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? [x] Yes. i. If yes, check if the Lead Agency: [ ] Sets the same payment rates for the entire State or Territory. [x] Sets different payment rates for different regions in the State or Territory. [ ] No. ii. If no, identify how many jurisdictions set their own payment rates: 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). 5/1/2022 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)? Daily rates are multiplied by 5 to establish weekly rates. 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) 62.50 Per Day 55.00 312.50 73.00 260.00 290.00 327.00 Family Child Care for Infants (6 months) 45.00 Per Day 92.00 225.00 75.00 197.50 200.00 223.75 Center Care for Toddlers (18 months) 57.00 Per Day 78.00 285.00 67.00 253.16 227.60 285.29 Family Child Care for Toddlers (18 months) 45.00 Per Day 91.00 225.00 79.00 185.00 198.00 223.75 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 Preschool ers (4 years) 51.50 Per Day 98.00 257.50 68.00 224.52 242.65 271.00 Family Child Care for Preschool ers (4 years) 46.50 Per Day 92.00 232.50 92.00 167.50 180.00 200.00 Center Care for School- Age (6 years) 48.00 Per Day 43.00 240.00 66.00 180.00 205.20 252.00 Family Child Care for School- Age (6 years) 46.00 Per Day 78.00 230.00 100.00 140.00 144.00 150.00 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) 53.50 Per Day 52.00 267.50 60.00 250.00 290.00 305.00 Family Child Care for Infants (6 months) 40.50 Per Day 90.00 202.50 68.00 190.00 200.00 211.25 Center Care for Toddlers (18 months) 52.50 Per Day 47.00 262.50 60.00 240.00 275.00 296.00 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? Family Child Care for Toddlers (18 months) 40.00 Per Day 85.00 200.00 65.00 190.00 200.00 211.25 Center Care for Preschool ers (4 years) 47.50 Per Day 62.00 237.50 72.00 200.00 222.00 242.00 Family Child Care for Preschool ers (4 years) 40.00 Per Day 90.00 200.00 75.00 180.00 190.00 200.00 Center Care for School- Age (6 years) 42.50 Per Day 71.00 212.50 65.00 196.00 200.00 215.00 Family Child Care for School- Age (6 years) 40.00 Per Day 82.00 200.00 85.00 165.00 175.00 182.50 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: Add-ons above the base rate are available based on QRIS star ratings for licensed provider types and are included in the provider's monthly payment. [ ] 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. [ ] Differential rate for children with special needs, as defined by the Lead Agency. Describe: 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: Tiered rate for higher star rating in QRIS participating licensed providers. vi. [x] Other differential rates or tiered rates. For example, differential rates for geographic area or for type of provider. Describe: Differentiated rates are set by geographic area and provider type. Nevada has different rates for Clark County, Washoe County, Carson/Douglas Counties, and rural counties, as well as different rates by provider type and age of child. vii. If applicable, describe any additional add-on rates that you have besides those identified above. Nevada used contract rates for certain types of care offered through piloted contracted slots programs in 2022-2024 using ARPA Discretionary funds. Contracted slots were used to create spaces for child care scholarships for children in hard to serve populations, such as infants/toddlers, children with special needs, and those receiving care during non-traditional hours as part of pilot projects. These projects are being formally evaluated and may be reinitiated using CCDF as funding permits. 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? Current rates were effective on May 1, 2022, and are set at approximately the 75th percentile of the 2022 MRS, which is equivalent to the 95th percentile of the 2018 MRS for each provider type. The 2022 MRS data was used and the rate amounts were not changed from the 2018 rates since they were the same. When the 2022 and 2018 MRS reports were compared, the 75th percentile of 2022 MRS was equivalent to the 95th percentile of the 2018 MRS. Maintaining the rates at the 95th percentile of the 2018 MRS, allows for greater access to child care for the eligible population. b. How did the Lead Agency determine that the rates are adequate to meet health, safety, quality, and staffing requirements under CCDF? A narrow cost analysis was conducted as a part of the 2022 MRS. The 75th percentile rate was compared to the Cost of Quality Calculator quality baseline amount which is set at meeting licensing requirements. Compared to the calculator, the 2022 75th percentile was $237.95/month more than the base rate for center-based infant care, the toddler rate was $326.34/month more, and preschool rate was $311.97/month more. For licensed family child care, the 75th percentile was consistently less than the calculator: $94.58/month for infants, $132.41/month for toddlers, and $187.16/month for preschool. 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? DWSS/CCDP conducted a narrow cost analysis as part of the 2022 MRS to compare the cost of care baseline amount to the Cost of Quality Calculator which allowed data to be identified that supports using an alternative methodology cost model to stabilize the child care system. By utilizing a cost of care alternative methodology beginning October 1, 2024, the Lead Agency will be able to determine a more appropriate model that reflects the actual cost associated with providing care for children in different age groups and in different geographic locations. d. How did the Lead Agency account for the cost of higher quality while setting payment rates? There are five (5) rates for each region, provider type, and age of child: a base rate for everyone and a gradual increase in rate for each star level (2-5). There is an increase of $1 for each star level: 2-star bonus is $10/day or $10/week/child , 3-star is $3/day/child or $15/week/child, 4-star is $4/day/child or $20/week/child, and 5-star bonus is $5/day/child or $25/week/child. 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. N/A