section 14 funding and purchasing

8/7/2019 Section 14 Funding and Purchasing

1/36

Virginia Department of Social Services Foster CareNovember 2010 Volume VII, Section III, Chapter B SECTION 14

TABLE OF CONTENTS

14. FUNDING AND PURCHASING ............................................................................290

14.0 Table of contents ....................................................................................... 290

14.1 Paying for maintenance............................................................................. 293

14.1.1 Definition of maintenance.......................................................... 293

14.1.2 Sources of funding..................................................................... 293

14.1.3 Rates......................................................................................... 293

14.1.4. General guidance regarding maintenance payments................ 293

14.1.5 Maintenance payments from Title IV-E Funds.......................... 294

14.1.6 Maintenance payments from State Pool Funds......................... 295

14.1.7 SSI and maintenance (Title IV-E and State Pool Funds)..296

14.1.8 Paying supplemental clothing allowance................................... 297

14.1.9 Paying maintenance for minor child of foster youth................... 298

14.1.10 Documenting maintenance payments in Child WelfareInformation System................................................................... 298

14.2 Paying for Independent Living Arrangements .......................................... 299

14.3 Paying for children supervised by another agency .................................. 300

14.4 Using funds from special welfare accounts ............................................. 300

14.5 Lump sum retroactive SSI payments ...................................................... 301

14.6 Paying for services through Medicaid ...................................................... 302

14.6.1 Medicaid eligibility...................................................................... 302

14.6.2 Medicaid out-of-state................................................................. 302

14.6.3 Extension of Medicaid for children in adoptive placement......... 303

14.6.4 Medicaid services...................................................................... 303

14.6.5 Early and Periodic Screening, Diagnosis and Treatment(EPSDT) .................................................................................... 304

290
http://table_of_contents.pdf/http://table_of_contents.pdf/


2/36


291

14.6.6 Dental services.......................................................................... 304

14.6.7 Mental health treatment and intellectual disability services....... 304

14.6.8 Long term care services............................................................ 306

14.6.9 Using Medicaid providers.......................................................... 308

14.7 Paying for Services with CSA State Pool Funds ..................................... 308

14.7.1 Services that may be purchased............................................... 308

14.7.2 Children eligible for funding services from State Pool Funds.... 310

14.7.3 Overview of CSA process for services and funding.................. 310

14.7.4 What is needed to purchase any CSA service.......................... 311

14.8 Paying expenses by foster parents on behalf of child ............................. 312

14.9 Paying for Family Partnership Meetings .................................................. 312

14.9.1 Using VDSS funds................................................................... 312

14.9.2 Using CSA funds ..................................................................... 313

14.9.3 Determining whether to use VDSS or CSA funds.................... 313

14.10 Purchasing home studies and placement services ............................... 313

14.11 Purchasing child care services............................................................... 314

14.11.1 Choosing an allowable child care provider............................. 314

14.11.2 Rates for child care................................................................. 315

14.11.3 Funding sources..................................................................... 316

14.12 Purchasing transportation services ......................................................... 317

14.12.1 Using Medicaid to purchase transportation............................ 317

14.12.2 Using Title IV-E funds for transportation................................. 317

14.12.3 Using State Pool Funds to purchase transportation............... 318

14.13 Paying for medical care......................................................................... 319

14.14 Paying for independent living services ................................................. 319


3/36


14.15 Purchasing regular education services ................................................. 319

14.15.1 When regular education services may be purchased............. 320

14.15.2 Educational services that may be purchased......................... 320

14.15.3 Other school related expenditures.......................................... 320

14.16 Purchasing special education services ................................................ 320

14.16.1 Local school responsibility...................................................... 320

14.16.2 Length of time child is eligible for special education services321

14.16.3 Use of State Pool Funds for special education services........ 321

14.16.4 Cross jurisdictional placements.............................................. 321

14.17 Purchasing emergency shelter services................................................ 322

14.18 Paying for care in a residential facility ................................................... 322

14.18.1 Requirements for Medicaid funding........................................ 323

14.18.2 Absence from a residential facility.......................................... 324

14.19 Paying for incidentals ............................................................................ 324

14.19.1 Paying for incidentals in residential care................................ 325

292


4/36


14.Funding and Purchasing

14.1. Paying for maintenance

14.1.1 Definition of maintenance

Maintenance means payments made on behalf of a child in foster care tocover the cost of (and the cost of providing) food, clothing, shelter, dailysupervision, school supplies, a childs personal incidentals, liabilityinsurance with respect to a child, and reasonable travel for the child tovisit with family or other caretakers and to remain in his or her previousschool placement.

14.1.2 Sources of funding

Maintenance costs should be paid with:

A childs own income (i.e. SSI, SSA, or child support);

Title IV-E funds for eligible children;

State Pool Funds for Non-Title IV-E children.

14.1.3 Rates

Age groupings and uniform monthly maintenance payment rates are, asfollows:

Effective July 2009Maintenance Payment Rates

Age of ChildRoom and

BoardClothing

Personal care,Recreation,

Reading

MonthlyAllowance

TotalPayment

Rate

0 thru 4 $307 $56 $85 $0 $448

5 thru 12 $351 $72 $92 $10 $525

13 and over $426 $113 $99 $28 $666

Independent Living $644

Supplemental Clothing Allowance

Age 0 thru 4 $300Age 5 thru 12 $375

Age 13 and over $450

14.1.4 General guidance regarding maintenance payments

Maintenance payments are designed to assist the caregiver inproviding for the childs basic needs as defined inSection 14.1.1. It is

293


5/36


not expected that the maintenance rates will cover all the needs of thechild. Service needs of children and their families are not included inthe definition of maintenance. Therefore, services shall not be paid forwith maintenance funds.

Maintenance is paid directly to the foster parent by the child placing

agency on a monthly basis. The costs of day care, transportation ofthe child for visitation or to school may be reimbursed to the fosterparent if they are paying the cost up front or may be paid directly tothe individual or organization providing the service directly. Receiptsfor such costs are required for reimbursement.

Duplicate payments for maintenance shall not be made. Payments to afoster home for room and board are not considered duplicate paymentsif the child is temporarily absent for fourteen or fewer consecutive daysand the childs placement continues with the same provider. Anabsence may include run away, respite care, hospitalizations, trips orvacations. If the childs absence exceeds fourteen days and the child

does not return to the same placement, payments shall be prorated.

Prorating room and board for part of a month is based upon the actualnumber of days of care provided and the number of days in the month.

Payments begin on the date a child is placed in the home and end asof the date prior to the removal date.

14.1.5 Maintenance payments from Title IV-E Funds

Planned temporary absences from an approved placement forreasons of hospitalization, education or training, a vacation or trial

home visit do not terminate eligibility for Title IV-E.

Runaway Status: Title IV-E cannot be used to pay for maintenance formore than fourteen days for a child on runaway status and the childmust return to the same provider.

Youth over age 18 are not eligible for funding from Title IV-E unlessenrolled in an educational, vocational or technical training programand are expected to graduate or complete the program prior toreaching age 19. If Title IV-E payments are to be changed to StatePool funds prior to age 19, because it is anticipated the youth will notcomplete the educational or vocational program, the switch to State

Pool funds should begin on the first day of the month, after the monthin which the child turns 18. For youth remaining in foster care afterage 19, state pool funds pay for maintenance.

When the local department of social services (LDSS) acceptscustodyor placement of a child and places the child in a relative home, theagency shallapprove the relative home as a foster family home onlyifthey meet foster home provider requirements, and shallpay therelative foster parents maintenance payments per state rates. If the

294


6/36


relative home does not meet foster home provider requirements, therelative cannot be approved as a foster parent and no payment canbe made.

When necessary, LDSS shoulduse the emergency approval processand varianceprocess to fullyapprove relative foster parents.

However, Title IV-E payments cannot be made to a relative or otherprovider who is not fully approved. Thus, Title IV-E cannot be usedduring the emergency approval period but shall be used if the relativehome is fully approved.

