The purpose of the proposed rules is to consolidate criteria for assessment and validation of parent co-pays and school readiness provider reimbursement.

 

DEPARTMENT OF EDUCATION

Florida’s Office of Early Learning

RULE NOS.:RULE TITLES:

6M-4.400Required Parent Co-payment

6M-4.500Reimbursement-General Provisions Regarding Reimbursements for Holidays and Absences

6M-4.501Reimbursement During Emergency Closures

PURPOSE AND EFFECT: The purpose of the proposed rules is to consolidate criteria for assessment and validation of parent co-pays and school readiness provider reimbursement.

SUMMARY: School Readiness Co-Payments and Reimbursement.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION: The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the Agency.

The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: The rule amendments are a consolidation of existing regulations with the exception of the addition to Rule 6M-4.501, F.A.C., where the amendment if any economic impact is felt would be a positive one for the participating school readiness providers.

Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.

RULEMAKING AUTHORITY: 1001.213(2), 1002.82 (2)(f)1.a.(III) FS.

LAW IMPLEMENTED: 1002.82(2)(c), 1002.82(2)(f)1.a.(III), 1002.82(2)(p), 1002.84(8), 1002.87(8), (9) FS.

IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW (IF NOT REQUESTED, THIS HEARING WILL NOT BE HELD):

DATE AND TIME: Wednesday, November 12, 2014, 10:00 a.m. to noon or at the conclusion of business whichever is earlier

PLACE: via Webinar; for information about how to register for the webinar go to: http://www.floridaearlylearning.com/oel_resources/rules_guidance_technical_assistance/proposed_rules.aspx

Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 7 days before the workshop/meeting by contacting: Judy Jones at [phone] or [e-mail]. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Reginal Williams, Manager, Program Integrity Unit, 250 Marriott Drive, Tallahassee, FL 32399, [phone], [e-mail]

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

(Substantial rewording of Rule 6M-4.400 follows. See Florida Administrative Code for present text.)

 

6M-4.400 Required Parent Co-payment.

(1) Co-payment Assessment. Each family that receives school readiness services shall be assessed a co-payment based on family size, the hours of care needed, and the family’s income, according to the sliding fee scale included in the coalition’s approved plan. If a child is authorized for part time care, the parent shall be assessed a part time co-payment. If a child is authorized for full time care, the parent shall be assessed a full time co-payment. A parent with two or more children receiving school readiness services may receive a co-payment discount for the second and any subsequent child in their care based on the coalition’s approved sliding fee scale. When a discount is applied, the youngest child must be assessed a full co-payment based on the approved sliding fee scale and the hours of care needed.

(2) Co-payment collection. The co-payment amount for which the family is responsible shall be subtracted from the provider’s reimbursement, prior to payment by the coalition or its designee. Collection of the family’s required co-payment for school readiness services shall be the responsibility of the provider of school readiness services in accordance with Section 1002.84(8), F.S.

(a) When a school age child, who is authorized part time care during the school year, attends a full time day on a school holiday or school closure, the parent shall pay the part time co-payment but the provider is reimbursed at a full time rate.

(b) During the summer break, if a school age child attends full time, the parent shall pay the full time co-payment and the provider shall be reimbursed at a full time rate. The coalition’s co-payment policy shall be submitted with the coalition’s sliding fee scale as part of the coalition’s approved plan.

(3) Transfers. A parent may not transfer his or her child to another school readiness program provider until the parent has submitted documentation from the current school readiness program provider to the early learning coalition stating that the parent has satisfactorily fulfilled the co-payment obligation related to school readiness program. If an at-risk child’s parent is unable to satisfactorily fulfill the co-payment obligation prior to tranfer, the provider shall attempt to arrange a repayment plan with the at-risk child’s parent. The provider shall document the repayment attempt with the coalition and the coalition shall report the parent’s intent to transfer child care providers to the Child Welfare Program Office of the Department of Children and Families or the community-based lead agency.

(a) The provider is responsible for collecting the parent co-payment from the parents. The parent co-payment shall be collected within 10 calendar days of the provider’s payment due date. The provider shall provide written notice of the co-payment due date.

