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—152.9(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.
“Child” means a person under 18 years of age or a person 18 or 19 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 group care services through the Iowa 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 Iowa department of human services and a provider of foster group 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.
“Extrapolation” means that the total dollars of overpayment or underpayment will be estimated by using sample data meeting the confidence level requirement.
“Family,” for purposes of child welfare service delivery, shall include the following:
	  1. 	 The natural or adoptive parents, stepparents, 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(7).
“Grant” means an award of funds to develop specific programs or achieve specific outcomes.
“Host area” means:
	  1. 	 The department service area where the provider’s corporate office is located, or
	  2. 	 The service area designated by the chief of the bureau of purchased services when the provider’s corporate office is out of state.
“Juvenile court officer” means a person appointed as a juvenile court officer or chief juvenile court officer under Iowa Code chapter 602.
“Level of care” means a type of foster group care service that is differentiated by the ratio of staff to children. There are three levels of foster group care services:
	  1. 	 Community-level group care (service code D1), which requires a minimum staff-to-client ratio of 1 to 8 during prime programming time.
	  2. 	 Comprehensive-level group care (service code D2), which requires a minimum staff-to-client ratio of 1 to 5 during prime programming time.
	  3. 	 Enhanced comprehensive-level group care (service code D3), which requires a minimum staff-to-client ratio during prime programming time as follows:
	  ● 	 1 staff person for facilities serving up to 4 children.
	  ● 	 2 staff persons for facilities serving 5 to 7 children.
	  ● 	 3 staff persons for facilities serving 8 to 10 children.
	  ● 	 4 staff persons for facilities serving 11 to 13 children.
	  ● 	 5 staff persons for facilities serving 14 to 16 children.
	  ● 	 6 staff persons for facilities serving 17 to 19 children.
	  ● 	 1 staff person for every 3 children for facilities serving 20 or more children.
“Nonprime 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 group 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 group care services.
“Provider” means any natural person, company, firm, association, or other legal entity that is seeking a contract or is under contract with the department pursuant to this chapter.
“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(6).
“Site” means a location from which services are delivered or where staff report or records are kept. In the foster group care programs, each separately licensed location is a site.
“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 group care services program and to which the provider is entitled.
“Unit of service” means one day.
“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 7741B, IAB 5/6/09, effective 7/1/09]