[27 Pa.B. 4615]
[Continued from previous Web Page] (b) [The Department will not subsidize a] A child whose absence exceeds [20] 10 consecutive enrollment days will be determined ineligible for subsidized child day care funding. Exception: a child whose absence exceeds 10 consecutive enrollment days for reasons listed in § 3040.52(d) (relating to eligibility agent responsibilities).
(c) The Department will not subsidize absences of more than 30 units of care in a fiscal year for an eligible child.
§ 3040.38. Prospective employment or a prospective [training] education program for new parent applicants.
(a) A [caretaker] parent or a family member with prospective employment or prospective enrollment in [a training] an education program as defined in § 3040.3 (relating to definitions) is eligible to apply for subsidized child day care [service] if the following requirements are met:
(1) The employment or [training] education program begins within 30 calendar days following determination of [eligible status] eligibility.
(2) Written verification is provided [, signed and dated by a representative of the prospective employer or training program, documenting] on a form which contains the information indicated in § 3040.34(c) (relating to nonfinancial eligibility), and also documents:
(i) The approximate hours and days of employment or [training] education per week for a 4-week period.
(ii) The approximate gross earnings [, if applicable,] and first expected pay date in the prospective employment [or training program].
(iii) The anticipated start date of employment or the education program.
[(b) A training program or a vocational training program shall be accredited by a State or National board of examiners.
(c) A training program is one of the following:
(1) Completion of junior high school.
(2) Completion of high school.
(3) Remedial courses at a secondary or postsecondary level required for entrance into an accredited training program.
(4) A training program at a postsecondary level which leads to a specific job.
(5) General Educational Development (GED) training for 20 or more hours per week.
(6) English as a Second Language training for 20 hours or more per week.
(7) A 2-year associate degree program which qualifies an individual for a specific job.]
[(d)] (b) A [child may not be enrolled in subsidized child day care service] child's subsidy may not begin until the [caretaker or family member] parent and his spouse or live-in companion begins employment or [a training] an education program.
[(e) Six] (c) Eight weeks following enrollment of a child based on prospective employment or enrollment in [a training] an education program, the [caretaker] parent shall provide verification of employment or [training] enrollment in the education program for that [6] 8-week period. Verification shall be in the form described in §§ 3040.32 and 3040.33 (relating to [documentation of] financial eligibility; and documentation of self-employed income), if applicable, and § 3040.34 (relating to [documentation of] nonfinancial eligibility). [Redetermination of the family in this eligibility status requires a new application for service and a new fee agreement.]
(d) If the parent will not receive payment for employment for more than 30 days from the starting date of employment, eligibility will be established based on the anticipated income as estimated by the employer. Until payment for employment is received, the family will be assessed the minimum weekly fee for a family of its size. When payment for employment is received, the parent shall notify the eligibility agent. Upon receipt of the payment notice from the parent the eligibility agent shall do the following:
(1) Within 10 days complete a partial redetermination of eligibility.
(2) Within 20 days adjust the family fee, if applicable.
(e) A parent who has exhausted all available TANF benefits and who has not yet obtained employment may have 30 calendar days of subsidized child day care while seeking work.
§ 3040.39. [Title IV-A child care benefits] (Reserved).
[(a) A family determined eligible by the local CAO for Title IV- A child care benefits is not eligible to receive subsidized child day care service provided with funds made available under this chapter. Individuals not eligible for service include:
(1) A recipient of AFDC benefits who is participating in an approved education or training activity and who is eligible for Title IV-A child care benefits. Exception: Individuals may receive subsidized child day care services under this chapter until the local CAO implements the vendor payment process for recipients in this category.
(2) A prior recipient of AFDC benefits who is eligible for the Title IV-A TCC Program.
(b) When an individual's 12-month period of TCC eligibility has expired, the individual may be eligible for subsidized child day care service and may be placed in service or as first priority on the waiting list, if the following steps are completed:
(1) The application for placement on the subsidized child day care waiting list is completed before the individual's 12-month period of TCC eligibility ended.
(2) An eligibility determination made according to the requirements of this chapter did not include benefits available under TCC. See Appendix A, Part III (relating to sources of earned or unearned income to be included, deducted and excluded in determining monthly gross income.
(3) The date of enrollment in subsidized child day care service is the day following the date TCC benefits end.
(c) An individual whose 12-month period of TCC eligibility has expired and who has not met the requirements of subsection (b)(1) and (2) shall apply as a private caretaker according to the requirements of this chapter.
(d) A recipient of AFDC benefits who is employed and who is eligible for the Title IV-A earned income child care deduction, as determined by the local CAO is eligible for subsidized child day care service.
(1) The eligibility agent shall perform an eligibility determination to assess the family's eligibility for subsidized child day care service.
(2) On a form approved by the Department, the eligibility agent will notify the CAO of the AFDC-employed recipient's eligibility for subsidized child day care service, the amount of the family fee and the date service will begin. The CAO will complete portions of the form regarding adjustments to be made by the CAO to the individual's AFDC monthly grant as a result of Title XX eligibility.
