OAR 414-175-0076: High Needs Child Care Payments

(1) The supplemental high needs payment is allowable if the child is eligible for the special needs rate outlined in OAR 414-175-0075(1)(e) and the requirements of the following subsections are met: (a) The child requires significantly more direct intervention by the child care provider than typical for a child of the same age as determined by the Department through an assessment with the family and child care provider input and review of submitted documentation. (b) The child is enrolled in an Early Intervention or Early Childhood Special Education program or school-age Special Education Program with a written plan that supports the child’s need for increased intervention and supervision while in care or is receiving additional supportive services as private therapies or behavioral or mental health services.There must be a written plan, treatment plan, or ongoing proof of services dated within the last 12 months. If an updated plan is not available due to program delays, the caretaker must provide documentation that an updated plan is delayed. (c) Eligibility for the supplemental high needs payment must be reviewed by the Department at least once every 12 months from the date of the prior determination. (2) The supplemental high needs payment is intended to cover the cost of additional care and intervention required due to a child's physical, mental or behavioral condition. To determine the supplemental high needs payment, a factor ranging from 0 to 2, determined by this rule is multiplied by: (a) $5.00 for a payment calculated on an hourly basis; or (b) $840 for a payment calculated on a monthly basis. (3) The factor used to make the calculation described in section (2) of this rule is determined by first establishing a score for each category listed in section (5) of this rule. The score is established by multiplying a rating and the weight for each category. The weight is given in section (5). The rating is determined as follows: (a) The child’s need for care and supervision is assessed and is compared with the needs of other children of the same age, and a rating is determined for each category. The rating is a whole number from zero to ten. (b) Benchmark scores are given in section (5) of this rule for each category using several descriptions of need. The child’s level is matched with the benchmark descriptions, and a rating is assigned based on a comparison of the child’s needs and the benchmark descriptions. If a child’s level of need falls between — or is described in part by — two benchmarks in the rule, an appropriate intermediate rating is assigned based on the benchmarks scores. (4) After a score is determined for each category, the scores are added. The sum of the scores is changed to 100 if it is less than 110 and is reduced to 300 if it exceeds 300. The adjusted score is decreased by 100, and the remainder is divided by 100. The result is the factor used in section (2) of this rule. (5) The categories, their weights, and standards for their ratings are as follows: (a) Level of medical care — weight is 7: (A) Child requires on-site medical attention by a licensed medical or mental health professional and the child care provider must have specialized training related to the child’s medical or mental health needs — rating of 10. (B) The provider must have specialized training related to the child’s medical or mental health needs and consults frequently with a medical or mental health professional — rating of 8. (C) Child requires medical attention by an individual who has received some specialized training related to the child’s medical or mental health needs — rating of 4. (D) Child requires medical attention or monitoring by an individual who has received special instructions from the parent or a service provider related to the child’s medical or mental health needs — rating of 1. (E) Child’s needs can be met by staff with general knowledge — rating of zero. (b) Self-sufficiency with daily tasks — weight is 5: (A) Child requires total assistance with eating or toileting, such as requiring tube feedings or with special toileting needs, such as ostomy care — rating of 10. (B) Child requires considerable assistance in eating or toileting — rating of 5. (C) Child requires only minor assistance with eating or toileting — rating of 1. (D) Child can take care of daily tasks with very little assistance — rating of zero. (c) Mobility — weight is 5: (A) Child is unable to help with positioning or movement, needs frequent repositioning, and the child is difficult to move — rating of 10. (B) Child can help with transfers, pivoting and position — rating of 5. (C) Child is able to move independently with minor support — rating of 1. (D) Child’s mobility is similar to other children of the same age — rating of zero. (d) Communication skills — weight is 6: (A) Child is unable to communicate needs and wants, and is unable to use alternative communication methods — rating of 10. (B) Child relies entirely upon alternative methods such as sign language, picture boards, gestures, or facial expressions, to communicate the child’s needs or to understand requests made of the child — rating of 8. (C) Child has limited verbal skills. The child may require one-on-one communication to gain the child’s attention, simplify instructions, or to understand the child’s speech or gestures. Child may use alternative methods, mentioned in paragraph (B) of this sub-section, as a supplement to verbal skills — rating of 4. (D) Child’s communication skills are roughly similar to other children of the same age — rating of zero. (e) Need for monitoring and intervention — weight is 11: (A) The child must remain within the child care provider’s direct view at all times and needs frequent intervention to prevent harm to self or other children — rating of 10. (B) The child must remain within the provider’s direct view at all times but does not need frequent intervention — rating of 7. (C) Child has behaviors that frequently require adult intervention but are not a threat to the child’s or other children’s safety — rating of 4. (D) Child needs assistance to initiate, respond to, or engage in peer interactions that are safe, positive, and appropriate — rating of 2. (E) Child needs some assistance but generally does well if the assistance is provided — rating of zero. (f) Cognition and comprehension — weight is 7: (A) Child is unable to recognize danger, is unable to follow instructions without one-on-one assistance, and has difficulty processing basic sensory information about the environment. This does not include vision or hearing as the primary difficulty — rating of 10. (B) Child needs to be given one instruction at a time and may need reminders of what was asked in order to complete instruction — rating of 5. (C) Child is able to understand and solve problems with some special attention — rating of zero. (g) Other special considerations — weight is 5. There are other considerations relating to the level of supervision required for the child that are not included in the above categories. A rating is determined based on how much more supervision the child needs — because of the other consideration — than other children of the same age.