Continuum of Care Reform (CCR)

Assembly Bill (AB 403 reformed placement and treatment options for youth in foster care as part of the CCR initiative. The main goals of CCR are to further improve outcomes by reducing the use of congregate care (group homes), increasing the use of home-based foster care (HBFC and decreasing the length of time to achieve permanency. The passage of this bill necessitated the implementation of a new rate system that bases payment on the needs of the child and not on the child’s age.

Phase 1 of the initiative became effective on January 1, 2017, when Foster Care, Non-Related Legal Guardianship (NRLG), Kinship-Guardianship Assistance Program (Kin-GAP), and Adoption Assistance Program (AAP) cases were paid the same basic rate, regardless of the child's age
In Phase 2, the state implemented the Level of Care (LOC for Foster Family Agencies (FFA in March 2018.
Effective April 1, 2021, as per ACL 21-117 and 21-117E, Phase 3 includes LOC implementation for all HBFC placements, regardless of the date of entry into foster care. There are no retroactive payments prior to 4/1/21 for non-FFA placements.

Important: The AAP LOC implementation differs from the HBFC process. For more information, refer to the AAP subsection further below.

Level of Care

The HBFC LOC rate structure applies to all placements in approved resource family (RF) homes, Kin-GAP, (non Probate) Legal Guardianships, and AAP placements. Payment of a rate higher than the LOC basic rate requires the Level of Care Protocol (LOCP to be used by the SW/PO for all out-of-home placements, except for Static Criteria and Intensive Services Foster Care (ISFC placements based on the outcome of an interagency placement committee (IPC decision. Counties are not permitted to lower LOC levels 2-4 when the child/NMD remains in the same placement. The exception to this is when the youth is stepping down from Static Criteria or an ISFC rate.

HBFC LOC implementation introduces a new documentation type: the Individual Health Care Plan (IHCP. This documentation is received when an ISFC request is based on a Special Health Care Needs (SHCN reason.

Initial and Re-Entry Placements

For initial and re-entry placements, FC Intake will only receive a SOC 158A form with placement information and issue the placement type’s LOC basic rate (FC basic, FFA basic, KG basic, etc.) unless Static Criteria is applied. The SW/PO has 60 days from the date of placement to complete the LOCP. If the rate changes after completing the LOCP, then the EW will receive a revised SOC 158A, SOC 500, and IHCP documentation, if applicable. The LOC rate is effective retroactive to the date of placement provided all other eligibility conditions are met.

Reminder: If the LOCP results in the LOC Basic Rate (and provider remains the same), then the EW will only receive a SOC 500. In this instance, a new SOC 158A is not necessary as no change in rate or placement has occurred.

Subsequent Placements

For subsequent placements (within the same episode) and intraprogram changes (with the same provider), the FC EW will continue issuing the existing LOC rate until new documentation is received to update the rate. Counties are not permitted to lower LOC levels 2-4 when the child/NMD remains in the same placement.

Important: The SW/PO has sixty days from the date of placement to complete the LOCP.

The only exception to lowering the rate is when the youth is stepping down from Static Criteria or an ISFC rate. This change would take effect on the first day of the month following the completion of the LOCP and the documentation should reflect this date. This may result in an uncollectable overpayment. The LOC triggering event information is in the “Triggering Events and Rate Effective Dates” subsection below.

Level of Care Protocol

At the initial placement, if the LOCP is not completed within 60 days, the SOC 500 and applicable documents will not be sent to FCE. In this case, workers will continue using AFDC-FC funds to issue the placement type’s LOC basic rate (FC basic, FFA basic, KG basic, etc.) until the necessary documents are received to update the rate.

In addition to FFA placements, the HBFC LOC rate structure applies to all placements in approved Resource Family (RF) homes including:

Relative/ARC,
NREFM,
FFH,
NMD residing in a HBFC family setting,
Tribally Approved Homes (TAH),
NRLG established in Juvenile Court on or after 1/1/17,
Kin-GAP established on or after 1/1/17,
AAP where the initial agreement or amendment was signed on or after 4/1/21. Also, cases where the initial agreement was signed on or after 1/1/17 that have been renegotiated and an amendment agreement signed on or after 4/1/21 may be reassessed using the LOCP.
DAR placements eligible for regional center services. A child/NMD (eligible for Regional Center Services or Early Head Start) may receive the LOC rate if the LOC rate and any applicable SCIs are higher than the Dual Agency Rate; at a minimum, the child/NMD shall receive the Dual Agency Rate.
Cases converting to RFA. These are cases that were previously approved under the SOC 800 series and are now converting to RFA.
If a LOC rate (2-4, Static Rate or ISFC) is requested on an EA or EC case, then the worker must first confirm that the caregiver has been approved and there is a RFA 05 certificate on file.
If there is a RFA 05 on file, The worker will stop EA/EC funding and issue LOC rate payment using AFDC-FC funding (fed or non-fed).
If there is not a RFA 05 on file, The worker will inform the SW/PO that the case is not eligible for a LOC rate until a RFA 05 has been received. In this situation, EA/EC funding continues.

