Exhibit_B_-_Child_Care_Provider_Registration_Agreement__PRA_.pdf

ARIZONA DEPARTMENT OF ECONOMIC SECURITY

Child Care Administration (CCA)

SIGNATURE PAGE FOR THE

CHILD CARE PROVIDER REGISTRATION AGREEMENT

Between the Arizona Department of Economic Security (ADES) which is duly authorized to execute and administer Registration

Agreements under A.R.S. § 41-1954; and the Child Care Provider (Provider or Contractor)

DHS/Tribal/Military Licensee or Certificate Holder

Mailing Address (No., Street, City, State, Zip Code) Area Code / Phone Number

Contract Term: This Agreement to provide child care services as defined in R6-5-4901(10), as amended, shall be effective on , or date of last signature, whichever is later, and shall terminate on . .

ADES enters effective date

The Child Care Provider shall address all notices relative to this Agreement electronically or by mail to:

Arizona Department of Economic Security

Child Care Administration

P. O. Box 6123 – Mail Drop 5474

Phoenix, AZ 85007

Email: CCAContracts@azdes.gov

I HEREBY CERTIFY, UNDER PENALTIES OF PERJURY, THAT I HAVE THE LEGAL RIGHT TO ENTER INTO THIS AGREEMENT OR AM LEGALLY EMPOWERED

WITH THE AUTHORITY TO DO SO, WHETHER EXPRESS, IMPLIED, OR APPARENT, TO BIND MY PRINCIPAL OR EMPLOYER BY THIS AGREEMENT.

FOR AND ON BEHALF OF THE

ARIZONA DEPARTMENT OF ECONOMIC SECURITY:

FOR AND ON BEHALF OF THE

CONTRACTED CHILD CARE PROVIDER:

SIGNATURE OF AUTHORIZED SIGNER

Signature Date

TYPE OR PRINT NAME AND TITLE OF AUTHORIZED SIGNER Type or Print Name and Title of Authorized Signer

ADES ASSIGNED CONTRACT NUMBER

EIN Number or Social Security Number

Print name and title of alternate person(s) authorized to sign this Agreement and any amendments for the signer listed above, if the signer is not available.

ADES ASSIGNED PROVIDER ID NUMBER

DATE SIGNED BY ADES CHILD CARE ADMINISTRATION

Type or Print Name/Title of Alternate Person

Type or Print Name/Title of Alternate Person

Equal Opportunity Employer/Program • Under Titles VI and VII of the Civil Rights Act of 1964 (Title VI & VII), and the Americans with Disabilities Act of 1990 (ADA), Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, and Title II of the Genetic Information Nondiscrimination Act (GINA) of 2008, the Department prohibits discrimination in admissions, programs, services, activities, or employment based on race, color, religion, sex, national origin, age, disability, genetics and retaliation. The

Department must make a reasonable accommodation to allow a person with a disability to take part in a program, service or activity.

For example, this means if necessary, the Department must provide sign language interpreters for people who are deaf, a wheelchair accessible location, or enlarged print materials. It also means that the Department will take any other reasonable action that allows you to take part in and understand a program or activity, including making reasonable changes to an activity. If you believe that you will not be able to understand or take part in a program or activity because of your disability, please let us know of your disability needs in advance if at all possible. To request this document in alternative format or for further information about this policy, contact 602-542-

4248; TTY/TDD Services: 7-1-1. • Free language assistance for DES services is available upon request. • Disponible en español en la oficina local.

Provider Registration Agreement

Table of Contents

Page 2 of

Table of Contents

Scope of Work 3

Exhibit 1 – Tracorp Instructions 29

Exhibit 2 – Disaster Emergency Evacuation Preparedness Plan 30

Exhibit 3 – About Me Questionnaire 31

Exhibit 4 – Provider/Parent/Guardian’s Agreement for Child Care Charges 32

Exhibit 5 – DES Accepted Accreditation Agencies for Centers

Exhibit 6 – Verbal Notice of Eligibility 34

Exhibit 7 – Unpaid Copayment Worksheet 35

Exhibit 8 – Notice to All Families Enrolled At DES Child Care Facility

Exhibit 9 – Sign-In/Sign-Out Record 37

Special Terms and Conditions 38

Division Special Terms and Conditions 48

Uniform Terms and Conditions 50

Attachment 1 - Certification Regarding Lobbying

Attachment 2 - Participation in Boycott of Israel 59

Attachment 3 - Certification Regarding: Debarment, Suspension, Ineligibility and Voluntary Exclusion 60

Attachment 4 - D.E.E.P. and EMPOWER Program Overview and Acknowledgement Form 62

Attachment 5 - Child Care Provider Rate Agreement 63

Attachment 6 – Provider’s Child Care Operational Information 64

Attachment 7 – State of Arizona Substitute W-9 65

Attachment 8 – Direct Deposit Enrollment 66

Attachment 9 – Direct Service Position (Certification Form) 67

Scope of Work

1. Arizona Department of Economic Security (ADES) Mission and Vision Statement

1.1 ADES Mission: The Arizona Department of Economic Security makes Arizona stronger by helping Arizonans reach their potential through temporary assistance for those in need, and care for the vulnerable.

1.2 ADES Vision: All Arizonans who qualify receive timely ADES services and achieve their potential.

1.3 Child Care Administration (CCA) Mission: The CCA supports the well-being and economic independence of

Arizona families by providing quality child care assistance and developing quality child care services.

