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Financial Support Systems > Specialized Support & Client Services > Specialized Care Increment (SCI) – F-Rate

Specialized Care Increment (SCI) – F-Rate

0900-522.11 | Revision Date: 07/29/15

Overview

The Specialized Care Increment (SCI)A rate paid in addition to the basic care rate for the care of children/youth with special needs. F-Rate is a higher foster care rate paid in addition to the basic foster care rate, for the care of children/youth with special needs. This policy guide provides information on caregiver requirements, and on assessing for, determining, and reevaluating an F-Rate for a child/youth.

TABLE OF CONTENTS

Policy

Specialized Care Increment (SCI) F-Rate

F-Rate Criteria

F-Rate Determinations

F-Rate Reevaluations

Caregiver Requirements

Caregiver Training - F-Rate Certification

Caregiver Training - Child Specific Medical Training

Kinship Guardianship Assistance (Kin-GAP) Legal Guardians

Placement Capacity

Out-of-County Placements

Out-of-State Placements

Dual Agency Rate

Procedure

Assessing for and Determining the F-Rate

CSW Responsibilities

SCSW Responsibilities

ARA Responsibilities

RA Responsibilities

PHN Responsibilities

MCMS Coordinator Responsibilities

Six (6) Month F-Rate Alerts

Designated Person (ITC/CSA) Responsibilities

SCSW and PHN Responsibilities

CSW Responsibilities

SCSW and PHN Responsibilities

Approvals

Helpful Links

Attachments

Forms

Referenced Policy Guides

Statutes

Version Summary

This policy guide was updated from the 07/01/14 version, with clarification and streamlining provided by external advocates, Medical Case Management Services (MCMS), Public Health Nurses (PHN) and County Counsel.

POLICY

Specialized Care Increment (SCI) - F-Rate

The F-Rate is the Specialized Care Increment (SCI) rate paid in addition to the basic care rate for the care of children/youth with medical problems, physical conditions or developmental disabilities/delays. Children receiving Regional Center or Early Start Program services who have no medical problems should receive the Dual Agency Rate not the F-Rate. The amount is based upon the specific medically related activities that the caregiver must perform in caring for the child.  There are four F-Rate levels: F-1, F-2, F-3, and F-4. The guidelines for determining the appropriate level are detailed in the F-Rate Level - Evaluation Guide. Details of required care for specific disorders are described in the Definitions of F-Rate Evaluation Elements.

F-Rate Criteria

Eligibility for F-3 and F-4 rates must be approved by Regional Administrators (RAs).

 

When a child is receiving mental health services related to, or in addition to their medical condition, the F-Rate should be increased by one higher level.

 

Children/youth who in conjunction with their medical condition also have emotional or behavioral issues may qualify for the D-Rate or an increased F-Rate level. Upon consultation,  the Public Health Nurse (PHN) will recommend the CSW refer the child to the D-Rate EvaluatorLicensed clinician who provides assistance to CSW in identifying and assessing the needs of children with special needs by ensuring that the caregiver's home meets the child's needs and that all children having special needs have those needs met in accordance with the provisions of the Katie A. settlement agreement. to determine if a D-Rate is needed or alternatively, if the child requires an increased F-Rate.

 

Children who receive an F-Rate must have a customized individualized health plan, coordinated by their health care team. The child's case plan must be congruent with the individualized health care plan, including referring the child for an Individual Education Plan (IEP). The plan must reflect the specific activities required improving the child's functioning and how the F-Rate supports those goals.

F-Rate Determinations

The Public Health Nurse (PHN) determines the appropriate F-rate, based upon their assessment of the child's medical record. All medical documentation must be from a health care provider who has examined the child within the prior six (6) months. Any medical concerns should be examined and diagnosed by a pediatrician and/or a pediatric specialist. All identified diagnoses must be documented in the case and health care plan.

 

The F-Rate set by the PHN cannot be changed unless the child has new or change in current medical condition(s). If there is concern about the level, the CSW should provide additional information to the PHN.

F-Rate Reevaluations

Children receiving the F-Rate must be reevaluated every six (6) months. When there is no longer a medical need for it, the F-Rate must be discontinued. If at the six (6) month re-evaluation, the child still requires the F-Rate, their case plan must be updated to reflect any progress (or lack of progress), and must include any future undertakings or activities to improve the child's functioning. Documentation must also be made of the need for continued care and compliance with the health care plan.

