Specialized Care Increment (SCI) – F-Rate
0900-522.11 | Revision Date: 2/26/2025

Overview

The Specialized Care Increment (SCI) F-Rate is a higher foster care rate paid in addition to the basic foster care rate, for the care of children/youth with medical needs that do not qualify for the Level of Care (LOC) Protocol. This policy guide provides instruction for referring potentially eligible children for a F-Rate assessment in cases where there is an open Probate Legal Guardianship, Legal Guardianship and/or a Kin-GAP case ordered by the Court prior to 01/01/2017 or retroactive F-Rate prior to 04/01/2021.

Table of Contents

Version Summary

This policy guide was updated from the 07/29/15 version, to clarify the process of referring a child for an F-Rate evaluation, the scope of children who are eligible for the F-Rate, and the implementation of Level of Care (LOC) Specialized Care Increment (SCI) rates starting 04/01/2021. 

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 should receive the Dual Agency Rate not the F-Rate. When a child qualifies for more than one rate, it is DCFS policy to pay the higher rate, when applicable.

The F-Rate applies to children who have open Probate Legal Guardianship cases, Legal Guardianships and/or Kin-GAP, and Adoption Assistance Program (AAP) cases ordered by the Court prior to 01/01/2017 or retroactive F-Rate (prior to 04/01/2021) requests. The Level of Care (LOC) program began determining SCI rates starting on 04/01/2021, based on the child’s needs and level of care within a tier rate system.

The F-Rate 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.

Unlike children receiving AFDC-FC, children receiving Adoption Assistance Program (AAP) benefits and who are eligible for Early Start services but who do not have any other medical condition can receive the F-1 Rate instead of the Early Start dual agency rate (i.e. the Monthly Dual Agency flat rate (P1)).

For retroactive F-Rate requests, refer to the F-Rate policy(ies) in effect as of the date of the request for the time period(s) that need to be assessed. For a copy of the policy version that was previously in effect, submit an inquiry to the DCFS Policy Section at Policy@dcfs.lacounty.gov.

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. If the child qualifies for D-Rate, the child should receive either the increased F-Rate or the D-Rate, whichever is higher.

F-Rate Determinations

The Public Health Nurse (PHN) recommends 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. For retroactive requests, the medical documentation should be from the time period of the retroactive request. 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.

F-Rate Re-Evaluations

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:

  • Most resource parents residing in Los Angeles County prior to 4/01/2021
  • Most relative placements residing in Los Angeles County prior to 4/01/2021
  • Kin-GAP legal guardians who received legal guardianship prior to 1/01/2017.
  • Most nonrelative extended family members (NREFMs) residing in Los Angeles County prior to 4/01/2021
  • All Los Angeles County Probate legal guardians
  • Caregivers who signed AAP agreements prior to 1/01/2017.

The following individuals or groups are not eligible to receive the F-Rate on behalf of the child/youth/NMD:

  • Resource parents licensed through Foster Family Agencies (FFA) 
    • Children/youth residing in FFA certified homes that are potentially eligible for a SCI, must be referred for F-Rate evaluation at the time of the Concurrent Planning Assessment (CPA) process if the alternative plan is adoption or legal guardianship.
  • Resource and/or relative homes not approved by the Resource Family Approval (RFA) Program.
  • Nonminor dependents (NMDs) in a Supervised Independent Living Place (SILP)
  • Short-term Residential Treatment Program (STRTP), Treatment Centers, Group Homes and Intensive Services Foster Care (ISFC) placements.

Caregiver Training - Specialized Care Increment (SCI) Training

To be certified to receive SCI funding a caregiver must have an initial twelve (12) hours of Core Training plus four (4) hours of specialized training classes. To remain certified, a caregiver must complete six (6) hours of training yearly (consistent with the Level of Care policy for caregivers receiving the SCI rate). The 12-hour Core Training is offered through the Foster and Kinship Care Education (FKCE) Program.

Caregivers are also expected to:

  • Participate in the child/youth's treatment, including family counseling (when clinically indicated);
  • Arrange transportation to various facilities and providers; and
  • Provide social and recreational activities consistent with the child/youth's needs.

Exemption to Caregiver Training Requirements

Prospective and current caregivers may be exempt from the SCI trainings (formerly referred to as F-Rate trainings) requirement if they have a: 

  • Verified professional health care background (e.g. they are a licensed Medical Doctor, Registered Nurse, Nurse Practitioner, Physician's Assistant, Doctor of Osteopathic Medicine, etc.).
  • Caregivers who, despite their lack of the SCI training (formerly referred to as F-Rate training), demonstrate requisite knowledge, training, education or ability to meet the child's medical needs.

