For example, in Maryland , to be eligible for the rate adjustment, there must be a signed and dated statement from a physician, licensed psychologist or licensed social worker that verifies the existence of a diagnosis of a mental or physical disability and provides a description of the condition. The disability must cause the child to be incapable of self care, as appropriate for the child's age. Further, the inability to provide self care must be significant enough to necessitate additional supervision or specialized care. These special needs must be documented by a physician or licensed or certified psychologist. Those paying differential reimbursement rates for children with special needs are doing so using a variety of mechanisms.
Some illustrative examples follow.
Historically, the state created a ratio of the market rates charged by providers serving typically developing children to the rates charged by providers serving children with special needs. Once the passage of ADA made such a survey no longer a useful instrument for gauging providers' costs, the State began to apply the 1.5 factor that had historically been used by subsidized programs under contract with the state. The documentation required to obtain the special needs rate varies by county. The first program, integration grants, is available to licensed, accredited centers. These grants are available to increase the capacity of the centers to serve children with disabilities, and cover items such as training, hiring additional staff, consultation and so forth.