Caregiver Requirements

F-Rate eligible caregivers (that can receive the F-Rate on behalf of the child/youth) include:

 

The following individuals or groups are not F-Rate eligible:

 

Prior to placing or re-placing a child with medical needs/condition, CSWs must ensure, in consultation with the Medical Case Management Services (MCMS) Intake Coordinator that the prospective caregiver is able and trained to meet the child's needs.

 

The caregiver must (with some exceptions listed in Caregiver Training below) attend caregiver training and be able to:

Caregiver Training - F-Rate Certification

Training includes sixteen (16) hours of initial F-Rate certification and twelve (12) hours yearly thereafter to remain certified. If the specialized training is not available (summer break, etc.) the training is to be completed within three (3) months of the next training session.

 

Prospective and current caregivers may be exempt from the F-Rate training requirement under either of the following circumstances. This exemption must be made in consultation with the MCMS Intake Coordinator and must be documented in the case. The final decision regarding exception is determined by the MCMS in consultation with medical professional and/or treating physician.

 

 

Caregivers in closed dependency cases who are receiving a specialized care increment (SCI) as part of their AAP or Kin-GAP payment are no longer required to participate in the F-Rate Certification training, once the case is closed.

Caregiver Training - Child Specific Medical Training

All caregivers are required to be trained on the child's specific medical needs. Verification of this training is documented on the Medical Training Confirmation form.

Kinship Guardian Assistance (Kin-GAP) Legal Guardians

For recipients of state and federally funded Kin-GAP programs, the F-Rate is available to the relative caregiver or relative guardian once DCFS determines that the assessed child meets the criteria.

 

If the relative guardian resides outside of the county with payment responsibility, the county with payment responsibility pays the host county's specialized care rate or its own specialized care rate if the host county has no specialized care system.

Placement Capacity

An out-of-home caregiver may not have more than two (2) children receiving a specialized care rate, regardless of their licensed capacity, unless one of the following conditions have been met:

 

 

The section below only applies to Placing Children with Special Health CareNeeds:

 

Placement of a third child, with or without special needs, requires ARA approval.  If the ARA(s) for the already placed child(ren) is different from the third child's ARA, all involved ARAs must confer and agree to the third placement or follow the chain of command as needed, with the Division Chief at MCMS having the final decision-making authority. This decision must be documented in CWS/CMS Case Notes.

 

Additionally, Community Care Licensing (CCL) requires a waiver when placing a third child with special needs in a "Specialized Foster Home".

Out-of-County Placements

Out-of-County placements require the cooperation of both county agencies. This applies to children being sent to live with parents or relatives as well as non-relative placements. When children are placed outside of LA County, the host county's rate and training, along with any educational and/or other requirements apply.

 

If the host county does not have a specialized rate, the LA County increment applies in conjunction with the host county's basic rates. As needed, the host county's child protective agency can assist in making a referral to have the child assessed by the host county's mental health agency or other DCFS approved entity.

Out-of-State Placements

Out-of-State placements require the cooperation of agencies in both states. All issues related to care; services and funding are based on the Interstate Compact on the Placement of Children (ICPC).

 

If the host state does not have a specialized rate, the Los Angeles County Increment applies in conjunction with the host state's basic rates.

 

A letter must be on file from the host state indicating what criteria, if any, is required and the rate the child is eligible to receive. The case-carrying CSW is responsible for acquiring this information.

Dual Agency Rate

Eligible dependent children of the court may receive either the F-Rate or the dual agency rate (for dual agency children), provided that they are placed in a qualified placement. Dual Agency children are defined in the Dual Agency Rate policy.

 

 

Unlike children receiving AFDC-FC, children receiving Adoption Assistance Payment (AAP) and Early Start services who have no other medical condition can receive the F-1 Rate instead of the Early Start rate.

 

The child's eligibility for the Dual Agency Rate may be verified by one of the following documents provided by the servicing Regional Center.  There is no eligibility requirement for a caregiver.

 

If a child has a medical condition or special health care needs the caregiver must receive child-specific medical training from a medical provider.  A caregiver should also attend an F-rate training class through the Community Colleges unless it is determined that an exemption applies.

