Nebraska DHHS uses this form when a family or provider requests a higher child care rate because of a child's special needs. The health care professional checks the qualifying conditions, gives the diagnosis, explains why the condition needs special child care accommodations or attention, and estimates how long it will last. Approved special needs rates last up to six months.
A physician, licensed or certified psychologist, or licensed mental health practitioner completes page 1 from item 1 onward and signs with printed name and specialty. The parent supplies the child's details; page 2 is completed by the DHHS resource development worker.
Download the current version from the source each time; forms change without notice.
Documentation of Special Needs for Child Care
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The conditions must be documented by a physician, a licensed or certified psychologist, or a licensed mental health practitioner. The professional enters their name, address and specialty, completes items 1 through 5 and signs and dates page 1.
The office-use section states that special needs rate exceptions are for a period of up to six months. If the child's needs continue, a new evaluation is required, which means a new CC-6 from the child's health care professional.
Eleven categories: emotional or behavioral impairment, developmental age below chronological age, movement, sensory or speech impairment, and needing assistance or equipment for hygiene, feeding or toileting, plus medical conditions needing respiratory aids or special procedures, required therapy, and medications needing assistance.