For more information, see:

The Local Department Resource, Foster and Adoptive FamilyHome Approval Guidance

Spark website

Publicwebsite

Title IV-E Eligibility Manual

The LDSS may use Title IV-E to pay enhanced maintenancewhenfoster parents provide care to Title IV-E eligiblechildren placed inLDSS homes and the Virginia Enhanced Maintenance AssessmentTool (VEMAT) is used to determine the need for, and amount of,enhanced maintenance. Title IV-E eligible children placed intreatment foster care programs shall be assessed with the VEMAT forenhanced maintenance and if such payment is indicated, allmaintenance costs shall be charged against Title IV-E for the eligiblechild. A copy of the VEMAT and all supporting documentation of thechilds needs resulting in an enhanced maintenance payment must bedocumented in the case record. These additional payments are made

from State Pool Funds for non-Title IV-E children.

See Rate-Structuring for Enhanced Maintenance Guidance at:

Spark website Public website

14.1.6 Maintenance payments from State Pool Funds

This is a source of funding, using primarilystate and local money, throughthe Comprehensive Services Act for At-Risk Youth and Families (CSA).

Costs of maintenance are paid from this source for all children whoare not eligible for Title IV-E. This includes the basic as well as theenhanced maintenance rate for those children where the VEMAT isused and the child is determined to have additional needs requiring anenhanced maintenance payment for the foster parent.

LDSS shall use procedures established by the Community Policy andManagement Team (CPMT) for referring the child to the FamilyAssessment and Planning Team (FAPT) for services and funding.

295
http://spark.dss.virginia.gov/divisions/dfs/resource_family/index.cghttp://spark.dss.virginia.gov/divisions/dfs/resource_family/index.cghttp://www.dss.virginia.gov/divisions/dfs/resource_family/index.cgihttp://www.dss.virginia.gov/divisions/dfs/resource_family/index.cgihttp://spark.dss.virginia.gov/divisions/dfs/permanency/iv_e/files/eligibility/manual/IV-E_Manual_July-07.pdfhttp://spark.dss.virginia.gov/divisions/dfs/fc/procedures.cgihttp://www.dss.virginia.gov/family/fc/procedures.htmlhttp://www.dss.virginia.gov/family/fc/procedures.htmlhttp://spark.dss.virginia.gov/divisions/dfs/fc/procedures.cgihttp://spark.dss.virginia.gov/divisions/dfs/permanency/iv_e/files/eligibility/manual/IV-E_Manual_July-07.pdfhttp://www.dss.virginia.gov/divisions/dfs/resource_family/index.cgihttp://spark.dss.virginia.gov/divisions/dfs/resource_family/index.cg


7/36


The CPMT may establish policies and procedures for authorizingpayments for children who only require foster care maintenancewithout a full review by the FAPT(2.2-5209).

LDSS shall not decrease or increase the state-determined basicmaintenance rates to foster parents. However, LDSS may determineadditional financial support to foster parents is necessary to maintainthe child in the home and provide for his or her needs.Such paymentsare not determined through administering the VEMAT and are notconsidered enhanced maintenance. Rather, they are servicepayments and shall be paid from state pool funds. The CPMT mustapprove services and payments through its normal approval process.

State poolfunds can only be used for placement in an approved orlicensed facility or foster home, based on the identified strengths andneeds of the child.

14.1.7 SSI and maintenance (Title IV-E and State Pool Funds)

It is the responsibility of the service worker to inform the SocialSecurity Administration (SSA) whether Title IV-E benefits are beingreceived for the care of the child:

At the time of application for social security benefits; or

When the LDSS becomes the representative payee for a childwho is already receiving SSI.

SSI benefits shallbe reduced dollar for dollar by the amount of TitleIV-E funds actually received for the child. A Title IV-E eligiblechilddoes not have to receive a Title IV-E payment. The LDSSmaychoose to receive only the SSI payment to cover the costs of thechilds care.

SSI benefits are not reduced for children whose maintenance is paidfrom State Pool Funds.

If a Title IV-E eligible child is in a residential facility where the monthlymaintenance rate is greater than the SSI payment, the LDSS shoulduseTitle IV-E benefits to pay for maintenance. If Title IV-E funds areused, the service worker shall immediately, within two business days,notify the SSA to suspend the SSI payment. If a child returns to afoster home, the serviceworker shall evaluate and determine whichfunding option is most beneficial for the child andinform the SSA ofthe change in placement and maintenance rate within two businessdays ifSSI benefits are tobe reinstated.

296
http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+2.2-5209http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+2.2-5209


8/36


When a child enters a Medicaid funded residential facility, the LDSSshallnotify the SSA of the placement in order to ensure that thechilds SSI benefits are reduced to appropriate levels. In somesituations, the child may continue to receive full SSI benefits. Foradditional information, see Social Security Administration Online.

14.1.8 Paying supplemental clothing allowance

In addition to basic maintenance payments, the supplemental clothingallowance inSection 14.1.3should be used for:

Every child each year they are in foster care;

The child of a foster child; and

A new foster care episode for the child, even if the child was in carepreviously during the year and received the allowance in the initial

foster care episode.

The clothing allowance should pay for needed clothing:

At initial placement;

At placement changes;

For back-to-school;

As the child grows; and

If items are lost or destroyed.

The supplemental clothing allowance shall not exceed the designatedrate posted inSection 14.1.3, regardless if the amount was paid by TitleIV-E, CSA or a combination of the two. It shall be used by May 31steachyear. Supplemental clothing allowances apply to all children regardlessof funding source. Items allowable for purchase include basic clothingand accessories that any reasonable person would determine necessaryand appropriate for any child.

All supplemental clothing allocations shall be verified through

documentation that the funds were used to purchase clothing for thedesignated child. This may include a purchase order to the store andreceipt or a receipt from store(s) where the foster parents purchased theitems. The decision as to the appropriateness and reasonableness of theitems purchased is the responsibility of the service worker. If the serviceworker has questions regarding the appropriate use of the supplementalclothing allowance, the service worker should discuss the issue with hisor her supervisor and may consult the regional Permanency Consultantfor technical assistance.

297
https://secure.ssa.gov/apps10/poms.nsf/lnx/0500520140https://secure.ssa.gov/apps10/poms.nsf/lnx/0500520140


9/36


14.1.9 Paying maintenance for minor child of foster youth

The minor child of a youth in foster care, who is livingin a foster home orresidential facility with his or her parent and whois in the custody of theparent, shall be eligible to receive a foster care maintenance paymentand shall not be eligible for TANF. The foster care provider shouldreceive a maintenance payment for the minor child in the amountappropriate for the age of the child and from the same fundingsource asthe parent of the child (i.e., Title IV-E or State Pool Funds).

The service worker does not open a case for the minor child; all costs arepaid under the foster youths case. The maintenance payment shouldbeadded to the foster youths foster care payment. If the foster youthresides in a residential facility with her minor child, the rate paid will bethe rate negotiated with the facility for maintenance for the minor child. Ifthe foster youth lives in an independent living arrangement, the minorchild may be eligible for TANF (See Section 15.4).

If the minor child of a foster youth has his/her own income (i.e. SSI,SSA, or child support), these resources shall be used toward themaintenance cost.

If the LDSS finds it necessary to assume custody of a child of a fosteryouth, the child of the foster youth may be eligible for Title IV-E orState Pool Funds. Eligibility for the child of the foster youth isdetermined in the same manner as are all other children in foster care.

14.1.10 Documenting maintenancepayments in Child Welfare Information

System

Maintenance for a child newly placed in foster care is initially paid fromthe CSA State Pool funding source until the childs eligibility for Title IV-Ehas been determined. The service worker must select CSA on thefunding screen in the Child Welfare Information System. If a child isfound to be Title IV-E eligible, the case is recoded to Title IV-E eligible inthe Child Welfare Information System. State Pool Funds expended formaintenance during the determination process shall be reimbursed byTitle IV-E funds for maintenance, except for any period where theprovider was not fully approved.

If the child remains funded by CSA, then CSA should remain the fundingcategory. Under source of payment on the funding sources screen, theLDSS checks what the source of payment is for maintenance payments.If the LDSS receives SSI or other resources for the child, the worker mustchoose other resources and identify the resource the child receives.Even if a LDSS initially pays for a child out of CSA and then reimbursesCSA out of SSI, the LDSS should choose the resource that ultimatelypays for maintenance as the funding source.

