Or. Admin. Code § 461-195-0541

Current through Register Vol. 63, No. 12, December 1, 2024

Section 461-195-0541 - [Effective 2/18/2025] Liability for Overpayments

(1) In all programs except the Health Systems Division (HSD) medical, Oregon Supplemental Income Program (OSIP), Oregon Supplemental Income Program Medical (OSIPM), Qualified Medicare Beneficiaries (QMB), Refugee Assistance Medical (REFM), Summer EBT (SEBT) and Supplemental Nutrition Assistance Program (SNAP) or a child care program, the following persons are liable for repayment of an overpayment (see OAR 461-195-0501):

(a) Each individual in the filing group or required to be in the filing group and the payee when the overpayment was incurred, except an individual who did not reside with and did not know they were included in the filing group.

(b) A caretaker relative (see OAR 461-001-0000) and their spouse (see OAR 461-001-0000) who were not part of, but resided with, the filing group when the overpayment was incurred.

(c) A parent (see OAR 461-001-0000) or caretaker relative of a child (see OAR 461-001-0000) in the benefit group (see OAR 461-110-0750) and the spouse of the parent or caretaker relative if the parent, caretaker relative, or spouse was a member of or resided with the filing group when the overpayment was incurred.

(d) An individual determined liable for an overpayment remains liable when the individual becomes a member of a new filing group.

(e) An authorized representative (see OAR 461-115-0090) when the authorized representative knowingly gave incorrect or incomplete information or intentionally withheld information resulting in the overpayment.

(2) In the HSD medical and REFM programs, the following persons are liable for repayment of an overpayment:

(a) Each individual in the filing group, the HSD medical programs eligibility determination group (see OAR 410-200-0015), or required to be in the filing group and the payee when the overpayment was incurred, except an individual who ---

(A) Was a child or dependent child (see OAR 461-001-0000) at the time of the overpayment; or

(B) Did not reside with and did not know they were included in the filing group.

(b) A caretaker relative and their spouse who were not part of, but resided with, the filing group or HSD medical programs eligibility determination group when the overpayment was incurred.

(c) A parent or caretaker relative of a child in the filing group or HSD medical programs eligibility determination group and the spouse of the parent or caretaker relative if the parent, caretaker relative, or spouse was a member of or resided with the filing group or HSD medical programs eligibility determination group when the overpayment was incurred.

(d) An authorized representative (see OAR 461-115-0090 and OAR 410-200-0015) when the authorized representative knowingly gave incorrect or incomplete information or intentionally withheld information that resulted in the overpayment.

(3) In a child care program:

(a) An overpayment caused by administrative error is collectible as follows:

(A) The provider is liable for a provider overpayment made on behalf of a recipient (see OAR 461-195-0301) eligible for child care payments.

(B) Each adult in the filing group or required to be in the filing group is liable for an overpayment if the recipient was not eligible for the payment.

(b) Each adult in the filing group or required to be in the filing group is liable for a client error overpayment (see OAR 461-195-0501), and a provider is liable for an overpayment caused by the provider. The recipient and provider are jointly and severally liable for an overpayment caused by both. In the case of an alleged provider overpayment, a provider's failure to provide contemporaneous records of care provided creates a rebuttable presumption that the care was not provided.

(c) An adult who cosigned an application with a minor provider applicant is liable for an overpayment incurred by the minor provider.

(d) An authorized representative (see OAR 461-115-0090 and 414-175-0002) is liable for an overpayment when the authorized representative knowingly gave incorrect or incomplete information or intentionally withheld information that resulted in the overpayment.

(4) In the General Assistance (GA), OSIP, OSIPM, and QMB programs, the following persons are liable for repayment of an overpayment:

(a) Each individual in the filing group or required to be in the filing group and the payee when the overpayment was incurred, except an individual who ---

(A) Was a child or dependent child at the time of the overpayment; or

(B) Did not reside with and did not know they were included in the filing group.

(b) A caretaker relative and their spouse who were not part of, but resided with, the filing group when the overpayment was incurred.

(c) A parent or caretaker relative of a child in the filing group and the spouse of the parent or caretaker relative if the parent, caretaker relative, or spouse was a member of or resided with the filing group when the overpayment was incurred.

