Section 148-5-II - CONTRACT DEVELOPMENTA. REFERRAL FOR SERVICES1. PURPOSE: The Department of Health and Human Services is aware that there are more individuals in need of social services than there are resources to serve them. To ensure that individuals determined to be in need have access to service within the limitation of available funds, the Department identifies priority target groups for federal and state funded services. Individuals served by Department regional social service units and other agencies designated by the Department as its representatives in the community are afforded the highest priority for social services purchased with Office of Child and Family Services funds.
2. STANDARDS OF CONDUCT: a. The Office of Child and Family Services shall stipulate in purchase of service contract agreements the amounts of services to be delivered to each category of Department or Area Agency on Aging referred priority clients.b. The Office of Child and Family Services shall consider Department or Area Agency on Aging individuals as priority clients for purchased services when one or more of the following occurs:i. It is determined during the course of the case study that a purchased service is an integral part of a case plan to remove or prevent circumstances of abuse or neglect of children, or to remove or prevent danger to an incapacitated or dependent adult.ii. It is determined as a result of the case study and is part of the case plan that one or more particular service(s) is/are an integral part of a case plan: a. To remedy abuse and neglect to children, or danger to an incapacitated or dependent adult;b. For the parents to be rehabilitated and the children to be reunited with their families;c. To prevent neglect and abuse from recurring in a family previously open for protective intervention or to prevent danger recurring to an incapacitated or dependent adult;d. Necessary to accomplish the objective for the child and/or his family or adult;e. Necessary to accomplish the objective for an active Family Services participant.f. Necessary to prevent institutionalization of an elderly person; org. Necessary to accomplish the objective for an active WEET participant.c. Provider organizations shall be required to give priority for those services which are: 1. Integral to accomplishing the objective for the child and/or his/her family;2. Integral to meeting life, health and safety needs of the child and/or his family, or an adult, or an elderly person; or3. Integral to the attainment or maintenance of employment of a WEET participant.d. Priority for services for Department and Area Agency on Aging referred individuals shall be limited to those services consistent with those identified on the formal DHHS referral form, after assessment, consultation and agreement.e. Department regional social services staff and Area Agency on Aging Case Managers shall complete and transmit to provider organizations formal referral forms on all priority clients in the manner prescribed in the Purchase of Service Procedures Manual.f. Provider organizations shall consider Department or Area Agency on Aging referred individuals as priority clients only when a formal written referral is received.g. The assigned Human Services caseworker or Area Agency on Aging manager is responsible for the case management of child protective, substitute care, adult protective, adult guardianship/conservatorship, Family Services, WEET cases and elderly at risk clients.h. The Human Services caseworker or Area Agency on Aging manager and provider agency staff shall meet at agreed upon intervals to discuss future need for purchased services. Results shall be confirmed in writing by the Department of Health and Human Services worker, or Area Agency on Aging case manager, filed in the client's record, and a copy sent to provider(s) for that agency's client record.i. Provider organizations shall have the right to deny service to priority clients when: i. Circumstances in the case would constitute a danger to the provider organization's staff or other clients;ii. The services requested are not within the provider organization's service description.iii. The client or the client's guardian refuses the service. iv. The services for which the Department contracted are depleted.j. Provider organizations shall have the right to terminate service to priority clients when: i. The provider organization has not received a formal DHHS referral form within ten (10) working days of the initial referral after contacting the appropriate DHHS or Area Agency on Aging supervisor indicating non-receipt of an appropriate referral.ii. Circumstances arise in the case which constitute a danger to the provider organization's staff or other clients.iii. Referring staff informs the provider organization that either the client is no longer eligible for priority service or the client is no longer in need of the service.k. Referring staff shall review all cases at least every six months to determine eligibility in priority status and need for service, and shall notify the appropriate provider organizations in writing of the case status.l. Provider agencies shall be notified by Area Agency on Aging Case Managers when the following occur: i. Immediately, upon determination that a client is eligible for services through an alternative fee -for-service arrangement that precludes continued payment for services with Office funds.ii. When it has been determined that the client is no longer at serious risk of institutionalization, the Case Manager shall close the case in accordance with Department policy and notify the agency ten (10) calendar days in advance of closing.iii. When the client is being institutionalized, the Case Manager shall close the case in accordance with Department policy and notify the provider agency ten (10) calendar days in advance of closing.m. If, in the judgment of the Department of Health and Human Services worker, the WEET participant would not be subjected to loss of employment or training by discontinuation of service, the worker shall close the case in accordance with Department policy, and notify the agency 10 calendar days in advance of closing.n. Upon notification by the Department or Area Agency on Aging that a case is to be closed, the provider organization shall initiate the procedures for closing the case from referred status as outlined in the Purchase of Service Procedures Manual.o. When the Department caseworker determines that continuation of purchased services in a priority status is no longer necessary to stabilize the family or adult's situation, the caseworker shall notify the provider of the client's loss of priority status with 10 calendar days of the determination.p. When the Department caseworker determines that continuation of purchased services in a priority status is necessary to stabilize the family or adult's situation, the caseworker shall notify the provider(s) of closure as a protective case, with an accompanying referral form indicating the need for continued service(s) in post-protective status.q. Purchased services may be delivered under post-protective status without regard to income for up to three (3) months.B. CLIENT FEES FOR SERVICES1. PURPOSE: The Department of Health and Human Services is committed to utilizing its resources to make social services available to those in the greatest economic and social need. At the same time, the Department is aware of the increasing costs of delivering services, and the subsequent reduction in available services.
