Chapter 4 : Section 10

Out-of-Home Care Rates, Allowances & Payments

Procedures

Request by an Out-of-Home Caregiver

The DCS Specialist will complete a New Service Request to authorize placement services:

• at the time of initial placement;

• if a special rate is being requested for a child; or

• if a child has a change in the living arrangement.

Out-of-Home Caregiver Rates

Licensed foster homes, including licensed kinship family foster homes, will receive a daily rate, which is based on the child’s age and needs, to provide for the cost of caring for a child in out-of-home care.

Unlicensed, kinship caregivers will receive a kinship stipend and may receive other financial supports as outlined in Kinship Care.

Daily rates for DCS Funded Therapeutic Foster/High Need Foster Care (HNFC) are set by the Department. Medically necessary Therapeutic Foster Care (TFC) rates are set by Arizona Health Care Cost Containment System (AHCCCS). All rates for congregate care setting types are determined by contract.

Out-of-home caregivers receive a monthly personal and clothing allowance for each child in their care. The amount is a daily rate, based on the child’s age. The caregiver will disseminate the monthly personal and clothing allowance to the child when age and developmentally appropriate. Children in secure detention facilities such as county or state run juvenile or adult jails or prisons do not receive the monthly clothing and personal allowance during the time of the incarceration.

The DCS Specialist or Licensing Worker should discuss the monthly personal allowance with caregivers and explain the following:

• the amount of the allowance (see Child Placement Rates and Special Allowances Approval Matrix, CSO-1109A);

• that personal allowances belong to the child and cannot be withheld or used as a payment for chores; and

• that small payments for reimbursement of damages or loss may be established in consultation with the DCS Specialist, the out-of-home caregiver and the child.

If the child’s access to all or a portion of the monthly personal allowance is temporarily restricted (for the purpose of reimbursement of damages or loss, or to prevent the child from harm), the DCS Specialist must agree to and document the restriction (including the amount and time-frame for the restriction). The DCS Specialist and Licensing Worker will ensure the caregiver has discussed the restriction with the child. Provide out-of-home caregivers with information regarding the Provider Indemnity Program in the event of damage or loss.

Foster Home Special Rate Approval Guidelines

Upon request by the licensed foster home, the DCS Specialist submits a new Special Rate Evaluation Request to the Placement Administration for consideration of a special rate. Any retroactive pay will be approved up to 60 days from the date the Special Rate Evaluation was requested. Special Rates will need to be resubmitted every 6 months. Contact PlacementServices@azdcs.gov for any questions.

The Placement Administration will utilize the following guidelines when assessing the reimbursement rate for a child in a licensed foster home (Special Rates are not available to therapeutic foster care, group homes, shelter, or Qualified Residential Treatment Program (QRTP)). All approved Special Rates will be reviewed every six months, minimally. See Child Placement Rates and Special Allowances Approval Matrix, CSO-1109A for more information on approval levels.

1. A child in a foster home will be assessed a Family Foster Home (FFH) rate when the child’s care requires a foster parent to provide routine care that includes care and supervision consistent with the needs of children who have experienced trauma. Routine care includes but is not limited to the following:

   • transportation for school, social, and religious functions, routine medical appointments: i.e., shots, annual physical and dental appointments, examinations or evaluations;

   • managing the routine daily needs of a child who has experienced trauma (such as assisting a child exhibiting disruptive behavior after a family visit or other event to de-escalate);

   • providing the child with age-appropriate recreational activities (indoor and outdoor) on a regular basis;

   • facilitating face-to-face contact with siblings in out-of-home care who reside in other settings on a minimum monthly basis, as specified in the case plan; and

   • applying the Reasonable and Prudent Parenting Standard.

