Missouri Code of State Regulations
Title 13 - DEPARTMENT OF SOCIAL SERVICES
Division 35 - Children's Division
Chapter 35 - Alternative Care
Section 13 CSR 35-35.100 - Response and Evaluation Process for Case Management of Children in Foster Care
Universal Citation: 13 MO Code of State Regs 35-35.100
Current through Register Vol. 49, No. 18, September 16, 2024
PURPOSE: This rule implements House Bill 1414 (2020), which amended section 210.112, RSMo. The purpose of this rule is to regulate the response and evaluation process for case management services that are identified in the amended statute.
(1) Purpose and Scope.
(A) The purpose of this regulation is
to implement the amendments to section
210.112,
RSMo, that were enacted into law in HB 1414 of the 2020 regular session of the
Missouri General Assembly. This regulation applies to case management services,
whether provided by employees of the Children's Division (hereinafter the
"division") or by Foster Care Case Management Contractors (FCCMs).
(B) In implementing this regulation, the
safety and welfare of children shall be the paramount
consideration.
(2) Definitions. For the purposes of this section the following definitions shall apply:
(A) "Accrediting body" shall refer to
the Council on Accreditation of Services for Children and Families, Inc., the
Joint Commission on Accreditation of Healthcare Organizations, or the
Commission on Accreditation of Rehabilitation Facilities;
(B) "CFSR" shall mean the Child and Family
Services Review process, standards, goals and measures established by the
Administration of Children and Families of the United States Department of
Health and Human Services;
(C)
"CFSR-OSRI" shall refer to the CFSR On-Site Review Instrument utilized by the
Administration of Children and Families of the United States Department of
Health and Human Services;
(D)
"Case management services" shall include assessments, case planning, placement
services, service planning, and concurrent planning for children. These
services include, but are not limited to:
1.
Coordinating and facilitating the provision of services necessary to ensure the
safety and well-being of the child, to meet the needs of the child's parent(s)
or caretaker, and to promote timely permanency;
2. Facilitation of family support team
meetings;
3. Facilitation and/or
supervision of visits between children and their family members;
4. Preparation of court reports;
5. Attending and participating in court
hearings; and
6. Coordination of
services and provisions in compliance with federal and state law, and directed
by Children's Division policy and regulation;
(E) "Child" or "Children" shall mean any
individual who has been placed under the supervision of the division or in the
legal or physical custody of the division by judgment or order of a juvenile or
family court;
(F) "Direct Service
Providers" means any person or entity who is providing case management services
to children and families of children who are under the jurisdiction of the
juvenile court and who are either placed under the supervision of the division
or placed in the legal or physical custody of the division. This applies to
alternative care Children's Division Case Managers and their supervisors, and
to FCCMs;
(G) "Foster Care Case
Management Contractors," "FCCM," or "FCCMs" shall mean any individual or entity
which has a contract with the children's division to provide case management
services for children. It also shall mean any contractor or subcontractor of an
FCCM which provides case management services. It does not mean individual
employees of the FCCM;
(H) "Large
Contractor" shall mean any FCCM which is contracted to provide case management
services for one hundred (100) or more children. It shall also refer to the
lead FCCM contractor and their sub-contracted partner agencies;
(I) A "near fatality" means any physical
injury or illness of a child caused by suspected or substantiated child abuse
or neglect that, as certified by a physician, places the child in serious or
critical condition;
(J) "Provider"
shall mean the Children's Division and FCCM, but shall not mean individual
employees of the division or FCCMs;
(K) "Response and Evaluation Team" or "the
R&E Team" shall refer to the Response and Evaluation Team established
pursuant to 210.112.3, RSMo;
(L)
"Sentinel events" shall mean any critical incident as described in
13 CSR
35-71.070, any unusual event as described in 13 CSR
3573.050 and-
1. A child fatality or near
fatality;
2. An incident that
causes serious emotional harm or serious bodily injury to a child. For purposes
of this regulation a serious emotional or physical injury occurs when it is
medically reasonable or necessary for a child to obtain professional medical
intervention as a result of something that happens to the child while placed
with the individual or organization;
3. A child elopes from his or her
placement;
4. A fire in a location
routinely occupied by children, which requires the fire department to be
called;
5. A report of child
physical abuse, emotional abuse, sexual abuse, or neglect pertaining to a
child; and
6. Whenever a child
attempts to harm him/herself or others, including suicide attempts;
(M) The term "serious bodily
injury" means bodily injury which involves substantial risk of death, extreme
physical pain, protracted and obvious disfigurement, or protracted loss or
impairment of the function of a bodily member, organ, or mental faculty;
and
(N) Children with "Special
Needs" shall include children who have physical, behavioral, or mental health
conditions that require specialized care.