Caregivers with 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 SCI 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 (DCFS 6079).

For recipients of state and federally funded Kin-GAP programs, the F-Rate is available to the relative guardian if the legal guardianship was established prior to 1/01/2017, and if 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

See Placement Capacity and Placing Children with Special Health Care Needs.

Out-of-County Placements

When children receiving AFDC-FC or ARC benefits are placed outside of Los Angeles County, the host county's rate and training, along with any educational and/or other requirements apply. See Out-of-County placements. If the host county does not have a specialized rate, the applicable Los Angeles County SCI is added to the basic rate. For AAP benefits, it is the higher rate between the host county’s rate, statewide rate, or applicable Los Angeles County SCI rate.

 

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 SCI applies in addition to the host state's basic rates.

PROCEDURE

Assessing for and Determining the F-Rate for a Child Where LOC Does Not Apply (Guardianship Granted Prior to 2017) or a Retroactive F-Rate Assessment (Prior to 04/01/2021)

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
    2. Related activities needed to determine the needs of the child
  2. 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.
  3. 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.
      • The caregiver or CSW can also obtain a medical report, or other documentation instead of the DCFS 149A, from the physician. 
      • Information must include a detailed diagnosis, prognosis, treatment plan, and the specific, medically related activities to be performed by the caregiver.
      • Documentation must be current (within the past six [6] months) or within six months of the relevant time period for which the retroactive benefits are being sought.
  4. Within one (1) business day of receiving the completed DCFS 149A and/or the medical records, forward the packet to and consult with the PHN. Provide a copy of the caregiver's SCI training certificate, if the caregiver is not exempt from the SCI training requirements, and DCFS 6079 Medical Training Confirmation Form, if available. 
  5. 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.
    2. If the caregiver has not attended the SCI training (formerly referred to as the F-Rate training), advise the PHN that the SCI training has not been completed by the caregiver and document if they fall under an exemption. 
      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 Assistant Regional Administrator (ARA) to assess the child's safety in placement and determine the appropriate action.
    3. If there are unresolved training issues, contact the Director of the Bureau of Clinical Resources and Services for assistance.
  6. Within one (1) business day of receiving the DCFS 1696 with the PHN's signature and training verification (if applicable), sign the 1696 and then submit the signed DCFS 1696 to the SCSW or ARA/RA as appropriate.
    1. F-1 and F-2 require SCSW Signature
    2. F-3 and F-4 require ARA and RA Signature
    3. If it is an open case, once the 1696 is signed by all levels, complete the Foster Care Search System (FCSS) Automated 280 Miscellaneous Request: 
      1. Select Rate Change
      2. Select F-1, F-2, F-3 or F-4 from the Drop-Down menu
      3. Enter the effective date
      4. Mark “6 Month F-Rate Re-Evaluation,” if appropriate
        1. Levels F-1 and F-2 do not require ARA or RA approval
        2. Levels F-3 and F-4 require ARA and RA approval
        3. RA approval is waived for the six-month review.
    4. If it is a closed case: 
      1. Once the approval documents are received after SCSW approval (and ARA/Children Services Administrator (CSA) approval, when applicable) scan and email these to the assigned Revenue Enhancement Kin-GAP Eligibility Worker (EW).
      2. Scan all documentation submitted and upload to Child Welfare Services/Case Management System (CWS/CMS).
  7. File documentation in appropriate case folders.
  8. Document all contacts with the caregiver and physician in the Contact Notebook.
  9. 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.
  10. 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. Kin-GAP and AAP are reviewed every two (2) years. 
  11. If the child is not eligible for the F-Rate, within one (1) business day of receiving the packet from the PHN, complete the Automated 280 directing Revenue Enhancement staff to issue a Notice of Action (NOA) to the caregiver and submit it, along with the DCFS 1696 to the SCSW for approval. 

SCSW Responsibilities

  1. Within one (1) business day of receiving the DCFS 1696, review all documentation including training verification.
    1. If approved for rates F-1 or F-2, sign the DCFS 1696 and return to the CSW. 
    2. If approved for rates F-3 and F-4, sign the DCFS 1696 and forward to the ARA. 
  2. Within one (1) business day of receiving the  Automated 280, review all documentation:
    1. If approved for rates F-1 or F-2, and there is no capacity issue, apply electronic approval via FCSS. 
      1. If approved for rates F-3 or F-4, apply electronic approval via FCSS and alert the ARA of the need to approve the Automated 280.
    2. If not approved, return the Automated 280 for corrective action.