(3) Upon receipt of the form completed by the CAO, the eligibility agent shall take the following actions:
(i) If the CAO information reflects that the AFDC grant is being reduced, the eligibility agent shall redetermine eligibility based on the new income information reported by the CAO.
(ii) If the CAO information reflects that the AFDC grant is being discontinued and that the family is now eligible for the TCC program, the eligibility agent shall advise the caretaker that the family is ineligible in accordance with paragraph (2). Discontinuance of subsidized day care eligibility shall be in accordance with § 3040.71 (relating to general requirements regarding notification).
(iii) On a form approved by the Department, the eligibility agent will notify the CAO of changes in subparagraph (i) or (ii), to include a change in family eligibility or in the amount of the family fee.]
ELIGIBILITY DETERMINATION PROCESS § 3040.51. General requirements in the eligibility determination process.
(a) An initial determination of eligibility [shall] will be completed before [service shall] subsidy will be [provided] authorized.
(b) A full redetermination of eligibility shall be completed at least once every [12] 6 months and prior to the expiration of the current period of eligibility.
(c) A redetermination may be required at any time in a period of eligibility if the eligibility agent receives information that the family's eligible status [is] may be altered. See § 3040.35 (relating to factors affecting eligibility status). The eligibility agent shall conduct a partial redetermination for each reported change within 20 calendar days of notification of the change. The eligibility agent may conduct a full redetermination if the information obtained during the partial redetermination gives indication of a change in the family's eligibility status.
§ 3040.52. Eligibility agent responsibilities.
(a) Initial determination of eligibility.
(1) The eligibility agent shall provide the [caretaker applicant] parent with written instructions regarding documents which the [applicant] parent shall provide to establish eligibility for subsidized child day care [service].
(2) The eligibility agent [shall arrange] may require a face-to-face interview with the [caretaker applicant] parent or shall arrange to have necessary documents and information mailed by the [applicant] parent to the eligibility agent. When a face-to-face interview is conducted, the eligibility agent shall verify the identity of the parent who has signed the application and will note in the family file how the identity was verified.
(3) If the eligibility interview is face-to-face, the eligibility agent shall require the [applicant] parent to sign and date an application provided by the Department, at the time of the interview.
(4) If the [caretaker] parent mails or delivers the application without a face-to-face interview, the eligibility agent shall stamp the date of receipt on the signed, dated application.
* * * * * (6) The eligibility agent shall [submit requests for] obtain verification of [caretaker eligibility status related to Title IV-A eligibility] the parent's TANF eligibility status from the local CAO [on a form approved by the Department].
(7) The eligibility agent shall determine eligibility within 30 calendar days [which begin on] of the date the [signed, dated] application, signed and dated by the parent, is received by the eligibility agent.
(8) The eligibility agent shall sign and date the completed application when eligibility has been determined. That date represents the first day of the [caretaker's] family's eligibility for the subsidized child day care [service] program.
(9) The eligibility agent shall notify the [caretaker applicant] parent of the [caretaker's] family's eligibility status according to the Department's notification requirements in § 3040.71 (relating to general requirements regarding notification).
(10) The eligibility agent shall conduct a face-to-face interview before authorization of subsidized day care for a child. [The] At the time of the interview the, eligibility agent shall inform the [caretaker applicant] parent of his rights and responsibilities, as detailed in § 3040.53 (relating to [caretaker] parent rights and responsibilities). The parent shall acknowledge, in writing, receipt of the rights and responsibilities information.
(11) This chapter [shall] will be made available to the [caretaker] parent upon request.
(b) Subsequent redeterminations of eligibility.
(1) The eligibility agent shall set a redetermination due date which does not exceed [12] 6 months following the most recent date that the [caretaker] family was determined eligible.
(2) The eligibility agent shall schedule a redetermination, or partial redetermination, to occur in less than [12] 6 months [following the current redetermination] if one or more of the following conditions exist or come to the attention of the eligibility agent:
* * * * * (iii) [A family member is newly employed or newly self-employed and unable to provide the required documentation.] A family member is self-employed. Eligibility shall be redetermined on a quarterly basis for self-employed individuals.
(iv) A family member is disabled and the disability is anticipated to end prior to 6 months.
(v) A family member's employment is seasonal or temporary.
(vi) A parent's education program ends prior to 6 months.
[(3) The eligibility agent shall establish administrative controls to assure that the caretaker is notified of the responsibility to submit the necessary documentation for a timely redetermination.]
[(4)] (3) The eligibility agent shall notify the [caretaker] parent in writing of the documents and information required to complete a redetermination of the [caretaker's] family's eligibility for subsidized child day care [service]. A copy of that notification shall remain in the [caretaker's] family file.
[(5)] (4) The eligibility agent shall notify the [caretaker] parent of the [caretaker's eligible] family's eligibility status according to the Department's notification requirements in § 3040.71 (relating to general requirements regarding notification).
