Rate Redesign Project Overview

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Rate Redesign Project Overview

• District Managers
• July 7, 2009

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What is the Rate Redesign Project?

• A system change for the way the state provides
  services to children and financial assistance to
  family foster care parents and relative
  caregivers for the care of children in the states
  legal care and custody.
• This change includes what we use to call base
  rate, special rate, personal care rate, and has
  impacts on other system things such as clothing,
  transportation, respite and daycare.

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Why is this occurring ?

• Oregon like all states rely on Federal Funding to
  assist the state in providing funds for family
  foster care.
• Federal regulations and a Federal audit has
  required Oregon to change our practice in the way
  we provide foster care funding and has required
  Oregon to develop a more thorough and consistent
  methodology of rate setting in foster care.
• Foster parents, department staff, judges,
  legislators and community partners have longed
  requested for a change in the Special Rate /
  Personal Care program.

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Where have we been ?

• Rate Redesign Project started in April 2008 with
  a dedicated team of three individuals with the
  full-time job to focus on the project. They
  researched other states, federal regulations, and
  explored various assessment tools and models.
• Prior to this team there had been several
  workgroups internal and external to the
  department and previous proposals along the way
  that have been used in this redesign.
• The work has utilized Guiding Principles along
  the way.

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Guiding Principles of Rate Redesign

• Rate reimbursements must support a foster system
  that keeps children safe and healthy.
• No surprises. The process of changing the rate
  reimbursement structure will be transparent to
  foster parents, stakeholders and interested
  parties.
• Maximize federal dollars for foster children as
  we meet the new federal mandates. In responding
  to the new federal rules, we will design a system
  that ensures the greatest federal support for
  Oregon's foster children.
• Make the system more fair, consistent and
  transparent. From first-time relative foster
  parents to seasoned veterans, the system has to
  work for all foster parents.
• Keep foster parents involved. As we improve the
  rate reimbursement process, foster parent
  involvement will help us make the best decisions
  for Oregon's foster children.
• Use the work done before as guidelines. The rate
  redesign will use the input of foster parents
  from prior workgroups and hearings to point the
  way to a better system for Oregon's foster
  children.

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Where are we now ?

• July 1, 2009 new administrative rules are being
  filed with the Secretary of State office to allow
  for the implementation of this system change to
  begin.
• September 1, 2009 new base rates and rates for
  levels-of-care (pending Legislative approval)
  will be implemented for all foster parents and
  relative caregivers. This also includes a new
  daily rate for family shelter care.
• Reimbursement checks for foster parents and
  relative caregivers received or about October 1,
  2009 will reflect the base rate changes started
  in September.

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So what is this new model look like ?

• The model is a Child Centered level-of-care
• Three primary components
• Base Level
• Enhanced Supervision
• Personal Care Services

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Level-of-Care Model
Level One- Moderate
Enhanced Supervision
Level Two-Intermediate
Level Three-Advanced
Base Level of Care
Level One- Moderate
Level Two-Intermediate
Personal Care Services
Level Three-Advanced
Level Four-Intensive
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Base Level

• A family foster care level for all foster
  children in certified DHS foster homes.
• Children who do not have any extraordinary
  ongoing medical or behavior supervision needs but
  may have mild to moderate level of care based on
  the fact of being a child in need of foster care
  services and support.
• The base level of care will include financial
  assistance for
• Food Clothing Shelter
• Incidentals Cost of Providing Daily
  Supervision

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Two new areas not previously outlined in a base
rate

• Daily supervision including teaching and
  directing to ensure the child or young adult is
  attended to appropriate to his or her age,
  developmental level and to ensure safety
• The cost of providing including local travel
  associated with expenditure for gas and oil,
  vehicle maintenance and repair, and
  transportation to and from extracurricular, child
  care, recreational and cultural activities.

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Enhanced Supervision

• Enhanced Supervision is a component that
  provides three levels-of-care based on the
  additional supervision needs (non-medical) of a
  child.
• Level One Moderate
• Level two Intermediate
• Level three Advanced

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Enhanced Levels Defined

• Level One Moderate to Intermediate. A child or
  youth requires close monitoring, frequent
  redirection, learning or relearning of socially
  acceptable behavior.
• Level Two Intermediate to Advanced. A child or
  youth requires a high degree of structure,
  frequent adult supervision which may include
  one-to-one monitoring and frequent redirection.
• Level Three Advanced. A child or youth requires
  constant high degree of structure and close
  monitoring, constant redirecting and close
  supervision for safety needs of the child.
• The levels of care are determined by the results
  of a CANS screening that is preformed by a
  trained CANS screener.

