Level of Care (LOC) and Specialized Care Increment (SCI) Rate Determinations / Re-determinations
0900-522.00 | Revision Date: 7/26/2022

Overview

This policy was developed to provide an overview of the Home-Based Family (HBFC) Level of Care (LOC) and Specialized Care Increment (SCI) rate structures and provides guidelines for implementation of the HBFC LOC Protocol (LOCP) and SCI Protcol.

Table of Contents

Version Summary

This policy guide was updated from the 08/23/2021 version to include instructions to staff on the roles and responsibilities in determining SCI rates for Resource Parents (RPs). Also, the title of the policy was changed from its previous title “Home-Based Family (HBFC) Level of Care (LOC) Rate Determination and Re-determination” to the current title.

POLICY

Continuum of Care Reform (CCR)

Pursuant to Assembly Bill (AB) 403, CCR was established to ensure that, when children/youth/nonminor dependents (NMDs) are removed from their families, they are supported by a broad-continuum of programs and services tailored for their individual needs and their family’s needs

Under CCR, the California Department of Social Services (CDSS) developed the LOCP, a strengths-based approach for determining foster care rates in which the individual care and supervision needs of children/youth/NMDs in out-of-home care (OHC) are aligned with an RP's level of support.

The LOCP utilizes a tool that assesses five (5) domains (Physical, Behavioral/Emotional, Health, Educational and Permanency/Family Services) that are scored separately and totaled to identify an OHC LOC payment rate.  The LOC CSW considers all available information (i.e., Child and Family Team Meetings (CFTMs); input from the RPs, medical, developmental and mental health information; existing assessment tools, such as CANS; court reports, etc.).

Centralized Unit for Completion of LOC and SCI Rate Determinations/Re-determinations

A centralized DCFS LOC/SCI rate determination/re-determination unit (LOC Unit) will complete rate determinations and re-determinations. An LOC CSW will collaborate with the assigned CSW and current RP in order to complete LOC and SCI protocols, concurrently; therefore, ongoing communication as well as documentation of any information received regarding RP supports and agreed upon services, and the child/youth/NMD’s strengths and needs is essential towards making an informed decision. The CSW should communicate with the RP that it is in the RP’s and the child’s best interests to answer all questions completely so that an accurate assessment can be completed to support the care and supervision needs of the child/youth/NMD.

For all LOC/SCI rate determinations/re-determinations, an LOC CSW will be designated as a secondary assignment in CWS/CMS by the LOC Unit’s assignment desk and will remain as the secondary assignment until the LOC/SCI rate determination/re-determination is completed. The secondary assignment will be end-dated by the LOC SCSW upon completion of the LOC/SCI rate determination/re-determination.

The LOC centralized unit does not perform LOC determinations/re-determinations for AAP homes. They are completed by the Resource Family Support and Permanency Division (RFSPD).

Level of Care (LOC) Determinations/Re-determinations

The HBFC LOC structure includes four (4) rates: Basic Level Rate/LOC 1, LOC 2, LOC 3, and LOC 4, and, if applicable, an Intensive Services Foster Care (ISFC) Rate and a Static Rate. This LOC rate structure is designed to support positive outcomes for children/youth/NMDs in HBFC settings.

  • The age-based system that existed prior to LOC implementation was replaced by the HBFC LOC four (4)-tiered rate structure, and is based on a child/youth/NMD's needs and the RP's level of expected supervision and supports as determined by LOCP. This allows greater flexibility to increase rates when an RP is able to provide a broader range of supports and services.
  • The Basic Level Rate (also known as LOC 1) is a rate based on what is considered typical care for a child of the same age.

The HBFC LOC rate structure applies to the following placement types:

  • County-approved RP
  • Foster Family Agency (FFA)-approved RPs
  • Certified/licensed foster homes transitioning to Resource Family Homes (RFHs)
  • Approved Relative Caregiver (ARC) homes
  • NMDs residing in HBFC family settings that are not Supervised Independent Living Placements (SILPs)
  • Kinship Assistance Program (Kin-GAP)
  • Non-Related Legal Guardians (NRLG)/Legal Guardianship (LG)
    • NRLG established in Probate Court is not eligible..
    • LG established prior to January 1, 2017 is not eligible.
  • Adoption Assistance Program (AAP) homes
    • The AAP Agreement must have been signed on or after January 1, 2017, or the AAP agreement was signed before January 1, 2017 and the adoption was finalized on or after January 1, 2017.
    • AAP homes are not eligible for the ISFC rate or the Static Rate.
    • The LOC centralized unit does not perform LOC determinations/re-determinations for AAP homes.  They are completed by the RFSPD.

The HBFC LOC rate structure was implemented in two (2) phases:

  1. Phase I: The Department's initial implementation began March 1, 2018 and was applicable to all newly detained children/youth/NMDs placed with FFA RPs.
    • The Basic Level Rate/LOC 1 was applied to all FFA RFHs at the time of the initial placement.
    • An LOC rate increase was given if the completion of the initial LOC rate determination reflected that an increased rate was warranted.
    • LOC re-determinations were also completed when requested by a CSW.  The LOC rate was increased if the LOC re-determination reflected that an increased rate was warranted.
  2. Phase II: On April 1, 2021, implementation expanded to all HBFC placements listed above regardless of the date of the child/youth/NMD's entry into OHC. This includes requests for re-determination.

SCI Rate Determinations/Re-determinations

The SCI rate is given when RPs assume additional responsibilities due to the child/youth/NMD’s unique needs as determined through an LOC/SCI assessment.

The SCI rate is applicable for RPs who,as described in the DCFS 1696, SCI three (3)-tier Indicators matrix criteria, support children/youth/NMDs who need additional care, supports, and/or services, including children /youth/NMDs. This applies to children/youth/NMDs with medical and/or emotional/behavioral and/or developmental concerns with needs in one (1) or more of the medical, emotional/behavioral and/or developmental domains.

