IV-A. A. Service Authorizations

Services provided to clients/recipients of the Department of Health and Human Services (DHHS), Child Welfare Division of the Office of Child and Family Services (OCFS),are based on assessed need, agreed upon goals, and specific, measurable outcomes, with clear timeframes for evaluating outcomes and progress, and are based on client/recipient's informed choice and concurrence. All services are to be provided in an ethical and respectful manner and should utilize evidenced-based models meaning those practices that are grounded in consistent scientific evidence showing that it improves client/recipient outcomes that are measurable and is sufficiently documented through research to permit assessment of fidelity.

1.	Rights of clients/recipients (name is interchangable) of services authorized by Child Welfare Services, OCFS in the context of child welfare cases.

All clients/recipients, including children and youth, have the right to participate in all service decisions, review their treatment, case, or service plan, refuse any service unless mandated by law or court order and be informed about the consequences of refusal or disengagement with services. The client/recipient of mental health services should be provided with a copy of the Rights of Recipients of Mental Health Services published by DHHS. Clients/recipients must be informed of their right to choice in the selection of a service provider qualified to meet the assessed service or treatment need. Services are to be provided to meet the assessed need and should not go beyond the scope of that need unless requested by the client/recipient. The client/recipient is to be informed prior to any engagement in services of their rights regarding confidentiality and privacy protections by the provider. DHHS staff must comply with the DHHS confidentiality policy and the confidentiality tools that can be found at Hhttp://inet.state.me.us/dhhs/confidentiality/index.shtmlH where client information is to be shared.

Any client/recipient denied or discharged from services or treatment must be informed of agency mechanisms for expressing and resolving grievances.

Medical, dental, mental health and substance abuse services shall be authorized in the context of a plan to provide for the safety, permanency and well being of a child and/or to address the threat or risk of abuse and neglect by a person responsible for the child. Child Protective Assessments, and case plans should identify the need for essential services and the effect of the provision of these services. In completing Child Protective Assessment and child case plans, caseworkers shall obtain and consider relevant evaluations, medical reports and therapist’s progress reports. When new needs are identified by the caseworker, family, other providers, and youth, services to meet those needs shall be incorporated into the Case Plan. Clinical providers will, under their own individual licenses, conduct an assessment and determination of the most appropriate intervention. They must also go through their own process of informed consent.

For service authorizations made in conformity with established rates and number of hours as specified in policy, approval by the casework supervisor is sufficient.

For service authorization for services not specifically covered by MaineCare or Child Welfare Services, OCFS policy, a second level approval is required by the CW Program Administrator or Assistant Program Administrator. Examples of such exceptional service requests include:

3.	Exceptional need for a medical service to an adult client or child not in DHHS custody, when intended to meet established safety, permanency or well-being goals of the case.

The CW Program Administrator will obtain approval from the Child Welfare Division Director or designee prior to authorization of the entry of exceptional service type; and rates in the following circumstances:

Any time such a rate is entered in MACWIS, it must be done with the express approval of CW Program Administrator. Additionally, any time a caseworker or supervisor authorizes or approves a Service Authorization with this Service Type it must be sent to the CW Program Administrator for approval.

Authorizations for ongoing services cannot exceed 12 sessions. Supervisors shall not approve service requests for re-authorizations unless they have verified that the DHHS has received a written treatment plan with clearly defined and measurable goals met and a clear progress report from the clinician.

Client/recipient No Show –The Department will not authorize payment for client no shows. Providers should be notified that the Department will not accept financial responsibility for missed appointments. Caseworkers must inform clients of the importance of providing 24 hour advance notice to providers if they are unable to make an appointment. Caseworkers should verify that clients have transportation.

To access a contracted service the caseworker should complete a Provider Agency Referral Form in MACWIS Event Tracking. The rates specified by contract must be used for the contracted service, without exception.

It is acceptable to close a Child Welfare Services, OCFS case and prior to closure to authorize on going services for 90 days as a PX-99 for contracted mental health or substance abuse services. These services are provided to reduce or eliminate child abuse and neglect and to support any needed transportation to these services, also provided under contract.

