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Chapter 19 Child Care and Development Programs Subchapter 2.5 Utilization of the Regional Market Rate Ceiling Article 1 General Provisions Establishment of Provider Reimbursement Rate Utilizing the Comparable Local Rate   

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This section applies to providers described in Sections 18074.2(a)(1), (a)(2), and (a)(3), who are unable or unwilling to establish a rate pursuant to Section 18074.3. This section shall become effective on July 1, 2004.

(a) Services provided by an agency utilizing a center-based contract with the Department shall be reimbursed at the agency's contract rate.

(b) For all other providers, the contractor shall determine a comparable local rate for the provider's services that corresponds to the family's certified need for care.

(c) To determine the comparable local rate, the contractor shall randomly select at least five reimbursement rates established pursuant to Section 18074.3 and currently in use by providers operating the same type of facility in the same or comparable zip codes. If five examples of rates established pursuant to Section 18074.3 are not available in the same or comparable zip codes, the contractor shall select at least five established rates in the same county or region that correspond to the subsidized family's certified need for care.

(d) The contractor shall calculate the average of the rates selected pursuant to subsection (c). This shall be the comparable local rate. Contractors shall retain documentation of the rates selected and computations performed pursuant to this subsection.

(e) To determine the amount of reimbursement, the contractor shall use the provider's requested rate or the comparable local rate, whichever is lower.

(f) For the duration of each fiscal year, contractors shall apply the same comparable local rates throughout the zip codes, counties, or regions for which the comparable local rates have been determined. In each county, all agencies operating pursuant to Article 15.5, commencing with Section 8350, of Chapter 2 of Part 6 of Division 1 of the Education Code and reimbursing providers located in the same zip code(s) shall use the same comparable local rate.

(g) If the family's certified need for care can be met by more than one rate category, as defined in Section 18075, the contractor shall, whenever possible, calculate the comparable local rate in the rate category that will yield the lowest reimbursement.

Authority cited:

Education Code 8265

Education Code 8269

Reference:

Education Code 8222

Education Code 8265

Education Code 8266.5

Education Code 8269

Education Code 8357

(Added by Register 2004, No. 24)