Department for Community Based Services

Standards of Practice Online Manual

4.11.1 Level of Care Assignment

Cabinet for Health and Family Services

Department for Community Based Services
Division of Protection and Permanency
Standards of Practice Online Manual
Chapter 4-Out of Home Care Services (OOHC)
4.11.1 Level of Care Assignment

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Legal Authority/Introduction



The SSW: 

  1. Completes the level of care packet for a child who is:
    1. Four (4) years of age or above; or
    2. Any child who is designated medically complex regardless of age.
  2. Submits the following documents to the Children’s Review Program within five (5) working days of the child's entry into OOHC in order to obtain a level of care assignment:
    1. DPP-886-Private Child Care Interagency Referral;
    2. DPP-886A-Application for Referral and Needs Assessment;
    3. DSS-1251A-Child Placement History Log;
    4. Child Behavior Checklist (CBCL) for children with an IQ above seventy [70] (online version for children ages 6-18 or paper version for children ages of 1 1/2-5); and
    5. For medically complex children, documentation verifying medically complex status.
  3. Follows the guidelines in SOP 4.11.2 Request for Emergency Level of Care Assignment if an unforeseen circumstance necessitates a child without a level of care assignment, or with an expired level of care assignment, to be placed; and
  4. Ensures that the review of the level of care assignment occurs to keep the child’s level of care assignment active. 1

Practice Guidance

  • Within three (3) working days of receipt of the complete level of care packet, the Children’s Review Program determines the child’s assigned level of care, and returns the completed DPP-886-Private Child Care Interagency Referral Form to the SSW.
  • Children's Review Program works with the Medical Support Section to obtain an acuity level for children designated medically complex which will be considered when assigning the level of care.   
  • Levels may also be assigned upon request for children under the age of four (4) with significant behavioral or mental health needs.  In these cases, the SSW must submit to the Children's Review Program a request letter from a supervisor along with the items listed in number 2 above. If PCC or PCP staff requests that a child under the age of forty eight (48) months be leveled and the SSW and FSOS are not in agreement, a request from the provider will be sent to the Department of Protection and Permanency, Out of Home Care Branch Manager, at 502-564-2147, for determination.


  1. Review of the level of care assignment is outlined in SOP 4.11.3 Reviews of Level of Care Assignment.


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