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Appendix E3. CACFP Adult Day Care Handbook
This information is being collected from local government agencies and businesses (institutions)
to enable institutions wishing to participate in the Child and Adult Care Food Program (CACFP)
to submit applications to the administering agencies, execute agreements with those agencies,
and claim the reimbursement to which they are entitled by law. Section 17 of the National School
Lunch Act, as amended (42 U.S.C. 1766), authorizes the CACFP. This collection is required to
obtain or retain benefits and the Food and Nutrition Service (FNS) uses the information
collected to conduct reviews that determine whether or not institutions are observing the
requirements of the Program established by regulations and statute. In addition, the information
collection is necessary for administering agencies to monitor Program operations to ensure
compliance with legislative and regulatory requirements. Under the Privacy Act of 1974, any
personally identifying information obtained will be kept private to the extent of the law.
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and
a person is not required to respond to, a collection of information unless it displays a valid Office
of Management and Budget (OMB) control number. The valid OMB control number for this
information collection is 0584-0055. The time required to complete this information collection is
estimated to average 36 hours per response. This burden consists of the time it takes to review
all instructions and handbooks issued by FNS and the Department to clarify or explain existing
regulations. Send comments regarding this burden estimate or any other aspect of this collection
of information, including suggestions for reducing this burden, to: U.S. Department of
Agriculture, Food and Nutrition Services, Office of Policy Support, 1320 Braddock Place,
Alexandria, VA 22314, ATTN: PRA (0584-0055). Do not return a completed form to this
address.
OMB #0584-0055
Expiration Date
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Adult Day Care
A Child and Adult Care Food Program Handbook
U.S. Department of Agriculture
Food and Nutrition Service
January 2014
USDA is an equal opportunity provider and employer.
Policy Memoranda
Throughout the text, references have been made to
numbered memoranda issued by the Food and Nutrition
Service National Office. The numbering system may differ
from your State agency or Regional Office.
The U.S. Department of Agriculture prohibits discrimination against its customers, employees, and
applicants for employment on the bases of race, color, national origin, age, disability, sex, gender
identify, religion, reprisal, and where applicable, political beliefs, marital status, familial or parental
status, sexual orientation, or all or part of an individual’s income is derived from any public
assistance program, or protected genetic information in employment or in any program or activity
conducted or funded by the Department (Not all prohibited bases will apply to all programs and/or
employment activities.)
If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program
Discrimination Complain Form, found online at or at any USDA office, or call (866) 632-9992 to
request the form. You may also write a letter containing all of the information requested in the form.
Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture,
Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410,
by fax (202) 690-7442 or email at [email protected]
Individuals who are deaf, hard of hearing, or have speech disabilities may contact USDA through
the Federal Relay Service at (800) 877-8339; or (800) 845-6136 (Spanish).
USDA is an equal opportunity provider and employer.
Adult Day Care Centers
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Contents
Introduction ........................................................................................................................ 5
Background ................................................................................................................................ 5
Who Administers the Program?................................................................................................ 5
About this Guidance .................................................................................................................. 6
Part 1. Eligibility Requirements ....................................................................................... 7
A. Program Eligibility ................................................................................................................. 7
B. Center Eligibility .................................................................................................................... 7
C. Questions and Answers ...................................................................................................... 10
Part 2. Applying to Participate in the Program ............................................................ 12
A. Applying as an Independent Center or a Sponsored Facility .......................................... 12
B. Participating as a Sponsored Center ................................................................................. 13
C. Documents to Accompany an Application for Independent Centers and Sponsoring
Organizations ........................................................................................................................... 15
D. State Agency Review of Applications ................................................................................ 20
E. Permanent Agreements....................................................................................................... 21
F. Renewing Institutions .......................................................................................................... 22
G. Questions and Answers...................................................................................................... 22
Part 3. Participant Eligibility for those Enrolled in an Approved Institution ............. 24
A. Categories of Meals............................................................................................................. 24
B. Income Eligibility and Applications.................................................................................... 24
C. Process for Determining Eligibility .................................................................................... 26
D. Pricing and Non-pricing Programs of Free and Reduced-Price Meals ............................ 27
E. Identification of Low-Income Participants ......................................................................... 28
F. Media Release ...................................................................................................................... 29
G. Questions and Answers...................................................................................................... 29
Part 4. Meal Service ........................................................................................................ 30
A.
Meal Pattern Requirements .............................................................................................. 30
B. Serving Meals ...................................................................................................................... 35
C. Meal Preparation................................................................................................................. 37
D. Procurement Standards ...................................................................................................... 38
E. USDA Foods ......................................................................................................................... 39
F. Questions and Answers ...................................................................................................... 40
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Part 5. Program Reimbursement ................................................................................... 41
A. Reimbursement May be Claimed for Which Individuals? ................................................. 41
B. Current Reimbursement Rates ........................................................................................... 41
C. Receiving Reimbursement ................................................................................................. 41
D. Unallowable Claims ............................................................................................................. 42
E. Title III Funding .................................................................................................................... 43
F. Processing Claims ............................................................................................................... 43
G. Advance Payments ............................................................................................................. 43
H. Questions and Answers ...................................................................................................... 44
Part 6. Recordkeeping .................................................................................................... 45
A. Required Records................................................................................................................ 45
B. Record Retention................................................................................................................. 46
C. Questions and Answers ................................................................................................... 46
Part 7. Monitoring ........................................................................................................... 47
A. State Agency Monitoring Requirements ............................................................................ 47
B. Sponsoring Organization Monitoring Requirements ........................................................ 48
C. Corrective Action ................................................................................................................. 50
D. Appeals ............................................................................................................................... 50
Part 8. Acronyms and Glossary .................................................................................... 51
Part 9. Resources ........................................................................................................... 53
Part 10. Additional Food and Nutrition Programs for Older Americans .................... 56
A.
Federal Government Programs for Seniors .................................................................... 56
B. Research............................................................................................................................ 57
C. Partner Resources ............................................................................................................ 57
D.
Additional Resources ....................................................................................................... 58
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Introduction
The adult day care component of the Child and Adult Care Food Program (CACFP) offers
Federal funding for meals to adult day care centers. These centers enable elderly and
disabled adults to remain in their own home or in the home of a family member, guardian, or
other care giver, and avoid premature institutionalization. The CACFP plays a vital role in
improving the quality of day care and making it more affordable for many low-income
families. The Program provides meals and snacks to 112,000 adults who receive care in
nonresidential adult day care centers.
The purpose of this handbook is to help adult day care centers and sponsors of these
centers meet Federal requirements for meal reimbursement under CACFP. The handbook
contains a wide range of information about the adult day care component of CACFP,
including explanations of key aspects of the Program, Program resources, definitions of
Program-related terminology, and information on additional programs for older adults.
Background
1948: Congress provided financial aid to the States in the operation of school lunch
programs as permanent and integral parts of their school systems.
1968: Congress established the Special Food Service Program for Children to help
provide meals for children when school was not in session. This was later
separated into the Summer Food Service Program and the Child Care Food
Program.
1987: The Older Americans Act Amendments authorized participation of eligible adult
day care centers.
1989: The Program name was changed to the CACFP.
Who Administers the Program?
The United States Department of Agriculture (USDA), Food and Nutrition Service (FNS)
administers CACFP at the national level. The National Office develops regulations and
establishes policies necessary to carry out the Program. Regional Offices oversee
participation by State agencies and provide technical assistance to States in administering
the Program. The Code of Federal Regulations (CFR) at 7 Section 226 contains the CACFP
regulation. State agency contact information can be found on the FNS website at:
http://www.fns.usda.gov/cnd/Contacts/StateDirectory.htm
Each State administers and directs the Program through State health or aging agencies.
Locally, adult day care centers that want to participate in CACFP and that are approved by
the State agency to operate the Program, apply as either an independent center or enter
into an agreement with a sponsoring organization that oversees Program administration.
Independent centers receive meal reimbursements directly from the State, while sponsored
Adult Day Care Centers
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adult day care centers receive Federal reimbursements through their sponsoring
organization.
About this Guidance
This handbook addresses requirements that apply to adult day care centers participating in
CACFP. This handbook provides information about:
•
Eligibility;
•
How to apply to participate in the Program;
•
Meal patterns and food service requirements;
•
Program reimbursements;
•
Monitoring; and
•
Recordkeeping.
Adult day care centers provide a much-needed service to their communities. They provide
meals to older and disabled adults who wish to remain in their own communities and avoid
costly institutionalization. FNS recognizes that maintaining a high-quality, nutritious meal
service for older and disabled adults requires a commitment to excellence on the part of
caregivers. FNS applauds the many dedicated persons who ensure that adult day care
participants are served wholesome and nutritious meals in a sociable environment.
Adult Day Care Centers
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Part 1. Eligibility Requirements
An adult day care center may participate in the adult day care component of CACFP as an
independent center or sponsored center. This section will explain the eligibility requirements
and the services the center must offer in order to be considered for participation in CACFP
under either option of administration.
A. Program Eligibility
To be eligible to participate in the adult day care component of CACFP either independently
or through a sponsoring organization; adult day care centers may be operated by public
agencies, private nonprofit organizations, or certain for-profit organizations. A private
organization is considered to be nonprofit if it has tax-exempt status under the Internal
Revenue Code of 1986.
For-profit organizations are eligible to participate in CACFP if they receive compensation
under Title XIX (Medicaid Program) and/or Title XX (Block Grants to States for Social
Services) of the Social Security Act and at least 25 percent of enrolled participants receive
Title XIX or Title XX benefits.
Each for-profit center must meet the 25 percent requirement every month and under at least
one of these categories in order to be eligible to claim meals for that month. However, there
is no requirement that an appropriately enrolled Program participant be in attendance, or
participate in a meal, at any time during the claim month for that center to be determined
eligible to claim that month [7 CFR 226.2; and 226.19a].
Once the center’s eligibility has been established and approved, each participant’s claiming
status must be determined. See Part 3 for more information.
B. Center Eligibility
An adult day care center also must meet the following criteria in order to be eligible for
reimbursement through CACFP for meals served to participants:
•
•
•
•
Provide services to adults who are functionally impaired or over age 60;
Provide community-based programs;
Provide nonresidential services; and
Be licensed or approved to provide adult day care services [7 CFR 226.2;
226.6(b)(1) and 226.19a].
Each of these requirements is discussed in greater detail below.
Provide Services to Adults who are Functionally Impaired or Over Age 60
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To be eligible to participate in the adult day care component of CACFP either as an
independent center or through a sponsoring organization, an adult day care center must
provide services to adults who are functionally impaired or over age 60.
Functionally impaired adults are defined as chronically impaired disabled person’s age 18
years or older. This includes people who are physically or mentally impaired to the extent
that their capacity for independence and their ability to carry out activities of daily living is
markedly limited. Activities of daily living include, but are not limited to, activities such as
cleaning, shopping, cooking, taking public transportation, maintaining a residence, caring
appropriately for one’s grooming or hygiene, using telephones and directories, or using a
post office.
Marked limitations refer to the severity of impairment, and not the number of limited
activities. They occur when the degree of the person’s limitation seriously interferes with his
or her ability to function independently [7 CFR 226.2, Functionally Impaired]. For purposes
of determining CACFP eligibility, it is sufficient that an adult day care center is able to
provide services for functionally impaired adults. It is not necessary that the majority of the
clients receiving care in the center be functionally impaired.
Sheltered workshops, vocational or substance abuse rehabilitation centers, and social
centers do not qualify as adult day care centers for purposes of CACFP participation,
because they are not operated primarily to provide day care to elderly and disabled adults in
order to avoid premature institutionalization.
Provide Community-Based Programs
For purposes of CACFP, an adult day care center is a licensed or approved center that
provides a coordinated program in a community-based, nonresidential setting to enrolled
participants who need supervised care in a safe place outside the home during the day.