Important: Cases funded with Emergency Assistance (EA) or Emergency Caregiver (EC) are only eligible for the placement type’s basic rate using aid codes 5K or 5L.

LOC rates do not apply to the following placements:

SILP,
NMDs in a Transitional Housing Placement (THP-NMD)or a STRTP,
Group Homes,
NRLGs established in Probate Court,
Emergency Caregivers (until they are approved as RFs or Tribally Approved Homes),and
Shelters, unlicensed or unapproved homes.

Note: Probate Legal Guardians are not eligible for LOC rates.

Forms and Documents

“Foster Child's Data Record And AFDC-FC Certification” form (SOC 158A) is used for foster care and NRLG cases. Kin-GAP cases will only receive the form when the case is initially transitioning from FC to Kin-GAP.
“Level of Care Digital Scoring Form” (SOC 500). Per state guidance, only the digital SOC 500 form is acceptable. If a manual SOC 500 is submitted to FCE, then the worker must return the form to the SW/PO for a completed digital copy.
“Kin-GAP Agreement Amendment” form (SOC 369A). This form is used whenever there is a rate change in a Kin-GAP case.
Individualized Health Care Plan (IHCP). The SHCN population has been added to the Static Criteria list as a health indicator. Documentation (IHCP) must be provided by a health care professional indicating that the medical condition is not likely to change, is considered/deemed to be permanent or requires specialized in-home health care. There is no standardized form to document IHCP. The IHCP may be a hospital discharge plan or other documentation from a health professional.
Requested Changes/Redetermination Request from Resource Family (RF). The RF may submit a request (verbally or written) for a rate redetermination from the SW/PO at any time. These requests and supporting documentation will forwarded to FCE. As there is no standardized form to request a redetermination, EWs may receive a copy of an email, CWS/CMS contact copy, or other notice to trigger the rate change. This documentation must be noted in Case Comments and sent to IDM. Workers must receive documentation to issue the new rate along with the SOC 158A, SOC 500 and if applicable, the IHCP. The effective date of the rate change is retroactive to the date the RF made the request. The “Rate Effective Date” line on the SOC 500 must match the date the RF requested the redetermination. Workers must document the redetermination request in Case Comments.
“Notice of Action - For Resource Families...” (NA 403). This NOA for Resource Families must be used for all actions affecting a case. This includes situations when a caregiver requests an increase to the rate and the request is denied and when the LOCP is completed and there is no change to the rate.
“Notice of Action - Approval, Change or Discontinued For Kinship - Guardians Only” (NA 403A). This includes situations when a caregiver requests an increase to the rate and the request is denied and when the LOCP is completed and there is no change to the rate.
“Notice of Action - Approval/Denial/Change - AAP” (NA 791)

Triggering Events and Rate Effective Dates

The LOC Protocol should be completed within 60 days of a new placement or when a triggering event occurs. When there is a change in placement the child/youth should continue to receive the ISFC or any rate they were receiving in the previous placement until a new rate is determined. If the new rate is determined to be higher than the previous LOCP determination, then becomes retroactive to the date of placement. If an ICP indicates a child should remain at an ISFC rate, then the IPCs decision should be used in lieu of the LOCP results.

Important: There are no retroactive payments prior to 4/1/21 for non-FFA placements. Also, we cannot lower LOC levels 2-4 when the child/NMD remains in the same placement unless the case is stepping down from ISFC.

Event	Description	LOC Rate Effective Begin Date
Placement Changes	This includes any placement change to a new caregiver.	Date of placement change. Note: An uncollectable overpayment may result if the placement change is to a different caregiver and the new LOCP results in a rate lower than the previous placement.
Changes in the child/ youth’s needs The child/youth remains in the same placement but their needs have changed.	This includes CFT or IPC Initiated. When the IPC approves the referral, the SW/PO will indicate this decision on the LOC Scoring Sheet (SOC 500) by selecting the box in Section A.	Date of the completion of the LOCP as indicated on the SOC 500.
Lowering/Ending ISFC	When services to a child/youth receiving ISFC changes placements to another HBFC placement which is not an ISFC home or when the child remains with the same Resource Family and the needs have decreased which results in a lower rate. Rates may also be lowered if the RFs training requirements are not met at the end of the 120 days from placement.	The first day of the month following completion of the LOCP or IPC (as indicated on the SOC 500). *This is the only circumstance when counties may lower the rate when the child/NMD remains with the same RF.
Requested Changes/ Redetermination Request from Resource Family	When the RF requests a rate change from the SW. These requests and supporting information will be sent to FCE. EWs must document the requested change in Case Comments.	Retroactive to the date the RF made the request. SW will indicate this date on the SOC 500. *LOC 2-4 may only be paid retroactively to 4/1/21 for non-FFA Resource Families.

