Sec.17b-749-13. Payment calculations

(a) Calculating the Approved Cost of Care

(1) The CCAP administrator shall calculate the approved monthly cost of care for each eligible child based on the activity schedule, the need for care, the applicable payment rate and eligibility for increased payments due to an ongoing special needs supplement. The approved cost of care shall represent the maximum ongoing CCAP payment, excluding adjustments for supplements, accreditation and professional development incentives or underpayment corrections. The approved cost shall not exceed the amount charged by the provider, except to the extent that weekly charges are converted to an average monthly amount as specified in subdivision (2) of this subsection.

(2) In calculating the approved cost, the weekly payment rate and the provider's actual weekly charges shall be converted to average monthly amounts by multiplying by a factor of four and three tenths weeks per month. The results may be rounded to the nearest whole dollar amount.

(3) The approved monthly cost of care shall be the lesser of the following amounts:

(A) the maximum payment rate based on the authorized hours of care, the type of child care setting, the age of the child, the location where care is given or the location of the family's residence in cases were payment is approved for an out-of-state provider pursuant to subdivision (a)(2) of section 17b-749-12 of the Regulations of Connecticut State Agencies, plus

(B) fifteen percent of the amount determined in subparagraph (A) for a child with special needs who is eligible for an increase in the standard payment rate pursuant to the requirements of subdivision (b)(3) of section 17b-749-16 of the Regulations of Connecticut State Agencies; or

(C) the provider's actual monthly charges.

(4) The actual charge shall be the amount charged to the parent for services, unless the child attends a state-funded day care center or a school readiness program that charges families according to a sliding income scale pursuant to subdivision (b)(7) of section 17b-749-12 of the Regulations of Connecticut State Agencies. For children attending such programs, the actual charge shall be considered to be the lesser of the following amounts:

(A) provider's full charge for the program; or

(B) the maximum CCAP payment rate based on the authorized hours of care, the type of child care setting, the age of the child and the location where care is given; plus

(C) fifteen percent of the amount determined in subparagraph (B) for a child with special needs who is eligible for an increase in the standard payment rate pursuant to the requirements of subdivision (b)(3) of section 17b-749-16 of the Regulations of Connecticut State Agencies.

(5) Actual charges shall not exceed the amount charged by the provider for children attending the same program who do not receive assistance from CCAP.

(b) Authorized Hours of Care

(1) The CCAP administrator shall calculate the number of hours of care that are needed for each eligible child. The number of hours of care authorized shall be based on all of the following factors and shall be limited to not more than twelve hours in a twenty-four hour period:

(A) hours of the work or employment services activity;

(B) the availability of a parent who is living with the child to provide care;

(C) the hours the child is in school;

(D) travel time to and from the approved activity; and

(E) the hours of care specified on the child care agreement form.

(2) Care shall not be authorized during the hours the child is in school, an academic or home schooling program, when a parent living in the home is available and capable of providing care or outside the activity schedule, including travel and lunch time.

(3) The time needed to commute to and from the activity shall be taken into consideration when determining the actual number of hours of care that is needed. Travel time shall be limited to a maximum of one hour per day, unless the parent verifies that additional time is needed.

(4) Households where both parents participate in approved activities at different times shall be required to arrange their home schedules, including sleep time, in a manner that maximizes each parent's availability to provide care. If after making reasonable efforts to adjust their schedules child care is needed, care shall be authorized for the part of the day the parents are not able to supervise the child.

(5) A maximum of four hours per day may be approved to allow a parent who works third shift or an equivalent schedule to sleep if the child does not attend school or if the other parent is not available to provide care.

(6) Care shall not be authorized between the hours of eleven p.m. and seven a.m. if the child care provider is a person who resides in the same home as the child, unless the child is less than three years of age or has special needs.

(7) Weekly schedules shall be converted to monthly figures by multiplying by a factor of four and three tenths weeks per month. The result may be rounded to the nearest half-hour.

(8) If the hours of the activity fluctuate in an unpredictable manner, the CCAP administrator shall calculate the authorized hours by using a representative average of number of hours the individual is expected to participate in the activity over the period of the certificate.

(9) For parents beginning a new employment services activity, employment or changing schedules, the number of hours authorized shall be based on documentation provided by the parent, the employer or entity responsible for coordinating the employment services activity.

(10) The number of hours authorized shall not exceed the number of hours specified on the child care agreement form.

