All children who are adopted or children who are placed for legal guardianship with an eligible relative or qualified close nonrelated person through the Children’s Division are eligible for the following basic subsidy services:
Maintenance (daily living expenses including room and board, clothing and incidentals) at standard rate to age 18.
At the time of placement, no payment may exceed the maintenance rate paid if the child had remained in out-of-home care, even when used in combination with other benefits available to the child. Standard maintenance Agreements should be written to expire on the last day of the month of the child’s 18th birthday. Medical and Youth with Elevated Needs-Level A maintenance are approved according to the Above Base Maintenance Section in this chapter.
At the time of placement, the amount paid is determined by information obtained from the family as to what financial assistance they need to meet the needs of the child and the resources available to the child such as OASDI, VA or SSI, etc.
The purpose of maintenance is to contribute toward those items as defined in Section 4 Chapter 11 (room and board, clothing and incidentals). The definition of maintenance should be explained to the adoptive or guardianship family at the time of negotiation of a new subsidy.
In the event that a child becomes eligible for OASDI due to the adoptive parent’s /guardian’s disability after adoption or guardianship, the family may receive both.
MO HealthNet coverage to meet the healthcare needs of the child to age 18 or maximum of age 21 on a yearly negotiated 18 and above Agreement.
A child, eligible for adoption subsidy IV-E, adoption subsidy-HDN, SSI, or guardianship subsidy is automatically eligible for MO HealthNet within the policy and procedural requirements of this program. This eligibility is included in the Agreement. Services covered by MO HealthNet do not require special approval in the service section of the Agreement. <p”>In the MO HealthNet program, a child who has an adoption/legal guardianship subsidy monthly maintenance payment may be eligible for a MO HealthNet vendor payment (which includes daily living expenses and an allowance for personal incidentals). Vendor payments are made to a facility providing 24-hour care, such as a regional diagnostic center, nursing home, convalescent center, etc. If so, the maintenance payment from adoption/legal guardianship subsidy will be counted against the MO HealthNet vendor payment on a dollar-for-dollar basis. It is to the family’s advantage to allow MO HealthNet to use the entire vendor payment and drop maintenance from the Agreement. Families may have expenses relating to support of a child’s placement in a MO HealthNet contracted facility. These may be negotiated and included in the Adoption Subsidy Agreement, CD AD, or the Subsidized Guardianship Agreement, CD SG as a special expense to support the family relationship.
Payment will not be made from Division funds to supplement payment made from MO HealthNet, except in certain extreme circumstances, determined on a case-by-case basis.
Important MO HealthNet procedural requirements include:
A Third Party Resource Form, TPL-1, must be submitted to MO HealthNet Division (MHD) by the worker as soon as the child is eligible for coverage under the adoptive parent(s) or guardian(s)’ private insurance. The information needed for this form is located on the family’s insurance card.
The child’s inclusion in the family’s private insurance will usually occur at the time of the final decree of adoption or granting of the guardianship. Some policies may exclude eligibility for the child with a pre-existing condition. In this instance, the child’s needs will be covered by MO HealthNet within the limitations of this program.
Families are not required to add their adopted or guardianship children to their private insurance, although it is encouraged. Payment for an insurance premium as prescribed by their private health insurance plan is the responsibility of the adoptive parent(s)/guardian(s). Medicaid can be used as the secondary insurance. However, non-Medicaid services are the responsibility of the adoptive parent(s)/guardian(s).
If a family has added the adopted or guardianship child to their private health insurance, they must use their private health insurance, if the child is covered in their policy, before using MO HealthNet. However, the family must indicate to the provider that the child is also eligible for MO HealthNet. Showing the card and informing the provider of MO HealthNet eligibility should prevent the provider from charging for services above the MO HealthNet rates.
Providers will bill the adoptive parent(s)’ or guardian(s)’ insurance company for payment before they bill MO HealthNet for payment. If full payment is not made by the private insurer, MO HealthNet may be billed. MO HealthNet will then pay any balance of service charges within their allowable rates for the specific service. If a balance of charges remains, the provider may not bill the adoptive parent(s)/guardian(s) for the service, except in certain allowable circumstances.
Adoptive parent(s) and guardian(s) should be made aware of the HIPP-Health Insurance Premium Payment Program through the MO HealthNet Division. This program pays the cost of health insurance premiums, coinsurances and deductibles. The program pays for health insurance for MO HealthNet eligible persons when it is cost effective for the state. Information about this program or the HIPP-1 application may be obtained from Family Support Division, or by calling the HIPP Unit at (573) 751-2005. You may write to them at:
Third Party Liability Unit
HIPP Section PO Box 6500
Jefferson City, MO 65102-6500
MO HealthNet providers must be utilized whenever possible. The Division acknowledges that specific circumstances/conditions may arise that require payment to be made for care not covered by MO HealthNet.
