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.
- 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.
- 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.
- All COMPLETE request for additions, deletions and changes must be received by the 15th of each month in order to be effective at the beginning of that month. Any requests
received after the 15th 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 15th 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.
- 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.
- 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).
- A complete request for deletions includes: A completed CAC20 Form and a
Provider Transfer Form or comparable letter of termination from the provider.
- 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
- IF YOU NEED ADDITIONAL FORMS, PLEASE CONTACT THE RALEIGH OFFICE.
- 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.
- 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 15th 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