(d) An authorized representative when the authorized representative knowingly gave incorrect or incomplete information or intentionally withheld information that resulted in the overpayment.

(5) In the SNAP program, the following persons are liable for repayment of an overpayment or a claim that results from trafficking (see OAR 461-195-0601(2)) of SNAP benefits:

(a) The primary person (see OAR 461-001-0015) of any age, an ineligible student in the household, and all adults (see OAR 461-001-0015) who were members of or required to be in the filing group (see OAR 461-110-0370) when excess benefits were issued.

(b) A sponsor of a noncitizen household member if the sponsor is at fault, for payments prior to November 21, 2000.

(c) A drug or alcohol treatment center or residential care facility that acted as the authorized representative of the recipient.

(e) For a claim that results in trafficking, the payee and the authorized representative when they actually traffic the benefits.

(6) Except as provided otherwise in section (7) of this rule, in all programs, both a noncitizen and the sponsor of the noncitizen are liable for an overpayment incurred if the overpayment results from the failure of the sponsor to provide correct information (see OAR 461-145-0820 to 461-145-0840). If the sponsor had good cause (see OAR 461-195-0521(5)) for withholding the information, the sponsor is not liable for the overpayment.

(7) In the SNAP program, the sponsor of a noncitizen is not liable under section (6) of this rule for payments on or after November 21, 2000.

(8) In the HSD medical programs, the November 2013 amendments to OAR 461-195-0501, 461-195-0521, 461-195-0541, and 461-195-0561 apply as of October 1, 2013.

(9) In the SEBT program, the following individuals are liable for repayment of an overpayment or a claim that results from trafficking (see OAR 461-195-0601(6)(b)) of SEBT benefits:

(a) All adults (see OAR 461-196-0020) who were members of or required to be in the filing group (see OAR 461-196-0020) when excess benefits were issued.

(b) An authorized representative (see OAR 461-196-0030) when the authorized representative knowingly gave incorrect or incomplete information or intentionally withheld information that resulted in the overpayment.

Or. Admin. Code § 461-195-0541

AFS 3-2000, f. 1-31-00, cert. ef. 2-1-00; AFS 17-2000, f. 6-28-00, cert. ef. 7-1-00; SSP 23-2003, f. & cert. ef. 10-1-03; SSP 4-2005, f. & cert. ef. 4-1-05; SSP 14-2005, f. 9-30-05, cert. ef. 10-1-05; SSP 15-2006, f. 12-29-06, cert. ef. 1-1-07; SSP 4-2007, f. 3-30-07, cert. ef. 4-1-07; SSP 38-2009, f. 12-31-09, cert. ef. 1-1-10; SSP 25-2011, f. 9-30-11, cert. ef. 10-1-11; SSP 7-2013(Temp), f. & cert. ef. 3-25-13 thru 9-21-13; SSP 13-2013, f. & cert. ef. 7-1-13; SSP 14-2013(Temp), f. & cert. ef. 7-1-13 thru 12-28-13; SSP 23-2013, f. & cert. ef. 9-20-13; SSP 36-2013(Temp), f. & cert. ef. 11-1-13 thru 4-30-14; SSP 9-2014, f. & cert. ef. 4-1-14; SSP 25-2016(Temp), f. 6-30-16, cert. ef. 7-1-16 thru 12-27-16; SSP 31-2016, f. & cert. ef. 9/1/2016; SSP 5-2019, temporary amend filed 02/27/2019, effective 03/01/2019 through 06/30/2019; SSP 15-2019, amend filed 06/11/2019, effective 7/1/2019; SSP 27-2021, amend filed 03/24/2021, effective 4/1/2021; SSP 8-2022, minor correction filed 02/16/2022, effective 2/16/2022; SSP 20-2023, amend filed 06/22/2023, effective 7/1/2023; SSP 47-2024, temporary amend filed 08/23/2024, effective 8/23/2024 through 2/18/2025; SSP 58-2024, amend filed 11/27/2024, effective 12/1/2024

Statutory/Other Authority: ORS 409.050, 411.060, 411.404, 411.816, 412.014, 412.049, 329A.500, 413.085 & 414.685

Statutes/Other Implemented: 411.060, 411.404, 411.816, 412.014, 412.049, ORS 409.010, 411.087, 411.630, 411.635, 411.640, 411.690, 416.350 & 329A.500