  • The criteria in the DCFS 1696 was developed to include the child/youth/NMDs condition and any additional supports, services and/or RP responsibilities to meet the unique needs of child/youth/NMD’s.

For example, receiving Wraparound services alone does not necessarily qualify an RP for increased compensation. The criteria on the DCFS 1696 in the Emotional/Behavioral section shows what is needed in terms of the child/youth/NMD’s condition, care needs and any RP activities to qualify for an SCI rate.

Every child/youth/NMD who receives an LOC rate determination will also be assessed for an SCI rate, concurrently. If applicable, the SCI rate will be paid retroactively to the date of placement in an approved home.

For redetermination requests, every child/youth/NMD who receives an LOC rate redetermination will also be assessed for an SCI rate, concurrently. If applicable, the SCI rate will be paid retroactively to the date the child’s condition/care needs met the criteria for the new rate (or the date of RFA approval, whichever date is later), even if that date precedes the date of the redetermination request, CSWs shall not delay submitting a redetermination request.

For redetermination requests, the effective date of the retroactive payment is the date of the date the redetermination was submitted by the CSW to the LOC Unit, thus CSWs shall not delay submitting a redetermination request.

  • If it is determined that the SCI rate criteria is met, the RP will receive an SCI rate in addition to the LOC rate.

A County-specific three (3)-tiered SCI rate structure has been developed to replace the existing D- and F-Rate protocols and is used to address emotional, behavioral, developmental, and medical conditions. This rate structure aligns with the criteria and payments currently provided under the D- and F-rate guidelines (DCFS 1696). Existing D- and F-Rate caregivers will be informed that these payments will be evaluated within the LOC matrix and three (3)-tiered SCI rate structure at the time of their reassessments.

SCI protocol requires that reassessments must be completed to determine if there is a need to continue providing the RP with an SCI rate. Re-assessments will occur, as follows:

  1. Every twelve (12) months (D- and F-rate equivalent), or more frequently if determined by the PHN
    • On a case-by-case basis, a reassessment (i.e., F-rate equivalent) may be completed more frequently to ensure the needs and supports of the child/youth and caregiver are met.

Once the SCI rate reassessment is completed, the RP will be notified of one (1) of the following:

  1. Approval for continued SCI payments at the current rate, or
  2. Denial/discontinuance of SCI payments, or
  3. A newly determined SCI rate may be greater than or less than the existingSCI rate.

Out-of-State Placements

The LOC unit does not conduct LOC/SCI rate determinations/re-determinations. For children/youth/NMDs placed out-of-state, the RP receives the rate for the state in which they are residing as LOC rates are statewide. (SCI rates are county-based).

Out-of-County Placements

The LOC Unit will conduct out-of-county placement LOC/SCI rate determinations/re-determinations.

Since LOC rates are statewide rates, the LOC rate determination/re-determination is the same regardless of the county (in California) where a child/youth/NMD resides.

SCI rates (previously known as D-rate, F-rate, etc.) vary amongst counties. If it is determined that an RP will receive an SCI rate, they will receive an SCI rate based on the rate for the county where they reside with the child/youth/NMD. When using the host county SCI, the host county (i.e., the county in which the child resides) SCI methodology, criteria, and rates will apply. If the host county does not have an SCI rate, the Los Angeles County SCI applies and is added to the applicable LOC rate. As needed, the host county’s child welfare agency may assist in making a referral to have the child/youth/NMD assessed by the host county’s mental health agency or other DCFS-approved entity.

  • L.A. County is responsible for completing the SCI determination using thehost county’s forms. The LOC unit is responsible for completion of those forms.

Implementing the LOCP: Criteria and Effective Dates

Implementation of the LOCP is required under the following circumstances:

  1. Initial removal/Newly detained (Detention)The Basic Level Rate/LOC 1 will be provided to all HBFC settings, until the LOCP is completed except in those circumstances where the ISFC or Static Rate have been applied.
    • The initial LOC/SCI rate determination must be completed within sixty (60) calendar days of placement.
      • Upon completion of the LOCP, if the rate is higher than the Basic Level Rate/LOC 1, the new, higher rate will be applied retroactively to the date of placement. For non-FFA RFHs, the rate may only be retroactively to no earlier than April 1, 2021.
      • If the placement occurred prior to RFA approval, and the LOCP determination results in a higher rate, the new rate will be applied retroactively to the date the home was RFA-approved, but no earlier than April 1, 2021 for non-FFA RF homes.
    • The LOCP will be completed for each child/youth/NMD in out-of-home care, including those within the same family.
    • When a child/youth/NMD exits OHC in less than thirty (30) days, an LOC determination is not completed/not required. These short-term placements will automatically receive the Basic Level Rate/LOC 1.
      • The LOC CSW will document in CWS/CMS case notes the rationale for not completing the LOCP.
  2. Replacements
    • An LOC/SCI determination will be completed at the time of every replacement of the child/youth/NMD into a new RF home. If a child/youth/NMD qualifies for a Static Rate, the Static Rate will be paid until the completion of the new LOCP. The Static Rate will be effective retroactive to the date of placement.
    • The LOC/SCI rate determination must be completed within sixty (60) calendar days of replacement.
  3. Step Down From A Short Term Residential Therapeutic Program (STRTP)
    • For a change in placement from an STRTP to a HBFC setting, the LOCP is to be completed. Prior to completion, the RP will receive the Basic Level Rate/LOC 1 unless the child meets the ISFC or Static Rate Criteria or a decision is made from the Interagency Placement Committee (IPC) to approve a referral to an ISFC home.
      • If it was determined that the ISFC is applicable at the time of placement, they will receive the ISFC Rate. The LOC/SCI re-determination will not be completed by the LOC CSW.
        • The ISFC unit will issue the ISFC rate letter and notify the CS CSW of the RP’s ISFC status and guide the CS CSW on how to submit the DCFS 280, Technical Assistance Action Request to ensure the RP receives the ISFC rate.
    • If the RP does not want to become ISFC-certified, or does not complete the required pre-placement training hours, the highest available rate (LOC 4) will be given.
      • The RP must show that they are in substantial compliance with the FFA requirements to become ISFC-certified within 120 days or risk a rate reduction.
  4. Request for Re-determination
    • The CSW, SCSW, RA, PHN or any other CFT member may endorse a referral to the LOC unit to be made by the CS CSW if it appears a child/youth/NMD may qualify for a higher LOC/SCI rate based on their condition and care provided by the RP. The convening of a CFTM is best practice, but shall not delay the referral for a re-determination.
      • The CS CSW will submit the request for the re-determination to the LOC Unit.
      • Upon completion of the LOCP, if the rate is higher than the Basic Level Rate/LOC 1, the new, higher rate will be applied retroactively to the date the CSW RP made the request to the LOC unit.
      • The CSW shall not delay the referral to the LOC Unit; it shall be done as practically as possible.
    • An RP may request an LOCP Rate Re-determination to the CS CSW. The RP’s request be it verbal, written or otherwise for an LOCP re-determination must be documented in the CWS/CMS Contact Notebook.
  5. Transition from ISFC or Therapeutic Foster Care (TFC)
    • When a child/youth/NMD is receiving ISFC or TFC and those services are ending, the LOCP and DCFS 1696 is to be utilized to determine the new LOCand SCI rate. The new LOC and SCI rate will be effective on the first (1st) day of the month following the completion of the LOC/SCI rate re-determination.