2. A child in a foster home will be assessed a Special II foster care rate when the child’s care requires a foster parent to provide routine care and supervision as listed in A., and one or more of the following:

   • transportation to and from weekly visitation with a parent/guardian or prospective permanent caregiver;

   • transportation to the child’s school of origin if travel is greater than the distance to the caregiver’s district assigned neighborhood school ;

   • behavioral health related meetings or treatment requiring participation by the licensed foster parent, such as participating in Child and Family Team meetings, transportation for the child to and from therapeutic appointments four (4) or more times per month; as recommended by the Regional Behavioral Health Authority (RBHA) and/or by an Individual Education Plan (IEP);

   • unusual or prolonged (six months or longer) transportation to and from physical, occupational, speech therapy 2-3 times per week; or

   • care for a child transitioning from a congregate care living arrangement where the child has resided for more than six months and is under 10 yrs. of age;

   • care for a child who has been in at least 6 living arrangements while in out-of-home care, including a status of runaway or having resided in a detention facility.

   • three or more siblings reside in the same foster home.

3. A child in a foster home will be assessed a Special III foster care rate when the child’s care requires a foster parent to provide routine care and supervision as listed in A. and the child has one of the following diagnosed medical conditions, behavioral issues, or other needs:

   • repeated and documented history of sexually reactive behavior; i.e., public masturbation, use of sexually explicit and/or suggestive language, sexual play, inappropriate behaviors between children, etc. (this does not include normal childhood sexual exploration);

   • continual and documented history of aggression requiring intensive supervision or has had two or more changes in living arrangements in the last six months due to the child’s behavior;

   • identified as having an acute or chronic medical condition diagnosed by the child’s treating physician that does not meet the Medically Complex criteria and the condition is expected to last six months or longer;

   • unusual or prolonged (six months or longer) foster parent transportation to and from physical, occupational, feeding or speech therapy 4 or more times per week;

   • thirteen years of age or older, and requires transportation for day-to-day activities, visitation, or other activities or appointments designated in the Special II rate requirements;

   • transitioning from a congregate care living arrangement and the child is over 10 yrs. of age;

   • is in the third trimester of pregnancy; or

   • has been placed in at least 10 previous living arrangements while in out-of-home care, including a status of runaway or having resided in a detention facility.

4. A child in a foster home will be assessed a teen parent rate when the teen is a parent of a child (non-ward or ward) in the teen’s physical custody.

Medically Complex

Children qualify for the Medically Complex rate when they are identified as children with medical complexity (CMC), which includes children who have or are at a high risk for chronic physical, developmental, or emotional conditions and who also require health and related services of a type or amount beyond what is generally needed by children as determined by the Department. See Guide for Assessing Medical Complexity for a Medically Complex (Foster) Home, DCS-1700.

For children with special needs who may require a living arrangement through the Division of Developmental Disabilities (DDD), contact the Placement Administration.

DCS Funded High Needs Foster Care

Children may qualify for DCS-funded High Needs Foster Care when certain criteria is met for the child to be placed in a higher level of care. See Selecting an Out-of-Home Caregiver and DCS 19-01 Criteria for High Needs Foster Care.

Conflict Resolution

If the foster parent or licensing worker disagrees with the Placement Administration’s assessed rate for a child in a licensed foster home, the DCS Specialist shall direct the foster parent and licensing worker to contact the Placement Administration Program Manager within 30 calendar days of rate determination for resolution of all Special rate requests .

Special Payments (Allowances)

To determine eligibility for a special allowance, including diapers, refer to the Child Placement Rates and Special Allowances Approval Matrix, CSO-1109A and the guide for Authorizing Special Allowances, DCS-1699. Special allowances are available to children in out-of-home care under the following categories, unless otherwise noted:

• Emergency Clothing;

• Extra Emergency Clothing;

• Special Needs Allowance;

• Books and Education;

• Graduation Expenses;

• Supplemental School Tuition and Fees;

• Passport; and

• Diapers.

The DCS Specialist should enter a new Service Request for all special payments. Include in the service request narrative the reason for the allowance and provide any documentation needed.

For diapers due to medical needs, the child’s physician will need to provide Mercy Care with documentation of medical necessity for approval. The child’s Care Coordinator with Mercy Care can assist with the process. To receive assistance from Mercy Care DCS CHP Member Services, contact 602-212-4983 .

