Chapter 04. Rate Setting for Child Care Providers
Regulation .01 Scope.LinkCopy Citation
This chapter outlines the requirements for the determination of rates for the following services purchased by the departments for children:
A.
Residential services licensed by:
(1)
The Department of Human Services;
(2)
The Department of Juvenile Services;
(3)
The Maryland Department of Health; or
(4)
Any State department;
B.
Nonresidential services in programs approved or accredited by the Maryland State Department of Education, under COMAR 13A.09.10, or the Department of Juvenile Services; and
C.
Out-of-State services from providers licensed, accredited, certified, or approved by the providers' respective states and approved for placement by the departments described in Regulation .02B(9) of this chapter.
Regulation .02 Definitions.LinkCopy Citation
A.
In this chapter, the following terms have the meanings indicated.
B.
Terms Defined.
(1)
“Advisory Committee” means the Maryland Interagency Rates Advisory Committee which consists of parents, advocates, and providers appointed by the Children's Cabinet.
(2)
“Allowable variance” means less than or equal to plus one standard deviation from the mean as determined by the factors and methodology outlined in the Manual defined in §B(11) of this regulation.
(3)
“Child placement agency” means a private agency licensed by the Department of Human Services to receive and place children in foster homes, treatment foster homes, and independent living arrangements.
(4)
“Children's Cabinet” means those agencies listed under Executive Order 01.01.2024.05C.
(5)
“Class Guidelines” means the Class Determination Guidelines for Residential Child Care Programs, which are maintained and updated, as necessary, by the Committee.
(6)
“Committee” means the Maryland Interagency Rates Committee, consisting of an individual or individuals representing:
(a)
The Maryland Department of Health;
(b)
The Department of Human Services;
(c)
The Department of Juvenile Services;
(d)
The Department of Budget and Management;
(e)
The Maryland State Department of Education; and
(f)
The Governor’s Office for Children.
(7)
“Cost Guidelines” means the Cost Guidelines for Child Placement Agencies, Education Programs, and Non-Residential Programs, which are maintained and updated, as necessary, by the Committee.
(8)
“Days” means calendar days, unless otherwise specified.
(9)
“Departments” means the:
(a)
Maryland Department of Health;
(b)
Department of Human Services;
(c)
Department of Juvenile Services; and
(d)
Maryland State Department of Education.
(10)
“Educational program” means a program approved under COMAR 13A.09.10 as a nonpublic general education school to operate in conjunction with residential or nonresidential child care program licensed or approved by the Department of Health, Department of Human Services, or Department of Juvenile Services.
(11)
“Manual” means the Rate Setting Methodology Manual for Providers, which is maintained and updated, as necessary, by the Committee.
(12)
“Nonpreferred provider” means a provider whose rate or rates, when grouped by service type and, when appropriate, capacity, falls or fall outside an allowable variance.
(13)
“Nonresidential program” means a community nonresidential youth program that serves youth served by the Department of Juvenile Services and is not otherwise licensed or certified by the State.
(14)
“Preferred provider” means a provider whose rate or rates, when grouped by service type and, when appropriate, capacity, falls or fall within an allowable variance.
(15)
“Provider” means an entity licensed, approved, accredited, or certified to provide services to children and adolescents within:
(a)
Maryland under:
(i)
COMAR 07.05.01;
(ii)
COMAR 10.21.07;
(iii)
COMAR 16.06.01; or
(iv)
COMAR 14.31.05—14.31.07;
(b)
Maryland or another state under COMAR 13A.09.10; or
(c)
A state other than Maryland under the applicable laws of that state.
(16)
“Provider Instructions” means the Interagency Rates Committee Provider Instructions, which are maintained and updated, as necessary, by the Committee.
(17)
“Rate” means the daily reimbursement for services provided to children in residential child care programs and other specified programs.
(18)
“Rate Section” means the Rate Section at the Maryland State Department of Education.
(19)
Residential Child Care Program.
(a)
“Residential child care program” means an entity that provides for children 24-hours per day within a structured set of services and activities that are designed to achieve specific objectives relative to the needs of the children served and that include the provision of food, clothing, shelter, education, social services, health, mental health, recreation, or any combination of these services and activities.