(5) The eligibility agent shall verify the Social Security number for any family member who did not have a Social Security number at the time of application.
(c) Continuing eligibility.
(1) The eligibility agent shall supply the [caretaker] parent with a written statement regarding [caretaker] the parent's responsibility to report financial or nonfinancial changes to the eligibility agent as detailed [at] in § 3040.35 (relating to factors affecting eligibility status). The eligibility agent shall discuss with the parent the specific changes which shall be reported and are listed in § 3040.35 (relating to factors affecting eligibility status).
(2) The eligibility agent shall evaluate a financial or nonfinancial change reported by the [caretaker] parent and make a redetermination as necessary within [10] 20 calendar days from the date the [caretaker] parent reports and documents a change.
(3) If, during a period of eligibility, a [caretaker] parent reports a change in financial or nonfinancial criteria [which does not cause a fee or status change], the eligibility agent [is not] shall be required to complete a full family redetermination or a partial family redetermination. The eligibility agent retains, in the family file, the information used in the evaluation, but the eligibility agent and [caretaker] parent are not required to complete an eligibility determination form. The original period of eligibility will not be changed as a result of a partial redetermination.
(4) If a reported change results in the family, or a child in the family, becoming ineligible for [service] subsidy, the eligibility agent shall take the necessary steps to terminate the [service] subsidy according to § 3040.71 and § 3040.72 (relating to content of a written notice of adverse action).
(5) Eligibility continues for 30 calendar days from [the date a training program is completed,] the date of involuntary termination from employment [or training or] the date a strike begins or the date of graduation from an education program.
* * * * * (7) Eligibility for subsidy will continue in the case of regularly scheduled breaks in an education program, if the regularly scheduled break is less than 31 days.
(d) Suspended subsidy.
(1) Child day care subsidy may be suspended if a child is unable to attend day care for more than 10 consecutive enrollment days and will be absent for no more than 90 consecutive calendar days. On the 91st day of consecutive absence, the child is no longer eligible for subsidy. Subsidy may be suspended for one or more of the following situations:
(i) The child is visiting the noncustodial parent.
(ii) The child is ill or hospitalized for 5 or more service days.
(iii) The child must accompany the parent on a trip because of family illness or emergency, and the illness or emergency is documented.
(iv) The child remains at home with his mother during maternity leave.
(v) The child day care provider is closed because of licensing requirements.
(vi) The child's needs cannot continue to be met by the child day care provider.
(vii) The child's needs cannot continue to be met by the child day care provider, and subsidized child day care funds are not available to utilize the newly chosen provider.
(viii) The child's parent is a minor parent on break from attendance at elementary school, middle school or high school.
§ 3040.53. [Caretaker] parent rights and responsibilities.
(a) A [caretaker applicant] parent shall provide all documentation required by the eligibility agent prior to [being determined eligible or ineligible] an eligibility determination for subsidized child day care [service].
(b) [The caretaker applicant] A parent shall sign and date [an] the application for subsidized child day care [service].
(c) A [caretaker] parent has the right to have the eligibility determination completed within 30 calendar days after the eligibility agent receives the signed and dated [caretaker] subsidized child day care application.
(d) A [caretaker] parent has the right to receive written notification regarding [a determination of the caretaker's ineligibility for care] the family eligibility status.
(e) A [caretaker] parent has the right to appeal the eligibility agent's determination as provided in § 3040.73 (relating to grounds for appeal).
(f) A [caretaker] parent shall report financial or nonfinancial changes in [a] the family which affect eligibility for [service] subsidy, as required [at] in § 3040.35 (relating to factors affecting eligibility status) and provide documentation as required by the eligibility agent to verify change.
(g) A parent shall meet at least once face-to-face with the eligibility agent prior to enrollment of a child for subsidized child day care.
(h) A parent shall supply accurate and complete financial and nonfinancial information to determine eligibility for subsidized child day care.
§ 3040.54. [Establishing waiting] Waiting list [service priorities].
[(a)] After completion of an application and determination of the family's eligibility for [service] subsidy, [a] an eligible child shall be placed on a waiting list, if funds for service are not available, based on [the following priorities:] a first come, first served basis. Placement on the waiting list shall be determined by the date and time eligibility for the child was determined.
[(1) A caretaker who is employed, who is moving from welfare dependency, whose income is between 0 and 235% of the FPL and who is not eligible for Title IV-A child care entitlement benefits. Exception: a caretaker who is participating in an approved education or training activity, until the local CAO implements the vendor payment system.
(2) A caretaker who is employed and whose income is between 0 and 185% of the FPL.
(3) A caretaker who is employed and whose income is between 186 and 235% of the FPL.
(4) A caretaker who is in a training status and who is not receiving AFDC benefits.
(b) If two or more caretaker applicants achieve the same priority ranking based on the priorities in subsection (a), the date eligibility is determined shall determine the applicant's placement on the waiting list.]