2. Purpose of Contract

2.1. Purpose Statement: The purpose of this contract is for Group Homes and Child Care Facilities to become registered child care providers with ADES/CCA, statewide. The goal of this service is to enhance and support the provision of child care services to children and their families.

2.2. Legal Authority: A.R.S. § 41-1954(A)(6) provides ADES, also referred to herein as the Department, the authority to contract and incur obligations within the general scope of its activities and operations.

3. Definitions

3.1. Additional Charges – any fees a Provider charges that exceed the Reimbursement Rate.

3.2. ADHS – the Arizona Department of Health Services.

3.3. Agreement or Contract – all scope of work, terms and conditions of this Child Care Provider Registration Agreement, any amendments to the Agreement, any attachments and exhibits to the Agreement, and any terms applied by law.

3.4. Alternative Approved Records - one of three available Child Care sign-in and out possibilities.

3.5. Arizona Early Childhood Workforce Registry – a statewide workforce registry website that tracks individuals who are knowledgeable and skilled in early childhood work based on their verified professional achievements.

3.6. Audit Exception – the amount determined by the Department that a Provider has been overpaid based on a review of available documentation.

3.7. AZCCATS - Arizona Child Care Automated Tracking System

3.8. Billing Form/Claim – the form furnished by ADES that shall be completed and submitted by the Provider in order to receive payment for child care services rendered.

3.9. BCCL – Bureau of Child Care Licensing that is administered by ADHS.

3.10. CCA – the Child Care Administration of the ADES.

3.11. Certificate of Authorization – the document issued by ADES that contains a Provider’s authorized level of service, the corresponding level of potential ADES payments, and the ADES approved period of eligibility for each authorized child.

3.12. Charter School – a Public School established by contract with the state board of education, the state board for charter schools, a university under the jurisdiction of the Arizona board of regents, or a community college district of a group of community college districts that provides learning that will improve pupil achievement.

3.13. Child – any child enrolled with a Provider.

3.14. Child Care – Child care means the compensated service that is provided to a child who is unaccompanied by a parent or guardian during a portion of a twenty-four hour day. (A.R.S. § 46-801(4))

3.15. Child Care and Development Fund (CCDF) – the federal and state partnership program authorized under the Child Care and Development Block Grant Act (CCDBG) (PL 113-186) and administered by states, territories, and tribes with funding and support from the Administration for Children and Families’ Office of Child Care in the U.S.

Department of Health and Human Services. States use CCDF to provide financial assistance to low-income families to access child care, so they can work or attend a job training or educational program.

3.16. Child Care Facility or Child Care Center – any facility in which child care is regularly provided for compensation for five or more children not related to the proprietor.

3.17. Child Care Group Home – a residential facility in which child care is regularly provided for compensation for periods of less than twenty-four hours per day for not less than five children but no more than ten children through the age of twelve years.

3.18. Child Care Resource and Referral (CCR&R) System – Pursuant to A.R.S. § 41-1967 assists families in choosing child care through referrals to local child care providers, information on state licensing requirements, availability of child care subsidies, and other pertinent information.

3.19. Child Care Specialist – an employee of ADES or an employee of an ADES contracted entity that is authorized to determine eligibility for ADES child care subsidies.

3.20. Client – a person authorized by ADES to receive child care services, means the same as “existing client.” For example, a parent or guardian.

3.21. Claim - a demand against the State for payment for either goods delivered or services performed.

3.22. Compliance Review – the audits, reviews, or site visits that seek to ensure that Providers are complying with contractual requirements outlined in this Agreement.

3.23. Compliance Specialist – an employee of ADES that has the authority to authorize reimbursement for claims, negotiate contracts, monitor and review program operations, and who performs a variety of contractual functions.

3.24. Co-Payment – the portion of the Reimbursement Rate that shall be paid by ADES eligible families. ADES establishes the Co-Payment amount based on family size and level of income within the minimum Co-Payment rates prescribed by Appendix A to Arizona Administrative Code (A.A.C.) Title 6, Chapter 5, Article 49. The Co-

Payment is subtracted from the Reimbursement Rate (see definition of “Reimbursement Rate” below).

3.25. Corrective Action Plan (CAP) – a document describing the steps a Provider will take to remedy non-compliance with terms and conditions of this Agreement.

3.26. Criminal Background Check – an investigation into an individual’s background to determine any criminal history.

The criminal background check searches the national, federal, state, and/or county criminal court databases for any felony and misdemeanor criminal convictions, and any pending criminal cases. The information provided is used by ADES to determine whether to qualify an individual for pre-employment or employment, or whether to contract with or use an individual’s services.

3.27. Department (or ADES) – the Arizona Department of Economic Security.

3.28. Disaster Preparedness Plan – the Provider’s written plan that includes a comprehensive approach to emergency situations that could impact the operation of the child care facility in the event of a natural or man-made disaster.

The ADES/CCA Disaster Preparedness Plan can be found on the CCA website.

3.29. Electronic Signature -

3.29.1. Means an electronic or digital method of identification that complies with the requirements of A.R.S. § 18- 106 section and that is executed or adopted by a person with the intent to be bound by or to authenticate a record.

3.29.2. Includes a digital signature.

3.30. Empower Program – the Empower Program is a public health program for state licensed and certified child care facilities in Arizona that focuses on 10 strategies to empower children to lead healthy lives. Participating facilities receive a 50% discount for child care licensing fees. A written policy and implementation for each standard is a component of the Provider’s Empower Agreement with ADHS.

