AGREEMENT NUMBER

CHILD CARE MAXIMUM RATES AVAILABLE ON WEBSITE: https://dssapp.dss.mo.gov/ccrate/

This document is an offer to contract with the State of Missouri as a Child Care Provider to offer services to authorized clients of the Department of
Social Services (Hereinafter referred to as the “Department”). This agreement, made by and between the Department and
hereinafter referred to as the “Provider”, shall be as follows:
Name as it appears on the child care license issued by the Missouri Department of Health and Senior Services, Section for Child Care Regulation (DHSS/SCCR).
1. This agreement shall become effective for services delivered beginning	(Begin date - Cannot be prior to Child Care License Begin Date)
and shall continue in force through June 30,	unless altered by a mutually accepted written amendment. In the case of a mutually
accepted written amendment, the effective dates specified in the said amendment shall control.
The Provider shall be contracted with the Department as the type of child care facility specified on the Provider’s child care license, which is: Child Care Center Family Child Care Home Group Child Care Home
2. The Provider shall be contracted for all services for which the facility is licensed. The maximum child care (state base) rate the Provider shall accept for this agreement and for which the Department will reimburse for each service is the rate stated on the above website according to the county location of the Provider’s child care business. If the Provider is willing to accept less than the child care maximum rates, the Provider shall complete the attached Pricing Page.
FACILITY INFORMATION: Please complete all fields below
Name of Facility Owner /Licensee	E-mail Address
Facility Address	City	State	Zip
Mailing Address (if different from above)	City	State	Zip
County	Departmental Vendor Number (DVN) as it appears on the child care license issued by MO DHSS/SCCR
Telephone Number	Number of Employees	Federal Tax ID or Social Security Number (Provide copy of proof with pre-printed tax identification name and number)
MINORITY BUSINESS ENTERPRISE (See Definition) YES NO	CHECK APPLICABLE BOX Privately Owned Government Owned	WOMEN BUSINESS ENTERPRISE (See Definition) YES NO
THE DEPARTMENT AND THE PROVIDER HEREBY EXECUTE THE AGREEMENT IN ITS ENTIRETY. The undersigned hereby agrees to provide the services and/or items, at the prices stated, pursuant to the requirements of this document and further agrees that when this document is countersigned by an authorized official of the Missouri Department of Social Services, a binding agreement shall exist between the Provider and the Department of Social Services. The authorized signer of this document certifies that the Provider (named below) and each of its principals (as defined by 45 CFR 76) are not presently debarred, suspended, proposed for debarment, declared ineligible, voluntarily excluded from participation, or otherwise excluded from or ineligible for participation under federal programs. I certify that the information I have given is true and correct upon penalty of losing contracted status and payment from the Department, or legal action brought by the Department against me for fraudulent statements, records, or business practices.
In witness thereof, the parties below hereby execute this agreement.
Authorized Representative of Provider Facility Owner/Licensee ►	DATE
Authorized Signature of the Department ►	DATE

Return completed agreement to the address shown on the CM-5 Provider Agreement Checklist, which can be found at http://dss.mo.gov/cd/info/forms/. A copy of the agreement will be returned to the Provider after it has been signed by the Department Director or a Designee.