Forms and Documents Utilized to Complete the LOCP

The LOC/SCI protocol is comprised of the following:

  1. SOC 501, Level of Care (LOC) Rate Determination Matrix
  2. DCFS 1696, SCI three (3)-tier Indicators matrix
  3. Resource Family Reporting Tool: Activities In Support of Child (RFRT form)
    • A form to be completed by the RP, or by the LOC CSW who reviews each question with the RP and records the RP’s answers.
      • Regardless of who completes the form, the LOC CSW may interview the RP either as a means to complete the form on behalf of the RP or to obtain additional information if the RP completed the form.
      • If the LOC CSW completes the RP form, or adds information to the RP form after an interview with the RP, the RP will be contacted to confirm the information is correct prior to the completion of the rate determination/re-determination.
  4. SOC 500, Level of Care (LOC) Scoring FormConversations with, and engagement of, RPs must occur to inform completion of the LOCP. In addition, in order to complete the LOC/SCI rate determination/re-determination, the LOC CSW will gather and review information from various sources that will provide insight into the child/youth/NMD’s needs which may include, but is not limited to the following:
    • The RFRT form
    • Assessments/evaluations, such as the CANS assessment
    • CFTM notes
    • Court reports
    • Minute orders
    • Case plans
    • Medical records/Health Education Passport (HEP)
    • Educational records
    • Mental health records
    • Delivered service log
    • Regional Center or other developmental records
    • Communication with the FFA CSW

LOC Domains

Information may be gathered during a CFTM in order to complete the LOC/SCI rate determination/re-determination; however, a specific discussion about the LOC/SCI rate and completion of the tools should not be discussed during a CFTM.

The strength-based LOCP is designed to identify the individual care and supervision needs of children/youth/NMDs that can be translated to an appropriate LOC rate in order to support their placement in a family setting. Care and supervision needs are based on five (5) domains:

  • Physical
  • Behavioral/Emotional
  • Educational
  • Health
  • Permanency/Family Services

SCI Domains

The process for determining if a child/youth/NMD’s condition and needs require additional supports and services beyond routine or standard care thus qualifying them for an SCI rate is determined by the LOC Unit in consultation with the RP and CSW. Supporting documentation to assist in determining the SCI rate may be required. Care and supervision needs are based on three (3) domains with the highest rate being given. Tiers are reviewed separately and in combination with one another to determine the highest rate warranted.

  1. Emotional/Behavioral Conditions
    • Eligibility for a Tier 1 rate must include at least one (1) mild symptom listed in the DCFS 1696 Behavioral Concerns Tier 1 section.
    • Eligibility for a Tier 2 rate must include at least one (1) moderate symptom listed in the DCFS 1696 Behavioral Concerns Tier 2 section.
    • Eligibility for a Tier 3 rate must include Tier 3 criteria and at least one (1) severe symptom listed in the DCFS 1696 Behavioral Concerns Tier 3 section.
  2. Developmental Conditions
    • Eligibility for a Tier 1 rate must include at least one (1) of the mild developmental delays/disability characteristics listed in the DCFS 1696 Developmental Conditions Tier 1 section.
    • Eligibility for a Tier 2 rate must include one (1) of the moderate developmental delays/disability characteristics listed in the DCFS 1696 Developmental Conditions Tier 2 section.
    • Eligibility for a Tier 3 rate must include one (1) of the severe developmental delays and/or disability characteristics listed in the DCFS 1696 Developmental Conditions
  3. Medical Conditions
    • Eligibility for a Tier 1 rate must include one (1) of the criteria in theMedical Conditions section in the DCFS 1696 Tier 1 section
    • Eligibility for a Tier 2 rate may include one (1) of the criteria in the Medical Conditions section in the DCFS 1696 Tier 2 section
    • Eligibility for a Tier 3 rate may include one (1) of the criteria in the Medical Conditions section in the DCFS 1696 Tier 3 section

Cumulative Scoring

The scoring for the [medical portion] of the SCI tiers is cumulative and additional points in SCI Tiers 1 and 2 may increase the level rating to a higher Tier as follows:

  • If three (3) or more of the Tier 1 conditions exist, the rate will increase to Tier 2.
  • If three (3) or more of the Tier 2 conditions exist, the rate will increase to Tier 2
  • If two (2) Tier 2 conditions exist and three (3) Tier 1 conditions exist, the rate will increase rate to Tier 3.
  • If one (1) Tier 2 condition exists and six (6) Tier 1 conditions exist, the rate will increase rate to Tier 3.

