Provider Policy Manual State of Tennessee Department of Children's

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Provider Policy Manual State of Tennessee Department of Children's Powered By Docstoc
					                                Provider Policy Manual
                                  State of Tennessee
                         Department of Children’s Services (DCS)

                                         July 1, 2010



The Core Standards described in SECTION ONE apply to every agency regardless of the
population of children and youth served. SECTIONS TWO through EIGHT outline the levels of
care available to children and youth through contractual relationships between the State of
Tennessee’s DCS and private provider agencies and serve to inform agencies of DCS policies
that will help children and families achieve permanency in a timely manner. These Sections
are subdivided by type of program and describe the requirements that apply to those agencies
serving that specific population of children and youth. SECTION NINE contains attachments
including a listing of applicable DCS policies, forms and other guides. SECTION TEN is the
Glossary.
Within each level description, the reader will find a definition of the service and placement
type, the admission/clinical criteria, and the service components required within the per diem.
The Manual user will find hyperlinks to mandated DCS Policy. Please note that in some cases
entire sections of the previous version of the manual have been removed and replaced with
the DCS hyperlink. As updates are made, there will be other sections that will be treated the
same way.
As stated in each private provider agency’s contract, the agency is subject to monitoring and
evaluation by all appropriate State entities and is bound to all requirements outlined in this
manual. In addition to monitoring for compliance to specific quantitative requirements, DCS
provider monitoring is concerned with contributing to an understanding of the quality of
services. Monitoring is geared toward helping to gauge the degree to which effective services
are consistently provided in a way that supports family engagement and, ultimately, timely
permanency for children.

Situations may arise in which discrepancies or ambiguities are encountered when applying the
policies contained within the Provider Policy Manual. In such situations, DCS and providers
will use the following documents to govern decisions and as the final authority on policy. The
documents are listed in order of precedence.

Brian A. Settlement Agreement (Civil Action NO. 3-00-0445)
http://www.state.tn.us/youth/dcsguide/settlement.pdf

DCS Policy
http://www.state.tn.us/youth/dcsguide/policies.htm
                                            TABLE OF CONTENTS

SECTION ONE          CORE STANDARDS                                                                 Pages 1-51
   I.    Organizational and Administrative Requirements
         A. Accreditation/Licensing……………………………………………………………….……1
         B. Subcontracting ................................................. ………………………………1
         C. Special Health Precautions..................................................................2
         D. Physical Environment and Equipment ..................................................2
         E. Transportation and Vehicle Maintenance ..............................................3
         F. Non-discrimination .............................................................................4
         G. Confidentiality ..................................................................................4
         H. HIPAA Compliance ............................................................................5
         I. Expansion of Services Protocol ...........................................................5
         J. DCS Initiatives...................................................................................6
         K. Invoicing Reconciliation ......................................................................8
         L. Facility Change of Location/Address ...................................................9

    II.       Personnel Requirements
              A. Personnel Policies and Practices ....................................................... 10
              B. Background Checks ......................................................................... 10
              C. Personnel Files ................................................................................ 11
              D. Staff Responsibilities and Qualifications ............................................. 12
              E. Staff Development. .......................................................................... 14
              F. Caseload Sizes……………………………………………………………………………. . 19
              G. Employee Performance Review and Accountability….………………………..19

    III.      General Program Requirements
              A. Referral, Acceptance and Admissions Procedures................................ 21
              B. Client Information and Records ......................................................... 22
              C. Initial Assessment............................................................................ 24
              D. Treatment Plan and Documentation .................................................. 24
              E. Rights of Youth and Family ............................................................... 28
              F. Search Procedures ........................................................................... 29
              G. Grievance Procedures ...................................................................... 31
              H. Services and Support to Children/Youth and Families………………………..31
              I. Movement and Movement Reporting…………………………………………..…..35
              J. Placement Exception Requests (PER) ................................................ 36
              K. Detentions, Runaways, Hospitalizations……………………………………………36
              L. Reporting, Compliance, Corrective Action Plans .................................. 37
              M. Child and Family Team Meetings ....................................................... 39
              N. Face-to-Face Contact/Visitation Requirements .................................... 40
              O. Child Abuse Reporting/Investigation .................................................. 41
              P. Serious Incident Reporting ............................................................... 42
              Q. Allowance/Clothing/Incidentals ......................................................... 44
              R. Educational Standards...................................................................... 45
              S. Mandated “Protection from Harm” Standards and Policies ................... 45
              T. Successful/Unsuccessful Program Completion……………. ……………………47
              U. Discharge and De-authorization of Services........................................ 47
              V. Referral to Post-Custody Adult Services for Mentally Ill/MR Youth ........ 49
              W. Appeals Procedures ......................................................................... 50

