"Affiliates" means persons having an overt
or covert relationship such that any one of them directly or indirectly
controls or has the power to control another.
"Authorized representative," within the
context of rule 441-152.3 (234), means that
person appointed to carry out audit procedures, including an assigned auditor,
fiscal consultant, or agent contracted for a specific audit or audit
procedure.
"Bureau of service contract support" means
the division of fiscal management bureau that is responsible for administering
performance-based contracts.
"Child" means a person under 18 years of age
or a person 18, 19, or 20 years of age who meets the criteria in Iowa Code
section 234.1.
"Claim" means each record the department
receives that tells the amount of requested payment and the service rendered by
a provider to a child and family.
"Client" means a child who has been found to
be eligible for foster care services through the department of human
services.
"Confidence level" means the probability
that an overpayment or underpayment rate determined from a random sample of
charges is less than or equal to the rate that exists in the universe from
which the sample was drawn.
"Contract" means a formal written agreement
between the department of human services and a provider of foster care
services.
"Contract monitor" means a department
employee who is assigned to assist in developing, monitoring, and evaluating a
contract and to provide related technical assistance.
"Department" means the Iowa department of
human services and includes the local offices of the department.
"Extrapolation" means using sample data
meeting the confidence level requirement to estimate the total dollars of
overpayment or underpayment.
"Family," for purposes of child welfare
service delivery, shall include the following:
1. The natural or adoptive parents,
stepparents, domestic partner of the natural or adoptive parent, and children
who reside in the same household.
2. A child who lives with an adult related to
the child within the fourth degree of consanguinity and the adult relatives
within the fourth degree of consanguinity in the child's household who are
responsible for the child's supervision. Relatives within the fourth degree of
consanguinity include: full or half siblings, aunts, uncles, great-aunts,
great-uncles, nieces, great-nieces, nephews, great-nephews, grandparents,
great-grandparents, great-great-grandparents, and first cousins.
3. A
child who lives alone or who resides
with a person or persons not legally responsible for the
child's support.
"Fiscal record" means a tangible and legible
history that documents the criteria established for financial and statistical
records as set forth in subrule 152.2(5).
"Grant" means an award of funds to develop
specific programs or achieve specific outcomes.
"Juvenile court officer" means a person
appointed as a juvenile court officer or chief juvenile court officer under
Iowa Code chapter 602.
"Non-prime programming time" means any
period of the day other than prime programming time and sleeping time.
"Overpayment" means any payment or portion
of a payment made to a provider that is incorrect according to the laws and
rules applicable to foster care services and results in a payment greater than
that to which the provider is entitled.
"Prime programming time" means any period of
the day when special attention, supervision, or treatment is necessary (for
example, upon awakening of the clients in the morning until their departure for
school, during meals, after school, during transition between activities,
evenings and bedtime, and on nonschool days such as weekends, holidays, and
school vacations).
"Probation" means a specified period of
conditional participation in the provision of foster care services.
"Provider" means the entity that has
executed a contract with the department to provide services.
"Random sample" means a systematic (or every
"nth" unit) sample for which each item in the universe has an equal probability
of being selected.
"Referral worker" means the department
worker or juvenile court officer who refers the case to a provider and who is
responsible for carrying out the follow-up activities of determining client
eligibility and ensuring that the service authorization is completed.
"Service authorization" means the process of
determining service necessity and the level of care and number of units of
service to be provided to a child.
"Service record" means an individual,
tangible, and legible file that records service-related activities set forth in
subrule 152.2(4).
"Site" means each licensed location of the
foster care provider.
"Sleeping time" means any period of the day
during which clients are normally sleeping.
"Suspension of payments" means the
withholding of all payments due a provider until resolution of the matter in
dispute between the provider and the department.
"Underpayment" means any payment or portion
of a payment not made to a provider for services delivered to eligible
recipients according to the laws and rules applicable to the foster care
services program and to which the provider is entitled.
"Unit of service" means one day for group
care and child welfare emergency services shelter.
"Universe" means all items (claims)
submitted by a specific provider for payment during a specific period, from
which a random sample will be drawn.
"Withholding of payments" means a reduction
or adjustment of the amounts paid to a provider on pending and subsequently
submitted claims for purposes of offsetting overpayments previously made to the
provider.
