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					ADOPTION SERVICES: ADOPTION ASSISTANCE, SECTION 109

TABLE OF CONTENTS

SECTION                 TITLE

109                     Introduction to Adoption Assistance /
                        Glossary of Definitions and Terminology

109.1                   Categories of Adoption Assistance

109.2                   Eligibility for Adoption Assistance

109.3                   Eligibility Criteria for Monthly Adoption Assistance
                        for Children not in DFCS Permanent Custody

109.4                   Application for Adoption Assistance / Special Needs Determination

109.5                   Specialized Rate Request for Adoption Assistance

109.6                   Deferred Adoption Assistance Application / Agreement

109.7                   Case Record Documentation Requirements for
                        Monthly Adoption Assistance

109.8                   County of Responsibility for Completing the
                        Adoption Assistance Application/Agreement for
                        Monthly Benefits

109.9                   Negotiating the Monthly Adoption Assistance
                        Agreement

109.10                  Reviewing and Signing the Monthly Adoption
                        Assistance Agreement

109.11                  Approving the Monthly Adoption Assistance Package /
                        Initiating Benefits

109.12                  Duration of Benefits – Federal and State Policy

109.13                  Duration of Benefits – After Age 18

109.14                  Verification of Continuing Eligibility for Monthly
                        Adoption Assistance Payments

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ADOPTION SERVICES: ADOPTION ASSISTANCE, SECTION 109
SECTION                 TITLE

109.15                  Non-recurring Adoption Assistance – General Description

109.16                  Approving the Non-Recurring Adoption Assistance
                        Application Package / Initiating Payment

109.17                  Special Services Adoption Assistance -
                        General Description

109.18                  Special Services Adoption Assistance -
                        Application and Approval Process

109.19                  Funding Categories of Adoption Assistance

109.20                  Social Security Disability Benefits / SSI

109.21                  Medicaid – General Information

109.22                  Medicaid for Child Receiving Adoption Assistance
                        From Another State

109.23                  Status Change

109.24                  Family Relocations

109.25                  Administrative (Fair) Hearings

109.26                  Data Collection

109.27                  Record Maintenance




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Social Services Administration Unit                                 Adoption Assistance, Section 109
March 1, 2010                                                                                 Page 2
ADOPTION SERVICES: ADOPTION ASSISTANCE, SECTION 109
109


                                      ADOPTION ASSISTANCE

INTRODUCTION


The primary goal of the Title IV-E and State adoption assistance program is to provide financial
support to families who adopt difficult-to-place children from the public child welfare system.
These are children who otherwise would grow up in State foster care systems. Adoption
Assistance is available to adoptive families when specific eligibility requirements are met.

Children placed on adoptive status while in the permanent custody of the Georgia
Department of Human Services (DHS) may be eligible for Adoption Assistance if
determined by the State/Tribe to meet Federal and State special needs criteria and either
Federal Title IV-E or State Title IV-B adoption assistance eligibility requirements.

Children placed on adoptive status while not in the permanent custody of the Georgia
Department of Human Services (DHS) may only be eligible for Adoption Assistance if
determined by the State/Tribe to meet special needs criteria AND Title IV-E adoption
assistance eligibility criteria.

The State of Georgia has identified specific factors and conditions because of which it is
reasonable to conclude that a child cannot be adopted without providing Adoption
Assistance. At the time of the special needs determination and prior to the time a child is
placed on adoptive status, the child must be determined to meet at minimum one of the
State’s special needs criteria, in addition to other requirements (in order for Adoption
Assistance benefits to begin when the child is placed on adoptive status).

The current special needs criteria, which must be utilized for all new special needs
determination requests submitted after March 1, 2010 are listed below:

SPECIAL NEEDS CRITERIA – EFFECTIVE March 1, 2010

   A child who has been in the care of a public or private agency or individual other than
    the legal or biological parent for more than 24 consecutive months.
   A child with a physical, mental, or emotional disability, as validated by a licensed
    physician or psychologist.
   A child who is a member of a sibling group of two or more placed in the same home.


The following special needs criteria were utilized for all special needs determination
requests submitted prior to March 1, 2010:
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SPECIAL NEEDS CRITERIA - PRIOR TO March 1, 2010
(The set of criteria below will no longer be utilized for Special Needs Determinations made
 after February 28, 2010)

    Eight years of age or older
    A child of black heritage and is one year of age or older
    Member of a sibling group of three or more to be placed together at the same time
    Member of a sibling group of two placed together at the same time where one is over
     the age of eight or has another special need
    A child with documented physical, emotional, or mental health problems or limitation.

In each case, all appropriate eligibility criteria must be met and an Adoption Assistance
Agreement must be completed and signed by all parties prior to the finalization of the
adoption. Further clarification of Georgia’s current Special Needs Criteria (Post March 1,
2010) is provided in Section 109.2.

Please note: Adoption Assistance is not available for parents who have previously
surrendered their parental rights or who have previously had their parental rights
terminated. Step-parents are not eligible to receive Adoption Assistance.


            ADOPTION ASSISTANCE GLOSSARY OF TERMS/DEFINITIONS


ADMINISTRATIVE (FAIR) HEARING

An Administrative (Fair) Hearing is a proceeding before a court of law or other decision-making
body or officer. It is less formal and shorter than a trial. The administrative hearing involves
hearing evidence and/or arguments and reaching an acceptable solution without legal trial. This
hearing can be initiated by any person who feels he/she has been wrongfully denied Adoption
Assistance benefits or who disagrees with a decision by the State Agency which affects their
Adoption Assistance benefits.

ADOPTION (PUBLIC AGENCY)

Adoption of a child through the Georgia Department of Human Services or through the Interstate
Compact from a public agency in another state.

ADOPTION (PRIVATE AGENCY)

Adoption of a child through a private agency licensed by the State of Georgia to place children
for adoption or through the Interstate Compact from a licensed private agency in another state.
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ADOPTION (INDEPENDENT)

Adoption of a child without the benefit of agency involvement prior to the placement of the child
in the home.

ADOPTION ASSISTANCE AGREEMENT (FORM 402)

A legal and binding agreement between the agency and the adoptive parent(s) regarding
Adoption Assistance benefits. It establishes types, duration, amount(s) of benefits, and other
agreed upon stipulations.

ADOPTION ASSISTANCE FILE

This file includes forms and documentation related to Adoption Assistance and is maintained in
the County DFCS office until the last Adoption Assistance payment is made.

ADOPTION FINALIZATION

When a Court has legally finalized an adoption resulting in a Final Adoption Decree.

ADOPTIVE STATUS

For a Title IV-E or Title IV-B eligible child with special needs who is in the permanent
custody of DHS, the child is on adoptive status when physically placed in the home of the
adoptive parent(s) and the Placement Agreement (Form 33/37s) has been signed by all required
parties. Note: In these cases, after the signing of the Placement Agreement, the State of Georgia
may then complete the Adoption Assistance Agreement and begin adoption assistance benefits.

For a Title IV-E eligible child with special needs who is in the temporary custody of DHS
but permanent custody is given to a specified relative or individual for the purpose of
adoption, the child is on adoptive status when the child is legally free for adoption (TPR granted
by the court or Voluntary Surrenders completed) and written permanent custody of the child has
been given to the relative or individual for the purpose of adoption. Note: In these cases, the
State of Georgia begins adoption assistance benefits when an Adoption Assistance Agreement is
signed with the specified relative/individual who has gained permanent custody (must be signed
prior to finalization of the adoption).

For a Title IV-E eligible child with special needs, who is in an independent or private
adoption, the child is considered placed on adoptive status once legally free for adoption (TPR
granted by the court) but prior to finalization of the adoption. This type of adoption is often
handled by private agencies or attorneys without the involvement of DFCS. Note: The State of
Georgia begins adoption assistance benefits at the time of finalization.

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APPLICABLE CHILD

The Fostering Connections to Success and Increasing Adoptions Act of 2008 (110-351) revised
the eligibility criteria for Title IV-E Adoption Assistance. A child for whom the revised criteria
apply is defined as an ―applicable child.‖ Applicable children are not required to meet previous
AFDC requirements at the time of removal from their home in order to qualify for Title IV-E
Adoption Assistance. This revised eligibility criteria will be phased in over a period of time.
Applicable children meet certain criteria, according to age, length of time in foster care, and
placement in the same adoptive home with siblings. These criteria are more fully described in
Section 109.2.
(SEE ―Non-Applicable Child‖)

BASIC FOSTER CARE PER DIEM

This is the basic daily board rate provided to the foster parents for children placed in Family
Foster Homes.

BASIC RATE (ADOPTION ASSISTANCE)

The basic monthly rate which is provided for children who qualify for Adoption Assistance.

DEFERRED ADOPTION ASSISTANCE

If a child does not meet the definition of a child with special needs prior to adoptive placement, a
deferred adoption assistance application/agreement is completed with the adoptive parent(s). If a
medical, physical, or mental condition develops at a later date, adoption assistance may be
instated at the time that the agency determines these conditions to meet special needs criteria.

DFCS-INVOLVED CHILD

Children who are in the permanent custody of DFCS or who were transferred from temporary
DFCS custody to a specified relative/individual for the purpose of adoption.

DISRUPTION

The removal of a child(ren) from an adoptive placement after the signing of the placement
agreement but before legal finalization.

DISSOLUTION

The termination/voluntary surrender of parental rights by the adoptive parent(s) of a child(ren) on
whom the adoption has been legally finalized.



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DURATION OF BENEFITS

The length of time that a child remains eligible to receive Adoption Assistance benefits.

FOSTER PARENT ADOPTION

A child who becomes legally free to be adopted, and his/her foster family indicates their wish to
be considered to adopt this child and no other. The Foster Parent Adoption Process is completed
for the home.

GUARDIAN AND KINSHIP ASSISTANCE PAYMENTS

Subsidies provided by the Agency to support the placement of children with relatives outside of
Foster Care.

INTERSTATE ADOPTION

The placement of a child who is a resident of the State of Georgia in another State for the
purpose of adoption or the placement of a child who is a resident of another State in Georgia for
the purpose of adoption.

LEGAL FATHER

A male who:
has legally adopted a child; or
was married to the biological mother at the time the child was conceived or born; or
married the biological mother after the child was born and recognized the child as his own; or
has signed an Acknowledgement of Legitimation or
has been determined to be the father by a final paternity order; or
has legitimated the child; and
who has not surrendered or had his rights terminated to the child.

LEGAL MOTHER

The female who is the biological or adoptive mother of the child and who has not surrendered or
had terminated her rights to the child.

LICENSED TREATMENT PROVIDER

A licensed psychologist, psychiatrist, therapist, or physician who has evaluated and/or treated the
child.




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MEANS TEST

An investigation of a person's financial resources, made to determine whether that person is
eligible for various types of Public Assistance. A means test is not allowed when determining
eligibility for Adoption Assistance or the Adoption Assistance rate.

MEDICAID

Medical benefits which are available for all children receiving Adoption Assistance.

NON-APPLICABLE CHILD

Refers to children who do not meet the criteria for the ―Applicable Child‖, and who must meet
all AFDC requirements (as in effect July 1, 1996) related to Title IV-E Adoption Assistance
eligibility. See Section 109.2 for further description of criteria related to the Non-Applicable
Child. Also, see ―Applicable Child‖.

NON-DFCS INVOLVED CHILD

A child who has never been in permanent custody of DFCS and was not placed from DFCS
custody into the home of a specified relative/individual for the purpose of adoption.

NON-RECURRING ADOPTION ASSISTANCE

Reasonable and necessary adoption fees, court costs, attorney fees which are related to the
adoption of a special needs child. Fees are not reimbursed until after finalization of the adoption.

PARENTAL RIGHTS

The terms ―Parental Rights‖ and ―Termination of Parental Rights‖ are frequently used in Section
109. ―Parental Rights‖, as used in Section 109, refers to the rights of the legal mother and the
legal father of the specified child(ren). Termination of Parental Rights refers to the Court‘s
decision to sever the parental rights of the legal mother and/or the legal father.

PERMANENT CUSTODY OF DHS

For the purposes of this policy, ―permanent custody to DHS‖ means that DHS has been awarded
permanent custody of a child through termination of parental rights order or through a voluntary
surrender by the child‘s legal parents. There are situations in which one parent‘s rights may be
terminated by the Court while the other parent‘s rights are severed by Voluntary Surrender.




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PETITION TO TERMINATE PARENTAL RIGHTS

This is a formal pleading, filed in Court, which states facts/grounds in order for the Court to
consider in a Termination of Parental Rights in a future hearing. For Adoption Assistance
purposes, the filing of the Petition to Terminate Parental Rights is the first point in time that a
request for Special Needs Determination can be made (if the goal is adoption).

REV MAX

The Revenue Maximization Unit determines eligibility for Title IV-E funding for Adoption
Assistance, in addition to other programs.

SSAU

Acronym for the Social Services Administration Unit, which administers the State Adoption
Assistance Program in the State of Georgia.

SSI (SUPPLEMENTAL SECURITY INCOME)

Supplemental Security Income is a monthly benefit for children who are disabled or who have
functional limitations as determined by the Social Security Administration.

SPECIALIZED ADOPTION ASSISTANCE RATE

An Adoption Assistance rate determined by the SSAU, which is higher than the Basic Adoption
Assistance rate, and is based upon documented significant needs of the child.

SPECIALIZED FOSTER CARE PER DIEM

A Foster Care rate determined by the Provider Relations Unit, which is higher than the Basic
Foster Care rate, and is based upon documented significant needs of the child.

SPECIFIED RELATIVE/INDIVIDUAL (Placement with the Relative/Individual for the
Purpose of Adoption)

This refers to the placement of a child from the Temporary Custody of DHS into the Permanent
Custody to a ―Specified Relative/Individual for the Purpose of Adoption‖. For the purposes of
the State of Georgia‘s Adoption Assistance Manual, the specified relative is an individual related
to the child within the 5th degree of relationship, who is specified in the legal transfer of
permanent custody. The specified individual is the individual who is not necessarily related to
the child, but who is specified in the legal transfer of permanent custody.




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Social Services Administration Unit                                     Adoption Assistance, Section 109
March 1, 2010                                                                                     Page 9
ADOPTION SERVICES: ADOPTION ASSISTANCE, SECTION 109
STATUS CHANGE

Changes in the situation of an adoptive family which must be reported to the Adoption
Assistance Case Manager, as required by the Adoption Assistance Agreement.

TERMINATION OF PARENTAL RIGHTS

Termination of parental rights is the most serious legal action a county department can initiate
upon the parent/child relationship. An order terminating the parental rights of a parent is without
limit as to duration. In effect, it terminates the parent‘s rights and obligations with respect to the
child and all rights and obligations of the child to parent, including the rights of inheritance.

TITLE IV-E FUNDING

A combination of Federal and State funds which are available when specific criteria are met.

TITLE IV-B FUNDING

State funds, which are approved when Title IV-E eligibility criteria are not met.