3.31. Expulsion – when a child care provider removes or excludes a child from a child care service.

3.32. Fingerprinting – fingerprinting is evidence that confirms a person’s identity and any pending or past criminal matters, and criminal records that relate to the individual. An employer or provider shall ensure that all independent providers, subcontractors, employees, and volunteers comply with legal requirements related to fingerprinting and fingerprint clearance cards for employment and contract requirements. ADES requires Level I fingerprint clearance cards.

3.33. First Things First – First Things First is Arizona’s early childhood agency. By focusing on the first five years, we are making a difference in the lives of young children, their families, and our communities.

3.34. Gratuity – a payment, loan, subscription, advance, deposit of money, services, gift, present, promise or anything of more than nominal value that is given voluntarily or beyond one’s obligation for payment.

3.35. Guardian - a person with permanent or temporary court appointment, who has been given the power and responsibility of a parent over a minor child. Guardianship does not constitute legal or financial responsibility.

3.36. Group Size – the number of children assigned to a caregiver/teacher or a team of caregivers/teachers occupying an individual classroom or an assigned space within a larger room.

3.37. Investigation – a process that includes fact-finding, interviews, questioning, evidence collection and preservation and various methods of examination.

3.38. Legal Signature – the person’s unique mark or name, handwritten by that person for purposes of authentication of a document; electronic signatures as defined above shall be considered a Legal Signature.

3.39. Licensed Capacity – the maximum number of enrolled children for whom a licensee is authorized by ADHS to provide child care services in a facility or a part of a facility at any given time.

3.40. Parent – the natural or adoptive parent of a child or a person with permanent responsibility for the care, custody, and control of a child.

3.41. Paid Absence – payment for a day(s) that must be paid regardless of whether or not a child is present.

3.42. Pre-Signing – signing and dating an attendance record for any period of time prior to the date and time of actual attendance.

3.43. Primary Caregiver – one caregiver assigned to a small group of children for the majority of the child’s care throughout the day. Primary caregiving is an intentional practice, demonstrating individualized care for children one-on-one and within the group setting.

3.44. Provider or Contractor – any person or entity that has a Provider Registration Agreement with the Department for purposes of providing child care.

3.45. Public School – a school, including a charter school, that is maintained at public expense for the education of the children or a community or district and that constitutes a part of a system of free public education commonly including primary and secondary education.

3.46. Reimbursement Rate – the payment levels and amounts specified in the Child Care Provider Rate Agreement. The

Reimbursement Rate minus the daily Co-Payment amount is the amount that ADES will pay the Provider. ADES is the payer of last resort and will not reimburse for services covered by other grants, contracts or payments.

Maximum Reimbursement Rates are prescribed by Appendix B to A.A.C. Title 6, Chapter 5, Article 49.

3.47. Serious Injury – an injury or accident resulting in medical treatment (outside the child care facility or child care group home), hospitalization, or death of a child.

3.48. Service Month – the month in which the child care service was provided.

3.49. Special Needs Child – a child with an identified disability or special health care need who requires appropriate, individualized accommodations and supports to access, and participate in the routines and activities with their peers.

The child may need increased supervision and/or adaptive equipment.

3.50. Staff Member – child care personnel, including volunteers, who provide child care services that are the responsibility of a Provider.

3.51. State – the State of Arizona and/or the Department.

3.52. Unit of Care – represented by a “D” (Full Day of Care is 6 hours or more) or an “L” (Part Day of Care is less than 6 hours but more than 14 minutes) on the AZCCATS Billing Document, Certificate of Authorization form, and the

Verbal Notice of Eligibility form. 14 minutes or less is not a payable unit of care.

3.53. Verbal Notice of Eligibility – an oral notification from a Child Care Specialist to the Provider of the effective date of eligibility and the level of service approved by the Department for an ADES-eligible family.

3.54. Volunteer – a staff member who, without compensation, provides child care services under the direct supervision and responsibility of the Provider.

4. Service Description

4.1 Arizona Taxonomy Definition: A service that provides supervised planned care for children during a portion of a 24-hour day.

4.2 Actual Service Description: The services under this agreement shall provide children and families child care services at the site of an ADES/CCA contracted Group Home or Child Care Facility.

4.3 Service Eligibility Requirements/Target Population: Eligible service providers include ADES/CCA contracted

Group Homes or Child Care Facilities that provide child care assistance to eligible families who participate in employment activities and specific education and training activities related to employment, children who are involved with the Department of Child Safety due to child abuse or neglect, and families with children experiencing homelessness.

4.4 Background: The Child Care and Development Fund (CCDF) is the primary federal funding source in Arizona for child care subsidies to help eligible low-income working families access child care and to improve the quality of child care for all children. In Arizona, the designated agency for administering CCDF programs and funding is the Department of Economic Security, Child Care Administration (CCA). The CCA provides child care assistance to eligible families who participate in employment activities and specific education and training activities related to employment by providing financial support intended to offset a portion of child care costs. This financial support allows families better access to high-quality, early care and education settings for their children. Child care assistance is also available for children who are involved with the Department of Child Safety due to child abuse or neglect, and families with children experiencing homelessness.

