Current through Register Vol. 35, No. 18, September 24, 2024
A CYFD shall recover any payment made to an institution for
disallowed claims. CYFD identifies disallowed claims during program reviews and
considers payments made for such claims as over payments. CYFD shall notify all
institutions of the reasons for the disallowed claim and demand reimbursement.
The institution may request an administrative review of CYFD's decision as
provided in Paragraph (11) of Subsection A of
8.2.2.9
NMAC.
B. Disallowed claims include the
following for independent centers:
(1) lack of
documentation to verify sufficient milk purchases to meet the required portion
size for each age group, as documented in the menu record book and claimed for
any month reviewed;
(2)
reimbursement for meals, or snacks, claimed which lack required
components;
(3) reimbursement for
meals or snacks claimed which include non creditable foods as one of the
required meal components;
(4)
reimbursement for meals claimed when food production observed or recorded
indicate there was not enough food prepared to provide the minimum serving size
for the meals claimed for eligible children; food production is calculated
using the USDA food buying guide;
(5) reimbursement for meals claimed when
there is insufficient, or lack of, documentation to support the quantity and
types of foods served;
(6)
reimbursement for meals claimed in excess of two main meals and one supplement,
or two supplements and one main meal per child, per day;
(7) reimbursement for meals claimed when meal
count records do not support the meals claimed, or when any other required
documentation to support the meals claimed, is not available;
(8) reimbursement for meals served during
unapproved meal time periods;
(9)
reimbursement for individual meals claimed in excess of recorded attendance or
authorized capacity;
(10)
reimbursement for all meals claimed for any month by for-profit Title XX
centers when less than 25 percent of enrolled participants are Title XX
beneficiaries or eligible for free or reduced price meals.
C. Disallowed claims for sponsoring
organizations of day care homes include the following:
(1) reimbursement paid for meals served to
ineligible children;
(2)
reimbursement paid for ineligible meals or meals served during unapproved time
periods;
(3) reimbursement paid for
meals served that do not follow the USDA meal pattern as described in
7 CFR
226.20, and the state agency non creditable
foods list;
(4) reimbursement for
meals served to children not properly enrolled;
(5) reimbursement paid for meals served to
providers' own children without current and complete income eligibility
applications on file;
(6)
reimbursement paid for meals at Tier 1 rates to providers who are incorrectly
classified as Tier 1; the difference between Tier 1 and Tier 2 reimbursement
paid to providers, is considered an over payment;
(7) reimbursement paid for meals at Tier I
rates served by Tier II providers who do not have adequate Tier I eligibility
documentation for non resident children.
D. Sponsoring organizations of day care homes
shall recover payments from family day care home providers for the following
disallowed claims:
(1) failure to maintain
daily menu and attendance records;
(2) claiming meals when eligible enrolled
children are not present;
(3)
claiming meals which do not meet meal pattern requirements;
(4) claiming more than 2 main meals and a
snack or two snacks and a main meal per child per day;
(5) claiming provider's own children when non
resident children are not present at the meal service;
(6) program participants not found at the
family day care home during stated hours of care on two consecutive visits; in
such cases, the sponsoring organization shall dis-enroll these participants
from the program and shall disallow any future claims concerning such
participants until the sponsor verifies attendance.
E. Sponsoring organizations of family day
care homes shall notify providers of disallowed claims and afford an
opportunity for an administrative review in accordance with 7 CFR Part
226.6(l)(2).