§ 3040.54a. [Establishing waiting list service priorities--statement of policy] (Reserved).
[The first priority includes the following individuals:
(1) A caretaker who is employed and who currently receives AFDC benefits.
(2) A caretaker who is no longer eligible for TCC benefits under the Family Support Act of 1988, due to the expiration of the caretaker's 12-month period of eligibility.
(3) A caretaker who receives AFDC benefits and who is participating in an approved educational or training activity through the local CAO, until the CAO implements the vendor payment system.]
§ 3040.55. Maintaining a waiting list.
(a) A [caretaker] family with a child remaining on a waiting list prior to [service] receiving subsidy will be redetermined eligible for [service] subsidy at least once in a [12] 6-month period. [A redetermination shall be completed prior to the use of subsidized child day care service.
(b) A caretaker who is on a waiting list prior to July 1, 1992, will retain placement on the waiting list, based on the sole criterion of the initial date eligibility for service was determined. Service priorities may not be applied to a caretaker in this category.
(c) The waiting list priority placement of a caretaker initially determined eligible for subsidized child day care service following July 1, 1992, may change based on information, obtained in a redetermination.] (b) A child may not remain on the waiting list for more than 30 calendar days from the date subsidy is made available by the eligibility agent.
[(d) A child new to a family following the date the caretaker was initially determined eligible for subsidized child day care services is placed on a waiting list according to the caretaker's original date of eligibility if funding for service is not immediately available.] (c) If a parent requests subsidized child day care for an additional child following the date the family was initially determined eligible for subsidized child care, the child will be placed on the waiting list according to the date and time that the parent requests care for the child.
FEES § 3040.61. General requirements regarding fee payment.
(a) The eligibility agent determines the weekly family fee during the eligibility process. The parent is responsible for paying the assessed weekly family fee to the provider when a child is enrolled in subsidy. A weekly family fee for service shall be established at an initial determination of eligibility for subsidized child day care [service] and reestablished at each successive redetermination of eligibility. The weekly family fee covers children in the family who are eligible to receive subsidized child day care. The fee includes all days of the week for which the family has [agreed to use the service] established a need for child care as described in § 3040.34 (relating to nonfinancial eligibility).
(b) A [caretaker admitted for service] parent whose child is authorized for subsidy is required to pay a weekly family fee and an equivalent advance weekly family fee prior to enrollment in [service] subsidy. Only the weekly family fee is due thereafter. [A caretaker whose only day care child is enrolled in part-time school-age service is required to pay the assessed weekly family fee on a biweekly basis during the school year. This subsection does not apply to a caretaker with two or more children enrolled in child day care and does not apply during summer vacation when the school year has concluded.]
(c) If the weekly family fee is increased as a result of a redetermination, the [caretaker] parent shall owe the increased weekly family fee and an advance increased weekly family fee on the first day of the service week following expiration of the notice of weekly family fee increase. The increased advance weekly family fee is the amount of the difference between the current weekly family fee and the increased weekly family fee.
(d) If the weekly family fee is decreased as [a] the result of a redetermination, the reduced fee will be effective on the first day of the service week following the date of the redetermination. The decrease between the current advance weekly family fee and the decreased weekly family fee shall be refunded to the [caretaker] parent on the first day of the service week following the redetermination.
(e) The advance weekly family fee and an increased advance weekly family [fees are] fee is refundable at the termination of [service] subsidy if the [caretaker] parent has met applicable requirements in this chapter.
(f) The [regular] weekly family fee [for service] is due on the first day of the [service] week.
(g) A weekly family fee is delinquent if it is not paid by the [end of the 5th] last day of the [service] week. On the day that the fee becomes delinquent, the eligibility agent shall notify the [caretaker] parent in writing that action will be taken to terminate [service] subsidy for the child. When a weekly family fee is delinquent, the first fee paid during any week is applied to the current week's assessed weekly family fee. Subsequent fee payments during that week are applied to the delinquent fee. To remain current regarding the assessed weekly family fee payment, a parent shall pay the current week's fee and the delinquent weekly family fee.
(h) The following are the responsibilities of the eligibility agent [and provider]:
(1) The eligibility agent shall assure that required termination notices based on delinquent weekly family fees are generated in a timely manner. The eligibility agent shall retain a copy of the termination notice.
(2) The eligibility agent shall send the provider [shall receive and retain] a copy of [termination notices] each advance notice of adverse action issued to a parent whose child is enrolled with the provider.
(3) If a weekly family fee is delinquent, the eligibility agent shall mail to the [caretaker] parent, on a form approved by the Department, a written notice of termination at the end of the [5th] last service day of the service week in which the weekly family fee delinquency occurred. The written notice shall state that service will terminate in 10 calendar days unless the delinquent weekly family fee is paid.