TRANSFER OF CUSTODY

This is the transfer of permanent custody to a specified relative/individual for the purpose of
adoption as the final disposition following a DFCS-initiated TPR hearing or by Voluntary
Surrenders by the parent or by a combination of the two.

VALIDATED

This term is used in the current Special Needs Criterion: ―A child with a physical, mental, or
emotional disability as validated by a licensed physician or psychologist‖. In this case, validated
means that the licensed physician or psychologist has confirmed or substantiated a child‘s
physical, mental, or emotional disability. Written documentation is required for such validation
(i.e. tests, evaluations, and statements). The required documentation is provided in Section 109.

VOLUNTARY SURRENDER

The legal parent(s) gives up their rights and obligations to their child or children. Following
adoption, the parent (and all extended family) loses all parental rights and responsibilities to the
child. The child loses all rights to the parents (and extended family), including the rights of
inheritance. The parent may be obligated to pay child support until such time as the adoption is
finalized.
Note: This does not affect the child receiving Social Security Survivors/Disability Benefits on the
birth parent‘s account.)
Voluntary Surrenders are only taken when adoption is a viable plan for the child.
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Social Services Administration Unit                                     Adoption Assistance, Section 109
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CATEGORIES OF ADOPTION ASSISTANCE

 109.1

Requirement:

There are four categories of Adoption Assistance benefits available to assist in meeting the
special needs of the child who is on adoptive status.

109.1 Procedures:

1.   Monthly (Ongoing) Adoption Assistance:

     A. Children who are determined eligible for ongoing Adoption Assistance qualify for a
        monthly financial benefit. The amount of assistance may not exceed the Family
        Foster Care board rate the child would have received in a family foster home
        immediately prior to adoptive placement.

     B. Monthly Adoption Assistance benefits are not considered a board rate, rather they are
        designed to assist in meeting the cost of providing for a child who has been determined
        to meet special needs criteria by the state of Georgia.

     C. The monthly Adoption Assistance subsidy may be either Title IV-E or IV-B/State
        Funded. Criteria for Title IV-E and IV-B State-Funded Adoption Assistance are given
        in Section 109.2.

2.   Medicaid:

     A child who is a recipient of monthly Title IV-E Adoption Assistance or Title IV-B State
     funded Adoption Assistance is also eligible to receive medical benefits.


3.   Non-recurring Adoption Assistance:

     A. Non-Recurring Adoption expenses are considered by federal regulations as: "reasonable
        and necessary adoption fees, court costs, attorney fees and other expenses directly
        related to the legal adoption of a child with special needs and which are not incurred in
        violation of state or federal laws."

     B. This may include the following expenses:

         1)    The cost for travel/lodging and food during pre-placement visitation based on the
               current state rates. Receipts/documentation must accompany the request for
               payment.
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        2)     The cost of physicals for the adoptive parents required for the adoption assessment
               (medicals for other family members or for updates are not included).
               Receipts/documentation must accompany the request for payment.
        3)     Legal/court fees (Invoice/documentation must accompany the request for
               payment).

     C. Any costs relating to the court termination or voluntary surrender of parental rights on
        the birth parents are not reimbursable under this program (Child Welfare Manual
        8.2.D.3)

     D. Any adoption (excluding step-parent or birth parent adoptions) that meets the Federal
        and State criteria for special needs is eligible to receive Non-recurring Adoption
        Assistance. A determination of special needs must be made by the Social Services
        Administration Unit (SSAU) and an application/agreement signed prior to finalization
        of the adoption in order for non-recurring adoption assistance to be approved.

          Note: Payments may not exceed $1,500.00 per child, and will only be paid after
                the adoption has finalized.

4.   Special Services Adoption Assistance (State Funds ONLY)

     A. Special Services Adoption Assistance provides time-limited or one-time-only funds for
        a specified service when no other family or community resources are available to
        meet the special needs of the adoptive child. These funds must be re-applied for
        annually and the approval of such services is dependent upon the availability of State
        funds. See Section 109.17, 109.18.

     B. Only children who have been approved to receive Monthly Adoption Assistance
        benefits are eligible to apply for and receive Special Services Adoption Assistance.

     C. Special Services Adoption Assistance is paid with State Funds ONLY, which are
        limited and only available for special needs children in the following circumstances:

         1. Children who have been placed for adoption while in the permanent custody of DHS.
         2. Children who have been in the temporary custody of DHS and were placed into the
            permanent custody of a specified relative or individual for the purpose of adoption.
            In order to qualify for Adoption Assistance, these children must be Title IV-E
            eligible.

     Please Note: Private/Independent adoptions, where there was not a transfer of custody from
                  DHS to a relative/individual for the purpose of adoption, are not eligible for
                  Special Services Adoption Assistance funds.


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March 1, 2010                                                                                Page 12
ADOPTION SERVICES: ADOPTION ASSISTANCE, SECTION 109

ELIGIBILITY FOR ADOPTION ASSISTANCE

109.2

Requirement:

Eligibility for all types of Adoption Assistance is directly related to the child meeting
Special Needs Criteria (as determined by the State/Tribe) as defined below, and the
Adoption Assistance Agreement being discussed, signed, and dated by all parties prior to
the finalization of the adoption.

The availability of Adoption Assistance shall be discussed with anyone expressing interest in
adopting child(ren) with special needs. An Application shall be submitted for any person who
requests Adoption Assistance for child(ren) being adopted (other than step-parents or parents
who have previously surrendered their parental rights or had their parental rights terminated).



1. MONTHLY ADOPTION ASSISTANCE:

     A. Title IV-E Adoption Assistance – The Title IV-E adoption subsidy program
        has specific requirements that must be met prior to claiming Federal
        reimbursement. These requirements include:

          (1) Special Needs Criteria Being Met – The State/Tribe must determine that the child
              is a child with special needs in accordance with the criteria established in the
              Social Security Act. The child must meet the Federal and State Special Needs
              criteria.

               The Special Needs criteria for Adoption Assistance are met when:

                (a) The State/Tribe has determined, pursuant to established criteria, that the child
                    cannot or should not return to the home of his or her parents, and

                (b) The State/Tribe has determined that, except where it would be against the best
                    interests of the child because of such factors as the existence of significant
                    emotional ties/bonds with prospective adoptive parents while in the care of the
                    parents as a foster child, a reasonable, but unsuccessful, effort has been made
                    to place the child with appropriate adoptive parents without providing
                    adoption assistance under this section or medical assistance under title XIX,
                    and


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                (c) The State/Tribe has determined that there exists with respect to the child
                    a specific factor or condition (such as ethnic background, age, or membership
                    in a minority or sibling group, or the presence of factors such as medical
                    conditions or physical, mental, or emotional handicaps) because of which it is
                    reasonable to conclude that the child cannot be placed with adoptive parents
                    without providing adoption assistance under this section and medical
                    assistance under title XIX;

                (d) The State of Georgia requires that a child meets at minimum one of the
                     following special needs criteria at the time of special needs determination (as
                     determined by the State/Tribe), which must occur prior to the child being
                     placed on adoptive status in order for Adoption Assistance benefits to be
                     effective when a child is placed on adoptive status.
                     Please Note: After an initial request has been made for Special Needs
                     Determination, subsequent requests may be made (based on changing
                     circumstances) up until the point of the child‘s placement on adoptive status.
                     See Glossary of Terms/Definitions for the definition of ―adoptive status‖.

                SPECIAL NEEDS CRITERIA - EFFECTIVE March 1, 2010

               A child who has been in the care of a public or private agency or individual
                other than the legal or biological parent for more than 24 consecutive
                months.

                Please Note: 24 consecutive months is calculated by using the date of the
                child’s most recent removal to the date of the special needs determination
                request. A special needs determination may be requested up until the signing
                of the Adoption Placement Agreements (Form 33/37) for children in the
                permanent custody of DFCS, up until finalization for all private/independent
                adoptions (Non-DFCS Involved Adoptions) and up to the signing of the
                Adoption Assistance Agreement (Form 402) for children transferred from
                DFCS temporary custody to the custody of a specified relative/individual for
                the purpose of adoption (must be signed prior to adoption finalization).

               A child with a physical, mental, or emotional disability, as validated by a
                licensed physician or psychologist.

               A child who is a member of a sibling group of two or more placed in the same
                home.

                Please Note: Siblings are not required to be placed for adoption at the same
                time in order to meet the above criterion. A second sibling may be placed
                into the same home as a previously placed sibling and thus meet the above
                special needs criteria. However, if the previously placed sibling was not
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                determined to meet special needs criteria, he/she would not become eligible
                based on the second sibling being placed in the same home at a later time.
                He/she would remain non-special needs.

                SPECIAL NEEDS CRITERIA - PRIOR TO March 1, 2010
                (The following special needs criteria were utilized for all special needs
                determination requests submitted prior to March 1, 2010. These criteria are
                not utilized for special needs determination requests after February 28, 2010)

             Eight years of age or older

             A child of black heritage and is one year of age or older

             Member of a sibling group of three or more to be placed together at the same
               time

             Member of a sibling group of two placed together at the same time where one
               is over the age of eight or has another special need

             A child with documented physical, emotional, or mental health problems or
                limitation.

               IN ADDITION TO MEETING THE SPECIAL NEEDS CRITERIA, TO BE
               ELIGIBLE FOR IV-E ADOPTION ASSISTANCE, A CHILD MUST MEET
               THE IV-E CRITERIA FOR EITHER THE “APPLICABLE CHILD” OR
               THE “NON-APPLICABLE CHILD”, as described in the Fostering
               Connections to Success and Increasing Adoptions Act of 2008 (P.L. 110-351):

          (2) Applicable Child:

              The “applicable child” is a child who meets the criteria of the “Applicable
              Child” in the Fostering Connections to Success and Increasing Adoptions Act
              of 2008 (P.L. 110-351) and other required IV-E criteria listed below:

              Applicable Child / Age - The State must apply the ―applicable child‖ eligibility
              requirements to anyone who is an ―applicable child‖ based on his or her age if the
              child has attained the applicable age, as indicated in section 473(e)(1)(B) of the
              Social Security Act, any time before the end of the Federal fiscal year during which
              the adoption assistance agreement is entered into. The applicable age for a child
              begins at 16 years old in FFY 2010 and decreases by two years for each fiscal year
              until a child of any age meets the applicable age requirements in FFY 2018.
              See Chart below for further clarification:


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                Federal Fiscal Year                 Age of Applicable Child (Attained at Any
                (October 1st to September 30th)     Point During the Federal Fiscal Year)
                2010                                16
                2011                                14
                2012                                12
                2013                                10
                2014                                8
                2015                                6
                2016                                4
                2017                                2
                2018 or thereafter                  any age

              Applicable Child / Time in Foster Care and Siblings. As of FFY 2010, the law
              also defines an ―applicable child‖ to include: (1) a child who has been in foster care
              under the responsibility of the State/Tribal agency for at least 60 consecutive
              months; or (2) a child who is a sibling of an applicable child by virtue of age or
              time in foster care and is placed in the same adoption arrangement as his/her
              sibling.

              The “Applicable Child”, in addition to meeting Special Needs Criteria, must
              also meet one of the following four eligibility requirements (a, b, c, or d) for
              IV-E Adoption Assistance payments to be made:

              a) Child meets specific requirements at the initiation of adoption proceedings: the
                 child, at the time of the initiation of adoption proceedings, was in the care of a
                 public or licensed private child placement agency or Indian tribal organization
                 pursuant to:

                      An involuntary removal in accordance with a judicial determination to the
                       effect that it was contrary to the child‘s welfare to remain in the home; OR
                      A voluntary placement agreement or voluntary relinquishment. Thus, for an
                       ―applicable child‖, there does not have to be a title IV-E payment made
                       under a voluntary placement agreement.

               b) Child meets all medical or disability requirements of SSI: Child meets all
                  medical or disability requirements of Title XVI with respect to
                  eligibility for SSI benefits. An “applicable child” does not have to meet the
                  needs-based requirements for SSI (See 109.20).

               c) Child of a minor parent: the child was residing in a foster family home or child
                  care institution with his/her minor parent and the minor parent was removed
                  from home pursuant to either: (1) an involuntary removal in accordance with a
                  judicial determination to the effect that it was contrary to the child‘s welfare to
                  remain in the home; or (2) a voluntary placement agreement or voluntary
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                   relinquishment.

               d) Child was eligible in a prior adoption: the child was adopted and was
                  determined eligible for title IV-E adoption assistance in a prior adoption (or
                  would have been found eligible had the Adoption and Safe Families Act of
                  1997 been in effect at the time of the previous adoption), and is available for
                  adoption because the prior adoption has been dissolved or the child‘s adoptive
                  parents have died. In such an instance, the child may retain eligibility for
                  adoption assistance payments in a subsequent adoption. The State/Tribe
                  only needs to determine that the child is still a child with special needs for the
                  child to be eligible for adoption assistance.

               All other requirements in section 473(a) through (c) of the Social Security Act,
               the background check requirements in section 471(a)(20)(A) and (B) of the
               Act and 45 CFR 1356.30(b) and (c), the adoption assistance agreement
               requirements as defined in section 475(3) of the Act and regulation in 45 CFR
               1356.40 and 1356.41 (to the extent that they are not superseded by the law)
               apply equally to both an applicable and a non-applicable child.

                    OR

          (3) Non-Applicable Child:

               The “non-applicable child” is a child who does not meet the criteria for the
               “applicable child”.

               The “non-applicable child must meet Special Needs Criteria as determined by
               the State/Tribe and one of the requirements listed below (a, b, c or d) to be
               eligible for IV-E Adoption Assistance payments to be made:

                a) Child was removed from the home of a relative specified in section
                   406(a) of the Act (as in effect on July 16, 1996) and placed in foster
                   care in accordance with a voluntary placement agreement with respect
                   to which Federal payments are provided under section 474 (or section
                   403, as in effect on July 16, 1996), or in accordance with a judicial
                   determination to the effect that continuation in the home would be
                   contrary to the welfare of the child, and 1) received AFDC, in that
                   relative's home, under the State plan approved under section 402 of the
                   Act (as in effect 7/16/96), or would have received AFDC under such
                   plan had application been made, in or for the month the voluntary
                   placement agreement was entered into or court proceedings leading to
                   the judicial determination referred to in section 473(a)(2)(A)(i) were
                   initiated; or 2) had been living with a relative specified in section
                   406(a) of the Act within six months before the month in which a
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                    voluntary placement agreement was entered into or court proceedings
                    leading to the judicial determination referred to in section
                    473(a)(2)(A)(i), were initiated and would have received AFDC in that
                    relative's home under the State plan approved under section 402 of the
                    Act for that month, if in that month the child had been living with such
                    relative and application had been made
               b) Child meets all the requirements of title XVI of the Act with respect to
                  eligibility for supplemental security income benefits (See 109.20).

               c) Is a child whose costs in a foster family home or child-care institution are
                  covered by the foster care maintenance payments being made with respect to
                  the minor parent of the child as provided in section 475(4)(B).

               d) In the case of a child who is not an applicable child for the fiscal year as
                  defined in 473(e), the child will be treated as meeting the requirements to
                  receive adoption assistance payments if the child:

                        1) meets the requirements of section 473(a)(2)(A)(i)(II); and

                        2) is determined eligible for adoption assistance payments under 473 of
                           the Act with respect to a prior adoption; and

                        3) is available for adoption because the prior adoption has been dissolved
                           and the parental rights of the adoptive parents have been terminated or
                           because the child's adoptive parents have died; and
                        4) fails to meet the requirements of section 473(a)(2)(A)(i) but will meet
                           such requirements if the child is treated as if the child is in the same
                           financial and other circumstances the child was in the last time the
                           child was determined eligible for adoption assistance payments under
                           section 473 of the Act and the prior adoption is treated as never having
                           occurred.

