New Provider Residential Services Orientation

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New ProviderResidential Services Orientation

• State of Georgia

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AmWayThe Miracle of Pyramid Marketing

• How to sale soap and rule the world.

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Introduction

• What We Will Do - Educate
• Presented By
• Georgia Association of Homes and Services for
  Children (GAHSC)
• Department of Human Resources (DHR)
• Office of Regulatory Services (ORS)
• Division of Family and Children Services (DFCS)
• Division on Mental Health, Mental Retardation,
  Substance Abuse (MHMRSA)
• Department of Juvenile Justice (DJJ)

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Overview

• Normer Adams, Executive Director
• Georgia Association of Homes Services for
  Children
• www.gahsc.org
• normer_at_gahsc.org
• 404 572 6170

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Steps to Provision of Services

• 1. - Organizational Capacity and Needs
  Assessments
• 2. - Licensure
• 3. - Approval Process for Vendors
• 4. - Referrals and Payments

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Steps to Provision of Services

• Step one - Organizational Capacity and Needs
  Assessments

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FIRST PRIORITY

• Develop the BUSINESS PLAN
• The Plan vs Good Intentions
• Board -Facilities
• Mission -Budgets
• Constituency -Policies Procedures

Needs Assessment
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FIRST PRIORITY

• THE BUSINESS PLAN (continued)
• Research
• The Need
• The Competition
• Interviews
• Field Trips

Needs Assessment
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SECOND PRIORITY

• Develop YOUR CONSTITUENCY
• (Who Supports You)
• Your CommunityChurch, Civic Groups, Interested
  Parties
• Your SupportersGive Time, Money, and Resources
• Your BoardDeveloped from your Constituency

Organizational Capacity Assessment
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Board Development(Those who are accountable to
the organization)

• Truism - An organization is as strong as its
  Board.
• Choose people who can help you
• Go beyond friends and family
• Movers and Shakers of community make good Board
  Members

Organizational Capacity Assessment
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Executive Director(He/She who manages the
organization)

• Choose person of experience, integrity,
  responsibility and history
• He/She will represent your organization
• He/She will carry out your policies and procedures

Organizational Capacity Assessment
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Mission(Drives the activities of the
organization)

• Clear concise mission statement importantWe do
  good is concise but not clear.
• Determines the nature of your services

Organizational Capacity Assessment
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Budgets and Budgeting

• Budget DevelopmentExpensesIncome 62 of
  costState Reimbursement 38 Your subsidy

Organizational Capacity Assessment
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Budgets and Budgeting

• Medical CareCovered by Medicaid - Nearly all
  children in residential care qualify for Medicaid.

Organizational Capacity Assessment
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Budgets and Budgeting(See Handout)

• Staff--Base Pay
• Benefits
• Insurance--Property, Casualty, Liability
• Other, including Food, office supplies,
  clothing, travel recreation, medical expenses,
  school supplies activities, gifts, allowances,
  conference expenses,vehicle repair, fuel,
  maintenance, grounds, promotions, postage,
  utilities,telephone, moving expenses of staff,
  GAHSC membership dues, and legal and professional

Organizational Capacity Assessment
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Fundraising

• Grants for Startup
• List of all the Foundations and Charities that
  give to new organizations starting children homes
  and group homes

Organizational Capacity Assessment
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Fundraising

• Grants for StartupAll Foundations and Charities
  1.
• 2.3.4.

Organizational Capacity Assessment
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Fundraising

• Grants for Startup
• Very Few
• Only to Existing Groups
• Need 501(c)(3) status
• Anticipate 18 months for startup support
• Build constituency

Organizational Capacity Assessment
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Not-for-profit Organization(Nearly all are
501(c)3)

• IRS Regulations for securing tax deductible
  contributions
• Takes at least 1 year to secure
• A knowledgeable person can do it without lawyer

Organizational Capacity Assessment
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Your Facilities

• Fire Inspection
• 1 Problem Area
• Most Expensive to Correct
• State Regulations, County Interpretations and
  enforcement
• Community
• Build Support Carefully
• If negative, hard to overcome
• Use community leaders to lead

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Your Facilities

• Zoning-- Required before Licensing-- 2 Problem
  Area-- Zone for a licensed childcare
  institution for six or more unrelated
  children-- Movers and Shakers of community can
  help with this

Organizational Capacity Assessment
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Policies Procedures(Provides the why and how
of the organization)

• Get a person who has done residential child care
  to prepare your policies and procedures
• These are your rule books for operations
• You will live and die by them
• They become your Bible for operation

Organizational Capacity Assessment
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Technical Clinical Assistance(Gut instinct is
not enough.)

• Truism - Experience is more valuable than gut
  instinct.
• A compliant child may be a depressed child.
• An attentive, indulgent staff may be a pedophile.
• Money in your pocket may not mean money in the
  bank.
• Your High School Joe might like your facility as
  coed, but you wont.