Adult day care centers are required to provide an individual plan of care for each enrolled
functionally impaired participant through a community-based group program. These plans
demonstrate a center’s ability to provide a variety of health, social, and supportive services
for its enrolled participants.
Note: For CACFP purposes, participating centers are not required to have
an individual plan of care for participating adults 60 years of age or older who
are not functionally impaired.
The individual plan of care is a written evaluation of a functionally impaired individual’s
health and social needs. It must include:
• The goals and objectives of the planned care;
• The activities that will be completed to achieve the goals and objectives;
• Recommendations for therapy;
• Referrals to and follow-up with other service providers as needed; and
• Provisions for periodic review and renewal.
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Once an initial assessment is completed, a plan can be developed to meet the participant’s
needs. The plan should include a daily schedule of individual and group activities aimed at
providing both physical and mental stimulation to the functionally impaired participant. It
must be a structured, comprehensive program that provides a variety of health, social, and
related support services to enrolled functionally impaired participants [7 CFR 226.19a(b)(1)].
Nonresidential
The primary purpose of the adult day care component of CACFP is to provide
reimbursement to eligible adult day care centers which provide nutritious meals to adults in
day care [CACFP 20-2012 Participant Eligibility in the Adult Day Care Component of the
Child and Adult Care Food Program, August 7, 2012].
Therefore, centers that provide residential care are not eligible to participate in CACFP with respect
to those residential clients. This would include, but is not limited to, hospitals, nursing homes,
residential centers for the mentally ill or for the mentally or physically handicapped, convalescent
homes, apartment complexes designed only for functionally impaired individuals that provide meals
and full-time care, and hospice programs.
However, centers that operate residential programs, but also provide nonresidential adult day care
services may be eligible for participation with regard to the nonresidential participants [CACFP 212012 Adult Day Care Center Eligibility and Licensing/Approval dated August 7, 2012].
Licensed or State Approved
All centers participating in CACFP are required to have Federal, State, or local licensing or
approval to care for functionally impaired adults. In the absence of such licensing or
approval mechanisms, centers must demonstrate compliance with applicable State or local
government standards or the CACFP standards set forth at 7 CFR 226.6(d)(3).
This provides an assurance that those in attendance at the center are receiving care in a
safe and healthy environment approved by State or local officials. Rules and regulations for
licensing or approval vary by State and locality. In some States, there is licensing that
specifically governs care for the needs of the functionally impaired or the elderly; in other
States, more generic licenses may govern care for older persons. Either is acceptable.
Approval is granted by a State agency or local agency that has the authority to determine
which adult day care centers meet written standards or criteria. These standards may
include requirements for staffing and available services, fire and safety standards, building
layout, and maintenance requirements. These standards ensure that a safe and healthy
environment is provided for center participants. In the absence of licensing standards, the
State or local authority may grant alternate approval.
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Operation of a center by a State is
considered State “approval”. However,
the center must clearly be a State center,
funded by the State. This must be
confirmed by a written assurance to the
appropriate FNS Regional Office by a
State official.
Receipt of Medicaid funds by an adult day
care center also constitutes State
approval for purposes of CACFP
participation. However, the simple
presence of public funding, State or
Federal, in an adult day care center does
not constitute full “approval”. Centers
receiving public funding, State or Federal,
are required to implement a financial
management system which can show that
other public funding is being used to
support CACFP meals only after the
CACFP reimbursement has been
exhausted. This will ensure CACFP funds
are used for the food service and not redirected to non-Program activities.
Tribal Operated Centers
Facilities operated by Tribes are not required to
be licensed by the State. A Tribal center may
participate in CACFP if it is licensed or
approved by Tribal authorities; this would be
considered a form of “local licensing or
approval.”
If no Tribal licensing or approval is available
and the State cannot or will not license or
approve a Tribal center, the center may be
approved under either:
•
•
•
The CACFP child care standards set forth in
7 CFR §226.6(d)(3);
A system of State alternate approval
administered by the CACFP State agency;
or
A system of local alternate approval
administered by a local government entity
and approved by the State agency [CACFP
18-2012: Participation of Tribal Child Care,
July 24, 2012].
Additionally, adult day care centers
purchasing meals from other than clearly
commercial vendors must make a determination that the meals they are receiving are not
also supported by another meal service program. Again, CACFP funds must be used for
meal service expenses and if the center has access to other meal service funds, those
should be used to augment the meal service to the degree that the CACFP reimbursement
does not cover all expenses. We encourage such centers to preserve other public funding
for services they administer outside the meal service and not allow such funding to interfere
with the integrity of their CACFP claims [CACFP 21-2012 Adult Day Care Center Eligibility
and Licensing/ Approval, August 7, 2012].
C. Questions and Answers
1. What is considered an adult day care center in CACFP?
Licensed or approved adult day care centers that are operated by public, private
nonprofit organizations, and certain for-profit organizations may participate in CACFP, if
they serve persons 60 years of age or older or chronically impaired disabled persons, 18
years of age or older. To be eligible, a center must be nonresidential and provide a
community-based program. These programs should be structured, comprehensive, and
provide health and social support services to enrolled participants. Facilities that simply
provide social or rehabilitative services to adults do not qualify for participation in
CACFP.
Adult Day Care Centers
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2. Can senior citizens who live in institutions participate in CACFP?
Individuals who reside in institutions are not eligible to participate in the Program.
3. Can individuals residing in group homes participate in CACFP?
Yes. Houses in the community which may be subsidized by Federal, State or local
funds but which are private residences housing an individual or a group of individuals
who are primarily responsible for their own care but who may receive on-site monitoring,
are not considered institutions. Therefore, individuals residing in such homes may be
eligible to participate in CACFP when they attend an eligible day care center.
4. Who receives the reimbursement for meals or snacks served in the CACFP?
Participating independent centers or sponsoring organizations receive cash
reimbursement for meals or snacks served to adults under this Program. Sponsored
facilities receive cash reimbursement through the sponsoring organization. All
reimbursements are based on the number of meals served to enrolled participants in
their care. Eligible individuals receive meals or snacks, not cash reimbursements.
5. Can an individual receive CACFP meals outside of a participating center?
In CACFP, there are individual eligibility requirements as well as institutional
requirements. Because this Program requires that meals and snacks are served through
participating centers, individuals may not independently participate in CACFP.
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Part 2. Applying to Participate in the Program
This section provides information on the application process for participation in the adult day
care component of CACFP by adult day care centers.
A. Applying as an Independent Center or a Sponsored Facility
Once an adult day care center has determined that it meets the Program eligibility
requirements for participating in CACFP (see Part 1), it must determine if it will
independently manage and administer the Program or if it will work with a sponsoring
organization that administers the Program on its behalf.
Participating as an Independent Center
An independent center is an adult day care center that enters into an agreement with the
State agency to assume final administrative and financial responsibility for the Program
operations [7 CFR 226.2, Independent center].
If an adult day care center chooses to participate as an independent center it must be
willing and able to undertake the following administrative responsibilities:
•
•
•
•
•
•
•
•
Accept final administrative and financial responsibility for operating the food service
at the center;
Prepare and submit an application for participation;
Ensure that meals served meet the meal pattern requirements;
Comply with requirements related to the financial aspects of the Program;
Provide adequate supervisory and operational personnel for managing and
operating the Program;
Establish procedures to collect and maintain all necessary Program records;
Ensure proper storage and use of USDA Foods; and
If it is a for-profit independent center, not claim reimbursement for any month when
less than 25 percent of the enrolled participants are Title XIX or Title XX
beneficiaries [7 CFR 226.19a(b)6].
Although there are certain kinds of information necessary for approval to participate in the
Program, applications and other forms are developed individually by each State agency.
The following describes some of the forms that may need to be completed by independent
centers.
•
Application for Participation for Independent Centers. Typically, State agencies
request information about public and nonprofit status, the type of center, licensing,
planned meal service, administrative and food service budgets, eligibility status of
enrolled participants, staffing patterns, and whether the State agency offers funds in
advance of reimbursement payments to assist centers in meeting expenses while
waiting for reimbursements.
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•
Agreement between Independent Centers and State Agencies. This document
indicates the responsibilities of the independent center and the State agency. This
agreement is permanent, but may be terminated by either party.
•
Policy Statement. Each independent center must submit a written policy statement
to the State agency for approval. The policy statement specifies the operating
procedures and practices for the service of free and reduced-price meals. Approval
for participation in the Program cannot be granted unless this policy statement is
approved by the State agency.
All requested forms and information must be submitted to the State agency and must be
signed by the person authorized to assume legal responsibility for the CACFP, or the
person to whom this authority has been delegated, such as the chairman of a board of
directors, or a public official. If a delegated person signs the form, a letter stating this
delegation of authority must be provided with the application.
B. Participating as a Sponsored Center
If an adult day care center will not be assuming administrative responsibilities for CACFP,
either because it chooses not to or because it is not capable of doing so, it may participate
in CACFP under a sponsoring organization. Adult day care centers that choose to work with
a sponsoring organization apply to the Program directly through the sponsoring
organization. Contact information of sponsoring organizations currently overseeing the
participation of adult day care centers in CACFP may be obtained by contacting the CACFP
State agency for the State in which the center is located.
The following describes the two main types of forms that will need to be completed by
sponsored facilities and submitted to their sponsoring organization:
•
Application. The application to participate varies according to different
States and sponsoring organizations but will require the center to submit
information used to assess its eligibility to participate in CACFP. This would
include current licensing or approval status and information to demonstrate a
for-profit center’s enrollment meets the 25 percent requirement.
•
Agreement between the Sponsoring Organization and the Sponsored
Center. This outlines the responsibilities of the center and the sponsoring
organization. This agreement is permanent, but may be terminated by either
party. Separate agreements are required for each sponsored center.
Participating as a Sponsoring Organization
A sponsoring organization assumes administrative and financial responsibilities for the
operation of the CACFP within an adult day care center participating in the Program
[7 CFR 226.2, Sponsoring organization].
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The sponsoring organization must be willing and able to undertake the following
administrative requirements:
• Accept final administrative and financial responsibility for operating the food
service in any sponsored centers;
• Prepare and submit applications for participation for itself and for facilities
under its sponsorship;
• Provide training and technical assistance to sponsored centers;
• Ensure that meals served meet the meal pattern requirements;
• Comply with requirements related to the financial aspects of the Program;
• Comply with the three performance standards ensuring that it is financially
viable, administratively capable of operating the Program and can
demonstrate fiscal accountability;
• Make payments of Program funds to sponsored centers within five working
days of receipt from the State agency;
• Provide adequate supervisory and operational personnel for managing and
monitoring the Program;
• Establish procedures to collect and maintain all necessary Program records;
• Ensure proper storage and use of donated USDA Foods; and
• If it is a sponsoring organization of for-profit adult day care centers, not claim
reimbursement for any month when less than 25 percent of the enrolled
participants are Title XIX or Title XX. This threshold must be met by each
center.
The following describes some of the information that may need to be provided by those
applying to participate as sponsoring organizations:
•
•
Application for Participation and Management
Plan for Sponsoring Organizations. The State
agency typically requests information about
planned meal service, administrative and food
service budgets, eligibility status of enrolled
participants, staffing patterns, and advance
payments. The Management Plan includes
information about training, reviewing the facilities,
and distributing reimbursements to the sponsored
facilities for the meals served.
Agreement between Sponsoring Organizations
and State Agencies. This agreement indicates
the responsibilities of the sponsor and the State
agency.
Adult Day Care Centers
Remember
Sponsoring organizations
which have public or
nonprofit status may
sponsor public or
nonprofit centers that
have no legal relationship
with the sponsor;
however, for-profit
sponsoring organizations
may sponsor only those
centers which are a legal
unit of the sponsoring
organization.
