CACFP Administrative Manual Section 5.1Child and Adult Care Food Program Administrative Manual Section 5.1: Claims for Reimbursement.
Section 5: Claims for Reimbursement
Section 5.1 Claims for Reimbursement
Agencies must submit a claim for reimbursement no later than 60 calendar days after the month claimed. Example: A claim for June must be submitted by August 29, 60 days after the month of June. All claims are submitted through the CNIPS website .
Until a claim’s status changes to processed, the claim may be modified and resubmitted by the agency at any time. After the claim has been processed, an agency may submit a revised claim as follows:
- A revised claim resulting in an upward adjustment (higher payment amount) may be submitted only up to 60 days after the claim month.
- A revised claim resulting in a downward adjustment (less payment amount) may be submitted up to and after the 60 days deadline.
Although this section identifies key information required to successfully submit a CACFP claim, it is not a step by step guide. The CDE Nutrition Services web page contains the following resources to assist agencies with the claims submission process:
- The CACFP Reimbursement Instruction Booklet
- Claims submission deadlines
- Late claims policies and procedures
- A list of claims specialists by county
Application Submissions in the Child Nutrition Information and Payment System
Revisions made to an agency or provider application will only be approved prior to or in the month in which an approvable revision is submitted. This means that in order for an agency to make a change to its application(s) effective February 1, 2017, the agency must submit a revision through the CNIPS in February 2017 (or earlier). If the agency does not submit the revision until March 2017, the revision can only be made effective March 1, 2017, at the earliest.
Because the CDE cannot backdate approval for CNIPS revisions, it remains essential that agencies regularly review their CNIPS applications. Centers must ensure that staffing information, types of meals served, months of service, times of service, and all other information is correct and current. DCH sponsors must ensure that all provider applications are complete, correct, and approved for the correct claiming month.
Average Daily Participation
As part of the claims submission process, centers must calculate the average daily participation (ADP) for their site(s). To perform this calculation, a center should:
- Use the daily meal count records for all approved sites to compile the number of participants who consumed at least one meal or snack in the claim month; and
- Divide that total by the greatest number of days that food was served.
For example, in June a center sponsor served meals at one site on five days and at another site on four days. At the first site, 12 participants ate at least one meal or snack during the month. At the second site, 10 participants ate at least one meal or snack during the month. The center counts the total number of participants who consumed at least one meal or snack in the claim month and divides that total by the greatest number of days that food was served:
12 + 10 = 22 participants
22 participants ÷ 5 days of meal service = 4.4
ADP = 5
Remember: Since the ADP is an average of the number of participants served, center staff should always round up to include the fraction of a person.
Centers Only Claiming Instructions
Wraparound Programs—Child Care Centers Only
When a CC center claims meals for children enrolled in wraparound programs (see Sections 1.4 and 3.1 for more information), the center must report meal count and eligibility data for the Early Head Start, Head Start, or Even Start program portion of the day separate from the State Preschool or preschool portion of the day. Eligibility rosters must also be separate for both programs.
Incorporated School-age Licenses—Child Care Centers Only
When a CC center serves SA children under a preschool license, the center must report meal counts and eligibility data for SA children separate from the preschool children. Eligibility rosters and meal counts must also be maintained separately. Please see Sections 1.4 and 3.1 for more information.
Title III Funds—Adult Day Care Centers Only
Under Title III of the Older American’s Act of 1965, the Department of Health and Human Services provides meal service funds to some ADC centers. A meal that is supported by Title III funds may not be claimed for reimbursement under the CACFP.
Medi-Cal Funds—Adult Day Care Centers Only
If an ADC center receives Medi-Cal reimbursement for providing a meal, that same meal may not be claimed under the CACFP. For more information on Medi-Cal reimbursement, contact the California Department of Health Care Services.
Center Claiming Methodologies
Centers should select the claiming method that is most advantageous to its food service operation. There are two methods to choose from: fixed percentage and actual count. Centers that operate a pricing program are required to use the actual count method.
