(A) The department shall pay for a food instrument submitted by a vendor if all of the following conditions are met:
(1) The WIC transaction occurred during the valid period to redeem as recorded on the food instrument;
(2) The vendor submitted the food instrument to the processing firm designated by the director and the processing firm received it within thirty days after the last day of the valid period to redeem;
(3) The amount of sale is recorded at the time of the transaction on the food instrument in the appropriate box;
(4) The participant or authorized alternate shopper signed the food instrument in the appropriate box;
(5) The date of the WIC transaction is recorded on the food instrument in the appropriate box;
(6) The authorized four-digit WIC stamp number of the location that transacted the food instrument is stamped in the appropriate box;
(7) The food instrument is completed in ink and does not contain any unauthorized alterations or corrections;
(8) The vendor properly and legibly executed, processed, and submitted all other required documents;
(9) The warrant is for an amount of more than two dollars; and
(10) The WIC transaction occurred during the valid contract period.
(B) If the conditions specified in paragraph (A) of this rule are met, the department shall pay the vendor the actual amount of sale or the maximum value as established by the department for each food instrument, whichever is lower, within sixty days after the receipt of all legible, properly executed and processed documents.
(C) Notwithstanding paragraph (B) of this rule, the department may pay for a food instrument if:
(1) The vendor submitted the food instrument to the processing firm more than thirty days after the valid period to redeem has expired and the vendor justifies in writing and documents to the director's satisfaction that the failure to meet the required deadline resulted from circumstances beyond the control of the vendor and its current and former employees. If the total value of such food instruments submitted at one time exceeds five hundred dollars, the department must obtain approval from the FNS regional office to pay for the food instruments.
(2) The vendor submitted the food instrument in which the actual amount of sale exceeds the maximum value of the food instrument and the vendor justifies in writing and documents to the director's satisfaction that the actual amount paid for the authorized supplemental food was greater than the maximum value because of legitimate increases in the cost paid by the vendor for the authorized supplemental food. Documentation may include a copy of the wholesaler's invoice or similar evidence.
(D) The department shall notify a vendor if it determines that it will not pay for a food instrument based on the failure to meet the conditions specified in paragraph (A) of this rule. The vendor may request reconsideration of the department's determination not to pay for a food instrument. Any request for reconsideration must be in writing and must be post-marked within thirty days of the denied payment notification.
(E) The department may deny payment or initiate claims collection action within ninety days of either the date of detection of the vendor violation or the completion of the review or investigation giving rise to the claim, whichever is later. Claims collection action may include offset against current and subsequent amounts owed to the vendor.
(F) The department may delay payment to the vendor or establish a claim in the amount of the full purchase price of each food instrument that contained a vendor overcharge or other error. Such vendor violations may be detected through compliance investigations, food instrument reviews, or other reviews or investigations of vendor operations.
(G) Upon request by the department, a vendor shall refund to the department, within ninety days, any payments made to the vendor that later are found to be an overcharge, paid in error, or otherwise invalid because of noncompliance with paragraph (A) of this rule. At its option, the department may recover the invalid payments by withholding all or a portion of current or future payments due to the vendor. The department shall provide the vendor with notice of and an opportunity to respond to the department's determination that a payment is invalid in the same manner as prescribed by paragraph (D) of this rule for a determination not to pay for a food instrument.
(H) Any payment for a food instrument made by the department pursuant to paragraph (A) to (C) of this rule does not waive the department's right to refuse payment for another food instrument pursuant to paragraphs (A) to (C) of this rule at any other time or to take action pursuant to rule 3701-42-08 of the Administrative Code.
R.C. 119.032 review dates: 10/18/2010 and 04/01/2016
Promulgated Under: 119.03
Statutory Authority: 3701.132
Rule Amplifies: 3701.132
Prior Effective Dates: 1/10/1992 (Emer.), 4/12/92, 4/1/94, 1/26/96, 6/7/99, 6/21/04