For other contracted services not specified above, it is acceptable to close a case and prior to closure to authorize ongoing services for 90 days as a PX-99. These ongoing services after case closure are authorized as a PX-99 in the Special Definition field in the Service Authorization screen.

(a)	Reimbursement to Foster Parents - Miscellaneous reimbursement to foster parents including sporadic babysitting and day care within the licensed foster home setting, as well as foster parent travel, remain a paper authorization process, using a G-31 form.

(b)

Payments for Lay-Non-Expert Testimony - Payments in addition to the subpoena fee may be interpreted as compromising the witness. However, lost wages not covered by subpoena fee may be paid if lost wages would cause hardship and if the payment plan is made known to other counsel and the court. Individuals should be instructed to submit a bill. This must be authorized by a caseworker and supervisor and then sent to DROMBO for payment. (Note: this entry also appears in C&FS Policy under court preparation and testimony.) Subpoena/witness fees are to be provided to the witness at court and not mailed to prevent payment when a hearing is cancelled or a witness does not appear.

(c)

Travel reimbursement per MaineCare Rules 113.04-3Mileage Reimbursement to a Family. Actual miles traveled are reimbursable to the family at the amount listed in Chapter III, (half the MaineCare rate for like transportation services) when the client or family uses their own car or has arranged for the use of a privately-owned vehicle. Reimbursement to a recipient or family, except in an emergency circumstance, will be only for transportation authorized prior to the actual trip. Foster care parents when transporting Medicaid recipients are considered family and cannot enroll as volunteers. Foster care parents are reimbursed at the State Worker Rate.

The majority of children in the care or custody of the Department qualify for MaineCare services and should receive medically necessary treatment services from a provider who is enrolled in MaineCare as approved to provide the specific services requested Two groups of children in our custody do not have MaineCare.

•	children in custody placed with their parents. Every effort should be made to have parents apply for MaineCare when their children return home.

Payment for all medical/dental/mental health services will be made at the rates established by the MaineCare program (Child and Family Services Manual, Section V, Subsection J, Page 7). There are exceptions to the general policy, which will be noted below.

Only in unique and exceptional situations does Child Welfare Services, Office of Child and Family Services provide payment for the provision of medical services to adult clients/recipients or children not in the custody of the Department. If a unique client need exists, a specific request for such a service shall be directed to the CW Program Administrator and shall require their approval prior to the agreement to provide payment. This request to the Program Administrator shall have an explanation in the purpose/details window in MACWIS.

For V-9’s, medical services not covered by MaineCare continue to require service requests by caseworkers, with supervisory approval.

No service authorization is required in MACWIS for clients to receive medical services paid for by MaineCare. There are certain circumstances when MaineCare requires that a prior approval be obtained as a condition of payment.

Diagnostic medical services needed for child protective assessment will be requested by the caseworker in MACWIS for supervisory approval in the event that the service is not covered through MaineCare for the child. Rates approved should be the same as MaineCare or other DHHS approved rates. Examples of such services include, but are not limited to: evaluations through the Spurwink Child Abuse Program, medical exam at a hospital emergency room, full skeletal x-rays or CAT scans.

Only in unique and exceptional situations does the Child Welfare Services, Office of Child and Family Services provide payment for the provision of dental services to adult clients or children not in the custody of the Department. If a unique client need exists, a specific request for such a service shall be directed to the CW Program Administrator and shall require his/her approval prior to the agreement to provide payment.

In some geographic areas of the state, there is a scarcity of dentists to provide both regular dentistry and orthodontia at MaineCare rates. In the event that a caseworker is unable to find a dentist or orthodontist to provide care at MaineCare rates to a child in DHHS custody within 50 miles of the child’s residence, estimates of the work shall be sought from a non-MaineCare enrolled provider. Once given approval by the CW Program Administrator, a letter of financial authorization can be written by the caseworker.

In some cases, MaineCare will not approve orthodontia for children in custody of the Department, yet recommended orthodontic services are needed for the child’s well being. In such cases orthodontia can be provided with the approval of the CW Program Administrator.

a.)