Page 14
•
Agreement between Sponsoring Organizations and Centers. This agreement
indicates the rights and responsibilities of each sponsored center and its sponsoring
organizations. Separate agreements are required for each sponsored center. The
State agency can provide a prototype for use by the sponsoring organization with its
centers, or will provide technical assistance and approval for one developed by the
sponsoring organization. Contact your State agency for more information on its
required or provided forms.
•
Policy Statement. Each sponsoring organization must submit a written policy
statement to the State agency for approval. The policy statement specifies the
operating procedures and practices for the service of free and reduced-price meals.
It includes the use of the current family size and Income Eligibility Guidelines and
the assurance that no participant will be discriminated against during the course of
the food service. Approval for participation in the Program cannot be granted unless
this policy statement is approved by the State agency.
All forms submitted to the State agency must be signed by the person authorized to assume
legal responsibility for the CACFP, or the person to whom this authority has been
delegated, such as the chairman of a board of directors, or a public official. To ensure
Program integrity, if a delegated person signs the form, a letter must be provided stating this
delegation of authority with the application.
Also reference the Guidance for Management Plans and Budgets CACFP Handbook via the
link in Part 9 of this handbook.
C. Documents to Accompany an Application for Independent Centers and
Sponsoring Organizations
To participate in the Program, institutions must submit to their State agency an initial
application that includes all of the following required information necessary for approval:
Nondiscrimination Statement
All participating institutions must submit a nondiscrimination policy statement and
a media release unless the State agency has issued a statewide media release
on behalf of all institutions [7 CFR 226.6(b)].
Documentation of tax-exempt status
All private nonprofit institutions must provide documentation of their tax-exempt
status under the Internal Revenue Code of 1986 [7 CFR 226.6(b)].
Preference for USDA Foods or cash-in-lieu of USDA Foods
The USDA donates food to States and States make those foods available to
institutions. Institutions must indicate in their application if they prefer USDA
Foods or cash-in-lieu of USDA Foods. Each year, State agencies must provide
Adult Day Care Centers
Page 15
institutions with information about foods that will be available that year. This
information is provided to the State agency by FNS [7 CFR 226.6(h)].
Providing Benefits to Underserved Centers or Participants
Institutions must show documentation indicating that they meet their State’s
criteria for ensuring delivery of benefits to otherwise underserved centers or
participants [7 CFR 226.6(b)(1)].
Budget Planning
It is important to be able to estimate the cost of operating the adult care
component of the CACFP, and to know the approximate amount of
reimbursement that the State agency will provide. Estimating reimbursement can
be an effective management tool for food service operations, menu planning,
and staffing. To estimate reimbursement, independent centers and sponsors
need to know:
o
The number of meals served by type (breakfast, lunch, supper or snack) and
eligibility category, and if reimbursement is calculated based on the eligibility
category, the actual number of meals served to participants eligible for free, reduced
price, and paid meals;
o
The current rates of reimbursement; and
o
The actual or estimated monthly or annual administrative costs of operating the
Program.
Note: Applicant independent centers and sponsoring organizations should refer to the
Guidance for Management Plans and Budgets CACFP Handbook for details of these
requirements.
Ineligibility for other Publicly Funded Programs
If an institution or any of its principals are included on the CACFP National
Disqualified List (NDL) or have been declared ineligible for any other publicly
funded program for violating that program’s requirements, State agencies must
deny their application. So that State agencies can make this determination,
institutions must submit:
o
A statement listing the publicly funded programs in which the institution and
its principals have participated during the past seven years; and
o
A certification that during the last seven years, neither the institution nor its
principals have been declared ineligible to participate in any other publicly
funded program by reason of violating that program’s requirements; or
Adult Day Care Centers
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o
Instead of certification, an institution may provide documentation that it was
later reinstated or determined eligible for the program, including the payment
of any debts owed.
Information on Criminal Convictions
If an institution or any of its principals have been convicted of any activity related
to lack of business integrity in the past seven years, a State agency may not
approve the application. A lack of business integrity includes fraud, antitrust
violations, embezzlement, theft, forgery, bribery, falsification or destruction of
records, making false statements, receiving stolen property, making false claims,
obstruction of justice, or any other related activity as defined by the State.
Certification of Truth in Application and Submission of Names and
Address
Institutions must certify that all information on the application is true and correct,
along with the names, mailing addresses, and dates of birth of the institution’s
Executive Director and Chairman of the Board of Directors. Owners must sign on
behalf of for-profit institutions if they do not have a Board.
Compliance with Performance Standards
An applying institution must demonstrate that it can comply with the following
performance standards.
o
Financial viability and financial management
1. Institutions must document that participation will help ensure the delivery
of benefits to otherwise underserved centers or participants.
2. Institutions must demonstrate that they have the financial resources to
operate the Program on a daily basis and enough sources of funds to
withstand temporary interruptions in Program payments and/or fiscal
claims against the center.
3. Costs in the budget must be necessary, reasonable, allowable, and
appropriately documented.
o
Administrative capability
Institutions must have an adequate number and type of qualified staff.
o
Program accountability
1. Nonprofit institutions must have adequate oversight by an independent
governing board of directors.
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2. The institution must have a financial system with management controls
in writing. Written policies must ensure:
a) Fiscal integrity and accountability for all funds and property
received, held, and disbursed;
b) Integrity and accountability of all expenses incurred;
c) That all claims will be processed accurately, and in a timely
manner;
d) That funds and property are safeguarded and used, and
expenses incurred, for authorized Program purposes; and
e) That a system of safeguards and controls is in place to
prevent and detect improper claims or financial activities by
employees.
3. Institutions must maintain records to document compliance with
Program requirements, including budgets, accounting records, approved
budget amendments, and for sponsoring organizations, management
plans.
Additional Required Information Necessary for Approval of Sponsoring
Organizations
Management Plan
A management plan must be submitted that includes:
o
Detailed information on the sponsoring organization’s management and
administrative structure;
o
An administrative budget that includes projected CACFP administrative
earnings and expenses and demonstrates the institution’s ability to manage
Program funds;
o
Sponsoring organizations’ budgets may not have administrative
costs higher than 15 percent of the current fiscal year’s estimated
meal reimbursements. States may waive this limit, but waivers
should only be granted if the sponsoring organization provides
justification that it needs Program funds in excess of 15 percent,
and the State agency is convinced that the institution will have
adequate funding to provide high quality, nutritious meals and
snacks [7 CFR 226.7(g)].
A list or description of the staff assigned to monitor the Program; and
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o
The procedures that the institution will use to administer the Program and that
sponsoring organizations will use to disburse payments to sponsored adult
day care centers [7 CFR 226.6(b)].
Outside Employment Policy
Sponsors must submit an outside employment policy restricting other
employment by employees that interferes with an employee’s performance of
Program duties and responsibilities or that may indicate a conflict of interest.
Bond
Sponsoring organizations must submit a bond, if required by State law,
regulation, or policy.
Compliance with Performance Standards
o
Administrative capability
1. Sponsoring organizations must employ enough staff to meet the
monitoring requirements (one full-time staff person for each 25-150
centers it sponsors) [7 CFR 226.16(b)(1)].
2. Institutions must have written policies and procedures that assign
responsibilities and duties, and ensure compliance with civil rights
requirements.
o
Program accountability
1. Sponsoring organizations must document in their management plan
that they will:
a) Provide adequate and regular training of staff and
sponsored centers;
b) Perform monitoring to ensure centers are appropriately
operating the Program; and
c) Have a system in place to ensure that administrative costs
funded from the Program do not exceed 15 percent of
estimated or actual meal reimbursements.
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Requirements for all Independent and Sponsored Adult Day Care Centers
Documentation of Licensing/Approval
All centers must show that they meet State or local licensing requirements
[7 CFR 226.19(b)(3)].
Compliance with Performance Standards
o
Program accountability
Independent centers and sponsored centers must have practices in
place to ensure that the meal service, recordkeeping, and other Program
requirements are performed properly. These practices must be
documented in the application of independent centers or the sponsoring
organization management plans and must document that they will:
a) Provide meals that meet meal pattern requirements;
b) Comply with any licensing and health and safety requirements;
c) Have a food service that complies with applicable State and local
health and sanitation requirements;
d) Comply with civil rights requirements;
e) Maintain complete and appropriate records on file; and
f) Claim reimbursement for only eligible meals.
D. State Agency Review of Applications
The State agency must determine the eligibility of each independent adult day care center
based on the information included in the application. State agencies must notify institutions
in writing if they have been approved to participate in the Program within 30 days of receipt
of a complete application [7 CFR 226.6(b)].
Application Approval
The State agency is required to notify applying institutions in writing of approval or
disapproval within 30 calendar days after a complete and correct application is submitted. If
the application is denied, this notification letter must include the reason for denial and
information regarding the institution’s right to appeal the disapproval. If the application is
incomplete, the State agency should provide assistance to help the institution complete its
application.
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Retroactive Approval
A State agency may develop a policy that allows independent centers to be reimbursed for
meals that are served in accordance with Program provisions in the calendar month directly
prior to the month that the agreement is executed. For example, if the State agency has
this type of policy, an agreement that is executed on May 15 means that the center may be
able to receive reimbursement dating back to April 1. However, the center may not receive
a reimbursement until the agreement has actually been implemented, and proper records
must have been maintained for the meals served and claimed for reimbursement [7 CFR
226.11(a)].
See Part 5 and Part 7 for further information on reimbursement and required records.
Application Denial
If an institution’s application does not meet all of the requirements for participation in the
CACFP, the State agency will deny the application. The institution will be given a chance to
appeal this decision, but may also reapply at any time in the future after making any
necessary changes to meet Program requirements.
During the review of the application from a newly-applying, the State agency may find that
the institution has committed one or more serious deficiencies; such as, submitting false
information or lacking business, the State agency will initiate action to:
•
•
•
Deny the sponsor’s application;
Follow the appropriate notification procedures, including the institution’s right to
appeal and the process for appeal; and
Disqualify the sponsoring organization and the responsible principals and
responsible individuals (e.g., the person who signs the application).
The State agency also will give the institution the opportunity to take corrective action to
fully and permanently correct the serious deficiency(ies) within the allotted time and to the
State agency’s satisfaction. If the institution has corrected the serious deficiency(ies), it will
have the opportunity to resubmit its application. If timely corrective action is not taken, the
institution will be notified by the State agency that its application has been denied and that
the institution and its principals will be disqualified from participating in the Program and
placed on the NDL. The institution will be given the opportunity to appeal this decision [7
CFR 226.6(c); 226.6(c)(1);226.15(b); and 226.16(b) and the Serious Deficiency,
Suspension, and Appeals CACFP Handbook].
E. Permanent Agreements
Once the State agency has approved an institution’s application, the State agency and the
institution will enter into a permanent agreement. The agreement must describe the
approved adult day care Program(s) and, in the case of a sponsoring organization, list the
approved centers. The agreement also must require the institution to comply with applicable
requirements and provide that the institution will accept final financial and administrative
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responsibility for the management of a proper, efficient, and effective food service [7 CFR
226.6(b)(3);(4)].
Although the agreement is permanent, it may be terminated by the institution at any time or
for cause by the State agency if the institution does not comply with Program requirements
[CACFP 07-2011, Permanent Agreements in the Summer Food Service Program and the
Child and Adult Care Food Program, January 14, 2011].
F. Renewing Institutions
As a result of the passage of the Healthy, Hunger-Free Kids Act of 2010, renewing
institutions are no longer required to submit renewal applications on a periodic basis.
Instead, renewing institutions are required to annually provide:
•
Updated licensing information for each independent center and sponsored
center participating in CACFP (the State may choose to get this information
directly from the State licensing agency);
•
Certification that any information previously submitted to the State is current
(a prototype certification form is provided);
•
A budget for the upcoming year for sponsoring organizations, and, if
required by the State agency, for independent centers; and
•
A media release announcing the availability of meals and snacks at no
charge to the institution’s attendance area (unless the State chooses to
issue a statewide media release).