(4) If, during 1 year's eligibility, the [caretaker] parent has been sent two written notices of termination [due] relating to overdue weekly family fees and has paid the overdue weekly fees prior to [service] subsidy termination, at the time of the third [lapsed payment] overdue weekly family fee, the eligibility agent shall initiate action to terminate [the service] child care subsidy on the basis of habitual delinquency in weekly family fee payment. [The caretaker may appeal the action but does not have the right to continuing service pending hearing. See § 3040.74 (relating to appeal: continuation of service denied).]
(i) If [service] subsidy to a [caretaker] child terminates and weekly family fees are owed to the provider, [past due fees shall be paid before service to that caretaker may be resumed] the parent is ineligible to reapply for subsidized child day care for 90 calendar days after the delinquent weekly family fees have been paid.
§ 3040.62. Availability and use of the FPIG.
(a) The FPIG are published annually in the Federal Register and may be obtained from the [Department] Department's Office of Children, Youth and Families.
(b) The eligibility agent shall use the FPIG and a conversion method described [at] in § 3040.63 (relating to [computing] determining a weekly family fee) to [arrive at] calculate a weekly family fee.
(c) Following annual publication of the FPIG, the Department will notify the eligibility agent of changes in the [conversion chart] family fee scale chart contained in Appendix B [(relating to 1995-1996 Federal Poverty Income Guidelines and DPW Conversion Chart)]. The [Department] Department's Office of Children, Youth and Families will publish updated fee conversion charts in the Pennsylvania Bulletin to be recommended for codification [at] in Appendix B.
* * * * * § 3040.63. [Computing] Determining a weekly family fee.
(a) The eligibility agent shall use the [conversion chart in Appendix B (relating to 1995-1996 Federal Poverty Income Guidelines and DPW Conversion Chart) and fee formula] family fee scale chart in Appendix B issued prior to July 1 of each year by the Department, when completing an eligibility determination, as follows:
(1) To determine the adjusted monthly gross income, use [evidence] documentation of 4 consecutive weeks of income from employment which was obtained within the most recent 6-week period. Include other sources of income referenced in Appendix A (relating to sources of earned or unearned income to be included, deducted and excluded in determining monthly gross income). Following is the conversion method to determine adjusted monthly gross income:
Frequency of income Conversion method Daily Multiply the daily income by the number of workdays in a week, then multiply by [4.33] 4.3 for monthly gross income. Weekly Multiply by [4.33] 4.3 for monthly gross income. Biweekly (every
[two] 2 weeks)Divide by 2, then multiply by [4.33] 4.3 for monthly gross income. Semimonthly (twice
a month [, all public
assistance])Multiply by 2 for monthly
gross income.Lump sum income Divide by 12 for monthly gross income. (2) To convert the adjusted monthly gross income to an annual income, multiply the adjusted monthly gross income by 12. Following is the conversion method to determine annual income:
Frequency of income Conversion method Monthly (once a month) Multiply by 12 for annual income. Quarterly (as seen in
dividends or income
tax statements of self-
employed persons)Multiply by 4 for annual
income.Annually (when using
previous year's income
tax return as
documentation)Use annual figure given in tax return. Lump sum income Use the figure given. [(3) Locate the corresponding annual income by family size in Appendix B.
(4) Determine whether the annual income for the family size exceeds 235% of the FPL for a family of that size.]
(b) If the annual income for the family size exceeds [235%] 185% of the FPL, the family is not eligible for subsidized child day care [service].
(c) If the annual income for the family size does not exceed [235%] 185% of the FPL, the eligibility agent may proceed with the remaining steps of the weekly family fee determination process:
(1) Locate, in Appendix B, the family's annual gross income in the most recently distributed FPIG charts for the [appropriate] family size, and identify the FPL level for that income. The FPIG amounts are published annually in the Federal Register with an effective date of July 1 of the year in which they are published. When a family's annual gross income falls between two FPL levels, the highest FPL level will be used as the family's FPL percentage.
(2) [The annual gross income for the family size determines the multiplier known as N. That figure is found in column ''N'' of Appendix B.] Using the chart below, determine the multiplier, known as ''N,'' for the family's FPL percentage.
%FPL N +/- 60% 8% $5 70% 8.5% 5 80% 9% 5 90% 9.5% 5 100% 10% 5 110% 10.5% 5 120% 11% 5 130% 11.5% 10 140% 12% 10 150% 12.5% 10 160% 13% 10 170% 13.5% 10 180% 14% 15 185% 14.5% 15 (3) [Subtract from the annual gross income 50% of the FPL for the family size.] Using the annual gross family income from paragraph (1), determine the lower FPL% for that income in the chart in paragraph (2). Locate the annual income amount for that FPL%. Add $1 to that income amount. Multiply by ''N.'' This amount is the standard annual family fee.
(4) [Multiply the figure calculated in paragraph (3) by the ''N'' multiplier calculated in paragraph (2) and divide that number by 52. That figure represents the weekly family fee.] Divide the annual family fee by 52 to determine the standard weekly family fee.