SECTION TWO         FOSTER CARE/RESOURCE HOMES                                                 Pages 1-21
     I. General Requirements and Core Standards
         A. Approval Requirements for Resource Homes ........................................1
         B. Case File Organization .......................................................................2
         C. Working with DCS and Agency Staff ....................................................2
         D. Documentation of Approval for Resource Home ...................................2
       E.   Resource Home Composition .............................................................3
       F.   Health Requirements .........................................................................3
       G.   Income and Employment ...................................................................3
       H.   Background and Other Records Checks ..............................................3
       I.   Physical Facilities Related to Approval Process .....................................3
       J.   Expedited Placements ........................................................................3
       K.   Modification/Waiver of Requirements for Approval of Resource Home ....3
       L.   Resource Home Reassessment Checklist .............................................3
       M.   Resource Home Reassessment ...........................................................4
       N.   Resource Parents’ Rights ....................................................................4
       O.   Board Rates…………………………………………………………………………………….4

 II.   Standard Foster Care Services
       A. General Characteristics.......................................................................5
       B. Admission/Clinical Criteria .................................................................5
       C. Personnel..........................................................................................5
       D. Resource Parent Training ...................................................................6
       E. Individualized Treatment Plan .............................................................6
       F. Agency Responsibility/Services............................................................7
       G. Support to the Child/Youth ................................................................7
       H. Support to the Permanency Family .....................................................8
       I. Support to the Resource Family .........................................................8
       J. Education of the Child/Youth ............................................................9
       K. Program Monitoring/Utilization Review ................................................9
       L. Discharge Criteria ........................................................................... 10

III.   Medically Fragile Foster Care Services
       A. General Characteristics............................................................. ………11
       B. Admission/Clinical Criteria ............................................................... 11
       C. Personnel........................................................................................ 11
       D. Resource Parent Training ................................................................. 12
       E. Individualized Treatment Plans ......................................................... 12
       F. Agency Responsibility/Services.......................................................... 12
       G. Support to the Child/Youth .............................................................. 12
       H. Support to the Permanency Family ................................................... 12
       I. Support to the Resource Family ....................................................... 12
       J. Education of the Child/Youth .......................................................... 13
       K. Program Monitoring/Utilization Review .............................................. 13
       L. Discharge Criteria ........................................................................... 13

IV.    Continuum Foster Care Services
       A. General Characteristics..................................................................... 14
       B. Admission/Clinical Criteria ............................................................... 14
       C. Personnel........................................................................................ 14
       D. Resource Parent Training ................................................................. 15
       E. Individualized Treatment Plans ......................................................... 15
       F. Agency Responsibility/Services.......................................................... 15
       G. Support to the Child/Youth .............................................................. 15
       H. Support to the Permanency Family ................................................... 16
       I. Support to the Resource Family ....................................................... 16
       J. Education of the Child/Youth .......................................................... 16
       K. Program Monitoring/Utilization Review .............................................. 16
       L. Discharge Criteria ........................................................................... 16

  V.   Foster Care Services for Juvenile Justice Youth
       A. General Characteristics..................................................................... 17
       B. Admission/Clinical Criteria ............................................................... 17
       C. Personnel........................................................................................ 17
       D. Resource Parent Training ................................................................. 17
              E.   Individualized Treatment Plans ......................................................... 17
              F.   Agency Responsibility/Services.......................................................... 17
              G.   Support to the Child/Youth .............................................................. 17
              H.   Support to the Permanency Family ................................................... 17
              I.   Support to the Resource Family ....................................................... 17
              J.   Education of the Child/Youth .......................................................... 17
              K.   Program Monitoring/Utilization Review .............................................. 18
              L.   Discharge Criteria ........................................................................... 18

     VI.      Interdependent Living Services
              A. General Characteristics..................................................................... 19
              B. Admission/Clinical Criteria ............................................................... 19
              C. Personnel........................................................................................ 20
              D. Resource Parent Training ................................................................. 20
              E. Individualized Treatment Plans ......................................................... 20
              F. Agency Responsibility/Services.......................................................... 20
              G. Support to the Child/Youth .............................................................. 20
              H. Support to the Permanency Family ................................................... 21
              I. Support to the Resource Family ....................................................... 21
              J. Education of the Child/Youth .......................................................... 21
              K. Program Monitoring/Utilization Review .............................................. 21
              L. Discharge Criteria ........................................................................... 21