Only the Community Resource Lead and CW Program Administrator are exclusively responsible for the loading and management in MACWIS of the Mental Health providers in their geographic area. If an agency or medical association has several offices, it will be loaded in the geographic area of its administrative or corporate headquarters.

Mental Health providers for the purposes of Service Authorizations shall be located in MACWIS, Resources Module, Community Resource Directory. Individual providers shall be located under the Resource Types of Therapists and CR – MHA (Community Resource Mental Health Agencies.) For all providers located under Therapists, service types and rates for the services that they provide shall be loaded by the Community Resource Lead. Individual providers who are LCSW or LCPCs are only approved for payment through MaineCare for Child Welfare cases.

For all providers found under the Resource Type of Therapists, sufficient information shall be provided from the service authorization to enable the account clerk in the MACWIS Finance Module to complete the work to generate a prior approval for mental health services including a MaineCare procedure code.

Children and families who enter the child welfare system may require psychosocial, psychological, or psychiatric evaluations. All evaluations shall include a mental status exam and a differential diagnosis. Some evaluations identify psychological or behavioral difficulties while other evaluations include issues of child safety and child abuse and neglect risk reduction. Follow up evaluations may be required. This policy provides a framework for guiding decisions about when children and families will be referred for evaluation and what type of evaluation is needed that best meets the identified and individualized concern for the client.

A systematic approach to identifying children and their family members who require clinical interventions is critical.

§	Measurable and attainable goals that, when attained, will lend confidence to the judgment that the child will be safe in the family’s care

A major goal is to make sure children and families get the services they need while making referrals specifically for clinical or forensic evaluations only when they are absolutely necessary. For example, treatment providers begin their services with an intake assessment and then develop a treatment plan; additional evaluations may not be needed. On occasion, evaluations may be necessary for facilitating decision making with respect to permanency planning such as in complex cases involving conflicting information. Evaluation referrals may be necessary when further clinical information is needed to determine eligibility for services such as children’s and adult mental health and mental retardation services, or for determining the level of risk relative to child safety.

Referrals for any evaluations that may not provide essential information for child safety and the child welfare process and that could delay permanency planning should be avoided. This policy does not preclude treatment evaluations and assessments that occur as part of a course of treatment

When children, parents, or families are referred for treatment, the treatment provider will conduct a comprehensive initial assessment consistent with their respective discipline’s standards and best practice. Treatment providers will use this information to develop a treatment plan and will re-evaluate treatment progress on at least a quarterly basis. Treatment providers will assess the risks and needs for reducing the risk of child maltreatment. The DHHS caseworker will obtain a copy of the initial treatment assessment and treatment plan within 30 days of the provider opening the case, and any progress reports within 30 days of their completion.

This practice guideline will include treatment providers who provide interventions for parents who have neglected their children, who physically or sexually abused their children, who engage in substance abuse, or other unsafe behavior. This practice guideline also applies to children who have been maltreated regardless of whether they are in their parent’s or guardian’s custody, or DHHS custody.

Referrals for psychosocial evaluations will be made only when the DHHS caseworker and supervisor find:

1.	There is clear evidence of psychiatric symptoms, or high likelihood of psychiatric disorder with associated dysfunction in a major developmental area.

A thorough psychosocial evaluation should include mental status evaluation with appropriate evidence based treatment recommendations, and "First Signs" autism screen if child is less than 5 years old. Reimbursement is limited to 4 hours or 16 quarter (1/4) hour units.

Determine there is a need for information that will identify a specific need for services and what type of service may be most appropriate

There is a need to evaluate factors that may facilitate or impede effective interventions such as to:

2. Likely cognitive problem as indicated by learning problems in any area of learning (school, social, play, language, social development impaired, inability to read social cues) that will assist in determining the child’s eligibility for special education services, or special pre-school enhancement services

Psychological Assessment should contain recommendations addressing any learning disabilities and skill development to enhance cognitive growth. Not indicated if school has done testing in past 24 months. Reimbursement is limited to 4 hours or 16 quarter (1/4) hours.

This includes the administration of the test, interpretation of the test and preparation of test reports. Reimbursement is limited to 4 hours or 16 quarter (1/4) hours.