     Other Requirements for IV-E Adoption Assistance:

          National Criminal Information Data (NCID) Background Checks

          NCID background checks and child abuse/neglect history must be conducted on all
          prospective adoptive parents and all other adults living in the adoptive home. These
          must be checked in all states in which the prospective adoptive parent or other adults
          living in the adoptive home have resided in the last five years. Title IV-E adoption
          assistance may not be claimed if the prospective adopted parent has a felony conviction
          for child abuse or neglect, spousal abuse, a crime against children (including child
          pornography) or for a crime involving violence (including rape, sexual assault, or
          homicide, but not including other assault and battery). In addition, title IV-E adoption
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          assistance may not be claimed if the prospective adoptive parent has been convicted of
          the following felonies within the past five years: physical assault, battery or a drug-
          related offense.

          Title IV-E Adoption Assistance Citizenship Requirement:
          No payment may be made to parents with respect to any applicable child for a fiscal
          year that:

          a. Would be considered a child with special needs under 473(c)(2);

          b. Is not a citizen or resident of the United States; and

          c. Was adopted outside of the United States or was brought into the United States for
             the purpose of being adopted.
          A child that is not a citizen or resident of the U.S. and was adopted outside of the U.S.
          or brought into the U.S. for the purpose of being adopted may be eligible for adoption
          assistance payments if the initial adoption of the child by parents is a failure and the
          child is subsequently placed into foster care.

          Please Note: The placement of a child with a relative guardian and any kinship
          guardianship assistance payments must not be considered when determining eligibility
          for Adoption Assistance payments. Families shall not be eligible for Relative guardian
          and any kinship guardianship payments and Adoption Assistance benefits at the same
          time for the same child(ren).


    B. Title IV-B/State-Funded Adoption Assistance – All of the following eligibility
       requirements must be met in order for IV-B/State-Funded Adoption Assistance to
       be approved:

         1. Must be a child in the permanent custody of DHS when being placed on adoptive
            status, and determined not eligible for Title IV-E funding.

            Note: Children not in the permanent custody of DHS are not eligible for
                  Title IV-B/State Funded Adoption Assistance.

         2. The child must meet the Federal and State Special Needs Criteria and Requirements
            as described earlier in Section 109.2.

         3. The adoptive placement must be approved in accordance with State
            policy/guidelines.

         Other requirements for IV-B Adoption Assistance: National Criminal Information Data
         (NCID) background checks and child abuse and neglect registry checks must be
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        conducted on adoptive parents, with results meeting federal requirements (see details
        above in Title IV-E requirements, Section 109.2 1(A)(2,3)).

Please Note: The placement of a child with a relative guardian and any kinship guardianship
             assistance payments must not be considered when determining eligibility for
             Adoption Assistance payments. Families shall not be eligible for Relative guardian
             and any kinship guardianship payments and Adoption Assistance benefits at the
             same time for the same child(ren).


2. ELIGIBILITY FOR ADOPTION ASSISTANCE MEDICAID:

    A. Eligibility for Adoption Assistance Medicaid is covered in Section 109.1. Also, see
       Section 109.21, 109.22 regarding Medicaid policy.

    B. A child who is residing in Georgia and receiving Adoption Assistance and Medicaid
       from another state is eligible to receive a Georgia Medicaid card, which is in compliance
       with the Interstate Compact on Adoption and Medical Assistance (ICAMA).


3. NON-RECURRING ADOPTION ASSISTANCE

     Payments will be made for non-recurring adoption expenses incurred by or on behalf of the
     adoptive parents in connection with the adoption of a child with special needs, directly
     through the State/Tribal agency or through another public or nonprofit private agency, in
     amounts determined through an agreement with the adoptive parents.

    Eligibility for Non-Recurring Adoption Assistance is based on the following factors:

     A. The child must be determined by the State/Tribal agency to be a child with special needs,
        utilizing the Special Needs Criteria as defined previously in Section 109.2.

     B. A child does not have to be Title IV-E eligible to receive benefits under this program.

     C. Adoptive children who have been approved for monthly Adoption Assistance will
        qualify for non-recurring funds also. The Adoption Assistance Agreement (Form 402)
        serves as the agreement for monthly AND non-recurring benefits. This Agreement
        must be completed /signed by all required parties prior to the finalization of the
        adoption.

     D. Adoptive children who are not approved for monthly Adoption Assistance or for whom
        only non-recurring Adoption Assistance is being sought must have a completed /signed
        form 402-A (Non-Recurring Only) Agreement in place prior to the finalization of the
        adoption.
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     E. Children from foreign countries are not eligible under this program unless they meet the
        federal and state criteria for special needs. This must be determined prior to the
        finalization of the adoption.

          1. If the adoption is finalized in the foreign country, the family will need to fax
             documentation of special needs and verification that the child is free for adoption to
             the SSAU prior to finalization.

          2. The special needs determination must be in place prior to finalization.

     F. Step Parent and birth parent adoptions do not meet the criteria for reimbursement of
        non-recurring expenses.


 4. ELIGIBILITY FOR SPECIAL SERVICES:

     Special Services Adoption Assistance is paid with State Funds ONLY, which are
     limited and only available for children in the following circumstances:

        A. Children who have been placed for adoption while in the permanent custody of DHS.

        B. Children who have been placed from the temporary custody of DHS into the permanent
           custody of a specified relative or individual for the purpose of adoption. In order to
           qualify for Adoption Assistance, these children must be determined Special Needs and
           Title IV-E eligible.

        C. Children who have been approved to receive Monthly Adoption Assistance benefits.

    A complete explanation of Special Services criteria and the procedures for applying for
    Special Services can be found in Section 109.17 and Section 109.18.


ELIGIBILITY CRITERIA FOR MONTHLY ADOPTION ASSISTANCE FOR
CHILDREN WHO ARE NOT IN THE PERMANENT CUSTODY OF DHS AT THE
TIME OF ADOPTIVE PLACEMENT (Transfer of Custody to Specified
Relatives/Individuals for Purpose of Adoption and Non-DFCS-Involved Adoptions)

109.3

Requirement:

Eligibility requirements for Adoption Assistance do not specify that DHS must have care,
custody and oversight of a child. However, to be eligible for monthly Adoption Assistance,
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 a child who is not in the permanent custody of DHS must be determined by the Department
 to meet Title IV-E and Special Needs eligibility criteria, and there must be an Adoption
 Assistance Agreement signed by all parties prior to the finalization of the adoption (See
 Section 109.2 for Title IV-E and Special Needs criteria).

 109.3 Procedures:

1. TRANSFER OF CUSTODY FOR THE PURPOSE OF ADOPTION - Any child who
   was placed from the temporary custody of DHS into the permanent custody of a
   specified relative/individual must have the following:

     A. Must meet Title IV-E eligibility criteria as determined by Rev Max, prior to the signing
        of the Adoption Assistance Agreement.

     B. A Special needs determination for the child must be approved by the SSAU prior to the
        signing of the Adoption Assistance Agreement.

     C. Once permanent custody is given to the specified relative/individual, and the child has
        been determined to meet the Title IV-E and Special Needs criteria (Application in
        SHINES approved), the Adoption Assistance Agreement must be signed by all parties,
        and the benefits may begin at that point. The Agreement must be signed prior to
        finalization of the adoption.


2.    NON-DFCS-RELATED INDEPENDENT ADOPTIONS - Any child who has not been
      in the custody of DHS for whom adoption assistance benefits are being requested must
      have the following:

      A.   A determination of Title IV-E eligibility must be made by the Revenue
           Maximization Unit (Rev Max) prior to the finalization of the adoption. The Case
           Manager should make this request through the SHINES system prior to finalization.

            Note: The Case Manager should ask the family if the adoptive child is SSI-eligible or
                  if they have applied for SSI, because SSI-eligible children automatically meet
                  the Title IV-E criteria. The child must still be determined to meet Special
                  Needs criteria by the SSAU.

     B. A Special Needs determination for the child must be approved by the SSAU through the
        SHINES system prior to the finalization of the adoption.

      C. Once the child is determined eligible for adoption assistance, the Adoption Assistance
         Agreement shall be signed prior to finalization, but benefits will not be effective
         until finalization of the adoption has occurred.

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           Note: Benefits will terminate on the last day of the month of the child‘s 18th birth
                 month if the child was never in the permanent custody of DHS or was not
                 placed from DFCS temporary custody into the permanent custody of a specified
                 relative/individual for the purpose of adoption (See Section 109.13, Duration of
                 Benefits –After 18)

 3. The county of residence of the adoptive family shall be responsible for completing the
    Adoption Assistance application. If DHS is involved with the termination of parental rights,
    the child‘s legal county shall be responsible for providing eligibility information to the DFCS
    office in the county where the adoptive family resides


Note: It is important that that any family adopting a child outside of DFCS custody be made
      aware of the eligibility criteria and the eligibility determination prior to finalization. If the
      family chooses to adopt a child who is not Title IV-E eligible, they will not be eligible for
      monthly Adoption Assistance benefits, and may potentially lose eligibility for other
      benefits, such as TANF or Relative Care Subsidy.


APPLICATION FOR ADOPTION ASSISTANCE / SPECIAL NEEDS DETERMINATION

109.4

Requirement:

    A. Special Needs Determination must be made by the Social Services Administration
       Unit (SSAU) for all children when Adoption Assistance is being sought. The Special
       Needs Determination is based upon the child’s assessed needs at the time of the
       Request for Special Needs Determination The earliest the Case Manager may submit
       the Request for Special Needs Determination is AFTER the Petition for TPR has been
       filed or a signed Voluntary Surrender has been completed.

                 Please Note: The initial or subsequent special needs determination may be
                requested up until the signing of the Adoption Placement Agreements (Form
                33/37) for children in the permanent custody of DFCS, up until finalization
                for all private/independent adoptions (Non-DFCS Involved Adoptions) and
                up to the signing of the Adoption Assistance Agreement (Form 402) for
                children transferred from DFCS temporary custody into the permanent
                custody of a specified relative/individual for the purpose of adoption (must
                be signed prior to adoption finalization).




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109.4 Procedures:

1. REQUEST FOR SPECIAL NEEDS DETERMINATION FOR
   MONTHLY ADOPTION ASSISTANCE

     IMPORTANT: Prior to submitting the request for Special Needs Determination, the Case
                Manager must ensure that a determination of IV-E Adoption Assistance
                eligibility has been completed by the Rev Max Unit.

    A. The Case Manager must submit the Adoption Assistance Application in SHINES to the
       SSAU Program Consultant for a determination of special needs.

          1. Case Manager will ensure that accurate Adoptive Placement information, per diem
             amount, Legal information, and Eligibility Status (IV-E/IV-B) are in the SHINES
             system when the Adoption Assistance Application is submitted to the SSAU
             Program Consultant.

          2. The monthly Adoption Assistance Application should always indicate the Special
             Needs type being requested, it should indicate a Basic Rate request, and it should
             indicate a request for Non-recurring Adoption Assistance.

          3. Supporting documentation from a licensed Treatment Provider must be submitted
             as a part of the Adoption Assistance Application for children whose special needs
             request is based on physical, mental, or emotional disability. This
             documentation should be uploaded into SHINES External Documents at the time of
             submission, and must include:

               Statement (within three months) from the treating licensed psychiatrist,
                psychologist, therapist, or physician regarding the child‘s diagnosis, the severity
                and chronic nature of the child‘s condition, focus and frequency of treatment, and
                prognosis for the future AND the applicable evaluation(s) listed below:

               Developmental Evaluation (if applicable), current within one year.
               Psychological Evaluation (if applicable), current within two years.
               Medical Evaluation (if applicable), current within three months.

          4. The Case Manager must send the Application for Special Needs Determination to
             the SSA Unit as early as possible (after the Petition for Termination of Parental
             Rights, after a Voluntary Surrender or after the first TPR) to allow adequate time for
             careful review of the child‘s needs prior to the adoptive placement. The Case
             Manager must also be aware of the results of the special needs determination when
             compiling the Life History and making placement plans for the child.


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          5. Specialized Rate Requests can be submitted at the same time as the request for a
             Basic Special Needs Determination. Specific supporting
             documentation/information is required for Specialized Rate requests, and is
             explained in Section 109.5.

     B. The SSAU Program Consultant will review the Adoption Assistance Application and
        supporting documentation in order to make a Special Needs Determination. The Program
        Consultant will either Approve/Deny/Defer or Reject the Adoption Assistance
        Application in SHINES, and the Case Manager will receive an Alert or Notification that
        the Application has been processed. If the Application submitted by the Case Manager is
        incomplete, the Program Consultant will ―Reject‖ the Application in SHINES,
        documenting what information is missing.

        Please Note: The Case Manager must inform any prospective adoptive parent(s) of the
                     decision regarding the Special Needs Determination. This may be done at
                      the time of the Permanency Staffing with the Foster Parent (Section
                     104.16) or at the time of the Presentation (Section 105.4) to the newly
                      identified adoptive parent(s).

     C. The Case Manager will review the completed Adoption Assistance Application in
        SHINES in order to create an Adoption Assistance Agreement that is appropriate and
        accurate, if the Application was approved or deferred. The Case Manager will ―Launch‖
        the Adoption Assistance Agreement for review and signing with the adoptive parent(s) on
        the same day as the Adoptive Placement Staffing. Please note that all required signatures
        must be secured prior to giving the adoptive parent(s) a copy of the Agreement (Form
        402).

     D. For children determined NON special needs, a Deferred Application/Agreement can be
        completed which will allow for a future request for Adoption Assistance should the child
        develop Special Needs related to a medical, physical, mental, or emotional/behavioral
        need, which is documented by a licensed treatment professional. ONLY children who
        were in the permanent custody of the State/DHS or who were placed from DFCS
        temporary into the Permanent Custody of a relative/specified individual for the purpose of
        adoption are eligible for Deferred Applications/Agreements. See Section 109.6 for more
        information about Deferred Applications/Agreements.

