DCC-94 – Child Care Service Agreement and Certificate

When child care enrollment is added to an approved CCAP case, a DCC-94 Child Care Service Agreement and Certificate will be sent to the parent and the provider through the provider portal (if the parent granted Provider Portal access during the interview process). The DCC-94 shows the child’s pending enrollment, along with other valuable information.

Please review certificates for:

Child’s schedule
State reimbursement rate
Provider payment
Family copay
Start and end date of enrollment

A provider needs to be aware of the child’s eligibility end date on the certificate because a notice will not be sent when the end date is nearing. An enrollment that does not have any changes during the 12-month eligibility period uses the dates on the certificate as notice of end of care. A DCC-94C, Provider Notification Letter is only sent 10 calendar days prior to an enrollment ending if the enrollment is ending during the 12-month certification period.

Before signing the certificate

Before signing the certificate, discuss with the Parent:

• Enrollment start/end date
• Enrollment schedule
• Copay amount to be paid weekly
• Overage amounts (difference between the State Max Rate and what the center charges daily. Overages are not printed on the form as they are unique to each child care center)

If any of the information on the certificate is incorrect, DO NOT sign and return the certificate. When both parties sign and return the certificate, this means they are BOTH agreeing to the information on the certificate. It is the parent’s responsibility to contact Family Support for corrections to the certificate. DCC/CCAP staff cannot correct a certificate.

The certificate must be signed (not electronically) by the provider and client and returned to DCBS Family Support or uploaded to the Provider Portal within ten (10) calendar days of being generated. Payments cannot be made until the signed certificate is returned. It is the responsibility of the parent to make sure the certificate is returned.

If the parent has questions about the certificate, the parent will need to call (855) 306-8959 or visit a DCBS Family Support office.
If you, as the provider, have questions about the certificate, email CCAPProviderPayments@ky.gov or call DCC at (844) 209-2657. When contacting DCC be prepared to provide your license number, the case number, and a brief description of the issue.

Find a tip sheet for CCAP Certificates here: https://chfs.ky.gov/agencies/dcbs/dcc/Pages/kiccsportal.aspx

DCC-97 Provider Billing Form

To receive a DCC-97 Provider Billing Form (PBF), or for a child to show up on a PBF in the portal, the DCC-94 Service Agreement and Certificate must be signed by the provider and parent then returned to the DCBS office or provider portal within ten (10) calendar days. Once returned a Family Support worker will change the enrollment from pending to active in the system. Changing the enrollment from pending to active will signal to the system to send out a DCC-117: Enrollment Approval Notice to the provider.

Return the ENTIRE 3-page Certificate by:

Upload to the KICCS Provider Portal (fastest and most efficient)
Fax to 502-573-2007
(keep the fax transmission sheet for verification of dates and success of transmission)
Hand deliver to the local DCBS office
Mail to:
DCBS
PO Box 2104
Frankfort, KY 40603

*Keeping a copy of all pages of the certificate for the provider’s records is useful if the certificate is lost in the mail or not all pages are received through the fax. Retaining a copy of the fax transmission sheet to guarantee number of pages faxed, date, and time faxed is also advisable.

DCC-97 Provider Billing Form (PBF). Click each page to view larger.

Allowing children to begin receiving care without a signed certificate is a business decision the provider may make. Please remember, CCAP payments are not guaranteed until a certificate has been signed, returned to the DCBS office, and entered into the system (which completes the enrollment process) and a DCC 117 Provider Enrollment Approval Notice has been received.

What happens if the DCC-94 Service Agreement and Certificate is not returned within ten (10) calendar days?

If the 3-page certificate is not signed and returned on time, CCAP payments cannot be made and may be denied for the time the child was in care. The parent will be sent a DCC-118 Child Care Reminder Notice to notify them the certificate has not been returned, that CCAP payments will not be made, and that a new provider needs to be chosen within ten (10) calendar days.

The DCC-118 gives a due date of 10 additional calendar days, and states if the certificate is not received in the next 10 additional calendar days, the enrollment will be denied, and the parent will be responsible for any charges incurred.

If a certificate is not returned within the time limit and the enrollment is denied, then a DCC-119 Child Care Certificate Denial Notice will be sent to the provider on the 20th day alerting them that the enrollment was denied.

If all 3 pages of a signed certificate are not returned on time, per policy, the enrollment is added back into the system with the date the untimely certificate is received by the Family Support office. If the signed certificate is returned more than ninety (90) calendar days after the care was provided, Kentucky Administrative Regulations (KAR) 922.2:160.17(1)3(g) states that payments will not be made.

For Example:

If a certificate is generated on 6/1, it is due back at the Family Support office on 6/10.
If not received on 6/10, the system sends out a DCC 118 to the parent giving an additional 10 days, 6/20, to return the untimely certificate.
If the certificate is not returned to the Family Support office by 6/20, the enrollment denies and a DCC 119 is sent to the provider.
If the certificate is received by Family Support on 6/21, then Family Support will add the denied enrollment back into the case with a start date of 6/21 and the parent is responsible for any payments from 6/1-6/20.

What happens when the DCC-94 Service Agreement and Certificate is returned?

When the DCC-94 is returned and all 3 pages are signed, the enrollment is marked as active in the IEES system by DCBS Family Support.

The day after the enrollment is marked active, a DCC-117 Enrollment Approval Notice is sent to the provider through the Provider Portal (KICCS)or via mail. This notice alerts the provider that the enrollment is now approved and ready for payments to begin.

If more than one child in the family is receiving CCAP, it is important to check for all children’s names on the DCC-117. If all children are not listed, not all enrollments were marked active.

If a certificate is returned and the provider doesn’t receive the DCC-117 in a few days or not all children are listed, the provider can contact CCAPProviderPayments@ky.gov