Effective May 28, 2004

clarifying information

1. No two children with special needs are alike. You must look at each child's situation and needs individually and develop a plan to meet the child's specific needs. Do not assume children who receive a certain service or benefit, such as SSI, automatically have additional care needs while in child care and qualify for the special needs rate. Children with the same diagnoses do not always have the same exact child care needs.

   Children's levels of care may vary from setting to setting. What a child needs at home may not be the same when at school or child care. For the purposes of authorizing the special needs rate, it is important to focus on the child's additional care needs while in child care.

   Likewise, all child care providers skill and comfort levels are not the same when serving children with special needs. One provider may request the special needs rate, while another may not for the same child. This does not mean the child's needs have increased or decreased.

2. Special needs child care can be authorized at one of two levels:

   1. Level 1: Authorize special needs payments in the amounts listed in WAC 170-290-0225, -0230 or-0235 when the consumer and professional have verified the child's special needs and the need for a higher level of care, or

   2. Level 2: The provider's reasonable documented additional cost associated with the care of the child if the provider requests a rate above the State special needs rate listed in Level 1.

Level 1 Requirements:

1. Requests by consumers for special needs payments must come with documentation outlining the child's special needs for a higher level of care. This documentation must come from:

   1. A registered nurse; or

   2. A  health, mental health, education or social service professional with a master's level or above degree.

   Professionals meeting the criteria in (a) or (b) above who are contracted by a licensed provider are not considered an employee of the provider. The contracted professional can provide the documentation verifying a child's special needs and additional care needs while in child care.

   Documentation from the professional may come in a variety of forms, but must clearly state what the child’s special needs are and the additional care needs while in child care. Documentation can include, but is not limited to items such as Individual Education Plans (IEP), basic health records from a pediatrician, comprehensive assessments from public health nurses, or medical/psychological reports from specialists.

2. The severity and duration of a child's special and additional care needs may vary from time to time. The professional documentation verifying the child's needs should be dated no longer than 18 months before the date of the request. If a child has an ongoing condition which is not expected to improve, periodic documentation of the child's special need is not necessary.

   The documentation from the provider who requests a rate above the daily special needs rate must be updated at least annually.

3. The State does not pay for training or equipment. If a provider indicates the additional cost of care associated with a child with special needs is due to special training or equipment, refer the provider to the local Child Care Resource and Referral (CCR&R) agency. The CCR&R agency may be able to assist the provider in obtaining special funding for training and/or equipment.

   The provider may also find there are tax credits or deductions available to help offset the costs associated with complying with the American with Disabilities Act (ADA) and serving a specific child with a disability. For more information, they can contact the:

   U.S. Department of Justice
   P.O. Box 66738
   Washington, D.C.
   www.ada.gov/
   

Level 2 Requirements:

1. Consumers and providers can use specific forms to submit information about a child's additional care needs (beyond Level 1) while in child care. These are not mandatory forms, but help standardize the process.

   • The consumer can use DEL 10-287, Consumer Request for Special Needs Child Care Rate.

   • Providers can use DEL 10-288, Provider Request for Additional Special Needs Payment.

2. You can accept other documents in place of the DEL 10-288, including an Individual Habilitation Plan (IHP), Individual Education Plan (IEP) or Individual Family Plan (IFP). Whichever document the consumer uses, it must provide documentation according to WAC 170-290-0225, -0230 or -0235.

worker responsibilities

For both Level 1 and Level 2 Special Needs Rate Authorizations:

1. Document in WCAP the consumer's request for the special needs rate. The DEL 10-287 can be used to gather the request information from the consumer.

2. Obtain from the consumer the documentation from the professional outlining the child's special needs and need for a higher level of care.

3. If the initial request for the special needs rate comes from the provider, contact the consumer to discuss whether they agree with the request.

4. The special needs authorization can begin the date of request for the special needs payment, regardless of who (consumer or provider) made the request. For example, a child begins care on 5/1. The provider requests the special needs rate on 6/15 and all required verification is received on 6/30. Begin the authorization for special needs rate 6/15.

Level 1 Authorization

1. A level 1 authorization means the provider is willing to accept the standard special needs rate outlined in WAC 170-290-0225, 170-290-0230, or 170-290-0235.

2. For children in licensed / certified care, authorize the:

   1. Provider's or State standard child care rate, whichever is less, with the appropriate SSPS code for full- or half-day regular care, and

   2. Special needs rate according to region, provider type, and the child's age category, with the appropriate SSPS Special Needs code.

3. The number of special needs units must match the number of regular child care units authorized.

4. For children in in-home / relative care:

   1. Use the "Rate Authorization Table" (provided to all staff) to find the correct rate to authorize with the appropriate SSPS code, and

   2. $.62 per hour for special needs with the appropriate SSPS code 2957.

Level 2 Authorization

1. A level 2 authorization means the provider asked for a special needs rate greater than one listed in WAC 170-290-0225, 170-290-0230, or 170-290-0235.

   For Level 2 authorizations providers submit their “reasonable documented additional cost associated with the care of the child”. What is “reasonable” will differ from provider to provider and the amount of additional care provided.

   There is not a WAC limiting the amount you can authorize at this time. However, you can use the following dollar figures as guidelines. These figures are based on other State agencies' payment limits for similar care.

   1. In-home/relative care- Total of the regular rate and special needs rate; not to exceed $9.41 an hour.

   2. Licensed care- Special needs rate only; not to exceed $15.89 an hour.

2. When a provider requests a rate greater than those above in 1 (a) or (b), you can staff the case with DEAP headquarters or DEL central office staff, using local chains of command.

   1. Authorize the provider's or State standard child care rate, whichever is less, with the appropriate SSPS code,

   2. Obtain from the provider a written description of the child's additional care needs and the provider's additional cost associated with the care. The DEL 10-288 can be used to obtain this information. Reminder: You can accept other documents in place of the DEL 10-288, including an Individual Habilitation Plan (IHP), Individual Education Plan (IEP) or Individual Family Plan (IFP). Whichever document the provider uses, it must provide documentation according to WAC 170-290-0225(2) (centers), -0230(2) (licensed family homes) or -0235(3) (in-home / relative providers).

   3. Determine whether the provider's requested rate supports the documentation of care given.

3. The number of special needs units must match the number of regular child care units authorized.

4. If a special needs rate above that listed in WAC 170-290-0225, 170-290-0230, or 170-290-0235 is authorized, you must precede the special needs SSPS service code by a '9' and obtain supervisory approval.