4.4 Payment Practices to Providers

Lead Agencies must use subsidy payment practices that reflect practices that are generally accepted in the private pay child care market. The Lead Agency must ensure timeliness of payment to child care providers by paying in advance or at the beginning of delivery of child care services. Lead Agencies must also support the fixed cost of child care services based on paying by the child’s authorized enrollment, or if impracticable, an alternative approach that will not undermine the stability of child care programs as justified and approved through this Plan. Lead Agencies must also (1) pay providers based on established part-time or full-time rates rather than paying for hours of service or smaller increments of time, and (2) pay for reasonable, mandatory registration fees that the provider charges to private-paying parents. These policies apply to all provider types unless the Lead Agency can demonstrate that in limited circumstances the policies would not be considered generally-accepted payment practices. In addition, Lead Agencies must ensure that child care providers receive payment for any services in accordance with a payment agreement or an authorization for services, ensure that child care providers receive prompt notice of changes to a family’s eligibility status that could impact payment, and have timely appeal and resolution processes for any payment inaccuracies and disputes. 4.4.1 Prospective and enrollment-based payment practices Lead Agencies must use payment practices for all CCDF child care providers that reflect generally- accepted payment practices of providers serving private-pay families, including paying providers in advance or at the beginning of the delivery of child care services and paying based on a child’s authorized enrollment or an alternative approach for which the Lead Agency must demonstrate paying for a child’s authorized enrollment is not practicable and it will not undermine the stability of child care programs. Lead Agencies may only use alternate approaches for subsets of provider types if they can demonstrate that prospective payments and authorized enrollment-based payment are not generally-accepted for a type of child care setting. Describe the Lead Agency payment practices for all CCDF child care providers: a. Does the Lead Agency pay all provider types prospectively (i.e., in advance of or at the beginning of the delivery of child care services)? [ ] Yes. If yes, describe: [x] No, it is not a generally-accepted payment practice for each provider type. If no, describe the provider type not paid prospectively and the data demonstrating it is not a generally-accepted payment practice for that provider type, and describe the Lead Agency’s payment practice that ensures timely payment for that provider type: DEL currently requires in the annual grant agreement all ELCs and RCMA to pay child care providers within no more than 21 calendars days for services rendered during the prior month. The DEL will work to amend Rule 6M-4.500, F.A.C. and other applicable policies to align with the new final rule and pay based on enrollment. b. Does the Lead Agency pay based on authorized enrollment for all provider types? [ ] Yes. The Lead Agency pays all providers by authorized enrollment and payment is not altered based on a child’s attendance or the number of absences a child has. [ ] No, it is not a generally-accepted practice for each provider type. If no, describe the provider types not paid by authorized enrollment, including the data showing it is not a generally-accepted payment practice for that provider type, and describe how the payment policy accounts for fixed costs: [x] It is impracticable. Describe provider type(s) for which it is impracticable, why it is impracticable, and the alternative approach the Lead Agency uses to delink provider payments from occasional absences, including evidence that the alternative approach will not undermine the stability of child care programs, and thereby accounts for fixed costs: State supports fixed costs of providing child care services by requiring the ELCs to reimburse the provider based on the child's authorized hours of care needed, either part- time or full-time. For a child who is authorized only full-time care an ELC shall not recoup or adjust a provider's reimbursement for days a child attends part-time. The ELC shall not reduce authorized hours of care prior to redetermination unless the parent requests a reduction in the authorized hours of care based on hours of care needed (Rule 6M-4.500, F.A.C.). The State currently supports fixed costs of providing child care service’ by delinking provider payments from a child's occasional absences and providing full payment if a child is absent for up to a certain number of days in a month. In accordance with Rule 6M- 4.500(4), F.A.C., reimbursement shall be authorized for no more than three absences per calendar month per child except in the event of extraordinary circumstances, in which case the coalition or its designee shall document approval for payment based on written documentation provided by the parent justifying the excessive absence for up to an additional 10 days. 4.4.2 Other payment practices Lead Agencies must (1) pay providers based on established part-time or full-time rates rather than paying for hours of service or smaller increments of time, and (2) pay for reasonable, mandatory registration fees that the provider charges to private-paying parents, unless the Lead Agency provides evidence that such practices are not generally-accepted for providers caring for children not participating in CCDF in its State or Territory. a. Does the Lead Agency pay all providers on a part-time or full-time basis (rather than paying for hours of service or smaller increments of time)? [x] Yes. [ ] No. If no, describe the policies or