2.   REQUEST FOR NON-RECURRING ONLY ADOPTION ASSISTANCE

     A. Adoptive children who are not approved for monthly Adoption Assistance or for
        whom only non-recurring Adoption Assistance is being sought must have a
        completed /signed form 402-A (Non-Recurring Only) Agreement in place
        prior to the finalization of the adoption. The completed Form 402-A must be uploaded
        into the SHINES system, with a copy being faxed or mailed to the SSAU for its files.

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     B. The Case Manager shall submit the Non-recurring Only Adoption Assistance
        Application in SHINES to the SSAU Program Consultant for a Special Needs
        Determination prior to the finalization of the adoption.

     C. Documentation that the child meets Federal and State Special Needs Criteria (described
        in Section 109.2) must be uploaded into SHINES External Documents.
        Documentation must show that the child is legally free to be adopted.

     D. The Non-recurring Only Application screen should indicate the Special Needs Type and
        should indicate the request for Non-recurring Adoption Assistance. It does not need to
        indicate a request for a Basic Rate, since that would not be applicable.


SPECIALIZED RATE REQUEST FOR ADOPTION ASSISTANCE

109.5

Requirement:

A request for an Adoption Assistance Specialized Rate will be considered by the SSAU for
children who have significant levels of special needs which require care and services that
cannot be adequately compensated by the basic adoption assistance rates and Medicaid.
Federal and state policy states that the Adoption Assistance payment cannot exceed the
amount the child received or would have received in a family foster home. Thus, any
specialized rate for Adoption Assistance must not exceed the rate a child is receiving or
would have received in a DFCS foster home, a private child placing agency foster home, or
in a child caring institution. When a child is placed in a child caring institution, such as a
group home, at the time of the specialized rate request, the SSAU assigns the rate based on
the projected rate that the child would receive in a family foster home setting.
Children placed in DFCS foster homes who have been assigned a Specialized Foster Care
per diem board rate may receive up to the same amount in Adoption Assistance. This
amount must be determined by the SSAU prior to the signing the Adoptive Placement
Agreement (Form 33/37) and the Adoption Assistance Agreement (Form 402).

109.5 Procedures:

1.   As mentioned in Section 109.4, the Adoption Assistance Specialized Rate request may be
     submitted to the SSAU in the SHINES system at the same time as the Basic Special Needs
     Determination request/application. The Specialized Rate request may also be submitted
     separately at a later time, but it should be submitted at least two months prior to the planned
     adoptive placement staffing (signing of 33‘s/37‘s). The application/request should be
     submitted after the first TPR/Voluntary Surrender has occurred for children for whom the
     plan is adoption.

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2.   If a child is not receiving a Specialized Foster Care per diem in a DFCS foster home or an
     additional RBWO Waiver amount in the foster home of a Child Placing Agency at the time
     of the adoptive placement, the child is not eligible to receive a Specialized Adoption
     Assistance rate. If the above higher foster home rates have not been established for foster
     care placements, they must be applied for/requested prior to or at the same time as the
     request for the Adoption Assistance Specialized Rate in order to meet the federal/state
     requirement.

3.   The adoption assistance rate shall be based on the child‘s current level of functioning,
     diagnosis, current treatment services, and prognosis (future treatment needs).

4.   The Specialized Rate packet for Adoption Assistance must include the following
     information, which should be uploaded into SHINES External Documents at the time of the
     request/application:

     A. Current statement (within 90 days of the request) from the child‘s treatment provider(s)
        that documents the focus and frequency of treatment and the child‘s prognosis (future
        treatment needs).
     B. Psychological or developmental evaluation (less than 2 years old) when the specialized
        rate request is based on a child‘s emotional/behavioral, mental, or developmental
        issues. Current medical evaluations are required for significant medical conditions.
     C. Match Profile Instrument (MPI-1 or Bubble Sheet) filled out completely.
     D. Attachment A (Required for children applying for a Specialized Per Diem while in
        DFCS foster homes).
     E. Documentation that SSI benefits have been applied for and either approved or
        denied. A Specialized Rate will not be considered without this information included
        in the packet.
     F. Documentation of any sources of income for the child, such as RSDI benefits (i.e.
        Survivor‘s Benefits).

5.   Once the child‘s eligibility for the specialized rate has been determined by the SSAU, the
     SSAU Program Consultant will either approve, deny, or reject the request in the SHINES
     system. Any SHINES Application which does not contain all necessary forms and
     documentation will be rejected, with comments indicating the information that is missing.

     Note: Upon receipt of all required documentation, the SSAU will complete the
           determination of the Adoption Assistance Specialized Rate within 30 days.

6.   Specialized Rate approvals in DFCS foster homes must be re-assessed annually by the
     SSAU in coordination with the State level staff who determine the Specialized Foster Care
     per diems, until the adoptive placement occurs, in order to keep the rate current and in line
     with the child‘s current needs.



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7.   If a child in foster care who has a Specialized Adoption Assistance rate moves to a different
     placement resource or has a situation where the foster care rate becomes lower than the
     Specialized Adoption Assistance rate, the Case Manager must notify the SSAU
     immediately, so that the specialized adoption rate can be adjusted or terminated in the
     SHINES system.

8.   For children not in the custody of DHS, the specialized rate request packet must be
     submitted for review by the SSAU. The rate determination must be completed prior to the
     signing of the Adoption Assistance Agreement, which must be signed prior to the
     finalization of the adoption.


DEFERRED ADOPTION ASSISTANCE APPLICATION / AGREEMENT

109.6

Requirement:

If a child has background factors only and does not meet the special needs criteria by the
time he/she is placed on adoptive status, a Deferred Adoption Assistance Agreement shall
be completed and kept on file by the county and a copy faxed or mailed to the Social
Services Administration Unit. To be eligible for a “Deferred” Adoption Assistance
Agreement, the child must have been in the permanent custody of DHS or placed from
DFCS temporary custody into the custody of a relative or individual for the purpose of
adoption.

109.6 Procedures:

1. The county agency must complete the Adoption Assistance Agreement screen in the SHINES
   system and launch (print out) the Adoption Assistance Agreement (Form 402) on the date of
   adoptive placement, indicating the deferral of all benefits. Once the Agreement is launched,
   the county agency and adoptive parent will review and complete this ―Deferred‖ Adoption
   Assistance Agreement, signing and dating the form.

2. The ―Deferred‖ Adoption Assistance Agreement must indicate no money payment ($0) is
   being made for monthly or non-recurring benefits and that no Medicaid is being provided.

 3. The county agency must provide the parents with a copy of the signed Adoption Assistance
    Agreement (Form 402) which indicates the deferral of Adoption Assistance benefits. At this
    time, the county agency shall also provide the adoptive parents with post adoption services
    information, including Federal adoption income tax credit information.

4. A copy of the ―Deferred‖ Adoption Assistance Agreement must be maintained in the
   Adoption Assistance case file, with a copy sent to the SSAU. In cases where Adoption
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    Assistance has been ―deferred‖, the Adoption Assistance case file must contain required
    application information, including eligibility information, a narrative regarding federal/state
    special needs criteria being met, and a copy of the initial court order removing the child from
    the home or a copy of TPR Order/Voluntary Surrender(s).

5. The family shall be instructed to contact their county DFCS office if documented medical,
   physical, mental, or emotional/behavioral conditions arise that may render the child eligible
   for Adoption Assistance benefits. Written evaluations with diagnoses, focus and frequency of
   treatment, and prognosis are needed.

6. If a future determination of special needs is requested, the Adoption Assistance request /
   application must include the supporting documentation from a licensed treatment
   provider. This subsequent Adoption Assistance Application must be submitted to the SSAU
   through the SHINES system for review/determination of special needs.

7. If the child is determined to meet special needs criteria at a later date, a revised Adoption
   Assistance Agreement will be completed and signed with approved benefits indicated.
   Adoption Assistance benefits / payments will begin on the date of the determination by
   SSAU, not retroactively to the time of the initial placement in the home. Prospective adoptive
   parent(s) must be informed of this policy and the effective date of any future
   payments.

8. The amount of adoption assistance may not exceed the family foster care board rate the child
   would have received prior to the placement in the adoptive home.

9. A denial of benefits (not qualifying for deferred agreement) requires the sending of a letter to
   the adoptive family, notifying them of the reason(s) for denial and their right to a Fair
   Hearing.



CASE RECORD DOCUMENTATION REQUIREMENTS FOR
MONTHLY ADOPTION ASSISTANCE

109.7


Requirement:

All initial Monthly Adoption Assistance Application/Agreement packages shall contain
specific required documentation, and shall be maintained in the county adoption assistance
case record.


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109.7 Procedures:

The Adoption Assistance Application/Agreement package must contain the following:

         1. Adoption Assistance Application/Agreement, Form 402 (the signed copy must be
            kept in the physical record, in addition to uploading into SHINES).

         2. Adoption Assistance Memorandum, Form 403

         3. Form 399, Verification of Receipt of Information Regarding Post Adoption
            Assistance Benefits, if not previously submitted. (The Case manager must maintain a
            copy of this form in the Adoption Assistance file and submit a copy to the Social
            Services Administration Unit (SSAU) along with Forms 402 and 403).

         4. A Narrative, which states that the adoption meets the following Special Needs
            criteria requirements:
                a) Documentation that the child cannot or should not be returned to his/her
                     family and that the child is legally free for adoption. The Case Manager
                     needs to make reference to these criteria being met in the Petition for
                     Termination of Parental Rights and in TPR Order/Voluntary Surrender(s).
                b) Documentation of efforts to place the child without adoption assistance
                     (documentation that the child is being adopted by the foster family or
                     relative(s) or is registered with the State Adoption Exchange is adequate).
                c) Documentation that there exist factors or conditions which would make it
                     difficult for the child to be adopted without adoption assistance
                     (documentation of the child meeting Georgia‘s special needs criteria). If
                     Adoption Assistance is Deferred, documentation of Background Factors,
                     such as abuse issues or prenatal exposure to drugs should be documented, in
                     case they create problems in the future.
                     Note: The narrative should include the amount of the per diem the child
                            received in Family Foster Care (or other type of placement)
                            immediately prior to the adoptive placement.

         5. The determination of special needs eligibility by the SSAU (from the completed
            Adoption Assistance Application in SHINES or the previously utilized Special
            Needs Memorandum) (See Section 109.4)

         6. If applicable, the determination of the Specialized Adoption Assistance rate approval
            by the SSAU (in the SHINES system or documented on the previously utilized
            Specialized Rate memorandum).




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         7. Documentation of the negotiation of the Adoption Assistance rate with the adoptive
            parent(s), including the discussion of the child‘s needs, the family‘s resources to
            meet the needs, and the negotiated rate.

         8. Documentation of any income available to the child such as SSI, Survivor‘s Benefits,
            etc.:

         9. Documentation in the Adoption Assistance Record supporting the eligibility
            determination (all eligibility determinations must be made by Revenue
            Maximization):

                 A. If the child is Title IV-E eligible with removal of the child from the home by
                    a court order, this order must be included in the Adoption Assistance record.

                     Note: For Non-Applicable Children, the first court order that judicially
                     removes the child from the home of a specified relative is usually the order
                     for shelter care. It must contain the finding that ―return to the home would be
                     contrary to the welfare of the child‖ (Reasonable efforts language is not
                     required). This initial finding must be initiated within six months of the
                     child‘s physical removal from the home.

                 B. For Non-Applicable Children, verification of AFDC eligibility for Title IV-E
                    must be determined in writing and made by the Revenue Maximization Unit.
                    All documentation of this determination must be included in the record (for
                    example: SHINES IV-E eligibility print out, Form 225 or IV-E eligibility
                    documentation on other previously used DFCS form). Verification of
                    eligibility must be made at the time of the initial judicial removal with the
                    exception of a child who receives SSI.

                 C. If the child is placed in the permanent custody of a private agency, a copy of
                    the Voluntary Surrenders or TPR Orders must be included, along with the
                    petition date and the first court order that judicially removes the child from
                    the home and contains the finding that the return to the home would be
                    contrary to the welfare of the child‖ (for verification of IV-E eligibility).

                 D. For a ―Non-Applicable‖ Child (see section 109.2) who entered foster care
                    under a Voluntary Foster Care Placement Agreement or a Voluntary
                    Surrender, documents of Title IV-E foster care payments made for the child
                    must be maintained in the adoption assistance case file. This is not required
                    for an ―Applicable Child‖.

                 E. For a title IV-E eligible child in a subsequent adoption, verification of prior
                    Title IV-E Adoption Assistance eligibility must be in the Adoption
                    Assistance record.
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                 F. If a child is a recipient of SSI, a copy of the award letter or some verification
                    of eligibility must be contained in the record.

         10. A copy of the Initial Removal Order, must physically remain in the county Adoption
             Assistance record in addition to uploading into SHINES. For Private or Independent
             Adoptions, physical copies of the TPR Orders and/or Voluntary Surrenders are
             required.

         11. For Non-recurring Only Applications), the case record must contain:

                 A. Form 402-A with all required signatures and dated prior to the finalization
                    date.
                 B. A Narrative, containing documentation of the child meeting Special Needs
                    criteria, including documentation of efforts to place without Adoption
                    Assistance.
                 C. Legal paperwork, documenting the child being legally free to be adopted
                     (TPR or Voluntary Surrender documents).
                 D. Date and proof of finalization. Following finalization, the file must contain
                     the finalization order, and Form 402-A must contain the finalization date.
                 E. Special Needs Determination memo or SHINES approved Application.
                 F. Receipts for expenditures.
                 G. Copy of Form 403 (also to be submitted to Regional Accounting and SSAU).


COUNTY OF RESPONSIBILITY FOR COMPLETING THE ADOPTION ASSISTANCE
           APPLICATION/AGREEMENT FOR MONTHLY BENEFITS

109.8

Requirement:

The Case Manager in the child’s legal county is responsible for obtaining all eligibility
information and court documentation that is needed for the initial Adoption Assistance
Application/Agreement. The child’s Case Manager must provide this to the adoptive
family’s worker prior to signing the Adoption Assistance Agreement.

109.8 Procedures:

The County‘s Responsibility for Completion of the Adoption Assistance and Maintenance of
    Adoption Assistance depends upon the following circumstances:

1.   If a child is being placed with a DHS resource in another county, the child‘s (legal county)
     Case Manager shall provide the required information to the family Case Manager in the
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     boarding county. This must be made available prior to the negotiation of the agreement.
     Completion of the Adoption Assistance application/agreement package shall be the
     responsibility of the Family‘s Case Manager. Adoption Assistance benefits shall be
     managed and paid by the county department where the family resides after the Agreement is
     signed and approved (the legal county should not manage the Adoption Assistance file,
     under ordinary circumstances, after the Agreement has been signed and approved).

2.   If a child is being placed with an adoptive resource that is a private child placing agency
     resource, it is the responsibility of the child‘s Case Manager to complete the Adoption
     Assistance Application/Agreement.

     A. This application/agreement shall be maintained by the child‘s legal county until the
        finalization of the adoption.