DEFINITIONS:
Services purchased under the terms of this Provider Agreement shall be defined as follows: “Child Care” includes the care, supervision, and guidance of a child for compensation for periods of less than twenty-four (24) hours but more than one-half (1/2) hour per day in a licensed facility. “Full Time Care” shall be any combination of hours of care equaling at least five (5) hours and up to ten (10) hours in the calendar day. “Half Time Care” shall be any combination of hours of care equaling at least three (3) hours and up to five (5) hours in the calendar day. “Part Time Care” shall be any combination of hours of care equaling at least one-half (1/2) hour and up to three (3) hours in the calendar day. “Infant” includes any child under the age of two (2) years. “Pre-school” includes any child at least two (2) but less than five (5) years of age. “School Age” includes any child five (5) years of age or older. “Child Welfare Services”, formerly referred to as “Protective Services”, shall mean any child, regardless of age, who is authorized child care by the Department as part of a plan for the treatment of child abuse or neglect. Services to these families and children are administered by the Missouri Department of Social Services, Children’s Division. Child Welfare Services includes, but is not limited to Adoptive Services, Alternative Care (Foster Care), Family Centered Services, Legal Guardianship, and Intensive In-Home Services. “Income Eligible” families includes any child who is authorized child care by the Department as a plan to assist low income families administered by the Family Support Division. “Sliding Fee” is the Income Eligible family’s portion of their child care bill, which must be collected by the Provider as part of the Provider’s Department payment. “Co-payment” means the difference between the Provider rate and the child care maximum rate when the Provider’s rate for care is higher than the child care maximum rate. “Daytime Care” begins at 6:00 a.m. and ends at 7:00 p.m. Monday through Friday. ”Evening Care” begins or ends within the designated time frame of 7:01 p.m. to 5:59 a.m. regardless of the day of the week. “Weekend Care” begins or ends within the designated times of Saturday morning at 6:00 a.m. to Sunday evening at 7:00 p.m. Eligibility for evening/weekend Department child care rates are only valid when your facility is licensed to operate within the evening/weekend time designations as specified herein. Minority Business Enterprise/Women Business Enterprise (MBE/WBE) MBE or WBE means a business that is a sole proprietorship, partnership, joint venture, or corporation in which at least fifty-one percent (51%) of the ownership interest is held by minorities or women and the management and daily business operations of which are controlled by one or more minorities or women who own it. Minority is defined as belonging to one of the following racial minority groups: African Americans, Native Americans, Hispanic Americans, Asian Americans, American Indians, Eskimos, Aleuts, and other groups that may be recognized by the Office of Advocacy, United States Small Business Administration, Washington, D.C. In order to be considered a qualified MBE or WBE for purposes of this agreement, the MBE/WBE must be certified by the State of Missouri, Office of Administration, Office of Equal Opportunity (OEO). The Office of Equal Opportunity (OEO) may be contacted at: Office of Administration, Office of Equal, Opportunity (OEO), Harry S Truman Bldg., Room 630, P.O. Box 809, Jefferson City, MO 65102-0809, Phone: (877) 259-2963 or (573) 751-8130, Fax: (573) 522-8078, Web site: http://oa.mo.gov/oeo/.
GENERAL CONTRACTUAL REQUIREMENTS:
The Provider shall perform services under this agreement for the Department on an “as needed, if needed” basis and the Department does not guarantee any amount of business to the Provider on this agreement.
The Provider shall perform services at the prices stated herein for the entire agreement period.
The Provider shall notify the Department in writing at least thirty (30) days in advance of any changes in the program that will affect the quality, extent, timelines, or frequency of services delivered under the terms of this agreement and further agrees that no such changes shall be implemented without the prior written consent of the Department. The Department shall not be required to make payment for services rendered according to such changes unless the Department has agreed to said changes in writing prior to their delivery. In the event the Provider is no longer able to provide child care services, the Provider shall refer families to Child Care Aware® of Missouri to find alternative child care arrangements. Child Care Aware® of Missouri may be contacted online at www.mo.childcareaware.org or by calling 1-866-892-3228.
The Provider shall maintain an active mailing address for receipt of notices and correspondence required by this agreement and shall notify the Department in writing of any mailing address changes within thirty (30) days.
The Provider shall accept the child care maximum rates for payment in full for families receiving Child Welfare Services, as defined herein. The child care maximum provider rates are inclusive of all child care services, therefore, the Provider shall not collect any additional funds from Child Welfare Services (i.e., Children’s Division) families or children. The Provider shall not invoice the Department for services which include enrollment, activity, late fees, or any other fees not associated with the direct care of the child. Any additional funds include co-payments, enrollment fees, field trip fees, activity fees, transportation, etc. The Department has the authority to make payment of child care services for Child Welfare children based on current rates and payment policies.
Income Eligible families are responsible for making their own co-payment to the Provider, when the Provider’s rate for care is higher than the child care maximum rate. The co-payment is not the sliding fee. The Department cannot take action on an Income Eligible family which does not pay their co-payment.
If the Provider charges less than the child care maximum rates charged to other non Department clients, the Provider shall not collect additional funds from the Income Eligible family.
The Provider shall accept the child care maximum rates for payment in full for Income Eligible families, unless it is allowed by the Department for the Provider to accept a sliding fee. The Provider shall accept a sliding fee from clients authorized for child care by the Department who are required by the Department to pay such a sliding fee. The Provider further agrees that the amount payable by the Department per unit of service for those non-Child Welfare Services clients shall be the contracted unit price less the aforementioned client fee. The Income Eligible family must pay their portion of the sliding fee.
If the Provider meets eligibility requirements established and approved by the Department, the Department reserves the right to make payments to the Provider in excess of the child care maximum rates, in the following instances; To pay the Provider an additional child –specific payment for a child with special needs as approved by the Department; or To pay the provider an additional amount per unit to a facility accredited by a state or national accrediting body, acceptable and approved by the Department. The Department may implement and discontinue such additional amounts at its sole discretion and without further modification to the agreement.
The Provider shall maintain a valid license through DHSS/SCCR throughout the entire agreement period. The Provider shall notify the Department if their license is suspended/revoked for any reason during the agreement period. The Provider shall comply with all licensing rules as established by DHSS/SCCR. In the event the Provider’s license is suspended/revoked, the Department reserves the right to terminate the Provider’s agreement, regardless of the appeal of the DHSS/SCCR decision.
PROVIDER CERTIFICATION OF PAGE 2 Provider Initials_______________

