Effective July 1, 2012-June 30, 2013 ANNEX E

Comprehensive Child and Family Assessment (CCFA)

RATE SCHEDULE

Service Authorization/Referral Required for ALL Services

UAS Program 511 CCFA (CONTRACT REQUIRED FOR ALL SERVICES)

DESCRIPTION / CODE / SPECIFIC SERVICE REQUIREMENTS
Complete CCFA Assessments
(Codes 29a-29o) / CCFA is gathering, assembling, and compiling information into a comprehensive assessment from various resources for the child/family.
*Includes ALL transportation and mileage cost.
CCFA staff requirements for ALL CCFA services:
  • Licensed Professionals must be:
  • Fully Licensed Counselor
  • Provisionally Licensed Counselor with a Masters in Human Services being supervised by a fully Licensed Counselor
  • Licensed clinical social workers can also be used
  • Masters in Human Services being supervised by a fully Licensed Counselor
Exception: Degreed professionals are authorized to complete relative/non-relative home evaluations. FSW’s are not authorized to complete home evaluations (See 29j).
Coordination of Medical/Dental/
Health Check
(ages 0-17)
*Initial OR Subsequent / 29a /
  • $150.00
  • Coordination & scheduling within 6 days of receipt of the service authorization/referral from DFCS
  • Results must be integrated into the CCFA Assessment within 21 days of receipt of the service authorization/referral from DFCS
  • Includes transportation and mileage costs

Coordination of Trauma Assessment
(ages 4-17) / 29p
New letter code assigned /
  • $150.00 (one time fee)
  • Coordination & scheduling within 2 days of accepting the referral
  • Results should be integrated into the CCFA Assessment, if available, within 21 days of receipt of the service authorization/referral from DFCS
  • Includes transportation and mileage costs

Initial Comprehensive Child and Family Assessment (CCFA) –
1st Child / 29e /
  • $600.00 Compiling the Family Assessment (CCFA)
  • Completed within 21 daysof receipt of the service authorization/ referral from DFCS
  • Requires Family Team Meetings
  • Family Assessment report must include Form 419 (Background Information for State Agency Child)
  • Includes transportation and mileage costs
  • Billed ONLY if CCFA is completed. Otherwise, bill 29n.

Initial Comprehensive Child and Family Assessment (CCFA) –
(Ages 0 to 17) / 29f
Rate Reduced /
  • $150.00for each additional child in the family
  • Completed within 21 daysof receipt of the service authorization/referral from DFCS
  • Includes transportation and mileage costs

Relative/Non-Relative Care Assessment (RCA) and Home Evaluation / 29j /
  • $350.00 Per family
  • Completed within 25 days of receipt of the service authorization/referral from DFCS
  • Rate includes cost related to a Family Team Meeting
  • Includes transportation and mileage costs
  • Family member or non-family member has been identified as a placement resource for children
  • This assessment is completed to determine the appropriateness of placement resources for children.

Comprehensive Child and Family Assessment (CCFA)

RATE SCHEDULE

Effective July 1, 2012-June 30, 2013

Service Authorization/Referral Required for ALL Services

UAS Program 511 CCFA (CONTRACT REQUIRED FOR ALL SERVICES) continued

DESCRIPTION / CODE / SPECIFIC SERVICE REQUIREMENTS
Updated Comprehensive Child and Family Assessment (CCFA) / 29m /
  • $300.00 Coordination and UpdatingComprehensive Child and Family Assessment
  • Includes transportation and mileage costs

Updated Comprehensive Child and Family Assessment (CCFA)
– each additional child
(Ages 0 up to age 17) / 29n
Rate Reduced /
  • $75.00 for each updated assessment or new assessment for ADDITIONAL children
  • Includes transportation and mileage costs

Cancelled/Incomplete Assessment / 29o /
  • ONLY completed components will be paid
  • Justification must be provided
  • Includes transportation and mileage costs
  • Total payment may NOT exceed $600.00 per family unit

Court Appearance and/or Testimony / 88a /
  • CCFA Assessment-Invoice and a copy of subpoena must be attached to invoice for payment
  • Court appearances by a psychologist are to be authorized by
the SAAG.
  • Licensed Professionals (ONLY): $50.00 per hour (Maximum per day amount claimed cannot exceed $400.00)
  • Licensed clinical social workers can also be used

WRAP-AROUND SERVICES (WA)

RATE SCHEDULE

Service Authorization/Referral Required for ALL Services

UAS Program 518 WA (CONTRACT REQUIRED FOR ALL SERVICES)

