Code of Maine Rules
10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL
Chapter 323 - MAINE GENERAL ASSISTANCE MANUAL
Section 144-323-IX - REVIEW OF MUNICIPAL ADMINISTRATION OF GENERAL ASSISTANCE

Universal Citation: 10 ME Code Rules ยง 144-323-IX

Current through 2024-38, September 18, 2024

A. The Department shall review the administration of General Assistance for each municipality for compliance with statute, municipal ordinance and this manual.

1. Reviews shall be conducted on a regular basis.
a. At the Department's discretion, municipalities may be reviewed by mail and/or telephone.
i. The Department shall consider the amount of General Assistance expended, the number of cases, and the overall cost effectiveness when determining if an on-site review is warranted.

ii. Municipalities shall have an on-site review no less than every three years.

iii. Any municipality that receives a mail review may request an on-site review by the Department's representative.

2. Reviews may be conducted whenever the Department has reason to believe that a municipality is violating General Assistance statute, municipal ordinance or the rules in this manual.

3. Reviews may be conducted in response to a complaint from any person.
a. The Department may decline to investigate a complaint based on factors including, but not limited to: the severity of the alleged problem, whether or not the alleged problem is ongoing, the client's needs, and the duration of time between the allegedly erroneous action and the date of the complaint.

B. Review Procedure.

1. On-site reviews shall be conducted during regular business hours of the Department.

2. The review shall be scheduled at least 48 hours in advance, unless a shorter period is agreed on by both parties.

3. The Department's representative will conduct an entrance conference for each review.
a. The conference will take place by e-mail or phone at the time of scheduling or in person prior to the review to discuss:
i. The purpose of the review,

ii. the scope of the review,

iii. the time period of the review, and

iv. the case selection process, if applicable.

4. The General Assistance Administrator or designee shall be available during the Department's review and shall cooperate in providing all necessary information.

5. Once the Department's representative has finished the review, he/she will conduct an exit conference with the General Assistance Administrator or a designee.
a. The representative will provide the municipality with written findings of the review, indicating any program violations believed to have been made, previewing penalties that may be imposed by the Department and corrections that will need to be made before compliance can be achieved.

b. The representative and the administrator shall both sign the exit conference form.
i. The administrator may write comments on the form.

ii. The administrator's signature does not signify agreement with the review findings; it signifies that the review findings have been discussed with the Department's representative.

c. If the administrator does not agree with the findings, he/she shall send a written response to the Department within 10 days of the exit conference.
i. The Department shall consider the information presented in this written response before finalizing its findings or assessment.

6. Municipalities that are found to be in compliance with the requirements of Chapter 1161 and these regulations at the time of the review shall be notified in writing at the exit conference and by letter from the Department.

7. Municipalities that are found to be out of compliance with the requirements of Chapter 1161 and these regulations after the 10-day waiting period from the date of the exit conference shall be notified in writing by the Department. Upon receipt of findings of non-compliance by the Department, the municipality may, if dissatisfied with the findings, request a fair hearing.
i. If a municipality requests a fair hearing, the Department shall stay all penalties pending a fair hearing decision.

ii. If the Department's findings are upheld by the hearing officer, or if no hearing is requested, penalties will be imposed as described in Section X of this manual.

C. Departmental reviews may include some or all of the following elements.

1. Municipal fiscal records. The Department may assess whether only direct (and not administrative) costs are billed to the Department, and whether the correct calculations were used to seek state reimbursement.

2. Proper Notice. During an onsite review the Department must determine if a notice is posted in accordance with 22 M.R.S. §4304(1).

3. Applications. The Department may determine whether applications are available for review.

4. Case files. The Department must review a sample of cases. The size of the sample will depend on the number of cases granted in the municipality each month, and will be no smaller than:

No. Cases Monthly

Minimum To Be Reviewed

1-25

10 (or all cases if fewer than 10)

26-50

20

51-100

30

101-150

40

151-200

50

201-300

60

301-400

75

more than 400

90

5. For each case under review, the Department will determine whether:
a. Conditions of eligibility from the previous application were met, if applicable;

b. a budget was completed to determine a deficit;

c. a budget was completed to determine unmet need, whenever there was deficit or an emergency situation;

d. unverified expenditures and expenditures verified as misspent were added to prospective income as misspent income and were considered available, unless the applicant was considered to be a first-time applicant;

e. the lesser of the deficit or unmet need was the amount granted, unless an emergency existed that could not have been averted by the applicant's use of income and resources;

f. there is a narrative statement of case activity in emergency situations that indicates the emergency and the reason for granting more than the maximum allowed;

g. if an emergency application was made outside of normal working hours, and the applicant failed to appear later to document eligibility, the case record, in lieu of an actual application, includes a budget and narrative explanation describing circumstances that led up to the granting of assistance;

h. a written decision was given in each instance that eligibility was determined/re-determined, granted, denied, reduced, terminated or suspended; and the written decision included the specific reason(s) for the determination, information on fair hearing rights, conditions of future eligibility, and the Department's toll free number;

i. the applicant was required to sign an Interim Assistance Reimbursement authorization if waiting for an initial eligibility determination for SSI or waiting for a post-eligibility determination due to suspension or termination of SSI benefits;

j. records required under Section VII (Retention of Records) are included in the case record.

k. A decision was made within 24 hours.

6. Denials. The Department shall review cases that have been denied assistance to ensure that reasons for denial, notices of ineligibility and other aspects of the case comply with ordinance and statutory provisions.
i. If possible, 20% of the cases reviewed by the Department will be denials.

ii. The review of denied cases may extend beyond the time period used for the active case record.

7. The Department may find it necessary to conduct a more in-depth case review, if during the initial review, it discovers a significant number of errors or inconsistencies in the case files being reviewed. This review may require the Department to conduct interviews with clients, vendors, advocates, or any other relevant source.

8. At the Department's discretion, it may review a municipality's General Assistance Program for compliance with any legislation regarding client rights, Department or municipal responsibilities, and cost saving measures, after the effective date of said legislation.

9. At the Department's discretion, its review may include an audit of the grants, expenditures, and computation of SSI reimbursements.

10. The Department's representative will examine fiscal records of the municipality as they relate to each case for the month to be reviewed. This review will ensure that vouchers issued correctly correspond to the individual case files.

D. Corrective Action

a. Within 30 days of receiving written notice of noncompliance from the Department, the municipality must submit a plan of corrective action, specifying the steps it will take to achieve compliance for each violation.
i. At a municipality's request, the Department will work with the municipality in developing an acceptable plan of correction.

ii. If the municipality fails to submit a corrective action plan timely, it will be subject to penalty in accordance with Section X, Subsection A(1)(b).

b. The Department will respond in writing to the proposed corrective action plan, accepting or rejecting the plan.
i. Upon acceptance of a corrective action plan, the Department will review the municipality again within sixty days to determine whether the corrective action plan is being followed and the municipality has achieved compliance.
a. If the Department finds the same violations in its follow-up review or finds that the municipality is not following its corrective action plan, the municipality will be subject to a withholding penalty in accordance with Section X, Subsection A(1)(d).

b. If the Department finds new violations in its follow-up review, the municipality must submit a new corrective action plan, and will not be subject to a withholding penalty for the new violations until after it has been given an opportunity to correct them.

ii. Upon rejection of a corrective action plan, the Department will specify what is needed for an acceptable plan of corrective action.

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