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Child and Adolescent Needs and Strengths (CANS)
screening tool.

• CANS is a comprehensive screening instrument that
  identifies a child or youth needs and strengths
  in the areas of Safety, Strengths and
  Well-Being.
• CANS screening instrument is specific to age
  groups
• Ages Birth through Five (0-5)
• Ages Six through twenty (6-20)
• The CANS screening tool consist of a series of
  questions that will be assessed by reviewing
  information provided to the screener about the
  child and by interviews that may include the
  child, parent, foster parent, caseworker,
  teacher, or others who may have a caretaking role
  in this child or youth life.

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Level of Care Determination

• Once the CANS screening and results are completed
  by the screener, they will send the results to
  the Level of Care Unit in Central Office who will
  make the determination of the appropriate level
  of care based on a standardize methodology of the
  screening tool.
• The result of the CANS and the determination of
  the Level-of-Care will then be sent to the foster
  parent and caseworker .
• This is the opportunity for the foster parent and
  caseworker to work together on developing a
  supervision plan if necessary and determining if
  other services for the child are needed such as
  mental health counseling, additional education
  support such as an IEP, etc

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Personal Care Services

• Personal Care Services is also a model that
  provides levels-of-care based on the additional
  medical interventions needs of a child.
• Level one Moderate
• Level two Intermediate
• Level three Advanced
• Level four Intensive

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Personal Care Services Levels Defined

• Level One Moderate to Intermediate. A child or
  youth is at risk for or is experiencing
  infrequent or predictable changes in medical
  needs. Simple medical interventions that are
  provided by a trained Personal Care provider.
• Level Two Intermediate to Advanced. A child or
  youth is experiencing frequent and predicable or
  unpredictable changes in medical needs. Medical
  interventions that are provided by a trained
  Personal Care provider.
• Level Three Advanced to Intensive. A child or
  youth is experiencing frequent and unpredictable
  changes in medical needs. Medical interventions
  that can be provided by a trained Personal Care
  provider during unanticipated events.
• Level Four Intensive. In rare and extraordinary
  situations a child or youth in family foster care
  may have ongoing medical needs and experiencing
  frequent and unpredictable changes in their
  health that requires constant observation for
  medical attention and interventions that may be
  provided by a trained Personal Care provider.

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Personal Care Services Assessment

• A Personal Care Services Assessment (PCSA) is a
  tool administered by a licensed Registered Nurse
  through which the department employ's or
  contracts with and is authorized to administer
  this assessment.
• The PCSA consists of a series of questions that
  will be assessed by reviewing information
  provided to the nurse about the child and by
  interviews that may include the child, parent,
  foster parent, caseworker, medical providers, or
  others

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Determination of the Level of Care

• Once the PCSA is completed, the results are sent
  to Central Office for review of the assessment
  and the results forwarded to the Level of Care
  Unit in Central Office who will make the
  determination of the appropriate level of care
  based on a standardize methodology of the
  screening tool.
• The result of the PCSA and the determination of
  the Level-of-Care will then be sent to the foster
  parent and caseworker.
• This is the opportunity for the foster parent,
  caseworker and Registered Nurse to work together
  on developing a Personal Services Care Plan for
  the care of the child and to identify the
  responsibilities of each participant.

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What other changes are occurring in this new
Level-of-Care model ?
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Level of Care follows the child

• The Level-of-Care determination for Enhanced
  Supervision follows the child. There will not be
  a requirement to re-screen the child if they move
  to a different foster family placement.
• The Level-of-Care determination for Personal Care
  Services does not follow the child since a
  Individualize Care Plan and an assessment of a
  Qualified Medicaid Provider must occur in each
  setting.

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Re-screening

• Children will be re-screened using the CANS on an
  annual basis.
• Children with a Personal Care Service Plan will
  be re-assessed at a predetermined time period
  based on their condition but no later then an
  annual reassessment.
• A re-screening may occur sooner then on an annual
  basis if a "Precipitating event" has occurred. An
  observed, ongoing change in a child or young
  adult's behavior or condition. (Trauma, a
  significant sustained change, etc..)

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Family Shelter Care looks different

• Relative and Foster Family Shelter Care now
  extends to 20 days for the initial placement
  rate. This initial shelter care rate is for
  only the childs initial placement into foster
  care and not subsequent placement moves in foster
  care.
• An Enhanced Shelter Care has been developed for
  children or youth who are stepping down from
  higher levels of care in Residential Treatment
  Programs to family foster care. This period of
  time extends to 20 days or less if a CANS and
  level of care is determined earlier.

