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(2) the child’s name and date of birth;

(3) the name of the child care provider;

(4) documentation that establishes each of the child’s special needs; the documentation must be completed by a health care or mental health care professional and include confirmation by the health care or mental health care professional that additional services are needed for the child’s care in a child care setting.

(5) a copy of the plan for care developed by the child care provider and family at the time the child was enrolled with the child care provider, or when the special need was identified; and

(6) the child care provider inclusion plan that the child care provider develops, in consultation with the department or designee, on a form prescribed by the department; the plan must include each of the child care provider’s additional costs associated with providing the additional services required because of each of the child’s special needs and how those services will be provided. (b) The department will or a designee may authorize a supplement to program payment rates to the child care provider under this subsection only if the information listed in (a) of this section is provided and determined by the department to meet the criteria described in (a) of this section that are necessary for the Alaska Inclusive Child Care Program. The supplemental payment amount is based on the actual cost to the provider for providing additional services divided by the months remaining in the family’s current child care assistance eligibility period. The monthly supplemental payment may not exceed 100 percent of the unit of care authorized under 7 AAC 41.025(b) during the remaining months of their certification period and may or may not fully reimburse the child care provider for the costs that the provider incurs. Items identified on the child care provider’s inclusion plan, purchased to meet a specific child’s need and approved for qualification in the Alaska Inclusive Child Care Program may not also be submitted to the child care grant program, established under 7 AAC 39, for reimbursement. (c) The family must reapply for participation in the Alaska Inclusive Child Care Program with each application or renewal in the child care assistance program under this chapter. (Eff. 1/5/2017, Register 221) Statutory Authority: Authority: AS 47.25.001 AS 47.25.041 Article 2. Provisions for Providers.