298
http://section_15_other_requirements.pdf/http://section_15_other_requirements.pdf/


10/36


Total maintenance costs shall be entered in the funding screen and theamount shall be changed in the System whenever the total costs change.The total amount to enter into the System includes any payments forbasic maintenance, enhanced maintenance, child care, transportationand the supplemental clothing allowance. If the LDSS provides thesupplemental clothing allowance payment (or a portion of this payment) in

a particular month, the amount entered into the system for that monthshould be changed to reflect the actual total maintenance paid. This samerule is applicable to how much is paid out each month for transportationcosts and child day care costs.

LDSS who pay a special services payment to a family from CSA fundsshall enter the basic maintenance payment, but NOT the special servicespayment into the funding screen.

For additional information on what to include in the Child WelfareInformation System funding screen on this topic, workers are referred tothe Help section of the Child Welfare Information System.

14.2 Paying for Independent Living Arrangements

The standard statewide payment for independent living (IL) arrangementsis a maximum of $644.00 per month.

Payment cannot be made from Title IV-E, but is made from State PoolFunds.

Payments may be made directly to the youth and may be made moreoften than once a month, provided the maximum is not exceeded. Themethod of payment must be documented in the agreement with the youth.

For the youth over age 18 who remains in his or her foster home, Title IV-Efunds (when the child meets requirements for use of these funds up to age19) or CSA funds may continue to be used to pay for maintenance costs.Ifneither Title IV-E nor CSA funds are being used to pay the foster caremonthly maintenance rate, the IL stipend may be used to support theyouth in enabling him or her to remain in the foster parents home. If thestipend will be used to pay rent to the foster parent, this arrangementshould be documented on the agreement with the youth and in the ChildWelfare Information System.

Payments are intended to assist the youth in covering the costs of rent,utilities, household equipment, food, clothing, personal care items,insurance, recreation and transportation.

A portion of Chafee Independent Living funds may also be used tosupport the living expenses of youth between age 18 and 21 inaccordance withChafee guidelines. The regionalProject LIFEIndependent Living Consultantis also available to provide additionalguidance in this area.

299
http://spark.dss.virginia.gov/divisions/dfs/fc/files/child_welfare_funding/ilp_education_training/2011_etvguidelines.pdfhttp://www.vaprojectlife.org/http://www.vaprojectlife.org/http://www.vaprojectlife.org/http://www.vaprojectlife.org/http://spark.dss.virginia.gov/divisions/dfs/fc/files/child_welfare_funding/ilp_education_training/2011_etvguidelines.pdf


11/36


14.3. Paying for children supervised by another agency

Payment for the costs of maintenance and social services is theresponsibility of the agency holding custody of the child or having acceptedplacement of the child.

Certification of a child to a state mental health facility does not relieve theLDSS of custody. In this instance room and board and medical costs arethe responsibility of the public facility. Costs of clothing and personal careitems must be paid by the LDSSholding custody and cannot be Title IV-Efunds.

The Department of Juvenile Justice (DJJ) is responsible for themaintenance and care of the child committed to its care. Payments cannotbe made by the LDSS for maintenance of the child at the DJJ facility.

For children placed in out-of-state foster homes:

Payment for non-Title IV-E eligible children is from State Pool Fundsat the rate set by the other state.

Payment from Title IV-E is at the standard rate for Virginia. Where thisrate is not acceptable to the other state, payment of Virginiasmaintenance rate is from Title IV-E funds, with the balance paid fromState Pool Funds as a specialized payment.

The foster homes must meet standards for care set by the other state.

14.4. Using funds from special welfare accounts

All recurring monthlybenefits, including SSI, SSA and VA for the child are tobe placed in a special welfare accountin the name of the child to be used forexpenses on behalf of the child. Certain large, retroactive SSI payments tofoster care children covering more than six months of payments shall be paiddirectly into a separate dedicated account in a financial institution (SeeSection.14.5). For more informationon special welfare account, see VDSSFinance Guidelines Manual.

Accumulated funds in a special welfare account may be used to meet thecurrent and future needs of the child (63.2-320). These funds are to be

used to reimburse expenditures on behalf of the child for maintenance,medical expenses not covered by Medicaid, and services.

Funds in excess of those used to reimburse expenditures for the child areto be used for savings for the child or for the personal needs of the child.The worker, in consultation with the parents and foster parents, isresponsible for identifying how these excess funds are to be used.

300
http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+63.2-320http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+63.2-320http://localagency.dss.state.va.us/divisions/dof/files/local_support/finance_guidelines_manual/by_section/reimbursement/section_3.50_-_special_welfare.pdf


12/36


For Title IV-E eligible children, the resource maximum for Title IV-E hasincreased to $10,000. Children in foster care may accumulate combinedresource/funds to a maximum of $10,000 before becoming ineligible forTitle IV-E.

For non-Title IV-E children, the limit has not changed. If funds accumulate

in excess of $2,000 in an account, the child may become ineligible for SSIand non-Title IV-E Medicaid.

If LDSS cannot maintain a child's special welfare account below theresource level, it can establish an irrevocable trust account. Thisirrevocable trust account will allow resources to accumulate over theresource level, while not making the child ineligible for future benefits.

LDSS should consult with an attorney to ensure these accounts are set upproperly. The trust fund must have a maturity date restricted to a birthdate or date of custody transfer from LDSS. Under no circumstances canthe child or LDSS have access to the trust funds prior to the maturity date.

The size of the trust fund may affect the child's eligibility for Title IV-E,Medicaid and SSI. The worker should consult with eligibility staff whenestablishing a trust fund regarding the amount of funds in the trust.

14.5 Lump sum retroactive SSI payments

When a child receives an initial retroactive lump sum SSI payment and theretroactive amount covers more than six months, LDSS shallestablish aseparate dedicated account for the initial lump sum payment and keepthese funds separate from the childs other resources. A payment of

retroactive benefits for six months or less can be released to theindividual/representative payee. These funds do not count as income to theindividual/child.

The LDSS shall not spend the lump sum funds to reimburse maintenancecosts. (Only on-going monthly SSI payments may be used to reimbursemaintenance costs). Lump sum funds of greater than six months may beused only for medical treatment, education or job skills training if related tothe childs impairment, personal needs assistance, special equipment,housing modification, therapy or rehabilitation, or other items or services asSSA deems appropriate. Other items have been defined as the following:

Specialized child care or special education not included in the childsspecial education program;

Food and veterinary care for a guide dog;

Repair of walls, carpets, or furnishings that have been damaged by achild with a mental impairment;

301


13/36


Counseling, crisis intervention, respite, or treatmentfoster care servicesnot covered by health insurance or public service program;

Repayment of a past debt, including reimbursement of a creditor payee, ifthe items or services provided were related to the childs impairment andbenefited the child;

Personal aids to facilitate living and learning, such as assistive technologyfor communication and mobility, modified instructional materials, andspecialized transportation;

Special food for children with dietary needs or diapers for older,incontinent children;

Increased electrical bills resulting from needed mechanical devices thatmust constantly run.

Impact on eligibility for other resources: accumulated retroactive funds indedicated accounts do not affect SSI eligibility. LDSS have six months tospend down funds in dedicated accounts before these funds impact Medicaideligibility. The childs Title IV-E eligibility may be affected if the child is notSSI eligible when the retroactive benefits are received.

LDSS should obtain approval from their local SSA office regardingreimbursement of expenditures from the retroactive lump sum payment if theyhave questions about the appropriateness of a reimbursement. LDSS areheld liable for these funds if they are not used in accordance with the SocialSecurity Administrations guidelines. LDSS will be required to reimburse therecipient for the misuse of any funds identified by the SSA.

14.6. Paying for services through Medicaid

TheMedicaid Programis managed by the Virginia Department of MedicalAssistance Services.

14.6.1 Medicaid eligibility

Children in foster care placement areeligible for Medicaid unless they arenot considered Virginia residents, or they have income or other financialresources that make them ineligible for Medicaid.

14.6.2 Medicaid out-of-state

If a Title IV-E child is placed out-of-state, information certifying the child'sTitle IV-E status must be sent to the Interstate Placement Unit in CentralOffice so that it may be sent to the receiving state. Title IV-E fosterchildren and children receiving Title IV-E adoption subsidy are eligible forMedicaid coverage in the state where they reside.

302
http://dmasva.dmas.virginia.gov/Content_pgs/rcp-home.aspxhttp://dmasva.dmas.virginia.gov/Content_pgs/rcp-home.aspx


14/36


Non-Title IV-E children placed out of state will be eligible for VirginiaMedicaid; however, providers in other states often do not accept Virginia'sMedicaid coverage, and the LDSS will have to pay for medical expensesout of State Pool Funds.