procedures that are different than paying on a part- time or full-time basis and the Lead Agency’s rationale for not paying on a part-time or full-time basis: b. Does the Lead Agency pay for reasonable mandatory registration fees that the provider charges to private-paying parents? [x] Yes. If yes, identify the fees the Lead Agency pays for: A registration fee of up to $75 per child will be paid to SR providers. This payment will be limited to two times during a child's continuous time in the SR Program within a 5-year period. However, if the child is attending a provider and the provider closes or has its contract terminated, the ELC shall pay the registration fee at the new provider. This is a one-time exception and does not count towards the two-time limit. If there is a break in care of 12 consecutive months, the two-time limit refreshes. Hardship exceptions for the two-time limit include: -Illness of the child or parent requiring the family to relocate; -Loss of a parent that would result in the family having to move; -Loss of employment that would result in the family having to move; -Being evicted that would result in the family having to move; -Natural or man- made disasters; -The child is expelled; or - Guardianship transfer. Providers will be required to return the registration fee if they expel children or require families to transfer within three months of enrollment. The DEL has conducted a statewide survey and data analysis to support this policy. [Rule 6M-4.500(6), F.A.C.] [ ] No. If no, identify the data and how data were collected to show that paying for fees is not a generally-accepted payment practice: c. Describe how the Lead Agency ensures that providers are paid in accordance with a written payment agreement or an authorization for services that includes, at a minimum, information regarding provider payment policies, including rates, schedules, any fees charged to providers, and the dispute-resolution process: All CCDF providers complete Form DEL-SR-20 ￿ Statewide SR Provider Contract. This stipulates payment policies, including rates, schedules, and any fees charged to providers, and the dispute-resolution process. d. Describe how the Lead Agency provides prompt notice to providers regarding any changes to the family’s eligibility status that could impact payments, and such a notice is sent no later than the day that the Lead Agency becomes aware that such a change will occur: Through the ELCs, the State provides prompt notice to providers and families regarding any changes to the family’s eligibility status that may impact payment. Rule 6M-4.200, F.A.C., requires ELCs to notify providers within two weeks if a child is determined ineligible or whose enrollment will be terminated. e. Describe the Lead Agency’s timely appeal and resolution process for payment inaccuracies and disputes: The State has a timely appeal and resolution process for payment inaccuracies and disputes, as provided in the Statewide SR Provider Contract (contract). If a provider disputes any action taken by the ELC pursuant to the terms of the contract, the provider may request a review hearing. The ELC and provider will decide upon a date and time for the review hearing within 45 days of the request for the review hearing. At that point, a Review Hearing Committee will assess the claims of the provider. The ELC will be provided a reasonable opportunity to submit rebuttal evidence. Following the completion of the presentations the Review Heading Committee will vote on each of the provider's claims. f. Other. Describe any other payment practices established by the Lead Agency: 4.4.3 Payment practices and parent choice How do the Lead Agency’s payment practices facilitate provider participation in all categories of care? Florida uses the same process for all provider types. Payment practices are consistent with the child care industry and thus encourages a wide range of participation by providers in the program. Each ELC signs a grant agreement with the DEL to ensure that payments to providers will be made within 21 calendar days. The State supports fixed costs of providing child care services by requiring the ELC to reimburse the provider based on the child's authorized hours of care needed, either part-time or full- time. For a child who is authorized only full-time care, an ELC shall not recoup or adjust a provider's reimbursement for days a child attends part-time. The ELC shall not reduce authorized hours of care prior to redetermination unless the parent requests a reduction in the authorized hours of care based on hours of care needed (Rule 6M-4.500 F.A.C.). The State delinks provider payments from a child's occasional absences and provides full payment if a child is absent for up to a certain number of days in a month. Reimbursement for child care is full-time or part-time with additional units of care for extended hours (greater than full-time care), and one unit of care for less than part-time care. A registration fee of up to $75 per child will be paid to the provider, this payment will be limited to two times within a five year period during a child's continuous time in the SR Program. All CCDF providers complete Form DEL-SR-20 ￿ Statewide SR Provider Contract. This stipulates payment policies, including rates, schedules, and any fees charged to providers, and the dispute-resolution process. The State provides notice to providers regarding any changes to the family's eligibility status that may impact payment through the ELCs. ELCs provide notification to providers and parents of any eligibility status changes. Rule 6M- 4.200, F.A.C., requires ELCs notify providers within two weeks if a child is determined ineligible or whose enrollment is terminated. The State has a timely appeal and resolution process for payment inaccuracies and disputes, as provided in the Statewide SR Provider Contract.