An amendment to the subsidy Agreement must be completed if the adoptive parent(s) or guardian(s) request residential services. The amendment must be signed by the Authorized Signature of the Department of Social Services before residential services may begin and payment for such services made.
Any time the subsidy worker receives a request to place a child in residential treatment, the worker shall make a referral to IIS as an attempt to divert placement out of the home. This is to be treated as any other IIS case, and to be paid for out of county funds. If the IIS intervention is unsuccessful, or the parent(s)/guardian(s) refuse to use IIS, the worker is to begin working with the family towards other alternatives such as the use of community resources or residential treatment.
Community resources are to be researched by the parent/guardian, with assistance from the worker, and efforts documented, prior to making a residential treatment referral. The worker shall notify the parent(s)/guardian(s) of services that are available within the community which might prevent the child from being removed from their community and being placed in residential treatment. The worker shall ensure the parent(s)/guardian(s) tried to access these services before seeking residential care.
The worker may complete the Initial Referral – Residential Subsidy (CD-233) form with the parent(s)/guardian(s) in order to evaluate the child’s need for residential services. This is an optional form staff may use to help guide the discussion with the family during an initial meeting regarding residential services.
The parent(s)/guardian(s) must complete the Residential and Specialized Placement Referral, CS-9, with the assistance of the worker. Documentation of the child’s condition from appropriate professionals (psychological, psychiatric, etc.) is required and must be obtained by the parent(s)/guardian(s).
The CS-9 must be sent through the appropriate channels to the Authorized Designee for ASRT approvals in the region. The Authorized Designee will determine the child’s need for residential treatment; the level of care needed, and assist the parent(s)/guardian(s) in obtaining a residential treatment facility for the child in close proximity to their home to allow involvement by the parent(s)/guardian(s) in the child’s treatment.
The Adoption and Guardianship Subsidy Residential Referral (CD-302) must be completed, signed by the Authorized Designee, and included as supporting documentation when submitting an initial subsidy contract, amendment, or attachment that includes a request for residential services.
The parent should be provided with a letter of approval indicating the amount which will be paid. The parent/guardian is responsible for making arrangements for actual placement into the residential facility. The letter to the parent(s)/guardian(s) should also include information as a reminder that:
- Residential level changes require a new approval.
- Documentation provided by the facility on behalf of the parent/guardian must support the level being requested and be no more than 90 days old and include an estimated discharge date and prognosis, a monthly treatment summary, why a continued need for residential respite exists, and a description of parental involvement with the facility/treatment plan.
Once a child has been approved for residential treatment and it is on the subsidy contract, the worker will no longer refer the family to FCS unless there has been CA/N or significant needs to warrant an FCS case. Staff should consult with their supervisor.
Once the child has been placed, the worker may complete an initial home visit with the family as best practice, to gather information from the family about the child, their experiences, etc. If the worker is unable to complete a home visit, they will communicate with the family by phone or email. Monthly home visits may occur if the family and worker feel it is beneficial.
Monthly meetings are expected to keep the family engaged and accountable. Meetings may be provided and facilitated with the residential treatment team. Both parent(s)/guardian(s) and subsidy workers will participate. These can be held in conjunction with the facility’s treatment team meetings, or be held separately if a treatment team meeting isn’t held that month. These can be done in person or by conference call.
Staff may use the Ongoing Meetings – Residential Subsidy (CD-232) form to document the progress of the child and family. This form is to help guide discussions regarding the progress of the child and transition back into the home. Staff should document all communication via Case Member screen using the active case number.
Subsidy may be authorized for the cost of residential treatment at the level determined by the Authorized Designee. As with all services, payment for residential treatment will not be made until the service has been approved by the Authorized Signature of the Department of Social Services and shall not be backdated
Payment for these services must be made under the terms of the contracts the Division has with Missouri providers. Whether in state or out of Missouri, the Missouri contract rate will apply. Placements for children who are residents of Missouri will only be sought with Missouri residential facilities or facilities in bordering states because of the proximity to the adoptive home, or when the necessary treatment cannot be provided by a Missouri facility.