5. Provider Requirements

5.1 General Requirements:

5.1.1 Criminal Background Checks and Fingerprinting Requirements

5.1.1.1 ADES will conduct comprehensive criminal background checks on all individuals whose activities involve the care or supervision of children or unsupervised access to children whether they provide direct or indirect services to children including, but not limited to:

A. Any person who applies for a contract with this State and that person’s employees;

B. All employees of a contractor;

C. Any person who owns, operates, is employed by, or substitutes for a child care provider;

D. An independent contractor or subcontractor (collectively, “subcontractor”) of a contractor and the subcontractor’s employees;

E. Prospective employees of the contractor or subcontractor at the request of the prospective employer;

F. Volunteers; and

G. Other agents whose activities involve the care or supervision of children or unsupervised access to children.

5.1.1.2. The Contractor shall ensure that all applicable individuals under this agreement shall obtain and maintain a valid Arizona Level One (1) Fingerprint Clearance Card pursuant to A.R.S. §§ 36- 883.02, 36-897.03, and 41-1964, A.R.S.§ 46-141 issued prior to providing direct or indirect services to children, beginning employment, or beginning volunteer work.

5.1.1.3. The Department may conduct criminal background checks on all individuals under this section or request documentation from the Contractor or other state agencies to confirm compliance with licensing or certification requirements regarding criminal background checks, including fingerprint clearance card.

5.1.1.4. Federally recognized Indian tribes will submit and the Department shall accept certifications that state that no personnel who are employed or who will be employed during the contract term have been convicted of, have admitted committing or are awaiting trial on any offense as described in

A.R.S. § 46-321 (as amended).

5.1.1.5. A criminal background check will include a search of all of the following in the State where the applicable individual resides and each State where the individual has resided within the past five

(5) years:

A. Criminal and sex offender registry;

B. Child abuse and neglect registry;

C. National Crime Information Center (run by the FBI);

D. FBI fingerprint check using Next Generation Identification; and, E. National Sex Offender Registry.

5.1.1.6. Pursuant to A.R.S. § 46-811, the Department may conduct background checks pursuant to the requirements of the Child Care Development Block Grant Act of 2014 (P.L. 113-186) that are not included in the fingerprint clearance card process.

5.1.1.7. The Contractor shall submit a request to conduct a comprehensive criminal background check to the Department for each applicable individual under this section, at least once every (5) years, utilizing the process outlined on the Arizona Child Care Resource and Referral website:

http://www.azccrr.com/

5.1.1.8. The Contractor shall pay for any costs required for the processing and administering of criminal background check applications, both in and out of State.

5.1.1.9. ADES shall conduct Central Registry background checks for all Provider staff and volunteers and shall use the information contained in the Central Registry in accordance with A.R.S. § 8-

804 (as may be amended) ADES will use the information contained in the Central Registry as a factor to determine eligibility for employment.

5.1.1.10. For all individuals, before being employed or volunteering in a position that provides direct services to children under this contract, the individual shall certify through the completion and submittal of the Direct Service Position Certification Form CCA-1212A (Attachment 9) that:

A. The person is not currently the subject of an investigation of child abuse or neglect in

Arizona, or another state of jurisdiction; and

B. The person has not been the subject of an investigation of child abuse or neglect in Arizona, or another state or jurisdiction, which resulted in a substantiated finding.

5.1.1.11. The completed forms are to be maintained as confidential.

5.1.1.12. A person awaiting receipt of the Central Registry Background Check may provide direct services to ADES clients while under the supervision of a staff member or volunteer who has satisfied all of the criminal background check requirements

5.1.1.13. A person who is disqualified because of a Central Registry Background Check may apply to the Board of Fingerprinting for a Central Registry exception pursuant to A.R.S. § 41-619.57.

5.1.1.14. A person who is granted a Central Registry exception pursuant to A.R.S. § 41-619.57 is not entitled to a contract, employment, licensure, certification or other benefit because the person has been granted a Central Registry exception. The provider shall submit approval documentation from the board of fingerprinting to the compliance specialist by email to

CCAContracts@azdes.gov.

5.1.2. Arizona Early Childhood Workforce Registry Participation

5.1.2.1. Within 15 days of the effective contract date, the Provider administrator or director shall request and maintain administrative access to the Arizona Early Childhood Workforce Registry located at the following website: www.azregistry.org.

5.1.2.2. The Provider administrator or director shall create and maintain a current training profile of professional development for all provider staff on the Arizona Early Childhood Workforce

Registry.

5.1.2.3. The Provider administrator or director shall ensure all training profiles of professional development are up to date and shall make updates to profiles within 15 days of hire and upon any change to status.

5.1.3. Empower Program Participation

5.1.3.1. Register for the Empower Program. Registration is accessible on the ADHS website at: 2021

ADHS Licensing Empower Program Registration Form Survey.

5.1.3.2. Complete the D.E.E.P. and Empower Program Overview and Acknowledgement Form

(Attachment 4) and submit to the ADES Compliance Specialist.

5.2 Training Requirements

The Provider Shall:

5.2.1. ADES Health and Safety Training

5.2.1.1. Ensure all Provider staff are aware of and compliant with the initial and annual ongoing ADES

Health and Safety Training Requirements in order for Arizona to maintain compliance with the

CCDF (Sections 98.41; 98.44).

