441—152.1(234) Definitions.
“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.
[ARC 2885C, IAB 1/4/17, effective 3/1/17; ARC 3442C, IAB 11/8/17, effective 1/1/18; ARC 6857C, IAB 2/8/23, effective 4/1/23]