(3) Evaluation Tool and Metrics.
(A) The division shall establish and
implement a uniform evaluation tool, metrics, and performance outcome goals for
providers to evaluate the quality of case management services. Performance
outcome goals, but not metrics, may be adjusted regionally to account for
regional differences in the availability of services, provided that the same
performance outcome goals apply to all providers in the same region; provided
that the performance outcome goals that apply to the division shall be adjusted
to take into consideration the factors set forth in subsection (3)(F). The
division shall establish the tool in conjunction with the R&E Team and
other appropriate individuals. The division may establish and implement the
evaluation tool in phases as described elsewhere in this regulation. The
evaluation tool may draw from the following sources of data and information:
1. Data contained in the information system
of the division, including Family and Children Electronic System
(FACES);
2. Data from
surveys;
3. Detailed case reviews
of individual cases of children as described below;
4. Data and information from federal CSFR
reviews;
5. External audits and
program reviews;
6. Reports from an
accrediting body; and
7. Other
sources of information as may be necessary.
(B) The division will publish the proposed
tool for Phase I on its website by April 1, 2022, and solicit comments from
providers, stakeholders, and the public. Providers may recommend alternative
metrics based on the best interests of the child. In making such
recommendations the providers shall explain, in writing, how the alternative
metrics are in the best interests of the child and promote the safety and
welfare of children. The division and the R&E Team will review the
comments, and the R&E Team will submit recommendations based upon the
comments within thirty (30) days of receipt of the comments. The division will
consider the public comments and recommendations of the R&E Team and
publish final evaluation tools and metrics for Phase I on or before July 31,
2022. The final, Phase I evaluation tools, metrics and performance outcome
goals shall be implemented by and applicable to all effective October 1,
2022.
(C) The evaluation tool shall
include selected metrics and performance outcome goals from the CFSR and the
CFSR-OSRI.
(D) By October 1, 2022,
the division, in conjunction with the R&E Team and following the procedures
set forth in subsection (3)(B), shall implement and all providers are required
to utilize and implement a uniform, standardized stakeholder feedback tool.
This tool will collect data from stakeholders pertaining to the quantity,
quality, and effectiveness of case management services that the division and
FCCMs provide.
1. The tools may be surveys and
will also provide space for stakeholders to provide narrative feedback and
comments.
2. Separate stakeholder
feedback tools shall be designed for and provided to each of the following
categories of stakeholders: children twelve (12) years of age or older, parents
or legal guardians of children, foster parents or resource providers, juvenile
officers, and judges of juvenile and family courts.
3. Stakeholder feedback tools shall be
submitted on the following schedule:
A.
Children twelve (12) years of age or older: annually and at the conclusion of
the time the child is in care;
B.
Foster parents and resource parents annually;
C. Parents or legal guardians of children in
care, annually;
D. Juvenile
officers, annually; and
E. Judges
of the juvenile and/or family courts who preside over proceedings under Chapter
211, RSMo-annually.
(E) The evaluation tool for providers shall
include metrics and performance outcome goals for the following domains listed
below. The division may implement these in phases, but it shall implement at
least one metric and performance outcome goals for each domain in Phase I no
later than October 1, 2022; implement additional metrics and performance goals
in Phase II no later than October 1, 2023; and implement all remaining metrics
and performance goals in Phase III no later than October 1, 2024. The division
may implement additional performance outcome goals and metrics or make
amendments to any domain, performance outcome goal or metric in conjunction
with the Response and Evaluation Team following the process set forth in
subsection (9)(B) of this regulation as may be necessary and appropriate. Some
metrics and performance outcome measures may apply to more than one (1) domain.