14.6.3 Extension of Medicaid for children in adoptive placement

Medical coverage is extended during the adoptive placement until thefinal order of adoption for children who continue to meet the foster carecovered group for Medicaid purposes.

Medical coverage is extended past the final order if:

The child is Title IV-E eligible with a subsidized adoption assistanceagreement in effect, regardless of the existence of an interlocutoryorder or final judicial decree; or

The adoptive family meets the financial requirements of Medicaid; or

The child is not Title IV-E eligible, but has special medical needs andthere is an adoption assistance agreement in effect.

14.6.4 Medicaid services

Medicaid covers services including, but not limited to:

Clinic Services

Eye examinations

Eyeglasses

Hospital Care Inpatient/Outpatient

Hospital Emergency Room

Maternal and Infant Care Coordination (BabyCare)

Nursing Facility

Personal Care

Physicians Services

Prenatal Care Expanded Services (BabyCare)

Prescription Drugs when ordered by a Physician

303


15/36


Rehabilitation Services

Transportation Services for Medical Treatment

These services do not require a CSA or local match.

For a complete listing and description of covered and non-coveredservices, see theMedicaid and FAMIS-Plus Handbook.

14.6.5 Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)

EPSDTis a comprehensive and preventive child health program forchildren in Medicaid or FAMIS Plus up to the age of 21 that detects andtreats health care problems early through:

Regular medical, dental, vision, and hearing check-ups;

Diagnosis of problems; and

Treatment of dental, eye, hearing, and other medical problemsdiscovered during check-ups.

EPSDT services do not require a CSA or local match.

14.6.6 Dental services

The Smiles For Children program provides coverage for diagnostic,preventive, restorative/surgical procedures, as well as orthodontia

services for children. DentaQuest is the single dental benefitsadministrator that will coordinate the delivery of all Smiles For Childrendental services. Dental services do not require a CSA or local match.

Dental services

Dentists who accept Medicaid

14.6.7 Mental health treatment and intellectual disability services

Medicaid provides coverage for mental health treatment and intellectualdisability services. Services must meet service definitions, eligibilitycriteria, required activities, and service limitations. Providers of servicesmust meet qualifications specified under the Provider ParticipationRequirements. Covered services are grouped below based on whetheror not they require CSA or local matching funds.

Services that donot require CSA or local match:

304
http://dmasva.dmas.virginia.gov/Content_atchs/atchs/medbook-eng.pdfhttp://dmasva.dmas.virginia.gov/Content_pgs/mch-home.aspxhttp://dmasva.dmas.virginia.gov/Content_pgs/dnt-home.aspxhttp://www.dentaquestgov.com/FindProvider/FindProvider.aspxhttp://www.dentaquestgov.com/FindProvider/FindProvider.aspxhttp://dmasva.dmas.virginia.gov/Content_pgs/dnt-home.aspxhttp://dmasva.dmas.virginia.gov/Content_pgs/mch-home.aspxhttp://dmasva.dmas.virginia.gov/Content_atchs/atchs/medbook-eng.pdf


16/36


Outpatient psychiatric or psychological services: Individual therapy,family therapy, or group therapy provided by specified licensedprofessionals.

Physician services: Outpatient and inpatient therapy services.

Community mental health rehabilitative services:

Services provided in the childs home or community that providediagnosis, treatment, or care of children with mental illnesses orintellectual disability. The following services are provided primarily byCommunity Services Boards and private providers:

Crisis Intervention

Crisis Stabilization

Intensive Community Treatment (requires authorization)

Intensive In-Home Services for Children and Adolescents(requires authorization)

Therapeutic Day Treatment for Children and Adolescents(requires authorization)

Therapeutic Behavioral Services for Children and Adolescents(requires authorization)

Mental Health Support (requires authorization)

Mental Health Case Management (requires authorization)

Psychosocial Rehabilitation (requires authorization)

Substance Abuse Services

Crisis Intervention

Day Treatment

Case Management

Opioid Treatment

Day Treatment for Pregnant Women

Residential Treatment for Pregnant Women

305


17/36


For more information oncommunity mental health services, see the

DMAS Provider Manual.

DMASMedicaid Memo on Changes to Children Community MentalHealth Rehabilitative Servicesdated July 23, 2010.

Acute Inpatient Psychiatric Services

Childrens Mental Health Program

Funds intensive community based services for Medicaid eligiblechildren who have been in a Psychiatric Residential Treatment Facility(PRTF) for ninety or more days and for whom community-basedservices under the program are the critical services that enable thechildren to remain at home rather than reside in a PRTF. Theobjectives of the program are to: shorten stays in PRTFs by offering a

community alternative; provide access to an array of communitybased services designed to promote independence and support forchildren with serious emotional disturbances (SED); and improveoutcomes for children and their families by allowing children to live athome with their natural support system. For more information on theChildrens Mental Health Program, see the DMAS Provider Manual.

Intermediate Care Facilities for the Intellectually Disabled

Services that do require CSA or local match:

Treatment Foster Care Case Management

Community-Based Residential Services for Children and Adolescentsunder 21- Level A

Therapeutic Behavioral Services (Level B)

Residential Treatment Services (Level C)

14.6.8 Long term care services

Medicaid pays for long term care services in some institutional settings,

such as nursing facilities and Intermediate Care Facilities for theIntellectually Disabled and for individuals in their communities throughHome and Community Based Care Waivers.

Medicaid Waivers provide funds to serve people who are eligible for long-term care in institutions, such as hospitals, nursing facilities, andintermediate care facilities. Through Medicaid Waivers, certainrequirements are waived, including the requirement that individuals live

306
http://websrvr.dmas.virginia.gov/ProviderManuals/ManualChapters/CMHS/Chapter4_cmhrs.pdfhttp://www.dmas.virginia.gov/downloads/pdfs/mm-ChildrenCMHR.pdfhttp://www.dmas.virginia.gov/downloads/pdfs/mm-ChildrenCMHR.pdfhttp://websrvr.dmas.virginia.gov/ProviderManuals/ManualChapters/CMH/chapter4_cmh.PDFhttp://websrvr.dmas.virginia.gov/ProviderManuals/ManualChapters/CMH/chapter4_cmh.PDFhttp://www.dmas.virginia.gov/downloads/pdfs/mm-ChildrenCMHR.pdfhttp://www.dmas.virginia.gov/downloads/pdfs/mm-ChildrenCMHR.pdfhttp://websrvr.dmas.virginia.gov/ProviderManuals/ManualChapters/CMHS/Chapter4_cmhrs.pdf


18/36


in institutions in order to receive Medicaid funding. Waiver services do notrequire a CSA or local match.

Children may be eligible for the following waivers:

Mental Retardation/Intellectual Disabilities (MR/ID) Waiver

Eligibility: an individual must be age 6 or older and have adiagnosis of MR or be under age 6 and at developmental risk. Theperson must be eligible for placement in an intermediate-carefacility for persons with mental retardation or other relatedconditions (ICF-MR).

Services available: residential support services, day support,supported employment, prevocational services, personalassistance, respite, companion services, assistive technology,environmental modifications, skilled nursing services, therapeutic

consultation, crisis stabilization, and personal emergencyresponse systems (PERS). Support coordination is also provided.

Individual and Family Developmental Disabilities Support (IFDDS orDD) Waiver

Eligibility: The DD Waiver provides services to individuals 6 yearsof age and older who have a diagnosis of a developmentaldisability and do not have a diagnosis of mental retardation.Individuals also must require the level of care provided in anintermediate-care facility for persons with mental retardation orother related conditions (ICF/MR). Children who do not have a

diagnosis of mental retardation, and have received servicesthrough the MR/ID Waiver, become ineligible for the MR/IDWaiver when they reach the age of 6. At that time, they can bescreened for eligibility for the DD Waiver; if found eligible they willreceive a DD waiver slot without being placed on the DD waiverwaiting list.

Services available: day support, companion services, supportedemployment, in-home residential support, therapeuticconsultation, personal care services, respite care, supportedemployment, skilled nursing services, attendant services, familyand caregiver training, crisis supervision, environmental

modifications, assistive technology, personal emergency responsesystem (PERS), and prevocational services. Support coordinationis also provided.