     B. When the adoption is finalized, the Adoption Assistance record shall immediately be
        transferred to the county where the family resides, if different from the legal county.

3.   If a child is being placed with an adoptive resource in another state, the child‘s legal county
     will complete and maintain the Adoption Assistance record until the child is no longer
     eligible for benefits.

4.   For an eligible child who has been placed in the permanent custody of a specified relative/
     individual for the purpose of adoption, the application for Adoption Assistance shall be the
     responsibility of the agency that had temporary custody of the child. It is the responsibility
     of the county who is transferring permanent custody to the relative to inform the
     county of residence of the transfer. The county of residence must be provided with
     copies of the court orders and the adoption assistance case file.

5.   For the eligible child who has not been in the permanent custody of DHS and is being placed
     for adoption through a licensed, private child placing agency in Georgia, the application
     shall be maintained by the county department (DFCS) in the county where the family
     resides.

     A. The Adoption Assistance application shall be initiated by the child-placing agency and
        transferred to the county department where the family resides.

     B. The private child-placing agency shall be responsible for providing all pertinent
        eligibility and narrative information along with a completed application to the County
        Department.

6.   In Independent Adoptions, where DHS nor a private child placing agency have
     responsibility for placement and care of the child, it is the adoptive parents‘ county or state
     of residence that is responsible for the Adoption Assistance application (See Sections 109.3
     and 109.4 regarding eligibility and application procedures).
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.
7. Any Adoption Assistance case that is being transferred to another county department must
    include the following in a cover letter:

     A.   Identification of the current certification period
     B.   The class of Adoption Assistance the child is receiving (IV-E or IV-B State Funded)
     C.   The monthly amount of Adoption Assistance the child receives
     D.   Notification of the month the receiving county department will be responsible for
           assuming the monthly Adoption Assistance payments


NEGOTIATING THE MONTHLY ADOPTION ASSISTANCE AGREEMENT

109.9

Requirement:

The Adoption Assistance Agreement shall be negotiated with the adopting parents. The
    circumstances of the adopting parents must be considered together with the needs of
    the child when negotiating the adoption assistance agreement (Child Welfare Policy
    Manual 8.2A.2)

109.9 Procedures:

1.   Prior to the signing of the Adoption Assistance agreement, the legal county department
     representative/Case Manager and the adopting family must discuss the current and future
     needs of the child, and the resources that are available to meet the child‘s needs.

2.   Adoption Assistance benefits should not be confused with a foster care board rate. The
     agency representative should explain that adoption assistance benefits are based on the
     current and projected future levels of functioning of the child and are designed to assist in
     meeting the cost of providing for the special needs of the child (not covered by Medicaid)
     that would otherwise have prevented the child from being adopted.

3.   With the understanding that the amount of Adoption Assistance rate may not exceed the
     family foster home board rate, the child would have received in foster care, the rate must be
     negotiated with the adoptive family. The adoptive parent(s) must be asked if they require
     Adoption Assistance in the adoption of the child(ren). If the parent(s) indicate a need for
     Adoption Assistance, the rate can then be discussed.

4.   The use of a means test is prohibited when determining eligibility for Adoption Assistance
     and when negotiating the Adoption Assistance rate. Adoption Assistance is not based upon
     a standard schedule of itemized needs and countable income. Instead, the amount of the
     Adoption Assistance payment is determined through the discussion and negotiation process
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     between the adoptive parents and a representative of the State agency based upon the needs
     of the child and the circumstances of the family. The payment that is agreed upon should
     combine with the parents‘ resources to cover the ordinary and special needs of the child
     projected over an extended period of time and should cover anticipated needs (Child
     Welfare Policy Manual, 8.2.D.4).

     A. Review the resources and forms of support that are specifically designated for and
        available to the child, such as Retirement, Inheritance, Survivors, Disability Insurance
        (RSDI) or Veterans Administration (VA) benefits. These resources may be considered
        in combination with other factors when negotiation occurs. Any child who has Zebley
        Funds in a trust account is potentially eligible to receive these funds once the adoption
        has finalized. Once finalization occurs, the adopting parent(s) shall be notified, in
        writing, about the availability of these funds and other funds available in the child‘s
        DFCS restricted funds account, and how to access them (Refer to DFCS
        Administrative Policy and Procedures Manual Special Restrictive Funds-MATCH and
        Zebley Trust).
        NOTE: These resources must be made known to the SSAU whenever a
        Specialized Rate is requested, as they will be considered when the amount for the
        Specialized Rate is negotiated.

     B. Review with the family their budget and the potential impact of incorporating the child
        into the household. Help determine what portion of the cost of the child‘s needs
        the family can meet.

5.   Community resources should be explored with the family, such as Mental Health Services,
     Educational Services, Public Health Services, etc. These services may be available to assist
     the adoptive family with a wide variety of needs related to their adopted child.

6.   Any child’s eligibility for SSI must be discussed with the family. The family may choose
     to opt for concurrent SSI and Adoption Assistance benefits, but the Social Security
     Administration may consider the Adoption Assistance payment as income for the child who
     receives SSI benefits, and may reduce the SSI payments dollar for dollar following the
     adoptive placement. The Case Manager must inform the Social Security Administration at
     the point that an SSI-eligible child is approved for Adoption Assistance benefits. Since SSI
     eligibility is based on income as well as disability, the adoptive family should be made
     aware that their own income will be counted, following the finalization of the adoption. For
     that reason, the Case Manager should let the family know of their option to sign a Deferred
     Adoption Assistance Agreement, with $0.00 amounts, should they decide to initially accept
     SSI over Adoption Assistance. If the child becomes ineligible for SSI at a later time, the
     family can then request Adoption Assistance benefits in line with the child‘s needs, per
     federal and state policy.

7.   All children for whom Adoption Assistance is being requested should be enrolled in Health
     Check (formerly EPSDT) before the adoptive placement. This shall be used to assist with
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     the negotiation of the Adoption Assistance Agreement and will determine what services can
     be provided under Medicaid.

8.   All prospective adoptive parents must be informed of their potential eligibility for the
     Federal Adoption Tax Credit by the State/Tribal Agency.


REVIEWING AND SIGNING THE ADOPTION ASSISTANCE AGREEMENT

109.10

Requirement:

The Adoption Assistance Agreement is a written, legal document, which must be entered
into by the prospective adoptive parents and the State/Tribal agency prior to finalization of
the adoption. The agreement must, at a minimum, specify the amount of the Adoption
Assistance payments and any other services or assistance to be provided, and list the
duration dates of the benefits. The Adoption Assistance Agreement must be fully executed
prior to any Adoption Assistance payments being made.

109.10 Procedures:

     1. For the adoptive placement of children in the permanent custody of DFCS, such as foster
        parent adoptive placements, the signing of the Adoption Placement Agreement (Form
        33/37) will be coordinated with the approval of the Adoption Assistance Agreement, For
        Foster Parent adoptions, the Agreements are usually arranged for the beginning of a
        month, to ensure continuity of payment for the child, and to prevent duplicate payments
        from the Foster Care program funds and the Adoption Assistance program funds.

     2. After the signing of the Placement Agreement (Form 33/37‘s) for children in the
        permanent custody of DFCS, the Adoption Assistance Agreement (Form 402) that was
        launched from SHINES, must be reviewed and signed in the presence of the adopting
        family. The Adoption Assistance Agreement should not be signed until the child is
        placed on adoptive status (Form 33/37‘s signed), however, it must be signed by all parties
        prior to the finalization of the adoption.

     3. For children not in the permanent custody of DFCS, the Adoption Assistance Agreement
        must be launched from the SHINES system, discussed with the adoptive parents, and
        signed by all parties prior to the finalization of the adoption. Adoption Assistance
        Agreements for children not in the permanent custody of DFCS do not have Placement
        Agreements (Form 33/37‘s). See Section 109.3.

     4. Verification of Receipt of Post Adoption Services Information (Form 399) must be
        reviewed and signed with the adoptive family at the signing of the Adoption Assistance
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         Agreement. The adoptive family will be provided an Adoption Assistance
         informational packet with information regarding post adoption services.

    5. A copy of the Adoption Assistance Agreement (Form 402) and Form 399 must be
       provided to the adoptive family. However, all required signatures, including
       Director/Designee, must be obtained on the Adoption Assistance Agreement (Form 402)
       prior to the adoptive parent receiving a copy.

    6.   All required parties must sign and date the Adoption Assistance Agreement to indicate
         agreement with the assigned benefits prior to Adoption Assistance payments beginning.

    7. Each Section of the Adoption Assistance application must be reviewed and discussed
       with the adopting family. If the adopting family lives in another state and a face-to-face
       contact is not possible, the agreement must be negotiated through the mail or by
       telephone contact. In some situations, Interstate Compact on the Placement of Children
       (ICPC) may be required. Particular sections of the Agreement that should be covered
       include:
          A. The negotiated Adoption Assistance rate.
          B. Non-recurring Adoption Assistance funds and limits
          C. The family‘s eligibility for Medicaid and their choice to utilize Medicaid alone or in
              conjunction with other insurance.
          D. Duration of benefits:
               1) Discuss the effective date and the termination date of the Agreement.
               2) The requirement that the family notify the county or state agency whenever there
                   is a change in status which may affect the child‘s continued eligibility for
                   Adoption Assistance.
                3) Discussion with the adoptive parent(s) about the potential eligibility of the child
                    to receive Adoption Assistance benefits past age 18 (eligibility factors are listed
                    in Section 109.13).
          E. Protection of Adoption Assistance benefits, despite a family relocation to another
              state, including Medicaid.
          F. Conditions under which the rate may be decreased or increased:
             After the Adoption Assistance Agreement is signed, changes in the monthly benefit
             may only occur through mutual agreement. Depending upon the needs of the child, a
             mutual agreement may be made to decrease or increase the Adoption Assistance rate
             of the child. Any request for an increase in the Adoption Assistance rate must
             contain current and specific information regarding the changes in the needs of the
             child, to include current professional evaluation(s) specifically related to the special
             need(s) of the child, a statement from a professional who works with the child
             regarding the focus and frequency of treatment and the child‘s prognosis, a current
             MPI-1, and a narrative regarding the effect upon the family that the change in the
             level of needs as had, and the efforts the family has made to meet those needs
             utilizing family/community resources. As stated previously, the rate assigned may

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              not exceed the foster home board rate the child last received or would have received
              in foster care.
           G. Description of the Fair Hearing process (See Section 109.25 for further information)
           H. Circumstances in which Adoption Assistance benefits may be terminated (See
              Sections 109.12 and 109.13).

     8.   The adoptive parent must be given information about the Federal Income Tax Credit for
          special needs children at this time by the State/Tribal agency (Refer to the Post Adoption
          Services Fact Sheet in DFCS Adoption Forms Online).

     9.   The Adoption Assistance payments may be paid directly through the State/Tribal agency
          or through another public or nonprofit private agency, in amounts so determined through
          an Adoption Assistance Agreement. Adoption Assistance payments may be made only to
          adoptive parents who have entered into an Adoption Assistance agreement with the
          State/Tribe. This should be made clear to the adoptive parent(s) at the time of signing, if
          not earlier. Upon the death of an adoptive parent, Adoption Assistance may not be
          transferred to another person who was not party to the original Adoption Assistance
          Agreement. In the event of a divorce, the divorce decree must identify who is to receive
          the Adoption Assistance subsidy. Otherwise, the payments will continue to be addressed
          to the adoptive parents who entered into the agreement with the agency.


APPROVING THE MONTHLY ADOPTION ASSISTANCE PACKAGE / INITIATING
   BENEFITS

109.11

Requirement:

When a child is being approved for Adoption Assistance, the County Director or Designee
must sign the Adoption Assistance Agreement (Form 402) in order for Adoption Assistance
benefits to begin for a DFCS-involved child or a non-DFCS-involved child.

109.11 Procedures:

1.    The monthly Adoption Assistance Application/Agreement package must be submitted to the
      Director/Designee for review and approval. The package must contain the applicable items
      listed in Section 109.7.

2.    The County Director/Designee will review the Adoption Assistance Application/Agreement
      package, signing the Adoption Assistance Agreement (Form 402) when satisfied with the
      accuracy and completeness of the package.



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3.   The Case Manager will provide the accounting staff with a copy of the Agreement (Form
     402) and the Memorandum (Form 403).

4.   Once all parties, including the Director/Designee have signed the Agreement (form 402), the
     county agency may make arrangements for providing payments directly to the family. The
     beginning of the monthly payments depends upon the factors below:

      A. Adoption Assistance payments may be received for the entire month, even if the
         agreement is signed at a date other than the first of the month, UNLESS the child has
         received a Foster Care per diem payment during the month the Adoption Assistance
         Agreement was signed. In cases where a Foster Parent is adopting a child and is
         receiving Foster Care funds during the month of the signing of the Agreement, the
         Adoption Assistance payment will begin the following month, to avoid duplicate
         payments.

      B. When a relative is receiving relative care subsidy payments for a child, the adoption
         assistance agreement will be signed at the beginning of the following month.
         Payments may not be made simultaneously for relative care and adoption assistance
         subsidies. The adoption assistance payments will begin in the 1st month following the
         signing of the Adoption Assistance Agreement. Verification of finalization must be
         obtained.

      C. Important: For independent adoptions, in which the Department does not have
          permanent custody of the child nor was the child placed from DFCS temporary
          custody into the permanent custody of a specified relative/individual for the purpose of
          adoption, Adoption Assistance payments will not begin until the finalization of the
          adoption has occurred.

5.   Copies of the Adoption Assistance Agreement (form 402), the Memorandum (Form 403),
     and form 399 must be submitted to the SSAU following approval of the package and signing
     of the Agreement by the Director/Designee. The originals shall be maintained in the county
     case record and shall be uploaded into the SHINES system.

6.   When finalization of the adoption occurs, the county responsible for Adoption Assistance
     must notify the Revenue Maximization Unit (Rev Max) of the finalization, providing the
     Notification of Change in the SHINES system, providing Rev Max with the necessary
     information to change the Medicaid from Foster Care to Adoption Assistance Medicaid
     under the child‘s adoptive name.

7.   The SSAU and Regional Accounting must be notified of finalization by the sending of the
      Adoption Assistance Memorandum (Form 403) by the county.




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DURATION OF BENEFITS – FEDERAL AND STATE POLICY

109.12

Requirement:

Monthly and special services benefits are available through the end of the child’s 18th birth
month, unless the State determines that the adoptive parents are no longer legally
responsible for support of the child or when the State determines that the adoptive parents
are no longer financially responsible for the child.

