Authority for approval of any of these expenses rests with the Regional Director (of the respective service county) except when delegated or otherwise specified. All other stipulations and the need for supervisory approval should be observed. Special expenses for a Child of a Youth in Alternative Care (CYAC) child must be invoiced using the CYAC parent’s name and Department Client Number (DCN).

Medical and Dental Expenses

These expenses are not covered by the MO Healthnet/Dental Services program. All non-MO HealthNet expenses must be cleared through the Regional Office. CD will not pay any medical expense for children not in agency custody unless specific exceptions are noted in the Child Welfare Manual:

• All necessary medical care, as determined by the county office, will be allowed. Staff must ensure that the Department of Health and Senior Services (DHSS) and the the MO HealthNet Division (MHD) resources are explored, as well as any other resources before utilizing HDN funds. Staff should instruct foster parents to request physicians to use MHD approved prescriptive medicine substitutes when possible. No payment will be made for vendor charges which exceed program maximums.
• Any non-subsidy dental (including orthodontia) expense over $500.00 must be sent through supervisory channels with Regional Office approval to CD Central Office. The Program Development Specialist (PDS) responsible for receiving dental requests will review the packet of required information, and if all required documentation has been submitted, will forward the packet to MHD. If the required documents are not enclosed, the packet will be returned to the Regional Office.
• The following information is required for prior authorization and should be included in the packet sent to Central Office.
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  • A written statement secured from the orthodontist who provides the following information:
    • A diagnosis and prognosis which includes an itemized listing with the procedural codes and an estimate of the number of months treatment will be required;
    • Orthodontic records which consist of a cephalometric x-ray, panoramic x-ray, or full-mouth survey, in addition to, dental study models, properly occluded and trimmed;
    • The amount of cost for the total treatment program; and
    • A statement from a medical doctor which indicates the treatment is medically necessary for other than cosmetic purposes.
    • NOTE: Orthodontic treatment will be covered when determined medically necessary by the State Orthodontic Consultant.
• The State Orthodontic Consultant will either approve or deny the request and return the packet to the PDS. The PDS will return the information to the Regional Office for approval or disapproval. After the county has received approval from the Regional Office, a letter of agreement, which addresses the following, should be submitted to the orthodontist:
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  • The Children’s Division will be responsible for payment only when the Division has care and custody of the child and the child remains in an out-of-home setting. The Division will not pay for any treatment received under this agreement after custody is removed from the Division;
  • The Division does not pay for any services in advance;
  • A lump sum payment will be made to cover the cost of initial diagnosis, consultation, initial banding and treatment; and
  • Any charges covered by MO HealthNet shall be billed to MO HealthNet.
• The orthodontist should bill the county office after the initial banding is completed. This usually includes all material and services from the initial diagnostic visit through the placement of bands.  The amount shall be invoiced on a payment request through FACES.
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  • Children’s orthopedic shoes and the abduction rotation bar will be paid for as a special expense if it is documented that the service cannot be paid for with MHD funds:

NOTE:  Both items are covered under the Durable Medical Equipment Program if the following conditions are met.

• The recipient is eligible for Missouri Medical/Dental Services
  • The provider is a participant in the program; and
  • The orthopedic shoes are attached with a brace.

Transportation Costs

Resource providers and youth in an Independent Living Arrangement (ILA) or a Transitional Living Advocate (TLA) placement may receive mileage reimbursement for transportation costs as outlined in this section. The resource provider or older youth must complete the Travel Expense Log, CD-106, and submit it to the local CD staff for approval within thirty days (30) of the month that the trip occurred. Transportation costs will be paid at the current state mileage rate as of the date of the trip. A copy of the approved CD-106 shall be provided to the resource provider prior to sending the documents to the FACES Payment Unit.

Round Trip:  Most transportation reimbursement is based on a round trip. A round trip is leaving from point “A”, traveling to point “B” and returning to point “A” again.

Some round trips may not include the foster child being in the vehicle on the return trip, as the youth is being dropped off to be picked up at a later time. The trip to pick the youth up and return to starting point will be considered a second round trip.