DESCRIPTION / CODE / SPECIFIC SERVICE REQUIREMENTS
Crisis Intervention to Prevent Disruption – Licensed Professional / 24a /
  • Services cannot exceed 30 days
  • Licensed Professionals $65.00 per hour, per service
  • Fully Licensed Counselor
  • Provisionally Licensed Counselor with a Masters in Human Services being supervised by a fully Licensed Counselor
  • Licensed clinical social workers can also be used
  • Masters in Human Services being supervised by a fully Licensed Counselor

Crisis Intervention to Prevent Disruption – Degreed Professional / 24b /
  • Services cannot exceed 30 days
  • Degreed Professional$35.00 per hour, per service
  1. Degreed Professional with a Bachelors in Human Services supervised by a fully Licensed Counselor
  2. Family Support Worker with a High School Diploma
and 5 years of Human Services experience supervised by a fully Licensed Counselor
Crisis Intervention Prevent Disruption – Mileage / 24c /
  • Mileage at state approved rate
  • May not exceed $150.00 per service
  • Services may not exceed 30 days
  • Should be included on the Wrap-Around Invoice

Crisis Intervention
Behavioral
Management – Licensed Professional / 47a /
  • Services cannot exceed 30 days
  • Licensed Professionals $65.00 per hour, per service
  1. Fully Licensed Counselor
  2. Provisionally Licensed Counselor with a Masters in Human Services being supervised by a fully Licensed Counselor
  3. Licensed clinical social workers can also be used
  4. Masters in Human Services being supervised by a fully Licensed Counselor

Crisis Intervention
Behavioral
Management- Degreed Professional / 47b /
  • Services cannot exceed 30 days
  • Degreed Professional$35.00 per hour, per service
  1. Degreed Professional with a Bachelors in Human Service supervised by fully a Licensed Counselor
  2. Family Support Worker with a High School Diploma and 5 years of Human Services experience supervised by a fully Licensed Counselor

Crisis Intervention Behavioral Management – Mileage / 47c /
  • Mileage at state approved rate
  • May not exceed $150.00 per service
  • Services may not exceed 30 days
  • Should be included on the Wrap-Around Invoice

Transportation Services / 56a
Service criteria Changed. See new description and staff provision. / This code is used solely when transporting the children/family to and from services.
Transportation services may include, but are not limited to, transporting child to/from school or court, transporting parent to/from a child’s doctor appointment, or parent/to from home for child’s visit.
  • Should be included on the Wrap-around Invoice
  • Set Hourly rate of $15.00 per hour
  • Max $150.00 per service
  • Hourly rate applicable for transporter no matter level of experience
*PLEASE NOTE: Crisis Intervention Services are PROHIBITED during transportation.

WRAP-AROUND SERVICES (WA)

RATE SCHEDULE

Service Authorization/Referral Required for ALL Services

UAS Program 518 WA (CONTRACT REQUIRED FOR ALL SERVICES) continued

DESCRIPTION / CODE / SPECIFIC SERVICE REQUIREMENTS
Mileage for Transportation Services / 56b /
  • Mileage at state approved rate
  • May not exceed $150.00 per service
  • Should be included on the Wrap-Around Invoice

In Home Case Management
Licensed Professional / 71a /
  1. Licensed Professionals $45.00 per hour, per service
  1. Fully Licensed Counselor
  2. Provisionally Licensed Counselor with a Masters in Human Services being supervised by a fully Licensed Counselor
  3. Licensed clinical social workers can also be used
  4. Masters in Human Services being supervised by a fully Licensed Counselor

In Home Case Management
Degreed Professional / 71b /
  • Degreed Professional$30.00 per hour, per service
  1. Degreed Professional with a Bachelors in Human Service supervised by a fully Licensed Counselor
  2. Family Support Worker with a High School Diploma and 5 years of Human Services experience supervised by a fully Licensed Counselor

In Home Case Management
Mileage / 71p /
  • Mileage reimbursed at the state approved rate
  • Should be included on the Wrap-around Invoice
  • May not exceed $150.00 per service

Court Appearance and/or Testimony /
  • WRAP-Invoice and a copy of subpoena must be attached to invoice for payment
  • Court appearances by a psychologist are to be authorized by the SAAG.