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Foster Family Group Homes

• The foster family group home program in Oregon is
  ending August 31, 2009 and is being replaced by
  the Level-of-Care model.
• All children in these homes will continue to stay
  in these homes if the group home providers choose
  to continue their foster care placement.
• Children will be assessed with a CANS and a Level
  of Care determination will be made.

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Respite Care Day Care for Working Foster
Parents and Clothing Allowance

• Respite is not an activity that can be supported
  by the federal funding streams used to fund our
  foster care system. We will continue to advocate
  federally and locally to develop a formal respite
  program but at this time we do not have a respite
  care program for foster families.
• Day Care for working foster parents is another
  identified need for foster families in Oregon,
  but we are unable to fund an employment related
  daycare program for working foster parents at
  this time.
• Clothing Allowance is built into the base level
  of care rate for all children and on a limited
  basis an additional allowance may be provided
  based on extraordinary needs of a child medical
  condition, health or safety related, etc

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Other changes

• This new model provides an opportunity for a
  foster parent on behalf of the foster child to
  request a Contested Case Hearing if they find
  that the Level-of-Care has not been accurately
  determined. This formal process may include an
  Administrative Law Judge and a formal order at
  the conclusion of the process.
• The Level-of-Care is determined at the Central
  Office Level of Care Unit and not at the
  caseworker, supervisor, or Special Rate Committee
  in the local branch. This was designed to bring a
  statewide consistency among levels of care
  setting and to remove caseworkers from the added
  responsibility of rate setting.

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What are the new rates based on ?

• Rate Redesign Project utilized a number of
  reports and studies to determine the costs of
  care for children.
• USDA's "Cost of Raising a Child" Report,
• Hitting the M.A.R.C. (Minimum Adequate Rates for
  Children) Report
• Comparison of Other States Rates (NRCFCPPP)
• Consumer Expenditure Survey,
• Oregon Child Care Market Study

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What are the new rates ?

• The state budget must still be approved by the
  Oregon legislature, but we estimate that about
  84-89 (4545-4827) children placed with foster
  families will have some increase in their overall
  monthly reimbursement rates, and 11-16 (609-891)
  children will see a decrease as a result of the
  restructuring of the system.
• Base rate estimate per child per month if funded
  at the proposed 100
• Age 0-5 639
• Age 6-12 728
• Age 13-21 823
• Note Base rate per child per month at current
  rate age 0-5 399 age
  6-12 414 age 13-21 512
• The Legislature is on track to have the final
  budget in place this month, and Oregon's new
  foster care rates will be implemented in
  September 2009.

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Levels of Care Rates

• Enhanced Supervision
• Level One 212
• Level Two 414
• Level Three - 850
• Personal Care Services
• Level One 207
• Level Two 413
• Level Three - 620
• Level Four - 620 (additional service may be
  authorized)

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• Shelter Care means care provided to a child or
  young adult during the first 20 days of placement
  in substitute care.
• Daily Payment Rates Shelter Care
• Ages 0-5 24.60
• Ages 6-12 28.00
• Ages 13-20 31.60
• Enhanced Shelter Care means care provided to a
  child or young adult when placement in a Behavior
  Rehabilitation Services is no longer needed.
  Eligibly is up to 20 days.
• Daily Payment Rates Enhanced Shelter Care
• Ages 0-5 29.40
• Ages 6-12 33.50
• Ages 13-20 37.90

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What should Foster Parents and Relative
Caregivers expect as the next steps for Level of
Care Implementation ?

• July 1 new rules are issued including the
  change in Family Shelter Care extending to 20
  days.
• June through August all children in foster care
  who currently have a Special Rate or Personal
  Care are expected to have a CANS or PCSA and a
  Level-of-Care determination.
• Foster Parents will be notified and requested to
  participate in the CANS or PCSA screenings.
• Children new to foster care may be referred for a
  CANS or PCSA within the first 20 days of
  placement, if their identified needs warrant such
  a screening. Otherwise there will not be a
  referral for CANS or PCSA during this initial
  phase.
• Reimbursement checks for foster parents and
  relative caregivers received or about October 1,
  2009 will reflect the base rate changes that
  start September 1, 2009.
• When the new rates are approved and become
  available they will be posted online and branch
  offices will be notified of the rates.
• January 2010, we anticipating starting to perform
  a CANS on all children entering foster care and
  remaining in care beyond 20 days.

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For More Information

• For more information be visit the Rate Redesign
  Project page on the Departments website at
• http//www.oregon.gov/DHS/children/fostercare/rate
  s/
• -- just click on "Project Updates."