Back to Policy

PROCEDURE

Assessing for and Determining the F-Rate

CSW Responsibilities

  1. Within one (1) day of notification or observation that a child may have a special health care need, discuss the following with the caregiver:
  1. Child's physical, neurological, and/or developmental disorders
  1. Related activities needed to determine the needs of the child

 

  1. When warranted and prior to completing the F-Rate assessment, consult with the PHN to determine if a joint visit should be conducted to assess the child's medical needs. Use the DCFS 5646-1, Public Health Nurse Consultation Request form and submit to the PHN.

 

  1. Provide the following F-Rate packet:
  1. DCFS 149A, Medical Care Assessment
  1. DCFS 416, Individual Health Care Plan (PHN is available to assist in completion)
  1. DCFS 709, Foster Child's Needs and Case Plan Summary
  1. DCFS 1696, F-Rate & Regional Center Rate Indicators
  1. Copy of the caregiver's F-Rate training certificate (if available)

 

  1. Forward the DCFS 149A to the appropriate California Children's Services (CCS) panel and/or Pediatric Specialty treating physician(s) and/or Primary Provider/Pediatrician.
  1. Request that the CCS and/or Pediatric Specialty treating physician(s) complete the DCFS 149A and return it along with all available medical records documenting the child's status and needs.

 

  1. In collaboration with the PHN, determine the F-Rate to be recommended by completing all relevant pages and sections of the DCFS 1696 using the medical/developmental documentation.
  1. Locate the child's condition or the caregiver's activity by using the F-Rate Level - Evaluation Guide and Definitions of F-Rate Evaluation Elements.
  1. Check the applicable boxes that correspond with the description of the required medical activities, infant behavior or Regional Center diagnosis.

 

  1. In the following circumstances, raise the F-Rate one (1) level, by checking the column that is one (1) level higher than the highest medically related level:
  1. The child has documented emotional or behavioral problems, is three (3) years or older, and is enrolled in and attending a treatment program designed to address their emotional or behavioral problem.
  1. The child has multiple medical problems that require the caregiver to attend multiple appointments, administer multiple treatments, or visit multiple specialists.

 

  1. Within one (1) business day of receiving the completed DCFS 149A and the medical records, forward the packet to the PHN.
  1. If a copy of the caregiver's F-Rate training certificate cannot be included in the packet, use the DCFS 1696 to notify the PHN as to why (i.e. caregiver has not completed the training, caregiver is willing to complete training but has not done so yet), where the caregiver is in the process of completing the training, or providing verification of training completion.
  1. As soon as possible, forward a copy to the PHN who is making the F-Rate assessment.

 

  1. Within one (1) business day of receiving the packet back from the PHN identifying the appropriate F-Rate:
  1. If caregiver training verification has not been previously obtained and provided to the PHN, obtain (if available), a copy of the caregiver's training certificate and forward it, along with the DCFS 1696 to the PHN for review.
  1. If the caregiver has not attended the F-Rate training, advise the PHN that the F-Rate training has not been completed by the caregiver.
  1. Consult with the MCMS Intake Coordinator and jointly make a determination as to whether or not the caregiver is able to meet the child's medical needs despite their lack of the F-Rate training.
  1. If in consultation with the MCMS Intake Coordinator it is determined that child-specific training and/or services are needed to ameliorate immediate safety concerns, discuss this with the caregiver.
  1. If the caregiver refuses to complete or has not followed through with the required child-specific training and/or services, consult with the SCSW and/or ARA to assess the child's safety in placement and determine the appropriate action.
  1. If there are unresolved training issues and the MCMS Intake Coordinator is not available, contact the Director of the Bureau of Clinical Resources and Services for assistance.

 

  1. Immediately Upon receipt of the DCFS 1696 with the PHN's signature and training verification (if applicable), submit the signed DCFS 1696, DCFS 280, medical documentation, copies of training certificate(s), and the psychological documentation (if applicable) to the SCSW or ARA/RA as appropriate.
  1. Indicate on the DCFS 280 "Child approved for an F-Rate, please update the Placement Notebook".
  1. If the child is not on SSI, include the statement "Evaluate the child for SSI".
  1. Levels F-1 and F-2 do not require ARA approval
  1. Levels F-3 and F-4 require RA approval

 

  1. Within one (1) business day of receiving the signed DCFS 280, complete the following:
  1. Forward the DCFS 280 with appropriate documentation (i.e. DCFS 1696) and if available, a copy of the caregiver(s) training certificate to the EW for processing.
  1. Attach the MCMS Intake Coordinator verified F-rate Certificates to the DCFS 280 in order for the caregiver to receive SCI funding unless the caregiver is exempt from training as determined by MCMS.