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Staff Personnel Issues(They make or break your
organization)

• Truism - Your program is as good as your worst
  staff.
• A thorough background check is essential.
• Would you let these folks care for your child?

Organizational Capacity Assessment
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Reporting Requirements

• Child Abuse Reporting Requirements
• Stuff will happen! Self Report.
• The law requires you to report abuse and neglect.
• Do not even THINK of not reporting.

Organizational Capacity Assessment
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Working with the State

• Some SteerThe State is our partner in caring for
  children. Their role is regulatory and
  contractual. Respect it.
• Others RowOur role is providing services to
  children. Together we work to provide the best
  care for children.

Organizational Capacity Assessment
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Departments Divisions of State Agencies

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Department of Family and Children Services
(DFCS)Budgeting/Rate Setting
Organizational Capacity Assessment
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BUDGETING/RATE SETTING

• Family Foster Care
• Institutional Foster Care

Organizational Capacity Assessment
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Family Foster Care

• DFCS Family Foster Homes Per Diem Rate --
• 33.30 Per Day Provider Rate
• Level of Care Family Foster Homes
• Daily Per Diem Calculated

Organizational Capacity Assessment
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Institutional Foster Care

• PER DIEM RATE
• Currently 44.22 /day for new providers.
• After first year reimbursement Rate
  Calculated-62 Total Allowable Costs

Organizational Capacity Assessment
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Allowable Costs

• Salaries
• Consultation Fees
• Occupancy Costs
• Insurance Costs
• Maintenance Repair
• Depreciated Equipment
• Consumer Supplies

• Payroll Related Expenses
• Travel
• Utilities
• Leased Equipment
• Purchased Equipment
• Lease Purchase

Organizational Capacity Assessment
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Unallowable Costs

• Bad Debt
• Contributions Donations
• Depreciation
• Investments
• Organizational Costs

• Contingencies
• Entertainment
• Fines Penalties
• Prohibited Activities

Organizational Capacity Assessment
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Provider ReportsInstitutional Foster Care (IFC)

• Annual Group Facilities Cost Report
• Description of Treatment Program
• Independent Audit Report
• Typical Weekly Schedule

Organizational Capacity Assessment
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Steps to Provision of Services

• Step Two - Licensure

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DHR Office of Regulatory ServicesChild Care
Licensing
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DHR Office of Regulatory ServicesChild Care
Licensing

• License Category -- CCI-Child Caring
  Institutions includes emergency shelters, group
  homes, and children's homes. (6 or more
  residents in (24 hour care)
• Application Process ? -- How to apply,
  temporary licensing, license

Licensure
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How to Apply for Licensure(Handout 3)

• Purchase licensure application package
• Familiarize yourself with ORS rules and
  regulations--develop a working knowledge of the
  meaning and intent of these rules and regulations
• Prepare your agency for compliance with the
  regulations

Licensure
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Staff Qualifications(Handout 5)

• Director Masters/2 years experience or
  Bachelors/4 Years experience
• Human Services Professional (Social Services)
  Bachelors/2 Years Experience or
  supervised by Masters
• Child Care Worker 21 Years Old/ High
  School or GED
• Satisfactory criminal records check

Licensure
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Staff Qualifications (continued)

• Human Services Professional--Masters Degree in
  social work, psychology, childhood education,
  education counseling and psychology, or related
  field ,
• OR a bachelors degree in one of these fields and
  two years experience, or under the supervision of
  another HSP with a Masters degree.

Licensure
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New Criminal Records Check Law----July 1, 1999

• Satisfactory state fingerprint result on
  Director, with FBI results pending
• Satisfactory preliminary results--employees
• Employee checks can be done by local law
  enforcement with results on file
• If employees check reveals any crime, person
  cannot be hired until resolved.

Licensure
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Physical Plant(Handout 6)

• Water/Sewage
• Bedrooms 63 Square Feet per resident
  Single 75 Square
  Feet
• Bathrooms - one sink /toilet per 8 kids, 1 shower
  per 10 kids
• Proper Storage for Hazardous Items
• SAFETY FIRST--Inside and Outside

Licensure
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Behavior Management(Handout 7)

• Forms of discipline which are not allowed
• Excessive or unreasonable work tasks
• Denial of meals and hydration
• Denial of sleep
• Denial of shelter, clothing, or essential
  personal needs
• Verbal abuse, ridicule, or humiliation

Licensure
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Behavior Management (continued)

• Chemical restraints or mechanical restraints
• Denial of communication and visits unless
  restricted in treatment planning process
• Corporal punishment

Licensure
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Specifics on Behavior Management

• Regulations on the use of isolation rooms
• Regulations on the use of physical control
  techniques--ONLY by staff trained by a certified
  trainer and documented in personnel record
• Discipline/behavior management methods MUST be
  documented in the treatment plan

