays child care providers on a
monthly basis, according to standard practice for the child care industry. Payment is based upon the child’s enrollment
with the provider as reflected in the child care placement agreement, rather
than daily attendance. As a result, most
placements reflect a month of service provision and are paid on this
basis. However, placements may be closed
at any time during the month. A
signed child care placement agreement must be returned to the department for
payment to be issued to the provider.
The following [describes] circumstances under which the
department may close placements or discontinue payment [when
placements may be closed and payment discontinued] at a time other than the
end of the month:
A. When the child care placement agreement expires during the month, or when the provider requests that the client change providers or the provider discontinues services; payment will be made through the last day that care is provided.
B. [Upon
a change of provider the client and former provider have three days after the
fifth day of nonattendance to notify the department. If this requirement for notification was met,
the provider will be paid through the 14th day following the first date of
nonattendance. If notification
requirement is not met, the provider will be paid through the last date of
attendance. The agreement with the new
provider shall become effective when payment to the previous provider ceases.
If the client notifies the department of the change in providers fewer than 14
days before the change will take place or after the change has taken place, the
client is responsible for payment to the new provider beginning on the start
date at the new provider and continuing up until the final date of payment to
the former provider, as described above.
Payment to the former provider will be made through the last day that
care is provided if the child is withdrawn from the provider because the health,
safety or welfare of the child is at risk, as determined by a substantiated
complaint against the child care facility.] Payment
for notification of changes:
(1) If a client fails to notify the
department within 14 calendar days of their expected last day
of enrollment, the department will pay the provider
14 calendar days from the last day of nonattendance. The child care placement agreement with the
new provider shall become effective when payment to the previous provider
ceases.
(2) If the provider notifies the
department of a child who is disenrolled or child care has
not been used for 14 consecutive calendar days, the
provider will be paid through the 14th calendar day following the last day of
attendance.
(3) If a provider does not notify the
department of disenrollment or of nonattendance
for 14 consecutive calendar days, the provider will be
paid through the last date of attendance.
(4) If a child was withdrawn from a provider because the health, safety, or welfare of the
child was at risk, as determined by a substantiated compliant against the child care provider, payment to the former provider will be made through the last day that care was provided.
C. The department shall pay a five dollar monthly, not to exceed sixty dollars per year, registration/educational fee per child in full time care, on behalf of department clients under 8.15.2 NMAC. Adjustments to the five dollar registration/educational fee will be made based on units of care. The registration/educational fee will discontinue when a placement closes as a result of a client changing providers, a provider discontinuing services, a child care placement agreement expiring, or a provider’s license being suspended or expiring.
D. The amount of the payment is based upon the age of the child and average number of hours per week needed per child during the certification period. The number of hours of care needed is determined with the parent or legal guardian at the time of certification and is reflected in the provider agreement. Providers are paid according to the units of service needed which are reflected in the child care placement agreement covering the certification period.
E. The department pays for care based upon the following units of service:
|
Full time |
Part time 1 |
Part time 2 (only for split custody or in cases where a child may have two providers) |
Part time 3 |
|
Care provided for an average of 30 or more hours per week per month |
Care provided for an average of 8-29 hours per week per month |
Care provided for an average of 8-19 hours per week per month |
Care provided for an average of 7 or less hours per week per month |
|
Pay at 100% of full time rate |
Pay at 75 % of full time rate |
Pay at 50 % of full time rate |
Pay at 25% of full time rate |
F. Hours of care shall be rounded to the nearest whole number.
G. Monthly reimbursement rates:
|
Licensed child care centers |
|||
|
Infant |
Toddler |
Pre-school |
School-age |
|
$720.64 |
$589.55 |
$490.61 |
$436.27 |
|
Licensed group homes (capacity: 7-12) |
|||
|
Infant |
Toddler |
Pre-school |
School-age |
|
$586.07 |
$487.11 |
$427.13 |
$422.74 |
|
Licensed family homes (capacity: 6 or less) |
|||
|
Infant |
Toddler |
Pre-school |
School-age |
|
$566.98 |
$463.50 |
$411.62 |
$406.83 |
|
Registered homes, [ |
|||
|
Infant |
Toddler |
Pre-school |
School-age |
|
$289.89 |
$274.56 |
$251.68 |
$251.68 |
H. The department pays a differential rate according to the license or registration status of the provider, national accreditation status of the provider if applicable, and star level status of the provider if applicable. In the case of a public health emergency, the department secretary may approve a differential rate be paid to licensed providers.
