(a) Difficulty of care (DOC) payments are available to reimburse tribal foster parents for the care of children in tribal custody. 

(b) The tribal Child Welfare (CW) worker submits a written request for DOC to the Children and Family Services Division (CFSD) tribal coordinator when the tribal CW worker determines that the child meets DOC criteria.  The CFSD tribal coordinator approves or denies the written request within 30 calendar days from the date the request is received.  • 1

(c) The written request details the child's special needs, including statements from medical or psychological reports that describe the child's condition and diagnosis, utilizing the rate descriptions as set out in Oklahoma Department of Human Services OKDHS Ap-C-20, Children and Family Services Division Rates Schedule, as amended from time to time, as approved by the Commission for Human Services.

• (1) The effective date of approval is the first day of the month in which the request is received by CFSD.
• (2) No retroactive payments are made prior to the date of the request.

(d) The tribal CW worker:

• (1) reviews the child's DOC rate increase every twelve months;
• (2) one month prior to the end date of DOC approval, submits notification to the CFSD tribal coordinator for continuation of DOC or that DOC is no longer needed;
• (3) notifies the CFSD tribal coordinator if the child's placement changes to a placement other than tribal foster care or the child returns to his or her own home; and
• (4) if the child's special needs change, requiring a DOC rate change, prepares a detailed request and submits to the CFSD tribal coordinator.  The CFSD tribal coordinator terminates the original request.