Cal. Welf. & Inst. Code § 11466.2
Computation and Payment of Aid Grants
Redline — January 1, 2011 → current.View current text →
Current — January 1, 2017
As of January 1, 2011
(a) (1) The department shall perform or have performed group home program and fiscal audits as needed. Group home programs shall maintain all child-specific, programmatic, personnel, fiscal, and other information affecting group home ratesetting and AFDC-FC payments for a period not less than five years.
(a) (1) The department shall perform or have performed provider program and fiscal audits as needed. Provider programs shall maintain all child-specific, programmatic, personnel, fiscal, and other information or records affecting ratesetting and AFDC-FC payments for a period of not less than five years, except that information and records shall be kept for a longer period of time if otherwise required by law.
(2) Notwithstanding paragraph (1), the department shall not establish an overpayment based upon a nonprovisional program audit conducted on less than a one-year audit period.
(2) Provider fiscal audits shall be conducted pursuant to Part 200 (commencing with Section 200.0) of Chapter II of Subtitle A of Title 2 of the Code of Federal Regulations, as implemented by the United States Department of Health and Human Services in Part 75 (commencing with Section 75.1) of Title 45 of the Code of Federal Regulations, including uniform administrative requirements, cost principles, and audit requirements, as specifically implemented in Section 75.106 of Title 45 of the Code of Federal Regulations.
(3) Notwithstanding paragraph (2), the department may conduct audits covering a period of less than 12 months. Based upon the findings of these audits, the department may reduce a group home program’s AFDC-FC rate or RCL pursuant to this paragraph. (A) In an audit of a period of less than 12 months, if a provider’s audited RCL is no more than three levels below the paid RCL, the provider’s rate and RCL will be reduced to the audited RCL. The provider will be allowed the opportunity to bring a program into compliance with the paid RCL. (B) In an audit of a period of less than 12 months, if the provider’s audited RCL is more than three levels below the paid RCL, the department shall conduct an audit as identified in paragraph (2) of subdivision (a) of Section 11466.2. The provider will be allowed the opportunity to bring a program into compliance with the paid RCL. (C) A group home provider may request a hearing of the department’s RCL determination under subparagraph (A) no later than 30 days after the date the department issues its RCL determination. The department’s RCL determination shall be final if the group home provider does not request a hearing within the prescribed time. Within 60 days of receipt of the request for hearing, the department shall conduct a hearing on the RCL determination. The standard of proof shall be the preponderance of the evidence and the burden of proof shall be on the department. The hearing officer shall issue the proposed decision within 45 days of the close of the evidentiary record. The director shall adopt, reject, or modify the proposed decision, or refer the matter back to the hearing officer for additional evidence or findings within 100 days of issuance of the proposed decision. If the director takes no action on the proposed decision within the prescribed time, the proposed decision shall take effect by operation of law.
(3) A provider may request a hearing of the department’s program or fiscal audit determination under this section no later than 30 days after the date the department issues its audit determination. A provider may request a hearing to examine any disputed audit determination, including, but not limited to, an audit finding regarding the provider’s internal controls, board of directors oversight, program operation, or a finding that results in an overpayment. The department’s audit determination shall be final if the provider does not request a hearing within the prescribed time. Within 60 days of receipt of the request for hearing, the department shall conduct a hearing on the audit determination. The standard of proof shall be the preponderance of the evidence and the burden of proof shall be on the department. The hearing officer shall issue the proposed decision within 45 days of the close of the evidentiary record. The department shall adopt, reject, or modify the proposed decision, or refer the matter back to the hearing officer for additional evidence or findings within 100 days of issuance of the proposed decision. If the department takes no action on the proposed decision within the prescribed time, the proposed decision shall take effect by operation of law.
(b) (1) The department shall develop regulations to correct a group home program’s RCL, and to adjust the rate and to recover any overpayments resulting from an overstatement of the projected level of care and services.
(b) (1) The department shall develop regulations to require corrective action to a program’s or provider’s operation as a result of program or fiscal audit findings, to adjust the rate, and to recover any overpayments resulting from an overstatement of the projected level of care and services or overpayments or disallowed costs resulting from other audit findings.
(2) The department shall modify the amount of the overpayment pursuant to paragraph (1) in cases where the level of care and services provided per child in placement equals or exceeds the level associated with the program’s RCL. In making this modification, the department shall determine whether services other than child care supervision were provided to children in placement in an amount that is at least proportionate, on a per child basis, to the amount projected in the group home’s rate application. In cases where these services are provided in less than a proportionate amount, staffing for child care supervision in excess of its proportionate share shall not be substituted for nonchild care supervision staff hours.
(2) Any repeat fiscal audit findings may result in a monetary penalty or rate reduction, suspension, or termination of the provider’s rate in accordance with regulations adopted by the department, all-county letters, or similar written instructions.
(c) (1) In any audit conducted by the department, the department, or other public or private audit agency with which the department contracts, shall coordinate with the department’s licensing and ratesetting entities so that a consistent set of standards, rules, and auditing protocols are maintained. The department, or other public or private audit agency with which the department contracts, shall make available to all group home providers, in writing, any standards, rules, and auditing protocols to be used in those audits.
(c) (1) In any audit conducted by the department, the department, or other public or private audit agency with which the department contracts, shall coordinate with the department’s licensing and ratesetting entities so that a consistent set of standards, rules, and auditing protocols are maintained. The department, or other public or private audit agency with which the department contracts, shall make available to all providers, in writing, any standards, rules, and auditing protocols to be used in those audits.
(2) The department shall provide exit interviews with providers whenever deficiencies found are explained and the opportunity exists for providers to respond. The department shall adopt regulations specifying the procedure for the appeal of audit findings.
(2) The department shall provide exit interviews with providers, whenever deficiencies are found, and shall explain the deficiencies and permit providers an opportunity to respond. The department shall adopt regulations, all-county letters, or similar written directives specifying the procedure for the appeal of program and fiscal audit findings.
(d) Nothing in this section shall preclude the department from revoking the license of, or initiating legal proceedings against, a provider that has violated relevant laws and regulations.
Official source: California Legislative Information. Reproduced from public-domain California statutes; confirm against the official source for the current text. Not legal advice.