Referrals for psychiatric evaluations for parents will only be made if there is information indicating that there may be an undiagnosed psychiatric condition that impairs the parent’s ability to safely parent their child or when there are reasons to suspect that current medications may not be effective.

For children in care, referrals for psychiatric evaluations will only be made if:

The only evaluations which may exceed 4 hours or 16 quarter(1/4) hour units per individual client are:

Sex offender evaluations completed in accordance with the Maine State Forensic Service Sex Offender Assessment Program Report Format – 16 hours or 64 quarter (1/4) hour units per individual client may be authorized for these.

•	Have significant child protective services histories that include divergent information and opinions from various professionals, cases that are unusually complex and that involve questions concerning psychological or psychiatric functioning and maltreatment risk

•	When a comprehensive, high quality evaluation may provide information that can assist DHHS and the court in making timely, well informed decisions with respect to permanency for children in the child welfare system

When CANEP referrals appear to be indicated, the DHHS caseworker and supervisor will consult with the state’s attorney to determine whether or not to request that the court order a CANEP evaluation and for which parties.

CANEP evaluations will be used only in cases when other types of evaluations will not be sufficient. All evaluations and evaluation practices will be empirically informed and consistent with each discipline’s professional standards and best practice guidelines. Reimbursement is limited to 16 hours or 64 quarter (1/4) hours.

Neuropsychological Evaluations – Referrals for a neuropsychological evaluation should only be considered if there are organic indicators and after Child Welfare Program Administrator approval and if the following applies:

•	There is medical, or child protective assessment information that indicates that the child may have suffered brain injury due to physical abuse, substance abuse and other factors that may impact cognitive and motor functioning skills.

•	Neuropsychological information may be needed to determine services needed for special education, vocational rehabilitation for adults and other services needed such as Occupational Therapy, Physical Therapy, and other support services.

•	Prior to making a referral for a neuropsychological evaluation, the DHHS caseworker will check to see if any prior, relatively recent neuropsychological evaluations exist that might preclude the need for referring the child for another evaluation.

•	There is a clear need for more current neuropsychological information to determine eligibility for adult mental retardation and/or mental health services.

•	There is a clear need for determining whether or not the child will need a legally appointed guardian when they become an adult, when a psychological evaluation is not sufficient to answer these questions.

A Halstead-Reitan Neuropsychological Battery or any other comparable neuropsychological battery is limited to 7 hours 28 quarter (1/4) hour units

Finally, if such evaluation information is already available in the case record, or relatively recent, relevant, and reliable evaluations are available, additional evaluations are not necessary and are precluded.

Again, because of additional testing required, 7hours or 28 quarter (1/4) hour units per individual may be authorized for these, per MaineCare regulations. These are only to be authorized when there has been a clinical assessment recommending this type of evaluation.

In unique situations, e.g. an evaluation to determine Factitious Disorder ("Munchausen Syndrome by Proxy"), a Program Administrator may authorize a one-time exception to increase hours. These exceptions should be made only as clinically indicated.

Miscellaneous clinical consultation - MaineCare rates shall be paid for clinical consultation when needed. If there is an evaluation rate which is higher than the treatment rate, the evaluation rate shall be authorized by the Program Administrator or CBHS Regional Administrator. If there is more than one evaluation rate, select the one consistent with the service provided. For example, a provider approved to do forensic evaluations should receive the forensic rate for consultation on a child maltreatment issue. Consultation at a Family Team Meeting requires Program Administrator approval.

Payment for Sex Offender Treatment and Batterer Intervention Programs - DHHS accepts prevailing expert opinion that it is critically important for sex offenders and batterers to pay for their treatment as a measure of their willingness to accept responsibility for their behavior. DHHS will supplement payment only if necessary, either by contracts or by supplementing hourly payment. Prior to supplementing, DHHS must receive a signed statement from therapist and batterer about what portion of hourly group rate (maximum $25.00) the client will pay. It is acceptable for DHHS to pay for evaluations to determine appropriateness for the actual treatment or intervention. DHHS shall refer only to Batterers Intervention programs certified by the Department of Corrections. The DOC role and responsibility for certification of Batterer Intervention programs is specified in MRSA Title 19-A, Chapter 101, section 4104.

