OKDHS.org - OAC 340:75-7-53. Difficulty of care

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340:75-7-53. Difficulty of care

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Revised 6-1-08

(a) Difficulty of care payments.

(1) Difficulty of care (DOC) rates are available to reimburse Oklahoma Department of Human Services (OKDHS), tribal, and contracted emergency foster care (EFC) foster families for the additional care and supervision required due to the child's extraordinary physical, mental, or emotional needs.
(2) DOC reimbursement is not available to children in specialized community homes, specialized foster care through Developmental Disabilities Services Division, therapeutic community homes, and therapeutic foster care placements.

(b) DOC rates and descriptions. DOC reimbursements are made in addition to foster care reimbursement or adoption assistance payments set out in OKDHS Appendix C-20, Children and Family Services Division Rates Schedule, as amended from time to time, as approved by the Commission for Human Services. The descriptions set out in OKDHS Appendix C-20 are viewed as guidelines from which Child Welfare staff makes the most appropriate increase recommendation. Not every situation clearly fits in one rate category. Consideration of the child's age is part of determining the appropriate rate category. When approved, DOC payments are:

(1) not retroactive; and
(2) available the first day of the month the DOC rate is requested.

(c) DOC request. The foster parent, Child Welfare (CW) worker, or adoption specialist may initiate the request for DOC.

(1) Requests are made in the child's KIDS case.
(2) The relevant CW supervisor reviews and may authorize DOC Rates I through IV based on the criteria per OKDHS Appendix C-20.
(3) Requests for DOC Rate V are forwarded to the Children and Family Services Division (CFSD) Foster Care programs manager.
(4) A CFSD committee reviews and makes the determination for DOC Rate V.
(5) Actions by each party in the DOC review process occur within ten calendar days of receiving all necessary information for a determination.
(6) Each DOC authorization is limited to six months. • 1

INSTRUCTIONS TO STAFF 340:75-7-53

Revised 6-1-08

1. (a) Requesting difficulty of care (DOC).

(1) The Child Welfare (CW) worker requests a DOC payment rate immediately in the child's KIDS case:

(A) upon determining the child's special needs, utilizing the rate descriptions to justify the payment rate; or

(B) when a request is made by a foster family, after a discussion about the rate descriptions to determine the payment rate.

(2) The CW worker includes in the request statements from medical or psychological reports that describe the child's condition and diagnosis.

(3) For DOC Rates I through IV, the CW supervisor approves or denies based on the documentation within ten working days from the date of the request on KIDS.

(4) For DOC Rate V, the CW worker makes a request in the child's KIDS case and faxes supporting documentation to Children and Family Services Division (CFSD) Foster Care Section for approval or denial.

(5) To make a DOC request in the child's KIDS case, the CW worker:

(A) selects the Placement screen and placement client;

(B) selects a new or continued request;

(C) enters specific details in the recommendation text box that justify the need and appropriate DOC level;

(D) documents the information and clicks on Add to electronically send to the designated person; and

(E) receives a tickler that is generated to notify the worker of a status change when the designated person approves or denies the DOC request.

(b) DOC review. KIDS generates a tickler for the review date one month before the DOC approval end date. Termination of the approval occurs when the child's placement status changes to an above foster care placement or when the child returns to own home or other non-paid placement. The CW worker:

(1) requests termination of DOC at any time the determination is made that the child no longer requires DOC; or

(2) on the review date, determines the status of the child's special needs and whether the child's special needs:

(A) meet the criteria, then either requests continuation of DOC or terminates the DOC request; or

(B) have changed, requiring a DOC rate change, and, if so, requests a rate change with detailed information.

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