To the maximum extent possible, the metrics and performance outcome measures
shall be based upon, and preferably mirror, the federal CSFR and Program
Improvement Plan (PIP) metrics, measures, and goals. The achievement of the
deadlines specified in this regulation are contingent on the availability
information processing capability and the availability of funds that are
necessary for implementation. The division, with the permission of the
Department of Social Services, may extend the deadlines for implementation of a
goal or metric if it is not technically feasible or if there are insufficient
funds to implement by the deadline. The domains are-
1. Safety Domain. The purpose of the Safety
Domain metrics and performance outcome goals is to ensure, to the maximum
extent possible, that children are kept safe from the risk of abuse and/or
neglect for the duration of their experience within the child welfare system.
Metrics and performance outcome goals will be developed and implemented to
address the following:
A. Worker/child
visits;
B. Reports of abuse and/or
neglect of a child;
C. Sentinel
events; and
D. Any other metrics
and outcome goals that may be required by law or that the division may decide
are appropriate;
2.
Well-Being Domain. The purpose of the Well-Being Domain metrics and performance
outcome goals is to ensure, to the maximum extent possible, that children
receive the necessary care and services for them to grow, develop, and thrive
for the duration of their experience within the child welfare system. Metrics
and performance outcome goals will be developed and implemented to address the
following:
A. Parent/child visits to the
extent that they are not contrary to the orders of the court;
B. Healthy Child and Youth program compliance
(i.e. compliance with federal Early and Periodic Screening, Diagnostic, and
Treatment (EPSDT) requirements and standards). This will include timely
completion of Healthy Children and Youth (HCY)/EPSDT screenings and also timely
compliance with diagnosed and prescribed treatment;
C. Residential-Placement of a child in a
residential or institutional setting shall be in compliance with the
requirements of federal and state law;
D. Education-such as achievement of
identified, developmentally, and age appropriate educational
milestones;
E. All case managers
and supervisors successfully complete training in providing trauma informed and
trauma based services; and
F. Any
other metrics and outcome goals that may be required by law or that the
division may decide are appropriate;
3. Permanency Domain. The purpose of the
Permanency Domain metrics and performance outcome goals is to ensure, to the
maximum extent possible, that children achieve permanency and are discharged to
a safe and appropriate placement from the care and supervision of the child
welfare system in a timely manner. Metrics and performance outcome goals will
be developed and implemented to address the following:
A. Worker/parent visits;
B. Re-entries into foster care;
C. Timely achievement of the child's court
approved permanency plan;
D.
Stability of placements;
E.
Provision of services to meet the needs of older youth;
F. Timely development and effective
implementation of a primary and concurrent permanency plan for each
child;
G. Development and
implementation of a social service plan to address the reasons why the child is
in care; and
H. Any other metrics
and outcome goals that may be required by law or that the division may decide
are appropriate; and
4.
Service Domain. The purpose of the Service Domain metrics and performance
outcome goals is to ensure that providers are effectively and efficiently
managing the services that they are providing. Metrics and performance outcome
goals will be developed and implemented to address the following:
A. Caseloads-including caseloads per case
manager and the number of changes in case manager that a child may experience
while a child is in care;
B.
Effective ratio of supervisors to supervision of case managers;
C. Timely reporting of sentinel
events;
D. Cases returned to the
division due to catastrophic costs or court order for case management by Foster
Care Case Management agencies; and
E. Any other metrics and outcome goals that
may be required by law or that the division may decide are
appropriate.
(F) All metrics and performance outcome goals
for the division shall be designed to take into consideration the following
factors:
1. The fact that caseloads of FCCM
case managers are capped; and
2.
The fact that FCCMs may return cases to the division due to catastrophic costs
or court order for case management.
(G) The division, in conjunction with the
R&E Team, shall develop objective standards and criteria to identify cases
which a provider may feel are anomalous and should not be considered in
developing the case management tool. The standards and criteria shall be
implemented following the process and deadlines established in subsection
(3)(B) of this regulation.
(H) To
calculate the performance and outcome scores, the division will calculate for
each provider the percentage of the performance outcome goal for each item in
each domain being scored under 13 CSR 35-35.100 that each provider actually
achieved for that item during the phase for the period. The percentage achieved
for each item under each domain shall then be multiplied by the weight factor
(if any) assigned to each item. The net sum of the weighted percentages will be
the total score for each provider for the period. The performance outcome goals
for the period and the weights to be assigned to each item will be established
by the division, in conjunction with the Research and Evaluation team and other
individuals, following the procedures specified in this
regulation.
