OCFP

Office

of Child and Family Policy

Department of Children and Family Services

Index No: 2001.03

Issuance Date: April 16, 2001

Origin of Request: Division of Operations and Community Services

Distribution: Department and POS staff, including Licensing staff, nurses of the Department and Purchase of Service Agencies

(X, Z, L)

Key Words: Level of Care; Specialized Foster Care; Step-Down; Treatment Foster Care

Approved by: Jess McDonald

INTERPRETATIONS

Many questions were raised during the recent statewide training on Policy Guide 2001.03 Review of Specialized and Treatment Foster Care Cases Level of Care Assessment and the new Level of Care (LOC) forms.

This document is the first in a series of interpretations that will provide answers to questions that were raised during training. Additional interpretations will be published over the next couple of months.

Important changes:

· All foster parents will receive their current rate for 2 months after a LOC review has determined that a child is ready to be stepped down. The option to slowly reduce the foster care payment over the 2 month period has been eliminated. In all step down cases, the foster care payment will remain at the current rate for these two months. The CFS 418-D Step Down Transfer Information Form must be faxed immediately to the DCFS Central Office Client Payment Unit for processing. For the 2 month transition period, the child will be moved to a traditional or relative type service code plus an unique special service fee (reason code 14/type service 0200) to equal their current payment.

· The CFS 418-D Step Down Transfer Information Form has been changed. The revised version is attached to this document. Please use this version of the form from this time forward. The forms may be ordered in the usual manner or found as a template on the SACWIS templates drive.

· There are some minor corrections to the Level of Care forms:

CFS 418:

The bottom of page 6 should read 15 business days not 10 days.

CFS 418-F- (H), Certification of Mental Health/Behavioral:

The wording 'see attached list of symptoms' on the first page should be eliminated

· Agencies can count cases that have closed or moved to permanency as part of their case numbers required for the re-reviews. For example, if the agency has two specialized cases that closed, they can count these cases toward their 25% requirement for 3/31/01. If the agency has specialized/treatment cases that have closed or achieved permanency, the agency must submit the following information to DCFS’s Central Office Client Payment Unit in Springfield (217-557-0639) regarding those cases; name of the child, child’s ID number and date the case was closed and/or achieved permanency.

Question 1. Will the LOC Worker Manual, forms, Policy Guide, and Scoring form be available in the DCFS stores?

The LOC Worker Manual, forms, and Policy Guide are available in the DCFS Chicago and Springfield stores. As with regular protocol, POS agencies in Cook County can order these documents directly from the store. However, POS agencies located outside of Cook County must contact the DCFS field office to obtain these documents. The forms are also available as DCFS templates. The forms can also be found on the DCFS web site. The web site address to access these forms is:

www.state.il.us/dcfs/com_communications_forms.shtml.

The Scoring Manual is not available in the stores. This manual was sent out in a mass mailing to all POS agencies on 2/23/01. Agencies that have not obtained the scoring manual can contact Melinda Woods-Lis at 312-814-6880.

Question 2. The question was raised that Medicaid agencies cannot bill for services provided to an unlicensed relative caregiver. With the new process outlined in the Policy Guide for unlicensed relative caregivers, will there be any problems with agencies that have a Medicaid certified specialized program?

As of 07/01/01, specialized and treatment contracts will no longer include unlicensed service codes. The new Policy Guide states that unlicensed relative caregivers who are caring for a child determined to be eligible for specialized/treatment foster care will NEVER be placed in the agency’s specialized/treatment contract. Instead these cases will stay in the agency’s HMR contract and the agency/worker will be able to request additional resources and services to meet the child’s needs. This process is outlined in the LOC Worker Manual.

Question 3. Will the LOC forms be on SACWIS?

The forms are on the SACWIS templates drive (T:) currently and are accessible for DCFS staff.

Question 4. Do DCFS LOC Reviewers need to review legacy cases between now and the end of the fiscal year?

Yes, DCFS staff need to review legacy cases as well as any other case that was in specialized/treatment foster care as of 2/15/01. However, the foster care payment on legacy cases will not be reduced regardless of the score on the CFS 418.

Question 5. Aren’t there specialized/treatment foster homes? How will these homes be impacted by the LOC revisions?

According to DCFS Rule 402, the only difference in licensing requirements between a foster parent caring for a child in traditional foster care versus a child in specialized/treatment care is the total number of children that can reside in the home at one time. However, it is true that private agencies and DCFS regions establish additional responsibilities to foster parents based on the level of the child’s needs. The Level of Care revisions further emphasize that the determination of specialized/treatment foster care is based on the child’s identified needs. All children in specialized/treatment foster care as of 2/15/01 will need to be re-reviewed on the new LOC forms. Children who do not meet the criteria for specialized/treatment foster care will need to be stepped down.

