Arnette Cowan, MS, RD, LDN
Head, Special Nutrition Programs Unit

This memo is to inform you of the process for submitting the Add, Drop, Transfer form (CAC 20). Recently, there has been some confusion concerning adding providers. PLEASE READ THE FOLLOWING INFORMATION CAREFULLY.

1. Previously, a transfer form was not needed in order to add a provider to your sponsorship during the month of October. We have found that several providers signed up under two different sponsors. This has caused delay in processing the agreements because our system will not allow us to add the same provider under two different sponsors. Therefore, if a provider is transferring to your sponsorship, even in the month of October, we ask that you submit a transfer form at that time. This will also inform the previous sponsor that the provider is transferring and the previous sponsor should not submit the paperwork for the provider with their agreement and will avoid the provider being paid by two different sponsors.
   
2. All requests for additions, deletions and changes to your active participating day care home providers must be accompanied by an Add, Drop, Change Form (DHHS-CAC20). There are three pages to this form and you do not have to use all pages, however, you MUST use Page One, which has a signature for Agency approval. A copy of the approved form will be returned to you once it has been processed and will serve as your verification that the changes contained on the form have taken place. PLEASE NOTE: IF A REQUEST FOR ADDITIONS, DELETIONS OR CHANGES IS MADE WITHOUT USING THE CAC20 FORM, THIS PAPERWORK WILL BE RETURNED TO YOU UNPROCESSED. YOU MUST SUBMIT THE CAC20 FORM FOR PROPER HANDLING OF YOUR REQUEST.
   
3. All COMPLETE request for additions, deletions and changes must be received by the 15^th of each month in order to be effective at the beginning of that month. Any requests received after the 15^th of the month will be effective the following month. If your request is submitted, incomplete, to the Raleigh office and is returned to you for correction, the CORRECT paperwork and all required attachments must be received by the 15^th of the month in order to be effective for that month regardless of when your original request was received. The reason for this is that the claims department must have time to update their records before processing claims for reimbursement at the beginning of each month. The claims department is unable to enter a large volume of late-month submissions at this very busy time. PLEASE BE SURE THAT YOUR REQUEST IS COMPLETE AND ALL ATTACHMENTS ARE INCLUDED BEFORE SENDING ANY PAPERWORK TO OUR OFFICES TO AVOID ANY DELAYS IN PROCESSING.
   
4. A complete request for addition of a home provider includes: A completed CAC20 Form, the Facility Agreement (with all sections filled out completely), a facility license, and a transfer form if the provider is transferring from another sponsoring organization. If you are adding a provider who is transferring from another sponsoring organization, you must provide documentation that they have terminated with the other sponsoring organization and will have completed the 30 day waiting period for transfers on the date of requested approval. We advise you to inform the providers that they can only transfer once during the fiscal year. If a provider has been approved with at sponsoring organization at the time of renewal but decides to transfer to another sponsoring organization in the month of October, this transfer will constitute the one time transfer for that provider. The "Dropping" sponsor must sign the transfer form. Please staple or paper clip the papers together. It is very easy for them to get lost.
   
5. WE CAN NOT ACCEPT PIECEMEAL SUBMISSIONS, I.E. PART OF THE REQUEST PACKAGE WITH THE OTHER PARTS TO FOLLOW UNDER SEPARATE COVER. IT IS EASY FOR THE PAPERWORK TO GET LOST IF IT IS NOT SUBMMITTED TOGETHER. ALL PAPERWORK MUST BE SUBMITTED AT ONE TIME OR IT WILL BE RETURED TO YOUR OFFICES, UNPROCESSED. IF YOUR PAPERWORK IS RETURNED TO YOU BECAUSE IT IS NOT COMPLETE, PLEASE RESUBMIT THE INFORMATION USING A NEW CAC-20 (DROP/ADD/TRANSFER FORM).
   
6. A complete request for deletions includes: A completed CAC20 Form and a Provider Transfer Form or comparable letter of termination from the provider.
   
7. A complete request for change of information (e.g. change in meal service, address, tiering, etc.) includes: A completed CAC20 Form and a copy of the Provider's Agreement (Form CAC 8b) with the new information highlighted so that we know what information is being changed. Also, this amended application should be dated and initialed by the sponsoring organizations representative.

   ALL OF THESE REQUESTS CAN BE PLACED ON THE SAME CAC20 FORM, YOU DO NOT HAVE TO USE A SEPARATE FORM FOR EACH TYPE OF REQUEST

8. IF YOU NEED ADDITIONAL FORMS, PLEASE CONTACT THE RALEIGH OFFICE.
   
9. A complete request for addition of a center includes: A fully completed Facility/Center Application (CAC 7) - be certain Enrollment Data is complete, a copy of the current license, and an Agreement Between Sponsoring Organization and Facility (CAC 8C). When submitting a For-Profit Center (401), you must also include the Certification of Eligibility for Title XX (CAC 1C) and the DSS turnaround sheet for the month prior to the month you are requesting approval. If submitting for a non profit center, a tax exempt letter or Articles of Incorporation (for churches) must be included.
   
10. The Raleigh office cannot accept fax copies of requests for additions of day care homes/centers. Because of the large volume of requests, and the poor quality of fax copies (they are often too dark, smudged or otherwise illegible and must be verified by hard copy), we will no longer accept requests via fax. Please send all submissions by mail and be certain that they reach our offices by the 15^th of the month in which you would like the provider to be added. No fax copies of information will be accepted unless specific information has been requested by our office and the use of a fax transmission has been requested by our staff.

Enclosed are updated copies of the CAC 20 and CAC 21. Please use these forms when submitting your changes.

We appreciate your cooperation in our effort to increase efficiency in our office. Many of these guidelines were already part of our program, but were not strictly enforced. Because of the volume of paperwork received, we must now ask that all sponsoring organizations adhere to these guidelines.

If you have any questions regarding this memo, please contact me at (919) 715-1926.

cc: Alice Lenihan
SNP Consultants