I. Providers holding and maintaining CYFD approved national accreditation status will receive the differential rate listed in Subsection I below, per child per month for full time care above the base rate for type of child care (licensed center, group home or family home) and age of child. All providers who maintain CYFD approved national accreditation status will be paid at the accredited rates for the appropriate age group and type of care. In order to continue at this accredited reimbursement rate, a provider holding national accreditation status must meet and maintain licensing standards and maintain national accreditation status without a lapse. If a provider holding national accreditation status fails to maintain these requirements, this will result in the provider reimbursement reverting to a lower level of reimbursement.
(1) Providers who receive national accreditation on or before December 31, 2014 from an accrediting body that is no longer approved by CYFD will no longer have national accreditation status, but will remain eligible to receive an additional $150 per child per month for full time care above the base rate for type of child care (licensed center, group home or family home) and age of child until December 31, 2017.
(a) In order to continue at this reimbursement rate until December 31, 2017 a provider holding accreditation from accrediting bodies no longer approved by CYFD must maintain licensing standards and maintain accreditation without a lapse.
(b) If the provider fails to maintain their accreditation, the provider reimbursement will revert to the base reimbursement rate unless they have achieved a FOCUS star level or regain national accreditation status approved by CYFD.
(2) The licensee shall notify the licensing authority within 48 hours of any adverse action by the national accreditation body against the licensee’s national accreditation status, including but not limited to expiration, suspension, termination, revocation, denial, nonrenewal, lapse or other action that could affect its national accreditation status. All providers are required to notify the department immediately when a change in accreditation status occurs.
J. The department will pay a differential rate per child per month for full time care above the base reimbursement rate to providers achieving higher Star levels by meeting FOCUS essential elements of quality as follows:
|
2+ Star FOCUS Child Care Centers, Licensed Family and Group Homes |
|||||
|
Infant |
Toddler |
Pre-school |
School-age |
||
|
$88.00 |
$88.00 |
$88.00 |
$88.00 |
||
|
3 Star FOCUS Child Care Centers, Licensed Family and Group Homes |
|||||
|
Infant |
Toddler |
Pre-school |
School-age |
||
|
$100.00 |
$100.00 |
$100.00 |
$100.00 |
||
|
4 Star FOCUS Licensed Family and Group Homes |
|||||
|
Infant |
Toddler |
Pre-school |
School-age |
||
|
$180.00 |
$180.00 |
$180.00 |
$180.00 |
||
|
5 Star FOCUS or CYFD approved national accreditation Licensed Family and Group Homes |
|||||
|
Infant |
Toddler |
Pre-school |
School-age |
||
|
$250.00 |
$250.00 |
$250.00 |
$250.00 |
||
|
4 Star FOCUS Child Care Centers |
|||||
|
Infant |
Toddler |
Pre-school |
School-age |
||
|
$280.00 |
$280.00 |
$250.00 |
$180.00 |
||
|
5 Star FOCUS or CYFD approved national accreditation Child Care Centers |
|||||
|
Infant |
Toddler |
Pre-school |
School-age |
||
|
$550.00 |
$550.00 |
$350.00 |
$250.00 |
||
K. In order to continue at the FOCUS reimbursement rates, a provider must meet and maintain the most recent FOCUS eligibility requirements and star level criteria. If the provider fails to meet the FOCUS eligibility requirements and star level criteria the provider reimbursement will revert to the FOCUS criteria level demonstrated.
L. Differential rates determined by achieving higher star levels determined by AIM HIGH essential elements of quality will be discontinued effective December 31, 2017. The department will pay a differential rate to providers achieving higher star levels determined by the AIM HIGH essential elements of quality until December 31, 2017 as follows: 3-Star at $88.00 per month per child for full time care above the base reimbursement rate; 4-Star at $122.50 per month per child for full time care above the base reimbursement rate, and 5-Star at $150.00 per child per month for full time care above the base reimbursement rate. In order to continue at these reimbursement rates, a provider must maintain and meet most recent AIM HIGH star criteria and basic licensing requirements. If the provider fails to meet the requirements, this will result in the provider reimbursement reverting to the base reimbursement rate.
M. The department pays a differential rate equivalent to five percent, ten percent or fifteen percent of the applicable full-time/part-time rate to providers who provide care during non-traditional hours. Non-traditional care will be paid according to the following charts:
|
|
1-10 hrs/wk |
11-20 hrs/wk |
21 or more hrs/wk |
|
After hours |
5% |
10% |
15% |
|
|
1-10 hrs/wk |
11-20 hrs/wk |
21 or more hrs/wk |
|
Weekend hours |
5% |
10% |
15% |
N. If a significant change occurs in the client’s circumstances, (see Subsection G of 8.15.2.13 NMAC) the child care placement agreement may be modified and the rate of payment is adjusted. The department monitors attendance and reviews the placement at the end of the certification period when the child is re-certified.