Licensure
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Management of Medications(Handout 8)

• System for Proper Storage, Administration and
  Documentation
• Monitoring for Side Effects/Complications
• Expired Medications
• Accurate Medication Logs
• Method of Managing Medication Errors
• Documentation in Treatment Plan

Licensure
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Regulatory Process (Handout 9)

• Submit Application with local approvals
• Self-Assess for Rule Compliance and Completed
  Application Materials
• Initial On-Site Inspection Temporary License (6
  Months)
• Annual Re-Licensing Inspections
• Follow-Up Inspections
• Complaints/Self-Reported Incidents

Licensure
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• Break

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Steps to Provision of Services

• Step Three - State Approval Process of Vendors

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• Division of Family
• Childrens Services
• DFCS

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DFCS (Division of Family Children Services)

Services Purchased by DFCS

• Services purchased by DFCS for children in its
  custody are
• Institutional Foster Care (IFC)
• Family Foster Care (FFC)

Services Purchased
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Services Purchased by DFCS

• Institutional Foster (IFC) requires license by
  the Office of Regulatory Services (ORS)
• IFC includes group homes, emergency shelters,
  child care institutions, and therapeutic camps.
• Family Foster Care (FFC) requires license as
  Child Placing Agency or Child Caring Institution
  with Foster Care Services.

Services Purchased
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Characteristics of Children in DFCS Custody

• Age
• Birth to 18 years old
• Mental/Emotional/Behavioral Difficulties
• Medical/Physical Difficulties Deprivation
  determined by the court
• Abused, neglected, or abandoned
• Committed status

Characteristics of Children
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DFCS Approval Process (Handout 10)

• Potential Provider requests application package
  from the Treatment Services Unit.
• Completed Application is submitted to the
  Treatment Services Unit.
• Application is reviewed by Treatment Services
  Unit.

Approval Process of Vendors
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Approval Process (continued)
DFCS Approval Process (Handout 10)

• Three Possible Outcomes
• (A) Application accepted--will conduct
  an on-site visit and review the program
  (B) Application incomplete--will include an
  explanation of application items for which more
  information is needed (C) Application
  denied--will include an explanation of the basis
  for denial

Approval Process of Vendors
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Approval Process (continued)
DFCS Approval Process (Handout 10)

• If approved to serve children who are in the
  custody of DFCS, a notification letter will be
  sent to the provider.
• DFCS Treatment Services Unit notifies all county
  DFCS offices of the approval status.

Approval Process of Vendors
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Referral Process

• Program will receive referrals directly from
  county DFCS offices.
• County DFCS is responsible for reimbursement for
  services.

Referrals and Payments
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MHMRSA

• Division of
• Mental Health
• Mental Retardation
• Substance Abuse

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MHMRSA

• Division of DHR
• Made up of 13 Regional Boards
• Contract with 27 Community Services Boards (CSBs)
  and other private providers
• CSBs also sub contract with providers

Approval Process of Vendors
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MHMRSA Regions
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Characteristics of Children in MHMRSA Care

• SED (Severely Emotionally Disturbed)
• Under age of 18
• Major mental illness diagnosis, such as Major
  Depression, bi-polar disorder, anxiety disorder,
  PTSD, ADHD, oppositional defiant disorder, and
  substance abuse disorders
• Many are multi-agency involved

Characteristics of Children
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MHMRSA Approval Process (Handout 11)

• Following appropriate licensing from ORS, contact
  the Regional Board or the Community Service
  Board (CSB) in your area (see handout material).
• If chosen as an eligible provider, you must
  comply with all Division standards and provider
  manual requirements (Regional Boards have this
  information).

Approval Process of Vendors
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SED Residential TreatmentServices of MHMRSA

• Highly structured and supervised home
• Individual, family, group and activity therapy
  services
• Psychiatric services, including medication
  monitoring by an M.D. (psychiatrist)
• Community Re-integration Services, including
  identification of natural support systems

Services Purchased
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MHMRSA Referral Process

• Contracts are made directly with Regional Boards
  or Community Service Boards.
• The Regional Boards or Community Service Boards
  are responsible for reimbursement for services.