Question 6. Can a foster parent or a caseworker ask for a re-review of the LOC because they are not satisfied with the results of the LOC review?

Yes, a foster parent or caseworker has 60 days after the LOC effective date to ask for a re-review of a case. In order for a re-review to be granted, the foster parent or caseworker (whoever is requesting the review) must submit a written notice that asks for a re-review of the case along with any additional information regarding the child’s special needs. Once the 60 days has past, the foster parent or caseworker cannot ask for a re-review of a case. Instead, an entire new LOC referral packet would have to be submitted to the appropriate LOC Reviewer.

Question 7. Will the foster care payment and/or the administrative rate be reduced after a request has been made to re-review a case?

In every step down case, the foster care payment will not be reduced for 2 months after the LOC effective date; however, the change in type service code will occur immediately on the LOC effective date. If the request for a re-review is made before the end of the 60 transition period but the re-review has not been determined, the foster care payment will remain at the current level for an additional 30 days awaiting a determination through the re-review. If the foster parent is still not satisfied with the results of the re-review, an appeal for an administrative hearing can be made to appeal the decision. If the appeal request is made within 10 days of the letter that was sent to the foster parent with the results of the re-review, the foster care payment will be reinstated. Please note that if it is determined during appeals that the LOC review was correct, the Department will set up a receivable to recover the higher foster care payment that was paid to the foster parent during this time period. If the appeals process determines that the LOC review was not correct, the caregiver will be paid the higher foster care amount for anytime period the payment was reduced since the LOC effective date.

The administrative payment is decreased on the original LOC effective date. The administrative rate will not be increased unless the appeal decision reverses the LOC review. In this situation, the administrative payment would increase the date the decision was made in appeals.

Question 8. If the LOC Reviewer exceeds the 15 business day time frame to complete a LOC review after a completed LOC packet has been submitted, what will the effective date be?

Once a completed LOC packet is received, the LOC Reviewer has 15 business days to complete the review. In situations where the review exceeds this time frame, the LOC effective date will still be 15 business days from the date the completed packet was received.

Question 9. Once a LOC has been done and it is determined that the child should be stepped down, will the foster parent have exactly 60 days to transition from the higher foster care payment?

Once a LOC is completed and it is determined that the child is ready to be stepped down, the foster parent will ALWAYS receive the same foster care payment for at least 2 full months following the LOC effective date. The child must remain in the same home. This two month period will begin the month following the LOC effective date. For example, if a LOC effective date was 1/15/01, the 2 month period would begin starting 2/1/01. The foster parent would receive the higher foster care payment all of February and all of March. The payment would be automatically reduced to the appropriate level in April.

Question 10. When it is determined through the LOC review process that a child is ready to be stepped down, how will the step down occur?

The caseworker must immediately complete the CFS 418D, Child Step Down Transfer Information Form, and fax it to the DCFS Central Office Client Payment Unit in Springfield at 217-557-0639. This will be done in lieu of 906/906-1.

Question 11. Will DCFS be able to code children into the DCFS treatment type service code?

Yes, DCFS should use the type service code 0144 for children that score at the treatment level. Additional information about the use of this code will be distributed in the future to the regions.

Question 12. What type of review must be done for cases that fall into the 0103 type service code?

All cases that fall into the 0103 type service code must be reviewed with the new LOC forms by 4/30/01. Those cases that are determined to score at the specialized level should be stepped up. Those cases that do not score at the specialized level will be reviewed by the Director’s Office in Springfield. The completed CFS 418 for these cases along with a brief description of the case should be sent to:

Director’s Office: Level of Care

DCFS

406 E. Monroe Street – Station #70

Springfield, IL 62601

The Director’s Office will notify the caseworker and the Central Payment Unit of the disposition of the review. The Payment Unit will make all system changes (for example 906/906-1 and CM 18 update).

Question 13. In addition to the 906, does any case being approved at the specialized/treatment rate also needs to have pages 5 and 6 of the CFS 418 submitted to the 906 unit?

Yes, the 906 for specialized/treatment foster care will not be entered with a specialized or treatment type service code unless pages 5 and 6 of the CFS 418 are faxed to the 906 unit. Workers should contact the appropriate 906 hotline and then follow the call with the fax of page 5 and 6 of the CFS 418 form. The fax numbers are listed below:

All of Cook County: 312-808-4315

Northern region in the Aurora sub region: 630-801-3472

Northern region in the Rockford sub region: 815-967-3737

All of Southern region: 618-583-2141

Central region in the Peoria sub region

and all POS : 309-693-2582

Central region in the Springfield sub region: 217-786-6771

Central region in the Champaign sub region: 217-278-5557

Question 14. Will caseworkers/supervisors receive a tickler report regarding the LOC re-reviews?

Yes, caseworkers/supervisors will receive a tickler report 3 months, 2 months, and 1 month prior to the LOC score expiring. DCFS will also be tracking those cases that have their LOC expire.