Elderly or Disabled with Consumer Direction (EDCD) Waiver

Eligibility: This waiver serves the elderly and persons of all ageswith disabilities. An individual must meet nursing facility eligibility

307


19/36


criteria, including both medical needs and functional capacityneeds (assistance with activities of daily living). An individual canremain on the waiting list for another waiver while being served bythe EDCD Waiver and then transfer to the preferred waiver once aslot becomes available.

Services available: personal care aide services, adult day healthcare, respite care, skilled respite care, personal emergencyresponse system (PERS), and medication monitoring.

For more information on these and other waivers, see the DMAS Guideon Virginias Medicaid Waivers for Persons with Disabilities, TheirParents, and Caregivers.

Waivers are funded per slot. A slot is an opening of waiver servicesavailable to a single individual. For some waivers, there are waiting listsof persons who have already applied or who have been assessed as

eligible and are still waiting to receive a waiver slot. It is important to putthe child on the waiting list as early as possible, even if no slots arecurrently available. Waiting lists also help document the unmet need forservices when funding priorities are decided.

Receiving a waiver slot also does not guarantee that a child or youth willbe able to access services included in the waiver. Services can beprovided only by approved agencies in each locality. There may be alimited number of approved persons or agencies in a particular area.

14.6.9 Using Medicaid providers

Medicaid providers shall be used whenever they are available for theappropriate treatment of children and youth. State pool funds shall not bespent for any service that can be funded through Medicaid for Medicaid-eligible children and youth except when Medicaid-funded services areunavailable or inappropriate for meeting the needs of a child(Appropriation Act Item 274E).

The needs of the child and family shall take precedence over the use ofMedicaid-funded services. For example, a child should not be placed in agroup home far away from his or her home just to use a Medicaid facility.Similarly, a child should not be placed in a higher level of care thannecessary just to access Medicaid funding.

See the CSA Medicaid Maximization Memo.

See information provided in theDMAS Medicaid Memos to Providers.

14.7 Paying for services withCSA State Pool Funds

14.7.1 Services that may be purchased

308
http://dmasva.dmas.virginia.gov/Content_atchs/ltc/ltc_md_waiver.pdfhttp://dmasva.dmas.virginia.gov/Content_atchs/ltc/ltc_md_waiver.pdfhttp://www.csa.virginia.gov/html/legp504.pdfhttp://www.csa.state.va.us/html/CSA%20Letterhead%20(2).dochttp://dmasva.dmas.virginia.gov/Content_pgs/pr-memos.aspxhttp://dmasva.dmas.virginia.gov/Content_pgs/pr-memos.aspxhttp://www.csa.state.va.us/html/CSA%20Letterhead%20(2).dochttp://www.csa.virginia.gov/html/legp504.pdfhttp://dmasva.dmas.virginia.gov/Content_atchs/ltc/ltc_md_waiver.pdfhttp://dmasva.dmas.virginia.gov/Content_atchs/ltc/ltc_md_waiver.pdf


20/36


State law mandates the provision of foster care services with CSA statepool of funds(2.2-5211 B3 and C). Foster care services are definedas a full range of casework, treatment and community services for aplanned period of time for eligible children and their families(63.2-905).Services funded through CSA may be public or private, nonresidential or

residential services(2.2-5211 A).

CSA strives to preserve and strengthen families and provide appropriateservices in the least restrictive environment that protect the welfare ofchildren and maintain public safety. Children should be served in theirhomes, schools and communities whenever possible and appropriate.

If community services have been explored and determined not to be inthe best interest nor meet the needs of the child, LDSS should work withthe family and FAPT to explore placements with the extended family andindividuals who can effectively care for the child whenever possible. Ifthere are no viable options, LDSS and FAPT should then exploreplacements in family-like homes.

Finally, LDSS, the FAPT and family should explore group or residentialsettings to serve the child if these are the most appropriate, leastrestrictive and cost effective services.

Before placing the child across jurisdictional lines, the FAPT shall:

Explore all appropriate community services for the child;

Document that no appropriate placement is available in the locality;

and

Report the rationale for the placement decision to the CPMT(2.2-5211.1 2).

Any service shallbe made available to a foster child when that service isdocumented as needed in the Foster Care Service Plan or the IndividualFamily Service Plan (IFSP) developed by the FAPT or approvedmultidisciplinary team. Rehabilitative, restorative and supportive servicesshall also be provided as needed to parents/prior custodians and fosterparents on behalf of the child.

Service plans that are developed outside of the FAPT process orapproved multidisciplinary team process shall not be eligible for state poolfunds(2.2-5209).

State pool funds may be used for emergency placements, consistent withCPMT policy, provided that the youth are subsequently assessed throughthe FAPT process or approved multidisciplinary team process within 14

309
http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+2.2-5211http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+63.2-905http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+2.2-5211http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+2.2-5211.1http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+2.2-5211.1http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+2.2-5209http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+2.2-5209http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+2.2-5211.1http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+2.2-5211.1http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+2.2-5211http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+63.2-905http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+2.2-5211


21/36


days of admission and the emergency placement is approved at the timeof placement(2.2-5209).

State pool funds may also be used to pay for the cost of facilitation ofFamily Partnership Meetings by skilled, trained facilitators at five keydecision points, consistent with CPMT policy (SeeSection 14.9onfunding these meetings).

The LDSS continues to be responsible for providing services that arewithin its normal scope of responsibility and that are funded separatelyfrom the state pool(2.2-5211 D).

14.7.2 Children eligible for funding services from State Pool Funds

Children who are abused or neglected as defined in63.2-100, andchildren in need of services as defined in16.1-228, and their familiesare eligible for mandated foster care services when the children(2.2-

5211 B3 and C):

Have been identified as needing services to prevent or eliminate theneed for foster care placements; or

Have been placed through an agreement between either the LDSS orthe public agency designated by the CPMT and the parents orguardians who retain legal custody; or

Have been committed or entrusted to a LDSS or licensed child placingagency by the court(63.2-905).

Any child placed through a non-custodial foster care agreement,committed or entrusted to local boards of social services or for whom aLDSS is given responsibility or aftercare supervision, and his family, areeligible for state pool funds. This includes:

Services for a child to prevent foster care placement(2.2-5211).

Services for a child living in his or her own home (pre and post fostercare placement) and/or in the custody of the local board.

Maintenance and services for a child placed outside of his or her own

home.

14.7.3 Overview of CSA process for services and funding

The CSA process is the avenue through which services for eligiblechildren and their families, along with funding for those services, isobtained. Services for children and their families should be providedthrough a collaborative system of services and funding that is child-centered, family-focused and community-based(2.2-5200). All children

310
http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+2.2-5209http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+2.2-5211http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+63.2-100http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+16.1-228http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+2.2-5211http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+2.2-5211http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+63.2-905http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+2.2-5211http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+2.2-5200http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+2.2-5200http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+2.2-5211http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+63.2-905http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+2.2-5211http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+2.2-5211http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+16.1-228http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+63.2-100http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+2.2-5211http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+2.2-5209


22/36


receiving services and funding through CSA shall be assessed using themandatory uniform assessment instrument(2.2-5212). SeeSection6.8.1 for information on the Child and Adolescent Needs and Strengths(CANS) tool.

LDSS refer children and their families to the FAPT or approved

multidisciplinary team. The team assesses the strengths and needs ofchildren and their families, develops individual family services plans(IFSPs) or uses the foster care service plan, refers children and familiesto services, and designates case managers to monitor childrensprogress. The teams are responsible for engaging families inparticipating in all aspects of assessment, planning and implementation ofservices(2.2-5208).

The FAPTs work in accordance with policies established by the CPMTs,consistent with state and federal law. CPMTs have statutory authority andaccountability for managing collaborative efforts and implementinginteragency policies that govern CSA in the community. They coordinatecommunity wide planning, develop needed services, maximize and poolresources across sectors, and manage local CSA funds(2.2-5206).

All efforts should be made to maximize and pool resources acrossagencies and sectors. The FAPT, or entity designated by the CPMT,explores all available family, private insurance, community and publicresources that may assist in funding the services and supports in theIFSP.