(11) The number of hours of care authorized shall be used as the basis for determining the level of care needed and the applicable payment rate. The maximum number of hours approved for any one child shall not exceed sixty-five hours per week or two hundred eighty hours per calendar month, except to the extent the child is eligible for a supplemental payment for an alternate child care provider pursuant to section 17b-749-16 of the Regulations of Connecticut State Agencies.

(c) Payment Rates

(1) The commissioner shall establish payment rates pursuant to the requirements of this subsection. The payment rates shall be updated periodically in accordance with state and federal requirements after consideration of local market conditions, or for unlicensed providers, changes in the minimum wage. The rates shall be established with the intention of providing participating parents with reasonable access to child care services available to the general public in a variety of settings. The payment rates shall be made available to the general public upon request.

(2) The payment rates for all providers shall be based on four levels of care. Each level shall cover a range of hours. The number of hours authorized in subsection (b) of this section shall be converted to an average monthly amount and used to determine the maximum allowable payment rate for each certificate of payment. The lower and upper limits of the four levels of care shall be as follows:

(A) for care in excess of full-time care, fifty one to sixty-five hours per week;

(B) for full-time care, thirty-five to fifty hours per week;

(C) for half-time care, sixteen to thirty-four hours per week; and

(D) for quarter-time care, one hour to fifteen hours per week.

(3) The commissioner shall have discretion to modify the payment rate structure to establish daily rates or other payment levels as necessary to approximate the manner in which child care providers charge for care in the open market, including supplemental payments for extended nontraditional hours.

(4) Payment rates for school-based child care programs and providers licensed by the Department of Public Health shall depend on the age of the child in care. Children shall be classified into the following age groups:

(A) infants/toddlers under the age of three;

(B) preschool children ages three through five; and

(C) school age children age six and older.

(5) The child's age group shall be established as of the date the certificate of payment is issued and shall remain the same until the family's next redetermination or until the certificate is cancelled and a new certificate of payment is issued for the child.

(6) Separate rates shall be established for the following types of child care providers:

(A) licensed child day care centers;

(B) licensed group day care homes;

(C) licensed family day care homes; and

(D) relatives, in-home care providers and other types of unlicensed providers.

(7) Payment rates for licensed providers shall be established for geographic regions as defined by the commissioner based on a review of local market conditions. The regional payment rate for a particular child shall be determined by the location at which child care is provided.

(8) With the exception of school-based child care programs, payment rates for unlicensed providers shall be based on the state minimum wage. The weekly payment rate for the full-time care of one child shall be equal to one third of the state minimum wage times forty hours. Payment rates for school-based child programs shall be determined in the same manner as rates for child day care centers, group and family day care homes licensed by the Department of Public Health.

(9) Providers who have attained national accreditation or completed professional development course work shall be entitled to bonus payments pursuant to subsection (d) of this section.

(10) The commissioner may take other market factors into consideration when establishing payment rates, including discounts given by providers who care for more than one child from the same family. The commissioner may establish payment limits or differentials for children who are cared for in their own homes pursuant to 45 CFR 98.30 based on the additional cost of providing care in a licensed setting, including insurance, facility and business expenses, staffing, professional certifications and early childhood education programming.

(11) The payment rate shall be increased by fifteen percent for a child with special needs who meets the requirements established in subsection (b) of section 17b-749-16 of the Regulations of Connecticut State Agencies.

(12) Payment rates may be modified at any time. Changes in rates shall be made effective on the date specified by the commissioner. A minimum of thirty days advance notice shall be given to parents and providers with active certificates of payment if the payment rates are decreased.

(d) Payment Incentives for Accreditation and Professional Development

(1) Licensed child care providers whose programs meet the standards promulgated by state or national accrediting agencies recognized by the commissioner shall be entitled to a payment incentive as long as they maintain their accreditation. The payment incentive shall be equal to five percent of the amount calculated in subdivision (b)(1) of section 17b-749-15 of the Regulations of Connecticut State Agencies prior to any deductions for fees, overpayments or any mandated withholding. Accrediting agencies recognized by the commissioner shall include but not be limited to:

(A) the National Academy of Early Childhood Programs, a division of the National Association for the Education of Young Children;

(B) the National School Age Child Care Alliance;

(C) the National Association of Family Child Care; and

(D) the Council on Accreditation of Services for Families and Children, Inc.

(2) The commissioner may establish additional payment incentives for licensed and unlicensed providers eligible for CCAP based on completion of course work toward achieving a Child Development Associate credential, a degree program or other professional development courses or credentials or other quality standards. Incentives may be paid as a lump sum bonus, a flat amount added to the monthly payment or as an increase in the payment rate.