(b) The provider shall provide written notification to the parent of the current outstanding co-payment balance within 15 days of the provider’s payment due date. This notification shall be provided at least on a monthly basis as long as there co-payment balance.

(c) If a transfer is requested, the parent must satisfactorily fulfill the co-payment obligation before a transfer will be authorized by the coaltion. In the context of this rule, satisfactory fulfillment of the co-payment obligation means immediate payment of the outstanding co-payment obligation or establishment of a repayment plan for the outstanding co-payment obligation.

(4) Sliding fee scale. A coalition’s sliding fee scale must be set at a level that provides economicially disadvantaged families equal access to the care available to families whose income is high enough not to qualify for financial assistance for school readiness services. To that end, the co-payment for the family should not exceed 10 percent of the family’s income, regardless of the number of children in care. If the coalition’s proposed sliding fee scale does exceed 10 percent of family income, the coalition must provide justification of how the sliding fee scale meets the federal requirement that the co-payment be affordable, prior to approval of the proposed sliding fee scale by the Office of Early Learning.

(5) Parent notification. Prior to a child’s enrollment, the person determining eligibility shall inform the parent and the school readiness service provider of the co-payment to be paid by the parent and that additional fees which are charged by the provider may apply. If a child is enrolled with more than one provider, a co-payment must be assessed for each authorized provider. Amount of co-payment shall be in effect for the family’s authorized eligibility period, unless:

(a) The parent or referring agency requests and the coalition grants a waiver of the co-payment specified in subsection (8) or (9); or

(b) An incorrect co-payment was assessed by the eligibility determiner as a result of an error of the eligibility determiner, program participant error, or program participant fraud, resulting in corrective action to reduce or increase the family’s co-payment; or

(c) If there is any change in marital status, employment status, income or family size.

(6) Coalition co-payment errors. The coalition shall not take action to recover an incorrect co-payment caused by an incorrect co-payment assessment made due to an error of the coalition or its designee. Once the error is discovered, the coalition should correct the error and apply the corrected co-pay. The coalition shall notify the parent within 10 days of changes to the co-pay.

(7) Co-payment recovery. A reimbursement overpayment caused by an incorrect co-payment which resulted from program participant error or parent fraud shall be recovered by the coalition from the parent.

(8) At-risk co-payment waivers. A co-payment may be waived on a case-by-case basis for families participating in an at-risk program as defined in Section 1002.81(1), F.S. The request for the co-payment waiver must be documented during the initial authorization for care and at each redetermination. Each coalition must include a list of such qualifying events in its coalition plan and outline the procedure for obtaining a waiver of a co-payment.

(9) Temporary co-payment waivers. A co-payment may be temporarily waived on a case-by-case basis for families with income at or below 100 percent of the federal poverty level during an event that limits a parent’s ability to pay in accordance with Section 1002.84(8), F.S. The request for the co-payment waiver must be documented in the case file during the initial authorization for care and at each redetermination. Each coalition must include a list of such qualifying events in its coalition plan and outline the procedure for obtaining a waiver of a co-payment.

Rulemaking Authority 411.01(4)(e) 1001.213(2) FS. Law Implemented 411.01(5)(d)4.a. 1002.84(8) FS. History–New 2-2-05, Formerly 60BB-4.400, Amended_________.

6M-4.500 Child Attendance and Provider Reimbursements-General Provisions Regarding Reimbursements for Holidays and Absences.

(1) General Provisions.

(a) A school readiness provider shall not receive payment for a student prior to the student’s first day of attendance or after the student’s last day of attendance.

(b) Reimbursement rates shall be paid based on a child’s care level and unit of care as defined by the coalition’s approved provider rate schedule for the county in which the provider’s facility is located.