Provider Type Initial Annual (every 12 months)

ADHS Licensed Centers Within 90 days of staff beginning employment or contract execution date;

whichever is later

18+ hours

ADHS Licensed Group Homes 12+ hours

Tribal and Military Child Care 12+ hours

5.2.1.2. In accordance with Arizona’s CCDF State Plan, the following training components must be met:

A. The Initial ADES Health and Safety Training which includes the following topics:

Initial ADES Health and Safety Training Topics prevention and control of infectious diseases emergency preparedness prevention of sudden infant death syndrome handling and storing hazardous materials administration of medication appropriate precautions in transporting children mailto:CCAContracts@azdes.gov http://www.azregistry.org/ http://www.azregistry.org/ http://www.azregistry.org/ http://www..azregistry.org/ http://www..azregistry.org/ http://www.azregistry.org/ https://www.surveymonkey.com/r/EmpowerRegistration https://www.surveymonkey.com/r/EmpowerRegistration response to emergencies due to food and allergic reactions First Aid and CPR building and physical premises safety compliance with child abuse reporting requirements prevention of shaken baby syndrome and abusive head trauma

B. The ADES Annual Ongoing Training must include two or more of the following topics:

Ongoing Training Topics strategies related to program administration, planning, development, or management availability of community services and resources nutrition (including age-appropriate feeding) training that maintains and updates health and safety topics as described and identified in this Agreement access to physical activity social-emotional development and behavior models to support healthy practices in children birth through school-age caring for children with special needs child growth and development

C. Other training and postsecondary education coursework not pre-approved by ADES that meets the topic areas listed in this Agreement must be submitted to ADES for approval.

5.2.1.3. In addition to the training requirement in this Agreement, ADES reserves the right to require additional training in its sole discretion. Said training may be in face to face and/or computer-based format(s).

5.2.1.4. Pre-service and annual required training and postsecondary education coursework must be registered and tracked in the Arizona Early Childhood Workforce Registry located on the website: www.azregistry.org.

5.2.1.5. Other than as provided in Section 5.2.1.2 above, ADES may, but is not obligated to, provide training and technical assistance to the Provider in the completion of required forms and records, terms and conditions and policies and procedures governing this Agreement.

5.2.1.6. Notwithstanding the requirements in Section 5.2.1, the Provider is not relieved of full responsibility and accountability for the provision of services and performance according to this

Agreement.

5.2.1.7. Other Training Requirements

A. As part of the annual staff training required by the Department of Health Services, the

Provider agrees to obtain training approved by ADES in subjects based on priorities set forth by the ADES to support the overarching goals of the program as identified in the

Child Care and Development Fund State Plan which can be located at https://des.az.gov/services/child-and-family/child-care. These topics include, but are not limited to, Expulsion Policy, Primary Caregiving, Social-Emotional Development of

Children, Parental Engagement, Infant/Toddler Development, or other topic(s) identified by the ADES.

B. Provider shall ensure that all staff who are responsible for completing billing must successfully complete the DE5417 Basic Billing for CCA Providers computer-based http://www.azregistry.org/ training through the Department’s current training system. Instructions on how to Access the training are found on the TraCorp Instructions (Exhibit 1).

C. Provider shall ensure that all staff who are responsible for writing and updating the

Emergency Preparedness Plan shall successfully complete and provide proof of the Disaster Emergency Evacuation Preparedness (D.E.E.P.™) online training completion that is accessible on the ADHS website located at:

http://azdhs.gov/documents/licensing/childcare-facilities/training/deep-online-training.pdf, or an ADES approved Emergency Preparedness training. Provider shall reference Exhibit 2 for the written Emergency Preparedness Plan Guide.

5.3 Service Requirements:

The Provider Shall:

5.3.1 Not accept children for ADES reimbursed child care prior to the start date and after the stop date as indicated by the Department on the Certificate of Authorization from the ADES/CCA Eligibility Specialist or the Verbal Notice of Eligibility form CC-031 (Exhibit 6).

5.3.2 Complete the Verbal Notice of Eligibility form CC-031 (Exhibit 6) when receiving an oral authorization of services from the ADES/CCA Eligibility Specialist.

5.3.3 Issue at the time of enrollment, a written, dated statement of services to each Client that shall include, but is not limited, to the following:

5.3.3.1 Days and hours of operation.

5.3.3.2 Holidays observed.

5.3.3.3 Age range of children served.

5.3.3.4 Current rates and the effective date of such rates and fees, including policies regarding payment of fees and late fees.

5.3.3.5 Absence charges policy as referenced in section 5.7.

5.3.3.6 Notification of access rights - if a Client is divorced or separated, or has a parenting agreement with one or more individuals, the Provider agrees to obtain specific instructions from the custodial Client regarding the other parent or named party or parties.

5.3.3.7 Disaster Preparedness Plan.

5.3.3.8 ADES Suspension and Expulsion Prevention Policy (CCA 1-01-01) and timeframes.

5.3.3.9 Notification that Clients will be given a 15-day written notice prior to the effective date of any change in services, policies, Provider’s email address, and rates.

5.3.4 Offer the same benefits, advantages, and discounts to ADES clients that are offered to non- ADES clients.

5.3.5 Not require Clients to utilize more child care hours or days than are needed.

5.3.6 Obtain from, and review with the client, the About Me Questionnaire CCA-1200A (Exhibit 3)

5.3.7 Complete a Provider/Parent/Guardian’s Agreement for Child Care Charges Form CCA-0208A (Exhibit 4) for each child in care.

5.3.7.1 A new form shall be completed within 3 business days after receiving notice of a subsequent change in child care rates, Co-Payment amounts, and additional charges, or upon receipt of a new Certificate of Authorization for the child in care from the ADES/CCA Eligibility Specialist.

5.3.8 Make available to Clients and their families any resources that ADES provides to the Provider.

http://azdhs.gov/documents/licensing/childcare-facilities/training/deep-online-training.pdf http://azdhs.gov/documents/licensing/childcare-facilities/training/deep-online-training.pdf http://azdhs.gov/documents/licensing/childcare-facilities/training/deep-online-training.pdf

5.3.9 Provide Clients with a statement of charges and payment history, as requested by the Client.

5.3.10 Provide Clients with a copy or copies of a child’s sign-in/sign-out record or any related ADES information in accordance with the Confidentiality terms of this Agreement.