O. The
department may conduct provider [or] , parent, or legal
guardian, audits to assess that the approved service units are consistent
with usage. Providers found to be
defrauding the department are sanctioned.
Providers must provide all relevant information requested by the
department during an audit.
P. Payments are made to the provider for the period covered in the child care placement agreement or based on the availability of funds.
[8.15.2.17
NMAC - Rp, 8.15.2.17 NMAC, 10/1/2016; A, 10/1/2019, A/E, 03/16/2020; A,
8/11/2020; A, 3/1/2021]
8.15.2.18 UNDER
PAYMENTS: If a client or provider is
underpaid for child care services, the department may issue a one-time payment
within 15 calendar days of the department’s knowledge or receipt of
notification. Notification of the
department by the client or provider must occur within [90 calendar days]
three months of the occurrence of alleged underpayment.
[8.15.2.18 NMAC - Rp, 8.15.2.18 NMAC, 10/1/2016; A, 3/1/2021]
8.15.2.19 OVER PAYMENT AND RECOUPMENT: If a provider receives payment for services for which he/she is not entitled, or a client receives benefits on behalf of their child for which he/she is not entitled, and this results in an overpayment, the child care worker will initiate recoupment procedures unless the early childhood services director deems otherwise in exceptional circumstances. Recoupments will only be sought from providers. The department will not seek a recoupment from a client unless substantiated fraud by that client has been determined. The client or provider must repay the amount of the overpayment to the department within 30 calendar days of notification, unless the department determines that the amount is so large that it cannot be paid in one lump sum. In this case, the department may allow the client or provider to repay the amount over a payment period, negotiated between the client and the department, usually not to exceed four months. Failure to pay the overpayment within 30 days of the notice or failure to make regular payments under an agreed upon payment schedule may result in sanctions including termination of benefits or referral of the account to a collection agency or legal action.
[8.15.2.19 NMAC - Rp, 8.15.2.19 NMAC, 10/1/2016; A/E, 9/18/2020; A, 3/1/2021]
8.15.2.20 FRAUD: The purposeful misrepresentation of facts relating to eligibility for benefits, or knowingly omitting information that affects eligibility is fraud and appropriate sanctions, including recoupment, termination of benefits, and referral to law enforcement, are initiated by the department. Fraudulent cases are reported to the department, which will take such action as is deemed necessary. The case remains open at the same rate of benefits until the investigation is concluded and disposition is determined. In cases where substantiated fraud has been determined, the department may disqualify a client or provider until their debt has been paid in full.
[8.15.2.20 NMAC - Rp, 8.15.2.20 NMAC, 10/1/2016; A, 3/1/2021]
8.15.2.21 SANCTIONS: [If a client or provider fails to meet
programmatic requirements that affect benefits and result in an overpayment,
sanctions] Sanctions may be imposed according to the severity of the
infraction as determined by the department [and] as detailed
below.
A. Providers or clients who fail to make timely payments in the case of recoupment of overpayments may be referred to a collection agency.
B. [Providers]
The department may initiate the recoupment process against any provider
who fail to report in a timely manner that a child [is not] has not
been in attendance for [five] 14 consecutive calendar days
[, scheduled days will have the payment recoupment process initiated].
C. Providers who allow their registration or license to lapse without renewal will not be paid during the periods for which the license or registration is not current. Providers who lose national accreditation status or lose eligibility for payment at any level of reimbursement for failure to maintain the standards required to be paid at that level of reimbursement, will not be paid at that level of reimbursement beginning with the first day of the month during which the loss of accreditation or eligibility occurred. Payment recoupment will be sought for any period for which excessive benefits have been paid.
D. Clients who fail to notify the department of any non-temporary change of activity may be placed on conditional eligibility status up to one year on the following eligibility period. Any further violations within the conditional eligibility period may result in termination.
E. Clients
who fail to pay co-payments may be disqualified until the co-payment is paid or
until an agreement is made between the client and the provider to bring the
co-payment current. [The department
assists the provider in collecting the co-payment only if the co-payment has
been in arrears 30 calendar days or less.]
[8.15.2.21 NMAC - Rp, 8.15.2.21 NMAC, 10/01/2016; A, 3/1/2021]