Static Criteria and Static Rate

Static Criteria is comprised of a list of certain behaviors or conditions that indicate the need to provide a higher level of care and/or supervision for a child/NMD prior to the use of the LOCP. The rate paid under the Static Criteria is referred to as the Static Rate. Although this rate is monetarily equivalent to the ISFC Rate, the terminology Static Criteria/ ISFC should not be used interchangeably. Cases receiving the Static Rate are not eligible for initial or annual clothing allowances.

Important: Approved HBFC homes are also eligible for the Static Rate. In this situation, the worker would issue the ‘family only’ rate which is currently $2,706. When the RF is under an FFA, the full ISFC amount is paid (currently $6,388).

When the Static Criteria are applied, it means the LOC rate determination is the Static Rate and may be paid up to 60 days pending completion of the LOC Protocol. The initial 60-day placement may be extended an additional 60 days upon DFCS manager approval. These two periods should be concurrent, where the extension begins the day after the first 60 days end. If the dates are not aligned correctly, the caregiver may receive an underpayment. The worker must inform the SW/PO of the discrepancy and request a revised SOC 500.

ExampleExample

The use of Static Criteria is short-term and does not assume the child/youth will remain at the ISFC level once the LOC rate determination is completed. It may be applied at initial placement or placement change.

The SHCN population has been added to the Static Criteria list as a health indicator and to the SOC 500. When SHCN is used on the SOC 500, it must be accompanied with child/youth’s IHCP. These documents, including the SOC 158A, must be maintained in both the Eligibility and DFCS case files.

Reminder: AAP cases are not eligible for the ISFC or Static Rate.

Static Criteria Case Flag

Because Static Rate is not a LOC rate option in CalSAWS, workers must use case flag Static Criteria to track these cases and the appropriate rate type.

After the 60 day period ends, the SW/PO must submit a new SOC 500 form indicating a LOC rate or extending Static Criteria. Each time the Static Rate ends, the EW must end-date the special indicator.

ExampleExample

For FFA placements, use the rate type of ISFA-ISFC-FFA
For non-FFA HBFC placements, use the rate type of ISFO-ISFC-Family Only.

Intensive Services Foster Care (ISFC)

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. A child or non-minor dependent in foster care who requires a higher level of care of supervision as determined by the decision made by the IPC, is eligible for this placement type and rate. ISFC placements are not eligible for initial or annual clothing allowances.

If the LOCP determination results in the ISFC eligibility, the ISFC rate can be paid for 120 days (or 180 days in a two-parent home) if the RF is engaging in the ISFC approval training requirements. If the RF becomes an approved ISFC family by a FFA or approved by a county with a state approved ISFC, the ISFC rate can be ongoing for as long as the child/NMD is eligible for ISFC.

Important: Per DFCS policy, Santa Clara County only places children/youths in ISFC homes that are operated by Foster Family Agencies. When the SOC 500 reflects the ISFC rate, the EW must review the SOC 158A placement type (Lines G1 and I1) to ensure the provider is a FFA. If the caregiver is not a FFA provider, then the EW must return the SOC 500 and 158A to the SW/PO.

Refer to Intensive Services Foster Care for additional ISFC information.

Kin-GAP

The “Kin-GAP Agreement Amendment” form (SOC 369A) and the “Notice of Action - Approval, Change or Discontinued For Kinship - Guardians Only” (NA 403A) are used whenever there is a change to the rate. This includes situations when a caregiver requests an increase to the rate and the request is denied and when the LOCP is completed and there is no change to the rate.

The LOCP process is the same for the Foster Care and Kin-GAP programs. Since the transition from FC to Kin-GAP is an intraprogram status change, no interruptions in payment should occur. Specifically, the FC LOC rate will continue to be issued until the EW receives other payment instructions. SW/POs have sixty days to submit a new LOCP. Workers will not receive a SOC 158A when a change has occurred but will receive a SOC 500.

Reminder: Counties are not permitted to lower LOC levels 2-4 when the child/NMD remains in the same placement. For further details, refer to the Triggering Events and Rate Effective Dates subsection above.