5.3.11 As required by the Internal Revenue Code 26 U.S.C. § 6109(a)(2), issue a notification of the Social Security

Number (SSN) or taxpayer identification number (Employer Identification Number/Federal Employer Identification Number) to any Client who was provided child care services at the Provider’s facility.

5.3.12 Instruct Clients on proper ADES sign-in/sign-out procedures. Refer to Notice to All Families Enrolled at

DES Child Care Facility CCA-1216A (Exhibit 8).

5.3.13 Provide Clients a 15-day written notice of rate changes, changes in the hours/days of operation, changes in the age range of children served, relocation of facility with ADHS approval, mailing address, and ADHS license/certification status including but not limited to, changes in Provider’s facility number or capacity.

5.3.14 Notify an ADES Compliance Specialist in writing at least 30 days prior to any rate change by submitting a new Child Care Provider Rate Agreement CC-214 (Attachment 5) or by completing the electronic online

Arizona Child Care Provider Rate Agreement

(https://www.cognitoforms.com/AZCCA1/arizonachildcareproviderrateagreement).

5.4 Group Size Requirements:

5.4.1 In accordance with Federal rule 45 CFR 98.41(d)(1), under the Child Care and Development Fund (CCDF), the Provider shall not exceed the following Group Size Maximum Standards and parameters:

Age Group Maximum Group Size

Infants 11

1 year old children 13

2 year old children 16

3 year old children 26

4 year old children 30

5 year old children (not school age)

School age children 40

5.4.2 In accordance with Arizona Administrative Code (A.A.C.) R9-5-404, ADHS ratios and licensed capacity may not be exceeded.

5.4.3 A child shall be assigned a Primary Caregiver upon enrollment. This caregiver is responsible for the majority of the child’s care and interactions throughout the day and ensuring needs such as diaper changing, feeding, etc. Children should always be given the opportunity to make autonomous choices of activity and their level of participation within that setting. In accordance with Arizona Administrative Code (A.A.C.)

R9-5-404, ADHS regulations for supervision while transitioning between activities must be maintained at all times.

5.4.3.1 Evidence of primary caregiving may be shown in alternate schedules, separate group rosters and classroom postings. Primary caregiving is a program practice and must be described in a written policy. All staff members, regardless of primary caregiver assignments, are responsible for the health, safety and well-being of all children in the child care setting.

https://www.cognitoforms.com/AZCCA1/arizonachildcareproviderrateagreement

5.5 Children with Special Needs Requirements:

5.5.1 Licensed Child Care Facilities and certified Group Homes will receive an enhanced rate over the basic rate for providing high quality inclusive child care to children with disabilities who meet the following

ADES/CCA family eligibility requirements for child care subsidy:

5.5.1.1 The Provider shall possess an ADES accepted national child care accreditation or a Quality First Star Rating of Three (3), Four (4) or Five (5) stars throughout the time that the enhanced rate is received.

A. ADES accepted Accreditation Agencies are identified on Exhibit 5, as may be amended.

5.5.1.2 A child with special needs must have a documented disability as follows:

A. A child under the age of three who is eligible for the Arizona Early Intervention Program

(IDEA, Part C services as identified at azdes.gov/azeip) and has an Individualized Family

Service Plan (IFSP); or, B. A child between the ages of three and 12 who is eligible for Special Education Services

(IDEA, Part B services as identified at azed.gov/specialeducation) and has an

Individualized Education Plan (IEP); or, C. A child over the age of three who is eligible for the Division of Developmental Disabilities

(as identified at des.az.gov/services/disabilities/developmental-disabilities) and has an

Individualized Support Plan (ISP); or, D. A child who has a 504 Plan under Section 504 of the Rehabilitation Act and the American with Disabilities Act (as identified at www2.ed.gov/about/offices/list/ocr/504faq.html); or, E. A child under the age of 13 with a diagnosis by a licensed physician, certified psychologist or a certified behavioral health specialist with a physical, cognitive and/or a psychosocial condition that substantially limits the child’s ability to perform age-appropriate activities;

or, F. Others, as approved by ADES; and

5.5.1.3 No more than 10% of the Provider’s licensed capacity can be children with disabilities.

5.6 Enhanced Rates Requirements:

5.6.1 In order to be eligible for an enhanced rate the Provider must meet and maintain the following criteria:

5.6.1.1 The Provider must either possess a Three (3), Four (4) or Five (5) Star Quality First Star Rating issued by First Things First or, be accredited by an ADES accepted Accreditation Agency (Exhibit 5). The Provider must furnish ADES with the corresponding documentation of qualification(s), only getting the basic rate plus a percentage of the basic rate, and not paid twice as listed on the CCA-1227A Maximum Reimbursement Form.

5.6.1.2 ADES will review the Providers’ First Things First Quality First Star Rating only twice annually, on April 1st and on October 1st. The Providers’ star rating at the review will be used to determine the enhanced rate status for the following six (6) months.