The intent of the fixed percentage method is to reduce paperwork. With this method, a center conducts an eligibility study to determine the numbers of free, reduced-price, and base (or paid) participants within its enrollment. This study is based on the enrollment and valid Meal Benefit Forms (and/or automatic documentation for CC centers; see Section 3.1 for more information) for the first month that the center will claim: each October for continuing centers, or the first month of operation for new centers. Fixed percentages must include all eligibly enrolled participants, even those that decline the program. For more information, CC centers can refer to Section 3.1 and ADC centers can refer to Section 3.3.
For instance, a center with an enrollment of 100 may have the following eligibility breakdown: 75 free, 15 reduced-price, and 10 base. Once the eligibility totals are reported, the NSD will then convert the figures into fixed percentages—in this example, 75 percent free, 15 percent reduced-price, and 10 percent base—and apply the percentages to the total meals claimed by the center in order to calculate the center’s monthly reimbursements throughout the program year.
Using the above percentages, if the center reports that it served a total of 1,000 lunches during June, the NSD will reimburse the center in the following manner: 750 free lunches, 150 reduced-price lunches, and 100 base lunches.
After the claiming percentages are established, centers are required to report new enrollment and eligibility data during a program year only when:
- Adding an approved site;
- The ADP exceeds previously reported enrollment; or
- A reporting error has been identified.
A center may update its enrollment and/or eligibility data on the claim if it is financially beneficial to the center (for instance, if the number of participants eligible for free or reduced-price meals increases).
Adult Day Care Centers and Fixed Percentages
Since not all enrolled adults in an ADC are eligible to participate in the CACFP, the fixed percentages are only calculated using the eligibly enrolled adults.
The reimbursement determinations for eligibly enrolled adults that decline participation must also be used when calculating the fixed percentage.
Fixed percentage for the reimbursement category = Number of adult participants in reimbursement category ÷ Number of eligibly enrolled adults
As with the fixed percentage method, a center using the actual count method must determine the numbers of free, reduced-price, and base participants within its enrollment. However, centers using the actual count method must conduct the enrollment and/or eligibility study for each month they wish to claim. Centers using the actual count method are also required to use a roster system to take meal counts by eligibility category (free, reduced-price, and base) at the time of service for each meal type claimed. For example, when taking a meal count for breakfast, a center must count the number of free breakfasts served, the number of reduced-price breakfasts served, and the number of base breakfasts served. Centers must then consolidate total meals served by eligibility category to report each month. For instance, a center may serve a total of 1,000 lunches during June; it must report the number of lunches in each category (i.e., 800 free lunches, 150 reduced-price lunches, and 50 base lunches) and receive meal reimbursements accordingly.
Day Care Home Only Claiming Instructions
In order to receive CACFP reimbursement, the sponsor must submit a monthly claim for reimbursement in the CNIPS that provides data in sufficient detail to justify the reimbursement claimed.
Sponsors must report the following data:
- The number of providers by tiering category approved to participate in the CACFP and that served at least one meal during the claim month
- The total number of children by tiering category enrolled for care that consumed at least one meal during the claim month
- The highest number of days that CACFP meals were served by providers
- The ADP for all providers being claimed
- The total number of each meal type by tiering category served during the claim month
- Actual administrative expenses incurred and income received during the claim month
All claims submitted must be certified in the CNIPS by the authorized individual to be considered a valid claim.
References: 7 CFR, sections 226.7(k), 226.9(b), 226.10(c), and 226.11(b)(1); MB CNP-07-2017 Reimbursement Claim One-time Exception Submission Deadline Policy Clarification, MB USDA-CACFP-11-2013 Clarification Regarding Required Meal Claim Edit Checks and Block Claims, MB NSD-CNP-02-2013 Reimbursement Claims Resources; and USDA Adult Day Care Handbook