(4) Collection of Data.
(A) Effective October 1,
2022, the division and FCCMs shall implement policies and procedures to require
their staffs to timely record all of the necessary data in the information
system. Information shall be timely posted if it is posted no later than the
fifteenth day of each calendar month for the preceding calendar month or sooner
as may be required by policy of the division.
(B) The division and each FCCM shall develop
and implement a system to track the timely and accurate recording of data in
the information system by October 1, 2022; this may include implementing a
system to send reminders to staff or prohibit completion of data entries when
mandatory data fields are not timely completed.
(C) The division will publish a list on its
website describing the specific items of data that providers will be
responsible for recording and reporting. The division will publish its first
list of data items on or before April 1, 2022 to be effective July 1, 2022. The
division shall send a notice by e-mail to all providers notifying them when a
change has been made in the data points at least one (1) quarter prior to the
effective date of the list to ensure that providers have notice and an
opportunity to prepare.
(D)
Detailed Case Reviews.
1. The division and
the R&E Team will utilize the information and findings from individual case
reviews from the federally required, statewide CFSR process.
2. In addition to the CFSR process, the
division, in conjunction with the R&E Team, may develop and implement a
detailed case review process if necessary to supplement the CFSR process and/or
to ensure the quality of data that is being reported and utilized for
calculating metrics and performance outcome goals and measures. The division
and the R&E Team may also utilize detailed case reviews as part of the
process of identifying and providing technical assistance to providers who are
having difficulty meeting performance outcome goals and measures, and for other
purposes as provided in the contract.
3. When a case has been selected for a
detailed individual case review the provider providing case management services
will be given the opportunity to propose different evaluation metrics if the
case may have circumstances far beyond those which would be expected.
A. The division, in conjunction with the
R&E Team and other stakeholders, shall develop and implement objective
standards and criteria for identifying cases which will be evaluated on
different evaluation metrics. The division shall utilize the process described
in subsection (3)(B) for developing, publishing, and implementing the standards
and criteria.
B. The provider shall
make the request to apply different evaluation metrics in writing within ten
(10) days of the date that the division identified the case for a detailed
review. The request shall include:
(I) A
detailed explanation for why the generally applicable criteria and metrics for
conducting case reviews cannot be reasonably and appropriately applied to the
case and why the case may have circumstances far beyond those that would be
expected; and
(II) Explain in
detail what performance measures and metrics the provider proposes that the
division and the R&E Team apply to the review of the case.
C. The provider shall have the
burden of proving that the case falls far beyond what is expected and what
alternative metrics should be applied by clear and convincing
evidence.
D. The division and/or
the R&E Team shall conduct a full case review of each and every case that a
provider identifies as a case that should be evaluated using different
evaluation metrics.
(E) The division will collect data and all
providers will provide data on a monthly basis provided that Detailed Case
Reviews will be conducted when necessary to supplement other data sources as
determined by the division in conjunction with the R&E Team.
(F) Providers shall make available all data,
files, records, and information pertaining to each and every case to the
division and the R&E Team to perform their duties under section
210.112,
RSMo, and this regulation. This includes information maintained in physical and
electronic formats. Providers shall direct their staffs to provide true,
complete, accurate, and timely information to the division and the R&E Team
members when performing their duties under this regulation. Providers shall
make their employees and subcontractors available for interviews when
conducting detailed case reviews.
(G) Providers shall ensure that staff are
trained and have the opportunity to enter data into the information system in a
timely manner to ensure that the data retrieved from the information system is
timely and accurate. Data for the preceding calendar month shall be entered
into the information system no later than the fifteenth day of the following
calendar month or sooner as may be required by policy of the
division.
(H) The data and metrics
shall be analyzed and reported in the aggregate across the whole system, and
then by judicial circuit, county (or city within a county), and
provider.
(5) The division and the R&E Team will develop, propose, and implement a system for reviewing and working with providers who request assistance or who show signs of performance weakness. Performance weakness shall be defined and measured with reference to the metrics and performance outcome goals as discussed in this regulation, in addition to other provisions in the contract.
