Chapter IV, Section 2, Family And Children’S Services

FOSTER CARE PER DIEM RATES POLICY

The foster care rate structure is designed to give foster parents flexibility and autonomy to decide how to spend money for the children in their home. Social worker approval will not be necessary for services included in the per diem. The foster parent will not need to submit receipts or other documentation except for clothing documentation.

PER DIEM RATE SCHEDULE BASIC ADVANCED DEGREE Regular Foster Care Birth – 11 $19.70 $21.90 N/A 12+ $21.70 $23.90 N/A Emergency Shelter Home $30.00 N/A N/A Family Treatment Home $37.00 $42.00 N/A Medically Fragile $37.00 $42.00 $45.00

COVERAGE OF RATE

These foster care rates include the costs of housing, food, clothing, incidentals, personal allowances, haircuts, respite care, routine babysitting, non- medical transportation, sports/activities, and school supplies.

FOSTER CARE ThisRATE rate methodologMETHODO y isLOGY based on the 100% 100% DCBS 100% USDA 100% USDA DCBS Regular USDA USDA Reimbursement Advanced Advanced

and $2.20 Schedule/Advan Rate reduction in ced Rate respite. Category Monthly Annual Monthly @ 21.90 Monthly @ Monthly Annual Monthly @ of Care per day 21.90 per 23.90 per Age 0-11 Age 0-11 Age 0-4 Ageday 5-11 Age 12 + Age 12+ Age12day + 245.00 2,940.00 248.10 230.60 233.34 2,800.00 217.10 food 110.63 1,327.50 110.59 110.59 153.34 1,840.00 153.34 transportati 92.92 1,115.00 92.92 92.92 (309 125.42 1,505.00 125.42 (418 on (non- miles) miles) schoolmedical) 40.00 480.00 40.00 40.00 52.92 635.00 52.92 babysitting 50.21 602.50 50.11 50.11 20.00 (does not 77.50 930.00 77.50 77.50 86.67 1,040.00 86.67 include 21.90 21.90 23.90 *clothing 43.33 520.00 25.00 35.00 75.84 910.00 40.00 *allowance 7.50 20.00 659.58 $666.12 $666.12 727.53 739.35 Annual 7,915.00 7,915.00 7,993.44 7,993.44 8,730.36 8,730.00 8,872.20 *Required Medicalfor each costschild. areAll separateother fromcategories per are flexible Age 0-11 Age 12+ and to be Basic daily 19.70 21.70 610.70 672.70 7,190.50 7,920.50 50.00 Christmas 60.00 Birthday 25.00 Advanced daily 21.90 23.90 Initial $100/$290 Clothing 678.90 740.90 *$235/$425* annual 7,993.50 8,723.50 *over & (365 above USDA* days) Ongoing Day Care is Basic: Applicabl Foster Advanced: Paide to all to Parent/Child fosterchildren

The following chart shows the minimum to be spent on a monthly basis for clothing/diapers, incidentals and allowance.

AGE CLOTHING INCIDENTALS ALLOWANCE 0-2 $25.00 6.00 0 5-11 $35.00 5.00 7.50 12+ $40.00 10.00 20.00

When a child remains in a foster home less than thirty (30) days, the breakdown of the rate amount for per diem, clothing, incidentals and allowance, is prorated for the number of days the child was in the home.

 Housing This includes such costs as shelter (mortgage interest, property taxes, or rent; maintenance and repairs; and insurance), utilities (gas, electricity, fuel, telephone, and water), house furnishings and equpment (furniture, floor coverings, major appliances, and small appliances), and children’s incidentals. PLEASE NOTE: Incidentals include medicine chest supplies, baby oil and powder, deodorants, sanitary napkins, and other personal toiletries.  Food Includes food and nonalcoholic beverages purchased at grocery, convenience, and speciality stores; dining at restaurants; and school lunches.  Clothing/Diapers Clothing expenses include children’s apparel such as diapers, shirts, pants, dresses, and suits; footwear; and clothing services such as dry cleaning, alterations and repair, and storage. Foster parents maintain records on clothing expenditures. Workers are responsible for reviewing foster parent records on clothing. When a child leaves his placement, the worker obtains the child’s clothing. Unspent money is transmitted to the next placement or returned by a check made payable to the Kentucky State Treasurer and mailed to the Child Placement Support Section. The use of cash in these transactions shall be avoided.  Allowance Please refer to previous chart  Haircuts