109.12 Procedures:

1. Adoption assistance benefits may terminate at any time with the concurrence of the adoptive
   parents and/or under the following circumstances:

         A. Adoptive parents are no longer legally responsible for the child. This may be due to
            parental rights being terminated (TPR), the child becoming an emancipated minor,
            marrying, or enlisting in the military.
         B. The agency has determined the adoptive parent is no longer providing financial
            support to the child. Payments for out-of-home placement, family therapy, tuition,
            clothing, maintenance of special equipment in the home, or services for the child‘s
            special needs are considered forms of financial support.
         C. Child has attained age 18 (some children may not meet eligibility criteria for
            Adoption Assistance after age 18—See Section 109.13)

2. There are circumstances, based on the Requirement above, where Adoption Assistance may
   be terminated prior to a child turning age 18. Whenever possible, DHS should seek to have a
   mutual agreement with the adoptive parents regarding the continuation or termination of
   Adoption Assistance:

    Below are situations where Adoption Assistance should be terminated, either by
    mutual decision or by the decision of the Department alone and situations where the
    Department and adoptive family may come to an agreement to continue Adoption
    Assistance:

    A. Disruption of Adoptive Placement prior to finalization. DHS may decide that the
       placement and adoption assistance should be terminated by mutual agreement with the
       family OR without mutual agreement, since DHS has legal custody.

    B. Dissolution of the Adoptive Placement after finalization—Permanent disruption of the
       adoptive placement that occurs after the finalization of the adoption, and the adoptive
       parent is not willing or able to maintain permanent custody of the child. DHS and the

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          family may decide that the Adoption Assistance should be terminated by mutual
          agreement or by the decision of DHS alone.

    C. Child enters foster care from the adoptive placement. There must be a determination as
       to whether the family will be working with DHS on a reunification plan to have the
       child returned to the home. If the plan is not reunification, there should be an effort to
       gain a mutual agreement to terminate adoption assistance. If the plans are reunification,
       efforts should be made to encourage financial and other support by the parent(s) toward
       the child and the foster care placement expenses (this may include a child‘s placement in
        a state-funded child caring institution). The Case Manager shall negotiate with the
        adoptive parent(s) to reduce their Adoption Assistance rate in order to support the
        child‘s out-of-home placement. If financial and other forms of support are not provided
        by the adoptive parent(s) and this lack of support is documented, the Case Manager shall
        meet with the adoptive parent(s) to discuss their motivation to reunify with the child and
        to gain mutual agreement to continue or terminate Adoption Assistance.

     Note: When a child comes into foster care from the adoptive placement, the adoptive family
           should not be referred to Child Support, as that would automatically constitute
           ―financial responsibility‖, and Adoption Assistance would not be able to be
           terminated for the reason of ―lack of support‖. The Case Manager must notify
           RevMax that the family should not be referred to Child Support Enforcement.

            If a child reunifies with adoptive family after being in foster care and Adoption
            Assistance benefits were not terminated, they should continue as before the foster care
            placement. If they were terminated while the child was in foster care, they may be re-
            started when the child returns to the adoptive home (if under age 18), using the same
            Adoption Assistance Agreement that was previously signed.

     D. If a child is placed in a Department of Juvenile Justice (DJJ) facility or any other
        inpatient treatment program on a temporary basis, the family may continue to receive
        Adoption Assistance payments if the adoptive parents remain legally or financially
        responsible for the child. If the adoptive parents are no longer legally or financially
        responsible for the child, Adoption Assistance payments shall terminate. Each case
        must be discussed on an individual basis with the SSAU. Funds shall be terminated if
        the child is no longer in the home and the family is not providing any support

     E.   The adoptive parent(s) must notify the Department when the adopted child is no longer
          living in the home (living with a relative, etc.), so that an evaluation of legal and
          financial responsibility can be made, and to see if a mutual agreement can be made
          regarding the continuation or termination of benefits.

     F.   Within the 1st six months of the signing of the Adoption Assistance Agreement, the
          Case Manager must confirm finalization of the adoption. If the adoption has not been
          finalized, the case manager will document the steps the adoptive parents are taking to
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          eliminate barriers to finalization of the adoption. If the adoption has not finalized after
          one year of the signing of the Adoption Assistance Agreement, termination of the
          adoption assistance benefits will be discussed with the adoptive parents and the SSAU
          will be notified. If adoption is no longer the goal, benefits under the program must
          terminate. This applies to agency adoptions and transfers of custody from DFCS
          temporary custody to the permanent custody of specified relatives/individuals for the
          purpose of adoption (This does not apply to purely independent/Non-DFCS-related
          adoptions, where Adoption Assistance benefits do not begin until after finalization).

Note: The Case Manager must notify Regional Accounting, SSAU and Rev Max
when the adoption assistance subsidy is terminated, through the use of the Memorandum
(form 403) and terminate the Adoption Assistance Agreement in the SHINES system.
The family must be notified of their right to a Fair Hearing.


DURATION OF BENEFITS – AFTER AGE 18

109.13

Requirement:

Termination of Adoption Assistance benefits will occur when a child turns age 18 unless
the child meets the State of Georgia’s criteria to continue benefits past age 18. If the
criteria and requirements are met, the child may receive Adoption Assistance up to age 21.

BASIC REQUIREMENT: Only children who were placed for adoption while in the
permanent custody of DHS are eligible for benefits beyond age 18, or those children who
were placed from DFCS temporary custody into the permanent custody of a specified
relative or individual for the purpose of adoption.

Once the Basic Requirement above is met, a child over age 18 may qualify for Adoption
Assistance in High School or College, if specific criteria are met and documented.

All benefits paid after the age of 18 must be paid out of Title IV-B funds.

109.13 Procedures:

1. Children who do not meet the Basic Requirement stated above are not eligible to receive
   Adoption Assistance benefits past the last day of the month of their 18th birthday.
   Adoptive parents of children who do not qualify for Adoption Assistance past age 18 should
   be notified by letter of the termination of Adoption Assistance at least 30 days prior to the end
   date.


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2. Adoption Assistance for Children Over 18 and Still in High School:

          All of the Following Criteria Must be Met:

                 The child‘s adoption MUST first meet the Basic Requirement above.
                 The child must remain in need of assistance and be dependent upon the financial
                  support of his/her parents.
                 The child must remain in secondary school (high school) on a full-time basis,
                  (summer school not required).

          Note: (Job Corp and GED programs do not meet the ―full-time school status‖
                requirement)

          Required Verification:

                 The adoptive parent(s) must provide documentation on a quarterly basis of the
                  child‘s full-time enrollment and attendance in school. Documentation from the
                  school must be on official letterhead with signatures of school personnel, and
                  must be verified by the Case Manager. Copies must be maintained in the county
                  adoption assistance case file.

          Termination of Adoption Assistance will occur when one of the following occurs
          (whichever occurs first):

                 The child graduates from high school (Adoption Assistance may continue
                  through the end of the graduation month).
                 The child drops out of school (Adoption Assistance may continue through the
                  end of the month that the child dropped out of school).
                 The child is not enrolled full-time in school or there is a lack of verification of
                  such (Adoption Assistance may only go through the last month of full-time
                  attendance.
                 The child turns age 21 (Adoption Assistance may continue through the birth
                  month)

3. Adoption Assistance for Children Over 18 and in College or Technical School

                 One of the Following Two Criteria Must be Met:

                 The child‘s adoption MUST meet the Basic Requirement above AND the child
                  must have been placed on Adoptive Status prior to July 1, 1998,

                  OR
.
                 The child‘s adoption MUST meet the Basic Requirement above AND the child
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                    must have been placed on Adoptive Status at age 13 or older,

                 AND Both of the Following Two Requirements Must be Met:

                 The child must remain in need of assistance and be dependent upon the financial
                  support of his/her parents,

                 The child must attend college or technical school on a full-time basis (not
                  including summer session).

          Note: (Job Corp and GED programs do not meet the ―full-time school status‖
            requirement)

          Required Verification:

                 The adoptive parent(s) must provide documentation that the child graduating
                  from High School in May or June has applied for College or Technical School by
                  July 31st.
                 The adoptive parent(s) must provide official documentation that the child
                  graduating from High School in May or June has been accepted and enrolled full-
                  time in a College or Technical School by September 15th (at least 12 hours).
                 The adoptive parent(s) must provide documentation on a quarterly basis of the
                  child‘s full time enrollment and attendance in /College or Technical School.
                  Documentation from the school must be on official letterhead with signatures of
                  appropriate personnel, and must be verified by the Case Manager. Copies must
                  be maintained in the county adoption assistance case file.

          Termination of Adoption Assistance will occur when one of the following occurs
          (whichever occurs first):

                 The child graduates from College or Technical School prior to age 21 (Adoption
                  Assistance may continue through the end of the graduation month).
                 The child drops out of College or Technical School (Adoption Assistance may
                  continue through the end of the month that the child dropped out of school).
                 The child is not enrolled full-time in College or Technical School or there is a
                  lack of verification of such (Adoption Assistance may only go through the last
                  month of full-time attendance).
                 The child turns age 21 (Adoption Assistance may continue through the birth
                  month)

     Please Note: Once the termination of Adoption Assistance has occurred for a child over the
                  age of 18, it can only be reinstated by the SSAU Director, after a review of the
                  case.

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VERIFICATION OF CONTINUING ELIGIBILITY FOR MONTHLY ADOPTION
ASSISTANCE PAYMENTS

109.14

Requirement:

The verification of a child’s eligibility to continue to receive the monthly adoption
assistance subsidy must be completed by each county department on a monthly basis.

109.14 Procedures:

1. Regional Accounting will forward the following reports monthly to each county
   department by the 20th of the month (for payments to be made the following month:

          A. SMILE Adoption Children Almost 18 Report – This report is of all children
             receiving Adoption Assistance that will be 18 years of age within the next 60 days.
             The case manager and supervisor/designee should review the report to determine
             if the child will remain eligible to receive adoption assistance after the child‘s 18th
             birth month.

          B. SMILE Adoption Children 18 & Over Report – This report should not have any
              children listed on the report as being paid from UAS Code 509 (Title IV-E).
              This report should also only have the names of children who were in the permanent
              custody of DFCS at the time of placement on adoptive status or children who were
              placed in the permanent custody of a relative or specified at a DFCS-initiated TPR
              hearing. Only children placed on adoptive status prior to July 1998 or at age
             13 can be eligible to continue to receive AA after age 18 when attending
             college or technical school on a full-time basis.

          C. SMILE Adoption Log – This report prints all children that were paid adoption
             assistance for the current month. The case manager should review each child on the
             adoption log to determine if the child remains eligible to receive ongoing monthly
             adoption assistance and make corrections, additions and deletions to the report. The
             report is then signed by the County Office Designee for Adoption approval and sent
             to the Regional Accounting office by the last day of the month prior to month of
             payments. If the report is received timely, Regional Accounting will then process
             the monthly adoption assistance payments and mail the checks by the 10th of the
             month that the payment is due.

                 Please Note: Within the 1st six months of the signing of the Adoption
                 Assistance Agreement, the Case Manager must confirm finalization of the
                 adoption. If the adoption has not been finalized, the case manager will document
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                  the steps the adoptive parents are taking to eliminate barriers to finalization of
                  the adoption. If the adoption has not finalized after one year of the signing of the
                  Adoption Assistance Agreement, termination of the adoption assistance benefits
                  will be discussed with the adoptive parents and the SSAU will be notified. If
                  adoption is no longer the goal, benefits under the program must terminate.
                  This applies to agency adoptions and transfers of custody from DFCS temporary
                  custody to the permanent custody of specified relatives/individuals for the
                  purpose of adoption (This does not apply to purely independent/Non-DFCS-
                  related adoptions, where Adoption Assistance benefits do not begin until after
                  finalization).

     2. The county Case Manager and Supervisor/Designee must review, approve and sign each of
        the adoption assistance reports from Regional Accounting monthly.


NON-RECURRING ADOPTION ASSISTANCE

109.15

Requirement:

Payments will be made for non-recurring Adoption expenses incurred by or on behalf of
the adoptive parents in connection with the adoption of a child with special needs, directly
through the State/Tribal agency or through another public or nonprofit private agency, in
amounts determined through an agreement with the adoptive parents.

Each eligible child may receive reimbursement for expenses related to the finalization of
the adoption. Reimbursement may not exceed $1500.00 per child, and can only be paid
after the adoption has finalized. Any adoption (excluding step-parent or birth parent
adoptions) that meets the Federal and State criteria for special needs is eligible to receive
Non-recurring Adoption Assistance.

109.15 Procedures:

1.     Non-Recurring Adoption Expenses are considered by federal regulation as: "reasonable and
       necessary adoption fees, court costs, attorney fees and other expenses directly related to the
       legal adoption of a child with special needs and which are not incurred in violation of state
       or federal laws."

       A. This may include the following expenses:

         1)     The cost for travel/lodging and food during pre-placement visitation based on the
                current state rates. Receipts/invoices/documentation must accompany the request
                for payment.
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        2)     The cost of physicals for the adoptive parents required for the adoption assessment
               (medicals for other family members or for updates are not included).
               Receipts/invoices/documentation must accompany the request for payment.

        3)     Legal/court fees. Receipts/invoices/documentation must accompany the request
               for payment.

     B. Any costs relating to the court termination or voluntary surrender of parental rights on
        the birth parents are not reimbursable under this program.

2.   Eligibility for Non-Recurring Adoption Assistance is based on the following factors:

     A. The child must be determined special needs by the SSAU. There must exist a special
         factor or condition because of which it is reasonable to conclude that the child cannot be
        placed with adoptive parents without providing Adoption Assistance.

     B. Children from foreign countries are not eligible under this program unless they meet the
        state's definition of special needs. This must be determined prior to the finalization of
        the adoption.

          1)   If the adoption is finalized in the foreign country, the family will need to fax
               documentation of special needs and verification that the child is free for adoption
               to the SSAU, Prior to finalization.

          2)   The special needs determination must be in place prior to finalization.

     C. Step Parent adoptions do not meet the criteria for reimbursement of non-
        recurring expenses

     D. A child does not have to be Title IV-E eligible to receive benefits under this program.

3.   The Non-recurring adoption assistance application sent to the SSAU must include:

         A. Request and required documentation of the child‘s special needs (must be submitted
            to SSAU prior to the finalization of the adoption).

         B. Statement that the Petition for Termination of Parental Rights has been filed,
            Voluntary Surrenders completed, or TPR has occurred.

         C. The date of finalization must be written on the Form 402 or Form 402-A. When
            submitted, Form 403 must also indicate the date of finalization and the amount
            reimbursed.

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          D. Reimbursement will be made only after the adoption is finalized.

4. The following must be maintained in the Adoption Assistance Case Record for Non-recurring
   Adoption Assistance:

     A. Special Needs determination

     B. Adoption Assistance Application, Form 402 or Non-Recurring Adoption Assistance
        Application, Form 402-A, signed by the agency representative, the County
        Director/Designee and the adopting parents(s) prior to finalization. If an existing Form
        402 is active and on file, another Form 402 does not need to be submitted nor does
        another narrative need to be included

     C.   A narrative which includes a description of the child's special needs, birth date, race;
          and efforts to place without assistance.