For example:  A resource parent leaves from foster home to take youth to work. The youth is dropped off at the workplace and the resource parent returns home. That is one round trip. The parent later leaves from the foster home to pick up the youth from work and returns back to the foster home. This is a second round trip.

Note: Older youth in an ILA or TLA would not be reimbursed for trips in which they are not in the vehicle.

Child Specific Transportation Costs

Allowable child specific transportation costs for Alternative Care (AC) cooperative agreements, Professional Parent (PP) cooperative agreements, Respite (RS) cooperative agreements, youth in Independent Living Arrangements (ILA), youth in Transitional Living Advocate (TLA) placements, and those who are behavioral and/or medical providers to transport the foster youth include transportation to and from:

• Medical care, TRMD
• Counseling, TRMD
• Family Visits, TRAN
• Family visits, TRAN
• Court and meetings with attorneys to prepare for court activities, TRAN
• Meetings with Guardian Ad Litem, TRAN
• FST and PPR meetings, TRAN
• Respite, TRAN

Allowable child specific transportation also includes trips that are child specific to support the foster youth’s development as approved by the Family Support Team and/or case manager and supervisor.  Identification of the purpose of the trip is entered in field 12 on the CD-106.  When Other Allowable is selected in field 12, an explanation must be entered.   Reimbursement for these transportation needs shall be at a per mile rate for each mile round trip.  This applies to youth in ILA and youth in TLA placements and that are not Level B, which include providers with AC cooperative agreements, PP cooperative agreements, RS cooperative agreements or who are behavioral and/or medical providers.  The payment will be reimbursed on a PR through FACES.  The type of the supporting documentation for other allowable transportation reimbursement is identified by the worker in field 12 on the CD-106.  The location of the supporting documentation is entered in the comments section of the PR.  The name and DCN of the foster youth should be included on the supporting documentation.

Areas that support the child’s development are:

• Life skills development
• Social skills development.

Acceptable child specific transportation also includes education related transportation needs to maintain the foster youth in the school enrolled in to ensure educational stability. The FST members should work with the school to discover and arrange transportation options. All resource parents may receive reimbursement at the current state mileage rate for each mile traveled to and from the child’s school of origin for the day. Level B resource parents also may be fully reimbursed for transporting the child to his/her school of origin, disregarding the mandatory 200-mile deduction. Resource parents, however, are not paid mileage for their commute to or from their place of employment. When transporting youth to or from their school of origin involves a shared route with the resource parent’s commute to work, only the additional mileage incurred transporting the child to the school of origin may be claimed and reimbursed. Full mileage will be reimbursed if the resource parent did not report to work the day being claimed. TRED does not include transportation to school functions. 

Transportation costs for any level of care for child care services is not an allowable cost, even if such services are part of the child’s case plan.

When there is more than one youth being transported for a trip, the trip mileage must be divided between each of the youth who were on the trip.  This is a Federal, IV-E requirement. Refer to CD-106 Instructions and FAQs for examples.

Youth with Elevated Needs-Level B Reimbursement

In compliance with the Level B Cooperative Agreement, CM-8, the Level B resource provider shall provide ordinary travel which is reasonable and customary including counseling, medical, dental, daily activities and family visits.

• Trips that are over a 200-mile round trip may be reimbursed at a per mile rate for each mile over a 200-mile round trip with Circuit Manager or Circuit Manager Designee in the metro areas approval using the Travel Expense Log for Level B Foster Youth,CD107.
• For cases that require frequent approval, the determination can be made at a Family Support Team meeting that a standing approval is granted for that frequent child specific trip.  The written approval from the Circuit Manager or in the metro areas the Circuit Manager Designee is identified by their signature on the CD-107.  The PR with the CD-107 attached is submitted to the FACES Payment Unit to process for reimbursement.
• A copy of the original approved CD-107 should be attached to the subsequent CD-107 forms for the approved reoccurring trip.

