Department for Community Based Services

Standards of Practice Online Manual

13.40 Approval of Adoption Assistance

Cabinet for Health and Family Services

Department for Community Based Services
Division of Protection and Permanency
Standards of Practice Online Manual
Chapter:
Chapter 13-Adoption Services
Effective:
11/30/2020
Section:
13.40 Approval of Adoption Assistance
Version:
3

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Legal Authority/Introduction

LEGAL AUTHORITY:

Practice Guidance

  • The adoption subsidy amount shall not exceed the amount paid for foster care maintenance for the same ch​ild, or exceed the foster care per diem reimbursement established by the Department for Community Based Services (DCBS) (including medically complex rates and care plus rates).  Children who are adopted with a level of care (LOC) one (1) or LOC two (2) shall qualify for up to the advanced rate.  Children being adopted with a LOC three (3), LOC four (4), or LOC five (5) shall qualify for up to the care plus or medically complex rate.  A private child placing (PCP) adoptive family meets the care plus standard for children with a LOC three (3), LOC four (4), or LOC five (5).     
  • A child placed in therapeutic foster care shall not receive an adoption subsidy in excess of the DCBS care plus rates, unless:
    • The amount is determined necessary to meet the child’s needs; and
    • The amount is approved by the DCBS commissioner or designee, through an Adoption Monthly Payment Exception memo and includes supporting documentation.
  • A child is eligible for the care plus rate if they have a LOC of a three (3), four (4), or five (5) and meets at least one of the following criteria (also outlined in SOP 4.10.1):
    • Displays aggressive, destructive, or disruptive behavior;
    • Has a diagnosed emotional or behavioral problem;
    • Is scheduled to be released from a treatment facility;
    • Is at risk of being placed in a more restrictive setting;
    • Is at risk of institutionalization; or
    • Has experienced numerous placement disruptions.
  • Child care services are paid by the adoptive parents and reimbursed monthly only with a paid receipt as verified by the child care provider.
  • Child care reimbursements are only available for children under the age of thirteen (13); or thirteen (13) years of age and older if there is an established need due to a physical, emotional, or developmental need of the child, and with documentation provided from a physician or qualified mental health professional (QMHP) as defined in KRS 202A.011 stating the child is physically or mentally incapable of caring for themselves.  1​
  • Adoption assistance may be requested for the following:
    1. Reimbursement of child care services The SSW facilitates DCBS reimbursement of payment for childcare services for full-time or part-time working foster and adoptive parents who work a minimum of twenty (20) hours per week and with annual employment verification or adoptive parents pursuing higher education. 2
    2. Transportation if mileage for health care treatment needs exceeds the yearly mileage for foster care rates.  (see Non-Medical Transportation Calculator for DCBS Foster Parents)
    3. Orthodontia with a dentist or physician’s verification that the child’s medical or dental need existed prior to the adoption finalization and a co-payment of fifty (50) percent of the cost.
    4. Tutoring not to exceed twenty-five ($25) dollars per hour for no more than two (2) hours per week.  Personnel other than immediate family must provide reimbursable tutoring, for which qualifications are verified by SSW​.  Tutoring may be approved for a child who:  
      1. Has an individual education plan (IEP); OR
      2. Is two (2) or more grade levels behind chronological age; and
      3. With need and unavailability of services as documented by the child’s school.  
    5. Evidence-based or evidence-informed health services after Medicaid and private health insurance have been exhausted, such as:
      1. Counseling;
      2. Expressive or art therapy;
      3. Behavioral therapy;
      4. Physical therapy;
      5. Occupational therapy;
      6. Speech therapy;
      7. Medication; or
      8. Special equipment.
  • ​​​​​A Kentucky medical assistance card is available to all children who have a DPP-1258 Adoption Assistance Agreement.  The adoption subsidy Kentucky medical assistance card is approved through the children's benefits worker (CBW) when the adoption finalizes and the child's agency case is sealed.  ​3
  • Respite care is not cumulative; this should be submitted monthly for reimbursement.  Respite care is offered to a child approved for:
    1. Medically complex or care plus rates prior to adoption finalization, at two (2) respite dates per child per month; or
    2. Specialized medically complex rate prior to adoption finalization, at three (3) respite days per month per child.​
Procedure
 
