8.4.0.6: Contracts and Reimbursement

If a child with a disability and/or special health care needs has an Individualized Family Service Plan (IFSP), the lead agency may arrange and contract for specialized services to be conducted in the child care facility in addition to the child’s home and other natural environments. If a child with disabilities or special health care needs has an Individualized Education Program (IEP), the local education agency may arrange and contract for specialized services to be conducted in the child care facility.

If the child or the specialized service or intervention is not covered by IEP/IFSP:

1. The caregiver/teacher should cover the cost when the service is reasonable and necessary for the child to participate in the program;
2. The parents/guardians or source arranged by the parents/guardians should cover the cost when the service is not a reasonable expectation of the caregiver/teacher or if it is provided while the child is in child care only for convenience and is separately billable (such as speech and language therapy).

RATIONALE

Child care facilities may have to collaborate with other service providers to meet the needs of a child and family, particularly if the number of children who require these services is too few to maintain the service onsite. To achieve maximum benefit from services, those services should be provided in the setting that is the most natural and convenient for the child and family. Whenever possible, treatment specialists (therapists) should provide these services in the facility where the child receives daytime care.

“Reasonableness” is a legal standard that looks at the impact of cost and other factors.

COMMENTS

The agency that has evaluated the child and/or is planning the entire service plan, or the facility, should make the arrangements. The specific methods by which these services will be coordinated with the child care facility is determined locally.

The facility should pursue the many funding mechanisms available to supplement funding for services in the facility. Even so, caregivers/teachers can and should discuss these options with the parents/guardians as potential sources of financial assistance for the needed accommodations. These sources might include:

1. Medicaid, including waiver funding (Title XIX);
2. Private health insurance, publicly subsidized private health insurance such as under the state child health insurance program (SCHIP);
3. State or federal funds for child care, education, or for children with special health care needs (Title V);
4. Individuals with Disabilities Education Improvement Act (IDEA) (particularly Part C funding);
5. Community resources (such as volunteers, lending libraries, and free equipment available from community-based organizations);
6. Tax incentives (credit and deductions are available under federal law to most for profit child care programs);
7. Local Community Development Block Grants (CDBG) and other community development funding.

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

10.3.4.5 Resources for Parents/Guardians of Children with Special Health Care Needs
10.3.4.6 Compensation for Participation in Multidisciplinary Assessments for Children with Special Health Care or Education Needs