 

  1. File documentation in appropriate case folders.

 

  1. Document all contacts with the caregiver and physician in the Contact Notebook.

 

  1. If the child is approved at levels F-3 or F-4, consult with and transfer the case to Medical Case Management Services (MCMS), per existing procedures, unless the child was raised to F-3 from F-2 based on the child's severe emotional problems.

 

  1. Advise the caregiver that the F-Rate will be reviewed every six (6) months. The F-Rate may also be reviewed between intervals if medical or psychological status changes.

 

  1. If the child is not eligible for the F-Rate, within one (1) business day of receiving the packet from the PHN, inform the caregiver that a Notice of Action (NOA) will be mailed to him or her with instructions on how to appeal the decision.
  1. Submit a DCFS 280 requesting that a NOA be mailed by the Regional TA/EW regarding the denial of the F-Rate.

SCSW Responsibilities

  1. Within one (1) business day of receiving the packet, review all documentation, including training verification.
  1. If approved for rates F-1 or F-2, and there is no capacity issue, sign necessary documents and return them to the CSW.
  1. When there is a capacity issue, or the rate is F-3 or F-4, forward the documents to the ARA.
  1. If not approved, return packet for corrective action.

ARA Responsibilities

  1. Within one (1) business day of receiving the packet, review all documents.
  1. If approved, sign the necessary documents and return to the SCSW.
  1. If the rate is for F-3 or F-4, forward the packet to the RA for approval.
  1. If not approved, return the packet for corrective action.

RA Responsibilities

  1. Within one (1) business days of receiving the packet, review all documents.
  1. If approved, sign the necessary documents and return to the ARA.
  1. If not approved, return the packet for corrective action.

PHN Responsibilities

  1. Review the documentation within three (3) business days of receiving the packet.
  1. If further medical information is needed, consult with the CSW.

 

  1. Collaborate with the CSW, to schedule a joint visit if it is determined that one is needed prior to completing the F-Rate assessment.

 

  1. Assist the CSW in contacting the physician or any other service providers as needed.

 

  1. Complete the PHN F-Rate Recommendations section of the DCFS 1696 to determine the F-Rate level and return it, along with medical documentation to the CSW.
  1. Indicate if no child-specific medical training documentation is attached and if it appears to be needed by the caregiver.

MCMS Coordinator Responsibilities

For children who qualify for F-rate and special needs placement and are either awaiting placement or in need of replacement:

 

  1. Conduct an intake with the CSW or SCSW to gather information that includes but is not limited to:

 

  1. Request the DCFS 149, DCFS 1696 and any other medical documentation from the CSW/SCSW.

 

  1. Use available information to locate an appropriate placement including F-Rate homes, Intermediate Care Facilities (ICFs), sub-acute facilities and Regional Center homes.

 

  1. Provide consultation if the child is to be placed with a relative or nonrelated extended family member (NREFM) caregiver.

 

  1. Once a placement is located:
  1. Assist, in conjunction with the PHN as needed, in setting up child-specific training unless the child is developmentally delayed with no accompanying medical issues.
  1. Provide the CSW/SCSW with information regarding the placement packet, budget, and caregiver F-rate certificate.
  1. When applicable, liaison with hospital social workers regarding hospital holds and discharge plans (including prescriptions and equipment).
  1. Arrange non-emergent transportation as needed.
  1. Trouble-shoot Medi-cal issues.

Back to Procedure

Six (6) Month F-Rate Alert

Designated Person (ITC/CSA) Responsibilities

SCSW and PHN Responsibilities

CSW Responsibilities

  1. Upon receipt of the six (6) month alert, review the cases and the appropriateness of the current F-Rate.

 

  1. Collaborate with the PHN (including a joint visit if possible) to review and evaluate the child's current medical condition(s).

 

  1. If the F-Rate should continue, follow steps in Assessing for and Determining the F-Rate.
  1. Continuing levels F-3 and F-4 require only ARA approval.