88a /
  1. Licensed Professionals $50.00 (Maximum per day amount claimed cannot exceed $400.00)
  2. Fully Licensed Counselor
  3. Provisionally Licensed Counselor with a Masters in Human Services being supervised by a fully Licensed Counselor
  4. Licensed clinical social workers can also be used
  5. Masters in Human Services being supervised by a fully Licensed Counselor

88b /
  • Degreed Professional:$25.00 per hour (Maximum per day
  1. Degreed Professional with a Bachelors in Human Service supervised by a fully Licensed Counselor
  2. Family Support Worker with a High School Diploma and 5 years of Human Services experience supervised by a fully Licensed Counselor

In-Home Intensive
Clinical/Therapeutic Services / 95a /
  • Services cannot exceed 6 months
  • A waiver is needed if services exceed 6 months
  • Licensed Professionals: $65.00 per hour, per service
  1. Fully Licensed Counselor
  2. Provisionally Licensed Counselor with a Masters in Human Services being supervised by a fully Licensed Counselor
  3. Licensed clinical social workers can also be used
  4. Masters in Human Services being supervised by a fully Licensed Counselor

In-Home Intensive
Clinical/Therapeutic Services– Mileage / 95b /
  • Mileage at state approved rate
  • May not exceed $150.00 per service
  • Should be included on the Wrap-around Invoice

Emergency Placement / 00 /
  • This code is ONLY to be used to pay a state approved WRAP provider for miscellaneous cost associated with caring for a foster care child overnight when no other placement can be found.

UAS Program 511 CCFA (CONTRACT REQUIRED FOR ALL SERVICES)

Coordination of Medical/Dental/Health Check
*Initial OR Subsequent / Code 29a / $150.00
Children ages 0-17 entering foster care are required to have a “health check screening” and a dental exam conducted within 10 days of entering care. For children ages (3) and under, the health check must include a dental screening. For children ages (4) and above, a dental exam must be completed. The Health Check and dental exam provides DFCS with information regarding the health needs of the child and further guides the development of the case plan. This service includes the CCFA provider complete the following items:
  1. Scheduling and arranging the child’s medical and dental (if applicable) appointment within two (2) days of accepting the referral.
  2. Gathering health information about the child to prepare for scheduled medical and dental(if applicable) appointment.
  3. Transporting child to and from medical and dental (if applicable) appointment
  4. Collecting historical medical and dental (if applicable) records.
  5. Analyzing medical information to include recommendations in the CCFA
The health screening must meet the Early Periodic Screening and Diagnostic Testing (EPSDT) standards. The Health Check can be performed at a local health department or with an approved medicaid/medical provider. The dental exam must be provided by a licensed dentist.
* Contractor must collect the informationfrom the provider of service (i.e. dentist, doctor)
Coordination of Trauma Assessment / Code 29p / $150.00 (one time fee)
Children ages 4-17 entering foster care are required to have a trauma assessment completed within 25 days of entering foster care. Caregivers may also be required to have an assessment depending upon the situation that necessitated the childs removal from the home. The trauma assessment provides the agency with a trauma history and recommendations for possible further assessment and treatment needs of the child, and further guides the development of the case plan. The service includes the CCFA provider complete the following items:
1.Scheduling and arranging the trauma assessment appointment within (2) days of accepting the referral
2.Gathering the information related to trauma history and mental health to prepare for scheduled trauma assessment appointment
3.Transporting child to and from trauma assessment if required
4.Reviewing/assessing mental health information to integrate into CCFA assessment/recommendations
5.If recommendations of trauma assessment or CCFA include a full scale psychological evaluation, CCFA provider will schedule and arrange for evaluation appointment within (2) days of receiving results or making recommendation-This may need to be omitted.

UAS Program 511 CCFA (CONTRACT REQUIRED FOR ALL SERVICES) continued

Comprehensive Child and Family Assessment
*Includes ALL transportation and mileage cost. / Code 29e
Code 29f / $ 600.00 (First Child)
$150.00each additional child
(ages 0 to 17)
Each child entering foster care is required to have a family assessment completed within (25)days of entering foster care. The family assessment provides the agency with a comprehensive assessment of the strengths and needs of the child and the family. The agency utilizes the assessment to guide the development of the case plan, service provision, and to ultimately meet the needs of the child and family. The Family Assessment report must include Form 419 (Background Information for State Agency Child).
The service includes the CCFA provider complete the following items:
  • Interviewing the child
  • Interviewing the child’s caregiver and extended family.
  • Collecting pertinent records to complete the assessment.
  • Participating in Family team Meetings (3-9 and Case Plans) to gather information and report recommendations
  • Completing a Genogram, Ecomap
  • Reviewing/assessing information to include in the assessment/recommendations of the CCFA.
  • Includes transportation and mileage costs.
Licensed Professionals
  1. Fully Licensed Counselor
  2. Provisionally Licensed Counselor with a Masters in Human Services being supervised by a fully Licensed Counselor
  3. Licensed clinical social workers can also be used
  4. Masters in Human Services being supervised by a fully Licensed Counselor

