4.3 Adequate Payment Rates

The Lead Agency must set CCDF subsidy payment rates in accordance with the results of the current MRS or ACF pre-approved alternative methodology and at a level to ensure equal access for eligible families to child care services comparable with those provided to families not receiving CCDF assistance. Lead Agencies are also required to provide a summary of data and facts to demonstrate how payment rates ensure equal access, which means the Lead Agency must also consider the costs of base level care and higher quality care as part of its rate setting. Finally, the Lead Agency must re-evaluate its payment rates at least every 3 years. The ages and types of care listed in the base payment rate tables are meant to provide a snapshot of the categories of rates and are not intended to be comprehensive of all categories that might exist or to reflect the terms used by the Lead Agency for particular ages. If rates are not statewide, please provide all variations of payment rates when reporting base payment rates below. Base rates are the lowest, foundational rates before any differentials are added (e.g., for higher quality or other purposes) and must be sufficient to ensure that minimum health, safety, quality, and staffing requirements are covered. These are the rates that will be used to determine compliance with equal access requirements. 4.3.1 Payment rates a. Are the payment rates that the Lead Agency is reporting in 4.3.2 set statewide by the Lead Agency? [ ] Yes. i. If yes, check if the Lead Agency: [ ] Sets the same payment rates for the entire State or Territory. [ ] Sets different payment rates for different regions in the State or Territory. [x] No. ii. If no, identify how many jurisdictions set their own payment rates: 31 b. Provide the date the current payment rates became effective (i.e., date of last payment rate update based on most recent MRS or ACF pre-approved alternative methodology as reported in 4.2.1). 7/1/2024 c. If the Lead Agency does not publish weekly rates, then how were the rates reported in 4.3.2 or 4.3.3 calculated (e.g., were daily rates multiplied by 5 or monthly rates divided by 4.3)? The market rate survey displays daily rates. The daily rates were multiplied by 5 to get the weekly rate. 4.3.2 Base payment rates a. Provide the base payment rates in the tables below. If the Lead Agency completed a market rate survey (MRS), provide the percentiles based on the most recent MRS for the identified categories. If the Lead Agency sets different payment rates for different regions in the State or Territory (and checked 4.3.1aii), provide the rates for the most populous region as well as the region with payment rates set at the lowest percentile. Percentiles are not required if the Lead Agency also conducted an ACF pre-approved alternative methodology but must be reported if the Lead Agency conducted an MRS only. The preamble to the 2016 final rule states that a benchmark for adequate payment rates is the 75th percentile of the most recent MRS. The 75th percentile benchmark applies to the base rates. The 75th percentile is the number separating the lowest 75 percent of rates from the highest 25 percent. Setting rates at the 75th percentile, while not a requirement, would ensure that eligible families can afford three out of four child care providers. In addition to reporting the 75th percentile in the tables below, the Lead Agency must also report the 50th percentile and 60th percentile for each identified category. If the Lead Agency conducted an ACF pre-approved alternative methodology, provide the estimated cost of care for the identified categories, as well as the percentage of the cost of care covered by the established payment rate. If the Lead Agency indicated it sets different payment rates for different regions in the State or Territory in 4.3.1.a, provide the estimated cost of care and the percentage of the cost of care covered by the established payment rate for the most populous region as well as the region with rates established at the lowest percent of the cost of care. For each identified category below, provide the percentage of providers who are receiving the base rate without any add-ons or differential payments. Provide the full-time weekly base payment rates in the table below. If weekly payment rates are not published, then the Lead Agency will need to calculate its equivalent. i. Table 1: Complete if rates are set statewide. If rates are not set statewide, provide rates for most populous region. Percentiles are not required if the Lead Agency also conducted an ACF pre-approved alternative methodology but must be reported if the Lead Agency conducted an MRS only. Care Type Base payment rate (specify unit, e.g., per day, per week, per month) % of providers receiving Base rate Full-Time Weekly Base Payment Rate What is the percentile of the rate? (MRS) What is the 50th percentile of the rate? (MRS) What is the 60th percentile of the rate? (MRS) What is the 75th percentile of the rate? (MRS) What is the estimated cost of care? (Alternative Methodology) What percent of the estimated cost of care is the rate? Center Care for Infants (6 months) 55.20 Per Day 100.00 276.00 76.50 220.00 240.00 275.00 Family Child