G. Questions and Answers
1. What are considerations in deciding whether to apply as an independent or
sponsored center?
One of the most important things to consider is the extent of your center’s administrative
capacities. An independent center must be willing and able to assume the final
administrative and financial responsibility for the Program operations. An adult day care
center may decide not to assume the administrative responsibilities for CACFP either
because it chooses not to or because it is not capable of doing so. If the center needs a
sponsoring organization, it can contact the CACFP State agency for contact information
of sponsoring organizations in the State in which the center is located.
2. What does our center’s application need to demonstrate?
Your center needs to document that it has financial viability and financial management
capability, including the financial resources to operate the Program on a daily basis. You
also need to demonstrate that you have an adequate qualified staff to support daily
operations and provide the administrative capability. It is also essential that you have a
financial system in place with management controls in writing so that you will be able to
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adequately maintain records to document compliance with Program requirements,
including budgets, accounting records, approved budget amendments, and for
sponsors, management plans.
3. How does my center’s participation in other publicly funded programs affect my
application?
If your center has participated in other publicly funded programs, you will need to certify that,
during the last seven years, neither your center nor its principals have been declared ineligible
to participate in any other publicly funded program by reason of violating that program’s
requirements or, if you were declared ineligible, that you were later reinstated or determined
eligible for the program, including payment of any debts owed. You will need to provide this
documentation for all of the publicly funded programs you have participated in the last seven
years.
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Part 3. Participant Eligibility for those Enrolled in an Approved
Institution
In this chapter you will find information on:
•
•
•
Meal categories;
Determining eligibility for free and reduced price meals; and
Income Eligibility Applications and their content.
To operate CACFP, independent centers and sponsoring organizations must determine
each participant’s eligibility for free, reduced-price, or paid meals. Reimbursements for the
meals served to enrolled participants are based on the types of meals served and the
number of participants eligible for free, reduced price, or paid meals. Documentation of
each participant’s eligibility must be maintained.
A. Categories of Meals
There are three different categories of meals in CACFP.
A free meal is a meal served to a participant whose household income is at or below the
USDA’s eligibility standards for free meals. A participant who is a member of a household
receiving Supplemental Nutrition Assistance Program (SNAP) benefits, formerly food
stamps), or who receives Supplemental Security Income (SSI) or Medicaid benefits, or
participates in the Food Distribution Program on Indian Reservations (FDPIR) is also
automatically eligible for a free meal. Independent centers and sponsors receive the highest
reimbursement amount from the State agency for these types of meals served through
CACFP.
A reduced-price meal is a meal served to a participant whose household income does not
meet the requirements for free meals, but is at or below the eligibility standards for reducedprice meals according to the USDA’s income eligibility guidelines. Independent centers and
sponsors receive a lower reimbursement from the State agency for these types of meals
served through CACFP.
A paid meal is a meal served to a participant whose household income does not meet the
eligibility standards for free or reduced-price meals according to the USDA’s income
eligibility guidelines, or for whom no Income Eligibility Application has been filed.
Independent centers and sponsors receive reimbursements from the State agency at the
lower “paid” rate for these types of meals served through CACFP [7 CFR 226.2; 226.23].
B. Income Eligibility and Applications
Each year institutions must obtain and keep on file an income eligibility application that is
completed and signed by the participant or guardian. The income eligibility application
should collect the following information:
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•
The names of all adults enrolled in care, for whom the application is made;
•
The names of all other household members;
•
Income received by each household
member, identified by source of income
(this includes gross earnings, wages,
welfare, pensions, support payments,
unemployment compensation, social
security, cash income received or
withdrawn from savings, investments,
trusts and other resources; individual
retirement account and Keogh
withdrawals);
Household Income
Only the income of the participant,
the spouse, and any dependent
children who reside with the
participant must be reported on the
application. See more detail below.
•
The signature of an adult household member that immediately follows a
statement verifying that the information provided on the application is true
and correct; and
•
The last four digits of the social security number of the adult household
member who signs the application, or an indication that he/she does not
possess a social security number.
Categorical Eligibility
A participant who is a member of a SNAP household, or receives assistance under SSI or
Medicaid, or who participates in the FDPIR is considered categorically eligible and may
receive free meal Program benefits without providing household size and income
information. The income eligibility form for these participants need only collect the following
information:
•
The name(s) and appropriate SNAP or FDPIR case number(s) for the
participant(s), or the adult participant’s SSI or Medicaid identification number;
and
•
The signature of an adult member of the household.
“Household,” which is defined as “family” in the Program regulations for the adult
component of CACFP, is slightly different than the definition used for child care institutions,
centers, or day care homes. In the case of adult participants, it is the adult participant and
the spouse and any dependents that reside with the adult participant. There may be
instances in which a spouse or dependent does not live continuously with the participant. In
that case, the spouse or dependent continues to be considered a part of the participant’s
family as long as his or her usual residence is with the participant.
However, functionally impaired adults living with their parents are considered a “family”
separate from their parents for the purpose of determining family-size and income.
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C. Process for Determining Eligibility
Distribute Income Eligibility Applications
Individual eligibility information must be collected from all participants at least once each
year. Institutions are required to distribute the income eligibility application along with a
letter to households or guardians of enrolled participants. The accompanying letter should
inform households of the procedures regarding eligibility for free and reduced-price meals.
This letter must contain the following information:
•
The income standards for free and reduced-price meals with an explanation
for how participants may qualify for these meals based on these standards;
•
Information regarding how a participant may apply for free or reduced-price
meals;
•
An explanation that free or reduced-price eligibility approval cannot be
completed until proper documentation is returned to the institution;
•
A civil rights statement explaining that no person in the Program will be
discriminated against due to race, color, national origin, sex, age or disability;
•
A statement that participants with household members that become
unemployed are eligible for free or reduced-price meals during the period of
unemployment if they meet the required income standards for Program
benefits; and
•
An explanation that the information included in the application may be
verified at any point during the year, and procedures for the household to
appeal a decision to deny, reduce, or terminate Program benefits.
Sample application forms and sample letters to the participant or guardian that explains the
purpose and eligibility for free and reduced price benefits are included in Part 9 and FNS
provides forms in a number of language translations for use by institutions [CACFP 25-2001
Translations for the Free and Reduced Price School Meals Application and Child and Adult
Care Food Program Meal Benefit Income Eligibility Form, August 3, 2011].
If an enrollee is unable to complete an application, and no family member or guardian is available
to assist, the center may, with the approval of the State agency, complete an application on the
enrollee’s behalf. If a participant is categorically eligible for free meals as described in above (See
Categorical Eligibility in section B above), the participant’s file must contain documentation of the
basis of the categorical eligibility.
Collect Completed Applications and Determining Benefit Eligibility
When participants or their households return the income eligibility form, the independent center or
sponsoring organization should calculate the household’s total current gross income and compare
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it to the USDA’s Income Eligibility Guidelines in order to determine the participant’s eligibility
category.
The income/household size standards for determining eligibility for free or reduced-price
meals are the same as those used to determine eligibility for free or reduced-price meals
under the National School Lunch and School Breakfast Programs. The State agency will
make these income standards available to all independent centers or sponsoring
organizations either currently participating or wishing to participate in the Program. The
State agency can also provide additional guidance on determining the eligibility of an
enrolled participant.
D. Pricing and Non-pricing Programs of Free and Reduced-Price Meals
Adult day care centers have options regarding the meal service Program they want to
implement. Both are tied to the Program’s free and reduced price meal policy; the options
are called nonpricing and pricing Programs. The majority of centers participating in the
Program operate nonpricing Programs though it is each center’s choice as to which system
it will use.
Nonpricing Programs are those in which no separate
charge is made for the meals served to participants. If
any funds are collected that support the food service, it
is in the form of a general tuition charge that covers all
areas of the day care services provided. No portion of
tuition payments is specifically earmarked for food
service, therefore, there is no separate charge for
meals nor is money exchanged at meal time.
A policy statement must be developed that assures all
participants are served the same meals at no separate
charge regardless of race, color, national origin, sex,
age, or disability and that there is no discrimination in
the course of the food service. The State agency can
provide guidance about the standard nonpricing policy
statement [7 CFR 226.2; 226.23(c)].
Educational Activities
In some adult day care
centers, as part of their
individual plan of care,
participants are given
currency to act out paying
for their meals as an
educational exercise.
This is an effort to teach
money handling skills as an
activity of daily living. This
is not considered a pricing
Program.
Pricing Programs are those in which a participant who does not qualify for free meals is
charged for any meals served. This may be a direct payment from the participant at the time
the meal is served or it can be included as part of a tuition payment which is specifically
earmarked for food service.
Independent centers or sponsoring organizations that charge separately for meals must
develop a policy statement that:
•
•
Identifies criteria used to determine eligibility for free and reduced-price
meals;
Identifies the method used to accept applications for free and reduced-price
meals;
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•
•
•
•
Identifies the method used to collect payments from participants paying the
full or reduced-price of the meal that will maintain the individual’s privacy
concerning the payment amount;
Provides for a hearing procedure for participants to appeal an eligibility
determination at the time an application is taken and/or if it is chosen for
verification of income and denied;
Provides an assurance that there will be no overt identification of free and
reduced-price meal recipients and no discrimination against any participant
on the basis of race, color, national origin, sex, age, or disability; and
Provides specific guidelines that must be followed concerning the charges
that may be made for the meals.
For more specific guidance on pricing Programs, contact your State agency.
Notify Eligible Participants
If a completed application indicates that a household meets the eligibility criteria for free or
reduced-price meals, the participants from that family will be considered eligible to receive
meal benefits. Programs that have a separate charge to the participants for meals (referred
to as pricing Programs) must promptly provide written notice to each family informing them
of this eligibility.
Notify Ineligible Participants
When the information provided in a completed application indicates that a household does
not meet the eligibility criteria for free or reduced-price meals in a pricing Program, the
participants from that family must be notified that they have been denied free and reducedprice meal benefits in CACFP. At a minimum, this notice must include:
•
•
•
•
The reason for the denial of benefits;
Notification of the right to appeal;
Instructions on how to appeal; and
A statement reminding the household that they may reapply for free or reduced-price
benefits at any time during the year.
E. Identification of Low-Income Participants
CACFP rules require that there is no obvious
identification of participants eligible for free
or reduced price meals so as not to cause
any embarrassment to any participant.
Therefore, the information on file on the free
and reduced-price applications and the
eligibility status of each participant is
confidential.
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Participant Confidentiality
It is important to maintain participant
confidentiality in your Program operations.
The enrollment status of individuals in the
free and reduced-price meal program must
be kept confidential.
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Programs that have a separate charge to the participant for meals must be careful not to
identify those participants who are eligible for free or reduced-price meals at the time of
collection or anytime during the actual meal service.
F. Media Release
In order to comply with the Program’s free and reduced-price meal policy rules, independent
centers and sponsoring organizations must annually issue a media release announcing
their intention to operate a USDA funded food service program. This release must include:
•
•
The USDA’s current income eligibility guidelines for free and reduced-price
meals; and
A statement that it does not discriminate against any participant because of
race, color, national origin, sex, age, or disability.
A copy of the media release along with any other information
Media Release
the center or sponsor wishes to include must be provided to
one or more newspapers, magazines, or radio or television
The State agency may
stations that serve the area. A copy of the release should be
choose to issue a statekept on file and one copy sent to the State agency. Whether
wide release on behalf
or not the media uses the public release, the responsibility
of all its institutions.
has been fulfilled when the release is sent [7 CFR 226.23(d);
and FNS Instruction 113-1, Civil Rights Compliance and
Enforcement- Nutrition Programs and Activities, November 8, 2005].