Medicaid funds should be used whenever available for the child andfamily. State pool funds shall not be spent for any service that can be

funded through Medicaid for Medicaid-eligible children except whenMedicaid-funded services are unavailable or inappropriate for meeting theneeds of a child(Appropriation Act Item 274E). (See the CSA MedicaidMaximization Memo)

After assessing all appropriate federal, state, private and communityresources, the team recommends to the CPMT a plan for funding theservices, including expenditures from the local allocation of the CSA statepool of funds(2.2-5208). The CPMT uses established policies andprocesses for authorizing and monitoring the teams requests for funding(2.2-5206).

Ongoing utilization management(2.2-2648 D15) shall be conducted toassess the effectiveness and appropriateness of services provided,based on the plan established by the CPMT following state guidelines.

For more information about the CSA Process, refer to theCSA Manual.

14.7.4 What is needed to purchase any CSA service

311
http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+2.2-5212http://section_6%20_child_and_family_assessment.pdf/http://section_6%20_child_and_family_assessment.pdf/http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+2.2-5208http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+2.2-5206http://www.csa.virginia.gov/html/legp504.pdfhttp://www.csa.state.va.us/html/CSA%20Letterhead%20(2).dochttp://www.csa.state.va.us/html/CSA%20Letterhead%20(2).dochttp://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+2.2-5208http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+2.2-5206http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+2.2-2648http://www.csa.virginia.gov/html/manual_pubs/csa_manual_publications.cfmhttp://www.csa.virginia.gov/html/manual_pubs/csa_manual_publications.cfmhttp://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+2.2-2648http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+2.2-5206http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+2.2-5208http://www.csa.state.va.us/html/CSA%20Letterhead%20(2).dochttp://www.csa.state.va.us/html/CSA%20Letterhead%20(2).dochttp://www.csa.virginia.gov/html/legp504.pdfhttp://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+2.2-5206http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+2.2-5208http://section_6%20_child_and_family_assessment.pdf/http://section_6%20_child_and_family_assessment.pdf/http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+2.2-5212


23/36


Before a service can be purchased or paid through the State Pool Fund, itmust:

Be included in the child's Foster Care Service Plan or IndividualFamily Service Plan (IFSP). The plan should specify the length oftime needed for the provision of services, which shall be based on

what is reasonable to meet the child's needs.

Be authorized based on the local procedures established by theCPMT.

Be provided by a provider listed in the CSA Service Fee Directory orexempt. Exempt from the requirement for listing in the CSA ServiceFee Directory are individuals not associated with an entity whoprovide services, individually approved foster homes, purchase ofgoods, and non-specialized services such as baby-sitting,transportation, and lessons. Non-specialized services such as childcare providers, general medical, dental, or legal providers do not needto be listed in the CSA Service Directory if they are providing ageneric (non-specialized) service to the child. See theCSA ServiceDirectory.

For services listed in the CSA Service Fee Directory, the rates mustbe negotiated between the provider and purchaser using the ratelisted in the CSA Service Fee Directory, as the maximum rate theprovider will charge.

For services exempted from listing in the CSA Service Fee Directory,rates will be based on the normal cost for services in the community.

14.8 Paying expenses by foster parents on behalf of child

The procedures required to reimburse foster parents for expenses paid bythem on behalf of the foster child are:

The services must be pre-authorized.

Services purchased on behalf of the child may include, but are not limitedto, transportation, exclusive of that required for medical care underTitle XIX, school fees and purchases from commercial establishments.

14.9 Paying for Family Partnership Meetings

14.9.1 Using VDSS funds

VDSS funds are available in state fiscal year 2011 to help LDSS defray thecosts of conducting Family Partnership Meetings (FPMs). These funds areallocated based on the total number of FPMs held statewide in theprevious quarter.

312
http://www.csa.virginia.gov/sfd/service_fee_directory.cfmhttp://www.csa.virginia.gov/sfd/service_fee_directory.cfmhttp://www.csa.virginia.gov/sfd/service_fee_directory.cfmhttp://www.csa.virginia.gov/sfd/service_fee_directory.cfm


24/36


For further information, seeinstructionsfor documenting FPMs on the dataintegrity website

14.9.2 Using CSA funds

State pool funds may be used to pay for the cost of facilitation of FamilyPartnership Meetings by skilled, trained facilitators at five key decisionpoints, consistent with CPMT policy. They shall not be used to pay forfacilitation costs when the service worker facilitates meetings comprised ofthe same team members and other partners to address issues other thanthe five critical decision points.

The cost of skilled facilitation is an allowable billable cost when the child iseligible for CSA funds at the time of the meeting. The cost is calculatedbased on a child-specific unit cost using the match rate where the child isplaced. For example, if the child is in a residential setting, the cost is at

the residential match rate. If the child is in treatment foster care orspecialized foster care, the cost is at the foster care rate. If it is a fostercare prevention expense, then it would be at the community-based matchrate.

See the CSA Listserve Facilitation Cost guidancein theFamilyEngagement Toolkiton the Childrens Services Transformation website.

14.9.3 Determining whether to use VDSS or CSA funds

LDSS should use VDSS funds as described inSection 14.9.1 beforerequesting to purchase such services using CSA state pool funds, if

the LDSS chooses to purchase a facilitator, transportation for meetingparticipants, or other FPM activities.

CPMT guidelines vary from locality to locality. If a CPMT does notcurrently provide CSA funding for FPMs at the two CPS-relateddecision points before the child enters foster care, then VDSS maywant to target VDSS funds, described inSection 14.9.1, for thoseactivities.

CSA funds shall be used as a last resort as described inSection14.9.2, consistent with CPMT policies and procedures.

The locality may want to consider the applicable match rate as adetermining factor.

14.10 Purchasing home studies and placement services

In-state home studies for the dual approval of a foster and adoptive home maybe purchased from licensed child placing agencies. In the case of a family onlywanting to adopt, the LDSS may access VDSS contracts with private child

313
http://spark.dss.virginia.gov/divisions/dfs/reporting/files/intro_page/data_integrity_oasis/guidance_procedures/family_partnership.pdfhttp://vafamilyconnections.com/family_engagement_tools.shtmlhttp://vafamilyconnections.com/family_engagement_tools.shtmlhttp://vafamilyconnections.com/family_engagement_tools.shtmlhttp://vafamilyconnections.com/family_engagement_tools.shtmlhttp://spark.dss.virginia.gov/divisions/dfs/reporting/files/intro_page/data_integrity_oasis/guidance_procedures/family_partnership.pdf


25/36


314

placing agencies to complete the adoption home study. These studies may befunded by Title IV-E (if on behalf of a Title IV-E child) or CSA.

Home studies that the LDSS performs at the request of another state or thatthe LDSS pays for which is conducted with a family in another country are100% funded by Title IV-E(Social Security Act, Title IV, 471 (a) (26)and

474 (a) (3) (E) [42 USC 671]). (See LASER Manual for budget line.)

Placement services, including study and approval of foster homes may bepurchased from licensed child-placing agencies for a specific child. Thesecosts are Title IV-E or CSA allowable depending on the childs eligibility statusfor Title IV-E.

14.11 Purchasing child care services

14.11.1 Choosing an allowable child care provider

The LDSS holding custody of a child shall consult with the foster/adoptiveparent when selecting a child care provider. Considerations when makingdecisions about which provider to use include such things as the specialneeds of the child, travel distance from the foster/adoptive home,availability of the provider, provider costs in relation to other providers inthe area, approval status of the provider, and the foster/adoptive parentrequest for specific services. Childrens special needs includecharacteristics such as developmental disabilities, mental retardation,emotional disturbance, sensory or motor impairment, or significantchronic illness which require special health surveillance or specializedprograms, interventions, technologies, or facilities.

The providers identified below are considered as legally operating inVirginia and are allowable for child care services and payment from TitleIV-E funds. Authorization of the providers status must be verified onlineprior to use of the provider and a hard copy of the authorization must bemaintained in the case record of the child. See the VDSS website forcontact information for verifying the licensure, approval, or certificationstatus of the types of child care providers listed below.

Voluntary registered family day homes;

Licensed family day homes;

Licensed child day centers;

Certified pre-schools;

Religiously exempt child day centers;

Department of Education- approved child care facilities;
http://www.ssa.gov/OP_Home/ssact/title04/0471.htmhttp://www.ssa.gov/OP_Home/ssact/title04/0474.htmhttp://www.dss.virginia.gov/family/cc/index.htmlhttp://www.dss.virginia.gov/family/cc/index.htmlhttp://www.ssa.gov/OP_Home/ssact/title04/0474.htmhttp://www.ssa.gov/OP_Home/ssact/title04/0471.htm


26/36


Local ordinance-approved providers (available in Fairfax County,Alexandria, Arlington); and

Family day system homes.

