12 Colo. Code Regs. § 2509-5-7.418

Current through Register Vol. 47, No. 11, June 10, 2024

Section 12 CCR 2509-5-7.418 - PROVIDER REIMBURSEMENT RATE COMPONENTS

For purposes of maximizing Colorado's federal funding, reimbursement rates are made up of three primary components:

A. Child maintenance, which can include a difficulty of care amount;

B. Administrative maintenance, which can include a direct child care allowance;

C. Services and administrative services.

Provider type will determine which of these three components will be included in the reimbursement rate.

7.418.1CHILD MAINTENANCE [Rev. eff. 2/1/10]

A. The Department shall utilize the most current and available United States Department of Agriculture (USDA) Expenditures on Children by Families Report to determine child maintenance. This report is available at no cost from the U.S. Department of Agriculture, Center for Nutrition Policy and Promotion 1400 Independence Avenue, S.W., Washington D.C. 20250 or at https://www.fns.usda.gov/. The report is also available for public inspection and copying at the Colorado Department of Human Services, Office of Children, Youth, and Families, 1575 Sherman St, Denver, CO 80203, during regular business hours. The child maintenance rate used for a child, age birth through 20, in out of home placement shall be determined based on the report's defined annual household expenditures on a child by single-parent families, overall U.S. (before-tax) income per year at the lowest income tier listed, and then averaged over the life of the child, birth through age 17. The rate does not include education, medical, and child care costs as these costs may be paid for with other sources and were not included in the rate methodology.

B. The categories of annual household expenditures considered and their descriptions are as follows:

1. Housing expenses: consist of shelter (mortgage payments, property taxes, or rent; maintenance and repairs; and insurance), utilities (gas, electricity, fuel, cell/telephone, and water), and house furnishings and equipment (furniture, floor coverings, major appliances, and small appliances). Mortgage payments include principal and interest payments;

2. Food expenses: consist of food and non-alcoholic beverages purchased at grocery, convenience and specialty stores, including purchases with supplemental nutrition assistance program benefits; dining at restaurants; and household expenditures on school meals;

3. Transportation expenses: consist of the monthly payments on vehicle loans, down payments, gasoline and motor oil, maintenance and repairs, insurance, and public transportation (including airline fares);

4. Clothing expenses: consist of children's apparel such diapers, shirts, pants, dresses, and suits; footwear; and clothing services such as dry cleaning, alterations, and repair;

5. Miscellaneous expenses: consist of personal care items (haircuts, toothbrushes, etc.), entertainment (portable media players, sports equipment, televisions, computers, etc.), and reading materials (non-school books, magazines, etc.).

C. Child maintenance may include a difficulty of care assessment amount. A difficulty of care assessment must be completed by the county department in conjunction with the provider.

D. A child maintenance payment is required to be paid to the direct care provider where the child is in residence.

E. Subject to available funding, the Department will make increases or decreases to the child maintenance rate in accordance with the United States Department of Agriculture (USDA) Expenditures on Children by Families Report. This report is available at no cost from the U.S. Department of Agriculture, Center for Nutrition Policy and Promotion 1400 Independence Avenue, S.W., Washington D.C. 20250 or at https://www.fns.usda.gov/. The report is also available for public inspection and copying at the Colorado Department of Human Services, Office of Children, Youth, and Families, 1575 Sherman St, Denver, CO 80203, during regular business hours.

7.418.2ADMINISTRATIVE MAINTENANCE

Administrative maintenance are components which are necessary for overall care of the child. Following is a description of the types of activities which may be included in this component along with the facility types which are eligible to have this component built into the rate.

A. "Support staff" responsible for building maintenance, janitorial, housekeeping, laundry, food preparation functions, and transportation.

B. "Direct child care staff" are responsible for implementing the treatment plan in the daily living situation, creating a therapeutic milieu and helping CHILDREN/YOUTH learn satisfactory ways of coping with the daily living process.

C. "Administration" are the staff responsible for the overall direction of the organization. This includes accounting, general record keeping, business management, budgeting, community relations, and clerical functions. This does not include hours spent in fund raising or clinical records management.

D. "Administrative overhead" is a fixed allowance for costs associated with the overall direction of the facility including, but not limited to: accounting, general record keeping, business management, budgeting, community relations, clerical functions, leased office equipment, and supplies necessary to conduct the administrative function.

E. "Support overhead" is an allowance for space, supplies, and other items related to building maintenance, janitorial, housekeeping, laundry, and food preparation services.

F. "Provider types" eligible for administrative maintenance reimbursement are:

1. "Receiving Homes" are only eligible for the direct child care component. The direct child care allowance may have the following elements:

* surrogate parents for supervising the children administrative participation in staff development

* assuring the county department of emergency care for children on a 24-hour basis

* the direct care staff shall be no less than one paid full- time equivalent staff

2. "Specialized Group Facility" - all components of administrative maintenance may apply.