ARA Responsibilities

  1. Within one (1) business day of receiving the DCFS 1696, review all documentation including training verification. 
    1. If approved, sign the DCFS 1696 and forward to the RA. 
  2. Within one (1) business day of receiving the Automated 280, review all documents.
    1. If approved, apply electronic approval via FCSS. 
    2. If it is not an F-Rate six (6) month re-evaluation, alert the RA of the need to approve the Automated 280. 
    3. If not approved, return the Automated 280 for corrective action.

RA Responsibilities

  1. Within one (1) business day of receiving the Automated 280, review all documents.
    1. If approved, apply approval on the Automated 280. 
    2. If not approved, return the Automated 280 for corrective action.

PHN Responsibilities

  1. Review the documentation including the completed DCFS 149A and/or medical records and any caregiver training within three (3) business days of receiving the packet.
    1. If further medical information is needed, consult with the CSW.
  2. Collaborate with the CSW, to schedule a joint visit if it is determined that one is needed prior to completing the F-Rate assessment.
  3. Assist the CSW in contacting the physician or any other service providers as needed.
  4. Complete the DCFS 1696 F-Rate Indicator to determine the F-Rate level. 
    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.
    2. Check the applicable boxes that correspond with the description of the required medical activities, infant behavior or Regional Center diagnosis.
      1. For children who have a Regional Center diagnosis, follow the instructions on page five (5) of the DCFS 1696 F-Rate Indicator to assist in the determination of whether the child should receive the Dual Agency Rate or an F-Rate.
    3. 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; or
      2. The child has multiple medical issues that require the caregiver to attend multiple appointments, administer multiple treatments, or visit multiple specialists.
  5. Indicate if no child-specific medical training documentation is attached and if it appears to be needed by the caregiver. 
  6. Return the completed 1696 F-Rate Indicator, along with medical documentation, to the CSW.

PHNs will follow the Department of Public Health's Children's Medical Services (CMS) Child Welfare Public Health Nursing Program (CWPHNP) Policy and Procedure: Public Health Nurse (PHN) Role for Level of Care/Specialized Increment Rate (LOC/SCI).

F-Rate Re-Evaluations

The F-Rate re-certifications will only need to be completed for children who were ordered into Legal Guardianship prior to 01/01/2017 or for children who have Legal Guardianship through Probate Court. The F-Rate eligibility will expire at the end of six (6) months unless another assessment is completed and determines the F-Rate shall continue. If there any changes in rate, the caregiver will receive a Notice of Action.

CSW Responsibilities

  1. Every six (6) months, review the cases and the appropriateness of the current F-Rate.
  2. Collaborate with the PHN (including a joint visit if possible) to review and evaluate the child's current medical condition(s).
  3. 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.
  4. If the rate remains the same, the caregiver does not need to sign a new DCFS 1696 F-Rate Indicator.
  5. Submit a new FCSS Automated 280 to the TA/EW for processing. Reassessments are indicated by a checkbox on the Automated 280 request.
  6. Document all contacts with the caregiver in the Contact Notebook.

SCSW and PHN Responsibilities

  1. Review F-Rate expiration dates to ensure:
    1. F-Rates are completed in a timely manner.
    2. F-Rates are appropriate and consistent according to the condition of the child as documented in the DCFS 1696.
  2. Follow up on identified delinquent and inconsistent F-Rates.
APPROVALS

SCSW Approval

  • FCSS Automated 280
  • DCFS 1696

ARA Approval

  • F-3 and F-4 Rates

RA Approval

  • F-3 and F-4 Rates (not required at six [6] month review)
HELPFUL LINKS

Attachments

CW-3006, Department of Public Health's Children's Medical Services (CMS) Child Welfare Public Health Nursing Program (CWPHNP) Policy and Procedure: Public Health Nurse (PHN) Role for Level of Care/Specialized Increment Rate (LOC/SCI)

F-Rate Level - Evaluation Guide

Definitions of F-Rate Evaluation Elements

Forms

LA Kids

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

FCSS Automated 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

DCFS 6079, Medical Training Confirmation Form

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 Needs

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

CW-3006, Department of Public Health's Children's Medical Services (CMS) Child Welfare Public Health Nursing Program (CWPHNP) Policy and Procedure: Public Health Nurse (PHN) Role for Level of Care/Specialized Increment Rate (LOC/SCI)

STATUTES AND OTHER MANDATES

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.