Adoption Assistance Payment Program

Like the standard LOCP, the AAP LOCP is a strength-based rate-setting methodology to identify the AAP-eligible child's individual care and supervision needs and may include SCIs, if eligible.The difference is that the APP LOCP evaluates the prospective and adoptive parent(s) role and how they will meet their adopted child's care and supervision needs.The AAP LOCP is to be used to determine an AAP eligible child’s maximum eligible LOC rate to be negotiated for initial agreements and subsequent amended agreements signed on or after April 1, 2021. The payment may be issued retroactive to the start date reflected on the signed initial AAP agreement (which is listed on the AAP 2) but no earlier than 4/1/21.

Initial AAP agreements signed on or after January 1, 2017 that have been renegotiated and an amended agreement signed on or after April 1, 2021 may also be reassessed using the LOCP. If the reassessment determines the child is eligible for a LOC rate between 2 through 4, an amended agreement must be completed and signed. The payment for this reassessed rate should be made retroactive to the start date reflected on the last signed amended AAP agreement (which is listed on the AAP 2), but no earlier than 4/1/21.

The AAP LOCP does not change our current AAP business process. FCE will not receive new LOC forms.

For dual agency (DAR) children, the eligible AAP LOC rate plus eligible SCI is to be used as the total rate to be negotiated, if this rate is greater than the maximum eligible dual agency rate.

Forms

Existing forms will continue to be used. As a reminder:

“Payment Instructions Adoption Assistance Program” form (AAP 2). While Adoption SWs will use new forms to conduct the LOCP, FCE will continue to only receive the AAP 2 when the LOCP is completed.
“Notice of Action - Approval/Denial/Change - AAP” (NA 791). Per current business process, the NA 791 will be used whenever there is a rate change.

Reminder: FC EWs must send a copy of all NA 791s to the Post Adoptions Social Worker.

Denied Rate Change Requests

The Adoption SW will send a denial NOA to the family whenever a rate change request is not supported by the LOCP results.

Triggering Events

The following are AAP LOCP triggering events:

The determination of a child’s eligibility for AAP benefits prior to the adoption finalization (when the case is moving from Foster Care to AAP).
The reassessment and benefit renegotiation per the adoptive parent(s) request post adoption finalization.

The effective date of the rate change will be noted on the AAP 2 form.

Static Criteria and Intensive Services Foster Care (ISFC)

AAP cases are not eligible for the Static Rate or ISFC placements.

Miscellaneous

AAP LOCP directions are based on ACL 21-54.
All other AAP policies and processes remain intact. Refer to FC Handbook Chapter 37 for AAP program details.

Special Care Increment (SCI)

The DFCS revised the SCI Rate Plan (which the state has approved) and may be used in conjunction with the LOC rate structure effective 4/1/21.

Effective 4/1/21, new HBFC cases may receive SCIs under the new plan. Refer to Santa Clara County Foster Care Rates Chart” form (SCD 2405) for details.
Existing cases receiving SCIs will be converted to the new plan by 3/31/22.
County-only funds must continue to be used for cases receiving EA/5K or EC/5L.
Cases receiving the Static Rate or ISFC are not eligible for SCIs.
SCIs are now eligible for the CNI annual increase.
Non-Related Legal Guardians and Non-Related Probate cases may receive a SCI.

Reminder: Effective 4/1/21, SCIs are paid for one year instead of six months. The exception is Kin-GAP cases which may receive the SCI for two years.

SCI Flexibility For Kin-GAP Cases

Kin-GAP SCIs are valid for two years. If the FC and Kin-GAP placements are with the same placement, there is some flexibility regarding SCIs. The SW or PO may extend the FC SCI for another two years so that the SCI end date matches with the new Kin-GAP redetermination date. A revised SCZ 414Z must be provided to the EW. For more information regarding SCIs, refer to Special Care Increments (SCIs).

Note: The flexibility in the SCI process only applies to the Kin-GAP program when the FC and Kin-GAP placements are the same.

Interstate Compact on the Placement of Children (ICPC)

There are no changes to existing ICPC policy or procedures. LOC rates are specific to the state of California and other states’ rates will vary.

Redeterminations (RRR)

There are no changes to existing RRR rules or processes

It is important to note that while a redetermination is not a triggering event, a caregiver may request a rate change at any time including during the RRR. In addition, the needs of the child may change at any time so a SW/PO may initiate a redetermination of the rate. There is a difference between the rate change effective dates under both scenarios. When a provider requests the change, the new rate is effective the date the request was made. If the SW/PO believes the youth’s needs have changed and initiates a rate change, then the effective date is that day the SW/PO completes the SOC 500.

Foster Family Agencies

When the relative or NREFM placement is also a FFA home.

Per ACL 17-78, in this situation, the relative/NREFM is treated like any other FFA placement. The SOC 158A will indicate that the placement is an FFA home and the payment is issued to the FFA, which in turn pays the relative or NREFM. This rule does not apply to guardianship cases, including Kin-GAP.

Reminder: Kin-GAP and AAP are not eligible for FFA rates.