Relative/Non-Relative Care Assessment / Code 29j / $350.00 per family
Other Family/Relative Assessments are utilized to evaluate the individual for a potential placement or visiting resource for children in foster care. Assessment is completed within (25) days of receipt of the service authorization/referral. The agency utilizes the assessment to determine if the individual can provide a safe environment for the child, has the child’s best interest in mind, and can assist the agency in meeting the permanency goals of the child. The service includes the CCFA provider complete the following items:
  • Interviewing the potential resource (s)
  • Interviewing the household members
  • Assessing the individuals and the home for safety
  • Gathering information (i.e., criminal records, drug screens, medical statements, check stubs, signatures on discipline policy, etc.) necessary to make an assessment regarding the appropriateness of the individual(s)
  • Travel to and from the home of the resource for collection of information
  • Analyzing information gathered to integrate into the completed assessment
  • Includes cost related to a Family Team Meeting (FTM)
  • Includes transportation and mileage costs

Updated Comprehensive Child and Family Assessment
*Remember: Code 29a is also used for Coordination of updated medical/dental/health screen for second CCFA / Code 29m
Code 29n / $300.00 updated family assessment
$75.00 updated assessment or new assessment for additional children (ages 0 to 17)
A Family Reassessment/Addendum is completed when certain circumstances occur that warrants adding to information obtained from a prior Assessment. These circumstances include, but are not limited to:
  • The child exits and re-enters foster care after a previous CCFA has been completed
  • An additional sibling enters foster care after a CCFA has been completed on the family.
  • Includes transportation and mileage costs
The prior assessment should serve as a basis for compilation of the reassessment/addendum, and the provider should verify/update all history and complete all necessary components and observations to compile an accurate family assessment.
CCFA staff requirements for ALL CCFA services:
Licensed Professionals
  1. Fully Licensed Counselor
  2. Provisionally Licensed Counselor with a Masters in Human Services being supervised by a fully Licensed Counselor
  3. Licensed clinical social workers can also be used
  4. Masters in Human Services being supervised by a fully Licensed Counselor

Cancelled Assessment / Code 29o / $ 600.00 maximum per family unit
The County Department has the right to terminate and/or cancel a CCFA if a child returns home at the Adjudicatory (10 Day) hearing. The Invoice with completed work must be submitted within (10) business days of the cancellation date. The amount reimbursed will be based on the documented, completed work. If the CountyDirector feels that the CCFA will assist the agency in continuing to work with the family, the County Director/designee may choose to have the assessment completed even though the child was returned home.
Justification must be provided. ONLY completed components will be paid for.
Court Appearance and/or Testimony / Code 88a / Licensed Professional Rate
$50.00 per hour (Maximum per day amount claimed cannot exceed $400.00)
Court appearances and/or testimony services are provided by the CCFA/Wrap Around provider to support the actions of the agency, children, and families in completing the goals defined in the Case Plan. Funding to support the appearance in court and/or providing testimony by the CCFA/Wrap around Provider is only utilized when the individual is subpoenaed. Court appearances by psychologist/clinician are to be authorized by the SAAG (Special Assistant to the Attorney General).
Licensed ProfessionalsONLY
Licensed clinical social workers can also be used

UAS Program 518 WA (CONTRACT REQUIRED FOR ALL SERVICES)