Routine hair care is included in the per diem at an average of $12 per month. Special hair care costs should be reviewed for approval by the Service Region Administrator.

 Respite Care

This reimbursement includes 1 respite day per month per child. NOTE: Medically Fragile and Family Treatment Home foster parents will receive an additional 2 days respite per month for each child placed in that home leveled as medically fragile or family treatment. That reimbursement will be processed monthly by the Regional Billing Clerk.

For those high medical acuity leveled children for whom the cabinet is paying Specialized Medically Fragile rates, the foster parent is entitled to 3 days of respite per month. These days are NOT rolled into the per diem and shall be paid in addition to the per diem.

 Routine babysitting Routine babysitting refers to babysitting needs for one or more foster children while the foster parent is providing a required service for another foster child(ren) in the home.

 Transportation

Non-Medical Transportation: This reimbursement provides for mileage expenses for transportation not related to medical services i.e., school related functions, sport functions, etc. An average of cost per child across all ages is $103.75 or 346 miles per month per child. This rate is reduced with the 11 and under population and is increased with the 12 and over population.

Please Note: Service Region Administrators may approve travel reimbursement to foster parents for family and sibling visitation and to attend case conference. Mileage records verifying other types of transportation are not necessary for approval of transportation for family and sibling visitation and attendance at case conferences.

Medical Transportation: For all children receiving Medicaid, the cost of non-emergency medical transportation is supported by the Department for Medicaid Services either through the regional transportation broker or managed care provider.

 School supplies

This reimbursement relates to the purchase of school supplies, school fees, etc. For those pre-school age children, these dollars can be used to assist in meeting other needs of the child.

 Sports/Social/Recreational Activities

This reimbursement relates to all social, and/or school activity expenses i.e. clubs, ballgames, participation in dance class, gymnastics, karate, church, team sports, etc. This allows all foster children to participate in normal activities and empowers the foster parent to make these decisions.

BASIC REGULAR RATE POLICY

Two basic rates are established according to the age of the child (0 – 11 and 12 +). The basic rate is applicable to all children in DCBS foster homes that do not meet the criteria for emergency shelter, medically fragile, or family treatment home placement.

BASIC ADVANCED RATE POLICY

The Basic Advanced rate is paid to foster parents who have completed twenty-four (24) hours of initial Advanced Foster Parent training and who complete 12 hours ongoing training each year. The R&C Family Service’s Office Supervisor authorizes payment of the Basic Advanced rate by their signature on the OOHC-111A until such time that the approval is recorded in TWIST.

EMERGENCY SHELTER RATE POLICY The emergency shelter rate is a flat rate that may be paid to foster families approved by the Service Region Administrator as Emergency Shelter foster homes for children age 12 and above who are in need of immediate, unplanned placement for less than thirty (30) days and for whom no other appropriate resources are available. The rate for Emergency Shelter is $30.00 and requires prior approval of the foster family’s eligibility for the rate in addition to approval for placement of the child. There is no Basic Advanced Rate for emergency shelter foster homes. One thirty (30 )day extension may be approved by the Service Region Administrator when all other placement resources have been exhausted. In no instance may a child be moved from one emergency shelter home to another emergency shelter home unless that move is determined to be necessary because of circumstances related to the child or the placement. A letter of approval as an Emergency Shelter home shall accompany the first Foster Parent Invoice/ Billing Statement requesting payment of those rates with OOHC-111A’s approving rates for individual children.