5.7 Paid Absences Requirements:

5.7.1 The Provider may claim and will be reimbursed for, no more than five (5) days per month for a child who is absent from the Provider’s facility if all of the following criteria are met:

5.7.1.1 The facility is open for business;

5.7.1.2 The child would normally be in care on the absent day;

http://www.azdes.gov/azeip http://azed.gov/specialeducation https://des.az.gov/services/disabilities/developmental-disabilities http://www2.ed.gov/about/offices/list/ocr/504faq.html

5.7.1.3 There are units of care remaining in the authorization;

5.7.1.4 Only the units that would have been used on the absent day will be claimed (for example, the

Provider may claim only a Part Day (“L”) if a school-age child is absent on a school day);

5.7.1.5 The Provider charges all families (Clients and non-Clients) the Co-Payment for absences and advises all families in writing that payment is required for all absent days;

5.7.1.6 The child is currently enrolled and received ADES subsidized care at the Provider’s facility at least one day during the service month in which the paid absence is claimed;

5.7.1.7 Claimed absences are indicated on the sign-in/sign-out record, or approved substitute record with a notation of “PA” or “Paid Absence” if the Provider is approved to use a computerized attendance tracking system;

5.7.1.8 The date of the paid absence is clearly indicated in the non-shaded area of the billing form, under the name of the child; and

5.7.1.9 The number of paid absences is included in the total amount of units billed when completing the billing document;

5.7.2 The Provider shall not claim a paid absence when the Provider failed to have proper documentation of the sign-in/sign-out record, approved substitute record, or approved computerized attendance tracking system.

5.7.3 The Provider shall not claim a paid absence prior to the start date or after the stop date as indicated in the

Certificate of Authorization.

5.7.4 The Provider shall not file a supplemental bill to capture absent days not previously claimed in prior service months.

5.7.5 The Client is responsible to pay the Provider directly for any absent day Co-Payment.

5.7.6 ADES will not pay for child care for school age children during the hours a Public School is in session. If a child is expelled or suspended from school, ADES may (with written verification from the school) authorize and pay for child care during school hours.

5.7.7 The Provider shall not claim more than the maximum number of units authorized for the billing month by ADES. Claims in excess will not be paid.

5.7.8 The Provider shall not claim units not used if a Client uses less than the maximum number of units authorized.

5.7.9 The Provider shall not claim or be paid by the Department for additional charges in excess of the rates indicated on the Arizona Child Care Provider Rate Agreement CC-214. Clients are responsible for payment of additional charges.

5.8 Expulsion and Suspension Prevention Requirements:

5.8.1 Federal rule, under the Child Care and Development Fund (CCDF), requires States to incorporate policies which prevent suspension, expulsion, and denial of services due to challenging behaviors of children in child care programs receiving CCDF funding.

5.8.2 The Provider shall adhere to all requirements of the ADES Suspension and Expulsion Prevention Policy (CCA 1-01-01), as may be amended.

5.9 Health and Safety Requirements

5.9.1 The Provider agrees to comply with all ADHS License/Certification requirements. The Provider shall comply with Tribal Health Services Environmental Health Survey, Military Standards, or any other applicable local, state or tribal laws, rules and regulations. If the Provider operates on Tribal Lands or on a

Military Installation, the Provider agrees to furnish ADES with a copy of the current applicable regulations pertaining to child care on the Tribal Land or Military Installation.

5.9.2 If any changes in the Provider’s license occur, the Provider shall notify ADES and furnish ADES with a copy of the Provider’s new ADHS license, Tribal Health Services Environmental Health Survey, Military

Standards or other verification of compliance with applicable local, state or tribal laws, rules and regulations within 15 days of receipt from the regulating agency.

5.10 Reporting Serious Injuries and Deaths

5.10.1 The Provider agrees to report all serious injuries and deaths as defined above, to the CCA Compliance

Specialist Unit, within one (1) business day.

5.11 Child Abuse Mandated Reporting Requirement

5.11.1 In accordance with A.R.S. §13-3620, the Provider agrees to comply with mandated reporting of child abuse or neglect.

5.12 Child Care Resource & Referral (CCR&R)

5.12.1 The Provider agrees to

5.12.1.1 Obtain and maintain a listing in the CCR&R provider database and on the statewide consumer education website to receive training information and child care referrals.

5.12.1.2 Cooperate with CCR&R by providing current business operational information upon listing.

5.12.1.3 Contact ADES within five (5) business days of any changes to the Provider’s business operational information which include business hours, days or times, rates, contact information.

5.12.2 The Provider may contact CCR&R via the Child Care Information line at 1.800.308.9000, or email at childcareinfo@cfraz.org, or via the “Contact Us” form on the website www.azccrr.com.

5.12.3 Additionally, a CCR&R Specialist will contact the Provider at least twice a year to update the Provider’s listing to ensure program information is accurate and up-to-date.

5.13 Administrative Requirements

5.13.1 Email Address

5.13.1.1 The Provider shall acquire and maintain a current email address which is readily available to

ADES and the Provider’s clients.

5.13.1.2 This email will be the main form of communication between the Provider and the Department.

mailto:childcareinfo@cfraz.org http://www.azccrr.com/

5.14 Required Documentation

5.14.1 Complete and submit the following forms (found under the “Providers” drop down menu at https://des.az.gov/services/child-and-family/child-care) to ADES via online application, and submit updated copies of the forms if any changes occur:

5.14.1.1 Arizona Child Care Provider Rate Agreement CC-214 (Attachment 5);

5.14.1.2 Provider’s Child Care Operational Information Form CC-100 (Attachment 6);

5.14.1.3 State of Arizona Substitute W-9 (Attachment 7) with a valid IRS Tax Identification Number for the Provider, or Social Security number if the Provider is an individual;