$5,000 limit per family including transportation costs

Crisis Intervention to Prevent Disruption / Code 24a
Code 24b
Code 24c / Licensed Professional Rate $65.00 per hour
Degreed Professional Rate $35.00 per hour
Mileage Reimbursed at State rate
($150.00 Maximum per service)
Crisis intervention services are utilized to prevent the placement disruption of a child by stabilizing the family situation that does not pose a threat to the safety of the child. These services may be utilized for children in the home of relatives, foster parents, and guardians. Caregivers may also utilize these services when the agency is providing Aftercare services and attempting to prevent the child from re-entering foster care. These services can include but are not limited to:
  • Coordinating community services (i.e., completing applications for services,, making referrals, providing transportation to and from service providers etc.)
  • Counseling (i.e., behavior management, domestic violence, stress management, anger management etc.)
  • In-Home parenting skills training
  • Services cannot exceed 30 days
Licensed Professionals
  1. Fully Licensed Counselor
  2. Provisionally Licensed Counselor with a Masters in Human Services being supervised by a fully Licensed Counselor
  3. Licensed clinical social workers can also be used
  4. Masters in Human Services being supervised by a fully Licensed Counselor
Degreed Professional
  1. Degreed Professional with a Bachelors in Human Service supervised by a fully Licensed Counselor
  2. Family Support Worker with a High School Diploma and 5 years of Human Services experience supervised by a fully Licensed Counselor

Crisis Intervention Behavioral Management / Code 47a
Code 47b
Code 47c / Licensed Professional Rate $65.00 per hour
Degreed Professional Rate $35.00 per hour
Mileage Reimbursed at State rate
($150.00 Maximum per service)
Crisis intervention services utilized for the behavioral management of the child are provided to stabilize and manage the behavior of a child who is at risk of disrupting his or her placement. These services may be utilized when the agency is providing Aftercare Services attempting to prevent the child from re-entering foster care. These services can include but is not limited to:
  • Coordinating community services (i.e., completing applications for services, making referrals, providing transportation to and from service providers etc.)
  • The hourly cost associated with a state approved WRAP provider assisting with the care of a foster care child placed in a hotel overnight when no other placement can be found. An approved waiver from the Regional Director is required.
  • Services cannot exceed 30 days
*Provisional licensed staff, Masters in Human Services staff & FSW staff must have notes by Licensed Counselor in client files.
Licensed Professionals
  1. Fully Licensed Counselor
  2. Provisionally Licensed Counselor with a Masters in Human Services being supervised by a fully Licensed Counselor
  3. Licensed clinical social workers can also be used
  4. Masters in Human Services being supervised by a fully Licensed Counselor
Degreed Professional
  1. Degreed Professional with a Bachelors in Human Service supervised by a fully Licensed Counselor
  2. Family Support Worker with a High School Diploma and 5 years of Human Services experience supervised by a fully Licensed Counselor

Transportation / Code 56a
Code 56b / Paraprofessional $15.00 per hour
Mileage Reimbursed at State rate
Transportation services are utilized solely to transport children and families to and from services to meet goals and steps defined on the case plan.
*Services requiring supervision should be referred and serviced under In-Home case Management.
Transportation services include but are not limited to the following:
  • Transporting child to and from school (no supervision)
  • Transporting child to and from court (no supervision)
  • Transporting parent to child’s doctor appointment (no supervision)
  • Transporting parent home from child’s visit (no supervision)
  • Hourly rate of $15.00 per hour
  • Max $150.00 per service
  • Hourly rate applicable to transporter no matter level of experience
*PLEASE NOTE: Crisis Intervention Services are PROHIBITED during transportation.
This code is used for a Paraprofessional.
In-Home Case Management / Code 71a
Code 71b
Code 71p / Licensed Professional Rate $45.00 per hour
Degreed Professional rate $30.00 per hour
Mileage Reimbursed at State rate ($150.00 maximum per service)
In home Case Management services are provided to assist children and families in meeting the defined permanency goals (i.e., reunification, adoption, custody to relative, guardianship) and steps as outlined in the case plan. These services can include but is not limited to:
  • Coordinating community services (i.e., completing applications for services,, making referrals, providing transportation to and from service providers etc.)
  • Coordinating and supervising visitation between children and their caregivers, relatives, and/or siblings
  • Parent/Behavioral Aide
  • Assist in coordinating and facilitating Family Team Meetings
  • Translation services
*Provisional licensed staff, Masters in Human Services staff & FSW staff must have notes by Licensed Counselor in client files.
Licensed Professionals
  1. Fully Licensed Counselor
  2. Provisionally Licensed Counselor with a Masters in Human Services being supervised by a fully Licensed Counselor
  3. Licensed clinical social workers can also be used
  4. Masters in Human Services being supervised by a fully Licensed Counselor
Degreed Professional
  1. Degreed Professional with a Bachelors in Human Service supervised by a fully Licensed Counselor
  2. Family Support Worker with a High School Diploma and 5 years of Human Services experience supervised by a fully Licensed Counselor

UAS Program 518 WA (CONTRACT REQUIRED FOR ALL SERVICES) continued