(b)
“Residential child care program” includes a program:
(i)
Licensed by the Department of Health, the Department of Human Services, or the Department of Juvenile Services; and
(ii)
Subject to the requirements of the Governor’s Office of Children governing operations of residential child care programs.
(20)
“Unallowable costs” means those expenditures defined by applicable federal regulations and the Cost Guidelines as unreimbursable.
Regulation .03 Rate Setting Methodology.LinkCopy Citation
A.
The Committee shall develop and maintain a rate setting methodology for reimbursing specified providers.
B.
Cost-Based Methodology.
(1)
Child placement agencies, educational programs, and nonresidential programs shall receive a rate based on a cost-based methodology.
(2)
The cost-based methodology determines a rate based on an individual provider’s budget, including, but not limited to:
(a)
Management and general services;
(b)
Direct services;
(c)
Education services;
(d)
Medical services; and
(e)
Clinical services.
(3)
The rate determination shall be calculated using:
(a)
An individual program budget application;
(b)
A mean annual rate for a specified program category; and
(c)
A direct care cost comparison metric.
(4)
The cost-based methodology is contained in the Manual and the Cost Guidelines, which are published on the Maryland State Department of Education website.
C.
Class-Based Methodology.
(1)
Residential child care programs shall receive a rate based on a class-based methodology.
(2)
The class-based methodology determines a rate based on the level of services provided by the residential child care program.
(3)
The Committee shall determine the level of services the residential child care program must provide to meet the requirements of each class as defined by the Committee.
(4)
Each class is assigned a flat rate by the Committee.
(5)
The class-based methodology is contained in the Manual and the Class Guidelines, which are published on the Maryland State Department of Education website.
Regulation .04 Rates Determination Application.LinkCopy Citation
A.
Renewal Rate Application and Submission.
(1)
The Rate Section shall distribute the Provider Instructions and applications for determinations of renewal rates to in-State and out-of-State providers whose programs previously received an approved rate from the Committee by December 31 of each year.
(2)
Except as provided in §A(3) of this regulation, providers shall submit an application to the Rate Section for a renewal rate determination by February 15 of each year in accordance with this chapter.
(3)
For fiscal year 2025, residential child care programs shall submit an application to the Rate Section by July 31, 2024, for a class-based rate, consistent with the Provider Instructions and Regulation .03C of this chapter.
B.
New Rate Application and Submission.
(1)
On written request by a provider, the Rate Section shall distribute the Provider Instructions and applications for a rate determination for in-State and out-of-State providers whose programs have not previously received an approved rate from the Committee.
(2)
Providers shall submit to the Rate Section an application for a rate for new programs before anticipated licensure, certification, or approval.
C.
Out-of-State Providers.
(1)
An out-of-State provider that does not have a rate established in the state in which services are provided may submit an application in accordance with this regulation.
(2)
A provider that provides services in a licensed out-of-State facility which has a rate established by the authorized rate-setting body of the state in which the facility is located shall submit documentation to the Committee of the rates established by the authorized rate-setting body of their respective state, if applicable, instead of an application.
D.
Conformance with Manual, Cost and Class Guidelines, and Provider Instructions. Provider applications shall conform to the requirements set forth in the Manual, Cost and Class Guidelines, as appropriate, and the Provider Instructions.
Regulation .05 Rate Determination, Approval, and Notification.LinkCopy Citation
A.
Use of Guidelines.
(1)
Rates for child placement agencies, educational programs, and nonresidential programs shall be determined, excluding unallowable costs, consistent with the Cost Guidelines.
(2)
Rates for residential child care programs shall be determined consistent with the Class Guidelines.
B.
Review of Application. After review of a rate application, the Committee shall take one of the following actions:
(1)
Approve the rate requested in the application;
(2)
Return the application to the provider, requesting that additional information or changes to the application be resubmitted within 10 business days; or
(3)
Deny the rate requested in the application and issue a revised rate.
C.