Any brochures, news articles, or bulletins made available to the public should state that the
Program is open to all participants regardless of race, color, national origin, sex, age, or
disability. Part 9 of this handbook includes a copy of sample public releases that may be
used for pricing and nonpricing Programs.
G. Questions and Answers
1. How does a participant’s enrollment in other benefit programs affect their
eligibility for free meals in CACFP?
A participant who is a member of a SNAP household, or receives assistance under SSI
or Medicaid, or who participates in the FDPIR is considered categorically eligible and
may receive free meal Program benefits without providing household size and income
information. The income eligibility form for these participants only needs to document
their name and their SNAP or FDPIR number, or their SSI or Medicaid identification
number.
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Part 4. Meal Service
In this chapter you will find information on:
•
•
•
•
•
Pricing programs;
Meal pattern requirements;
Different serving methods to provide meals;
Meal preparation options; and
Procurement requirements.
A. Meal Pattern Requirements
One or more of the following meal types must be served to adults and approved by the
State agency in the center’s application:
•
•
•
•
Breakfast;
Lunch;
Supper; or
Snack.
Adult Meal Patterns
Institutions and facilities may be approved to serve and claim up to two meals and one snack or
two snacks and one meal per day. The following table shows the required food components for
each meal type, and the minimum required serving sizes for adults. All of the required food
components identified in this table must be offered with each meal, with the exception of the snack.
Only two of the four food components are necessary for snacks.
Breakfast
Food Components
1 milk
fluid milk
1 fruit/vegetable
juice,1 fruit and/or vegetable
1 grains/bread2
bread or
1 cup
1/2 cup
2 slices
cornbread or biscuit or roll or muffin or
2 servings
cold dry cereal or
1 1/2 cups
hot cooked cereal or
1 cup
pasta or noodles or grains
1 cup
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Lunch
Food Components
1 milk
fluid milk
2 fruit/vegetable
juice,1 fruit and/or vegetable
1 grains/bread2
bread or
1 cup
1 cup
2 slices
cornbread or biscuit or roll or muffin or
2 servings
cold dry cereal or
1 1/2 cups
hot cooked cereal or
1 cup
pasta or noodles or grains
1 meat/meat alternate3
1 cup
meat or poultry or fish or
alternate protein product or
cheese or
egg or
cooked dry beans or peas or
peanut or other nut or seed butter or
2 ounces
2 ounces
2 ounces
1 egg
1/2 cup
4 Tbsp.
nuts and/or seeds4 or
1 ounce
yogurt5
8 ounces
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Supper
Food Components
2 fruit/vegetable
juice,1 fruit and/or vegetable
1 grains/bread2
bread or
1 cup
2 slices
cornbread or biscuit or roll or muffin or
2 servings
cold dry cereal or
1 1/2 cups
hot cooked cereal or
1 cup
pasta or noodles or grains
1 meat/meat alternate3
meat or poultry or fish or
1 cup
alternate protein product or
cheese or
2 ounces
2 ounces
2 ounces
egg or
1 egg
cooked dry beans or peas or
peanut or other nut or seed butter or
1/2 cup
4 Tbsp.
4
nuts and/or seeds or
1 ounce
yogurt5
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8 ounces
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Snack
Food Components
1 milk
fluid milk
1 fruit/vegetable
juice,1 fruit and/or vegetable
1 grains/bread2
bread or
1 cup
1/2 cup
1 slice
cornbread or biscuit or roll or muffin or
1 serving
cold dry cereal or
3/4 cup
hot cooked cereal or
1/2 cup
pasta or noodles or grains
1/2 cup
3
1 meat/meat alternate
meat or poultry or fish or
1 ounces
alternate protein product or
1 ounces
cheese or
1 ounces
egg or
1/2 egg
cooked dry beans or peas or
1/4 cup
peanut or other nut or seed butter or
2 Tbsp.
nuts and/or seeds4 or
1 ounce
yogurt5
4 ounces
1
Fruit or vegetable juice must be full-strength.
2
Breads and grains must be made from whole-grain or enriched meal or flour. Cereal must be
whole-grain or enriched or fortified.
3
A serving consists of the edible portion of cooked lean meat or poultry or fish.
4
Nuts and seeds may meet only one-half of the total meat/meat alternate serving and must be
combined with another meat/meat alternate to fulfill the lunch requirement.
5
Yogurt may be plain or flavored, unsweetened or sweetened.
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Sample Meals
The following table provides an example of how each individual meal pattern could be met
with commonly consumed foods.
Please note that variety is key to a healthy diet, so it is important to serve and select a wide
variety of foods within each food component throughout the menu cycle.
Sample Breakfast
½ cup cooked oatmeal
1 slice whole wheat toast
½ cup diced peaches
1 cup 1% or nonfat milk
Sample Lunch
2 oz lean hamburger made from 100% ground beef
½ cup baked sweet potato fries
½ cup berries
1 whole wheat bun
1 cup 1% or nonfat milk
Sample Snack
4 oz yogurt
1 small muffin
Sample Supper
White bean and kale soup (½ cup beans and ½ cup kale
per serving)
2 slices bread (or rolls, or cornbread)
½ cup cooked squash
Variations/Substitutions
If the institution serves adults that have disabilities or special dietary needs that lead to alterations
of the meal pattern or the menu, ensure that these adults are being served meals in accordance
with their needs and confirm that the appropriate documentation has been obtained and retained to
support claiming the meals. See Part 11, Attachment 6 for a prototype form for documenting a
medical or special dietary needs substitution.
o
Medical Statements – In order to claim a meal that does not conform to the regulatory
meal pattern, there must be a medical reason or a special dietary need and a signed
statement on file.
o
Disabilities - If an institution is serving an adult with a disability and that disability directly
affects which foods the adult can consume, the guardian must submit a medical statement
signed by a licensed physician. The medical statement must be kept on file, handled
confidentially, and must describe:
The adult’s disability and an explanation of why the disability restricts the adult’s diet;
The major life activity affected by the disability;
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o
The food or foods to be omitted from the adult’s diet, and
The appropriate substitutions.
Special Dietary Needs - If an institution is serving an adult with special dietary needs (e.g.,
vegetarian), the guardian may request substitutions by submitting a medical statement
signed by a recognized medical authority, such as physician, physician assistant, nurse
practitioner or other professional specified by the State agency, listing the foods to be
omitted and appropriate substitutions.
Note: Milk substitutions that are made due to special dietary needs that are not a disability must
be nutritionally equivalent to milk, even if accompanied by a medical statement. The institution can
make such substitutions at its discretion.
For additional information, see FNS Instruction 783-2 Accommodating Children with Special Dietary
Needs, and CACFP 21-2011, Child Nutrition Reauthorization 2010: Nutrition Requirements for
Fluid Milk and Fluid Milk Substitutions, September 15, 2011, and contact the State agency if there
are additional questions.
B. Serving Meals
The intent of the Program is that all meals provided through CACFP must be consumed in a
congregate setting. This means that all of the adult participants in CACFP at a particular
center must eat their meals together in a central location. If there are several rooms in
which meals might be served, the center is encouraged to contact its State agency for
compliance information.
Offer versus Serve
At the discretion of the adult day care center, participants may be permitted to decline a
certain number of food servings without the price or reimbursement for the meal being
affected. This provision is called “offer versus serve” (OVS).
OVS
All meal items must be offered, but a certain number of items
may be declined by the participant. The reimbursement for the
meal will not be affected if an adult participant declines a food
item [7 CFR 226.20(q)].
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The following bullets provide a quick guide to the food items that must be offered at each
meal, and which may be declined by the participant (while still counting as a reimbursable
meal):
•
Breakfast: Offer
1 serving of milk;
1 serving of vegetables and/or fruit; and
2 servings of bread or bread alternate.
4 servings
Under OVS, participants may decline only one of the four servings
offered.
•
Lunch: Offer
1 serving of milk;
2 servings of vegetables and/or fruit;
2 servings of bread or bread alternate, and
2 serving of meat or meat alternate.
6 servings
Under OVS, participants may decline up to two of the six servings
offered.
•
Supper: Offer
2 servings of vegetables and/or fruit;
2 servings of bread or bread alternate; and
1 serving of meat or meat alternate.
5 servings
Under OVS, participants may decline up to two of the five servings
offered.
•
Snack: Because the snack meal pattern only contains two food items, OVS is
not available for snacks. Participants may not decline any servings.
Family Style Meal Service
Family style is a type of meal service that allows adults to serve themselves from common
platters of food with assistance from supervising adults. Unlike cafeteria lines and preplated meals, the family style method gives the adults more control over their servings.
Because adults are generally used to family style eating, the day care participants may
welcome this method and feel most comfortable when the center chooses to implement this
style of service [7 CFR 226.20(p); FNS Instruction 783-9, Rev. 2., Family Style Meal Service
in the CACFP, May 3, 1993].
If chosen, this serving style option must be exercised in compliance with the following
practices:
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•
Enough food must be placed on each table to provide the full required
portions of each of the food components for all participants at the table, and
to accommodate adults supervising the meal service at the table if they eat
with the participants;
•
The full minimum portion required under the applicable meal pattern must be offered to
each participant; and
•
When the full portion required by the applicable meal pattern is not initially
taken by a participant, supervising adults must actively encourage the
participant to accept the full portion during the course of the meal.
C. Meal Preparation
The best system of meal preparation in a given situation will depend upon such factors as the type
of menu desired, the availability of food service equipment, space and personnel, and the budget of
the organization. The following list includes the several types of food service systems available
centers.
1. Onsite: Onsite preparation is the most commonly used food service system. The meals
are prepared at the same location where they are to be served. This is usually the most
economical method when the center has a kitchen, sufficient food preparation
equipment, and available staff. All or part of the food may be prepared onsite and the
remainder purchased by the institution (center or sponsoring organization) from an
outside source, such as a school, hospital, or commercial vendor.
2. Central Kitchen: A sponsoring organization
with only one center that can prepare meals may
want to prepare all meals at that central kitchen.
The sponsor can arrange to transport meals from
the central kitchen and deliver them to other
facilities. This system also may be utilized when
the sponsoring organization arranges to have a
school prepare and provide meals. When
transporting meals, equipment will be needed to
keep both hot and cold foods at temperature
levels required under State or local health laws.
Remember
Only institutions, not facilities may
enter into contracts, so only
independent centers or sponsoring
organizations may contract for
meals or parts of meals.
3. Purchasing from a School: Meals may be purchased from a school that participates
in the National School Lunch Program, either in bulk or as individual packaged units. An
independent center or sponsoring organization that receives meals from a school must
enter into a written agreement with that school. This agreement must contain the basic
provisions of the Program requirements. Signing an agreement with a school to provide
meals does not relieve the independent center or sponsoring organization of its Program
responsibilities for monitoring and recordkeeping. The school should provide a copy of
the menus served and meal service records required by the State agency [7 CFR
226.19a(b)(7)].
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4. Purchasing From a Food Service Management Company: Food service
management companies are organizations that prepare and deliver meals. An
independent center or sponsoring organization that purchases meals from a food
service management company must enter into a written contract with the company. The
State agency can provide a copy of the standard contract that must be used and
guidance on meeting procurement standards. Signing a contract with a food service
management company does not relieve the center or sponsoring organization of its
Program responsibilities for monitoring and recordkeeping. Regulations require that a
copy of the contract be submitted to the State agency before the beginning of Program
operations under the contract [7 CFR 226.19a(c)].
5. Purchasing from a Commercial Vendor: Commercial vendors are public
organizations (hospitals, college cafeterias, etc.), private commercial enterprises, or
individuals that provide nonfood items or individual food items but not complete meals.
An independent center or sponsoring organization that purchases from a commercial
vendor must enter into a written contract with the vendor. The State agency can provide
a copy of the standard contract and additional guidance on meeting procurement
standards.
D. Procurement Standards
Purchasing rules were developed for institutions that utilize public funds in their Programs.