Question 15. Will any of the LOC forms be printed in Spanish?

Yes, the caregiver reports will be printed in Spanish. These forms should be available in the DCFS stores within the next couple of weeks. Workers can use the Spanish version of the forms when working with the foster parents; however, they will need to transfer the information to the English version before submitting it to the LOC Reviewers.

Question 16. Will LOC Reviewers state on page 5 of the CFS 418 which type service code should be used on the 906 for cases determined eligible for specialized/treatment foster care?

The LOC Reviewers will list all appropriate codes for specialized and/or treatment foster care. From the type service codes listed, the agency (DCFS or POS) will need to determine which type service code applies to their type of contract. For example, Medicaid certified agencies would choose the Medicaid type service code.

Question 17. The Worker Manual states something different from the Certification of Medical/Physical Special Needs in regards to who can complete this form. Who can complete this Certification?

The Certification for Medical/Physical Special Needs must be completed by a MD if the child is currently not in specialized/treatment foster care and the agency is requesting this level of service. A RN supervised by a MD can complete this form on all re-reviews. The RN completing the Certification cannot work directly for DCFS or a Private Agency. The RN and/or MD should be located at the clinic/hospital that the child is receiving care for his/her medical/physical condition.

Question 18. If a case is stepping down from a higher level to a lower level does the regional 906 unit need to be contacted?

No, on ALL step down cases the caseworker must immediately complete the CFS 418D, Child Step Down/Transfer Information form and fax it to the Central Payment Unit at 217-557-0693. The CFS 418 D is completed in lieu of a 906/906-1. The regional 906 unit does not need to be notified in these situations.

Question 19. Is there any way that workers can get verification from the Central Payment Unit that they received the CFS 418D?

Yes, the CFS 418D form has been changed so that it includes a line for the Central Payment Unit to sign indicating they received and completed the work on the form. Once it is signed, the CFS 418D will be faxed back to the caseworker. The CFS 418D has also been changed so that the caseworker and foster parent must sign the form.

Question 20. Since the CFS 418D can be used in lieu of a 906/906-1, does the small print listed on the 906 that states the placement agreement also need to be added to the CFS 418D form?

No, it will not be necessary to have the small print on the CFS 418D form because the previous 906/906-1 will still be in effect for the placement.

Question 21. When a child in an unlicensed caregiver’s home is approved for specialized or treatment by the Director’s Chicago Office, who will send the CFS 418 Level of Care form to the Central Office Client Payment Unit for entry in lieu of the 906/906-1?

The Director’s Chicago Office will send the CFS 418 along with an approval letter to the caseworker and the Central Payment Unit. The caseworker will be responsible for relaying this information to the caregiver. The CFS 418D Step Down/Transfer form is not needed in these situations.

Question 22. When a child is approved by the Director’s Chicago Office for specialized/treatment foster care and the agency does NOT have such a contract, who will send the CFS 418 to the Central Payment Unit for entry in lieu of a 906/906-1?

Question 23. Will those agencies that have a specialized/treatment contract but don’t have a HMR/Traditional contract be given one so that they can step down children from their specialized/treatment contract?

There are a few agencies that currently do not have a traditional/HMR contract but do have a specialized and/or treatment contract. These agencies will be given the opportunity to have a small performance contract this fiscal year. These agencies will not be put on rotation to obtain new cases; however, they will be able to serve cases within their agency that are stepping down to a less intense level of service.

Question 24. For POS cases, will special service fees (reason code 14/0200 type of service fee) be paid by DCFS or will the POS agency be asked to fund them?

DCFS will pay special service fees to unlicensed caregivers directly. The special service fee for licensed foster parents will be paid to the POS agency and then passed on to the foster parent. The child will be placed in the appropriate contract depending on the level of care determination

Question 25. Does a LOC need to be done when a child is stepping down from I/GH?

This answer depends on where the child is going upon discharge. If the child is going to a foster care placement, the monitoring caseworker (most often DCFS) must complete the LOC referral packet before the search for a placement begins. The child will not be able to step down to specialized/treatment foster care unless the LOC has been completed and approved by the DCFS LOC Reviewer. If the child is not stepping down to foster care then the LOC does NOT need to be done.

Question 26. Does a LOC re-review need to be completed during this special review process (2/15 – 6/30) before a child in specialized/treatment foster care is transferred to another agency?

Yes. Between now and the end of this fiscal year all children that were in specialized/treatment foster care as of 2/15/01 must be re-reviewed with the new LOC forms and process. Agencies should not accept one of these cases as a transfer unless the LOC has been re-reviewed. If a transfer does take place without the LOC re-review being completed, the receiving agency will then be responsible for conducting the re-review and depending on the results of the LOC review, may need to step the case down.