     D. For children receiving Non-Recurring Adoption Assistance only, the Adoption
        Assistance record must include verification that the child is legally free for adoption.
        (TPR or Voluntary Surrender documents);

      E. Date and proof of finalization;

      F. Receipts for expenditures;

      G. Copy of Form 403. Must be completed in its entirety.


APPROVING THE NON-RECURRING ADOPTION ASSISTANCE APPLICATION
PACKAGE / INITIATING PAYMENTS

109.16

Requirement:

The Case Manager shall submit the Non-Recurring Expenses Application Package to the
County Director/Designee:

109.16 Procedures:

1.   The County Director/Designee will review the application package and supporting
     documentation and approve the request.

2.   The Case Manager will notify the family of the decision and send them their copy of the
     Form 402 / Form 402-A.
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3.   The Case Manager will provide the accounting staff with a copy of the Form 402 / Form
     402-A and all supporting documentation.

4.   Form 403 will be submitted to the SSAU and Regional Accounting.

5.   The county may pay either the provider or the parent directly. (Both require invoices/
     documentation of expenses paid) and the completion of the W9 form.

6.   Payment will not be made until proof of finalization is obtained by the County in the form of
     a Final Adoption Decree.


SPECIAL SERVICES ADOPTION ASSISTANCE – GENERAL DESCRIPTION

109.17

Requirement:

Special Services Adoption Assistance (IV-B/State Funds) is intended to provide time-
limited or one-time-only funding for a needed service when no other family or community
resource is available.

Special Services Adoption Assistance benefits are available only to children in the
permanent custody of DHS at the time of being placed on adoptive status, and who are
receiving monthly Adoption Assistance benefits OR to children who were in the temporary
custody of DHS and placed in the permanent custody of a specified relative / individual by
Voluntary Surrenders of the parent(s) or by the Juvenile Court at the disposition of a
DFCS-initiated TPR hearing and who are receiving monthly Adoption Assistance benefits.

Special Services Adoption Assistance must relate to the special needs of the child.
If a child receives monthly assistance based on a specialized rate, it must be documented
that the specialized rate does not meet the child’s needs before special services funds may
be considered. These funds must be re-applied for annually.

Note: Title IV-E funds may not be used to pay for Special Services Adoption Assistance.

109.17 Procedures:

1. There must be written justification for Special Services. Documentation must also be
   attached to the request that no other resources (community, family, specialized adoption
   assistance rate, or otherwise) are available to meet the child‘s particular need. A list of the
   contacted resources must be attached. The SSAU is responsible for processing all Special
   Services requests.
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     A. Examples of other resources would include, but are not limited to: Children‘s Medical
        Services, Easter Seals, the Department of Education (IEP), Early Intervention Programs,
        Medicaid, Mental Health Developmental Disabilities and Addictive Diseases
        (MHDDAD).

      B. It is the family‘s responsibility to provide this information to the agency when applying for
         funds. (The financial income and outflow directly related to the family‘s indebtedness will
         also be considered in determining if the family qualifies for these services).

2.       Special Services funds are limited and not available for every child each State Fiscal Year.

3.       The financial ability of the family to meet the specific need of the child shall be taken into
         consideration before Special Services Assistance may be approved.

4.       Certification is for a twelve-month period. Any reconsideration of requests must be
         completed annually.

5.       All requests must have prior approval by the SSAU before any funds may be provided to
         families.

6.       Types of Special Services:

         A. Special Services funds may include but are not limited to: special medical equipment;
            psychiatric/psychological testing and therapy (not covered by Medicaid or private
            insurance); special educational equipment, orthodontic services, child care or respite
            care.

         B. It is at the discretion of the SSAU as to whether the child is eligible for more than one
            Special Services request during a certification period.

    7.   Limits of Special Services

         A. Private schooling and recreational activities (tutoring karate, summer camp,
            gymnastics, taekwondo or horseback riding) are not payable from these funds.

         B. Special Services funds are available only until a child reaches age 18.

SPECIAL SERVICES TYPES AND REQUIREMENTS

    Special Services CHILD CARE requirements:

         A. All Adoptive parent(s), whether single or part of a two parent household, must be
            employed full time (at least 30 hours on average per week). They must be unable to
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             meet the cost of child care through their own resources. For two parent households,
             both parents must be employed full-time outside the home to qualify (utilize income
             chart below).

       B. An adoptive family has sought to utilize child care services through the early
          intervention program, the school system or other resources whenever available.

       C. The adoptive family‘s total annual gross income must fall within the limits of the
          Maximum Allowable Income Per Family Unit Size Chart below. (UAS 512,
          Entitlement Code 17)

       D. Child care services are available only until the child reaches age 13 (continuing until
          the last day of the month that he/she turns 13) unless it is documented by a
          licensed Treatment Provider that the Child care is needed for a specific
          purpose and family nor community resources are available.

      E.   For child care being provided prior to the finalization of the adoption, the requirements
           of DFCS pertaining to supplemental supervision must be applied. Refer to Section
           1011.11 in the Foster Care Services Manual.

       F. Following finalization, the parents may select another provider as long as they remain
          income eligible for services.

       G. To determine eligibility based on gross income use the Maximum Allowable Income
           Per Family Unit Size Chart below. The adoptive family‘s gross annual income cannot
          exceed the limits established in the chart (UAS 512, Entitlement Code 17)

       H. Maximum allowable gross income per family unit size (excluding Adoption Assistance)



     UAS            2          3            4            5          6           7           8
    Entitle.       in         in           in           in         in          in          in
    Codes        family     family       family       family     family      family      family

    512-17      $24,900     $30,040     $36,200      $42,360    $48,520     $54,680     $60,840

       I. Child care shall be applied for annually with documentation as outlined included in the
          request.

       J. For any child receiving specialized adoption assistance, it must be documented that the
          payment is insufficient to cover the cost of child care. This documentation must be
          maintained in the case record.


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      K. Child care is payable up to 100% of the allowable state rate for the area in which the
         family resides. Payment may be made directly to the provider or reimbursed to the
         parent. Payments shall be made for services provided unless the Child Care Center
         requires payment in advance of attendance. If advance payment is required by the child
         care center, a copy of the policy must be attached.

      Note: Invoices are required for all child care reimbursements.

    Special Services RESPITE requirements:

      Respite funds are available when the special needs of the child are based on an
      emotional/behavioral, physical/developmental or mental limitation, and the need for a short
      term reprieve from the demands of caring for a child with such special needs can be
      documented. (UAS Code 512 -Entitlement Code 60)

      A. Prior to finalization, the respite care provider must meet the same requirements as
         supplemental supervision providers. (Refer to Section 1011.11 in the Foster Care
         Services Manual.)

      B. The documentation of special needs may come from consultation with the family and/or
         a licensed Treatment Provider.

      C.   Respite is not to be used as a substitute for child care or ongoing supervision.

      D. Any respite services available through the community shall first be utilized such as
           those available through MH/MR.

      E.   Respite may be approved for up to 20 hours per month per family. Funds may not
           be borrowed from a future month within the certification period unless there is an
           emergency situation. These type circumstances will require approval by the county
           director or SSAU and approval documentation must be submitted to accounting staff
           when requesting payment for more than 20 hours a month. A family‘s use of Special
           Services Child Care funds will be taken into account when determining eligibility for
           Respite funds. The number of Respite hours approved may be reduced or eliminated,
           depending on the Child Care approval and depending upon the severity of the child‘s
           special needs.

      F.   Once approved, respite services shall be provided for a twelve month period, not to
           exceed the approval amount.
                   1) The established rate is $6 per hour for the first child. Additional adopted
                      children needing respite may be eligible for a rate of $2 per hour per child.

                   2) All requests for respite shall be submitted to SSAU by the county
                      department.
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                    3) For any child receiving a specialized rate for adoption assistance, it must be
                       documented that the payment is insufficient to cover the cost of respite.

                    4) Advanced payments are not allowed for respite.


SPECIAL SERVICES ADOPTION ASSISTANCE – APPLICATION AND APPROVAL
PROCESS

109.18

Requirement:

Any request for Special Services shall be submitted to the Social Services Administration
Unit (SSAU) for approval. Approval is contingent on the availability of funds and the
appropriateness of the request and must be re-applied for annually.

109.18 Procedures:

1. The application package shall include:

         A. Cover letter/Memo from the Case Manager, which specifies the name and date of
            birth of the child, name(s) of the parent(s), an explanation of the type of Special
            Service being requested by the family and the amount being requested. This
            letter/memo should describe the special needs of the child and its impact on the
            family, and how the requested Special Services funds will assist the family in meeting
            the child‘s needs.

         B. Documentation by a licensed Treatment Provider that the special service is necessary,
            including type of treatment recommended, length of service and approximate cost
            (for medical, dental, orthodontic, psychological service requests or child care requests
            for children 13 and older)..

         C. Documentation of the family‘s efforts to locate community resources and that the
            special service is not available including any denials for services being sought from
            other resources. A statement from the family regarding their efforts to find other
            resources and regarding their need for the Special Service would be appropriate.

         D. Documentation of the family's current average monthly income and outflow of
            financial resources (documented on Form 44). For Child Care, income verification
            and full-time employment verification is required. Verification of all income may
            come in the form of current income tax forms (i.e. W-2, form 1040), four consecutive
            check stubs or the DFCS/SSAU Income Justification Statement completed by

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             employer. Pay stubs are always required in order to document full-time employment
             of at least 30 hours per week on average.

         E. Evaluation of the family's medical insurance including coverage of pre-existing
            conditions, i.e. duration of waiting period. Statement from the Provider as to whether
            Medicaid is able to cover any of the cost of the procedure/treatment.
.
2. The Special Services Adoption Assistance package shall be submitted to SSAU for final
   approval. The SSAU Program Consultants will review the package, generate Form 24 and
   send it to the county Case Manager, who will only then obtain signatures from the adoptive
   parent(s) and DFCS. Please Note: Form 24 is no longer to be completed by the Case
   Manager prior to the determination. The SSAU Program Consultants will complete
   Form 24 and send to the County Case Managers, who will then obtain signatures for all
   Approvals and give a copy to the adoptive parent(s). Denials do not require adoptive
   parent signatures (only DFCS signature), but a copy of the form must be sent to the
   adoptive parent(s).

3. Funds will not be paid until the SSAU Program Consultant completes and sends Form 24 to
   the county with the approval amount and approval period indicated, and until Form 24 is
   subsequently signed by all required parties. The Case Manager must provide the accounting
   staff with a copy of the fully executed and approved Form 24 along with related invoices for
   the approved time frame.

4. Special Services funds may be paid directly to the provider or as a reimbursement to the
   family. In situations where the child care provider requires payment prior to service
   provision, a copy of the child care provider‘s policy regarding advanced payment must be
   sent to accounting and maintained in the AA file) No funds shall be pre-paid to the family or
   the provider. The county shall not enter into a payment contract with the provider.

5. Any subsequent requests for Special Services Adoption Assistance shall be submitted to the
   SSAU for review and approval 60 days prior to the expiration of the previous approval
   period.

NOTE: Special Services invoices must be submitted to Regional Accounting within 60 days
of the service or they will not be paid.


FUNDING CATEGORIES OF ADOPTION ASSISTANCE

109.19

Requirement:


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Adoption Assistance benefits for eligible children will be paid out of either Title IV-E
(Federal) funds or IV-B (State) funds after an eligibility determination by Rev Max has
been completed and recommends the appropriate funding category.

The county should ensure that the appropriate funding category is being utilized for the
payment of Adoption Assistance benefits.

109.19 Procedures:

1. Title IV-E Adoption Assistance (Federal Funds) UAS CODE – 509

Program Description – To provide financial assistance for a child at the point of placement in the
adoptive home and beyond the finalization of the adoption. A direct money payment is made to the
adoptive family in the form of a monthly supplement. The child must be determined IV-E eligible by
the REV MAX unit and special needs by the SSAU prior to the use of funds.
Title IV-E Eligibility (UAS 509) is only to age 18.

2. Title IV-B Adoption Assistance (State Funds Only) UAS CODE - 508

Program Description – To provide financial assistance for a child at the point of placement in the
adoptive home and beyond the finalization of the adoption. A direct money payment is made to the
adoptive family in the form of a monthly supplement. State funded adoption assistance is provided
to children who have been determined to have special needs and placed on adoptive status while in
the permanent custody of DHS. These children must have been determined ineligible for Title
IV-E funds (UAS 509). Eligibility is to age 18 or 21, depending upon the child meeting the
eligibility criteria for children after age 18 (See Section 109.13, Duration of Benefits – After 18)

3. Non-recurring Adoption Assistance (State and Federal Funds) – UAS CODE - 510

Program Description – To provide reimbursement to the Adoptive Parent or Direct Payment to the
Vendor Providing Service for one-time expenses related to the finalization of the adoption of a child
with special needs. Total reimbursements shall not exceed $1,500.00 for children who had Special
Needs Determinations completed after July 1, 2009. Special Needs Determinations completed prior
to July 1, 2009 may have a limit of $2000.00.

Note: No payments can be made to the Adoptive Parents or Vendors prior to the Finalization
      of the Adoption.

Allowable expenses include:
 Court costs and/or attorney fees
 Cost of physicals for adopting parents
 Payment for pre-placement visits costs (travel, food and lodging) incurred during the pre-
   placement adoption period

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ADOPTION SERVICES: ADOPTION ASSISTANCE, SECTION 109
4. Special Services Adoption Assistance – UAS CODE – 512

Program Description – Special Services Adoption Assistance provides a time-limited or one-
time only funding for a special service related to the child‘s special need(s) when family or
community resources are not available. Approval is based on specific criteria. Annual approval
is required for all Special Services, and the approval period is not to exceed 12 months.
See Section 109.17 for specific examples of different types of Special Services and the related
criteria.


SOCIAL SECURITY DISABILITY BENEFITS / SSI

109.20

Requirement:

A child is eligible for Adoption Assistance if, at the time the adoption petition is filed, the
child meets the requirements for SSI benefits, and prior to the finalization of the adoption
is determined by the State/Tribe to be a child with special needs, and an Adoption
Assistance application is signed by all required parties. In addition to the requirement
above there are also other procedures that must also be met and documented.

Please Note: Applicable Children as defined in 109.2 must meet medical and disability
             criteria for SSI.

               Non-Applicable Children as defined in 109.2 must meet medical and disability
               criteria, along with income-based requirements, for SSI.

109.20 Procedures:

A. Any child‘s eligibility for SSI and how it relates to Adoption Assistance must be discussed
   with the family:

          1)   The family may choose to opt for concurrent SSI and Adoption Assistance
               benefits, but the Social Security Administration will consider the Adoption
               Assistance payment as income for the child who receives SSI benefits, and may
               reduce the SSI payments dollar for dollar following the adoptive placement.

          2)   The Case Manager must inform the Social Security Administration at the
               point that an SSI-eligible child is approved for Adoption Assistance benefits.
               Communicating with the Social Security Administration at this point will help to
               prevent any overpayments and resulting penalties to the adoptive parent(s).


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          3)   Should the adoptive family decide to initially accept SSI over Adoption Assistance,
               the adoptive family should be made aware that following the adoption
               finalization, SSI benefits may be reduced or terminated based on the family
               income and amount of Adoption Assistance. For that reason, the Case Manager
               should encourage the family to sign a Deferred Adoption Assistance Agreement,
               with $0.00 amounts. If the child becomes ineligible for SSI at a later time, the
               family can then request Adoption Assistance benefits in line with the child‘s needs,
               per federal and state policy.

          Please Note: Retirement, Inheritance, Survivors, Disability Insurance (RSDI) funds are
          not the same as SSI funds. The adoptive family‘s income or any other income of the
          child will not affect ongoing eligibility for RSDI funds. RSDI funds can be received in
          addition to Adoption Assistance without a ―dollar for dollar‖ reduction, as well.

B.   If a child is a recipient of SSI, the SSI funds and Medicaid card will continue to
     be sent to the child‘s legal county DFCS office until finalization. Once the
     finalization occurs, that agency shall transfer the assignment of benefits to the
     adopting family or instruct the family to apply for the transfer.

C. The Case Manager must apply for SSI whenever submitting a Specialized Adoption
   Assistance rate for children in DFCS custody.

D. The Case Manager should also encourage families who are adopting children not in the
   custody of DFCS to apply for SSI. If the child is approved for SSI, it would make the child
   eligible for Title IV-E Adoption Assistance if the child is also determined by the State to
   have special needs.


MEDICAID – GENERAL INFORMATION

109.21

Requirement:
Any child who is eligible for and receives Title IV-E Adoption Assistance is eligible to
receive Medicaid (Title XIX).

A Child eligible for State funded Title IV-B Adoption Assistance is eligible to receive State
funded Medicaid benefits (Title XIX).

Only a child who has been approved by SSAU for State-funded Adoption Assistance after
age 18 may receive State-funded Adoption Assistance Medicaid after age 18
(See Duration of Benefits – After Age 18, Section 109.13).

109.21 Procedures:
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March 1, 2010                                                                                 Page 57
ADOPTION SERVICES: ADOPTION ASSISTANCE, SECTION 109

1.   The family's Case Manager will discuss the availability of Medicaid benefits and the
     eligibility requirements for this benefit with the family.

2.   All children will continue to receive Medicaid through foster care until the adoption is
     finalized. (See Section 2885 of the Medicaid Policy Manual)

3.   The family must be informed that the Medicaid card will be in the birth name of the child
     until finalization. When the adoption is finalized, the Adoption Assistance Case Manager
     will notify the Rev Max Unit of the finalization and apply for a Medicaid card in the child‘s
     legal name.

4.   The Case Manager shall submit Form 403 to the Rev Max Unit when the adoption is final.
     The forms should identify the child‘s new name as it should appear on the Medicaid card
     and indicate the exact date of finalization. The Rev Max Unit will change the child‘s name
     on the Medicaid card and return Form 403 to the county for signature. This will contain the
     new Medicaid number. The Case Manager shall send Form 403 to the Regional Accounting
     Office. A copy of Form 403 with the newly assigned Medicaid number shall then be sent to
     the SSAU. (Please refer to Chapter 2885 in the Medicaid Policy Manual.)
     Copies of all forms must be maintained in the adoption assistance case record.
     Rev Max is required to maintain documentation of the IV-E funding determination for foster
     care in their Adoption Assistance Medicaid record.

5.   The SSAU shall be notified of the name and Medicaid number change via Form 403. The
     change will also be reflected in the SHINES system.

6.   Annual Redetermination of Medicaid is required by Revenue Maximization for children who
     receive Adoption Assistance Medicaid.

Note: If the Medicaid Redetermination is not completed timely, the Medicaid
      will terminate.

7.   The Rev Max Unit will send notification to the Case Manager 60 days prior to the
     expiration of the Medicaid Redetermination.

8.   The Case Manager will complete Form 403 (Annual Medicaid
     Redetermination Section) within 5 business days and forward to the Rev Max
     Unit. A copy shall be maintained in the Adoption Assistance case file.

9.   Medicaid benefits under Title IV-E will terminate at age 18.

10. After age 18, benefits for a child who receives Title IV-E Adoption Assistance monthly
    payments shall be converted to Title IV-B State funds. The Medicaid must also be changed
    to State-funded Medicaid. The Social Services Case Manager shall notify Rev Max staff
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      of the change in benefit category (See Section 109.13 for eligibility requirements for
      adoptive children after age 18).

11. All address changes must be made at the county level with notification sent via Form 403
    to the SSAU within 5 business days. The change must also be made in SHINES via a
    Notification of Change (NOC). Rev Max will be notified via NOC of changes in address in
     SHINES so that the Medicaid case record and the Medicaid card can be corrected.

12.   If a family is moving to another state, Form 402 and Form 403 must be submitted
      within 3 business days of notification by the family to the SSAU to initiate a referral
      to Rev Max for a Continuing Medicaid Determination. Residency is a Medicaid
      eligibility criteria.

13.   The SSAU Compact Administrator will make the referral for Medicaid to the Compact
      Administrator in the new state of residence.

 14. Once the family has moved, the county case manager will notify the Rev Max
     Unit to terminate Georgia Medicaid.


MEDICAID FOR CHILD RECEIVING ASSISTANCE FROM ANOTHER STATE

109.22

Requirement:

A child who is residing in Georgia and receiving Adoption Assistance and Medicaid from
another state is eligible to receive Georgia Medicaid under COBRA Reciprocity.

109.22 Procedures

1.    If the family contacts the local DFCS office, they shall be referred to the SSAU Program
      Manager (Compact Administrator)

2.    The SSAU staff is responsible for taking the application and referring the information to
      Rev Max.

3.    All Adoption Assistance Medicaid approvals are initiated by Rev Max.



STATUS CHANGE

109.23
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March 1, 2010                                                                                 Page 59
ADOPTION SERVICES: ADOPTION ASSISTANCE, SECTION 109

Requirement

Status changes must be reported to the Social Services Administration Unit (SSAU),
Rev Max Unit, and Regional Accounting via Form 403. Form 403 and the SHINES system
should be utilized when reporting status changes.

109.23 Procedures:

Below are some examples of situations in which the Case Manager must notify the SSAU.
Notification should be made to SSAU, Regional Accounting, and the Rev Max Unit by sending
out Form 403 and updating SHINES as appropriate for the agency being notified.

1. The child moves from Title IV-E (Federal) Adoption Assistance to Title IV-B (State funded)
   Adoption Assistance (i.e. child turns 18 but is still attending school).

2. The name of the adoptive parent(s) changes.

3. The address of the adoptive parent(s) changes.

4. There is a change in the amount of the monthly Adoption Assistance benefit (such as a
   renegotiated rate following a child‗s return to foster care temporarily).

5. Finalization of the Adoption occurs.

6. Death of one or both adoptive parents occurs.

7. Divorce of the adoptive parents occurs.

8. Adoptive child dies.

9. Child is emancipated or joins the military.

10. After contacting the SSAU and it is agreed that monthly adoption assistance is to be
    terminated or is no longer needed, the case manager shall take the following actions, utilizing
    Form 403 and the SHINES system:

     A. Notify the adoptive parents in writing that their Adoption Assistance, and Medicaid if
        applicable, will terminate.

     B. Notify the SSAU via Form 403 and that the Adoption Assistance has terminated, stating
        the reason for termination and providing the effective date. Also, indicate closure by
        terminating the Adoption Assistance Agreement in the SHINES system.

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ADOPTION SERVICES: ADOPTION ASSISTANCE, SECTION 109
     C. Notify the Rev Max Unit that the Adoption Assistance Medicaid should be terminated
        via Form 403 and by terminating the Adoption Assistance Agreement in the SHINES
        system.

     D. Notify Regional Accounting staff via Form 403.


FAMILY RELOCATIONS

109.24

Requirement:

Adoption Assistance benefits shall continue if a family moves.

109.24 Procedures:

1.   The family moves to another county within the state.

     A. The Case Manager from the county Department that the family is leaving will
        coordinate the transfer of the Adoption Assistance case with the new county in order
        that there is as little disruption as possible for both the family and the county budgets.

     B. A letter shall be written to the new county of residence notifying the county of the
        transfer at least 60 days prior to transferring the record. A copy of the letter shall be
        sent to the SSAU Program Manager.

     C.   The county of previous residence shall transfer the Adoption Assistance record, in its
          entirety, to the new county of residence and notify the accounting staff in their county of
          the transfer (See Section 109.8). If the appropriate documentation is not included,
          the new county of residence shall not accept the transfer of the case. The
          Adoption Assistance case transfer must include the following in a cover letter:

          1. Identification of the current certification period
          2. The class of Adoption Assistance the child is receiving (Title IV-E or Title IV-B)
          4. The monthly amount of Adoption Assistance the child receives
          3. Notification of the month the receiving county department will be responsible for
              assuming the monthly Adoption Assistance payments

     D. The case manager in the previous county shall notify the Medicaid Eligibility Specialist
        of the need to transfer Medicaid.

     E.   The Rev Max Specialist receiving the transfer will forward the documentation of the
          Medicaid eligibility determination to the Case Manager in the county of residence.
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     F.    The county of previous residence shall notify the family who they may contact if they
           have problems or questions regarding Adoption Assistance.

     G.    Once the transfer is complete, the Case Manager in the new county of residence shall
           provide the family with information regarding whom they may contact if they have
           problems or questions regarding Adoption Assistance.

     H. The Case Manager in the old and new county shall notify the regional accounting office
        of the receipt of the new case or termination of the old case via Form 403.

2.   The family moves to another state.

     A. The procedures for the Interstate Compact on Adoption and Medical Assistance
        (ICAMA) must be followed as outlined. This provides for Medicaid in the new state of
        residence.

     B. All cases involving an interstate transfer will be referred to the SSAU for processing
        even though not all states are members of ICAMA.

     C. A Form 403 shall be mailed to the SSAU, within 3 days of the case manager receiving
        notification of the new address for the family. This will serve as the notification to
        initiate processing of the referral.

     D. The county Case Manager, within 3 days of receiving the notification that the family is
        moving, will notify the Rev Max Specialist to terminate Medicaid.

     E. Each notification will contain a copy of the Adoption Assistance Agreement and the
        following identifying information:

          1)   Parents' names.

          2)   Child's name, date of birth, social security number.

          3)   New address.

          4)   Date of move.

     F.    All Title IV-E eligible Adoption Assistance recipients are eligible for Medicaid (Title
           XIX) in their new state of residence.

     G. Georgia will continue to be responsible for providing the Adoption Assistance
        payments to the child.

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ADOPTION SERVICES: ADOPTION ASSISTANCE, SECTION 109
     H. In the majority of cases, a child who receives Medicaid in Georgia due to a medical
        or rehabilitative need, but who is not Title IV-E eligible, may receive Medicaid in their
        new state of residence. The SSAU will inquire as to eligibility when
        making the interstate referral.


ADMINISTRATIVE (FAIR) HEARINGS

109.25
Requirement:

An Adoption Assistance Agreement must be signed and in effect at the time of or prior to
the finalization of the adoption. If any adoptive family feels they were wrongly denied
benefits, they may request an administrative (fair) hearing. Procedures for an
administrative (fair) hearing are outlined in the Foster Care Manual, Section 1013 –
Administrative Hearings.

109.25 Procedures:

1.   Some allegations that constitute grounds for a fair hearing include:

     A. Failure by the State agency to advise potential adoptive parents about the availability of
        adoption assistance for children in the State Foster Care system.

     B. The agency erroneously determined that the child was ineligible for Title IV-E benefits.

     C. Relevant facts regarding the child were known by the State agency or child-placing
        agency and not presented to the adoptive parents prior to the finalization of the
        adoption.

     D. Denial of Adoption Assistance based on a means test of the adoptive family.

     E.   Decrease in the amount of Adoption Assistance without the concurrence of adoptive
          parents.

     F.   The adoptive family disagrees with the determination by the State that the child is
          ineligible for Adoption Assistance.

2.   It is important to note that a change in statute, regulation or policy is only effective from the
     date it is enacted.

3.   If the fair hearing determines that extenuating circumstances exist, then the earlier decision
     to deny benefits under Title IV-E may be reversed. Benefits will be retroactive to the date
     of the request of the special needs determination by the SSAU.
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ADOPTION SERVICES: ADOPTION ASSISTANCE, SECTION 109

4.   Complete the appropriate forms located in Forms Online/Foster Care Manual - OSAH
     Request for Administrative Hearing (FC 129) and OSAH Form 1 (FC 131). These forms are
     also available from OSAH on line at: http://www.osah.ga.gov.

5.   Case Manager must inform adoptive parents in writing that they may be represented at the
     fair hearing by legal counsel or other spokesperson.

6.   Submit the claimant's written request along with the hearing request summary and
     supporting documentation to:

     DHS Legal Services
     2 Peachtree Street. NW
     29th Floor
     Atlanta, Georgia 30303

A copy of the request should be submitted to:

     Adoption Assistance Program Consultant
     Social Services Administration Unit
     2 Peachtree Street NW, Suite 8-407
     Atlanta, Georgia 30303

7.   The referring case manager will be required to attend the fair hearing.

8.   The SSAU will be available to provide technical assistance to the county at the time of
     the fair hearing.


DATA COLLECTION

109.26

Requirement:

Information regarding Adoption Assistance cases must be reported to the Social Services
Administration Unit (SSAU) to satisfy internal and federal reporting requirements.

109.26 Procedures:

Each Adoption Assistance case must contain Form 403 (see Form Section). One copy will
remain in the county file, and one copy is to be submitted to the SSAU at the following times:

1.   At the time of initial certification.
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ADOPTION SERVICES: ADOPTION ASSISTANCE, SECTION 109

2.   At the time of any status change (i.e. address change, termination of Adoption Assistance,
     notification of change in child's eligibility from Title IV-E to Title IV-B, etc.)

3.   For Non-DFCS children /Independent adoptions and recipients of non-recurring, all pages of
     form 403 must be completed in its entirety.


RECORD MAINTENANCE

109.27

Requirement:
The Adoption Assistance record must be maintained separately from the family's adoption
file.

109.27 Procedures:

1.   The Adoption Assistance record, not the family's adoption file, is to be kept in the county
     following finalization of the adoption so that information will be available for re-
     certification of Special Services funds.

2.   All eligibility determination information is to be maintained in the county Adoption
     Assistance record.

3.   The Adoption Assistance records must be kept in a separate locked file cabinet since they
     contain confidential, identifying information on the biological family of a child whose
     adoption has been finalized.

4.   When the Adoption Assistance record is closed it shall be sent to the SSAU.




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Social Services Administration Unit                                  Adoption Assistance, Section 109
March 1, 2010                                                                                Page 65

				
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