To ensure Federal or State funds are used as wisely as possible, procurement standards
outline specific steps to compare costs and to seek bids from interested vendors prior to
making expenditures.
An independent center or sponsoring organization that contracts with a food service
management company or commercial vendor should be aware of the procurement
provisions governing the Program as outlined in detail in the CACFP regulations [7 CFR
226.22]. Here, in brief, are those guidelines.
Independent centers and sponsoring organizations may use their own procedures for
procurement with Program funds as long as they comply with the following requirements.
•
All procurement transactions will provide open and free competition and will not
restrict or eliminate competition.
•
Institutions must maintain a written code of standards of conduct that will
govern the performance of all individuals involved with awarding and
administering the contracts that are supported by Program payments. As a
part of this code, employees, officers, or agents of the grantee may not
participate in the selection, or in the award of administration of a contract
supported by Federal funds if a conflict of interest real or apparent, would be
involved. Additionally, favors or gratuities may not be solicited or accepted to
or from parties or potential parties involved with the award.
•
Policies will be put into place to ensure that proposed procurement actions
will be reviewed by institution officials to avoid the purchase of unnecessary
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or duplicative services or items and to choose the most economical
approach.
•
Affirmative steps will be taken to utilize small and minority business when
possible. This includes but is not limited to: including these types of
businesses on solicitation lists, soliciting them when possible, dividing tasks
or quantities when possible to ensure maximum small or minority business
participation, and using the Small Business Administration and the Minority
Business Enterprise of the Department of Commerce as required. Similar
steps should be taken in support of women’s business enterprises as well.
USDA requires all procurements of $150,000 or more to be formally advertised for a
contract in accordance with regulations, unless, under certain instances, the State agency
decides otherwise [CACFP 01-2013, Federal Small Purchase Threshold Adjustment,
October 2, 2012]. State or local laws may require independent centers or sponsors to
advertise for a contract of procurement of less than $150,000. State and local laws should
be reviewed for specific requirements. State agencies may require the following when
formally advertising a contract.
•
The State agency must be notified and public announcement of the proposed
contract must be made at least 14 calendar days before the opening of bids.
The announcement must include the time and place of the bid opening and
information about obtaining a copy of the complete specification for the
proposed meal service.
•
The invitation for bid (IFB) must be clear and accurate so that all prospective
bidders have an equal chance of potentially getting the contract.
•
The IFB may not provide for liens or other monetary benefits, terms, or
conditions to be made by food service management companies or
commercial vendors.
•
The only nonfood items that can be included are those necessary for the
food service (such as straws, napkins, or packaging).
•
The bids must be opened publicly.
•
Bids totaling $50,000 or more must be submitted to the State agency for
approval.
•
The State agency must be informed which bid will be chosen. If the lowest
bid is not accepted, a justification for awarding the contract to a higher bidder
must be provided.
E. USDA Foods
The FNS provides another type of assistance (in addition to Program reimbursement)
through USDA Foods or additional cash instead of USDA Foods [7 CFR 226.5].
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USDA Foods are foods that USDA purchases or acquires in large quantities. Depending on
the season and the crops, USDA may buy or acquire beef, canned or fresh fruits and
vegetables, wheat products, peanut butter, or any number of other products. USDA then
distributes these foods to States, which in turn distribute them to schools and other
Federally-funded food programs.
Each institution has the option of receiving USDA Foods or
cash-in-lieu of USDA Foods in addition to reimbursement for
meals served. A sponsoring organization must choose either
USDA Foods or cash-in-lieu of USDA Foods for all its
sponsored facilities. The State agency will annually contact
each institution to determine its preference and will also
provide information on the types of foods that are plentiful,
how these foods are packaged, and where the foods may be
obtained. Some choose cash-in-lieu of USDA Foods because
they have determined that the available food packages are
too large for timely use or because pick up and adequate
storage would be difficult. If cash-in-lieu of USDA Foods is
chosen, a per-meal payment for each lunch and supper
served to enrolled participants will be provided in addition to
the reimbursement; sponsoring organizations will forward
these funds to their facilities along with the monthly reimbursement. This payment is
equivalent to the dollar value of the USDA Foods allotment. However, if the State agency
demonstrates that distribution of commodities to the number of institutions is difficult, the
State agency can provide cash-in-lieu of USDA Foods for all independent centers and
sponsoring organizations.
Some State agencies may allow an institution to change its choice between USDA Foods
and cash-in-lieu of USDA Foods during the fiscal year. Contact the State agency for more
information.
F. Questions and Answers
1. If an adult day care participant refuses to take most food items offered because of
limited appetite, is the meal still reimbursable?
A center has the option to implement OVS, whereby participants may decline a certain
number of food items that are offered without reimbursement (or meal cost) being
affected. However, a minimum number of items is still required to be served for
reimbursement. For example, at the lunch meal, a participant must take at least four of
the six servings offered.
2. What milk choices must be offered to adults participating in a CACFP adult day
care center?
The law requires all CACFP institutions to serve low-fat or fat-free milk, which includes
adult day care centers [42 USC 1766(g)].
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Part 5. Program Reimbursement
A. Reimbursement May be Claimed for Which Individuals?
Reimbursement for meals served to eligible adults is made to those institutions that have an
agreement with a State agency to operate the adult day care component of CACFP.
Reimbursements are paid out of Program funds made available to the State from the
USDA. Reimbursements may be paid by the State agencies directly to independent centers
or to sponsoring organizations which then reimburse or use the funds to provide food to
sponsored facilities [7 CFR 226.11(a)].
Reimbursements are based on the number of meals and/or snacks served to eligible adults
times the applicable free, reduced price, or paid rate for meals and snacks [7 CFR
226.11(c)].
B. Current Reimbursement Rates
Reimbursement Rates are based on a formula established by Congress.
How is reimbursement calculated?
State agencies calculate reimbursement for meals served and claimed by adult day care
centers by one of the following methods:
•
Actual counts. Reimbursement is based on actual time of service counts of meals
served. The number of meals, by type, served to participants that are eligible to
receive free meals, participants eligible to receive reduced-price meals, and
participants not eligible for free or reduced-price meals is multiplied by the applicable
reimbursement rate.
•
Claiming percentages. Reimbursement is based on the ratio of the number of
enrolled participants in a center in each reimbursement category, to the total of
enrolled participants in the center. That claiming percentage is applied to the total
number of meals, by type, served to participants. These percentages then are
multiplied by the assigned rate of reimbursement for each meal type.
•
Blended rates. Reimbursement is determined by adding the products obtained by
multiplying the applicable reimbursement rate of reimbursement for each category
(free, reduced-price, paid) by the claiming percentage for that category. Blended per
meal rates of reimbursement are multiplied by the total number of meals, by type,
served to participants [7 CFR 226.11(c)(5)].
C. Receiving Reimbursement
To receive reimbursement, sponsoring organizations and independent centers must submit
claims to their State agency. Claims for reimbursement must report information in
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accordance with the financial management system established by the State agency
[7 CFR 226.10(c)]. Only institutions that have an agreement with the State agency will
receive payments [7 CFR 226.11(a)].
All institutions must send the State agency
accurate monthly reports on the number of
meals served. These monthly reports are
submitted on claim for reimbursement forms.
Claims for reimbursement must be postmarked
and/or submitted to the State agency no later
than 60 days following the last day of the month
covered by the claim [7 CFR 226.10].
Remember
It is important that institutions submit
claims timely and correctly. Late claim
submission can impact prompt
payment from the State agency. If
there are any questions, contact the
State agency for assistance.
Sponsored facilities submit claims to their sponsoring organization. Sponsoring
organizations then check each sponsored center’s meal claim to ensure accuracy. At a
minimum, edit checks must verify that each facility has been approved to serve the meals
claimed and compare the number of eligible adults at each facility, multiplied by the number
of days on which the facility is approved to serve meals, to the total number of meals
claimed by the facility for that month.
If the first or last month of Program operations in any fiscal year contains 10 operating days
or less, the claim for those days may be combined with the claim for the prior or following
month. If a Program operates for more than 10 days in a month, a separate claim for that
month must be sent to the administering State agency [7 CFR 226.10(e)].
An approved for-profit center may claim reimbursement only for those months when 25
percent of the enrolled participants are Title XIX and/or Title XX beneficiaries (the 25
percent may include the sum of both) or 25 percent of those enrolled are eligible for free or
reduced-price meals. Independent centers and sponsoring organizations of for-profit
facilities must submit the percentage of enrolled participants receiving Title XIX and/or Title
XX benefits or the percentage of free and/or reduced-price enrollees for each month during
which Program reimbursement is claimed [7 CFR 226.19a(b)(6)].
D. Unallowable Claims
Meals which may not be claimed for reimbursement include those that:
•
•
•
•
•
•
•
•
Do not meet the meal pattern requirements;
Are served to participants who are not enrolled;
Are served to adults residing in residential care institutions;
Exceed the limit of no more than two meals and one snack or two snacks and one meal
served daily to each eligible participant;
Are supported by funds from Title III of the Older Americans Act of 1965;
Are served to enrolled participants who are under 60 years of age and not considered to be
functionally impaired;
Are served to enrollees under 18 years of age;
Are served to participants in excess of the authorized license capacity at any time; or
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•
Are served at a for-profit center during any calendar month when less than 25 percent of the
enrolled participants are Title XIX and/or Title XX beneficiaries or eligible for free and/or
reduced-price meals.
E. Title III Funding
Funds for meals served by adult day care centers are also available from other Federal and
State sources. The Administration on Aging of the Department of Health and Human
Services provides meal service funds to some adult day care centers under Title III of the
Older American’s Act of 1965. However, a single meal may not be supported by funds from
both the CACFP and Title III. As noted above, if a center uses Title III funds for costs
associated with a meal, the center may not claim reimbursement for that meal under
CACFP.
Title III benefits include all assistance provided under Part C of Title III of the Older
Americans Act, including USDA Foods (or cash-in-lieu of USDA Foods) authorized by the
Act and provided by the Department of Agriculture and nutrition grants authorized by the Act
and provided by the Department of Health and Human Services. An adult day care center
may use CACFP and Title III funds for different individuals’ meals within the same meal
service or for different individual’s meal services (breakfast, lunch, dinner, or snacks).
F. Processing Claims
The State agency must pay all valid claims for reimbursement within 45 calendar days after
receiving them. If an incomplete or incorrect claim is submitted, the State agency will notify
the institution, within 15 calendar days, explaining the problem and how the claim can be
corrected. If all or part of the claim is disallowed, the State agency will explain why and
provide an opportunity to appeal the decision under the fair hearing procedures. A sponsor
is required to distribute reimbursement to each facility under its sponsorship within 5
working days after receiving it from the State agency (unless the sponsoring organization
provides the meals).
G. Advance Payments
Facility Advances
Sponsoring organizations must disburse
All institutions are eligible to receive
advances to sponsored facilities within
advance payments at the State agency’s
five working days of receipt from the
discretion. These payments should
State agency.
approximate the average monthly
reimbursement. The State agency
makes advance payments available on the first of each month for estimated expenses
incurred for the rest of that month. The institutions may choose to receive all or part of the
advance payment or may choose not to receive any advance payments. The State agency
will estimate the amount of the first advance payment each fiscal year using information
such as prior year reimbursement claims and enrollment figures [7 CFR 226.6(f)(3)].
When the claim for reimbursement is submitted after the end of each month, the State
agency will compare it to the amount that was received in the advance payment. If the
advance was for more money than the claim for reimbursement at the end of the month, the
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State agency will either demand full repayment or adjust subsequent payments, including
advances [7 CFR 226.10(b)(3)].
The State agency will not advance money if it believes the institution will not be able to
submit a valid claim for reimbursement for any month. If the State agency withholds an
advance payment, it must explain why and provide the institution an opportunity to appeal
[7 CFR 226.10(b)].