Inpatient substance abuse treatment – We have an obligation to the payment of services which have a direct impact on CA/N. In the event that other funding is not available for in-patient substance abuser treatment, the caseworker shall obtain a clinical recommendation for the need for inpatient and the basis for the recommendation. Once a recommendation is received, the following questions need to be answered by worker and supervisor:

3.	Does the client have any income or other resources that could help to defray the cost and also be a part of accepting responsibility?

Requests should be forwarded through the CWPA to Child Welfare Division Director or designee with a recommendation for approval. It is expected that such recommendations will only be made in exceptional situations. In situations where approval is given, District staff shall request the treatment program to move the client to a MaineCare or OSA funded bed as soon as available.

Out-patient substance abuse - A LADC provider must be associated with an agency in order to be paid through MaineCare. Assessment under the Child Welfare/Substance Abuse Protocol will be allowed 4 hours with 2 hours additional for written evaluation.

Court Preparation and Testimony – Generally the caseworker will receive a bill for these services from the provider. It is acceptable for the provider to include preparation time with DHHS staff and the AAG, as well as all time spent at the courthouse. The provider may also bill for travel time. Payment for mileage should be prepaid and included with the subpoena, along with the witness fee which is to be paid to the witness at court only. The worker will authorize the correct number of hours and include the travel expense amount and authorization in the Purpose/Details field on the MACWIS Service Authorization window, in the case about whom the provider testified.

For professional providers, MaineCare rates shall be paid for testimony. If there is an evaluation rate which is higher than the treatment rate, the evaluation rate should be authorized. If there is more than one evaluation rate, select the one consistent with the service provided. For example, a provider approved to do forensic evaluations, but providing sex abuse treatment should receive the forensic evaluation rate for testimony.

If a provider who provides a service through a mental health clinic at a MaineCare blended rate, s/he should receive that rate for court preparation and testimony.

If court is cancelled and the provider has less than 24 hours notice and is unable to utilize/reschedule the time, the Department will pay up to three hours of time per day.

For a child charged with an offense while in care or custody or the offense occurred while the child was in the care of custody of the Department:

2.	If the Department must hire an attorney to represent the child, it is expected that the negotiated rate will not exceed the rate for court appointed counsel. If an exception to this rate is needed it can be approved by the CWPA.

If law enforcement wants to question a child in DHHS care or custody, the Department must hire an attorney to represent the child, as specified in #2 above.

Parenting education should not exceed the rate for mental health treatment by an individual with the same level of licensure. For parents of children in DHHS custody, this service should be sufficiently available through District Parenting and Visitation contracts, except in exceptional situations. If parent training is delivered to groups, group rates apply. Effort should be made to determine if the parenting education program is an evidenced-based model, implemented with fidelity and adherence to a manual.

Only fully licensed Child Care facilities are to be used for children in foster care or custody of the Department.

Routine ongoing Child Care Expenses should be authorized as a Service Authorization, including the reasons in the Purpose/Details field on the Service Authorization Window. The Child Care facility should be instructed to bill DROMBO for the service and payment should be made directly to the facility.

When a child in our custody resides and remains in an unapproved living arrangement despite the caseworker’s efforts to place him/her elsewhere, the Department may authorize purchase of food in amounts which monthly do not exceed the amount of the food stamp standard for one person per month. Such an authorization will be done by the generation of an on line authorization and a Purchase Order in Event Tracking.

VII. CLOTHING AND OTHER SUPPLEMENTAL PAYMENT AUTHORIZATIONS FOR CHILDREN IN FOSTER CARE For transportation payments refer to C&FS Manual, Section V. G-3

Children shall be placed on a clothing allowance immediately after coming into custody, and into voluntary care if the voluntary agreement so states.

Exceptions to the requirement that children be placed on a clothing allowance may be made:

2.	When it is anticipated that the child will remain in a specific foster home/facility for a very short time and no clothing will be purchased for the child by the foster parent/facility.

3.	When a child is in a living arrangement, such as a boarding school, and there is no appropriate person to receive and manage the clothing allowance.

