Form For Disclosure Report

TITLE 39 HEALTH AND SAFETY CHAPTER 12 CHILD CARE LICENSING REFORM ACT 39-1204. Form for disclosure report. (1) The department shall design a form for the initial disclosure report which shall contain only the following information: (a)  The name, address and telephone number(s) for each children’s agency or children’s institution. (b)  The name(s), address and telephone number(s) of the individual(s) in charge at each children’s agency or children’s institution. (c)  The number of children that can be accommodated for child care at each children’s institution and a description of such accommodations. (d)  Whether and how the children’s institution seeks, receives or enrolls students for treatment of special needs such as substance abuse, mental illness, emotional disturbance, developmental disability, intellectual disability, or students who have been identified by the judicial system as requiring treatment, therapy, rehabilitation or supervision. (e)  A complete description of the child care services to be provided at each children’s institution. (f)  Whether and how the children’s institution expects to receive payment, including payment from health insurance carriers, for identified treatment needs such as substance abuse, mental illness, emotional disturbance, developmental disability, or intellectual disability. (g)  Whether and how the children’s institution represents to the payor of the child care services provided by the children’s institution that such payment may qualify for health insurance reimbursement by the payor’s carrier or may qualify for tax benefits relating to medical services. (h)  A description of the educational programs provided at each children’s institution and their accreditation status. (2)  The department shall design a form for the annual update disclosure report which shall reference the information provided in the initial disclosure report and shall request identification of any changes in the information provided on the initial report or the previous annual update disclosure report.