SECTION THREE                 CONGREGATE CARE                                                       Pages 1-20
     I. Core Standards for Congregate Care Residential Treatment Facility
         (RTF) or Level II Group Care
         A. General Characteristics.......................................................................1
         B. Admission/Clinical Criteria ..................................................................1
         C. Personnel..........................................................................................1
         D. Service Components Provided within the per diem ................................1
         E. Education of the Child/Youth ..............................................................2
         F. Monitoring Progress ...........................................................................2
         G. Utilization Review ..............................................................................3
         H. Discharge .........................................................................................3

       II.    Level II Group Care Facilities
              A. General Characteristics.......................................................................3
              B. Admission/Clinical Criteria .................................................................3
              C. Assessment Requirements ..................................................................4
              D. Personnel & Staffing Requirements .....................................................5
              E. Individualized Treatment Plans ...........................................................5
              F. Service Overview ...............................................................................5
              G. Service Components .........................................................................5
              H. Medication Administration .................................................................7
              I. Education of the Child/Youth .............................................................7
              J. Monitoring Progress ...........................................................................7
              K. Utilization Review ..............................................................................7
              L. Discharge Criteria .............................................................................8
              M. Recreational Activities in the Group Home Setting ..………………..………….8
              N. Individual Health, Hygiene and Grooming in the Group Home Setting……8
              O. Record Management..………………………………………………………………………8

     III.     Level III Residential Treatment Facility (RTF)
              A. General Characteristics.......................................................................9
              B. Admission/Clinical Criteria .................................................................9
              C. Personnel........................................................................................ 11
              D. Resource Parent Training ................................................................. 11
              E. Service Overview ............................................................................. 13
              F. Education of the Child/Youth ............................................................ 15
               G.   Record Management ...................................................................... 15
               H.   Monitoring Progress ........................................................................ 16
               I.   Utilization Review ............................................................................ 16
               J.   Discharge Criteria ........................................................................... 16

IV.     LEVEL IV RESIDENTIAL TREATMENT
            A. General Characteristics..................................................................... 17
            B. Admission/Clinical Criteria ............................................................... 17
            C. Admission Process ........................................................................... 18
            D. Personal ......................................................................................... 18
            E. Individualized Treatment Plan ........................................................... 19
            F. Service Components Provided within the per diem .............................. 19
            G. Education of the Child/Youth ............................................................ 20
            H. Monitoring Progress ........................................................................ 20
            I. Utilization Review ............................................................................ 20
            J. Discharge Planning and Discharge Criteria ......................................... 20

SECTION FOUR                  CONTINUUMS                                                            Pages 1-24
     I. Continuum of Care Core Requirements
         A. General Characteristics.......................................................................1
         B. Admissions/Clinical Services and Movement .........................................1
         C. Personnel..........................................................................................2
         D. Resource Parent Training ...................................................................2
         E. Individualized Treatment Plans ...........................................................2
         F. Service Overview ...............................................................................2
         G. Service to the Child/Youth ..................................................................3
         H. Documentation/Utilization Review .......................................................3
         I. Discharge Criteria ..............................................................................4

       II.     Level II Continuum
               A. Admissions/Clinical Criteria .................................................................6
               B. Personnel..........................................................................................7
               C. Service Overview ...............................................................................7
               D. Service Components Provided within per diem ....................................7
               E. Services to the Family ...................................................................... 11
               F. Education ...................................................................................... 11
               G. Placement Types ............................................................................ 11

   III.        Level III Continuum
               A. Admissions/Clinical Criteria ............................................................... 13
               B. Personnel........................................................................................ 14
               C. Service Overview ............................................................................. 14
               D. Service Components within the per diem .......................................... 14
               E. Services to the Permanency Family ................................................... 18
               F. Education of the Child/Youth ........................................................... 18
               G. Placement Types ............................................................................ 18
               H. Accessing Managed Care Organization (MCO) and Behavioral Health
                  Organization (BHO) Services……………………….………………………………....20

      IV.     Level III Continuum Special Needs Program Requirements
              A. General Characteristics..................................................................... 21
              B. Admissions/Clinical Criteria ............................................................... 21
              C. Assessment ..................................................................................... 22
              D. Personnel ....................................................................................... 23
              E. Individualized Treatment Plans ......................................................... 23
              F. Service Overview ............................................................................. 23
              G. Service Components within the per diem ........................................... 24
              H. Education of the child/youth ............................................................ 24
              I. Monitoring Process .......................................................................... 24
             J. Services to the Permanency Family .................................................. 24
             K. Utilization Review ............................................................................ 24
             L. Discharge Criteria ............................................................................ 24