(5) Round down the weekly family fee found in paragraph (4) to the nearest $5. [A fee which exceeds more than one-half of the difference between increments of $5 should be rounded up to the nearest $5 amount. A fee which is less than one-half of the difference between increments of $5 should be rounded down to the nearest $5 amount.]
(6) [The fee formula can be represented as follows:
(7) The fee determination formula represents the Department's weekly family fee. A parent may choose a child day care provider whose rates are higher or lower than the rates included in the range for the standard weekly family fee.
(8) The weekly family fee is based on an ''average child care rate.'' The ''average child care rate'' is determined by adding the total amount of provider rates for all children for whom the parent is requesting subsidized child day care, and dividing that total by the number of children for whom subsidy is requested.
(9) If the ''average child care rate'' is less than the Department's standard family fee, the family fee will be reduced by the corresponding amount in the ''+/-'' column of the chart in paragraph (2) according to the family's FPL.
(10) If the ''average child care rate'' is greater than the Department's standard family fee, the family fee will be increased by the corresponding amount in ''+/-'' column of the chart in paragraph (2) according to the family's FPL.
(d) If the weekly family fee exceeds the weekly [cost of care] provider rate for care, the family is not eligible for subsidized child day care [service].
(e) If [computation of] the weekly family fee [yields a] is 0 or a negative number, [a] the minimum fee [of $5] for the family size shall be assessed.
§ 3040.64. [Departmental] The Department's payment.
If the weekly family fee does not exceed the weekly [cost of care and,] provider rate for care, and if the family annual gross income does not exceed [235] 185% of the FPIG, the difference between the weekly cost of care and the weekly family fee represents the Department's copayment for subsidized child day care [service].
NOTIFICATION REQUIREMENTS § 3040.71. General requirements regarding notification.
(a) The eligibility agent shall notify the [caretaker] parent in writing of the results of the eligibility determination. Notification shall occur within 30 calendar days following the date the eligibility agent receives a [completed] signed and dated application from the [caretaker] parent.
(b) The eligibility agent shall notify the [caretaker orally or] parent in writing of an eligibility determination which renders the [caretaker] family eligible for [service] subsidy. The notification shall include the following:
(1) The amount of the assessed weekly family fee.
(2) The [caretaker's] parent's responsibility to report changes in circumstances cited in §§ 3040.32--3040.34 (relating to [documentation of] financial eligibility; documentation of self-employed income; and [documentation of] nonfinancial eligibility).
(c) Eligibility agents shall [, by means of] on a written notice form approved by the Department, notify each [caretaker] parent of a determination or redetermination resulting in ineligibility for subsidized child day care [service].
(d) At least 10 calendar days before the adverse action is effective, the eligibility agent shall hand deliver or mail the adverse action notice to the [caretaker] parent. The 10-day period begins on the day following the day the written notice is hand delivered or mailed to the [caretaker] parent.
(e) If the 10-day period ends on a holiday or a day when the [service site] eligibility agent is not open for business, the next business day is considered the 10th day.
(f) The eligibility agent shall, by written notice of the parent, confirm the parent's voluntary withdrawal of a child from subsidized child day care.
§ 3040.72. Content of a written notice of adverse action.
(a) Written notices to [applicants] a parent regarding the family's eligibility for [service and to caretakers receiving service which are issued under this section] subsidy shall be prepared on a form approved by the Department and include the following:
* * * * * (4) A statement explaining the right of the [caretaker] parent to appeal the adverse action and to receive a Departmental hearing. The following information will be included in the statement:
(i) An appeal shall be submitted to the eligibility agent. The appeal shall be in writing and be mailed within 30 calendar days of the date the written notice was mailed or hand delivered to the [caretaker] parent.
(ii) If service is to be continued pending a Departmental hearing decision, a written request for a Departmental hearing shall be postmarked no later than 10 calendar days following the date the written notice was mailed or hand delivered to the [caretaker] parent by the eligibility agent. Exceptions to service continuation are contained [at] in § 3040.74 (relating to appeal: continuation of [service] subsidy denied).
(iii) The [exact] specific date by which the appeal and request for a hearing shall be postmarked or hand delivered to the eligibility agent.
(iv) A request for a Departmental hearing postmarked from the 11th calendar day [and to] through the 30th calendar day from the date the written notice was mailed or hand delivered to the [caretaker] parent will be accepted by the Department's [Office] Bureau of Hearings and Appeals, but [service will] subsidy may not be continued pending the hearing decision. The parent may reapply for subsidized child day care while awaiting the hearing decision.
(v) A request for a Departmental hearing postmarked or hand delivered after the date required in subparagraph (iii) may be dismissed by the [Office] Bureau of Hearings and Appeals, under Chapter 275 (relating to appeal and fair hearing and administrative disqualification hearings), without a hearing.
(vi) The conditions specified in § 3040.78 (relating to continuing [service] subsidy and fee payment during an appeal) which become effective if a [caretaker] parent appeals an adverse action.
(5) A statement of agreement by the parent to repay all subsidy received by the family if subsidized child day care continues while awaiting an appeal decision if the decision is in favor of the eligibility agent/department.