Referrals and Payments
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DJJ

• Department of Juvenile Justice
• DIVISION OF COMMUNITY CORRECTIONS

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Department of Juvenile Justice Division of
Community Programs Serves to Protect the Citizens
of Georgia by Providing Prevention Services,
Court Services and Supervision, Treatment and
Rehabilitation of Youthful Offenders.
Approval Process of Vendors
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DJJ Approval Process

• No Formal, Written Application
• Upon Obtaining Licensure, Contact the Residential
  Placement Specialist (RPS) in the District in
  which Your Facility is Located

Approval Process of Vendors
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State Outline of DJJ Districts (Handout 12)
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Residential Placement Specialists (Handout 13)

• 13 Districts match DHR Districts

• Regional Placement Specialists
• 1. Wayne Reynolds
• 2. Kim Settles
• 3. Marie Martin
• 4. Carl Harrison
• 5. Sue Riner

Approval Process of Vendors
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DJJ Approval Process

• Residential Placement Specialist (RPS) Conducts
  Site Visit
• Assesses Willingness and Ability to Service
  Delinquent Youth
• School Issues
• Supervision
• Contract

Approval Process of Vendors
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DJJ Contracts and Payments

• Contract - referrals and payments are negotiated
  through contracts.

Referrals and Payments
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Characteristics of Children in DJJs Care

• Average Age - 15 (range is from 8-17)
• 82 Males - 18 Females
• Most Common Offenses - Property Status
• Oppositional - Lack Impulse Control
• Common Mental Health Diagnoses - Conduct
  Disorder, Depression, PTSD
• Substance Abuse Issues

Characteristics of Children
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Services to Children in DJJs Care

• During FY 1998, 789 youth were served in the
  Contract Home Program.
• Youth were served in either
• Group Homes
• Private Family Placements

Services Purchased
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Private Placements

• Normer Adams, GAHSC

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Private Placements

• Agency determines what services to sell (or give
  away) to the private individual. The nature of
  these services are determined on the ability to
  provide those services within the Licensing
  framework

Services Purchased
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Characteristics of Children in Private Placement

• Characteristics of the children -- Determined by
  agency according to their mission and ability to
  care for the child.
• And by ability to serve.

Characteristics of Children
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Private Placements

• Application Process-- Licensing allows an agency
  to provide out of homes services. Within the
  rules of Licensing, each agency develops their
  own application process.
• Approval Process -- There is no approval process
  save Licensure.

Approval Process of Vendors and Marketing
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Private PlacementsReferrals and Payments

• Referrals - Referrals are made by private
  individuals or agencies. This referral network
  is determined by the agency.
• Payments - Payments are negotiated with each
  referring party.

Referrals and Payments
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MATCH

• Multi-Agency Team for Children

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Characteristics of Child Served by MATCH

• Children have severe mental, emotional and
  behavioral disturbances.

Characteristics of Children
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MATCH(Multi-Agency Team for Children)

• Includes DFCS, DJJ, DOE, ORS, and DMHMRSA
• MATCH is responsible for arranging and purchasing
  residential treatment services for children with
  mental, emotional and behavioral disturbances.

Approval Process of Vendors
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MATCH Services Purchased

• Intensive Residential Treatment Programs
• Intermediate Residential Treatment Programs
• Outdoor Therapeutic Programs
• Therapeutic Foster Care (Levels I and II)

Services Purchased
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MATCH Enrollment Process (Handout 14)

• Potential provider requests application package
  from the Treatment Services Unit.
• Potential provider must have the appropriate
  license from ORS.
• The agency must be in compliance with the
  Certification Standards for Enrollment as a
  Provider of Therapeutic Residential Child Care
  Services prior to the submission of the
  completed application to the Treatment Services
  Unit.

Approval Process of Vendors
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MATCH Enrollment Process (continued)

• Completed application is submitted to the
  Treatment Services Unit.
• Application is reviewed by Treatment Services
  Unit.

Approval Process of Vendors
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MATCH Enrollment Process (continued)

• Three Possible Outcomes (A) Application
  accepted--Treatment Services Unit and ORS will
  conduct an on-site visit and review the
  program (B) Application incomplete--will
  include an explanation of application items for
  which more information is needed (C)
  Application denied--will include an explanation
  of the basis for denial

Approval Process of Vendors
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MATCH Enrollment Process (continued)

• If enrolled as a MATCH provider, appropriate
  paper work, including rate notification and
  contract with DHR will be sent.
• Program is added to the list of approved MATCH
  providers.

Referrals and Payments
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MATCH Outcome Project
MATCH Enrollment Process (continued)

• A system designed to measure and track the
  effectiveness and results of residential
  treatment services provided to children and
  adolescents with severe emotional disturbance.
• All providers are required to participate.

Services Purchased
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MATCH Referrals and Payments

• Provider will receive referrals from County DFCS
  or Community Mental Health after the child has
  been approved for funding by the State MATCH
  Committee.
• Approval letter is sent to the MATCH provider.
• The State Office of DHR is responsible for
  reimbursement for service.

Referrals and Payments
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Steps to Provision of Services

• 1. - Organizational Capacity and Needs
  Assessments
• 2. - Licensure
• 3. - State Approval Process for Vendors
• 4. - Marketing to Referral Sources, DFCS, DJJ,
  Private Sector

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WRAP-UP

• Questions????????
• Evaluation Forms
• Training Certificate