Care for Infants (6 months) 55.20 Per Day 100.00 276.00 92.10 170.00 200.00 215.00 Center Care for Toddlers (18 months) 40.80 Per Day 100.00 204.00 57.70 195.00 207.50 230.00 Family Child Care for Toddlers (18 months) 40.80 Per Day 100.00 204.00 78.80 160.00 170.00 200.00 Center Care for Preschool ers (4 years) 28.00 Per Day 100.00 140.00 36.60 160.00 180.00 210.00 Family Child Care for Preschool ers (4 years) 28.00 Per Day 100.00 140.00 42.70 150.00 150.00 175.00 Center Care for School- Age (6 years) 22.07 Per Day 100.00 110.35 33.50 133.00 150.00 175.00 Family Child Care for School- Age (6 years) 22.07 Per Day 100.00 110.35 28.60 130.00 145.00 160.00 ii. Table 2: Do not complete if rates are set statewide. If rates are not set statewide, provide rates for region with payment rates set at the lowest percentile. Percentiles are not required if the Lead Agency also conducted an ACF pre-approved alternative methodology but must be reported if the Lead Agency conducted an MRS only. Care Type Base payment rate (specify unit, e.g., per day, per week, per month) % of providers receiving Base rate Full-Time Weekly Base Payment Rate What is the percentile of the rate? (MRS) What is the 50th percentile of the rate? (MRS) What is the 60th percentile of the rate? (MRS) What is the 75th percentile of the rate? (MRS) What is the estimated cost of care? (Alternative Methodology) What percent of the estimated cost of care is the rate? Center Care for Infants (6 months) Family Child Care for Infants (6 months) Center Care for Toddlers (18 months) Family Child Care for Toddlers (18 months) Center Care for Preschool ers (4 years) Family Child Care for Preschool ers (4 years) Center Care for School- Age (6 years) Family Child Care for School- Age (6 years) b. Does the Lead Agency certify that the percentiles reported in the table above are calculated based on their most recent MRS or ACF pre-approved Alternative Methodology? [x] Yes. [ ] No. If no, what is the year of the MRS or ACF pre-approved alternative methodology that the Lead Agency used? What was the reason for not using the most recent MRS or ACF pre-approved alternative methodology? Describe: 4.3.3 Tiered rates, differential rates, and add-ons Lead Agencies may establish tiered rates, differential rates, or add-ons on top of their base rates as a way to increase payment rates for targeted needs (e.g., a higher rate for serving children with special needs). a. Does the Lead Agency provide any rate add-ons above the base rate? [x] Yes. If yes, describe the add-ons, including what they are, who is eligible to receive the add-ons, and how often are they paid: Quality Performance Incentive: Providers who receive a program assessment composite score at or above the Contract Minimum Threshold score, as defined in Rule 6M-4.500, F.A.C., shall receive a tiered QPI differential rate above the established coalition reimbursement rate for each care level and unit of care. A child care provider’s QPI differential shall be based on the most recent program assessment composite score. - Providers who receive a score of 4.50 to 4.99 shall receive a four percent differential. - Providers who receive a score of 5.00 to 5.99 shall receive a seven percent differential. - Providers who receive a score of 6.00 to 7.00 shall receive a ten percent differential. Reimbursement for Child Assessments: An eligible child care provider shall receive a child assessment differential reimbursement rate of five percent higher than the established coalition reimbursement rate for each care level and unit of care. To be eligible to receive the child assessment differential rate, a provider shall complete child assessments with a DEL approved assessment tool conducted by teachers determined reliable as defined by the child assessment tool at least three times per year and submit valid and reliable data to the statewide information system. A child care provider that is currently on a Quality Improvement Plan, pursuant to Rule 6M-4.740, F.A.C., is not eligible for the child assessment differential reimbursement. The reimbursement rate for the Gold Seal differential must be a minimum of 20 percent above the established coalition reimbursement rate for each care level and unit of care, to SR providers who have achieved a Florida Gold Seal Quality Care designation through accreditation. A special needs rate may be negotiated up to 20 percent above the infant payment rate. This rate differential is locally determined and helps ensure that providers who accept children with special needs are able to make the appropriate modifications necessary to meet each child's unique circumstances. To justify this rate, a provider must show that they are providing care above and beyond Americans with Disabilities Act (ADA) requirements for child care facilities. [ ] No. b. Has the Lead Agency chosen to implement tiered reimbursement or differential rates? [x] Yes. [ ] No. Tiered or differential rates are not implemented. If yes, identify below any tiered or differential rates, and, at a minimum, indicate the process and basis used for determining the tiered rates, including if the rates were based on the MRS or an ACF pre-approved alternative methodology. Check and describe all that apply: i. [ ] Differential rate for non-traditional hours. Describe: ii. [x] Differential rate for children with special needs, as defined by the Lead Agency. Describe: A special needs rate may be negotiated up to 20 percent above the infant payment rate. This rate differential is locally determined and helps ensure that providers who accept children with special needs are able to make the appropriate modifications necessary to meet each child's unique circumstances. To justify this rate, a provider must show that they are providing care above and beyond ADA requirements for child care facilities. iii. [ ] Differential rate for infants and toddlers. Note: Do not check if the Lead Agency has a different base rate for infants/toddlers with no separate bonus or add-on. Describe: iv. [ ] Differential rate for school-age programs. Note: Do not check if the Lead Agency has a different base rate for school-age children with no separate bonus or add-on. Describe: v. [x] Differential rate for higher quality, as defined by the Lead Agency. Describe: The reimbursement rate for the Gold Seal differential must be a minimum of 20 percent above the established coalition reimbursement rate for each care level and unit of care, to SR providers who have achieved a Florida Gold Seal Quality Care designation through accreditation. Quality Performance Incentive: Providers who receive a program assessment composite score at or above the Contract Minimum Threshold score, as defined in Rule 6M-4.500, F.A.C., shall receive a tiered QPI differential rate above the established coalition reimbursement rate for each care level and unit of care. A child care provider’s QPI differential shall be based on the most recent program assessment composite score. - Providers who receive a score of 4.50 to 4.99 shall receive a four percent differential. - Providers who receive a score of 5.00 to 5.99 shall receive a seven percent differential. - Providers who receive a score of 6.00 to 7.00 shall receive a ten percent differential. vi. [ ] Other differential rates or tiered rates. For example, differential rates for geographic area or for type of provider. Describe: vii. If applicable, describe any additional add-on rates that you have besides those identified above. Does the Lead Agency reduce provider payments if the price the provider charges to private-pay families not participating in CCDF is below the Lead Agency’s established payment rate? [ ] Yes. If yes, describe: [x] No. 4.3.4 Establishing payment rates Describe how the Lead Agency established payment rates: a. What was the Lead Agency’s methodology or process for setting the rates or how did the Lead Agency use their data to set rates? DEL and the state legislature compared data from the Narrow Cost Analysis that established three levels of quality and compared this data to the Market Rate Survey. It was determined that the goal would be to increase rates to meet the base quality of care level from the Narrow Cost Analysis. To achieve this, reimbursement rates were increased to, at a minimum, 85% of the 75th percentile. b. How did the Lead Agency determine that the rates are adequate to meet health, safety, quality, and staffing requirements under CCDF? By comparing the current rates to the 75th percentile of the market rate and the 3 tiers used in the narrow cost analysis. Using the narrow cost analysis, DEL determined that the current rates set in 2022 did not meet the base level of quality to ensure the minimum health, safety and staffing requirements are met. DEL will continue to work with the legislature to increase payment rates. c. How did the Lead Agency use the cost of care, either from the narrow cost analysis or the ACF pre-approved alternative methodology to inform rate setting, including how using the cost of care promotes the stabilization of child care providers? Using the narrow cost analysis, DEL determined that the current rates set in 2022 did not meet the base level of quality. The legislature passed legislation during the 2024 legislative session to increase rates to, at a minimum, meet 85% of the 75th percentile of the current market rate survey. d. How did the Lead Agency account for the cost of higher quality while setting payment rates? 1002.945(6), F.S., provides that a child care facility which participates in the SR program and has achieved Gold Seal Quality status shall receive a minimum 20 percent rate differential for each enrolled SR child by care level and unit of care. Quality: SR providers are eligible to receive QPI differentials for each care level and unit of care based upon their program assessment composite scores. Providers with program assessment composite scores of: 4.50 to 4.99 receive a 4% differential. 5.00 to 5.99 receive a 7% differential. 6.00 to 7.00 receive a 10% differential. Using the narrow cost analysis, DEL determined that the current rates set in 2022 did not meet the base level of quality to ensure the minimum health, safety and staffing requirements are met. DEL will continue to work with the legislature to increase payment rates. e. Identify and describe any additional facts (not covered in responses to 4.3.1 – 4.3.3) that the Lead Agency considered in determining its payment rates to ensure equal access.