Department of Education
M a r c h 2 4 ,
1997
SUBJECT:
Provider Letter and Application for Tier 1 Reimbursement CACFPDCH - 7 Sponsoring Organizations of Day Care Homes Sandra Kangas, Director Child and Adult Nutrition Services
TO: FROM:
Enclosed is the prototype Provider Letter and Application for Tier 1 Reimbursement to be used to determine provider eligibility for Tier 1 rates. This application can be used beginning April 1, 1997. If your agency wishes to make any additions to the letter or application, they must be submitted to Child and Adult Nutrition Services for approval prior to distribution. Please note that there is a separate instruction page for the Multi-Agency Intake Form that must replace the instruction page (page 3 of the provider letter) for the Provider Application to Tier 1 Reimbursement. All of the other pages of the provider letter remain the same. The following procedures apply to the Provider Letter and Application for Tier 1 Reimbursement: The provider letter must be distributed with the application for Tier 1 Reimbursement. The provider letter includes the income eligibility guidelines effective July 1, 1996-June 30, 1997. These are the guidelines that will be used to determine provider eligibility for Tier 1 rates at this time. An updated provider letter with the 1997-98 income guidelines that will need to be used with all applications distributed after July 1, 1997. The updated prototype letter will be provided later. All provider applications completed between April 1-June 30, 1997 will have an effective date of July 1, 1997. These applications will be valid until June 30, 1998. Applications completed after July 1, 1997, will be effective the date they are approved by the sponsoring organization. These applications will expire 1 year from the date of the provider or parent signature.
Child and Adult Nutrition Services 700 Governors Drive, Pierre, SD 57501-2291 Office - (605) 773-3413 FAX - (605) 773-6846
Applications for Tier 1 rates for all children can be approved by the sponsoring organization only after the supporting documents are verified for all income or case numbers listed Applications for Tier 1 rates for the provider’s children only are not required to be verified.
Also enclosed is a page listing the types of documents to be submitted for verification of income or case numbers. You may wish to include this page with the provider letter and application to clarify what must be attached to the application. Only those providers wishing to be determined eligible for Tier 1 rates for all children, based on their own household income, are required to attach documentation for verification.