3. "Child Placement Agency" (CPA) - all components of administrative maintenance may apply.

4. "Residential Child Care Facility" (RCCF) - all components of administrative maintenance may apply.

7.418.3SERVICES AND ADMINISTRATIVE SERVICES

Services and administrative services are components that may be included in the rate to cover the cost of providing services and/or treatment for the child as identified in the Family Services Plan. The following activities are to be considered when developing a rate for a child in a facility:

A. Foster parent payment which is in addition to the child maintenance payment and is not for difficulty of care of the child.

B. Educational liaison staff are responsible for coordinating the educational needs of a child between the facility and public/private school and in obtaining public or private educational services for a child.

C. Recreation staff are responsible for planning, organizing, and leading recreational activities.

D. Direct therapy staff are responsible for those activities which occur between a professional (Bachelors Degree or above in the mental health profession) staff member, and the child and/or child's family which are based upon a specific treatment plan and are aimed at making changes in the child/family maladaptive behavior, intra- psychic conflict, or development impediments. Direct therapy includes the ongoing evaluative function which is part of a therapist's role. Speech therapy is included in this category.

E. Other treatment staff (individuals with at least a Bachelor of Arts in a mental health discipline qualify as treatment personnel) are responsible for the treatment of the child or family, including:

1. "Evaluation services" are formal activities which are directed toward an understanding or diagnosing of the reasons for a child or family's maladaptive functioning. The evaluation may extend beyond the child and family to other important persons in the child's life, community institutions, and the evaluation of records or other written information that pertains to the child. Evaluations result in a written report or other documentation related to this function. Evaluation includes intake evaluation which results in a decision to accept or not accept a child into the facility's program.

2. "Treatment supervision" is the function of supervising treatment activities of staff members. This function may include conducting staff training.

3. "Treatment liaison" are those child-related activities that are directed toward the state and county departments of social services, court, medical providers, and other community agencies that serve to further the care and treatment which the child receives from the providers. Such activities may involve information sharing, coordination of programs, and interagency problem-solving resulting from the child's behavior.

4. "Medical services" are those activities that are directed toward prevention or elimination of physical illness or dysfunction, such as physical therapy or other services not reimbursable under Medicaid.

5. "Recreational allowance" is an amount for the recreational activities of the children in a facility.

6. "Transportation" is for mileage, vehicle rental, vehicle depreciation, maintenance, insurance, parking charges, licenses, registration fees, tires, gas, oil, public transportation, and other expenses pertaining to travel, including client travel.

F. Services and administrative services components shall only be included in the rates of child Placement Agencies and Residential Child Care Facilities.

7.418.31Operating an Out-of-Home Placement Provider Consortium [Rev. eff. 4/1/12]

An out of home provider consortium is defined at Section 26-6-102, C.R.S., as a "group of service providers that are formally organized and managed to achieve the goals of the county, group of counties, or mental health agency contracting for additional services other than treatment-related or child maintenance services".

A. Each consortium shall be registered with the State Department providing information as follows:

1. Name of consortium

2. At a minimum: name, address, telephone, and e- mail of the members of the consortium/board of directors.

3. Legal status of the consortium as established by the Secretary of State.

4. The purpose of the consortium and the population to be served.

5. Contact person: Director of consortium, name and address.

6. Liability insurance carrier for the consortium.

B. Each consortium shall file an annual report with the State Department, depicting the activities of the consortium that includes:

1. Information regarding contracts held.

2. Outcome data/studies.

3. Data on children involved.

4. Complaint and resolution process.

5. Description of the justification for different rates charged to different counties.

C. Each consortium:

1. Shall cooperate with the State Department, counties and other entities in seeking the maximum federal fiscal reimbursement for children participating in consortium services.

2. May enter into contracts with county departments for additional services and outcomes, in addition to treatment and maintenance, to be provided to children in care.

3. Shall include planned outcomes achieved on behalf of a child along with the consequence for not achieving the outcome in contracts.

4. Shall develop and implement corrective action plan with either the State Department or county departments when performance fails to meet contracted expectations.

12 CCR 2509-5-7.418

38 CR 23, December 10, 2015, effective 1/1/2016

40 CR 17, September 10, 2017, effective 10/1/2017

40 CR 21, November 10, 2017, effective 12/1/2017

41 CR 21, November 10, 2018, effective 12/1/2018

42 CR 17, September 10, 2019, effective 10/1/2019

42 CR 23, December 10, 2019, effective 1/1/2020

43 CR 21, November 10, 2020, effective 12/1/2020

44 CR 21, November 10, 2021, effective 11/1/2021

44 CR 23, December 10, 2021, effective 12/30/2021

46 CR 09, May 10, 2023, effective 6/1/2023