Part 600 - PRINCIPLES OF REIMBURSEMENT CLAIMING

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Statutory Authority: 
Social Services Law, Sections 20, 34, 62, 65, 80, 81, 82, 83, 84, 85, 86-a, 87, 88, 90, 92, 93, 153

Section 600.1 - Reimbursement by the State.

Section 600.1 Reimbursement by the State. Expenditures made by social services districts for public assistance and care, or for other purposes for which reimbursement is available pursuant to State law, will, if approved by the department, be subject to reimbursement in accordance with the provisions of this Title.

 

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Section 600.2 - Definitions.

600.2 Definitions. Terms used in this Subchapter have the meaning ascribed to them by the Social Services Law or this Title or by normal usage unless a different meaning is apparent from the context in which they are used. For purposes of this Subchapter:

(a) Administrative costs means expenditure or costs incurred in relation to the overseeing or delivery of public assistance, care or services, as opposed to payments to recipients, vendors or others actually receiving or providing the assistance, care, services, supplies or other items for which reimbursement is available.

(b) Allocation means a process of dividing costs or expenditures among more than one program or activity.

(c) Allocation basis means a standard or method, used as a reference or guide, for making an allocation.

(d) Allocation plan means a plan or scheme prescribing a means of allocation, usually used to ascribe a portion of a larger unit's costs to a subunit.

(e) Appropriation means an amount authorized to be spent by a governmental unit for a specified purpose during a specified time.

(f) Control means an accounting device used to consolidate information concerning particular types of transactions, resources or other aggregated matters for the purpose of facilitating management of those matters.

(g) Direction means a published statement made by the commissioner, or an authorized agent exercising a power of the department or the commissioner, pursuant to section 20(3) or 34(3) or other appropriate provisions of the Social Services Law, such as regulations, administrative directives, bulletins, manuals and other numbered, titled and indexed communications, but will not include oral or written statements made by any official other than one authorized to act for the commissioner pursuant to section 9 of the Public Officers Law.

(h) Electronic data processing means a process utilizing mechanized claims processing or information retrieval systems, usually using equipment commonly called computers.

(i) Federally nonparticipating (FNP) means reimbursement made by the State or another entity for which there is no Federal financial participation, usually indicating reimbursement in whole or in part by a State governmental entity.

(j) Federal participation (FP) means reimbursement made in whole or in part by a Federal governmental entity or agency.

(k) Format means a specified manner of presenting information, such as a pre-printed form, a published description of the manner in which such information must be presented, a computer or systems process, or any other specified manner of presentation.

(l) Function means a cost classification used by districts to code payroll and non-salary expenditures, as well as other specified expenditures, subject to direction of the department.

(m) Indirect costs means amounts derived or inferred, usually by allocation or a methodology used to distribute such amounts to a particular purpose or classification different from the designation given to them when originally expended or otherwise recorded, usually used in relation to general or administrative expenditures such as rent, electricity, fuel, utilities, equipment, management salaries and other similar classifications.

(n) Pool means a group of classifications that contains as yet undivided costs, the aggregate of which is to be subdivided and allocated to other classifications, subclassifications or pools.

(o) Recovery means a type of retrieval representing funds that cannot be attributed to specific items of assistance without the use of an allocation or derivation calculation provided by the department.

(p) Refund means money repaid to the district to cancel or reduce specific items of assistance previously expended or claimed, or current contribution received by a district and not reflected in the budget computation of a grant to or for a recipient, being a type of retrieval distinguished from recoveries or other retrievals.

(q) Retrieval means amounts received by or credited to the district or the department which represent the return of assistance, benefits or other expenditures provided on behalf of a recipient, vendor, provider, responsible relative or other party, and which should be returned, in whole or in part, to the State or Federal authorities or should be used to reduce current claims for reimbursement, whether for specified programs or activities or for unspecified or unclassified general assistance or expenditures.

 

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Section 600.3 - Reimbursement.

600.3 Reimbursement. (a) Costs subject to reimbursement.

(1) Expenditures for recipients of public assistance, care or services. Assistance properly furnished to eligible recipients of public assistance, care or services may be reimbursed to the extent authorized by law if the social services district which makes the expenditure submits claims to the department in accordance with department regulations and directions.

(2) Administrative expenditures. Expenditures for the administration of public assistance, care and services may be reimbursed if the expenditure is properly made or incurred by a social services district and the district submits a claim for reimbursement in accordance with department regulations and directions.

(3) Other costs. Any costs or adjustments specifically authorized by law will be subject to reimbursement or adjustment as directed by the department, in accordance with applicable provisions of State and Federal law and regulations.

(b) Costs not subject to reimbursement. Except as otherwise provided in this Subchapter, the following provisions concerning the claiming of reimbursement will apply:

(1) Costs subject to reimbursement may not be reported in any manner that results in any portion of such costs being subject to reimbursement more than once.

