Assess whether to recoup, waive, or refer for prosecution (0ef49c)

SITUATION Child-care attendance vs. school-calendar mismatches arrived with a CDR where treating-source evidence conflicts with a CE for issuance-system integrity manager. That is a Public Benefits Recoupment and Policy decision on to recoup, waive, or refer in a Medicaid agency with a surge in MAGI mismatches.

DECISION Issuance-system integrity manager in a Medicaid agency with a surge in MAGI mismatches must choose To recoup, waive, / Refer for prosecution using child-care attendance vs. school-calendar mismatches after a CDR where treating-source evidence conflicts with a CE.

HYPOTHESES TO TEST 1. The population in child-care attendance vs. school-calendar mismatches is the one a CDR where treating-source evidence conflicts with a CE named, so To recoup, waive, follows for this Recoupment and Policy file. 2. The population in child-care attendance vs. school-calendar mismatches is adjacent only to a CDR where treating-source evidence conflicts with a CE; Refer for prosecution is the honest Public Benefits call. 3. A Medicaid agency with a surge in MAGI mismatches already contained a CDR where treating-source evidence conflicts with a CE before child-care attendance vs. school-calendar mismatches arrived; no new Recoupment and Policy path. 4. Provenance on child-care attendance vs. school-calendar mismatches after a CDR where treating-source evidence conflicts with a CE is broken; do not pick To recoup, waive, or Refer for prosecution yet.

ANALYSIS REQUIRED 1. Separate a case-level error from a program-design failure in a Medicaid agency with a surge in MAGI mismatches. 2. Match household facts in child-care attendance vs. school-calendar mismatches to the rule that pays the benefit. 3. Trace the notice and appeal path issuance-system integrity manager must preserve. 4. For this Public Benefits Recoupment and Policy file, read child-care attendance vs. school-calendar mismatches against a CDR where treating-source evidence conflicts with a CE and write the one fact that would move to recoup, waive, or refer for issuance-system integrity manager.

RECOMMENDATION Choose To recoup, waive, / Refer for prosecution on this Public Benefits / Recoupment and Policy packet (child-care attendance vs. school-calendar mismatches after a CDR where treating-source evidence conflicts with a CE). The follow-on Recoupment and Policy action is what issuance-system integrity manager does next: implement the option, assign an owner, and log the missing fact.

COMMAND RETURNS - Bottom-line Public Benefits option on to recoup, waive, or refer, then the evidence in child-care attendance vs. school-calendar mismatches, then the action for issuance-system integrity manager - Hypothesis scorecard against child-care attendance vs. school-calendar mismatches: supported / rejected / untestable - Missing page in child-care attendance vs. school-calendar mismatches after a CDR where treating-source evidence conflicts with a CE, if any - Regulatory or exam hook Recoupment and Policy would cite