5.14.1.4 Direct Deposit Enrollment form CCA-1140A (Attachment 8).

5.14.2 Provide copies of the following documents to ADES:

5.14.2.1 Provider’s license to operate issued by an appropriate regulatory agency;

5.14.2.2 All documentation given to clients upon enrollment and thereafter, including but not limited to:

Provider’s policies (including expulsion and suspension prevention), ages served, rates, hours, days of operation, holidays observed, etc.;

5.14.2.3 The Sign-In/Sign-Out Record form the Provider intends to use;

5.14.2.4 National Accreditation certificate and/or of the Quality First Three (3), Four (4) or Five (5) Star

Rating approval issued by First Things First, as applicable;

5.14.2.5 Copy of the certificate of completion for the computer-based training, DE5417 Basic Billing for

CCA Providers;

5.14.2.6 Provider’s Emergency Preparedness Plan;

5.14.2.7 Provider’s Certificate of Liability Insurance (ACORD form) in accordance with the Special

Terms and Conditions.

5.15 Records and Record Retention

The Provider shall establish and maintain a records file for each child in accordance with the record retention policies of this Agreement. Electronic files are acceptable.

5.15.1 The file shall contain the following:

5.15.1.1 Certificate of Authorization for each child;

5.15.1.2 Child Care Provider Rate Agreement form CC-214;

5.15.1.3 Provider/Parent/Guardian’s Agreement for Child Care Charges Form for all DES families CCA-

0208A (Exhibit 4);

5.15.1.4 Unpaid Co-Payment Worksheet Form CCA-1021A (Exhibit 7);

5.15.1.5 Original Sign-In/Sign-Out Attendance Records or ADES approved computerized attendance tracking system Records;

5.15.1.6 All Electronically Signed Records in accordance with A.R.S. § 44-7012;

5.15.1.7 Acknowledgment Form (CCA-1272A);

5.15.1.8 Service Consent Form (CCA-1271A);

5.15.1.9 Preschool Suspension and Expulsion Prevention Support for Families (CCA-1275A);

5.15.1.10 Action Plan (CCA-1276A);

5.15.1.11 About Me Questionnaire (CCA-1200A);

5.15.1.12 Sample Child Care Provider Expulsion Prevention Policy (CCA-1277A);

https://des.az.gov/services/child-and-family/child-care

5.15.1.13 Any additional forms or documentation required by ADES.

5.15.2 The Provider shall establish and maintain a records file for all administrative forms relating to this agreement including, but not limited to:

5.15.2.1 A signed copy of this Agreement and all Amendments;

5.15.2.2 All claim and billing records;

5.15.2.3 Any additional forms or documentation required by ADES.

5.15.3 All ADES required or alternative approved records for the six (6) most recent months shall be retained on site and immediately available for viewing.

5.15.4 All records or alternative approved records older than six (6) months may be stored off site; however, they shall be made available within five (5) business days upon request by ADES.

5.15.5 If records are lost, damaged, or stolen the Provider shall notify the CCA Compliance Specialist, via electronic mail (e-mail), within 24 hours. ADES has the right to request any supporting documentation of the lost or damaged records which may include damage reports, police reports, and insurance claims.

5.15.6 Pursuant to A.R.S. § 35-214 and § 35-215, the Provider shall retain all records and supporting documentation relating to the acquisition and performance of the Agreement for a period of (5) five years after termination of this Agreement.

5.16 Record Keeping Requirements

The Provider shall educate clients on the importance of sign in and out procedures for proper payment reimbursement and child safety within the attendance method chosen. Refer to Notice to All Families Enrolled at DES Child Care Facility CCA-1216A (Exhibit 8)

5.16.1 Sign-In/Sign-Out Record format

5.16.1.1 For all enrolled children, the Provider shall use one of the following:

A. Sign-In/Sign-Out Record Form CC-0218A (Exhibit 9) provided by ADES; or, B. With ADES prior written approval, the Provider may design an alternative method of attendance record that can be reviewed and approved by the Department. An alternative record shall be legible when copied and measure 8-1/2” x 11”. The effective date of the approved alternative method of attendance will be the first day of the following month when the change is approved by ADES; or,

1. With ADES prior written approval, the Provider may use an alternative electronic attendance record that can be reviewed and approved by the Department such as a computerized attendance tracking system, biometric, digital fingerprint recognition, or facial recognition system.

2. Records maintained in an approved alternative format shall be signed and dated electronically or in ink on a monthly basis by the Client, or an individual identified on the Emergency Card.

C. If the computerized tracking system has the capability for electronic signature that acknowledges both the Client and Provider Penalty Warning Statements in section 5.16.3, ADES will accept the electronic signature.

D. If a system issue is identified the provider needs to contact ADES and provide written notice to CCAContracts@azdes.gov. The Provider is required to use the (CC-0218A) during the specified system issue.

5.16.1.2 Time clocks, time cards, and child rosters shall not be permitted as an alternative method.

5.16.1.3 Providers shall not make changes or edit sign in and out record time entries.

5.16.1.4 Paid Absence(s) shall be identified on the record by adding the Paid Absence Date(s) and indicate if the Paid Absence(s) claim is a “D” or “L” Unit of Care.

A. If the Provider is using an electronic alternative method of attendance tracking then the

Provider is allowed to add electronic notes to the file to include: Paid Absence Date(s) and indicate if the Paid Absence(s) claim is a “D” or “L” unit.

5.16.2 A staff member may sign a child in or out of a facility only when accepting or releasing a child transported to or from school

5.16.3 All daily attendance verification records shall include the following statements:

5.16.3.1…