The Provider shall complete the on-line Child Care Subsidy Orientation Training at https://dssapp3.dss.mo.gov/CCSOrientation/. The training must be completed either by the Owner or Director. The Provider shall attend other training(s) as directed by the Department.
The Provider shall not be authorized or paid for the provision of services to their own children. This includes an owner of a child care facility which the owner’s children attend, no matter who is responsible for the direct care of the children.
Pursuant to licensing requirements, the Provider shall accept and care for no more children unrelated to the Provider than the number specified in the license. Notwithstanding the previous sentence, incorporated Providers shall not, for any dates of service, charge, invoice, or collect from the Department for the care of any number of children, including children both related and unrelated to the Provider, which is in excess of the number specified in its licensed capacity.
Human Rights Requirements: The Provider shall comply with all federal and state statutes, regulations and executive orders relating to nondiscrimination and equal employment opportunity to the extent applicable to the agreement. These include, but are not limited to:
Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color, or national origin (this includes individuals with limited English proficiency) in programs and activities receiving federal financial assistance and Title VII of the Act which prohibits discrimination on the basis of race, color, national origin, sex, or religion in all employment activities; Equal Pay Act of 1963 (P.L. 88 -38, as amended, 29 U.S.C. § 206 (d)); Title IX of the Education Amendments of 1972, as amended (20 U.S.C §§ 1681-1683 and 1685-1686) which prohibits discrimination on the basis of sex; Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. § 794) and the Americans with Disabilities Act of 1990 (42 U.S.C. § 12101 et seq.) which prohibit discrimination on the basis of disabilities; The Age Discrimination Act of 1975, as amended (42 U.S.C. § 6101-6107) which prohibits discrimination on the basis of age; Equal Employment Opportunity - E.O. 11246, "Equal Employment Opportunity", as amended by E.O. 11375, "Amending Executive Order 11246 Relating to Equal Employment Opportunity"; The Pro-Children Act of 1994 (PL 103-227) regarding environmental tobacco smoke; Missouri State Regulation, 19 CSR 10-2.010, Civil Rights Requirements; Missouri Governor's E.O. #94-03 (excluding article II due to its repeal); Missouri Governor's E.O. #05-30; and The requirements of any other nondiscrimination federal and state statutes, regulations and executive orders which may apply to the services provided under the agreement.
The Department shall have the right to enforce all applicable clauses by appropriate procedures, including but not limited to, requests, reports, site visits and inspection of relevant documentation of the Provider.
Federal Funds Requirement: This agreement may involve the use of federal funds. Therefore, for any federal funds used, the following paragraphs shall apply:
The Provider shall comply with the requirements of the Single Audit Act Amendments of 1996 (P.L.104-156) and Circular A-133, including subsequent amendments or revisions, as applicable or 2 CFR 215.26 as it relates to for-profit hospitals and commercial organizations. A copy of any audit report shall be sent to the Department each year, if applicable. The Provider shall return to the Department any funds disallowed in an audit of the agreement. If the Provider is a sub-recipient as defined in OMB Circular A-l33, Section 210, the Provider shall comply with all applicable implementing regulations, and all other laws, regulations and policies authorizing or governing the use of any federal funds paid to the Provider through the agreement.
Office of Management and Budget (OMB): In performing its responsibilities under the agreement, the Provider shall fully comply with the following OMB administrative requirements and cost principles, as applicable, including any subsequent amendments, applicable implementing regulations, and all other laws, regulations, and policies authorizing or governing the use of any federal funds paid to the Provider through the agreement:
Uniform Administrative Requirements - A - 102 - State/Local Governments; 2 CFR 215 - Hospitals, Colleges and Universities, For-Profit Organizations (if specifically included in federal agency implementation), and Not-For-Profit Organizations. Cost Principles - A-87 - State/Local Governments; A-122 - Not-For-Profit Organizations; A-21 - Colleges and Universities; 48 CFR 31.2 - For- Profit Organizations; 45 CFR 74 Appendix E Hospitals.
The Provider, all its employees, and volunteers shall maintain the confidentiality of all information pertaining to the children and families receiving services under this agreement according to Section 208.120 RSMo. Certain family and child information may be released to specified parties as outlined in Section 210.150 RSMo; however, the Provider shall not disclose of said information without the expressed written consent of the Department.
The Provider shall maintain adequate, legible, genuine, current, and complete records of services rendered under the terms of this agreement. The Provider shall make all such records available to the Department or its designated representatives for a period of five (5) calendar years following the expiration date of this agreement.
Adequate verification and full documentation shall mean that the Provider’s records are such that:
an orderly examination by a reasonable person is possible and can be conducted without the use of information extrinsic to the records and that such an examination can readily determine that the Provider’s services were, in fact, provided; each service is verified by contemporaneous certification by the recipient of each service, to include when the service was provided, the extent of each service, all amounts received in payment by Provider, to whom the service was provided, the extent or duration of services, and the authorization thereof.
The required records, at a minimum, shall consist of but are not limited to the categories and/or documents set forth below in subparagraphs 1 – 3 of this paragraph. The Provider shall utilize the Child Care On-line Invoicing System (CCOIS), as required in the Invoicing and Payment Section, contained herein. This provision does not relieve the Provider of retaining complete records.
A document that certifies attendance for each day a claim is made under this agreement. The CS-109 form may be used as the certification document. At a minimum, the certification must contain the following information: The name of each child for whom reimbursement is requested. The date(s) the child was in attendance and the time of arrival and departure (the child’s parent or adult designee must initial each day at departure). The original signature of the parent or adult designee certifying the attendance of the child. The designee may not be an employee or operator of the child care facility. Invoices submitted to the Department for payment. State of Missouri Treasurer’s Check Attachment or Remittance Advice that lists children for whom the payment is made and the amount of payment.
PROVIDER CERTIFICATION OF PAGE 3 Provider Initials_______________