14.11.2 Rates for child care

Localities shall make a diligent effort to secure fully approved child carefor foster children at costs no greater than the established maximumreimbursable rates. These rates are established in accordance withfederal regulatory requirements.

Rates are determined by type of provider, number of hours the child is incare, and the age of the child, as described below. For more information,seeSection IX, Determining Payment Amount in the Child Care andDevelopment (CCD) Manual.

Provider type. Two levels of maximum reimbursable rates shall be

used based on the type of provider. LDSS shall have a writtenagreement with the provider for child care services. The types ofproviders for each rate level are listed in Appendix G of the CCDManual.

Number of hours in care. The unit price for services shall be basedon whether the child is in child care for a full day (five or more hours aday) or a part day (fewer than five hours for a day).

Age groupings. Rates shall be based on the age of children, asdefined by the VDSS Division of Licensing Programs for child daycenters:

Infants - children from birth up to 16 months,

Toddlers - children from 16 months up to 24 months

Preschool - children from 24 months up to the age ofeligibility to attend public school (five years by September30). Children turning five after September 30 areconsidered pre-school until they start school the following

year;

School age - children eligible to attend public school, agefive or older by September 30 of that same year. Childrenturning five after September 30 are considered pre-schooluntil they start school the following year.

315
http://spark.dss.virginia.gov/divisions/cc/files/manuals/ccd_current_manual/Guidance_Effective_6-1-10.pdfhttp://spark.dss.virginia.gov/divisions/cc/files/manuals/ccd_current_manual/Guidance_Effective_6-1-10.pdf


27/36


The maximum reimbursable rates for child care are listed for each localityby full day and part day for each age group in the CCD Manual.

Level 1 rates are listed in Appendix H; and

Level 2 rates are listed in Appendix I.

If the LDSS has made a diligent effort to secure child care at or lowerthan the maximum reimbursable rate and cannot locate a provider willingto accept that rate, the LDSS may choose to pay more if it is determinedto be a reasonable cost. Reasonableness is determined based on theconsiderations used in selecting the provider. Providers whose costscannot be justified as reasonable in comparison to costs charged bysimilar providers should generally not be used.

The service worker shall document in the case record the efforts made tosecure the maximum reimbursable rate and factors used to determine

reasonable cost.

14.11.3 Funding sources

Allowable Title IV-E expenditures:

Child care is an allowable Title IV-E expenditure when the child care:

Provides daily supervision during the foster parents workinghours when the child is not in school.

Facilitates the foster parents attendance at activities which arebeyond the scope of ordinary parental duties.

Is provided in a licensed day care facility or home.

As examples, child care is an allowable expenditure under Title IV-Efor the foster parent to attend:

Judicial or administrative reviews.

Mandated team meetings by the court or LDSS.

Approved foster parent training.

College classes when the foster child is not in school.

Not allowable Title IV-E expenditures:

316


28/36

Virginia Department of Social Services Foster CareOctober 2010 Volume VII, Section III, Chapter B SECTION 14

Child care provided to a child in foster care cannot be paid with TitleIV-E to facilitate a foster parents participation in activities that are:

Within the realm of ordinary parental duties.

Deemed a social service.

As examples, the following activities are not allowable expendituresunder Title IV-E:

Illness of the foster parent.

Respite care.

School conferences.

State Pool Funds are used to: (1) provide child care for non-Title IV-Echildren, and (2) pay for Title IV-E children who require child day care forreasons other than the foster parents working, attending judicial reviews,training or receive day care from a provider not required to belicensed/approved. These funds are used except in those situationswhere the foster parent is otherwise eligible for one of the child day carefunding sources.

14.12 Purchasing transportation services

Transportation may be provided from State Pool Funds or Medicaid (Title XIX),or Title IV-E funds as follows:

14.12.1 Using Medicaid to purchase transportation

Transportation to obtain medical services for the child may be providedthrough the Logisticare Program. Logisticare coordinates volunteerdrivers to transport Medicaid recipients from their medical appointmentsanywhere in VA. Additional information about covered transportationservices and limitations can be found in the Transportation Manual of theDivision of Medical Assistance Services.

14.12.2 Using Title IV-E funds for transportation

Title IV-E funds shallbe used to pay for transportation costs for Title IV-Eeligible children when transportation is needed for two distinct purposesdescribed below. These payments are made in addition to the basicmaintenance payments.

Transporting the child to visits with either parents or siblings.

317
http://websrvr.dmas.virginia.gov/manuals/TRA/chapter_4_tran.pdfhttp://websrvr.dmas.virginia.gov/manuals/TRA/chapter_4_tran.pdf


29/36


Title IV-E funds cannot be used for parents to travel to visit children.Reasonable costs of travel for a child to visit siblings, parents andprior custodians to whom the child is expected to return may be madeif needed. Costs may include mileage (calculated at the state mileagereimbursement rate), bus tickets, or other transportation costs.Providers shall submit receipts for travel costs to the LDSS in order to

receive reimbursement.

Transporting the child to remain in the school in which the child wasenrolled prior to entry into foster care or prior to a placement change.

Transportation costs for a child to remain in the same school areallowable maintenance costs and shall be made available when theLDSS and school jointly determine that remaining in the same schoolis in the childs best interests. Reasonable costs of transportationinclude mileage (paid at the state rate with proof of miles driven), busfare, or other similar and reasonable transportation costs. LDSS mayreimburse the local school districts school bus transportation fund. Ifthe LDSS chooses to reimburse for travel on the school bus, adocumented agreement or contract between the LDSS and the LEAor the company that manages the school bus system must beobtained and a copy placed in the childs file.

Information on funding to support transportation expenses as part ofmaintenance costs is available in theFinance Guidelines Manual,Section 4.25, LASER Budget Line and Cost Code Descriptions, 811.

14.12.3 Using State Pool Funds to purchase transportation

Transportation expenses for a non-Title IV-E eligible child to remain in theschool in which he or she was enrolled at the time of an initial or changein foster care placement are allowable maintenance costs and shall bepurchased from State Pool Funds. These payments are made in additionto the basic maintenance payments paid on behalf of the child. TheLDSS and school shall have jointly determined that remaining in the sameschool is in the childs best interests.

Transportation may alsobe purchased from State Pool Funds when it isnot otherwise available without cost, is not for purposes of obtainingmedical services covered under Medicaid (Title XIX), and is not for thepurposes of transportation covered by Title IV-E.

Payment may be made to specific providers as follows:

Foster parents and employees of child placing agencies andresidential facilities using their own cars to transport an eligible childto visitation, to school, or to a visit with parents or siblings are paid atthe State mileage rate for actual miles driven. Individual providers

318
http://spark.dss.virginia.gov/divisions/dof/local_support/laser/budget_lines.cgi.http://spark.dss.virginia.gov/divisions/dof/local_support/laser/budget_lines.cgi.


30/36


must have a valid driver's license and automobile insurance and shallsubmit proof of miles driven to the LDSS for reimbursement.

Public transportation paid at the established rate.

Friends, relatives, neighbors of the child or foster parent, are paid atthe State mileage rate. They must have a valid driver's license andautomobile insurance and shall submit proof of miles driven to theLDSS for reimbursement.

14.13 Paying for medical care

For the Medicaid eligible child, Medicaid must be used to pay for medicalneeds including transportation to the Medicaid provider.

Other funding can only be used to pay for medical needs not covered underMedicaid, or medical services provided by vendors or in facilities not covered

by Medicaid.

Resources for costs of medical care not covered by Medicaid include:

Childs own income or resources including parents insurance(SSI/SSA);

General relief; and

State Pool funds (CSA).

14.14 Paying for independent living services

Independent living services are paid from the LDSS allocation of the ChafeeFoster Care Independence Program funds. The LDSS must have anapproved Independent Living Services and TransitionPlan before funds maybe expended (See theguidelineson the Spark website.)

