Georgia Association of Homes and Services for Children   

Family and Children Service Providers - Level of Care Provider Meeting and Implementation

On January 13, 2004, GAHSC and its partnering providers of Level of Care Services met to discuss the Governor’s proposal for LOC rates and contract deliverables.   64 individuals from 45 different agencies representing services to all levels of care were in attendance.  The following position paper represents these discussions and the position of these providers.   

We have spoken with the Governor’s Office, the Commissioners Office, and the DFCS State Office about this proposal.  They all have indicated that they would work with us concerning the details of this position paper. 

The next meeting of the Level of Care Taskforce will be on January 22^nd at 9:30 am at the GAHSC Conference Room.  The agenda will be the negotiation of the LOC contract. 
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Georgia Association of Homes and Services for Children and its
Partnering Level of Care Providers

Position Paper
January 13, 2004 

Issue:               Level of Care Implementation February 1, 2004 

Background: 

Since 1998, the Department of Human Resources, the Department of Juvenile Justice, the Georgia Association of Homes and Services for Children and its partnering providers, and the Governor’s Office has been working on the development of a equitable, safe and appropriate system of care for Georgia's foster children. This system promised a framework for the goals of choosing the most appropriate, least restrictive placement environment for Georgia’s foster children while reducing the number of their moves, and decreasing their overall length of stay in out-of-home care.  This system would be assessment driven and outcome measured.  This system of care promised a better way of caring of Georgia foster children and an improvement in Georgia’s placement process.   

Many challenges and hurtles faced the stakeholders in this process.  Resources were not the least among them.  Georgia’s foster care system was growing each year.  As Georgia moved closer to the implementation of the Level of Care System, the economy of the nation and the state conspired to work against its implementation.  Many details had to be worked out.  Georgia had to move from a hundred different per diem rates to just twelve.  Levels of care had to be standardized and explained.  Children’s services had to be quantified and rated according to need.  These challenges were initially tested in Fulton County.  This pilot was very successful.  It answered many of the questions faced by stakeholders and provided the model for statewide implementation. 

The Georgia Association of Homes and Services for Children and its partnering stakeholders worked through 2003 to work out the details of implementation.  A Level of Care Implementation Taskforce was setup to oversee the implementation.  Regular meetings occurred.  Two subcommittees addressed key components of financing and service parameters.   

Resourcing Level of Care proves to be a significant challenge.  Providers of levels one through three were on average reimbursed historically based on fifty-three percent (53%)of cost.  Therapeutic placements typically average reimbursement is about ninety percent (90%) of the true cost of care.  At the same time that the State struggled with leveling the reimbursement, the number of children in foster care was increasing by more than 30% in the past two years.  In order to move to a level of care system, providers would need adequate reimbursement to provide the services the program mandated and the children needed.  Anything less, would put significant demands either on services or capacity.   

The Governor has recommended resources for Level of Care will put significant strain on building the capacity for services that children need. The needs of children are growing at a time that the number of children entering the system is growing.  Georgia’s budgetary crisis has worked against the State in addressing these issues.  Children who are in Georgia’s care are the most at risk.   

Position: 

In view of the extreme economic conditions facing the State of Georgia, the providers, in a show of partnership with the State and as a commitment to children, agree to work with the Level of Care rates proposed by the State on February 1, 2004 for a limited time.  It is acknowledged that the proposed rates are not adequate to build the full capacity and complete an array of services to implement an effective Level of Care System. 

Therefore it is resolved that: 

Providers agree to enter into a rates-only contract with DHR effective February 1, 2004.  Specific contract provisions will be determined and negotiated with DHR by July 1, 2004. 

Qualifiers on the Level of Care Implementation on February 1, 2004 

• The deliverables as outlined in the Service Indicator Manual must be renegotiated in light of these inadequate rates. 
• We must warn that the capacity to build a complete continuum and system of care will be severely limited by rates that are less than adequate for serving the most severely disturbed child. 
• Cost of Living adjustments for the LOC rates must be included in the FY’05 budget.
• The LOC Implementation Taskforce needs to reconvene to further workout questions in the deliverables in light of these rates.

We thank the Governor, the Governor’s Office of Planning and Budget and the Departments of Human Resources and Juvenile Justice for the partnership, collaboration and team work that they had demonstrated during the Level of Care Implementation process.  

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Unanimously voted and agreed upon by 64 individuals from 45 different agencies representing services to all levels of care on January 12, 2004.  The following agencies were represented:  

Unanimously voted and agreed upon by 64 individuals from 45 different agencies representing services to all levels of care on January 13, 2004.  The following agencies were represented:  

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Attachment A

 

 

Level of Care Implementation Questions

January 13, 2004

 

1.         Will all children in Level 4 services get Medicaid Cards?

2.         Is the State planning to implement low rates with a freeze on the placement of children?

3.         Does the State expect agencies to provide family support services at these rates?

4.         Will the State mandate of a certain number of counseling sessions?

5.         Will the State expect to build capacity with these rates?  If yes, how?

6.         Will the State expect step downs to be made within 60 days with the limited capacity implied by these rates?

7.         Will there be a cost of living adjustment for FY’05?

8.         Will the State expect strength-based work with these rates?

9.         How will reassessments in care be handled?

10.               What will be the role of ORS?  Will they raise their new funds with increased fines?
Will the Department have equal regulations with the private providers?

11.        What will happen to wrap around services?

12.        How will the State assist agencies with the increase insurance costs?

13.        Do providers have to sign contracts to take new children?

14.        What will the rate be after July 1st?

15.        How will the $2 million in transition funds be handled?  Will providers be at the table?

16.        Will providers be expected to contract only with DHR for children services?

17.        How will children be assessed initially?

18.        Will Level Six providers be protected from reassessments to lower levels while in the care of a hospital facility?

19.        Will Providers help determine the curriculum for Level of Care training?

20.        Will the publicity clause be modified in the LOC Contract?

21.        Will the patents clause be modified in the LOC Contract?