BASIC MEDICALLY FRAGILE RATE POLICY

The Basic Medically Fragile rate may be paid to foster parents approved to care for children who are identified as medically fragile. The rate for medically fragile is $37.00 and requires prior approval of the foster family’s eligibility for the rate in addition to approval for the specific placement of the child by the Quality Central Medical Staff. Approval of the Service Region Administrator is required for placement of each child and is available only to foster homes approved as medically fragile. This rate is available only while the child meets the agency’s definition of medically fragile. A letter of approval as a medically fragile child and as a medically fragile foster home shall accompany the first Foster Parent Invoice/Billing Statement.

ADVANCED MEDICALLY FRAGILE RATE

The Advanced Medically Fragile rate of $42.00 per day may be paid for those children who meet the definition of specialized medically fragile, require physician or licensed nurse supervision, 24 hour monitoring, and close proximity to a regional medical center. The $42 per diem rate covers the following services:

Care supervision by a licensed nurse;  24 hr/day staffing, including night time monitoring;  medication administration and medical care as ordered by the physician;  care of medical equipment needs;

DEGREE MEDICALLY FRAGILE RATE

The Degreed Medically Fragile rate of $45.00 per diem, based on the child’s medical acuity level, may be paid for those children who meet the definition of specialized medically fragile, require physician or R.N. supervision, 24 hour awake monitoring, and close proximity to a regional medical center. This per diem rate includes any services and procedures listed in the $42 per diem rate as required by the child. SPECIALIZED MEDICALLY FRAGILE RATE

Quality Central Medical Staff may recommend specialized medically fragile rates based on the medical acuity of a child. Dependent on the acuity level, the rate may be $55.00, $70.95, or $88.55. All requests for these rates shall be reviewed by the Quality Central Medical Staff. Approval by the Service Region Administrator is required following recommendation of Quality Central.

The Basic, Advance, Degree, and Specialized Medically Fragile rates also cover all basic services/expenditures as identified in the “Coverage of Rate”.

FAMILY TREATMENT HOME RATE POLICY

The Family Treatment Home Rate is a flat rate that is paid to foster parents who have completed the twenty four (24) hour initial Family Treatment Home training and who complete twenty four (24) hours ongoing training each year and who provide care for a Family Treatment Home child. The rate for family treatment homes is $37.00 during the first year’s participation. Upon completion of a positive annual re-evaluation, the per diem shall be increased to $42.00 The rate shall remain $42.00 contingent on a positive annual re-evaluation henceforth. The rate for family treatment homes requires approval of the foster family’s eligibility in addition to the needs of the child.

PAYMENTS

Payments are made monthly by check from the Finance Cabinet to the foster parents following submission, verification, and authorization of the Foster Parent Invoice/Billing Statement. Payment is made for the first day of placement but is not paid on the day the child leaves, except for emergency shelter homes which are paid for the first day of placement as well as the day the child leaves. When a child’s age qualifies him for a higher rate, the foster care rate is increased on the first day of the child’s birth month. Section A of the OOHC-111A is completed at this time with the new rate. Foster parents are paid the usual foster care payment when the child is temporarily away from home for a period not to exceed fourteen (14) days, and the plan is for the child’s return to the same foster home. Service Region Administrators may approve continued payments when foster parents are staying with a hospitalized child. This does not apply to Emergency Shelter Placements. .

ADDITIONAL REIMBURSEMENTS TO MEET CHILDREN’S NEEDS POLICY The Kentucky Tax Exempt Number for the cabinet CANNOT be used by foster parents or agency staff to purchase items or services on behalf of families served by the cabinet. Foster children will continue to receive services with separate reimbursement for the following categories:

INITIAL AND SPECIAL CLOTHING ALLOWANCES POLICY

An initial clothing allowance may be provided to children for whom the Cabinet is legally responsible and who are being placed in any out of home care setting. The initial clothing allowance shall not exceed the following amounts: Child’s Age Amount Birth to l year $100.00 1 through 2 years $120.00 3 through 4 years $130.00 5 through 12 years $180.00 13 years and over $290.00 Special purchases above and beyond the per diem and initial clothing allowance may be authorized up to $100.00 by the Family Service’s Office Supervisor or up to $250.00 by the Service Region Administrator.

