170-290-0269  <<  170-290-0271 >>   170-290-0275

Payment discrepanciesConsumer.

(1) DSHS establishes overpayments for past or current consumers when the consumer:
(a) Received benefits in an amount greater than the consumer was eligible to receive;
(b) Is determined eligible at application or reapplication based on the consumer's participation in an approved activity and used benefits, but never participated in said activity;
(c) Failed to report changes under the requirements of WAC 170-290-0031 to DSHS which result in an error in determining eligibility, amount of care authorized, or copayment;
(d) Used a provider who did not meet the eligibility requirements under WAC 170-290-0125;
(e) Received benefits for a child who was not eligible per WAC 170-290-0005, 170-290-0015 or 170-290-0020; or
(f) Failed to return, by the sixtieth day, the requested income verification of new employment as provided in WAC 170-290-0012.
(2) DEL or DSHS may request documentation from a consumer when preparing to establish an overpayment. The consumer has fourteen consecutive calendar days to supply any requested documentation.
(3) Consumers are required to repay any benefits paid by DSHS that they were not eligible to receive.
(4) If an overpayment was made through departmental error, the consumer is still required to repay that amount.
(5) If a consumer is not eligible under WAC 170-290-0030 through 170-290-0032 and the provider has billed correctly, the consumer is responsible for the entire overpayment, including any absent days.
[Statutory Authority: RCW 43.215.060, 43.215.070 and 2017 3rd sp.s. c 1 § 615. WSR 17-23-033, § 170-290-0271, filed 11/7/17, effective 12/8/17. Statutory Authority: RCW 43.215.070, chapter 43.215 RCW. WSR 16-19-107, § 170-290-0271, filed 9/21/16, effective 10/22/16. Statutory Authority: RCW 43.215.060, 43.215.070, and chapter 43.215 RCW. WSR 16-09-059, § 170-290-0271, filed 4/15/16, effective 5/16/16; WSR 12-11-025, § 170-290-0271, 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, § 170-290-0271, filed 10/28/09, effective 12/1/09. WSR 08-08-047, recodified as § 170-290-0271, filed 3/27/08, effective 3/27/08. Statutory Authority: RCW 74.04.050, 74.12.340, and 74.13.085. WSR 05-22-078, § 388-290-0271, filed 10/31/05, effective 12/1/05. Statutory Authority: RCW 74.04.050, 74.12.340, 74.13.085, and 2003 1st sp.s. c 25. WSR 04-08-021 and 04-08-134, § 388-290-0271, filed 3/29/04 and 4/7/04, effective 5/28/04.]
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