H. Questions and Answers
1. Can an adult day care center request reimbursement through CACFP for a meal served
to a participant who is also receiving services through a Medicaid Nursing Home
Diversion Waiver program?
Under Medicaid waiver programs, States may elect to furnish under Medicaid a broad array of
services, including meals that are not otherwise covered. A CACFP institution may not be
reimbursed for the same meal through two separate Federal programs. However, if an adult
day care center has the flexibility to use the Medicaid funds for other expenses and use CACFP
funds for meals, which would be permissible. Benefits for the Medicaid Nursing Home Diversion
Waiver vary by State. State agencies should contact the agency that administers Medicaid in
their State for more information.
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Part 6. Recordkeeping
By keeping accurate records, institutions can ensure that they receive all the reimbursement
payments to which they are entitled. This section provides information about the types of
records that must be kept to justify reimbursement claims. Institutions must establish
procedures to collect and maintain all Program records required by the USDA and the State
agency.
A. Required Records
Institutions are required to keep the following records relating to participation in the CACFP
[7 CFR 226.15(e)]:
•
Copies of the Program application and supporting documents submitted to the State;
•
Documentation of the enrollment of each participant including information used to determine
eligibility for free and reduced price meals;
•
Documentation of the age of each enrolled participant;
•
Documentation that each enrolled participant under 60 meets functional impairment eligibility
requirements;
•
Individual plans of care for each functionally impaired participant under 59 years old;
•
Documentation that participants reside in their own homes or in group living arrangements;
•
Daily attendance rosters or sign-in sheets, or other methods with State approval, which
result in accurate recording of daily attendance;
•
Daily point-of-service meal counts, by type (breakfast, lunch, supper, and snacks), served to
center participants;
•
Daily records indicating the number of meals, by type, served to adults performing labor
necessary to the food service;
•
Copies of invoices, receipts or other records required by the State agency financial
management instruction to document:
Administrative costs claimed by the institution;
Operating costs claimed by the institutions; and
Income to the Program.
•
Copies of all claims for reimbursement submitted to the State agency;
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•
Receipts for all Program payments received from the State agency;
•
If applicable, information concerning dates and amounts of payments to sponsored facilities;
•
Copies of menus, and any other food service records required by the State agency;
•
Documentation of nonprofit food service to ensure that all Program reimbursement funds are
used to either conduct the food service or improve food service operations for the benefit of
the enrolled participants;
•
Audit resolution documentation; and
•
For sponsoring organizations;
Information and dates of each adult day care center review, any problems noted, and
the corrective action prescribed and effected,
Information on staff training session date(s) and location(s), as well as topics
presented and names of participants, and
Records documenting the attendance at annual training of each staff member with
monitoring responsibilities.
B. Record Retention
Records that support a claim must be retained for three years after the final claim for the fiscal
year. However, if there are audit findings that have not been resolved, records must be retained
until the audit findings have been resolved. All accounts and records should be made available
upon request to the State agency, the USDA, and the United States Government Accountability
Office for audit or review at a reasonable time or place. Failure to maintain required records will
result in denial of reimbursement.
C. Questions and Answers
1. Are production records required?
Production records are not required by regulation for meal and snack service, though individual
State agencies may require them. However, documentation of compliance with the meal pattern
and records of all purchases including food are required under CACFP.
2. Individual plans of care are required for participating adults who are functionally
impaired and not yet 60 years of age. Must the center maintain a plan of care for
participants, functionally impaired or not, who are 60 years or older?
Centers may have a plan of care for non-impaired participants over 60, but it is not a CACFP
requirement.
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Part 7. Monitoring
Monitoring is the process of visiting and reviewing centers. Monitoring is critical to the effective
operation of the Program. As part of the review and monitoring process, State agencies and
sponsors must provide technical assistance. This assures that participants receive nutritious
meals and that institutions receive proper financial reimbursement.
A. State Agency Monitoring Requirements
State agencies must provide technical and supervisory assistance to sponsors and independent
centers to ensure effective Program operation, monitor progress towards achieving Program
goals, and ensure that there is no discrimination in the Program.
Review Content
State agencies must assess each institution’s compliance with the requirements related to:
•
Recordkeeping;
•
Meal counts;
•
Administrative costs (for centers reimbursed on actual costs and for sponsoring
organizations;
•
Any applicable guidance issued by FNS, the USDA, or the State;
•
If applicable, facility licensing and approval;
•
If an independent center, observation of a meal service;
•
If a sponsoring organization, training and monitoring of sponsored centers; and
•
All other Program requirements.
Frequency and Number of Reviews
State agencies must adhere to the following review schedule when monitoring sponsors and
independent centers:
•
Annually review at least 33.3 percent of all institutions.
•
At least 15 percent of the total number of facility reviews must be unannounced.
•
Independent centers and sponsors of 1 to 100 centers must be reviewed at least once
every 3 years.
•
Sponsoring organizations with more than 100 centers must be reviewed at least once
every two years (these reviews must include 5 percent of the first 1,000 centers and
2.5 percent of the centers in excess of 1000).
•
New sponsoring organizations with 5 or more centers must be reviewed within the first
90 days of operations [7 CFR 226.6(m)]
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Civil Rights
Institutions also must comply with the following civil rights laws and compliance will be
monitored by the State agency:
•
Title VI of the Civil Rights Act of 1964,
•
Title IX of the Education amendments of 1972,
•
Section 504 of the Rehabilitation Act of 1973,
•
The Age Discrimination Act of 1975 and
•
The USDA’s regulations concerning nondiscrimination.
See the FNS Instruction 113, Civil Rights Compliance and Enforcement- Nutrition Programs and
Activities, November 8, 2005 and the State Agency Monitoring CACFP Handbook for details on
compliance requirements for institutions and facilities.
B. Sponsoring Organization Monitoring Requirements
Each sponsoring organization must provide adequate supervisory and operational personnel for
the effective management and monitoring of the Program at all centers under its sponsorship.
Pre-approval Visits and Training Requirements
Sponsoring organizations must conduct pre-approval visits to each center to discuss Program
benefits and requirements and ensure that the center is capable of providing the proposed meal
service. Sponsoring organizations must also conduct training on Program duties and
responsibilities to key staff from all sponsored centers prior to the beginning of Program
operations.
At a minimum training must include instruction appropriate to the level of staff experience and
duties on:
•
Program meal patterns,
•
Meal counts,
•
Claims submission,
•
Review procedures,
•
Recordkeeping requirements, and
•
Reimbursement system.
Mandatory Training
Attendance at training by key staff,
as defined by the State agency is
mandatory.
Sponsors must provide additional annual training sessions for key staff from all sponsored adult
care facilities [7 CFR 226.16(b)]
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Review Elements
Reviews must:
•
Determine whether a center has corrected problems noted on prior reviews;
•
Include a reconciliation of the center’s meal counts with enrollment and attendance
records for a five day period; and
•
Include an assessment of the
center’s compliance with
Program requirements related
to:
o
The meal pattern;
o
Licensing or approval;
o
Attendance at annual
training;
o
Meal counts; and
o
Menu and meal records.
Review Averaging
If a sponsor conducts two unannounced
reviews of a facility in one year and finds
no serious deficiencies, the sponsor may
choose not to do a third review of that
facility that year. However, the first
review in the next review year must
occur no more than 9 months after the
previous review [7 CFR 226.16(d).
Follow-up Reviews
If during a center review, a sponsoring organization finds one or more serious deficiencies,
that center’s next review must be unannounced and the sponsoring organization must initiate
the serious deficiency process [7 CFR 226.16(d)(4)(v)].
Health and Safety
If a sponsoring organization, State, or FNS finds that a center’s conduct or conditions pose a
threat to the health or safety of participating adults or the public, the reviewer must immediately
notify the appropriate State or local licensing or health authorities and take action that is
consistent with the recommendations and requirements of those authorities [7 CFR 226.6(c)(5)(i)].
If the licensing or health authorities discover a problem and suspend the center’s license, CACFP
participation will be immediately suspended.
Frequency and Type of Required Reviews
Sponsors must adhere to the following review schedule:
•
•
•
•
•
Annually review each facility three times per year;
At least two of the reviews must be unannounced;
At least one unannounced review must include observation of a meal service;
At least one review must be during each new facility’s first four weeks of operations; and
No more than 6 months may elapse between reviews.
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Sponsoring organizations must ensure that the timing of unannounced reviews is varied in a
way that would ensure they are unpredictable to the facility [CACFP 16-2011 Child Nutrition
Reauthorization 2011: Varied Timing of Unannounced Reviews in the Child and Adult Care
Food Program, April 7, 2011].
C. Corrective Action
If a participating institution has committed one or more serious deficiencies, the institution’s
executive director and chairman of the board of directors must receive a notice of serious
deficiency. The notice must identify responsible principals and individuals and must be sent to
those persons as well. The notice will specify appropriate corrective action and the time periods
for completing the corrective action for the institution and responsible principals and individuals.
If one or more serious deficiencies result in a disallowance (a determination that the institution
must repay the State for unearned reimbursements) the State must establish an overclaim. To
the extent possible and appropriate, the State must identify the person or persons responsible
for the deficiencies for the purpose of assigning financial responsibility to the responsible
principal or responsible individual, in addition to the institution. Failure to take corrective action
to fully and permanently correct the serious deficiency by the allotted time will result in proposed
termination [7 CFR 226.6(c)].
D. Appeals
A facility may appeal the proposed termination by requesting an administrative review within 15
days of receiving the notice of proposed termination. A hearing is then held by the administrative
review official, and the official must inform the State agency, the institution’s executive director,
and the chairman of the board of directors, and the responsible principals and responsible
individuals, of the administrative review’s outcome within 60 days of the State agency’s receipt of
the request for an administrative review [7 CFR 226.6(k)].
States will use guidance in the State Agency Monitoring CACFP Handbook and the Serious
Deficiency, Suspension, and Appeals CACFP Handbook for addressing issues in institution or
facility operations.
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Part 8. Acronyms and Glossary
ADA - Americans with Disabilities Act
CACFP – Child and Adult Care Food Program
CFR – Code of Federal Regulations
FDPIR – Food Distribution on Indian Reservations
FNS- Food and Nutrition Service
OVS – Offer Versus Serve
SNAP – Supplemental Nutrition Assistance Program
SSI – Social Security Income
USDA – United States Department of Agriculture
See the CACFP regulations at 7 CFR 226.2 for Program definitions. Other definitions used in this
handbook follow.
Code of Federal Regulations (CFR) – The CFR is the codification of the general and permanent
rules published in the Federal Register by the departments and agencies of the Federal
Government.
Corrective Action – This is a series of steps taken to correct a weakness or error in a
management system in order to conform to the rules and regulations for the proper
administration of the program. Corrective actions are the result of a management evaluation
review performed by the State agency in charge of the administration of the Program.
Disability – The Americans With Disabilities Act (ADA) of 1990, including ADA Amendments Act
of 2008 (P.L. 110-325), defines an individual with a disability as a person with a physical or
mental impairment that substantially limits one or more major life activities; has a record of such
an impairment; or is regarded as having such an impairment. Major life activities include, but are
not limited to, caring for oneself, performing manual tasks, seeing, hearing, eating,
communicating, etc. A major life activity also includes the operation of a major bodily function,
including, but not limited to functions of the immune system, digestive system, bowel, bladder
neurological system, etc.
Enrolled Eligible Participant – An individual registered with a center to receive day care. Any
registered individual eligible for CACFP benefits (i.e., functionally impaired or 60 years of age or
older) must be included in all enrollment counts for the purposes of determining CACFP eligibility
and receipt of program reimbursement. “Drop-in: adults who eat meals at a center but are not
registered to receive care at the center are not “enrolled.” Enter volunteers, regardless of age,
cannot be considered enrolled in the center for purposes of receiving CACFP reimbursement
unless they are actually registered at the center with an individual plan of care and meet CACFP
eligibility requirements.