Notification of Approved Renewal Rates.
(1)
Except as otherwise provided in §C(2) of this regulation, the Committee shall notify providers of their approved rates for applications timely submitted that meet the requirements of the Provider Instructions by June 15 of each year.
(2)
For fiscal year 2025, the Committee shall notify residential child care programs that submit a timely and complete application to the Rate Section, consistent with Regulation .04A(3) of this chapter, by September 15, 2024.
D.
Notification of Approved New Rates. The Committee shall review applications, submitted in conformance with the Provider Instructions, and make a rate determination for new programs within 60 days of receipt. Rate determinations are not final until issuance of a license or accreditation.
E.
Effective Dates for Rates.
(1)
Except as otherwise provided in §E(2) of this regulation, renewal rates shall be in effect at the start of the State fiscal year and remain in effect until the end of that State fiscal year.
(2)
For fiscal year 2025, rates approved by the Committee for residential child care programs consistent with §C(2) of this regulation shall be in effect October 1, 2024, and remain in effect until June 30, 2025.
(3)
Rates for new child placement agencies, educational programs, and nonresidentIal programs issued after March 31 of each State fiscal year shall remain in effect until June 30 of the following State fiscal year.
F.
Determination of Preferred Providers.
(1)
The Committee shall categorize child placement agencies according to service type and, when appropriate, capacity.
(2)
The Committee shall use the methodology in the Manual to determine approved rates within each category and determine preferred providers.
G.
The Committee shall publish, annually, a list of all providers and approved rates and shall issue quarterly supplements with changes and additions. Child placement agencies shall be designated as preferred or nonpreferred in the listings, in accordance with the Committee's determination.
H.
Conformance with Federal Laws. Rates shall be determined in conformance with relevant federal requirements, including Title IV-E of the Social Security Act.
I.
Cost Containment. The Committee may impose cost containment measures to bring the rate structure into conformity with the budget appropriations approved by the General Assembly, and nothing in the Manual, Cost and Class Guidelines, or Provider Instructions shall preclude the implementation of cost containment.
Regulation .06 Reconsideration of a Committee Determination.LinkCopy Citation
A.
A provider may request reconsideration of a Committee determination made under Regulation .05 of this chapter.
B.
The Rate Section shall act on behalf of the Committee to receive and process requests for reconsideration.
C.
A provider seeking reconsideration of a determination shall file a written request with the Rate Section. The request is to be filed within 30 days of the provider's receipt of notice of the Committee's determination.
D.
The Rate Section shall review each request for reconsideration to determine if it provides sufficient information to complete analysis of the request.
E.
Each request for reconsideration shall include detailed information regarding:
(1)
The relief requested; and
(2)
The basis for the relief.
F.
If a request for reconsideration does not include sufficient information for review, the Rate Section shall provide written notice to the provider listing all information required to complete the review.
G.
If the provider fails to provide the additional required information within 45 days of receipt of the Rate Section notice, the Rate Section shall void the provider's request for reconsideration.
H.
Review by the Committee. Within 30 days of receipt of a complete request for reconsideration from the provider, the Committee shall provide written notification to the provider of its decision to:
(1)
Grant the request.
(2)
Grant the request with modification; or
(3)
Deny the request.
I.
A reconsideration of a determination by the Committee under this chapter is not a contested case within the meaning of State Government Article, Title 10, Subtitle 2, Annotated Code of Maryland.
Regulation .07 Appeals.LinkCopy Citation
A.
Filing of an Appeal.
(1)
A provider may appeal to the Children's Cabinet the Committee's decision regarding a request for reconsideration made under Regulation .06 of this chapter.
(2)
The provider shall file a written appeal with the Rate Section within 30 days of the provider's receipt of the Committee's decision regarding the request for reconsideration.
(3)
The appeal shall set forth the specific objections to the Committee's decision regarding the request for reconsideration.
B.
Rate Section Requirements. Upon receipt of an appeal, the Rate Section shall:
(1)
Forward the appeal to the Children's Cabinet or its designee; and
(2)
Provide to the Children's Cabinet a copy of the record upon which the Committee's decision regarding the provider's request for reconsideration was based, including:
(a)
The provider's written request for a reconsideration; and
(b)
Any supporting documentation.