In all of the above instances when a child is in need of clothing the clothing will be purchased by use of a purchase order.

When children are returned to their own families, any authorization of clothing will be consistent with the case plan and requires approval by the Casework Supervisor.

Clothing allowances are established for three age groupings. Daily rates for those age groups effective since 3/1/2000 are:

Increases in monthly clothing allowances are made effective on the child’s fourth or eleventh birthday. The clothing rates are programmed into MACWIS and the program will automatically advance the amount on the child’s birthday.

Purchase of clothing authorized by the child’s caseworker and supervisor via either the Purchase Order, and/or clothing allowance may not exceed the amount of the established clothing allowance for a child of the particular child’s age, except as provided for in Clothing at Entry into Custody.

Suitable clothing the child brings with him/her may be supplemented when needed to provide him/her clothing appropriate for the seasons by authorizing purchase(s) by use of Purchase Order in MACWIS. Clothing at entry into care should not exceed the following amounts:

Clothing purchases in excess of the monthly clothing allowance are to be authorized for children only upon the specific approval of the Caseworker and Casework Supervisor.

On-line service authorizations for supplementary clothing made in MACWIS must contain the reason the clothing is needed and list any supporting facts in the purpose/details window.

Approval for the purchase of supplemental clothing is based on the need for the clothing requested and on an evaluation that purchases to replace lost or destroyed clothing will not reinforce irresponsible behavior by the child. Some reasons for approving supplementary clothing purchases are:

•	Special medical problems such as foot problems requiring non-Title XIX reimbursable orthopedic shoes, or incontinence requiring an unusual supply of clothing.

The casework supervisor is responsible for approval and the CW Program Administrator is responsible for a periodic review of approved requests for purchases of supplementary clothing to assure compliance with policy.

With supervisory approval, the child’s caseworker may authorize payment for any necessary incidental items for a specific child pertaining to a child’s daily activities. This includes such items as infant supplies, initial school supplies, specialized sports equipment, specialized clubs or tutoring programs, and personal hygiene items. Two weeks of summer camp can be authorized for any child in foster care, as long as it meets the needs of the child.

VIII. NECESSITIES FOR PARENTS OR PREVIOUS CUSTODIANS – Authorizations for necessities can be considered as a way of supporting a smoother transition for a child and family as well as in response to emergencies. Miscellaneous reimbursement to parents remains a paper authorization process. Such authorizations include:

Assistance provided by the Department to parents for travel is limited to the rate of fare for public transportation or the established MaineCare rate for mileage, as well as tolls. Bills must be approved by the caseworker. Parents should never be reimbursed at a higher rate of pay than the current standard MaineCare rate per mile.

Groceries when parents do not have the ability to pay, as approved by casework supervisor. Purchase Order must be to a specific vendor and list a specific category of items.

Rent and/or Security Deposit – when parents do not have the ability to pay, as approved by casework supervisor. Any payments beyond 3 months must have Program Administrator approval.

Note: In unusual instances, when children are placed with parents prior to custody being returned to them, C&FS Policy states that "board may be provided to the parent(s) or previous custodians for up to three months as a transition to their assuming full responsibility for the child. The amount of board is determined on a case-by-case basis and may not exceed the amount of board for the child at a Level 1 classification". This should be done by entering the parent as a Community Resource in MACWIS. Casework supervisor approves. Beyond 3 months, CW Program Administrator must approve.

IV. PHYSICAL PLANT IMPROVEMENTS TO MEET LICENSING/ADOPTION STANDARDS TO MEET PERMANENCY GOALS

Prospective foster/adoptive/kinship/permanency guardianship families that are unable to meet standards due to a physical plant/home improvement issue that has been cited in the home study, fire marshal report or plumbing or town code may apply for funds to make the necessary repairs. It is the expectation that the family accepting these funds is making a permanency commitment to the child and must sign the Family Authorization Form agreeing to that. Authorization for these funds is made through the Director of Child Welfare Policy and Practice.

•	MaineCare enrolled providers are responsible for determining the appropriate service and allowable service hours under their license and the medically necessary treatment provided.