(2) Any portion of costs that could be reimbursed directly or indirectly by any entity other than the State may not be reported in any manner that results in such costs being reimbursed by the department, unless an appropriate adjustment is made properly reflecting the potential or actual reimbursement by such other entity.

(3) Costs of a social services district that could be reimbursed by an entity whose expenditures are not subject to reimbursement by the department, or whose expenditures have been or will be subject to reimbursement separately by the department, may not be claimed or reported by a social services district in any manner that results in any portion of such costs being subject to reimbursement by the department, unless the claim reflects the potential or actual reimbursement to be made to such other entity.

(4) Costs which are required to be attributed to a particular claiming category or pool must not be reported in a manner that results in any portion of such cost being reimbursed at an unauthorized rate or amount of reimbursement.

(5) Costs for services, supplies, facilities or other items incurred on behalf of a social services district by another agency of a governmental entity must not be reported in a manner that results in any portion of costs that are a general responsibility of such governmental entity being reimbursed by the department, except as permitted within the scope of an authorized cost allocation plan approved for such governmental agency or entity.

(6) Costs that are ascertainable must not be included in any plan, method or function of cost allocation if such inclusion would result in reimbursement greater than that which would be available if the cost had been charged directly to the activity for which reimbursement is claimed, unless such inclusion is directed by the department.

(7) Costs related to the acquisition of land, development of land, the construction of buildings, or the addition to, improvement of, alteration of or replacement of buildings which are of a fixed and durable character, must not be reported in any manner that results in any portion of such cost being subject to reimbursement. However, acquisition, construction, rehabilitation or improvement expenditures, to the extent of the amount appropriated for such purposes and approved by the department for acquiring, constructing, rehabilitating or improving a shelter for adults, and costs for investments in public buildings, claimed only as depreciation as an element of maintenance costs in lieu of rent, may be reported or claimed as directed by the department.

(8) Costs relating to the implementation of cooperative agreements and purchase of service agreements must not be reported in any manner that results in any portion of such cost being subject to reimbursement by the department unless prior approval for such agreement has been obtained from the department or unless such agreement is specifically permitted or required by the Social Services Law, department regulation or policy.

(9) Costs relating to expenditures or adjustments for which prior approval from the department or other entity is required must not be reported in any manner that results in any portion of such cost being subject to reimbursement unless such prior approval has been obtained, as required by the department.

(10) Costs subject to reimbursement must not be reported in any manner which is contrary to department direction.

(c) Limitations and conditions upon reimbursement. (1) Reimbursement will be available only for expenditures permitted by State or Federal law or regulation.

(2) Expenditures subject to reimbursement from more than one claiming classification must be allocated or distributed among the appropriate classifications in accordance with the directions of the department.

(3) All portions of all claims for reimbursement involving Federal participation or reimbursement from entities other than the department must be submitted in accordance with directions of the department, and in the absence of directions of the department, in accordance with directions of the Federal government.

(4) If the requirements for Federal participation or reimbursement from entities, other than the department, are not met by a social services district, the claiming requirements for purposes of State participation in reimbursing the claimed costs have not been fulfilled, unless:

(i) department directions have expressly and specifically set forth requirements that contradict requirements for Federal participation or reimbursement from other entities;

(ii) the department has expressly and specifically determined that State law and department policy require or permit partial or full State reimbursement for the particular items claimed by a district for reimbursement; or

(iii) there is an authorized administrative or legal determination issued or expressly and specifically accepted by the department which lawfully requires or permits partial or full State reimbursement for specific items claimed by districts for reimbursement.

(5) Any rejection, disallowance, recoupment or other reimbursement claim adjustment made by Federal or other authorities, or any penalty imposed or reduction made by such authorities, will result in an adjustment to or reduction of any claim for reimbursement to which such adjustment or reduction applies. In the event the Federal government imposes a fiscal penalty for incorrect issuance of benefits or improper administration of any program subject to Federal financial participation, the department will divide and allocate the penalty between the State and social services districts in a manner calculated to apportion such penalty among subject governmental entities in relation to their responsibility for the assessment of such penalty, and will attribute and assess any such proportion of such penalty to those governmental entities in accordance with such calculation.

(6) Previous claims for reimbursement submitted by any social services district may result in related adjustments to subsequent claims submitted by such district if the department determines that such adjustments are appropriate.

 

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Section 600.4 - Fiscal responsibilities.

600.4 Fiscal responsibilities. Reimbursement for allowable expenditures may be claimed by a social services district only if the district has fulfilled its responsibilities related to the activities for which reimbursement is claimed, including but not limited to the following:

(a) Local funds. The district supervises and administers all funds in accordance with the provisions of sections 82, 83, 84, 86, 86-a and 87 of the Social Services Law or other provisions of State or Federal law, regulation or policy.

(b) Appropriations. The district prepares and submits estimates and requests for appropriations as required by sections 88, 89, 90, 91, 92 and 93 of the Social Services Law or as required by any other provision of State or Federal law, regulation or policy.