C.
Review by the Children's Cabinet. Within 30 days of receipt of an appeal from the provider, the Children's Cabinet or its designee shall:
(1)
Review the written appeal and the record provided by the Rate Section;
(2)
Request additional information, if needed, from the provider or the Rate Section; and
(3)
Issue a final, binding opinion upholding, modifying, or reversing the rate set by the Committee.
D.
An appeal to the Children's Cabinet is not a contested case within the meaning of State Government Article, Title 10, Subtitle 2, Annotated Code of Maryland.
Regulation .08 Modification of a Committee Determination.LinkCopy Citation
A.
Request for Modification. A provider may request a modification of a current Committee determination during the State fiscal year under the following conditions:
(1)
To address health and safety issues which arise after the annual rate process;
(2)
To address an emergency situation, such as fire or natural disaster;
(3)
To address corrective action issues requested by the licensing agency or by a placing agency in conjunction with the licensing agency; or
(4)
To address a program modification requested by a licensing or placing agency.
B.
The Rate Section shall act on behalf of the Committee to receive and process requests for modifications.
C.
A provider seeking modification of a determination shall file a written request with the Rate Section.
D.
The Rate Section shall review each request for modification to determine if it provides sufficient information to complete analysis of the request.
E.
Each request for modification shall include detailed information regarding:
(1)
The relief requested; and
(2)
The basis for the relief.
F.
If a request for modification does not include sufficient information for review, the Rate Section shall provide written notice to the provider listing all information required to complete the review.
G.
If the provider fails to provide the additional required information within 45 days of receipt of the Rate Section notice, the Rate Section shall void the provider's request for modification.
H.
Review by the Committee. Within 30 days of receipt of a complete request for modification from the provider, the Committee shall provide written notification to the provider of its decision to:
(1)
Grant the request;
(2)
Grant the request with modification; or
(3)
Deny the request.
I.
A modification of a determination by the Committee under this chapter, or an appeal to the Children's Cabinet, is not a contested case within the meaning of State Government Article, Title 10, Subtitle 2, Annotated Code of Maryland.
Regulation .09 Interagency Rates Committee Advisory Committee.LinkCopy Citation
A.
An Advisory Committee to the Interagency Rates Committee, composed of parents, advocates, and providers, shall be appointed by the Children's Cabinet. The Advisory Committee may recommend and review policies and procedures regarding rate setting and provide information regarding the impact of rates on children, facilities, providers, and the business community.
B.
The Advisory Committee shall meet periodically.
Regulation .10 Interagency Rates Advisory Committee.LinkCopy Citation
A.
An advisory committee to the Interagency Rates Committee composed of parents, advocates, and providers shall be appointed by the Children's Cabinet. The Advisory Committee shall recommend and review policies and procedures regarding rate setting and provide information regarding the impact of rates on children, facilities, providers, and the business community.
B.
The Advisory Committee shall meet periodically.
Chapter annotations
Authority: Education Article, §§2-206 and 8-417; Family Law Article, §§5-506, 5-507, and 5-509; Health-General Article,
§§2-102, 2-104, 2-105, 7-306.1, 10-516, 10-902, 10-1203, and 15-102.1; Human Services Article, §§2-209 and 9-231; Annotated Code of Maryland
§§2-102, 2-104, 2-105, 7-306.1, 10-516, 10-902, 10-1203, and 15-102.1; Human Services Article, §§2-209 and 9-231; Annotated Code of Maryland
History: Effective date: June 29, 1998 (25:13 Md. R. 992)
History: Chapter revised effective February 18, 2002 (29:3 Md. R. 216)
History: COMAR 01.04.05 revised and recodified to 14.31.04 as an emergency provision effective June 30, 2005 (32:15 Md. R. 1314); revised and recodified permanently effective November 24, 2005 (32:23 Md. R. 1828)
History: Chapter revised effective July 1, 2024 (51:10 Md. R. 528)