(b) Following the preparation of a written notice of adverse action, the eligibility agent shall:
(1) Mail or hand deliver, within 1 working day of preparation, the original and one copy of the notice to the [caretaker] parent.
(2) Retain a copy of the notice in the [caretaker's] family file.
§ 3040.73. Grounds for appeal.
A [caretaker] parent has the right to request a Departmental hearing to appeal the following:
(1) The denial of [service] subsidy.
(2) The termination of [service] subsidy.
(3) The computation of [a] the weekly family fee amount.
(4) The eligibility agent's failure to act upon a request for [service] subsidy within the time limits specified [by] in § 3040.52 (relating to eligibility agent responsibilities).
(5) [Service] Subsidy disruption, as detailed in § 3040.19 (relating to [service] subsidy disruption).
§ 3040.74. Appeal: continuation of [service] subsidy denied.
(a) The [caretaker] parent has the right to appeal a decision which is based solely on changes in Federal or State law or regulations, but [service] subsidy will not [be continued] continue pending a hearing.
(b) The [caretaker] parent has the right to appeal the termination [based on unpaid fees as described in § 3040.61(h)(4) (relating to general requirements regarding fee payment), but service will not be continued] of subsidy when the eligibility agent lacks funding to continue subsidy to a child as indicated in § 3040.19(c) (relating to subsidy disruption). However, subsidy will not continue pending a hearing.
(c) A parent eligible for subsidy under § 3040.38(e) (relating to prospective employment or a prospective education program for new parent applicants) has the right to appeal the termination of subsidized child day care, but is not entitled to receive continued subsidy pending the final decision of the Bureau of Hearings and Appeals.
§ 3040.75. Filing an appeal: [caretaker responsibility] parent responsibilities.
(a) A [caretaker requesting to appeal] parent appealing an adverse action shall submit a written request to the eligibility agent in accordance with Chapter 275 (relating to appeal and fair hearing and administrative disqualification hearings). The [caretaker] parent shall specify the reason for the appeal, the current address and a telephone number where the [caretaker] parent can be reached during the day.
(b) A [caretaker] parent may have anyone represent him at the hearing, whether or not the representative is an attorney.
(c) If the [caretaker] parent desires that [service] subsidy continue pending a [Departmental hearing and] final decision, the [caretaker] parent shall submit [an] a written appeal within the time limits specified in § 3040.72 (relating to content of a written notice of adverse action). The [caretaker] parent is responsible for timely payment of the weekly family fee which was in effect prior to issuance of the adverse action until a decision is rendered in the appeal hearing.
§ 3040.76. Filing an appeal: eligibility agent [responsibility] responsibilities.
(a) If the [caretaker] parent is unable to prepare a written appeal, the eligibility agent shall assist the [caretaker] parent in preparing a written appeal.
* * * * * (c) The eligibility agent shall forward a copy of the request for appeal to the Department's [Office] Bureau of Hearings and Appeals within 3 working days from the date the appeal was received.
(d) The eligibility agent may not take the proposed adverse action until 10 calendar days from the date of the delivery or mailing of the adverse action [has] have elapsed, and then only if the [caretaker] parent has not filed an appeal. [Service] Subsidy may be continued only if the [caretaker] parent meets the requirements in § 3040.78 (relating to continuing [service] subsidy and fee payment during an appeal).
(e) The eligibility agent may take the proposed adverse action before 10 calendar days have elapsed when a [service site] provider closes for financial difficulties or loss of certification, or funding is not available to continue subsidized day care to the child.
§ 3040.77. Departmental actions.
(a) [Unless the appeal is] If a parent officially [withdrawn] withdraws an appeal, the eligibility agent or the Department, if appropriate, shall take part in the scheduled hearing to justify the action to which the [caretaker] parent objects. If the [caretaker] parent fails to appear at the hearing, the decision of the eligibility agent or the Department will be sustained by the Department's [Office] Bureau of Hearings and Appeals. If the eligibility agent or the Department fails to appear at the hearing, the [caretaker's] parent appeal will be sustained by the Department's [Office] Bureau of Hearings and Appeals. See Chapter 275 (relating to appeal and fair hearing and administrative disqualification hearings). If neither the eligibility agent or the parent appears for the hearing, the hearing officer will reschedule the hearing.
(b) The Department's [Office] Bureau of Hearings and Appeals will notify the eligibility agent and the [caretaker] parent, in writing, when disposition of the appeal is made. The eligibility agent shall, and the Department will, implement the final administrative action within the time limit ordered by the Department's [Office] Bureau of Hearings and Appeals, or on the first day child care is needed in the week following receipt of the ordered administrative action. If the Bureau of Hearings and Appeals finds in favor of the eligibility agent/Department, and subsidy has been continued pending the hearing, the family may not be subsequently determined eligible for subsidized care in this Commonwealth until the amount of the subsidy received during the period of ineligibility has been repaid.
