PM 06-16-05-b

  1. (Client) Requests child care.
  2. (Staff) Give the client a Child Care Application (Form 3455) for each provider for whom payment is requested, if it is not already in the record. A completed and signed Form 3455 must be received before a child care payment (prospective or based on verified costs) is approved. Also give the client Statement of Child Care Costs (Form 1897), unless a prospective payment is needed.
  3. (Staff) Record the client's request for child care and/or the child care copayment on the RSP (Form 4003).
  4. (Client & Provider) Completes and returns Form 3455 and/or Form 1897.
  5. (Staff) Receive Form 3455 and/or Form 1897 and determine if:
    • the child care is being provided in a legal care arrangement;
    • the amount of care to be provided is consistent with the agreed upon plan of participation; and
    • the client and provider have completed and signed the form.
    1. If Form 3455 is not returned within 30 days, send the Disposition of Child Care Request (Form 3185) to the client with a copy to the provider (if known) notifying them that DHS is unable to authorize payment because Form 3455 was not received.
    2. If Form 3455 is returned after 30 days, route the form to the appropriate CCR&R for disposition.
  6. (Staff) Determine the copayment amount, if applicable.
  7. (Staff) Complete Form 3185 from the information obtained on Form 3455 and/or Form 1897.

    NOTE: If payment to the provider is approved, indicate on the form the starting and ending dates of the period for which child care payments may be made (the duration of the plan), the copayment amount, and the maximum payment rate. 

  8. (Staff) Send the original Form 3185 to the client. Send a copy of Form 3185 to the child care provider(s). Forward Form 3455 and a copy of Form 3185 to the CCR&R. Keep copies of all forms in the case record.
  9. (Staff) Issue child care payment, minus the copayment, if applicable, redirected to the provider, after the care is provided and Form 1897 is returned, except in situations where not issuing a prospective payment will result in a loss of the child care arrangement. See WAG 06-16-06 for maximum payment rates.

    Prospective Payments 

  10. (Staff) Issue a prospective payment, minus the copayment, if applicable, redirected to the provider, when not issuing will result in the loss of a child care arrangement. Base the prospective payment on the Form 3455 and the client's statement of anticipated expenses, subject to the appropriate rates, maximums, and copayments (see WAG 06-16-06). Form 1897 is not required in this situation.