(A) The division, in conjunction with the
R&E Team, will identify objective, performance measures and standards based
on the metrics and performance goal outcome scores as calculated in subsection
(3)(H) to identify providers who are showing areas in weakness of performance.
This may be done in phases so as to be consistent with the phased
implementation of the evaluation tool and metrics and performance outcome
goals. The division will give the public and stakeholders thirty (30) days to
submit comments and suggestions. The division will consider the comments and
then publish the operational performance measures and standards on the
division's website consistent with the phased implementation
deadlines.
(6) Data Reporting.
(A) The division, in conjunction
with the R&E Team, shall develop and implement a standardized format for
analyzing and reporting the data and lessons learned from the data. This will
ensure that data is analyzed and reported in a consistent and comparable manner
from quarter to quarter. The division will follow the procedures specified in
this regulation for developing and implementing the reporting tools.
(B) All measures, metrics and performance
measures, shall be designed to take into consideration the following factors:
1. The fact that case loads of FCCM case
managers are capped; and
2. The
fact that FCCMs may return cases to the division due to catastrophic costs or
court order for case management.
(C) The division will publish the report
quarterly on its website. The report for the preceding quarter shall be
published on or before the last day of the end of the last month of the
subsequent calendar quarter. The initial report shall be published no later
than March 31, 2023, for the October 1, 2022 through December 31, 2022
quarter.
(D) In developing the
standardized format for reporting, the R&E Team shall be responsible for
determining how to aggregate cases for the division and large contractors; so
that performance and outcomes may be compared effectively while also protecting
confidentiality.
(7) Conflicts of Interest.
(A) Private Providers
shall not participate in conducting detailed case reviews under this regulation
when they or one (1) of their officers, employees, or subcontractors have a
conflict of interest. It shall be considered a conflict of interest-
1. For an officer or employee of a FCCM or
private provider to conduct a case review of a case managed by the FCCM or
private provider which employs them; and/or
2. For an officer or employee of a FCCM or
private provider to conduct a case review of a case managed by a subcontractor
of the FCCM or private provider which employs them; and
3. Where the provider or the employee of the
provider has any interest in the underlying case.
(B) Division staff shall not conduct detailed
case reviews of cases under this regulation arising from the circuit where the
division staff member conducting the review is assigned. The division may
assign special staff not affiliated with any one (1) particular circuit or
region to conduct case reviews.
(C)
No person shall conduct a detailed case review of a case in which he or she
participated as a case manager or supervisor.
(8) All members of the R&E Team shall maintain the confidentiality of all information, documents, and data that they receive in the performance of their duties as members of the R&E Team to the same extent that the information, documents, and data is confidential in the hands of the division, its employees, and contractors. R&E Team members shall submit requests for access to information and data to the division for review.
(9) Review and Evaluation of the Evaluation Tools, metrics, and reporting format.
(A) The R&E Team shall review the
evaluation tool and report format established under this section at least twice
each year and submit a report to the division making any recommendations for
changes in the tool. The reports shall be due each year on or before July 1 and
January 1 with the first report being due July 1, 2023.
(B) The division may amend the evaluation
tool, metrics, and report formats as may be necessary to ensure that
information is collected and reported in an accurate, efficient, and useful
way. The division will utilize the following process to amend the evaluation
tool and report format:
1. The proposed
amendments will be submitted to the R&E Team for review and comment. The
R&E Team will have thirty (30) days to provide comments;
2. The division will then publish an
announcement of the proposed amendments to all providers and to the public by
an announcement on the division's website. The announcement will give providers
and the public thirty (30) days to submit written comments;
3. The division may, but is not required to,
hold one (1) or more public hearings to solicit comments. These public hearings
may be held in person, virtually, or by telephone conference; and
4. The division will consider the comments
from the R&E Team and other sources and publish the final amendments on the
division's website. The amendments shall be effective on the first day of the
calendar quarter following the publication of the amendment; provided however,
that the effective date of the amendment shall not be less than thirty (30)
days from the date of publication.
(C) Twenty-four (24) months after the first
publication of the tools and metrics established under this regulation the
R&E Team and the division shall conduct a comprehensive review of the tools
and metrics established pursuant to the process established in section
210.112,
RSMo, and this regulation. The division shall publish a report on its
evaluation within six (6) months of commencing the review.
Disclaimer: These regulations may not be the most recent version. Missouri may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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