  1. The recruitment and certification (R&C) worker discusses with the adoptive family extraordinary medical services. 4
  2. The R&C worker submits a request for child care to the service region administrator (SRA) or designee that includes documentation from a qualified mental health professional (QMHP) or doctor of the therapeutic need for the service for non-working foster and adoptive home parents or for those children in need of child care who are age thirteen (13) and older. 5
  3. The SRA or designee conducts a special review of these approved requests every six (6) months. 6
  4. The R&C worker informs the adoptive parents are informed that approved child care co-payments will mirror those established by the Division of Child Care (DCC) in Kentucky Administrative Regulation 922 KAR 2:160 and adjustments in reimbursable amounts can be made at any time as also outlined in the child care section of the DPP-1258C Adoption Assistance Agreement for Extraordinary Medical Expenses.
  5. The R&C worker submits the request for approval of adoption assistance, extraordinary medical expenses, and non-reoccurring adoption expenses through the R&C supervisor to the SRA or designee. The packet should include the following:
    1. Approval letter;
    2. Memo for approval;
    3. Adoption Assistance Coversheet (the number of household members excludes foster children in the home);
    4. Adoption Assistance Request for each child;
    5. DPP-1258 for each child;
    6. DPP-1258C for each child;
    7. Non-Recurring Adoption Expense Request per sibling group;
    8. DPP-1258A per sibling group; and​
    9. ​Any other necessary documentation to determine eligibility (LOC, PCC rate, etc.).
  6. Upon approval by the SRA or designee, the DPP-1258 Adoption Assistance Agreement, and the DPP-1258C Adoption Assistance Agreement for Extraordinary Medical Expenses, and the DPP-1258A Adoption Assistance Agreement Non-Reoccurring Adoption Expenses are signed by all parties and copies are distributed to the adoptive family, CBW, and regional billing specialist CHFSAdptionsubsidy@ky.gov.
  7. The R&C worker reviews the information and forwards the bill and finalization documentation along with a copy of the DPP-1258A Adoption Assistance Agreement Non-Recurring Adoption Expenses to the Division of Administration and Financial Management (DAFM), in central office for payment. 7 (see link below to the Sample Letter to Reimburse Attorneys Directly).
 

Calculating Adoption Monthly Maintenance for PCP Adoptions 

 
  1. SSW requests from the PCP agency the current rate that the prospective adoptive parent is receiving, and the current LOC of the child.
  2. If the child is a LOC one (1) or LOC two (2, the family shall continue to receive the current daily rate that is received from the PCP. However, the family shall not receive more than the advanced DCBS rate.
  3. If the child is a LOC three (3), LOC four (4), or LOC five (5), the family shall continue to receive the current daily rate that is received from the PCP.  However, the family shall not receive more than the DCBS advanced care plus rate.
  4. If the child is deemed medically complex the family shall continue to receive the current daily rate that is received from the PCP.  However, the family shall not receive more than the established DCBS medically complex rate, (i.e., specialized medically complex, degreed medically complex, etc.)     
  5. The calculating formula to determine monthly maintenance rate is as follows: daily amount multiplied (x) by 365 divided (÷) by 12 equals (=) monthly maintenance amount (round to nearest dollar). 9

​Contingencies and Clarifications


 
  1. If the adoptive family requests payment to a private attorney, the attorney submits the bill for services and a copy of the adoption judgment to the R&C worker who processed the adoption assistance.
​​
 

Footnotes

  1. Documentation should include diagnoses and descriptions related to the child’s physical and/or mental incapacity to care for themselves and their need for supervision.  
  2. Verification documentation is reviewed during initial and annual contact. These requests for childcare services are reviewed at the annual contact.  Approved childcare rates cannot exceed the rates established by DCC. When possible, adoptive parents are encouraged to utilize public preschool services for children of appropriate ages.
  3. Adoptive parents should report any name, Social Security number, and/or address changes to the CBW.  The child may retain the Kentucky medical card if moving out of Kentucky, please refer to The Association of Administrators of Interstate Compact on Adoption and Medical Assistance.  Please review the Adoption Assistance Handbook for additional details and potential impact on the child’s medical coverage.  ​
  4. Discuss with the adoptive family, the Kentucky Integrated Health Insurance Premium Payment (KI-HIPP) for an adoptive child(ren) who is eligible for a medical card.  This Medicaid benefit will cover the premium cost for private health insurance when they enroll in this program.  Please refer to the KI-HIPP link for enrolling details.   ​
  5. Children approved by the medical review team (MRT) as physically or mentally disabled may be eligible for child care through age nineteen (19). 
  6. Approved childcare rates can not exceed the rates established by the Division of Childcare. When possible, adoptive parents are encouraged to utilize public preschool services for children of appropriate ages. The family must submit documentation every six (6) months to the R&C worker.  Approved childcare rates can not exceed the rates established by DCC.  When possible, adoptive parents are encouraged to utilize public preschool services for children of appropriate ages. 
  7. All non-recurring adoption expense reimbursement must be approved prior to the finalization of the adoption and cannot exceed one thousand dollars ($1,000) per child.
  8. Children can only be deemed specialized medically complex by the Medical Support Section.  Please refer to SOP 12.18.3 Medically Complex Home for degreed home requirements. 
  9. Examples of calculations:
    1. The child is a LOC three (3) and the PCP daily rate to the family is $33 per day.  $33 multiplied (x) by 365 days equals (=) $12,045 per year.  That amount divided (÷) by 12 months equals (=) $1,003.75, which rounds up to $1,004 per month.
    2. The child is age seven (7), a LOC two (2), and the PCP rate to the family is $33 per day.  In this scenario, DCBS staff should utilize the corresponding DCBS rate, which would be $26.40 per day, $9,636 per year, and $803 per month.
    3. The child is age seven (7), a LOC two (2), and the PCP rate to the family is $24 per day.  In this scenario, the family would continue to receive $24 per day multiplied (x) by 365 days equals (=) $8,760 per year divided (÷) by 12 months equals (=) $730 per month. 
    4. The child is a LOC three (3) and the PCP daily rate to the family is $50 per day.  In this scenario, DCBS staff should utilize the corresponding DCBS rate for advanced care plus which is currently $47.70 per day, $17,412 per year, $1,451 per month.         
       

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