For additional funds for diapers, medical documentation and Program Manager approval are required.

Unlicensed caregivers may receive a diaper allowance for children under the age of 3 years old without Program Manager approval or medical documentation.

Ending the Service Authorization

The DCS Specialist will contact the Service Approval Unit to end date service approval:

• after seven days for youth on runaway status, unless it has been decided sooner that the youth will not return to the same facility. If this determination has been made, service approval is terminated as of the date of the decision;

• after seven days, or up to fourteen days with Placement Administrator approval, for youth placed in detention, unless it has been decided sooner that the youth will not return to the same facility or it is likely the youth will remain in detention beyond seven days. If the youth will not return to the same facility, service approval is terminated the date of the decision; and

• after seven days, or up to fourteen days with Placement Administrator approval, if the youth is hospitalized or is out of the placement for an extended period of time, including visits to the parent's home unless it is decided that the youth will not return to the same facility. If the youth will not return to the same facility, service approval is terminated the date of the decision.

Payment Errors

To correct any errors in payment to providers, notify the Payment Processing Unit (PPU) Supervisor alerting them of the payment error.

The Service Approval Unit or Placement Administration shall refer the foster caregiver to PPU if the underpayment is due to a foster caregiver error.

The DCS Specialist will email the Service Approval Unit if the underpayment is due to placement date error.

DCS shall not accept cash as reimbursement for an overpayment.

Documentation

Document all information necessary to generate payment in Guardian.

Document the circumstances of the overpayment and underpayments using Notes.

Document the need for special diapers by maintaining a copy of the physician's statement or prescription in the child's hard copy record and in the Health tab (the physician's statement is not needed to authorize the diaper allowance for unlicensed caregivers when the child is under the age of 3).

Document any temporary restriction or restitution (including the amount and time-frame) of the child's monthly personal allowance using the Notes tab. The out-of-home caregiver maintains documentation that the child received his or her personal allowance in the Allowance Signoff Ledger, included in the Child's Placement Packet.

Document the circumstances necessitating the use of the Extra Emergency Clothing allowance using the Notes tab and using the Narrative on the Service Request.

Special Rates:

• Ensure DCS Comprehensive Health Plan (CHP) is provided all information about the child’s special needs and has updated the child’s health record in Guardian.

• Complete the Special Rate Evaluation Request in Guardian. For service-based approval request, the narrative sections or transportation sections must include name of services, start dates of service and frequency of service.

• Complete the Health Plan. File the hard copy in the case record.

Initiating payments to Caregivers

To initiate payment to a licensed or unlicensed foster caregiver, the DCS Specialist will complete the Service Request, within two working days of the request. See Child Placement Rates and Special Allowances Approval Matrix, CSO-1109A for approval levels of foster placement rates and allowances.

To initiate payment to an ICPC caregiver, the DCS Specialist will complete the Service Request within two working days of placing the child out-of-state.

Service Approval Unit will do the following:

• Enter the basic payment for a licensed foster family.

• Extend the service approval when appropriate. Payment cannot be made beyond the service approval end date.

Placement Administration staff will enter the approved special rate.

DCS Supervisor:

Ensure all Service Requests are approved for:

• Emergency Clothing;

• Extra Emergency Clothing;

• Special Needs;

• Supplemental School Tuition; and

• Diapers.

DCS Program Manager:

Ensure all Service Requests are approved for Extra Emergency Clothing and Diapers.

DCS Program Administrator:

Use Notes to document authorization for payments, for up to seven (7) days, to licensed foster homes for children who:

• are placed in detention;

• are hospitalized; and

• who will be absent from the licensed home for an extended period (including visits to the parent's home).

Effective Date: October 8, 2024

Revision History: November 30, 2012, October 15, 2018, August 26, 2019, March 13, 2020 , February 1, 2021, October 1, 2021, May 10, 2022