The assessment for medical care and support is determined in consultation with the RP, CSW and PHN. The PHN will review supporting medical documentation from the child/youth/NMD’s medical provider to assist the LOC CSW in determining the medical portion of the SCI rate. The LOC CSW will make the final LOC/SCI rate determination. Documentation includes, but is not limited to, medical records reflecting that 1) a medical examination occurred in the past six (6) months, 2) any medical condition and/or other diagnosis must have been identified by a pediatrician or other specialist and included in the case and health care plans, and 3) must contain all of the elements of the DCFS 149, Medical Care Assessment Request, if the DCFS 149 is not provided.

The CSW is to provide the DCFS 149 with the supporting medical documents or other appropriate documents for completion of the medical section of the DCFS 1696.

The SCI determination/redetermination can be conducted without the DCFS 149 if there is other information confirming the child’s condition, such as printouts from doctor’s visits, prescription slips/pharmacy prescription records, letter from a doctor/provider or other appropriate documentation.

The CSW is to provide the PHN with all training documents and certifications completed by the RP that demonstrate capability of meeting the medical needs of the child/youth/NMD.

Resource Parent (RP) Training

The SCI rate is not based solely on the special needs of the child/youth/NMD., The assessment takes into consideration the RP’s active involvement with supportive services, and daily demands that meet the overall needs of the child. Amongst the SCI rate-eligibility criteria, the RP must have participated in specialized training for high-needs children/youth/NMDs and is able to utilize modification techniques.

If specific medical training (e.g., use of a sleep apnea, checking insulin levels for a diabetic child, etc.) is needed by the RP, ensure the appropriate verification/certification has been obtained.

All RPs must take training; there are no exemptions.

A specialized Foster and Kinship Care Education (FCKE) curriculum/training, offered through the countywide community college system, is mandatory for caregivers of children/youth/NMDs who qualify for an SCI rate. Online course information is also available at Fosterparents.com.

The LOC CSW will provide the RP with information regarding required training.

Intensive Services Foster Care (ISFC)

ISFC is the highest level of HBFC for children with serious emotional and behavioral needs and/or special health care needs. In Los Angeles County, the ISFC program is administered by contracted FFAs. RPs who are caring for a child/youth/NMD who meets the ISFC eligibility criteria and want to join the ISFC program under an FFA can be referred to the ISFC team for consultation and linkage to an FFA provider.

The ISFC can be made by applied in the following circumstances:

  1. The CS CSW or IPC may make a referral to the ISFC program to determine if the child meets ISFC criteria. The ISFC Unit will request the LOC Unit to review the ISFC status to ensure the proper rate is given.
  2. The LOC CSW completes the LOCP and a rating score of seven (7) is given in the Behavioral/Emotional or Health Domains.
    • If the LOC CSW determines the child may be a candidate for the ISFC program, the LOC CSW will inform the CS CSW and the ISFC program of the possible ISFC eligibility.
  3. A Special Health Care Needs (SHCN)-eligible child/youth/NMD receiving the temporary Static Rate may receive a permanent ISFC rate when the child/youth/NMD’s health conditions are severe or unlikely to change.
    • Note: If the Static Rate is given to a non-ISFC-certified RP, the ISFC Unit shall communicate to the RP the ISFC training requirements, services and supports received through ISFC. The case-carrying CSW shall work with the RP to meet the requirements to become an approved resource home through an FFA with an ISFC program.

If RP chooses not to complete the training to become an ISFC home, the LOC 4 rate is applied.

Static Rate

Static criteria, or chronic indicators, are a list of certain behaviors or conditions which warrant an immediate temporary ISFC Static Rate (or equivalent) to provide a high level of care and/or supervision of a child/youth/NMD pending an LOC rate determination may be immediately applied in instances where a child/youth/NMD is identified with at least one (1) of the following behavioral concerns:

  • Adjudicated violent offenses, significant property damage, and/or sex offender or perpetrator
  • Aggressive and assaultive
  • Animal cruelty
  • Habitual runaway
  • Commercial Sexual Exploitation of Children (CSEC)
  • Eating disorder
  • Fire setting
  • Gang activity
  • Habitual truancy
  • Psychiatric hospitalization
  • Severe mental health issues, including suicidal ideations and/or self-harm
  • Substance abuse/use
  • Specialty Health Care Needs (SHCN)
  • Medically Fragile
  • Contraction of pandemic viruses, such as COVID-19

The Static Rate may only be applied through review and approval of an LOC SCSW, the ISFC unit, or the Accelerated Placement Team (APT).

Static criteria must have occurred within the preceding twelve (12) months.

Children in the AAP Program are not eligible for the ISFC or static rates.

The use of the Static Rate is intended to last no more than 60 days and may be paid to an RP who is willing to accept placement of the eligible child/youth/NMD. The Static Criteria rate will be effective retroactive to the date of placement.

  • After the first (1st) 60 days, if the LOCP was completed, an LOC or ISFC rate will be applied according to the Step Down" criteria above, or
  • If the LOCP has not been completed, the Static Rate may be extended on a case-by-case basis until the LOCP is completed. However, the total number of days that the Static Rate is paid cannot exceed 120 days.

For children/NMDs eligible for the Static Rate under SHCN the Static Rate may become a permanent ISFC rate when health conditions are severe and unlikely to change.

Staff may send an email to the Static Rate inbox at staticrate@dcfs.lacounty.gov for questions about static criteria and/or guidance. This inbox is not for making a referral for an LOC rate determination/redetermination for static criteria. Staff are to utilize the DCFS referral portal for all rate determinations/re-determinations.

Regional Center/Dual Agency Rates

For children receiving Regional Center services under age three who have not yet be found eligible under the Lanterman Act, the CSW will need to assess if they qualify for the 0-3 dual agency rate (P1 rate) in lieu of the combined LOC and SCI rates. If the LOC Rate plus SCI results in a rate that is higher than the 0-3 Dual Agency Rate, the LOC Rate plus the SCI Rate applies. In other words, the highest eligible payment is applied. (For additional information/assistance, refer to the Dual Agency Rates” policy and/or the Regional Center Support Section website on LA Kids.)

Children/youth/NMD’s eligible for Regional Center under the Lanterman Act receive a P2 rate will not qualify for the LOC or SCI rates as the P2 rate exceeds the LOC and SCI financial tiers.

  • The LOC Unit does not conduct rate determinations for RPs receiving the P2 rate.
  • This does not apply to FFA RFHs. FFA RFHs are not eligible for the P2 rate and, thus, will receive an LOC/SCI rate determination/redetermination.

Supplemental Security Income (SSI)

For all children/youth eligible or potentially eligible for SSI, consult with the SSI Unit. In addition, a mandated SSI screening is required for all youth 16 ½ years old.

  • An LOC and SCI rate determination must be completed for children/youth/NMD with pending SSI screenings or who have been found eligible for SSI. A child/youth/NMD that is determined eligible for an SSI rate will still receive the full amount of the LOC plus SCI, if applicable.

Placement Capacity

An RP may not have more than two (2) children/youth/NMDs receiving an SCI rate regardless of their license capacity. Additional children/youth/NMDs may be considered only:

  • If a child/youth/NMD receiving an LOC rate is later assessed as needing an SCI rate and a determination is made that the child/youth/NMD should remain in that home, or
  • When placement will keep siblings together and it is not clinically contraindicated.
  • In both circumstances above, all children/youth/NMDs will be assessed for LOC/SCI rates and any who meet the criteria will receive the LOC plus SCI.
  • Each child shall be assessed regardless of whether or not there are other SCI-qualified children in the home and placement capacity has already been met as the CSW may obtain a placement capacity waiver.

Verification of these requirements shall be documented in CWS/CMS Contact Notes by the placing CSW/case-carrying CSW.

Placement of a third child with or without special needs in the home, when there are already two (2) children with SCI rates of either Tier 2 or 3 in the home must be approved by the regional ARA When seeking ARA approval for the placement of a third child/youth, the placing CSW/case-carrying CSW must consider all children/youth in the home, including birth and adopted children/youth as well as children placed with a relative, guardian, or other RP.

Capacity concerns should not be a deterrent to refer a child/youth for an LOC/SCI rate assessment.

If the LOC CSW becomes aware of a placement capacity issue as mentioned above, the Primary CSW is to be alerted. It is ultimately the responsibility of the Primary CSW to ensure placement capacity issues are addressed and waivers are completed accordingly.

Notice of Action (NOA)

Except in those circumstances where static criteria have been applied, at the time of removal (detention), the Basic Level Rate/LOC 1 will be provided to all HBFC settings, until the LOC/SCI protocol is completed. RPs will be sent a notification at the time of placement that they are receiving the Basic Level Rate/LOC 1 via a NOA. After the initial LOC/SCI protocol is completed, a second NOA will be sent informing RPs that either they will continue to receive the Basic Level Rate/LOC 1 or if they will receive an LOC 2, 3 or 4 and if a Tier 1, 2, or 3 SCI rate is applies. The NOA explains how and why rates are set, why a rate is changing, or why a request for rate change is denied (i.e., LOC/SCI reassessments). Also, each time the LOC/SCI assessment/reassessment is completed, regardless of whether or not there is a rate change, a NOA will be sent to the RP. Additionally, caregivers will be provided a complete copy of the following:

  • SOC 500
  • SOC 501
  • RFRT
  • Completed DCFS 1696 and SCI Scoring form upon request by the RP

It should be noted that, if the rate given to an RP for a specific child/youth/NMD is LOC 2 through 4, the LOC rate will not be lowered while that specific child/youth/NMD remains in that RP’s home.

Rates may be subject to lowering in those instances where an RP is receiving the SCI or ISFC or Static Rate. This can occur if the RP does not complete the required ISFC training or, for SCI rates, the child/youth/NMD needs, supports, and/or services no longer warrant the existing SCI rate.

Assigned CSWs are encouraged to discuss an RPs concerns about the LOC rate given to try to reach a resolution, which may include a rate re-determination request. The assigned CSW shall not discourage the RP from completing the NA 403 (backside) to file a formal appeal requesting a State Hearing regarding their LOC rate.

  • When there is no rate change, NOAs will be sent to RPs by Eligibility Workers (EWs) and Technical Assistants (TAs).
  • When there is a rate change, the Payment Resolution Unit will send the NOA.

Medical Case Management Services (MCMS)

DCFS has six (6) MCMS Units that serve medically fragile children and children with special health care needs. These units are located in the Metro North, Torrance, and Covina Annex Offices. MCMS Case Transfers are screened by MCMS Intake Coordinators who can be reached via email at MCMSIntake@dcfs.lacounty.gov.

PROCEDURE

Assessing for, and Determining, the LOC/SCI Rates for Newly Detained and Replaced Children/Youth/NMDs

For those children/youth/NMD’s newly detained and replaced, an LOC and SCI rate determination request will automatically be generated. The centralized LOC assignment desk will receive daily notification of every detention where a child/youth/NMD was placed in out-of-home care; therefore, the assigned ER and/or CS CSW will not have to submit a request for an LOC rate determination in these instances.

  • For all other circumstances, the assigned ER or CS CSW will need to make an LOC/SCI rate re-determination request to the LOC unit.

For all determinations/re-determinations an LOC CSW will be designated as a secondary assignment in CWS/CMS by the LOC Unit’s assignment desk and will remain as the secondary assignment until the determination/re-determination is completed. The secondary assignment will be end-dated upon completion of the determination/re-determination by the LOC SCSW.

  • It should be noted that, while all LOC determinations include an SCI determination, not all RPs will qualify to receive an SCI rate.

CSW Responsibilities

  1. If, at the time of placement/replacement, the CSW suspects the child/youth/NMD may meet the criteria for the Static Rate, submit an LOC/SCI determination/re-determination referral via the DCFS referral portal and ensure the referral includes this information.
  2. If it is determined that the child/youth/NMD qualifies for an SCI and requires a special needs placement, contact MCMS.
  3. Obtain regional ARA approval, if applicable (see "Placement Capacity").

LOC CSW Responsibilities

  1. Within five (5) business days of assignment
    1. Contact the RP via telephone
      1. Multiple attempts to establish contact with the RP are to continue if immediate contact is not established. If, by the sixth (6th) business day contact is not established, inform the assigned CSW, placement agency and/or FFA CSW (if applicable) via telephone and/or email.
      2. Document communications with the RP and attempted contacts in the CWS/CMS Contact Notebook and on the LOC Case Cover Sheet. (This is an LOC Unit-specific form.  This form will only be used by LOC CSWs.)
    2. Contact the assigned CSW via email or telephone
      • Utilize the introductory email to inform the CSW of the LOC/SCI rate determination assignment, to obtain feedback on the child’s needs, and to inquire about the availability of documents in CWS/CMS that will inform the LOC/SCI rate determination.
      • Inform the assigned CSW to provide a copy of any documents needed to complete the LOC/SCI rate determination that are not uploaded into CWS/CMS.
        • The case-carrying CSW is to include SCI-related documents (e.g., DCFS 149, medical documents/records, Regional Center/developmental reports, emotional/behavioral documents if applicable, etc.).
        • The PHN will receive the information from LOC CSW and complete the medical section of the DCFS 1696 by providing input with regard to medical information and send back to LOC CSW. The LOC CSW will review the DCFS 1696 “Medical Conditions” information and complete the remainder of the DCFS 1696.
    3. If the assigned CSW does not respond within ten (10) business days, send a reminder email to the assigned CSW, their SCSW, and the LOC SCSW. (The LOC CSW will make two (2) attempts to contact the assigned CSW to verify the information in the case record.)
    4. Document communications with the CSW and SCSW and attempted contacts in the CWS/CMS contact notebook and on the LOC Case Cover Sheet.
  2. Inform the RP of the LOC/SCI rate determination process, explaining the importance of their input, including in the completion of the RFRT and send them a copy of the form if requested.
    1. Advise the RP that they may complete the form upon receipt with a follow up interview to discuss the RP's responses, or
    2. If agreed, upon by the RP, conduct a telephone interview utilizing the RFRT form. Clarify all written responses with the RP and document on the form.
    3. Inform the RP of the necessity for any SCI training and document communications with the RP in the CWS/CMS Contact Notes.
  3. For medical conditions, submit the DCFS 149 and/or other appropriate documentation, DCFS 1696, and any SCI-related medical documents to the PHN.
  4. In order to inform the LOC/SCI rate determination, review and document the records reviewed. Records may include, but are not limited to the following:
    • The RFRT form
    • Assessments/evaluations, such as the CANS assessment
    • CFTM notes
    • Court reports
    • Minute orders
    • Case plans
    • Medical records/Health Education Passport (HEP)
    • Educational records
    • Mental health records
    • Delivered service log
    • Regional Center reports
    • Communication with the FFA CSW
  5. Utilizing information obtained from the assigned CSW, RP, FFA (if applicable), and service providers as well as a result of the review of available documents, complete the SOC 500, SOC 501, DCFS 1696, and SCI Scoring Form.
  6. Submit the following documentation to the LOC SCSW for review and approval:
    • The completed RFRT form
    • The LOC Case Cover Sheet
    • The SOC 500, LOC Rate Scoring Form
    • The SOC 501, LOC Rate Determination Protocol Matrix
    • The SCI three (3)-tier matrix
    • The DCFS 1696, SCI three (3)-tier Indicators matrix and the SCI Scoring Form.
  7. Communicate with the case-carrying CSW regarding the need for them to obtain ARA approval, when applicable.
    • LOC ARA approval is needed for SCI Tier Rates 2 and 3, and ISFC Rates.
    • Division Chief approval is needed for SCI Tier Rate 3.
  8. Upon LOC SCSW approval, and approval by the LOC ARA and Division Chief for ISFC Rates and Static Rates:
    1. Upload the documents listed in item #6 above on the CWS/CMS "Existing Documents" page.
    2. If the home is RFA-approved, complete and submit the DCFS 280,Technical Assistance Action Request, for LOC SCSW approval.
      1. Attach the uploaded documents to the DCFS 280 for submission to the LOC SCSW.
      2. The DCFS 280 is not completed if the home is not RFA-approved.  The CS CSW is notified via email to submit an LOC request to initiate the rate utilizing the DCFS 280 when the home becomes RFA-approved.
      3. As applicable, document the completion of the DCFS 280; date of placement; the final LOC rate level determination or SCI or ISFC Rate, or Static Rate; and, the effective date in the CWS/CMS "Case Notes".
  9. If the LOC rate is not approved by the LOC SCSW, discuss concerns with the LOC SCSW to determine the final LOC rate. Upon approval, complete the tasks in item #6 and item #8 above.
  10. Email (encrypted) or first class mail, the following forms to the RP:
    • The completed RFRT
    • The SOC 500, LOC Rate Scoring Form
    • The SOC 501, LOC Rate Determination Protocol Matrix
    • The DCFS 1696 and SCI Scoring Form, if requested
      • If the RP has an email, the LOC CSW is responsible for sending the forms via encrypted email.
      • If the RP does not have an email, or wants to receive the forms via first class mail, the LOC CSW shall provide the forms to the ITC or other designated staff to mail.
  11. Send an email to the assigned CSW, their SCSW, and the LOC SCSW indicating that the LOC rate determination was completed.
  12. If the caregiver is an FFA-approved RP, they will be sent a NOA at the time the LOC rate determination/re-determination is completed by a TA or EW.

PHN Responsibilities

The PHN provides input to the LOC CSW to inform the SCI determination process.

  1. Review the documentation submitted by the LOC CSW within five (5) business days of receiving the packet.
    1. If further medical information is needed, consult with the LOC CSW and or assigned CSW.
    2. If specific medical training (e.g., use of a sleep apnea, checking insulin levels for a diabetic child, etc.) is needed by the RP, notify the CSW.
    3. Follow up in contacting the child/youth’s physician and any other service providers, as needed.
    4. Determine if a joint visit is needed.
  2. (As applicable), complete the DCFS 1696 “Medical Conditions” section and return all documentation to the LOC CSW CS CSW, CS SCSW, and PHN Supervisor.

MCMS Coordinator Responsibilities

  1. For children who qualify for a special needs placement and are either awaiting placement or in need of placement:
    1. Conduct an intake with the case-carrying CSW or SCSW to gather information that includes but is not limited to: Child's current location, medical condition, case status, and possible related caregivers.
    2. Obtain DCFS 149, or other appropriate documentation, the DCFS 1696 and any other medical records or documentation.
  2. Use available information to locate an appropriate placement.
    1. Provide consultation when a child/youth/NMD is placed with a relative or nonrelative extended family member.
  3. Ensure any child-specific training has been received or is scheduled, as needed.
  4. As applicable, consult with hospital social workers regarding hospital holds and discharge plans (including prescriptions and equipment).
  5. Arrange non-emergent transportation as needed.
  6. Trouble-shoot Medi-Cal issues.

LOC SCSW Responsibilities

  1. Upon receipt from the LOC CSW, review the following documents:
    1. The completed RFRT
    2. The LOC Case Cover Sheet
    3. The SOC 500, LOC Scoring Form
    4. The SOC 501, LOC Rate Determination Protocol Matrix
    5. The DCFS 1696 and SCI Scoring Form
  2. If accurate and complete, sign the LOC Case Cover Sheet, the SOC 500, DCFS 1696 and SCI Scoring Form.
    1. If approval is not given, discuss concerns and any corrective measures with the LOC CSW.
    2. Upon confirmation that the agreed upon measures were completed, sign the LOC Case Cover Sheet, the SOC 500, DCFS 1696 and SCI Scoring Form and return all of the reviewed documents to the LOC CSW or, 
    3. If the ISFC Rate or Static Rate is applied, complete item #3 below.
  3. If the applied rate is an SCI Rate or the Static Rate, forward the documents (Item #1 above) to the LOC ARA or designee for approval.
    1. Ensure corrective measures requested by the LOC ARA or designee are taken, if applicable.
    2. Upon approval by the LOC ARA or designee, as applicable, ensure the documents are forwarded to the Division Chief or designee for approval.
    3. Upon receipt of the approved documents by both the LOC ARA and LOC Division Chief or their respective designees, return the reviewed documents to the LOC CSW.
  4. Once returned, the LOC CSW will upload the documents into CWS/CMS and complete a DCFS 280 (if the home if RFA-approved). Upon receipt of the DCFS 280, review and approve.
    • The IPC will be held within forty-eight (48) hours of submission of the referral packet toDCFS 280 is not completed if the home is not RFA-approved. The CS CSW is notified by the LOC CSW via email to submit the DCFS 280 when the home becomes RFA-approved.
  5. End date the LOC CSW's secondary assignment in CWS/CMS.

LOC ARA or Designee Responsibilities

  1. For SCI Tier Rates 2 and 3, upon receipt, review the documents forwarded by the LOC SCSW.
    1. If accurate and complete, sign the DCFS 1696 and SCI Scoring forms and return to the LOC SCSW or LOC CSW.
      1. If approval is not given, discuss concerns and any corrective measures with the LOC CSW, LOC SCSW, ISFC Unit, or APT, whichever is applicable.
      2. Upon confirmation that the agreed upon corrective measures were completed, sign the LOC Case Cover Sheet and forward the reviewed documents to the Division Chief or designee for approval, as applicable.

LOC Division Chief or Designee Responsibilities

  1. For Tier Rate 3, complete ARA Responsibilities as reflected under "Assessing for, and Determining, the LOC Rate for Newly Detained and Replaced Children/Youth/NMDs".

LOC and SCI Re-determinations

CSW Responsibilities

  1. When considering an LOC/SCI rate re-determination consulting with the CFT is best practice, but shall not delay the referral for a re-determination.
    1. Any time a caregiver requests an LOC/SCI re-determination, an LOC/SCI referral must be submitted.
    2. For RPs who qualify for an SCI rate based on a child/youth/NMD’s medical needs (F-rate equivalent) and caregiver supports/activities, an LOC/SCI rate re-determination must be requested every six (6) months.
    3. For RPs who qualify for an SCI rate based on a child/youth/NMD’s behavioral and emotional needs (D-rate equivalent), an LOC/SCI rate re-determination must be requested every (12) months.
  2. If it is determined that an LOC/SCI rate re-determination is needed, submit a LOC/SCI Rate Determination/Re-determination Request form via the DCFS referral portal.
    • If the CSW suspects the child/youth/NMD may meet the static criteria, the referral shall reflect this information.
    • All applicable SCI forms (D- and F-rate equivalent, Regional Center, etc.) are to be submitted.
  3. Ensure to communicate with the LOC CSW, as needed, towards the completion of the LOC/SCI re-determination.
    • The LOC or ISFC unit will provide guidance on those circumstances when and how this is to be completed.

PHN Responsibilities

  1. Complete the PHN Responsibilities (items #1 through #2) under "Assessing for, and Determining, the LOC Rate for Newly Detained and Replaced Children/Youth/NMDs".

MCMS Coordinator Responsibilities

  1. Complete the MCMS Coordinator Responsibilitiess (items #1 through #6) under "Assessing for, and Determining, the LOC Rate for Newly Detained and Replaced Children/Youth/NMDs".

LOC CSW Responsibilities

  1. Complete the LOC CSW Responsibilities items #1 through #12 under "Assessing for, and Determining, the LOC Rate for Newly Detained and Replaced Children/Youth/NMDs".

LOC SCSW Responsibilities

  1. Complete the LOC SCSW Responsibilities (items #1 through #4) under "Assessing for, and Determining, the LOC Rate for Newly Detained and Replaced Children/Youth/NMDs".

LOC ARA or Designee Responsibilities

  1. For SCI Tier Rates 2 and 3, complete the LOC ARA Responsibilities under "Assessing for, and Determining, the LOC Rate for Newly Detained and Replaced Children/Youth/NMDs".

LOC Division Chief or Designee Responsibilities

  1. For SCI Tier Rate 3, complete the LOC Division Chief Responsibilities under "Assessing for, and Determining, the LOC Rate for Newly Detained and Replaced Children/Youth/NMDs".

APPROVALS

SCSW Approval

  • Basic Level Rate/LOC 1, LOC 2, LOC 3 and LOC 4 Rates
  • SCI Rates
  • ISFC Rates
  • Static Rates

LOC ARA or Designee Approval

  • SCI Tier Rates 2 and 3

LOC Division Chief or Designee Approval

  • SCI Tier Rate 3
HELPFUL LINKS

Forms

DCFS 149, Medical Care Assessment Request

DCFS 280, Technical Assistance Action Request

DCFS 1696, SCI three (3)-tier Indicators matrix

DCFS 6088, Notice of Action (NOA) - Level of Care (LOC) Level 1 Rate

DCFS 6089, Notice of Action (NOA) - :Levels of Care (LOC) (Levels 1 -4) Determination

DCFS 6089-FFA, Notice of Action (NOA) - :Levels of Care (LOC) (Levels 1 -4) Determination (FFA Only)

Level of Care (LOC)/Specialized Care Increment (SCI) Rate Determination/Re-determination Request

Level of Care (LOC) Static Rate Request

Resource Family Reporting Tool: Activities in Support of Child (RFRT)

SOC 500, Level of Care (LOC) Scoring Form

SOC 501, Level of Care (LOC) Rate Determination Matrix

Attachment

Level of Care Rate Determination Protocol (LOCP) FAQ
REFERENCED POLICY GUIDES

0070-516.15, Screening and Assessing Children for Mental Health Services and Referring to the Coordinated Services Action Team (CSAT)

0070-548.01, Child and Family Teams (CFT)

0070-560.05, Joint Response Referral: Consulting With PHN

0080-502.10, Case Plans

0080-505.20, Health and Education Passport (HEP)

0100-505.52, Placement Preservation Strategy, 14-Day Notice of Placement Changes, and the Grievance Review Process

0100-510.60, Placement Considerations for Children

0100-520.00, Resource Family Approval

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

0600-505.10, Placing Children with Special Health Care Needs

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

0600-515.11, Community Treatment Facility Placements through the Interagency Placement Screening Committee

0900-511.12, Dual Agency Rates

0900-523.10, Social Security (SS)/Supplemental Security Income (SSI) Benefits for Children in Care

FYIs

FYI 20-01, Intensive Services Foster Care (ISFC)

FYI 21-08, Implementation of Level of Care (LOC) and Specialized Care Increment (SCI) Rate Determination Protocol

 

STATUTES AND OTHER MANDATES

All County Information Notice (ACIN) I-73-23 - Provides answers to frequently asked questions regarding the Level of Care Rate Determination Protocol.

All County Letter (ACL) 16-79 - Provides information about the HBFC LOC and STRTP rate structures developed under the CCR, including implementation dates.

ACL 16-79E- Provides updated guidelines for KIN-GAP cases.  The guidelines supersede those set forth in ACL 16-79, stating that, effective January 1, 2017, Kin-GAP cases, where dependency was dismissed between May 1, 2011 and December 31, 2016, will receive the age-based rates identified

in ACL 16-57.

ACL 16-84 - Provides the requirements and guidelines for creating and maintaining a child and family team.

ACL 18-06 – Informs county agencies of the continued delayed implementation of the LOCP, including notification of two stages of rolling out implementation. Further, instructions on the use of LOC, including information on the tools utilized to make a LOC determination, are provided.

ACL 18-06E – Provides guidance regarding the prioritization of retroactive LOC rate determinations and clarifies the application of retroactive payments for these rate determinations.

ACL 18-25 - Provides instructions for implementing an ISFC program. The ISFC program is intended to serve children/youth who require intensive treatment and behavioral supports, as well as children/youth with specialized health care needs and including those served under ISFC. An eligible child for ISFC is a child or NMD in out-of- home care who requires a higher level of care of supervision as determined by the LOC rate determination protocol.

ACL 18-32 – Provides date entry instructions for entering LOC and ISFC rates into CWS/CMS.

ACL 18-48 - Provides guidance on the use of SCI rates in combination with the LOC rate structure and protocol.

ACL 21-17 - Advises counties of the requirement for full implementation of the LOCP for all approved RFs in HBFC settings beginning April 1, 2021. Additionally, it updates and clarifies the policies regarding the implementation and use of the LOC protocol for HBFC. Also, the notification informs counties that policies in this ACL supersede any prior conflicting directives regarding use of the LOC protocol with regard to FFAs and the ISFC program.

ACL 21-17E – Corrects multiple errors in information provided in ACL 21-17, including but not limited to, NMD eligibility for dual agency rates, scoring errors on the matrix, and effective dates for rate changes.

Welfare and Institutions Code (WIC) Section16002, States, in part, that efforts shall be made to place siblings together. If siblings are not placed together, the social worker shall document what efforts have been made/are being made to do so or why making those efforts would be contrary to the safety and well-being of any of the siblings.

WIC Section 16519.5, Addresses, in part, the RFA process.