ANNUAL SUPPLEMENTAL SCHOOL CLOTHING ALLOWANCE POLICY

An annual supplemental school clothing allowance may be provided to children ages 4 and above who have been in care more than six months, have used the amount allotted for initial clothing allowance and are enrolled in school. The allowance for children ages 3 - 10 is $100 and for children ages 11 and above is $200. The allotment is to assist in the purchase of clothing necessary for school.

SCHOOL EXPENSES POLICY

All foster children are eligible for free lunch programs and may participate upon completion of appropriate school forms. If foster parents choose to not participate in the school lunch program, the cost of school meals is included in the per diem.

Private child care agencies may be reimbursed for ordinary school supplies at a maximum of $35 per school year for the child 5 to 10 years old and $60 for the child age 11+. Receipts are not required for school expenses. Bus fares for school transportation may be reimbursed upon the approval of the Family Service’s Office Supervisor. Note: School expenses are included in the foster care per diem . GRADUATION EXPENSES POLICY

An amount not to exceed $500 may be reimbursed without prior approval for the senior class ring, cap and gown rental, senior pictures, yearbook, prom ticket, graduation invitations and name cards. Other items require prior written approval. Total reimbursable graduation expenses may not exceed $500. Some of these expenses may actually be incurred during the child’s Junior year.

TUITION ASSISTANCE POLICY

Financial assistance is available for children committed to the Cabinet and who plan to attend post-high school educational institutions. Enrollment in a state supported school is encouraged; however, private school enrollments may be considered, provided the cost to the Department is not greater than the cost at the most expensive state supported school. Tuition assistance is not approved for students in out-of-state schools unless extenuating circumstances exist. To be eligible for tuition assistance for college or post-secondary educational or vocational expenses, a child shall: 1. Maintain at least a 2.0 grade point, on a 4.0 system, standing; 2. Utilize all available financial aid resources to meet educational costs; 3. Obtain summer employment or participate in work-study programs when possible. See policies on extension of commitment, Commitment Section.

The worker assists the child in applying for all financial assistance for which he may be eligible. The worker shall insure that this is done prior to approval of tuition assistance. However, requests for tuition assistance are not held until grant awards or other similar information is received.

The worker completes and submits through supervisory channels, the OOHC-103, Application for Tuition Assistance, at least four weeks before any funds are needed. Requests for tuition assistance are made each semester. Tuition assistance for direct school expenses, tuition, room, books, fees, etc., not covered by other resources is paid through TWIST. Expenses are itemized and submitted to the regional billing clerk with a copy of the OOHC-103 showing the SRA’s approval.

All other approved expenses, i.e., clothing and incidentals, may be divided into a number of payments to be made during the semester. These payments may be made to the foster child or foster parents and are submitted with attached OOHC-103 showing the SRA’s approval.

When the approved tuition assistance is less than $150.00 it may be given to the student in one lump sum. The payments may be made payable to the student or the foster parents, dependent upon the student’s maturity, as determined by the caseworker. When the student is planning to attend school outside his home county, the worker is responsible for referring the student to the Family Service’s Office Supervisor for the county in which the student is attending school. A copy of the approved OOHC-103 is attached to the referral. This notice may be referred to the Regional Independent Living Coordinator by the SRA.

When a child lives on campus and returns to the foster parent(s)’ home for weekend and holiday visits, the foster parents may be reimbursed at the basic or advanced per diem rate. This must be reimbursed through TWIST – Special – Board.

EDUCATION RELATED SERVICES POLICY

Specific items needed in a classroom to enable a child to benefit from a free appropriate public education are the responsibility of the school. Such things may include, large print textbooks, teacher’s aides, or special transportation to and from school. The Director of Protection and Permanency shall be notified within three (3) working days of any request by a school for the Department to pay for such expenses. Those items that a child needs in other areas of life, such as glasses, wheelchairs, hearing aides, etc., are the responsibility of Medicaid if the child is Medicaid eligible with the Department for Community Based Services being the last alternative for payment.

