Principles guiding the rate redesign
- Rate reimbursements must support a foster system that keeps children safe and healthy.
- No surprises. The process of changing the rate reimbursement structure will be transparent to foster parents, stakeholders and interested parties.
- Maximize federal dollars for foster children as we meet the new federal mandates. In responding to the new federal rules, we will design a system that ensures the greatest federal support for Oregon’s foster children.
- Make the system more fair, consistent and transparent. From first-time relative foster parents to seasoned veterans, the system has to work for all foster parents.
- Keep foster parents involved. As we improve the rate reimbursement process, foster parent involvement will help us make the best decisions for Oregon’s foster children.
- Use the work done before as guidelines. The rate redesign will use the input of foster parents from prior workgroups and hearings to point the way to a better system for Oregon’s foster children.
Changes are coming next year for foster parent reimbursement rates that will affect all foster families--From reletives who are caring for one child for the first time to long-time foster homes that housde up to seven children.
Our goal when making these changes is to create a system that is more fair, more consistent and more transparent, and we also want to make sure that not foster parent is surprised by the changes.
The changes are necessary because of guidance from the federal government, which provides most of the funding for foster care. Some federal funds will not be available in the way they were before, other federal funds will be more available.
The changes are also necessary because foster parents across the state are adking for a better system. The work of foster parents is critical to keeping Oregon's children safe.
Foster parent involvement is key to ensuring that we create the best possible rate reimbursement system. We are working closely with foster parents to get their input and advice about how we move forward with creating a system that meets the federal guidance and is more fair, consistent and transparent.
Q. How are foster parents involved?
1. The Foster Parent Advisory Group, which includes more than 60 people from all corners of Oregon.
2. The Operation Steering Committee, which includes foster parents, Children, Adults and Familes Division (CAF) staff, and other Department of Human Services staff.
3. The Behavioral Sub-Committee, which includes foster parents and representatives from CAF and Addictions and Mental Health Division.
4. The Medical Tier Foster Care Sub-Committee, which includes foster parents, a registered nurse, medically fragile certifiers and CAF staff.
Check www.oregon.gov/dhs/ for more information
Oregon Department of Human Services
Children Adults and Family Division
October 15, 2008
Foster Care Rate Redesign - Frequently Asked Questions
Q. I live in Multnomah County and got a letter that says effective immediately I will no longer be reimbursed for respite care and that I will have to use a specific provider. Is that really happening?
Not right now. Based on the feedback we have received regarding changes in respite care reimbursement we are not immediately moving forward with this plan. While the federal directives are very specific that we have to change the way we handle respite care for foster parents in Oregon, foster parents have made it clear that the solution needs to be part of the larger rate design discussion.
Bottom line: the respite care change is not happening immediately and you do not have to change the way you handle respite care right now.
Q: When is the rate reimbursement structure changing?
A. In order to meet the deadlines set by the federal government, the plan must be in place by February in order for the changes to begin on April 1, 2009. The actual implementation will be phased in from April 1, 2009 to September 30, 2009. The federal government has directed that all changes must be completed by September 30, 2009.
Q. What will be changed in the rate reimbursement system?
A. One of the most important changes will be that children will not need to be reassessed if there is a change in placement – the level of reimbursement will follow the child. Also, a diagnosis will not be necessary for a child to be eligible for enhanced reimbursement related to behavioral or mental health issues. You can also expect that the ways we have reimbursed foster parents to be structured differently, including changes to the shelter rates, base rated, medical and behavioral reimbursement and respite care.
Q. Why is the rate restructuring necessary?
A. As in other states, most of the money for foster care comes from the federal government and recently a federal audit concluded that Oregon must make changes in the way we use federal dollars to reimburse foster parents. There are new restrictions on Medicaid revenue but also new opportunities in how we leverage other federal funds. There will also be changes to ensure that rates are more fair and objective and follow the child no matter where he or she is placed.
Q. In addition to making the system more fair and transparent, what other benefits will come of the redesign?
A. The new system will reduce the work required by agency staff to establish a rate for a child, eliminate the need for reassessment of children upon a placement change, and significantly reduce delays in payment. Also, the instrument used to establish the rate will include a comprehensive screening to assist in the planning around the physical health, mental health, educational, and attachment needs for the child.
Q. Will my reimbursement rates increase? Will they decrease?
A. We don’t know the answer to that yet and we won’t until the final plan is in place. Here is what we do know: the rules about how we use federal money have changed. These are the details that will be on the table over the next few months. The reality is that some foster parents may see increases in their rates, others may see decreases.
Q. When would I see a difference in my reimbursement?
A. Changes will be phased in between April 1, 2009 to September 30, 2009. When each foster parent sees the change – if there is one – would depend on many factors such as the child you are fostering and when your contract is up for renewal. We will have more details as we get closer to implementation date.
Q. What happens if we don’t make the changes?
A. Tens of millions of dollars are at stake that we currently receive from the federal government. In addition, if we do not make the changes, the federal government could impose fines on the Department of Human Services.
Q. Many foster parents say the rates are currently too low. What are you going to do to increase overall reimbursement rates and how is this change connected to that?
A. Children Adults and Family has been working with foster parents to narrow the gap identified in the “On the Mark” report between where we are on foster care reimbursement and where we should be. Out of that work CAF submitted a request for increased foster care rates for the 2009-2011 budget, but given national and statewide economic difficulties at this point it seems unlikely this request will be approved.
The current rate redesign is about our current 2007-2009 budget and it has to balance to that with the money available. In these current economic times we may not get to our goals in 2009 but we will have a more fair and transparent system that will be the foundation for the future. We will continue to stand with foster parents on telling the story of why the gap in foster care rate reimbursement must be narrowed in order to give Oregon’s foster children the best care possible.
Q. What has been done so far to implement these changes?
A. The final direction from the federal government came through in September 2008. Children, Adult and Family (CAF) staff has reviewed recommendations from the Oregon Foster Parent Association and others, along with best practices from other states. CAF staff is putting this information together to be presented to foster parents and stakeholders.
Q. How can foster parents get involved or make their opinions heard?
A. There are four foster parent advisor groups involved in the rate reimbursement redesign.
The Foster Parent Advisory Group includes more than 60 people from all corners of Oregon.
The Operation Steering Committee, which includes foster parents, Children Adult and Family Staff, and Department of Human Services Staff.
The Behavioral Sub-Committee, which includes foster parents and representatives from Children Adults and Family Division of DHS as well as Addictions and Mental Health.
The Medical Tier Foster Care Sub-Committee, which includes foster parents a registered nurse, medically fragile specialized certifiers and CAF staff.
Q. What are you using as a basis for the rate redesign?
A. The Child and Adolescent Needs and Strengths (CANS) instrument has been selected and is being modified to meet Oregon's needs. This is an instrument, in various forms, that is being used in over 20 states across the nation for the purpose of determining children's needs and level of care. It has been reviewed and recommended by Oregon Foster Parent work groups.
Q. Can you give more information about what's changing in the way federal revenues will be coming into Oregon?
A. The federal government will no longer allow us to use Medicaid funding to reimburse our foster parents for children with high behavioral needs. Because of this will be shifting our revenue stream to Title IV-E, the program that has funded our Foster Care Program for years. Each federal program has their own set of rules which means we will need to change the way that we do business to maximize the funding for our states Foster Care Program.
Q. What does it mean that the rate will follow the child?
A. Currently when children move into another placement the reimbursements rates are reassessed. That causes extra work for the new foster parents and isn't necessary because children's needs do not change when their home does. The new reassessment schedule will be based on the needs of the child and provide more accurate information.