(3) Providers shall apply for payment incentives in a manner specified by the CCAP administrator and shall provide satisfactory documentation. Incentives for eligible providers shall become effective in the month following the month in which the application and all required documentation are submitted to the CCAP administrator. Providers may be required to submit updated documentation confirming their current accreditation or professional development status. Providers shall notify the CCAP administrator if their accreditation is revoked or expires, or if the conditions that qualified the provider for the incentive pursuant to subdivision (2) of this subsection change. Incentives shall continue to be paid until the end of the month in which such status changes.

(e) Maximum Payments

(1) Payments for a child who is cared for by a single provider shall not exceed the established payment rate for fifty-one to sixty-five hours of care per week, excluding incentive payments for accreditation and professional development authorized under subsection (d) of this section and supplemental payments authorized under subsection (b) of section 17b-749-16 of the Regulations of Connecticut State Agencies.

(2) If a child receives care from two or more providers, the payment rate shall be calculated independently for each provider. The payment rate for each certificate of payment shall be based on the hours of care authorized for the provider, except that the total hours authorized for all providers shall not exceed sixty-five hours per week or two hundred eighty hours per month. To determine the level of care, the CCAP administrator shall first calculate the weekly number of authorized hours of care for the provider with whom the child spends the majority of time or the provider for whom an existing certificate is already in effect. The authorized hours for this provider shall be subtracted from the sixty-five to determine the maximum number of hours available for the other or new provider. If the hours are approximately equal, the CCAP administrator may consult with the parent to determine how the hours will be allocated. The CCAP administrator shall not be required to cancel a certificate that is already in effect.

(f) Parent Fee and Financial Responsibilities

(1) The parent shall be responsible for all costs not reimbursed by CCAP on behalf of the parent. In addition, families with earnings or self-employment income shall be responsible for paying a portion of the authorized cost of care based on a monthly sliding fee scale.

(2) To determine the monthly fee, the family's gross countable annual income shall be compared to the state median income standard (SMI) for the family size as promulgated annually by the Department of Health and Human Services. The fee shall be equal to the following percentage of the family's gross countable income:

(A) for families with income below twenty percent of the SMI, two percent;

(B) for families with income of twenty percent to less than thirty percent of the SMI, four percent;

(C) for families with income of thirty percent to less than forty percent of the SMI, six percent;

(D) for families with income of forty percent to less than fifty percent of the SMI, eight percent; and

(E) for families with income of fifty percent of SMI to less than seventy-five percent of SMI, ten percent.

(3) The fee may be rounded to the nearest whole dollar amount and applied against the approved cost of care as determined in subsection (a) of this section.

(4) The fee shall be allocated to the youngest child first or in a manner that will avoid the need to allocate a portion of the fee across multiple certificates. If the fee exceeds the approved cost for a child, the remaining amount shall be allocated to the next oldest child until the full parent share has been allocated. If payment is terminated, the CCAP administrator shall apply the unallocated fee to the remaining active children or to the new certificate issued for the same child after giving appropriate notice to the parent and provider.

(5) The family shall be ineligible if the monthly fee exceeds the approved cost for all of the eligible children.

(6) The monthly fee shall be determined at the time of application and when a redetermination is conducted. The fee shall remain the same until the next redetermination, unless an ongoing decrease in income occurs that is expected to last for at least two or more months. The fee shall not be increased between redeterminations if the family's income increases, except to correct an error in the prior calculation. Families shall be subject to the gross income limit and shall report increases in income exceeding fifty dollars per month even if the change does not immediately affect the fee.

(7) Decreases in the monthly fee shall be implemented in the month following the month in which the change is reported if the change is verified timely. If the change is not verified timely, the decrease shall take effect in the month following the month in which the change is verified, unless good cause exist for not providing timely verification pursuant to subsection (e) of section 17b-749-06 of the Regulations of Connecticut State Agencies.

(8) Parents shall be responsible for paying the fee to the provider. The family's eligibility shall not be affected if the fee is not paid to the provider.

(g) Compliance with Applicable Labor and Tax Laws for In-Home Care

Parents shall be responsible for compliance with applicable laws governing in-home domestic services. The CCAP administrator may withhold the parent's share of any mandated unemployment compensation, Social Security or Medicare taxes from payments issued to an in-home provider to the extent that benefits are paid to the in-home provider instead of the parent.

(Adopted effective July 10, 2001)