(c) Daily attendance documentation shall be maintained by each school readiness provider based on the terms of the Statewide School Readiness Provider Contract, specified in Rule 6M-4.610, Florida Administrative Code (F.A.C.). The provider must record daily child attendance using a paper sign-in and sign-out log or electronic attendance-tracking system that is maintained at the provider site to validate the attendance data. For electornic attendance systems, the provider msut backup records on a regular basis to safeguard against loss. The sign-in and sign-out forms will vary by provider but must contain the following information:

1. Provider’s name,

2. Child’s first and last name,

3. Time in and out,

4. Date, and

5. An authorized signature or other identifier that verifies each child’s attendance. Authorized signature includes provider designee for children who are transported via school to or from the provider site or a parent or person authorized by the parent.

(d) A provider shall be reimbursed for each day that there is evidence (i.e., parent statement, supplemental attendance logs, etc.) that the child was in attendance.

(e) For school readiness children who are transported to and/or from the provider site, attendance shall be documented in accordance with paragraph 65C-22.001(6)(f), F.A.C.

(f) The provider must report any discrepancy, overpayment, or underpayment within  sixty (60) calendar days of transmission of the reimbursement receipt. Reported changes must include supporting documentation. Discrepancies validated by the coalition will be corrected for reimburement purposes.

(g) For a child who is authorized only full-time care, a coalition shall not recoup or adjust a provider’s reimbursement for days a child attends part-time.  If through monitoring or participant self-reporting, the coalition determines that a family does not need full time care, the coalition shall conduct redetermination of care to re-assess the hours of care needed.

(h) The coalition must conduct monitoring activities to ensure the accuracy of payments of the monthly reimbursement requests. If it is determined through monitoring of the attendance documentation that a provider received an improper payment (overpayment or underpayment), a payment adjustment is required to correct the improper payment.

(i) In accordance with Section 1002.84(10), F.S., attendance records may not be altered or amended after December 31 of the subsequent year.

(2) Monthly certification of child attendance for payment reimbursement.

(a) An early learning coalition shall give a school readiness provider a monthly roster, prepared by using the statewide information system, that lists each child enrolled in the provider’s school readiness program, and includes spaces for a private provider or public school to report a child’s attendance for the calendar month.

(b) A school readiness provider must certify the monthly attendance of a child enrolled in the provider’s school readiness program. A school readiness provider may certify monthly attendance by electronic means approved by the early learning coalition.

(c) For each calendar month that a school readiness provider participates in the school readiness program, the coalition shall not pay the school readiness provider until the provider submits a monthly attendance roster to the coalition which certifies the attendance of each enrolled child from the prior month.

(d) If a child arrives at a school readiness provider’s site but the provider or school refuses the child’s attendance , the provider or school must record the instructional day as a non-reimbursable absence.

(3)(1) Holidays.

(a) A recognized holiday as approved by the local coalitions shall not be counted as an absence for purposes of reimbursement. The coalition Office of Early Learning shall include reimbursements to providers of full and part-time care for up to twelve (12) recognized holidays per year as authorized in the Statewide School Readiness Provider Contract.

(b) For school-aged children authorized part time care, a provider shall be reimbursed at a part time rate if a child care provider is closed on a coalition approved holiday. If a school-aged child is authorized full time care on school holidays, school closures or teacher inservice days, a provider shall be reimbursed at a full time rate if the provider is open. For school-aged children authorized full time care during the summer, a provider shall be reimbursed at the full time rate for coalition approved holidays.

(c) For a school-aged child, if the child is scheduled to attend full time at a provider that is open on a day when school is closed and does not attend because his/her parent has opted to keep the child home that day, the provider shall be reimbursed at the full time rate in accordance with paragraph (4)(a) below.

(4)(2) Absences.

(a) Reimbursement shall be authorized for no more than three (3) absences per calendar month per child except in the event of extraordinary circumstances in which case the coalition or its designee shall provide written approval for payment based on written documentation provided by the parent justifying the excessive absence for up to an additional seven (7) days. Extraordinary circumstances does not include vacation or recreational time.

(a) Examples of extraordinary circumstances include the following:

1. Hospitalization of the child or parent with appropriate documentation (i.e., doctor’s note, hospital admission);

2. Illness requiring home-stay as documented (doctor’s note, parent statement);

3. Death in the immediate family with appropriate documentation (i.e., obituary, death certificate, parent statement);

4. Court ordered visitation with appropriate documentation (i.e., court order); or

5. Unforeseen documented military deployment or exercise of the parent(s) (i.e., military orders of deployment, reserve duty).