For Example:  A 225-mile round trip would receive reimbursement that is the current state mileage rate x 25 with Circuit Manager Circuit Manager Designee in the metro areas approval.

NOTE: The first 200 miles of any Level B child specific trip will not be reimbursed.

Non Child Specific Costs:

Non child specific costs are entered in SAM II to generate payment.

• Transportation reimbursement will be paid to resource providers for trips to attend pre-service, after the license is approved and granted, and in-service training.  Transportation costs will be paid at the current state mileage rate as of the date of the trip using the Monthly Expense Report MO 300-1189.
• Transportation reimbursement will be paid to resource providers to attend Regional Foster Parent Advisory Board Meetings.  Transportation costs will be paid at the current state mileage rate as of the date of the trip using the Monthly Expense Report MO 300-1189.
• Transportation reimbursement will be paid to resource providers to attend Missouri State Foster Care and Adoption Board Meetings. Transportation costs will be paid at the current state mileage rate as of the date of the trip using the Monthly Expense Report MO 300-1189.
• Transportation reimbursement will be paid to resource providers to attend other meetings at the request of the Children’s Division. Transportation costs will be paid at the current state mileage rate as of the date of the trip using the Monthly Expense Report MO 300-1189.

Residential Provider Reimbursement

Residential treatment providers may receive mileage reimbursement for transportation costs as outlined in this section. The residential treatment provider will complete the Travel Expense Log, CD-107, and submit it to the local Residential Care Screening Team (RCST) Coordinator for approval within thirty (30) days of the month in which the trip occurred.

Child Specific Travel:

Allowable child specific transportation costs for residential treatment providers include:

• Medical Care
• Visits with caretaker(s), guardian(s), or less restrictive placement providers
• Court
• Family Support Team (FST) and Permanency Planning Review Team (PPRT) meetings

The residential treatment provider may be reimbursed at the standard state rate for child specific transportation over 200 miles round trip with RCST approval. The first 200 miles round trip are not reimbursable per contract and under this policy. Travel reimbursement begins on mile 201 when the single roundtrip child specific transport exceeds 200 miles. For cases that require frequent approval, the determination can be made at a Family Support Team (FST) meeting and a standing approval may be granted for that frequent child specific round trip. The approval in written form from the RCST Coordinator will be attached to the Travel Expense Log, CD-107.

Trips made with multiple foster youth in the vehicle will be reimbursed as a single trip. For example, if a 300 mile trip is made with three eligible foster youth in the same vehicle, the provider will be reimbursed 100 miles. The reimbursement should be divided among all three eligible youth in the vehicle. The provider would identify youth one as traveling 34 miles, youth two as traveling 33 miles, and youth three as traveling 33 miles.

NOTE: All transportation expenses should support the child’s specific treatment plan and have written authorization from the RCST Coordinator

Transporting a Child in Alternative Care via Airplane, Bus or Train:

A round trip is defined as leaving from point “A,” traveling to point “B” and returning to point “A.” Some round trips may not include the foster youth in the vehicle on a return trip, as when a youth is being dropped off and picked up at a later time.

Additional allowable child specific transportation trips that are intended to support the case plan may be made on a case by case situation and as approved by the FST, the RCST, and their supervisor.

All requests for tickets to transport a child in alternative care via airplane, train, or bus, must go through the Payment and Travel Unit in Central Office.  The ‘Airline or Bus Ticket Request’ form, located at Division of Finance and Administration, DFAS, should be completed and faxed to 573-751-6934.

• DCNs, full names and preferred travel dates and times must be listed on the form. All names should be as it appears on his/her photo identification (i.e. driver’s license).

Travel requests for family visits, hearings and other non-emergency situations need to be sent at least ten business days in advance, or as soon as the travel needs are known. All one-way out-of-state ticket requests for children in CD custody must be approved by the ICPC Unit at Central Office.

Emergency travel for disrupted placements also requires a ticket request form to be completed. In addition, the contact names on the form should be available to discuss travel options. Most emergency travel can be completed within an hour if local staff are available to answer questions and approve flight times.