Medically necessary orthodontic services when a MO HealthNet provider is not geographically accessible (over 100 miles round trip), or not paid entirely by private insurance may be included in an Agreement and approved up to the amount MO HealthNet would pay for the same service. These approvals are obtained through a prior approval process through the MO HealthNet Division and a MO HealthNet consultant. The MO HealthNet consultant must review and certify requested services as eligible for prior approval to be given. If prior approval is not obtained prior to the orthodontic treatment being completed the family will be financially responsible for treatment costs.
The following information is required for prior approval through a MO HealthNet consultant in the approval of orthodontia:
- A statement from the Orthodontist recommending the procedure and providing the following information:
- Orthodontic records that consist of cephalometric x-ray, panoramic x-ray or full-mouth survey in addition to dental study models, properly occluded and trimmed; and
- 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;
- Documentation regarding the lack of accessible MO HealthNet orthodontic providers within the area where the family resides;
- A letter from a Physician which indicates the treatment is medically necessary; and
- Documentation of all other sources explored: the family’s insurance and community resources.
This information should be sent to the Adoption/Guardianship Program Development Specialist in Central Office, who will review the packet of required information and if all required documentation has been submitted, will forward the packet to MO HealthNet Division. If the required documents are not enclosed, the packet will be returned to the worker.
The MO HealthNet Division will have the information reviewed by the State Orthodontic Consultant, who will determine if the procedure is medically necessary and would be reimbursable through MO HealthNet, if a MO HealthNet provider were available. Notice of this review and the consultant’s worksheet, will be sent back to local staff.
If the request for orthodontics is denied, the orthodontist may bill for an office visit, x-rays, and diagnostic casts. These costs may be approved for reimbursement by amendment to the subsidy Agreement.
If the request for orthodontics is approved, the amount indicated as acceptable through the MO HealthNet program and as indicated on the consultant’s worksheet may be added to the subsidy Agreement by amendment.
Families should be advised that “Orthodontics is only for the most handicapping malocclusions. A handicapping malocclusion is a condition that constitutes a hazard to the maintenance of oral health and interferes with the well-being of the patient by causing impaired mastication, dysfunction of the temporomandibular articulation, susceptibility to periodontal disease, susceptibility to dental caries and impaired speech due to malposition of the teeth.”
“Assessment of the most handicapping malocclusion is determined by the magnitude of the following variables: degree of malalignment, missing teeth, angle classification, overjet, overbite, openbite and crossbite.”
NOTE: Requests for services for cosmetic purposes will not receive approval.
Emergency care not covered under MO HealthNet or private insurance which is less than $500.00 may be included on an amendment to the contract without prior authorization.
The evaluation and recommendation of MO HealthNet Division must be secured for charges over $500.00. This approval is obtained by submitting the invoice and treatment summary to the Adoption/Guardianship Program Development Specialist in Central Office who will forward the information to the MO HealthNet Division for review, evaluation and recommendation. Upon receipt of the recommendation, the local office will be notified and if approved the amount may be included on an amendment to the Agreement and approved by the Division Director.
Child Care to age 13 as long as both parent(s)/guardian(s) or the single parent/guardian is working.
Child Care Services are regulated by Early Childhood and Prevention Services. Child care policy is available at the Child Care Policy Manual Web site on the Children’s Division Intranet.
A subsidy Agreement may include childcare services as a part of the basic subsidy package for children up to age thirteen (13) when both parent(s)/guardian(s) are working. Childcare is to be included on the Adoption Subsidy or Subsidized Guardianship Agreement as service code DAYC. In the maximum amount box the words, “State Contracted Rate” are to be entered. In the explanation section the statement, ”Childcare may be approved at the state contracted rate to age 13 when both parents/guardians are working. Payment may only be made to licensed/contracted or registered providers” must be included.
Due to the extreme needs of some children covered by subsidy agreements, exceptions may be made for childcare payment authorizations for children over age 13, and outside the eligibility of approval for childcare through the Office of Early Childhood. These requests will be considered on a case-by-case basis. Requests for exceptions must be sent to the Adoption/Guardianship Program Development Specialist in Central Office accompanied by verification of the child’s special need, which includes a statement from a physician or mental health professional explaining why childcare is required. A statement regarding the parent(s)/guardian(s) inability to locate community programs to assist with supervision of the child, a statement including the hours of care needed per day/week, and anticipated duration of care shall be included in these requests.