(c) Reports. The district makes such reports and furnishes such information to the department as required by section 81 of the Social Services Law or as required by any other provision of State or Federal law, regulation or policy.

(d) Other fiscal responsibilities. The district performs such other responsibilities as are required by State law, regulation, policy or direction of the department.

 

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Section 600.5 - Controls.

600.5 Controls. (a) Monetary controls. A social services district must maintain adequate monetary controls.

(1) Monetary controls include a predetermined check processing procedure or an electronic verification and issuance procedure to assure that a properly completed authorization, in a State-prescribed format, is on file at the district which establishes eligibility for an amount of assistance to be granted before there is an expenditure of public funds and establishes that the amount of assistance granted is in accordance with the amount authorized.

(2) Documentation of monetary controls to be used by a social services district will be maintained by the district in an appropriate record.

(b) Claims control. A social services district must implement procedures which will assure that monthly or other appropriate charges, credits and related revenues are properly reflected in claims for reimbursement and on supporting documents and summaries. Such documents and summaries must be retained in each district.

(1) Claims controls must be established for all programs operated and expenditures supervised by a social services district, subject to the direction of the department.

(2) Reconciliations to appropriation and revenue accounts will be made for each claim for reimbursement.

(3) Documentation of reconciliations for audit purposes will be maintained by each social services district.

 

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Section 600.6 - Records.

600.6 Records. A social services district must maintain adequate and accurate records relating to all claims for reimbursement.

(a) Records of assistance. A social services district must maintain a basic fiscal record on State-prescribed formats or approved local equivalents for each person who applies for or is in receipt of public assistance, care or services. The use of such formats or equivalents is mandatory for all activities for which reimbursement is claimed.

(b) Administrative records. Records relating to the provision of public assistance, care and services or to administering programs or expenditures subject to State or Federal reimbursement will be prepared and maintained by the district in accordance with the instructions of the department. Each district will:

(1) conduct an annual review of personnel assignments to identify and allocate administrative salary costs to specific functions, as defined by the department;

(2) code each payroll to distribute salaries and the number of staff to specific functions, as instructed by the department;

(3) code nonsalary administrative expenditures to specific functions, as instructed by the department;

(4) certify annually the existence of a cost allocation plan for services furnished to social services districts by other governmental units of the same municipality and distribute allowable costs according to instructions of the department;

(5) maintain, for audit purposes, fiscal records, statistics or required State approvals to support claims which include exceptional reimbursement amounts; and

(6) submit claims, schedules and required supporting documentation to the department in accordance with the directions of the department.

(c) Control support records. A social services district must establish and maintain, available for audit or review, records reflecting assets held or relinquished; receipts, retrievals and recoveries made; payroll substantiation; eligibility determinations establishing that a recipient or other person is authorized to receive assistance or other benefits reimbursed or supervised by the department; and any other transactions or information that could support claims for reimbursement or activities subject to the direction of the department.

(1) Assets. A permanent record for each category or piece of equipment must be established and maintained by each social services district, clearly indicating the date of purchase, the initial cost and the function for which acquired. When equipment is sold, scrapped, transferred to other departments or programs or otherwise disposed of, appropriate entries must be made in the record indicating the date and method of disposal, the value or amount realized, if any, and any other pertinent information relating to the transaction.

(2) Payroll substantiation. Permanent time records of attendance and leave of agency personnel must be maintained to substantiate payrolls. The record must contain, at a minimum, days worked and days absent, with appropriate explanation, such as sick leave, vacation, excused leave or other reason, and must be retained for reference and audit purposes.

(3) Recipient eligibility. All records which establish the eligibility of an individual to receive assistance or benefits reimbursed or supervised by the department will be maintained by each social services district in a manner that facilitates review by the department and in accordance with any direction of the department.

(4) Recipient real property. A record must be maintained of all real or personal property owned by a recipient of public assistance, care or services, which has been deeded, mortgaged, assigned or otherwise turned over to a social services official for the recovery of assistance, care or services provided to the recipient.

(5) Retrievals. A record will be kept of all monies received by social services officials as recoveries or retrievals and of any special funds held pending their distribution to the Federal, State or local governments, and/or the recipient or the recipient's estate.

(i) Monies received from recoveries must be recorded by the social services district receiving such monies in a cash receipts record. A record of recovery cash disbursements must also be maintained by the district.

(ii) A recoveries ledger must be maintained by the social services district with an account for each recipient from whom or from whose estate, or on whose behalf, a recovery is received. Receipts and disbursements must be posted to such account. A control account must also be maintained and the detail accounts must be balanced with the control account monthly or as otherwise directed by the department. The detail accounts must be reconciled monthly with the special fund accounts to reflect balances held pending distribution.

(6) Other support records. Each social services district must maintain such other control support records as may be required by law or by direction of the department.

 

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