If a caseworker is escorting the child/children, an Out of State Travel Authorization Form, located at DFAS must be completed, signed by a supervisor or Office Manager, and faxed along with the Airline/Bus Ticket Request Form.

Medical Expenses for Infants Released for Adoption at Birth

Costs will be paid if the following conditions are met:

NOTE:  Biological parents are expected, when at all possible, to meet the mother and the newborn’s hospital and medical care costs even though the child is relinquished for adoption.

• The child must be in Children’s Division (CD) custody.
• The natural parents and other resources should be contacted first to assess the ability to meet the cost of care.
• Hospital expenses for time delays between date of birth and date of custody transfer to the Division may be covered.
• The maximum allowable cost is determined by MHD guide-lines for these costs.
• All claims must be sent to the CD Deputy Director, through supervisory channels, for evaluation of cost appropriateness, and payment, if approved.

Child Care Costs for Children in Foster Family Care

• This is an allowable cost if it is deemed as a necessary part of the case plan or the foster parent needs child care due to employment, schooling, or training.
• Costs are to be paid through the use of Protective Service child care funds. Special education costs should be met by the local school district except for tutorial plans which are intended to support a child’s special education plan. Schools should be helped, as needed, to seek the assistance of the Department of Elementary and Secondary Education (DESE) in meeting the cost of a child’s special education needs.

Legal Fees

Agency payment for court costs relating to Termination of Parental Rights (TPR) hearings and adoption proceedings, including attorney fees for the birth parent, according to Administrative Rule, 13 CSR 40-30.020 Attorney Fees in Termination of Parental Rights Cases, allows the following fees:

• Any attorney shall, at the conclusion of representation be compensated at a rate not exceeding one hundred dollars ($100) per hour. Attorneys may be reimbursed, at the conclusion of the representation for expenses reasonably incurred, including the costs of transcripts authorized by court.
• The compensation to be paid for representation at trial shall not exceed one thousand dollars ($1,000) for uncontested matters and seven thousand dollars ($7,000) for contested matters.
• For representation in an appellate court, the compensation shall not exceed three thousand five hundred dollars ($3,500) at one hundred dollars ($100) per hour.
• At any time an attorney believes that the cost of representation will surpass the limits provided, they must provide notice to the Children’s Division that they may exceed the current maximum fee and this amount must be approved by the court.

Approval for payment of these costs must be received from the Regional Director or Designee by submitting the request through supervisory channels. The court must enter an order for the payment of these fees by CD before CD will pay court costs in a TPR or adoption case. Legal expenses in excess of $100 per hour shall be referred through supervisory channels to the Regional Director or Designee, who will then make the decision whether to approve or disapprove or seek consultation from Division of Legal Services (DLS) regarding the expense.

Fees of the attorney for the Juvenile Officer (JO) in a TPR action, and fees of an expert witness subpoenaed by the Juvenile Officer are not an allowable agency expense.

GAL and attorney fees in an abuse/neglect proceeding are not an allowable agency expense.

Missouri Statute, 453.020 states, “the Guardian ad Litem (GAL) may be awarded a reasonable fee for such services to be set by the court. The court, in its discretion, may award such fees as a judgment to be paid by any party to the proceedings or from public funds. Such an award of GAL fees shall constitute a final judgment in favor of the GAL.”

Exceptions to any of the above or allowances for any unusual costs for children in alternative care must be approved by the Regional Director and submitted to the CD Deputy Director, for processing.

If excessive attorney fees are ordered by the court, the worker is to send the order immediately through normal supervisory channels to the Regional Director or Designee so that a timely decision to pay fees or appeal the order may be made. Upon the decision of the Regional Director or Designee, the worker is to immediately notify DLS if the decision made is to appeal the order as a motion to appeal the order must be filed by DLS within 30 days of the court’s ruling.

Exceptions

Payment for legal costs for adoption subsidy cases must be approved by the Regional Director after submitting the request through supervisory channels using the CS-SA-2 ATT.