2. STANDARDS OF CONDUCT: a. The assessment of fees to clients receiving Office of Child and Family Services funded services shall be approved and authorized by the Office prior to the start-up of the contract.b. All fees assessed to clients receiving Office funded services shall be in the amount authorized by the Office prior to the start-up of a contract.c. Fees for Office funded services shall not exceed the actual cost of delivering the service.d. The Office of Child and Family Services shall determine the criteria to be used in determining the assessment of fees.e. All fee schedules shall not be less than the Office of Child and Family Services' current approved client fee schedule.f. The provider organization shall retain copies of all fee computation forms in client files.g. The client or another party acting on behalf of the client shall pay the assessed fee for service directly to the provider organization on pre-determined due dates.h. The provider organization shall issue a receipt upon payment of an assessed fee and retain copies of all receipts in agency files. i. The provider organization shall keep fiscal records on all fee transactions and on the use of the funds collected.j. One hundred percent (100%) of all fees collected shall be retained by the provider organization and reported as available program income. k. Provider organizations shall use the Office of Child and Family Services fees collected to maintain or expand the same or related services to Office of Child and Family Services eligible clients.l. The unauthorized assessment of fees by a provider organization to Office of Child and Family Services clients shall constitute a breach of contract, enabling the Department to terminate the contract.m. The Office of Child and Family Services shall allow provider organizations to waive or reduce Office authorized fees in individual cases when the following conditions exist:i. The provider organization's Board of Directors has established a written fee waiver and reduction policy which is pre-approved by the Office;ii. The client has requested the waiver or reduction, and it is in compliance with the provider organization's written policy or it is in the best interest of the client to receive service even when they or another party acting on their behalf has refused to pay; andiii. A time limit for each waiver or reduction has been established, with a review at least every six months.n. The Office of Child and Family Services shall approve provider organizations fee waiver and reduction policies only if all of the following are included in the policy: i. Designation of the provider organization official(s) with authority to grant waivers or reductions;ii. The criteria to be used to determine eligibility for reductions or waivers, to include: (1) emergency or catastrophic circumstances; (2) best interest of the client; (3) absence from the program;(4) open Department of Health and Human Services protective cases; (5) open Department of Health and Human Services substitute care and adult guardianship cases;iii. An internal client appeals process; andiv. Procedures for implementing the Office of Child and Family Services' late payment and collection policy (see Standard #16 in this section).o. Provider organizations shall retain documentation of all waivers and reductions in clients' case records.p. Provider organizations shall terminate service to Office of Child and Family Services funded individuals for non-payment of authorized fees only when all the following occur: i. The assessed fee is not paid within five (5) service days of the due date and the client is given written notification that payment is past due and if payment is not received within an additional five (5) service days official termination procedures shall be initialed;ii. The assessed fee is not paid within ten (10) service days of the due date, and the client is given written notice that service will be terminated within ten (10) calendar days if payment is not received; and iii. The client does not request an informal or fair hearing within ten (10) calendar days of the Notification of Termination.q. Not withstanding the provisions of #16 above, the Provider organization may not terminate services to Department referred priority clients, Child Protective or Substitute Care, Adult Protective or Guardianship, for inability or unwillingness to pay the Office of Child and Family Services assessed fee.r. Office of Child and Family Services' authorization to institute or terminate fees during a contract period shall require an amendment to the contract(s).s. Office of Child and Family Services funds transferred to another state agency to administer shall be governed by the other state agency's fee for service policies, unless otherwise stipulated in the transfer of funds agreement between the Office and the other state agency. 10-148 C.M.R. ch. 5, § II