Contracted childcare facilities receive financial incentives for providing care to special needs children. These incentives are automatically generated to the provider when a child is authorized through the SEAS system, or when a Children’s Services Integrated Payment System Invoice, CS-65, is entered using childcare service codes. These incentives and their service codes are as follows:
SPND – Special Needs. This incentive is paid whenever a child has been in the custody of the Division. All children who are adopted/under a guardianship Agreement qualify for this incentive payment if they are being cared for by a licensed/contracted or registered provider. The payment system automatically generates a payment which is 25% over the total cost for the month the child was in childcare. For instance, if the child’s total childcare bill is $300.00, the provider will automatically receive a payment of $75.00 in addition to the $300.00 they charged.
Other incentives may be available to the childcare facility based on their qualifications. These incentives will be automatically calculated into the “State contracted rate.”
Contracted services are authorized using the SEAS Request and Eligibility Form, CS-67, and SEAS Authorization Form, CS-67A, completed in the county/circuit of the child’s residence by the authorizing worker. Approval from the authorizing designee must be received.
The CS-67 and CS-67A will be completed and entered into SEAS after a provider is located and a referral completed. After entry of the CS-67 and CS-67A, both the provider and the adoptive or guardianship family will receive system-generated notifications detailing the childcare authorized.
The Services Eligibility and Authorization Provider Invoice, CS-65A, will be generated by the system directly to the provider(s) for all authorized services.
Upon receipt of the Services Eligibility and Authorization Provider Invoice, CS-65A, it will be the responsibility of the county payment designee to check the invoice for completeness, reasonableness, and accuracy.
The system will not allow payment for rates that exceed those specified in the provider’s contract.
Childcare expenses reimbursed on a Children’s Services Integrated Payment System Invoice, CS-65, for registered childcare must use the service codes ASDC (Adoption Subsidy childcare) and LGDC (Legal Guardianship Childcare) and will not be affected by the incentive payments, DISP and ACRD.
Respite services for all levels will be approved to the end of the month of the 18th birthday.
Adoptive or guardianship families may receive respite as a basic service. All paid receipts submitted for reimbursement must be submitted on the Respite Provider Payment Invoice for Adoptive/Guardianship Parents (CD-262) form within 6 months of the service being provided.
Respite units may only be approved according to the child’s level of maintenance. One unit is a time period of between 12 – 24 hours. A half unit is a time period of between 6 – 12 hours. The following eligibility rates apply:
Base Maintenance is 12 units at $25.00 per unit-maximum of $300, or $12.50 per half unit.
Above Base Maintenance is 19 units at approximately $26.25 per unit-maximum of $498.75 or additional units as approved or $13.13 per half unit. (The daily rate of maintenance they receive.
Level B respite units may only be approved for contracts that have Level B maintenance that was approved prior to July 31, 2002. Respite on these contracts is approved for 24 units at $40.00 per unit. There are no two-week vacations approved through subsidy as are available to Level B Resource Providers. Level B respite will not be approved as a new service.
Legal Attorney Fees at $100.00 per hour and court fees. In adoption cases, the maximums are up to $1,500.00 in non-contested cases, and $3,000.00 in contested cases. In guardianship cases, the maximum legal expense per guardianship is $2000 in non-contested as well as contested cases. This is a nonrecurring expense and include the entitlement of GAL fees per 453.025 RSMo.
According to 453.025 RSMo, the GAL may be awarded a reasonable fee for such services to be sent 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.
Legal fees include attorney’s fees, court costs, publication expenses, and Guardian Ad Litem (GAL) costs for the adoptive parent(s) or guardian(s) in adoption or the guardianship case filed in a court of competent jurisdiction.
The payment is intended to aid in the development, adjustment and continuity of the formation of the “new” family created by adoption or legal guardianship. Significant to the use of an adoption/legal guardianship subsidy is the realization that without this resource a family would not otherwise have the resources to provide permanency to a special needs child.
NOTE: Adoptive parent(s) may decline any or all of these services; guardian(s) may decline services as well, however are required to receive maintenance of at least one dollar.
In the event that services are declined, the parent(s) or guardian(s) must sign a dated statement indicating specifically which services they are declining. This statement is to be filed in the subsidy record and documented in the explanation section of the agreement.
Basic services declined cannot be approved at a future date. All basic subsidy services must be addressed in the explanation section in some manner.
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
Leave a Comment: