Chapter 3 : Section 7.1

Medical Services for Children in Out-of-Home Care

Procedures

Health Insurance

A child is eligible for Mercy Care DCS CHP health services if:

• placed in out-of-home care through a Voluntary Placement Agreement;

• in the custody of the Department in an out-of-home living arrangement:

  • in the home of a court approved relative or person with a significant relationship with the child (the parent may reside in the home of the relative, but the child may not be placed with that parent);

  • in an adoptive home prior to the finalization of the adoption;

  • in an independent living program under the age of 18; or

  • in runaway status and the Department retains custody.

If the child has other health insurance coverage, Mercy Care DCS CHP will be the secondary payor and will pay for all co-pays and deductibles.

Obtain information about any health insurance coverage for a child by requesting:

• information about the parents’ health insurance coverage for the child from the parents; and

• court assistance if the parents are uncooperative and unwilling to provide health insurance coverage information for their child(ren).

When a child is no longer eligible for Mercy Care DCS CHP coverage, send the child's medical identification card to DCS CHP at Site Code C010-18.

Initial and Ongoing Health Care Assessment and Services

Gather available information, including but not limited to clinical and medical reports on the child from previous medical, dental, and behavioral health care providers.

Complete the following at the time of placing the child:

• Provide the out-of-home caregiver a completed Notice to Provider (Out-of-Home, Educational, and Medical), Placement Packet Checklist, and a current Health Report if available. Confirm that the out-of-home caregiver has access to the Mercy Care DCS CHP Member Handbook.

• Arrange for the child to have a complete medical examination that meets Early Periodic Screening Diagnosis and Treatment (EPSDT) requirements prior to the initial placement, if possible (utilizing the parent's resources), or within 30 days after initial placement in out-of-home care and annually thereafter. (An examination for injuries conducted at a shelter care facility does not substitute for a complete medical examination.) The EPSDT examination will include immunizations as necessary.

• Inform the out-of-home caregiver of the need to schedule a dental assessment to be completed within 30 days of placement for children ages one year and older, and semi-annually thereafter.

• Inform the out-of-home caregiver of the need to pursue any recommended follow-up care and referrals from a health care provider (medical, dental, or behavioral). Refer to Behavioral Health and Substance Abuse Services for Children and Young Adults.

Immunizations

Obtain the child's immunizations history by accessing the Arizona State Immunization Information System (ASIIS) and document immunizations the child has received. The Primary Care Provider (PCP) or DCS CHP can assist in obtaining the child’s immunization history through ASIIS. Provide known immunization history to the out-of-home caregiver prior to the child’s initial medical appointment. Inform the out-of-home caregiver of the need to follow up with any immunization recommendations made by the health care provider.

If possible, request parental consent prior to immunization. All children in out-of-home care must be immunized except when:

• a parent objects based solely on religious grounds, or

• the immunization is medically contraindicated.

If a parent objects to the immunization of the child, determine the basis of the objection:

• If the parent objects on any grounds other than religious grounds, the child may be immunized unless medically contraindicated.

• If the parent objects to immunization based upon religious grounds:

  • consult the DCS CHP Chief Medical Officer to determine if this child’s specific need for immunization is greater than that of the average child;

  • consult the assigned Assistant Attorney General (AAG) before proceeding with the immunization; and

  • if it is determined that the child will not be immunized, direct the out-of-home caregiver to not have the child immunized.

Consent for Treatment

When making health care decisions, consult with the parent, if possible. Obtain a parent’s consent, if possible, for surgery, general anesthesia, blood transfusion, or unusual medical procedure. If it is not possible to obtain written consent from a parent, document verbal consent in Guardian. If it is not possible to obtain written or verbal parental consent, provide a copy of the Temporary Custody Notice or other court order granting custody to the Department to the medical providers.

A minor may request and consent to an emergency medical examination and treatment if the hospital, upon examination, determines that emergency treatment is necessary. If it is determined that emergency treatment is not necessary, then Department/parental consent is required, if possible.

A minor may consent to medical care or treatment for venereal disease.

Parental consent (written and notarized) or court order is required for a child in out-of-home care to receive an abortion. For more information, refer to Sexual Development Education and Family Planning Services and Pregnancy Care Services and Abortion.

Parental consent or court order is required for a child in out-of-home care to receive hormone therapy or hormone blockers for the purpose of treating gender dysphoria. For more information, refer to Process for Youth Requesting Hormone Treatment.

Inform the out-of-home caregiver of authorization to consent to:

• evaluation and treatment for emergency conditions that are not life-threatening;

• routine medical treatment and procedures;

• immunizations, unless the parents object based on religious beliefs;

• routine dental treatment and procedures;

• Early Periodic Screening Diagnosis and Treatment (EPSDT) services (e.g., developmental and behavioral health intakes, screenings, treatment and procedures);

• services by health care providers to relieve pain or treat symptoms of common childhood illness or conditions; and

• testing for the presence of the human immunodeficiency virus (HIV).

Prohibited Consents by Out-of-Home Caregivers

Inform the out-of-home caregiver that they are prohibited from consenting to:

• general anesthesia;

• surgery;

• clinical trials, including clinical trials for HIV/AIDS treatment;

• blood transfusions;

• abortions.

Emergency Consent by an Out-of-home Caregiver

Inform the out-of-home caregiver they may provide emergency consent if required by the hospital and the emergency room physician or medical provider advises that immediate treatment is necessary and delay of treatment (in order to notify the Department) is potentially harmful to the child.

Inform the out-of-home caregiver that they must:

• maintain a current record of the child’s medical care on the Child’s Health and Medical Record, in the child’s Placement Packet; and

• contact the DCS Specialist regarding:

  • any injury that exceeds three days or recurs regularly;

  • any illness that exceeds three days or recurs regularly;

  • any service for which the medical service provider requires written consent from the legal guardian or legal custodian;

  • any service for which the medical service provider requires prior authorization;

  • any recommended service or treatment, if there is a question about coverage under Mercy Care DCS CHP;

  • any service that requires prior authorization, according to Fostering a Medical Home: Mercy Care DCS CHP Handbook;

  • any service that would ordinarily require prior authorization but was provided in an emergency;

  • all visits to health care providers for non-routine services; and

  • inability to transport the child to medical appointments or to arrange other alternative appropriate transportation.

When parental rights have not been severed, and it is safe to involve the parent in decisions about the child’s medical and behavioral health care:

• consult with the parent(s) prior to seeking medical treatment or services unless an emergency situation exists; and

• encourage the foster parent to include the parent(s) in the child’s medical and behavioral health appointments.

Note: Contact DCS CHP at CHPHealthServices@azdcs.gov for prior authorization if a child needs to go out-of-state for medical treatment.

Medical Marijuana

The Arizona Medical Marijuana Act enables a person (a qualifying patient), who is registered with the Arizona Department of Health Services (ADHS), to legally obtain, under Arizona law, an allowable amount of marijuana and possess and use the marijuana for its therapeutic effects in treating and alleviating symptoms associated with a debilitating medical condition.

Marijuana is not covered by Mercy Care DCS CHP. Children who come into care with medical marijuana cards must be immediately evaluated by a primary care provider and behavioral health provider with expertise in chronic pain disorders, substance abuse, and/or mental health. As there is no physiologic withdrawal from marijuana, other appropriate therapeutic recommendations shall be followed.

Contact a CHPHealthServices@azdcs.gov for further instructions and assistance in locating providers with expertise in this area.

Clinical Trials

When in receipt of a request for a child to participate in a clinical trial:

• Contact the assigned AAG and the CHP Health Services upon receiving a request for a child in out-of-home care to participate in a clinical trial. Federal law protects the rights of children in foster care when they are subjects of clinical research. Federal law mandates that the rights of these children be protected through the appointment of an independent advocate and by gaining consent from a guardian.

• Inform all applicable parties that Mercy Care DCS CHP does not pay for clinical trials.

HIV Testing of Children While in Out-of-Home Care

Refer to HIV/AIDS: Testing, Diagnosis, and Services for detailed information on HIV testing, testing criteria, age criteria, and consents.

Child Death While in Department Custody

In the event of a child's death while in an out-of-home care, work with the parents/legal guardian to locate appropriate funeral arrangements for the child. With the approval of the Deputy Director of Field Operations, the Department may fund funeral expenses when there are no other resources available. Respect the parent’s/legal guardian’s wishes in their decision on how to care for the remains of the child's. Do not release the child’s remains until the manner of death is established and an autopsy has been completed, if needed. If the parents/legal guardians request that a recommended autopsy not be performed, consult with the Assistant Attorney General assigned to the case.

If the parents/guardians are unavailable to assist in making a decision for the child's remains, the county fiduciary office will provide burial services for the child.

If a request for organ donation is received, defer to the parent’s/legal guardian’s to make a decision, unless:

• the parents or guardians are deceased;

• there is an investigation related to the child’s death;

• the parents' rights have been terminated by voluntary relinquishment or by order of the court; or

• the court has rescinded the appointment of the legal guardian of the child.

DCS staff may not consent to the donation of a child’s organ(s) on behalf of a parent/legal guardian. If the parent/legal guardian wishes to donate the child’s organ(s), obtain the written consent of the parent or legal guardian authorizing the donation of a child’s organ(s) and document in Guardian.

When a request for organ donation is received and the rights of the parents/legal guardian have been terminated by death, voluntary relinquishment, or court order, consult with the Assistant Attorney General to obtain a court order authorizing the donation of the child’s organ(s). Consider the following when making a decision to submit a request for a motion authorizing an organ donation:

• possible need for an autopsy of the child;

• concerns of any involved extended family; and

• statement on the child's driver license (if applicable) or any other declaration made by the child regarding organ donation.

Documentation

Enter the parent's healthcare insurance coverage information for the child in Guardian.

Coordinate with DCS CHP to ensure all medical/dental information is updated timely in the Health tab in Guardian.

Use Notes to document immunization review and information from ASIIS or from the DCS CHP Health Services.

Document the parent’s objection to immunizations based on religious grounds and any court determination in Notes, as well as add any attachments that support those objections.

Submit a new Placement Service Request in Guardian with the Service Type of Hospital-Medical or Hospital-Behavioral Health, as appropriate, to update the current placement of the child. End date the service when the child is discharged.

Effective Date: February 13, 2023

Revision History: November 30, 2012, September 30, 2013, August 9, 2017, February 1, 2021, February 23, 2022