Provider Liability: The Provider shall be solely responsible for any and all personal injury, including death, or property damage as a result of the Provider’s actions, or inactions, including but not limited to, misconduct, negligence, or any future negligent act, involving any equipment or service provided under the terms and conditions, requirements and specifications of the agreement.
In addition to the liability imposed upon the Provider on account of personal injury, bodily injury (including death), or property damage suffered as a result of the Provider’s negligence, the Provider shall pay, indemnify, save and hold harmless the State of Missouri, including its agencies, employees, and assigns, from every expense, liability, or payment arising out of such misconduct or negligent act. The Provider shall hold the State of Missouri, including its agencies, employees, and assignees, harmless for any negligent or intentional act or omission committed by any subcontractor or other person employed by or under the supervision of the Provider under the terms of the agreement. The Provider shall acquire and maintain adequate liability insurance in the form(s) and amount(s) sufficient to protect the State of Missouri, its agencies, its clients, its employees and the general public against any loss, damage and/or expense related to his/her performance under the agreement. The Provider shall, at the request of the Department, provide proof of such insurance.
The Provider shall report to the Child Abuse/Neglect Hotline (1-800-392-3738) any instances of child abuse or neglect pursuant to state law (Section 210.115 RSMo).
The Provider shall follow applicable state statute, code of state regulations, and policy and procedures established by the Department for the purchase of child care.
The Provider shall have a system through which recipients of services may present grievances concerning the operation of their facility.
The Provider shall comply with all local, state and federal laws and regulations related to the performance of the agreement, including compliance with local, municipal, and county or city business ordinances and regulations.
The Department has the right to recover any overpayments found during the course of an audit or other review by recoupment, repayment, or any other collection method allowed by law or Department policy.
The Department has the authority to impose monetary or other sanctions in cases of non-fraudulent, fraudulent, repeated contract or payment violations.
INVOICING AND PAYMENT:
The Department has the authority to stop payments if there are questionable billing practices, until the question can be resolved.
The Department shall have the right to recover from the Provider all funds for which adequate verification and full documentation of expenditures are not maintained (i.e. inadequate or lack of attendance records).
The Provider is required to acquire and maintain an active direct deposit account for child care payments made by the Department.
The Provider shall be paid the child care maximum rate(s) by the Department for services provided under this agreement unless the Provider offered lower rate(s).
The Provider shall, within thirty (30) days following the last day of each calendar month, invoice the Department, on forms or by other methods approved by the Department for services rendered to authorized clients, by the Provider, during such month.
The Provider shall submit invoices as specified by the Department. Effective July 1, 2012, the Provider is required to submit invoices through the Child Care Online Invoicing System (CCOIS). To access CCOIS go to https://dssapp.dss.mo.gov/ccoip/wbFMB9LogonCCInv.asp. The Provider shall invoice and receive payment only for direct services authorized in writing by the Department. The Provider agrees that rates charged for state paid child care shall not exceed rates charged for private/parent paid care for Family Support Division clients.
Reimbursement shall be made for supplemental or corrected invoices only if such invoices are received by the Department within sixty (60) days of the end of the month in which services invoiced were provided, with the exception that all such invoices must be received within thirty (30) days after the expiration of the agreement or as otherwise approved by the Department. The Department is not required to make payment for services billed on invoices which are not timely submitted as required by this agreement.
The Department will within forty-five (45) days of receipt of the invoice, provided such invoice is submitted as outlined herein, initiate payment of such invoice. Such invoice shall be subject to audit and adjustment by the Department before and after such payment is made. Any overpayment made by the Department may be recovered by the Department.
34. Payment for absences and/or holidays is allowed only for units when the child would normally be in care. An absence is any day an authorized child is not in attendance when the facility is open for business and other children are receiving child care services. A holiday is any day the facility is closed for any reason during normal operating hours, and no children are in care. This includes standard holidays (New Year’s Day, Martin Luther King’s Birthday, Lincoln’s Birthday, Washington’s Birthday, Truman’s Birthday, Memorial Day, Independence Day, Labor Day, Veterans Day, Thanksgiving, and Christmas), local holidays, facility closing due to inclement weather or a Provider vacation. Payment may be made for the authorized units the child is not in attendance subject to the following limitations, as long as the child attended a minimum of one unit in the month: Children authorized to attend twenty (20) or more units per month may be paid a maximum of five (5) absence and/or holiday units per month. Units are paid at the full, half or part-time rate based on the child’s authorized level of care. Children authorized to attend two (2) to nineteen (19) units per month may be paid a maximum of three (3) absence and/or holiday units per month. Units are paid at the full, half or part-time based on the child’s authorized level of care. Payment will not be made if the child did not attend at least one (1) unit of care in the month. In no event will the Department reimburse Providers for more than eleven (11) holidays, during a fiscal year. Payment shall be made for a combination of holidays and absences per month according to the limitations stated above. The Department does not guarantee payment of absences and/or holidays. Payment shall not be made for child absences and/or holidays after the child has left the Provider’s care or if the child has not been in attendance for the entire month. Payment shall not be made for child absences and/or holidays if the child is not scheduled for attendance or was absent the entire month. The Provider shall not claim absences in lieu of holidays if all eleven (11) holidays have been exhausted within the fiscal year.
The Provider shall submit payment issues and/or discrepancies through the Provider Payment Resolution process within sixty (60) days of verified service month by completing a Resolution Request Form (http://dss.mo.gov/cd/info/forms/) and submitting it to the Department.
PROVIDER CERTIFICATION OF PAGE 4 Provider Initials_______________