(c) The Department's [Office] Bureau of Hearings and Appeals may conduct a hearing by way of a telephone conference call with the parties to the appeal, including the [caretaker] parent, the [caretaker's] parent's authorized representative, the eligibility agent, the Department and the Hearing Officer. The [caretaker] parent has the right to request a face-to-face hearing instead of a telephone hearing. Face-to-face hearings will be held in locations specified by the Department's [Office] Bureau of Hearings and Appeals.
* * * * * § 3040.78. Continuing [service] subsidy and fee payment during an appeal.
(a) If the [caretaker] parent files a timely appeal prior to the date the adverse action is scheduled to take place, [service] subsidy continues until the appeal is heard and a final decision is rendered by the Bureau of Hearings and Appeals. The [caretaker] parent shall continue to make timely payment of the weekly family fee in effect prior to the adverse action, as referenced [at] in §§ 3040.61 and 3040.75(c) (relating to general requirements regarding fee payment; and filing an appeal: [caretaker responsibility] parent responsibilities).
(b) If subsidy continues during the appeal process and the Bureau of Hearings and Appeals finds in favor of the Department, the parent will be required to reimburse the Department for the subsidy paid for the child in care from the initial effective date of the adverse action until the date subsidy is discontinued based on the final decision of the Bureau of Hearings and Appeals.
(c) The parent has the right to appeal an increased weekly family fee which occurs as a result of a redetermination of eligibility. The parent shall pay the provider the increased fee pending the final decision of the Bureau of Hearings and Appeals. Payment of the increased fee is required if the eligibility agent has calculated family income using the methods described in § 3040.63 (relating to determining a weekly family fee).
OVERPAYMENT, REPAYMENT AND DISQUALIFICATION § 3040.91. Overpayment.
(a) An overpayment exists when a child receives subsidized child day care for which the family is not eligible.
(b) The cause of an overpayment may be classified as:
(1) Fraudulent misrepresentation by the parent.
(2) Error by an eligibility agent or parent. Error may result from one of the following:
(i) A parent misunderstanding of eligibility requirements or failure to provide information.
(ii) An innocent concealment of facts by the parent.
(iii) The omission or error of an eligibility agent in obtaining or acting upon information.
(c) The Department is responsible for identification of overpayments and for the recovery of overpayment from a parent. The Office of the Inspector General (OIG) conducts fraud investigations and recovers overpayments for the Department. The OIG has the authority to:
(1) Refer an overpayment case for criminal prosecution.
(2) Refer a parent receiving subsidized child day care benefits for an Administrative Disqualification Hearing (ADH) if evidence exists of an intentional program violation.
(d) A parent who applies for or whose child receives a subsidy for child day care has an obligation to report any changes in family circumstances as required in this chapter. See § 3040.35 (relating to factors affecting eligibility status). The parent is responsible for reporting any changes which apply to the parent and to all other family members.
(e) The eligibility agent has the obligation to explain eligibility requirements to the parent. The eligibility agent shall be alert to change in family circumstances and shall advise the parent on specific reporting requirements appropriate to the situation. The plan for reporting changes will be entered into the family file.
(f) The eligibility agent shall inform the parent that subsidy the child receives during the period of the parent's appeal shall be reimbursed to the Department if the Bureau of Hearings and Appeals denies the parent's appeal.
§ 3040.92. Repayment requirements.
(a) The eligibility agent shall verify all cases of suspected overpayment. If the parent does not provide information related to the eligibility agent's requests for verification, the parent faces termination of subsidized child day care. If the parent fails to provide verification requested, the eligibility agent shall obtain the information needed without the consent of the parent.
(b) The eligibility agent initially determines suspected fraud. Suspected fraud is determined based on the intent of the parent to receive benefits the child is not entitled to.
(c) The parent shall make repayment when subsidized child day care is provided for which the family was not eligible.
(d) The eligibility agent will have the responsibility for determining ineligibility and eligibility for subsidized child day care. When a voluntary termination of subsidized child day care is requested by the parent, information will be obtained concerning the reasons for termination. The eligibility agent will determine whether the voluntary request for termination is timely or whether overpayment has occurred.
(1) When the voluntary termination is due to additional income, the eligibility agent will follow up to establish the amount and the date of the income increase.
(2) When the voluntary termination is due to termination of employment by the parent, the eligibility agent will establish the date and reason for termination of employment.
(e) If overpayment has occurred in either subsection (d)(1) or (2), repayment will be sought by the eligibility agent. When specific reasons for a voluntary termination due to income or employment termination are not provided by the parent, and all reasonable efforts to obtain the information fail, the eligibility agent will make a notation as a last entry in the family file. The eligibility agent will make this notation so that at any subsequent application, the eligibility agent will be alerted that the situation be addressed through the following action:
(1) The exploration of possible overpayment.
(2) A review of the parent's past reporting reliability.
§ 3040.93. Procedures for the parent to repay an overpayment.
(a) The Department is responsible for determining overpayments.
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