 

  1. If the rate remains the same, the caregiver does not need to sign a new DCFS 1696.

 

  1. If the rate is to be changed, submit the approved DCFS 280 to the TA/EW for processing.

 

  1. Document all contacts with the caregiver in the Contact Notebook.

SCSW and PHN Responsibilities

  1. Review and compare monthly F-Rate Alerts to ensure that:
  1. F-Rates are completed in a timely manner.
  1. F-Rates are appropriate and consistent according to the special health care needs of the child as documented in the DCFS 1696.

 

  1. Follow up on identified delinquent and inconsistent F-Rates.

 

  1. SCSW: Submit a monthly report to the ARA that includes an analysis, summary, and the corrective action to resolve delinquencies and inconsistencies of the F-Rate Alert.

Back to Procedure

APPROVALS

SCSW Approval

ARA Approval

RA Approval

HELPFUL LINKS

Attachments

F-Rate Level - Evaluation Guide

Definitions of F-Rate Evaluation Elements

Forms

CWS/CMS

DCFS 280, Technical Assistant Action Request

LA Kids

DCFS 149/149A, Medical Care Assessment Cover Letter and Medical Care Assessment

DCFS 280, Technical Assistant Action Request

DCFS 416, Individual Health Care Plan (IHCP)

DCFS 709, Foster Child's Needs and Case Plan

DCFS 1696, F-Rate & Regional Center Rate Indicators

DCFS 5646-1, Public Health Nurse Consultation Request

Hard Copy

Caregiver Medical Training Confirmation

NOA 290, Notice of Action

Referenced Policy Guides

0100-510.10, Placement Capacity

0100-510.46, Out-of-County Placements

0100-520.35, Kinship Guardianship Assistance Payment (Kin-GAP) Program

0100-525.10, Interstate Compact on the Placement of Children (ICPC)

0300-303.06, Hospital Holds

0600-505.10, Placing Children with Special Health Care NeedsAssembly Bill 2268, defines children with special health care needs as those children who are either temporarily or permanently dependent upon medical equipment or in need of other specific kinds of specialized in-home health care, as determined by the child’s physician. See "medically fragile."

0600-505.20, Hospitalization of and Discharge Planning for DCFS-Supervised Children

0600-530.00, Public Health Nurse (PHN) Roles and Responsibilities

0700-504.20, Referring Children for Special Education or Early Intervention Services

0900-511.12, Dual Agency Rates

0900-522.10, Specialized Care Increment (SCI) – D-Rate

1000-504.10, Case Transfer Criteria and Procedures

Statutes

Health and Safety Code Section 1501.1 – States in part that when placing children in out-of-home care, attention should be given to the individual child's needs, the ability of the facility to meet those needs, the needs of the other children in the facility, the licensing requirements of the facility, and the impact of the placement on the family reunification plan.

 

Manual of Community Care Licensing, Title 22, Division 6, Chapter 9.5, Section 89224 – Sets forth regulation regarding the waivers and exceptions to caregiver licensed capacity.

 

Welfare and Institutions Code (WIC) Section 11461(e)(1) – Defines the "specialized care increment" as an approved AFDC-FC amount paid on behalf of an AFDC-FC child requiring specialized care to a home listed in subdivision (a) in addition to the basic rate. This rate cannot be paid to a nonminor dependent placed in supervised independent living. In addition it states that counties can have and modify a specialized care rate system for specialized care to pay for the additional care and supervision needed to address the child's issues.

 

WIC Section 17710 – Provides a definition for "Child with special health care needs", which is a child, or a person, twenty-two (22) years or younger who is completing a publicly funded education program, has conditions that can rapidly deteriorate resulting in permanent injury or death, or has a medical condition that requires specialized in-home health care, and who has either been deemed a dependent of the court per Section 300 but is in the custody of the county welfare department, or who has a developmental disability and is receiving services and case management from a Regional Center.

 

WIC Section 17731 – States in part that prior to placing a child with special health care needs, an individualized health care plan must be developed by the child's physician or their designee.

 

WIC Section 17732 – States in part that no more than two (2) foster care child can reside in a specialized foster care home, except when the licensed capacity in the home is not exceeded and certain conditions have been met.

 

WIC Section 17733 – States in part that all documentation concerning children with special health care needs, including their placements, assessments, contacts with health care team plan members, and reports of training provided by the health care professional must be part of the child's case record.

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