Section 170-290-0268. Payment discrepancies—Provider overpayments.  


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  • (1) An overpayment occurs when a provider receives payment that is more than the provider is eligible to receive. Provider overpayments are established when that provider:
    (a) Bills and receives payment for services not provided;
    (b) Bills without attendance records that support their billing;
    (c) Bills and receives payment for more than they are eligible to bill;
    (d) With respect to license-exempt providers, bills the state for more than six children at one time during the same hours of care; or
    (e) With respect to licensed or certified providers:
    (i) Bills the state for more than the number of children they have in their licensed capacity; or
    (ii) Is caring for a WCCC child outside their licensed allowable age range without a DEL-approved exception; or
    (f) With respect to certified providers caring for children in a state bordering Washington:
    (i) Is determined not to be in compliance with their state's licensing regulations; or
    (ii) Fails to notify DSHS within ten days of any suspension, revocation, or change to their license.
    (2) DEL or DSHS may request documentation from a provider when preparing to establish an overpayment. The provider has fourteen consecutive calendar days to supply any requested documentation.
    (3) Providers are required to repay any payments that they were not eligible to receive.
    (4) If an overpayment was made through departmental error, the provider is still required to repay that amount.
    [Statutory Authority: RCW 43.215.070, 43.215.060 and chapter 43.215 RCW. WSR 12-11-025, § 170-290-0268, filed 5/8/12, effective 6/8/12. Statutory Authority: RCW 43.215.060, 43.215.070, 2006 c 265, and chapter 43.215 RCW. WSR 09-22-043, § 170-290-0268, filed 10/28/09, effective 12/1/09.]
RCW 43.215.070, 43.215.060 and chapter 43.215 RCW. WSR 12-11-025, § 170-290-0268, filed 5/8/12, effective 6/8/12. Statutory Authority: RCW 43.215.060, 43.215.070, 2006 c 265, and chapter 43.215 RCW. WSR 09-22-043, § 170-290-0268, filed 10/28/09, effective 12/1/09.