TERMINATION AND RENEWAL :
This agreement shall not bind, nor purport to bind, the Department for any commitment in excess of the original agreement period. Funding for the agreement must be appropriated by the Missouri General Assembly for each fiscal year included within the agreement period. Therefore, the agreement shall not be binding upon the Department for any period in which funds have not been appropriated, and the Department shall not be liable for any damages or costs, including attorney's fees, associated with termination caused by lack of appropriations.
The Department reserves the right to terminate the agreement, without penalty or termination costs, if such funds are not appropriated or available. In the event funds are not appropriated or available for the agreement, the Provider shall not prohibit or limit the Department's right to pursue alternate contracts, as necessary, to conduct state governmental affairs. The provisions of the above paragraphs shall apply to any amendment or the execution of any option to extend the agreement.
Any change, whether by modification and/or supplementation, shall be accomplished by a formal, written agreement amendment. Oral agreements or agreements confirmed by e-mail or otherwise to modify the agreement shall not be enforceable.
The Department shall have the right, at its sole option, to renew the agreement by written notice to the Provider. In the event the Department exercises its renewal option, all terms, conditions and provisions of the original agreement and any subsequent amendments shall remain in effect and shall apply during the renewal period.
The agreement may be terminated by either party, with or without cause, by giving thirty (30) days advance written notice to the other party at its principal address. The termination shall be effective thirty (30) days from the date of notice or the date specified in the notice. The Department reserves the right to withdraw any or all of its clients before the end of the thirty (30) day period, if applicable.
PROVIDER CERTIFICATION OF PAGE 5 Provider Initials__________

