Legal Authority/Introduction

LEGAL AUTHORITY:

• 922 KAR 1:360 Private child care placement, levels of care, and payment

Procedure

If the child is in a PCC foster home or a residential facility the SSW:

1. And foster parent complete or update the CRP-003-Children’s Review Program Foster Care Six-Month Progress Report and forward it to the Children’s Review Program every six (6) months;
2. And/or foster parent complete the Child Behavior Checklist (CBCL) for Ages 4-18, and forward it to CRP every six (6) months if the child has an IQ of seventy (70) or above;
3. And/or foster parent complete the Scales of Independent Behavior–Revised (SIB-R) and the Reiss Scales for Children’s Dual Diagnosis and forward to CRP every twelve (12) months if the child has an IQ below seventy (70).
   
4. If the child is placed in a PCC residential facility, and during the LOC review it is determined that a child’s level is decreased from a four (4) or five (5), to a three (3) or lower, the SSW completes a Prevention Plan to outline provisions of a planned placement move based on the re-leveling of the child (refer to SOP 4.11.4 Change in LOC Assignment). 1

The Medical Support Section:

1. Receives from CRP, a list every month of medically fragile children, placed in a PCC/PCP, whose acuity level will require a six (6) month reassessment;
2. Contacts the medically fragile liaison and the Commission for Child with Special Health Care Needs (CCSHCN) nurse to obtain updates on the child in order to assign an appropriate acuity level;
3. Forwards the acuity level to CRP to inform the level of care assignment as described in SOP 4.11.1 Level of Care Assignment.
   

If special circumstances exist which require that the SSW appeal (i.e. request a redetermination of the level of care assignment), the SSW submits: 

1. DPP-886-Private Child Care Interagency Referral, with Section H completed (for an initial level or reassignment);
2. CRP-002-Private Child Care Notice of Level of Care Payment or CRP-005-DCBS Foster Care Utilization Review Notice of Level Assignment, with Request for Redetermination section completed (for a level assigned by a utilization review); and
3. Copies of available documentation that indicate that the child’s level of care assignment may be higher or lower than is appropriate.

Practice Guidance

• Following review, CRP sends the assigned level of care to the SSW within ten (10) working days, along with the narrative reports of the CBCL and SIB-R/Reiss.
• If the child is in a PCP/PCC placement and has a valid initial level of care assignment, the PCP/PCC is responsible for keeping the level of care assignment valid by requesting a utilization review and by completing the appropriate paperwork.
• CRP is responsible for notifying the Medical Support Section one month in advance of any medically fragile utilization reviews. 
• For children that are designated medically fragile and also have behavioral issues, CRP will make the final level of care determination.
  
• When there is an appeal, CRP sends a copy of the results of the review to the SSW and placement within three (3) calendar days.
• Levels may also be assigned upon request for children under the age of four (4) with significant behavioral or mental health needs.  Refer to SOP 4.11.1 Level of Care Assignment.
  

Footnotes

1. This planned placement move should be from the residential facility into a foster home setting.