LDSS should utilize the independent living services made available throughProject LIFEfor all youth age 14 and over. Project Life coordinates andenhances the provision of independent living services to youth in foster carewho are about to transition out of foster care. Funded by VDSS, Project LIFEprovides free or low-cost regional and statewide activities for eligible youth.

14.15 Purchasing regular education services

The local school division shall provide free textbooks required for courses of

instruction for children attending public schools (22.1-243). Othereducational services needed by the child and not provided by local schooldivisions may be purchased using State Pool Funds. Some educationalservices may be purchased from independent living funds for youth ages 14and over.

319
http://spark.dss.virginia.gov/divisions/dfs/fc/files/child_welfare_funding/ilp_education_training/2011_etvguidelines.pdfhttp://www.vaprojectlife.org/http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+22.1-243http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+22.1-243http://www.vaprojectlife.org/http://spark.dss.virginia.gov/divisions/dfs/fc/files/child_welfare_funding/ilp_education_training/2011_etvguidelines.pdf


31/36


14.15.1 When regular education services may be purchased

To achieve an educational goal;

They are not the responsibility of State and/or local educationagencies;

Services are not available without cost; or

Charges for services are the same to all residents regardless ofincome

14.15.2 Educational services that may be purchased

Normal school expenses such as school trips, summer school, gymsuits, fees for labs, art classes, etc., and school supplies;

Tutoring;

Training for employment if no other resource exists;

Tuition and fees, school supplies, textbooks required for collegedegree or vocational education;

Tuition and fees, etc., for placement in a private school for the childwho is not eligible for special education. In this instance, the childscase record must document that:

All other resources to meet the childs specific need have beenexplored; and

These resources have been determined to be inadequate to meetthe childs needs.

14.15.3 Other school related expenditures

Expenses related to school activities that are not necessary to meet aneducational goal such as class rings, club dues, and prom fees may bepurchased from Chafee Independent Living Funds for youth ages 14years and older, private donations and local only funds. After all otherfunding sources are pursued and determined not available, State PoolFunds may be used based on CPMT procedures.

14.16 Purchasing special education services

14.16.1 Local school responsibility

320


32/36


Local school divisions are responsible for paying for special educationservices identified on the child's Individual Education Program (IEP) whenthe child is placed within the school system or regional special educationprogram.

When a child is placed in another jurisdiction, the receiving local school

division should seek reimbursement for education costs from the VirginiaDepartment of Education for any children receiving foster care services.

(22.1-101.1and22.1-215).

14.16.2 Length of time child is eligible for special education services

A child is eligible for special education services until: a) he is found to beno longer eligible by an eligibility team; b) graduates with a regular oradvanced diploma; or c) reaches age 22 by September 30 of the year.The local school division where the LDSS is located that has custody ofthe child is responsible for the childs special education services. In the

event that a child is placed in foster care in a different jurisdiction and thechild can be educated in the public school or a regional program thatincludes that jurisdiction, the school division where the child is placed isresponsible for the childs education.

14.16.3 Use of State Pool Funds for special education services

State Pool Funds are to be used to purchase special education andrelated services for a child placed in a residential facility approved forspecial education or private special education day school inaccordance with the childs IEP. Related services include suchservices as developmental day programs, infant/child stimulation,

training to maximize independence and sheltered workshops.Procedures to access State Pool Funds for these placements will bebased upon CPMT policies. Maintenance for Title IV-E eligiblechildren would be paid from Title IV-E funds and from State PoolFunds for non-Title IV-E children.

In addition, theCSA Manual(Section 4.3.3a) specifies how State PoolFunds may be used to keep a child in a less restrictive specialeducation environment, when the FAPT makes such a determinationand includes it on the IFSP.

If a child is placed in a facility for special education and is

subsequently determined ineligible for special education, removal ofthe child from the facility or continued funding of services for that childin the facility will be based on local CPMT procedures. LDSS, incoordination with the FAPT, is responsible for ensuring that anappropriate placement is provided for the child.

14.16.4 Cross jurisdictional placements

321
http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+22.1-101.1http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+22.1-215http://www.csa.state.va.us/html/manual_pubs/csa_manual_publications.cfmhttp://section_4_placement_to_achieve_permanency.pdf/http://section_4_placement_to_achieve_permanency.pdf/http://www.csa.state.va.us/html/manual_pubs/csa_manual_publications.cfmhttp://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+22.1-215http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+22.1-101.1


33/36


The cost of purchasing special education and related services, whereapplicable, for children in cross-jurisdictional placements will be coveredby the placing agencys school division through the policies of the CPMT.This also applies to children in permanent foster care placements oradoptive placements prior to the final order. If a child is served in a publicschool, the receiving school division pays for the services. All special

education needs shall be included on the IEP in accordance with federallaw.

14.17 Purchasing emergency shelter services

Emergency Shelter service is the temporary housing and supervision of achild to prevent abuse, neglect or exploitation. The service is provided infoster family homes and residential facilities approved for emergency shelter.Payments may be made for reserve space under the following conditions:

Payment may be made until a more permanent arrangement can bemade.

Rates are negotiated by the LDSS for approved emergency foster familyhomes. There must be an agreement specifying that the home isapproved for emergency shelter and the rate of payment.

Payment for the child in custody of the LDSS is from Title IV-E or StatePool Funds, not protective services. A child removed from foster careplacement because of abuse/neglect and placed in emergency shelterremains a foster care case.

Rates are negotiated between the provider and purchaser based upon

CPMT procedures for residential care.

The locality, based on CPMT guidelines, may negotiate a fee to reservespace in an approved emergency shelter foster family home or facility andpay those fees out of State Pool Funds.

14.18 Paying for care in a residential facility

The cost of maintenance for a child placed in a residential facility is paidfrom SSI, Title IV-E, Medicaid (called room and board), or State PoolFunds for non-Title IV-E children.

Title IV-E cannot be used to pay the cost of maintenance of a child in apublic facility licensed for more than 25 children. State Pool Funds mustbe used.

Services provided in a residential facility will be paid from Medicaid orState Pool Funds. Residential services that can be purchased includeservices provided to every resident and specialized services provided tomeet a child's individual needs.

322


34/36


Rates for maintenance and services shall be the rate negotiated betweenthe provider and purchaser. The purchaser must negotiate a rate thatspecifies the amount to be paid for maintenance. The purchaser shallalso require providers to use invoices that clearly delineate line itemsusing the language from the federal definition of maintenance.

Ambiguous language that does not clearly communicate that a charge isallowable based on the federal definition of maintenance, shall not bepaid for by Title IV-E funds even if the child for whom the charges arebeing made is Title IV-E eligible.

The facility must be listed in the CSA Service Fee Directory. The facilitywill list the maximum rate it will charge in the Directory. Lower rates maybe negotiated.

14.18.1 Requirements for Medicaid funding

To be eligible for Medicaid funding for a childrens residential facility, theLDSS, provider and facility should fulfill the following responsibilitiesprior to admission.

The LDSS is responsible for:

Referring the child to the facility;

Preparing the Certificate of Need signed by FAPT members;

An independent physician must certify that outpatient care doesnot meet the specific needs of the child, proper treatment of thechilds condition requires services on an inpatient basis underthe direction of a physician, and services can reasonably beexpected to improve the childs condition to prevent furtherregression;

Provide a copy of the latest CANS (within 90 days);

Coordinate with the facility for the Initial Plan of Care;

The plan must include the following: diagnosis, symptoms,description of the functional level of the child, treatmentobjectives with short and long-term goals, orders for medication

and treatments, plans for continuing care including reviews anddischarge plans;

Forward to the receiving facility all relevant background andtreatment history;

Negotiate a reimbursement rate and provide the CPMTsignature on the Rate Certification Form.

323
http://www.csa.virginia.gov/sfd/service_fee_directory.cfmhttp://www.csa.virginia.gov/sfd/service_fee_directory.cfm


35/36


The provider is responsible for:

Being certified/enrolled as a Medicaid provider;

Developing with the LDSS the Initial Plan of Care;

Completing the approved preauthorization forms;

Negotiating a payment rate with locality; and

Notifying the CPMT/FAPT of Medicaid approval or denial.

Under Medicaid, reviews must be completed for residential placementsevery 30 days.

14.18.2 Absencefrom a residential facility

Title IV-E prohibits paying for unscheduled absences and the costs ofthese absences shou

section 14 funding and purchasing

Documents