Title IV-E

Quality Assurance and Accountability (QAA) QAA Team: Program Manager 2 Program Supervisors 5 Regional Teams Central – 5 Program Consultants Piedmont – 5 Program Consultants Northern – 5 Program Consultants Eastern – 4 Program Consultants Western – 4 Program Consultants

QAA Reviews The QAA team conducts two types of agency reviews to ensure proper use of IV-E funding Child Welfare Case Reviews Quarterly review of every agency Reviews all new foster care funding cases to ensure proper IV-E eligibility determination IV-E Ongoing Reviews Once a year for every agency Reviews all ongoing IV-E eligible youth for the agency Verifies proper use of IV-E funds for services provided

2nd Quarter FY IV-E CWCR Error Rates

1st to 2nd Quarter Changes Number of cases reviewed Q1 = 648 Cases Reviewed Q2 = 681 Case Reviewed Federal Error Percentage decreased 3.06% 14.51 % to 11.45% AFDC Eligibility decreased 3.59% 10.49% to 6.90% Safety Requirements decreased 1.28% 2.16% to 0.88% Total number of errors found Q1 = 113 errors Q2 = 82 errors

2nd Quarter FY IV-E Ongoing Error Rates

Total Errors vs Cases with an Error Total number of errors found State level, regional level, and agency level Number of cases with an error Federal Case Error Number of cases which had an error regardless of the amount of errors for that case Example: One case had three errors found: 2 ineligible payments and 1 safety requirement finding 3 total errors but only 1 Federal Case Error

2019 Federal Review On-side Review – September 23rd through the 27th, 2019 Period Under Review – October 1, 2018 through March 31, 2019. 80 cases randomly selected (20 oversample) The cases that are determined for the review are selected from the Adoption and Foster Care Analysis and Reporting System (AFCARS). Any case that had at least one IV-E foster care maintenance payment made during the PUR is eligible to be reviewed.

Substantial vs Non-Substantial Compliance During the primary review, out of the 80 cases reviewed the State is allowed up to four federal case errors. If five or more federal case errors are found during the primary review, the State will not be in substantial compliance State must develop a Program Improvement Plan (PIP) State will undergo a secondary review following the completion of the PIP.

Secondary Review 150 cases are pulled from a new Period Under Review State must not exceed the compliance threshold of more than 10 percent in both the federal case error rate and the dollar error rate. If not in compliance with a secondary review, a disallowance is assessed on the basis of the agency’s total foster care population for the 6 month PUR.

QAA Preparation for IV-E Review AFCARS list of every IV-E youth during the PUR Share information with each agency Determine every CRF eligible to be reviewed Safety matrices are up to date Determine every out of state foster home eligible to be reviewed Meetings with federal government begin in April

Agency Preparation for IV-E Review PUR Ends 03/31/19 Complete an internal pull of all IV-E payments made during the federal PUR Provides a list of all cases that are eligible to be pulled Complete a thorough review of every case Eligibility Payment documentation Safety checks for each placement during the PUR Adjustments can be made up until the time we receive the list

Safety Requirements 3.34% of all cases were found to have a safety requirement error Checklist for provider approval and re-approval dates Inconsistent or inaccurate Pulling two resource home files during the review Verifying that the checks were completed and in the file Verifying the dates match the dates on the checklist Proper documentation for LCPA homes in eligibility file LCPA license Certificate of Approval of the home State Form Letter – CRC and Registry Checks

Safety Requirements Best Practice Good working relationship between resource home unit and eligibility unit Tracking each resource home to know when background checks are due Spreadsheets Shared Calendar Sharing these tracking tools with resource and eligibility staff creates another layer of internal quality control

Emergency Approvals Youth can be temporality placed for up to 60 days. IV-E can begin the first day of the month in which all federal safety requirements are met: Fingerprint background results Central Registry verifications All requirements have to be met within the 60 day and the license of approval issued. Example: 60 day emergency approval 09/23/18 – 11/22/18 License of Approval begin date: 11/27/18 – 11/27/21 IV-E cannot pay from 11/23/18 – 11/26/18

Emergency Approvals Best Practice Emergency Approval for title IV-E Reporting Available on the Fusion IV-E website Needs to be completed and put in eligibility file