Family Style Meal Service – A type of meal service that allows adults to serve themselves
from common platters or bowls of food.
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Group Living Arrangement – Residential communities which may or may not be
subsidized by Federal, State or local funds but which are private residences housing an
individual or a group of individuals who are primarily responsible for their own care and who
maintain a presence in the community but who may receive on-site monitoring.
Individual Plan of Care – Each person enrolled in the Adult Day Care program is
evaluated to determine their health and emotional needs. Once those needs have been
established, an individual plan of care is developed to meet the physical, emotional, and
social needs of the participant. For CACFP purposes, participating centers need not have
an individual plan of care for participating adults age 60 or older who are not impaired. They
must, however, have a plan for each impaired participating adult.
Meal Count – A daily count of meals served to participants by meal type.
Menus – A dated list of food, by meal type, served to CACFP participants.
National School Lunch Act (ACT) – was signed by President Harry Truman in 1946 and
established the National School Lunch Program and was later amended to establish the Child and
Adult Care Food Program.
National School Lunch Program – is a Federally assisted meal program operating in public and
nonprofit private schools and residential child care institutions. It provides nutritionally balanced,
low-cost or free lunches to children each school day.
Offer Versus Serve– Offer versus serve means that adults are offered all of the
components of the meal pattern, but are not required to take them all.
Reimbursable Meals – Meals that are served to enrolled participants at a center and that meet
USDA nutritional requirements.
Reimbursement means Federal financial assistance paid or payable to institutions for Program
costs within the rates assigned by the State agency
Respite – Temporary relief for family member(s) who are responsible for the daily care of
an impaired individual.
USDA Foods – Quantities of foods (beef, canned or fresh fruits and vegetables, wheat products,
peanut butter, etc.) distributed to organizations for consumption.
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Part 9. Resources
Below is a list of available resources including regulations, required notices, rates, and meal
service/planning guides.
CACFP Policy
http://www.fns.usda.gov/cnd/care/Regs-Policy/PolicyMemoranda.htm
CACFP Required Meal Patterns
http://www.fns.usda.gov/cnd/care/programbasics/meals/meal_patterns.htm
Code of Federal Regulations – Child and Adult Care Food Program 7 CFR 226.6
http://www.gpoaccess.gov/cfr/
Dietary Guidelines for Americans
The Dietary Guidelines for Americans are the cornerstone for Federal nutrition policy and
nutrition education activities.
www.dietaryguidelines.gov
Food and Nutrition Service (FNS)
The Food and Nutrition Service administers the Child and Adult Care Food Program on the
Federal level.
www.fns.usda.gov
FNS Instructions
FNS Instruction 113-1, Civil Rights Compliance and Enforcement- Nutrition Programs and
Activities, November 8, 2005
http://www.fns.usda.gov/sites/default/files/113-1.pdf
FNS Instruction 783-9, Rev. 2., Family Style Meal Service in the CACFP, May 3, 1993
[Attached]
Application for Free and Reduced-Price Meals
http://www.fns.usda.gov/cnd/care/Benefit_Forms/Translations.htm
MyPlate
MyPlate was developed as an effort to promote healthy eating to consumers. The MyPlate
symbol is easy to understand and it helps to promote messages based on the 2010 Dietary
Guidelines for Americans.
www.choosemyplate.gov
National Food Service Management Institute
The National Food Service Management Institute (NFSMI), part of the School of Applied Science
at The University of Mississippi, offers in-person training at little or no cost and free online
courses designed to support the professional development of child nutrition program and
child/adult care personnel at all levels of responsibility. The Institute also delivers free training
resources managers can use to train their staff.
www.nfsmi.org
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Reimbursement Rates which are updated and issued each July 1
http://www.fns.usda.gov/cnd/care/ProgramBasics/Payments/Rates.htm
State Agency Contact Information
www.fns.usda.gov/cnd/Contacts/StateDirectory.htm
Team Nutrition
Team Nutrition is an initiative of the USDA Food and Nutrition Service to support the Child
Nutrition Programs through training and technical assistance for food service, nutrition education
for children and their caregivers, and school and community support for healthy eating and
physical activity. Users can download recipes, activity sheets and other nutrition related materials.
http://teamnutrition.usda.gov/
The Healthy Meals Resource System
The Healthy Meals Resource System is an online information center for USDA Child Nutrition
Programs (CNP) and has been delivering resources to CNP staff since 1995.
http://healthymeals.nal.usda.gov
CACFP Handbooks
FNS guidance will be consolidated into subject-specific Handbooks and issued on the FNS
website.
•
Management Plans and Budgets
•
Serious Deficiency, Suspension, and Appeals
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Memoranda Issued by FNS Relating to the
Adult Day Care Component
of the CACFP
October 2, 2012
CACFP 01-2013 Federal Small Purchase Threshold Adjustment
August 7, 2012
CACFP 21-2012 Adult Day Care Center Eligibility and Licensing/Approval
August 7, 2012
CACFP 20-2012 Participant Eligibility in the Adult Day Care Component of
the Child and Adult Care Food Program
July 24, 2012
CACFP 18-2012 Tribal Participation in the Child and Adult Care Food
Program and the Summer Food Service Program
April 7, 2011
CACFP 16-2011 Child Nutrition Reauthorization 2011: Varied Timing of
Unannounced Reviews in the Child and Adult Care Food Program
January 14, 2011
CACFP 07-2011, Permanent Agreements in the Summer Food Service
Program and the Child and Adult Care Food Program
August 3, 2011
CACFP 25-2011 Translations for the Free and Reduced Price School Meals
Application and Child and Adult Care Food Program Meal Benefit Income
Eligibility Form
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Part 10. Additional Food and Nutrition Programs for Older Americans
USDA has a variety of programs that can help the elderly meet their dietary needs and stretch their
food budgets. USDA in partnership with the Department of Health and Human Services also
maintains the Dietary Guidelines for All Americans, including a special guide for older adults. The
following programs and resources are available to the elderly.
A. Federal Government Programs for Seniors
Commodity Supplemental Food Program
http://www.fns.usda.gov/fdd/programs/csfp/
The Commodity Supplemental Food Programs (CSFP) is a Federally funded program, which works
to improve the health of low-income pregnant and breastfeeding women, other new mothers up to
one year postpartum, infants, children up to age six, and elderly people at least 60 years of age by
supplementing their diets with nutritious USDA commodity foods. It provides food and
administrative funds to States to supplement the diets of these groups.
State Agencies on Aging and Indian Tribal Organizations may choose to receive part or all of that
support in the form of USDA foods.
The USDA foods portion of NSIP is funded through a transfer of funds from AoA to the Food
Distribution Division.
To apply for commodity foods under the Food Distribution Programs, please contact the State
Distributing Agency in your State which administers this Program at:
http://www.fns.usda.gov/fdd/contacts/sdacontacts.htm.
Dietary Guidelines -- Materials for Older Americans
http://www.health.gov/dietaryguidelines/dga2005/toolkit/default.htm#older_adults
This is a section within the Dietary Guidelines for Americans Toolkit for Health Professionals
collection of materials housed with the Dietary Guidelines for Americans on the Health And Human
Services Website. It includes many nutrition handouts specifically geared toward older adults and
would make excellent companion pieces to nutrition assistance program materials.
Nutrition Services Incentive Program (NSIP)
http://www.fns.usda.gov/fdd/programs/nsip/
The Older American’s Act (OAA) Nutrition Programs are administered by the U.S. Department of
Health and Human Service's (DHHS) Administration on Aging (AoA).
Under Section 311 of the OAA, the Nutrition Services Incentive Program (NSIP) rewards State
agencies on Aging and Indian Tribal Organizations that efficiently deliver nutritious meals to older
adults.
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Senior Farmers’ Market Nutrition Program
http://www.fns.usda.gov/wic/SeniorFMNP/SFMNPmenu.htm
The Senior Farmers' Market Nutrition Program (SFMNP) awards grants to States, United States
Territories, and Federally-recognized Indian tribal governments to provide low-income seniors with
coupons that can be exchanged for eligible foods (fruits, vegetables, honey, and fresh-cut herbs) at
farmers' markets, roadside stands, and community supported agriculture programs. The majority of
the grant funds must be used to support the costs of the foods that are provided under the SFMNP;
State SNAP agencies may use up to 10 percent of their grants to support administrative costs.
Supplemental Nutrition Assistance Program
http://www.fns.usda.gov/snap/
The SNAP provides financial assistance for food purchasing to low- and no-income people and
families living in the U.S. SNAP is the Federal name for the Program (formerly known as Food
Stamps); though some State Programs may have a different name.
B. Research
USDA produces research studies each year that have to do with Program usage and
characteristics, evaluations of pilot and demonstrations projects and other analysis. This research
often includes the elderly as a focus. All FNS research projects can be found on the FNS Office of
Research and analysis’ website:
http://www.fns.usda.gov/ora/.
C. Partner Resources
USDA partners with many organizations – such as other Federal agencies and nonprofit
organizations – that are working to improve the lives of elderly and disabled individuals. The
following are a few of our partners that have many programs, projects and initiatives that help
connect people to resources, raise funds to support the elderly and increase awareness about their
needs. For more information about forming partnerships, please see the Partnerships section of the
SNAP Outreach Toolkit at:
http://www.fns.usda.gov/snap/outreach/tool-kits.htm.
Department of Health and Human Services/ Administration on Aging (AOA)
http://www.aoa.gov/
Among many other important resources, AOA’s website includes:
•
Grant programs that fund projects for the Aging Network here:
http://www.aoa.gov/AoARoot/Grants/index.aspx.
•
Off-site resources for older adults caregivers and professionals
http://www.aoa.gov/AoARoot/Elders_Families/index.aspx
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•
The eldercarelocator, a locator that connects older adults and their families to local
services:
http://www.eldercare.gov/Eldercare.NET/Public/Index.aspx.
•
Aging and Disability Resource Centers (ARDC).
http://www.aoa.gov/AoAroot/AoA_Programs/HCLTC/ADRC/index.aspx
National Council on Aging (NCOA)
http://www.ncoa.org/
NCOA focuses on the following core areas: Improving Health, Enhancing Economic Security,
Promoting Independence and Dignity, and Strengthening Community Organizations.
NCOA’s website includes a link to Benefits CheckUp, a one stop benefits screening service, which
can be found here:
http://www.benefitscheckup.org/.
National Association of Area Agencies on Aging (N4A)
http://www.n4a.org/
N4A advocates on behalf of Area Agencies on Aging and about aging issues in general. They also
provide training and technical assistance to a national network of 629 Area Agencies on Aging and
246 Title VI programs.
AARP Foundation
http://www.aarp.org/aarp-foundation/
The AARP Foundation works to end poverty among the elderly in the United States. Grant
opportunities are often listed on their website – some of which include funding for anti-hunger
initiatives.
One of AARP’s current focus areas is hunger and the Foundation has an initiative called “Drive to
End Hunger” which raises money to fight hunger among the elderly in partnership with NASCAR
driver Jeff Gordon:
http://drivetoendhunger.org/.
D. Additional Resources
The following web sites provide additional information relevant to all aspects of adult day care and
nutrition and can be considered another valuable resource in caring for adults in need.
National Council on Aging:
www.ncoa.org.
National Aging Information Facility:
www.aoa.dhhs.gov/NAIC.
National Adult Day Services Association:
www.nadsa.org.
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National Respite Network and Resource Facility:
www.archrespite.org.
USDA, Food and Nutrition Service:
www.fns.usda.org.
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Adult Day Care Handbook
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| File Type | application/pdf |
| Author | Sarah Powers - ICF |
| File Modified | 2022-03-18 |
| File Created | 2021-07-06 |