Residential placements may be authorized for only six months at a time. Upon the sixth month, the documentation supporting the need for placement and level of care must be reviewed in a family meeting and the documentation provided to the Authorized Designee. The meeting should consist of the family, child, worker, supervisor, facility and any other persons involved in the treatment of the child. These reviews, along with the approval of the Authorized Designee, are to be submitted to Central Office with the amendment indicating a continued need for funding for residential treatment. No payment should be made until the amendment is approved by signature of the Authorized Signature of the Department of Social Services and approval should be given at least 30 days prior to expiration of the prior amendment to avoid any interruption in services.
Requests for out-of-state residential treatment are to be reviewed by the Residential Service Manager in consultation with Central Office, if necessary. The Residential Service Manager must have already determined a level of care. Residential treatment will be reimbursed at the rates of contracted providers located within Missouri.
When using out-of-state residential or Missouri non-contracted facilities, the worker is to contact the Residential Service Manager in order to request that a child-specific-contract be sent to the vendor. The worker and the Residential Service Manager are to work together with the vendor in order to negotiate the monthly rate. Contract Management Unit (CMU) are available for technical assistance while completing this process.
Out-of-state providers being utilized for families who reside out of state must have a child-specific contract with the Division in order to receive payment. The provider must submit a child-specific contract to the CMU for negotiation.
Update the Alternative Care Client Information screen in FACES new placement by leaving the adoptive parent(s)/guardian(s) Departmental Vendor Number (DVN) and placement type, but entering the sub-placement code of “S”, and changing the maintenance code to no maintenance. In the sub-placement type indicate the residential facility where the child is residing.
In certain circumstances use may be made of residential treatment services which are not currently covered by a contract with the Division. A contract must be developed between the facility and the Division by the facility, proposing a child-specific contract regarding the proposed care for the child. Payment shall not be made directly to the adoptive parent(s) or guardian(s).
In the case of children attending different school districts, the school district where the parent(s)/guardian(s) reside should be charged for any special education services needed.
The subsidy worker shall meet with the adoptive or guardianship family to discuss the child’s needs while in residential treatment, and explore the possibility of reducing the maintenance payment while the child is in treatment determining only the amount necessary while the child is in residential care (i.e. toiletries, clothing, and travel for visitation and therapy.) If the family agrees to suspend maintenance while the child is in the facility, this should be indicated in the narrative of the subsidy file and the maintenance code should be changed to no maintenance.
According to federal policy (ACYF-CB-PA-O1-01) the agency cannot lower an adoptive family’s amount of maintenance without the family’s concurrence. If the family does agree to lower their maintenance, this is to be documented in the narrative section of the subsidy record and the reduced amount indicated on the alternative care client information record.
If the family is unwilling to be a part of this process and has no desire for the child to be returned to their home, residential treatment may not be authorized through subsidy and the subsidy worker is to discuss other permanency options with the family. If the child enters the custody of the Children’s Division, the Division will pursue child support from the adoptive parent(s)/guardian(s).
Day treatment services may be considered on a child-specific, time-limited basis. Adequate documentation must support the need for day treatment. The adoptive or guardianship family must first inquire as to the ability of their private insurance to pay for all or part of this treatment prior to the agency approving this service through subsidy. In addition, a self-referral to the Department of Mental Health (DMH) may be appropriate to determine if they can assist in funding any or all of the day treatment services. Based upon their assessment, DMH may be able to provide services to the family which are not available through the Division. Services may only be approved for up to six months at a time, and a family meeting must occur.
Related Practice Alerts and Memos:
7-1-19 – CD19-52 – FY20 Rate Increases
12-4-19 – PA19-AD-06 – Transitional Living Placements and Subsidy Agreements
1-10-20 – PA20-AD-01 – Legal Fees for AD and LG Subsidies
10-29-2020 – PA20-AD-06 – Child Summary
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