CHRISTMAS GIFTS AND BIRTHDAYS POLICY

Foster parents may be reimbursed $60.00 for Christmas gifts for a child. Private child care facilities may request reimbursement when the child resides in the facility over the Christmas holidays. Foster parents may also request reimbursement of $25.00 for birthday gifts for a child. Private child care facilities may request reimbursement when the child resides in the facility over their birthday. Receipts are not required for Christmas and birthday gifts.

MEDICAL EXPENSES POLICY

Medical bills for $100.00 or less do not require special approval. Medical bills over $100.00 shall be itemized and require the appropriate level of supervisory approval. All bills for medical expenses shall state whether the child was ineligible for or the service was not covered by medical assistance. Bills for over-the-counter drugs commonly maintained in households with children are not suitable for reimbursement. The approval level for medical-related expenses (i.e., dental, office visits, laboratory tests or other expenses for children not covered by the medical card) is as follows: 1. Amounts $100.00 - $500.00- Family Service’s Office Supervisor Approval 2. Amounts above $500.00 – Service Region Administrator’s Approval CHILD CARE POLICY

The full cost of child care services may be paid by the Department. A copy of the approval memo from the SRA indicates the amount being paid for child care services and must be reviewed and re-approved every six (6) months. For non-working Foster Parents requesting child care, a special review and approval must be conducted by SRA every three (3) months.

Transportation for child care for working foster parents may be reimbursed only for the number of miles above the normal travel to the work place. It is the responsibility of the SRA to approve the total ongoing cost.

RESPITE CARE POLICY

Respite care is available for every child in foster family care. The purpose of respite care is to provide relief to foster parents who are meeting the extraordinary demands of children in out-of-home care. Foster parents are eligible for one day of respite care per month per child. This day is included in per diem. Foster parents of medically fragile and family treatment home children are eligible for two additional days, of respite care per month per child.

The respite care reimbursement rate for each child may not exceed the per diem of the child. Foster parents are encouraged to use respite care on a monthly basis. With the written approval of the Service Region Administrator, extended respite care for up to 14 additional days may be given when there is a family need or other emergency. Foster parents are responsible for selecting and initially screening their respite care provider to determine that the provider is appropriate to meet the individual child’s needs, i.e., knowledgeable of the particular care needs of the child. When respite care is to be provided within the foster home, the worker shall meet the potential respite provider and document their appropriateness to provide care for the child. When respite care is to be provided outside the foster home, the worker shall meet the potential provider and visit the respite site and document their appropriateness to provide care for the child. The name, address, and telephone number shall be included in the case record. Respite care providers may include other approved resource families, extended family members or neighbors, babysitters and trained respite care providers. A criminal records check shall be completed on persons who are providing respite care. A records check is not required when the respite provider is another foster parent or a relative of the foster parent. When respite care is purchased from a licensed agency authorized to provide respite services, an evaluation, home visit and records checks are not required. Medically fragile children may qualify for some Medicaid waiver services through local Home Health agencies which are contacted to determine eligibility criteria and procedures. Respite providers for the medically fragile child are also required to be trained in the specific care needs of the child and be currently certified in CPR and First Aid. Family Treatment Home respite providers shall complete the Family Treatment Home training and any child-specific training that the Family Treatment Home foster family receives. The Recruitment and Certification Supervisor shall maintain a central listing of approved respite care providers in the district.

The family, with the worker’s assistance, determines the most appropriate use of respite time which may include in home or out-of-home activities. The provision for respite care may be included on all Case Plans.

OTHER SPECIAL EXPENSES POLICY

The Service Region Administrator may, in their discretion, authorize special expenses not already specified in policy. Such requests must support the child’s goal toward permanency.