PRICING PAGE

If the Provider is willing to accept less than the child care maximum rate(s) as outlined at https://dssapp.dss.mo.gov/ccrate/, the Provider must complete this Pricing Page. If the Provider agrees to accept a rate less than the child care maximum rate(s), the Provider must enter the lower firm fixed rate that the Provider is willing to accept in the table below for all age groups and time periods that apply to the licensed child care facility and return this Pricing Page with the Provider Agreement to the Department.

The Provider is not required to complete this Pricing Page if the Provider does not wish to accept less than the child care maximum rate(s).

Infant – Under Age 2	CODES	DAYTIME Mon-Fri 6:00 a.m. to 7:00 p.m.	CODES	EVENING Mon-Fri 7:01 p.m. to 5:59 a.m.	WEEKEND Sat 6:00 a.m. to Sun 7:00 p.m.
Full Time - 5 to 10 Hours	INF	IEF
Half Time - At Least 3 and up to 5 Hours	INH	IEH
Part Time - At Least 1/2 and up to 3 Hours	INP	IEP
Preschool – At Least Age 2 but Less Than 5	CODES	DAYTIME Mon-Fri 6:00 a.m. to 7:00 p.m.	CODES	EVENING Mon-Fri 7:01 p.m. to 5:59 a.m.	WEEKEND Sat 6:00 a.m. to Sun 7:00 p.m.
Full Time - 5 to 10 Hours	PSF	PEF
Half Time - At Least 3 and up to 5 Hours	PSH	PEH
Part Time - At Least 1/2 and up to 3 Hours	PSP	PEP
School Age – Age 5 Years and Older	CODES	DAYTIME Mon-Fri 6:00 a.m. to 7:00 p.m.	CODES	EVENING Mon-Fri 7:01 p.m. to 5:59 a.m.	WEEKEND Sat 6:00 a.m. to Sun 7:00 p.m.
Full Time - 5 to 10 Hours	SAF	SEF
Half Time - At Least 3 and up to 5 Hours	SAH	SEH
Part Time - At Least 1/2 and up to 3 Hours	SAP	SEP