(b) Total monthly reimbursed absences shall not exceed ten (10) calendar days.

(c) In the event that a child is absent for five (5) consecutive days with no contact from the parent, the provider shall notify the local coalition or its designee who in turn shall determine the need for continued care. The coalition shall document any contact made with the provider, referring agency, if applicable and parent in the case file. If a determination is made that school readiness services are no longer needed, a notice of disenrollment will be sent to the parent and school readiness provider at least 2 weeks prior to disenrollment. However, an at-risk child may not be disenrolled from the program without the written approval of the Child Welfare Program Office of the Department of Children and Families or the community-based lead agency. A notice of termination shall be maintained in the case file and provided to the parent, provider and referring agency. If a termination is filed, the notice will be provided to the referring entity.

(d) When an at-risk child has an unexcused absence or seven consecutive days of excused absences, the school readiness provider shall notify the Department of Children and Families or community-based lead agency and the early learning coalition. The coalition shall document any contact made with the provider, referring agency and parent in the case file. The Rilya Wilson Act establishes these reporting requirements for children 3 to 5 years old. This rule shall apply to all at-risk children under the age of school entry of any age in a school readiness program.

(5) Reimbursement for Children with Special Needs.

(a) A child care provider may be paid at a higher rate if caring for any school readiness child with special needs requiring additional care. To receive a special needs rate, a child care provider must submit a list of the special needs services it is providing for each special needs child, in addition to the routine school readiness services. A special needs rate may be negotiated up to 20 percent above the maximum infant care rate established by the coalition.  However, this rate shall not exceed the providers private pay rate for infant care.

(b) To receive a special needs rate, in addition to the base rate, it must be requested by the provider and approved by the coalition in the Form OEL-SR 20 Statewide School Readiness Provider Contract, Exhibit 3. A special needs rate may be reimbursed for a school readiness child that has a documented physical, mental, emotional, or behavioral condition that requires a higher level of care in the child care setting. The special need child’s condition must be validated by a licensed health, mental health, education or social service professional other than the child’s parent or person employed by the child care provider.

(6) Reimbursement for Gold Seal Quality Care Programs.

A child care provider that has a current Gold Seal Quality Care designation, as defined in subsections 402.26(6) and 402.281, F.S, may receive a differential rate higher than the coalition’s base approved reimbursement rate for each care level and unit of care. The reimbursement rate for the Gold Seal differential may be negotiated up to 20 percent above an early learning coalition’s approved reimbursement rate for each care level and unit of care.

Rulemaking Authority 1001.213(2) FS. Law Implemented 1002.82(2)(c), 1002.82(2)(f)1.a.(III), 1002.82(2)(p), 1002.87(8), (9) FS. History–New 2-2-05, Formerly 60BB-4.500, Amended__________.

 

6M-4.501 Reimbursement During Emergency Closures.

(1) Each coalition shall maintain a Continuation of Operations Plan (C.O.O.P.) to be used in the event of emergency closings due to catastrophic events. Providers shall be reimbursed at the rate normally received during non-emergency hours when a coalition activates its Continuation of Operations Plan (C.O.O.P.).

(2) The coalition may consider reimbursement, in accordance with Federal and State law, for circumstances of temporary closure for individual providers when closure is beyond the control of the provider or the closure is caused by emergency circumstances, including but not limited to the declaration of a state of emergency by federal, state, or local officials, or the closure of public schools in the area in which the provider is located. In no circumstances may a coalition reimburse in excess of the pre-existing approved hours for an individual child during the temporary closure.

Rulemaking Authority 1001.213(2) FS. Law Implemented 1002.82(2)(c), 1002.82(2)(f)1.a.(III), 1002.82(2)(p) FS. History–New 2-2-05, Formerly 60BB-4.501, Amended___________.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Reginal Williams, Manager, Program Integrity Unit

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Shan Goff, Executive Director

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: October 15, 2014

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: August 29, 2014