SECTION FIVE        UNIQUE CARE AGREEMENT, PROGRAMS FOR SPECIAL
                     POPULATIONS AND SPECIAL NEEDS                                                      Pages 1-9
     I.      Unique Care Agreements (UCA)
             A. General Characteristics.......................................................................1
             B. Admissions/Clinical Criteria .................................................................1
             C. Utilization Review ..............................................................................1
             D. Monitoring ........................................................................................1

    II.      Special Population, Level II
             A. General Characteristics.......................................................................2
             B. Admissions/Clinical Criteria .................................................................2
             C. Personnel .........................................................................................3
             D. Individualized Treatment Plans ...........................................................3
             E. Service Overview ...............................................................................3
             F. Service Components Provided within the per diem ................................3
             G. Education .........................................................................................3
             H. Monitoring Process ............................................................................3
             I. Utilization Review ..............................................................................4

   III.      Special Needs, Level II
              A. General Characteristics……………………………………………………………….…...4
              B. Admissions/Clinical Criteria .................................................................4
              C. Personnel .........................................................................................5
              D. Service Overview ...............................................................................5
              E. Service Components Provided within the per diem ...............................5
              F. Education .........................................................................................5
              G. Monitoring Process ............................................................................5
              H. Utilization Review ..............................................................................5

   IV.       Special Needs, Level III …………………………………………………………………….6

   V.        Special Needs, Level IV
             A. General Characteristics.......................................................................6
             B. Admissions/Clinical Criteria .................................................................6
             C. Admission Process .............................................................................7
             D. Family of Care ...................................................................................7
             E. Personnel..........................................................................................7
             F. Individualized Treatment Plan .............................................................8
             G. Service Components Provided within the per diem ................................8
             H. Education .........................................................................................9
             I. Monitoring Process ............................................................................9
             J. Discharge Planning and Discharge Criteria ...........................................9

SECTION SIX         PTC AND DETENTION                                                               Pages 1-6
  I.    Primary Treatment Center
        A. General Characteristics.......................................................................1
        B. Admissions/Clinical Criteria .................................................................1
        C. Assessment and Evaluation ................................................................1
        D. Service Components Provided within the per diem ................................2
        E. Individualized Treatment Plans ...........................................................3
        F. Personnel .........................................................................................3
        G. Monitoring Process ............................................................................3
    II.      Detention Center
             A. General Characteristics…………………………………………………………………….4
             B. Admissions/Clinical Criteria .................................................................4
             C. Service Components Provided within the per diem ................................5
             D. Assessment and Evaluation ...............................................................5
             E. Individualized Treatment Plans ..........................................................6
             F. Personnel .........................................................................................6
             G. Monitoring Process ............................................................................6
             H. Discipline and Security .......................................................................6

SECTION SEVEN                IN-HOME SERVICES                                                     Pages 1-4
         In-home Service Requirements
         A. General Characteristics.......................................................................1
         B. Admissions/Clinical Services ...............................................................1
         C. Personnel Ratio .................................................................................2
         D. Resource Parent Training ...................................................................2
         E. Individualized Treatment Plan.............................................................2
         F. Service Overview ...............................................................................2
         G. Service to the Child/Youth ..................................................................2
         H. Service to the Permanency Family .......................................................2
         I. Service to the Resource Family ...........................................................3
         J. Education of the Child/Youth ..............................................................3
         K. Documentation/Utilization Review .......................................................3
         L. Discharge Planning ...........................................................................4

SECTION EIGHT               ADOPTION                                                            Pages 1-4
         A. Protocol for Marking Adoptive Placements ...........................................1
         B. Special Needs Children .......................................................................1
         C. Full Adoption Case Management Services ............................................1
         D. Primary Components of Adoption Services ..........................................1
         E. DCS Policies on Adoption services and Foster Care ...............................1
         F. Steps to Adoption .............................................................................1

SECTION NINE                  ATTACHMENTS
         1. Mandatory Policies
         2. Policies for Information
         3. DCS Forms
         4. Resource Home Eligibility (D-RHET) Protocol
         5. Foster Parent’s Bill of Rights
         6. TENNCARE Information
         7. Appeal of CFTM Decision
         8. Licensure Matrix
         9. Educational Standards for DCS Providers
        10. Informed Consent Provider Information
        11. Guide to Search Policy
        12. DCS Practice Model
        13. PACC
        14. Regional Administrator (RA) to RA Approval
        15. Continuum Model Utilization Guide
        16. Facilities and Group Care IV-E Compliance Protocol

 SECTION TEN                            GLOSSARY                                                        Pages 1-24