ICPC Foster Homes Forms 100 A and B should be in eligibility file These forms do not have information regarding background checks Home Study is not required to be in the eligibility file Should have the information regarding background checks QAA consultant will ask to see Home Study to verify checks If checks are not in the Home Study Agency will need to work with ICPC and the other state to get documentation of background checks

OASIS Documentation and Agency Practice Child Information Eligibility Determination: IV-E vs CSA Placement Information Court Information Maintenance Rates Agency Practice Eligibility File All documentation is in file All documentation is in the correct section of the file

Daily Supervision IV-E can pay as long as no services are calculated into the rate Case management Therapy Counseling Assessments Evaluations IV-E does not distinguish between levels A, B, or C

Daily Supervision Rate sheet defines what Daily Supervision entails and no services are being provided – IV-E can pay Therapeutic Behavior Services are built into the rate – IV-E cannot pay.

Daily Supervision Working with Medicaid and CSA Uniform rate sheet Daily Supervision and services are a “combined” rate – IV-E cannot pay. Working with Medicaid and CSA Uniform rate sheet Organizing IV-E/DMAS allowable costs Clear definitions of services

Family-Based Treatment Facility Part of Families First Allows claims for IV-E maintenance payments for a child placed with a parent in a licensed residential family-based treatment facility for substance abuse Currently no such facilities in VA are licensed up to the standards as specified by Families First Child must meet all IV-E foster eligibility requirements except the AFDC eligibility requirements Evaluation on Fusion Broadcast 09/24/18

January DYK – VEMAT Scores of 36 Common and costly VEMAT scores 28 or above must be reassessed every 3 months VEMAT score of 36 due solely to severe medical and physical needs can be assessed annually Physicians statement Detailing the child’s condition Statement that the condition is unlikely to improve Obtained within three months of the initial VEMAT Assessment score of 36 New statement must be obtained along with the next annual VEMAT Assessment

January DYK – VEMAT Scores of 36 If the agency does not receive the physician’s statement prior to the expiration date of the first VEMAT with the score of 36, then title IV-E funds should cease beginning the first day of the following month. Example: VEMAT effective 02/01/18 – 04/30/18 Physicians statement not obtained prior to 04/30/18 IV-E funds cannot be used beginning 05/01/18 If the agency receives a physician’s statement after the expiration of the VEMAT, title IV-E funds can be used again beginning the first day of the month following receipt of the statement for the remainder of the year of approval

VEMAT Best Practice Excel spreadsheet of all VEMATs and due dates Shared calendar with all VEMAT due dates Eligibility workers can serve as a secondary level of internal quality assurance. Any questions on the quality of the physician’s statement should be sent to regional permanency consultant

December DYK - Definitions and Details: Title IV-E Allowable Costs Available on the Fusion IV-E website

Supplemental Clothing Allowance Most common issue is the lack of documentation to support the purchase of clothing. Receipts need to be in eligibility file to support payment Shipping and handling is a non-reimbursable cost Shall not exceed the designated rate Regardless of IV-E, CSA, or combination of the two It should be used by May 31st of each year The date the bill is paid determines the fiscal year in which the payment is counted when it comes to fiscal year end

Supplemental Clothing Allowance Best Practice IV-E Quick Reference Guide: Internal Clothing Tracking Tool Ensure the agency does not go over Track which youth still has money available at the end of the fiscal year

Role of Finance Staff in IV-E Knowing which youth are IV-E eligible Access to OASIS Easily accessible database of IV-E eligible youth Knowing which payments can be paid from IV-E Knowing IV-E rules surrounding eligible payments Tracking of clothing allowances Communication Notice of Action

Updated IV-E Application/Evaluation Updated IV-E Application has been posted to Fusion An e-mail went out via our DYK distribution list with the application and description of changes Currently working on a updated IV-E Evaluation Once approved, will be posted to Fusion and sent to all agencies

Title IV-E Training New IV-E Training is offered every month Each training should be posted to the Learning Center six months prior to training taking place Online IV-E modules are available on Learning Center and are prerequisites for the in class training

Contact Information Morgan Nelson – QAA Program Manager Morgan.nelson1@dss.Virginia.gov 804-726-7521 Matthew Lafrinere – QAA Program Supervisor Matthew.lafrinere@dss.Virginia.gov 804-351-6203