MONDAY REPORT

March 17, 2003

SPECIAL NOTE:  Copyright 2003. The Monday Report is produced each week as a benefit to the member agencies of the Child Care Association. Please protect this membership benefit - DO NOT copy and distribute this report to agencies/staff that are not members of CCA. Thank you for your cooperation.

CHILD WELFARE.. 1

GOVERNOR�S STATE OF THE STATE ADDRESS.. 1

RESIDENTIAL SERVICE NETWORK FOR DCFS WORK GROUP REPORT.. 2

COST REPORT ANALYSIS.. 3

FEDERAL FINANCING OF CHILD WELFARE.. 3

DOWNSTATE PERFORMANCE WORK GROUP MEETING.. 4

DHHS ESTABLISHES RURAL ASSISTANCE CENTER.. 7

FAMILY CENTERED SERVICES STEERING COMMITTEE.. 8

EDUCATION.. 8

CCA MEMBERS WITH ORPHANAGE ACT PROGRAMS.. 8

GENERAL.. 8

BUSH WANTS HIPAA ENFORCEMENT FUNDS.. 8

HIPAA PRIVACY ISSUES.. 9

DHS RULE AMENDMENTS FOR ALCOHOLISM AND SUBSTANCE ABUSE PROVIDERS TO INCLUDE HIPAA.. 9

HHS ADOPTS FINAL SECURITY STANDARDS UNDER HIPAA.. 9

CCAI CONGRATULATES PHIL WARTH, JR ON HIS INDUCTION INTO THE 2002 CHICAGO AREA ENTREPRENEURSHIP HALL OF FAME.. 10

UPCOMING EVENTS.. 10

CUNNINGHAM CHILDREN�S HOME TO HOST TCI TRAINER�S UPDATE.. 10

MARK YOUR CALENDAR FOR CCAI�s ANNUAL MEETING.. 10

CALENDAR.. 10

GOVERNOR�S STATE OF THE STATE ADDRESS

Governor Blagojevich delivered his first State of the State address on March 12. He noted the state faces unprecedented challenges including its largest budget deficit ever and an ethical crisis in state government. The governor emphasized proposals to address people�s concerns in four core areas: jobs, education, public safety and prescription drugs for seniors. The area of jobs will include establishment of entrepreneurship centers, clean coal technology development and establishment of the Illinois Opportunity Fund to attract investments in the state. Perhaps most significant for CCAI agencies as employers is the governor�s proposal to increase the minimum wage in Illinois by $1.35/hour.

Proposals in the area of education include providing universal preschool, creating the Illinois Future Teacher Corps to provide scholarships for teachers for public schools, and expanding parental involvement. In the area of public safety, the governor proposed doubling the number of parole agents as more than 35,000 ex-offenders are released from prison, reopening of Sheridan Correctional Center as a model institution to deter drug crime, tripling of the investment in the Club Drugs Task Force and creation of a Statewide Terrorism Intelligence Center.   In the area of Prescription drugs, he proposed cost savings via consolidation of state purchasing, creating a discount card for seniors, expanding the number of seniors covered on the circuit breaker program and expansion of Family Care and Kid Care insurance programs.

The Governor�s estimated costs for his proposals are $88 million. He repeated his promise to balance the budget without an increase in the income or sales tax.

We must wait until April 9 for the Governor�s Budget Address. We will then be able to ascertain the full impact of any state budget decisions on our agencies. CCAI agencies can use this time productively, however. We ask you to respond to our survey about the impact of the minimum wage increase on your workforce and budget, about the amount of voluntary dollars used in your agency for operations, and about the current impact of budget cuts. We also ask you to study the CCAI tracking we are doing on pending bills and make those important calls to your senators and representatives!!! (MB)

RESIDENTIAL SERVICE NETWORK FOR DCFS WORK GROUP REPORT

The RSN work group of DCFS met in Chicago on March 13. The following topics were addressed:

Agencies should expect a call from DCFS within the next 2 weeks regarding their programs� status for the RSN. There will be a date set for the next work group meeting in the next 4-6 weeks. (MB)

COST REPORT ANALYSIS

CCAI has previously sent e-mails to member agencies asking you to share your cost reports with the CCAI finance group. The finance group will convene to identify sector trends and potentially develop ideas for alternate ways of financing child welfare programs in the future. The information you submit will be treated confidentially. We ask you to submit your most recent cost reports to Marge Berglind at the CCAI Springfield office. To date, six agencies have submitted the reports and 2 others have committed to sharing them when finalized. This will not be enough material for us to glean any trends. Please submit your reports today. Call Marge Berglind if you have any questions. (MB)

FEDERAL FINANCING OF CHILD WELFARE

We previously reported on the proposal by DHHS for more flexible use of federal funding for child welfare.  DHHS/ACF reports:

�This new, broad flexibility will allow states to develop a child welfare system that supports a range of services to families in crisis and children at risk, while removing the burdens of many federal requirements. We are providing children with foundations for a healthy future and strong, happy family life.

Secretary Thompson testified before the House Ways and Means Committee on the Child Welfare Program Option in the President�s FY 2004 budget that offers states a more flexible alternative to the current foster care entitlement program to best serve children and their families.

What will the Child Welfare Program Option allow states to do?

�      This new, broad flexibility will allow states to develop a child welfare system that supports a range of services to families in crisis and children at risk, while removing the burdens of many federal requirements.

�      States are the laboratory of innovation, and the field of child welfare is no different. We are looking to governors to create stronger child welfare systems to promote strong and healthy families.

�      We are providing children with foundations for a healthy future and strong, happy family life.

�      Background

�      Under the current system, these funds can only be used to provide services to children after they have been removed from their home due to abuse or neglect.

�      Under the President�s proposal, states would be allowed to use the funds for a much broader range of activities, including:

◉      Prevention, such as parenting education, home visiting programs and family strengthening activities.

◉      Permanency efforts, including reunification and adoption services.

◉      Training for child welfare workers and foster parents.

�      All states choosing this funding option must maintain the existing child protections to ensure child safety, permanency and well-being.�

We ask all member agencies to study this proposal and share ideas with CCAI on how you think such a flexible option could be used. We also ask you to share ideas about any areas you feel will be detrimental to the state�s financing of child welfare. We intend to bring these ideas to DCFS and the new administration. (MB)

DOWNSTATE PERFORMANCE WORK GROUP MEETING

The downstate Performance Work Group meeting was held in Springfield on February 27. Topics included:

�      Update on DCFS Personnel Changes

Larry Chasey reported that:

○       Close to 600 retirements from department staff of about 4000

○       Jeff Buhrmann retiring and Larry Chasey taking over Operations responsibility for this group

○       Regions have developed coverage plans in those areas where retirements have left vacated responsibilities.

�      Access to Psychiatric Services for Children/Consent Procedures

Jo Anna Sullivan indicated the department continues to apply pressure to Public Aid to more completely develop their provider network, particularly where providers are limited or non-existent.

○       Dr. Naylor asked consideration of telepsychiatry as an option for those areas with limited child psychiatric services

○       Proposed HB 2900 identifies access to mental health services as the target for a special study by the department

○       Dr. Naylor also suggested the possibility of UIC consultation with local mental health centers similar to how that happens currently in the CARTS program

○       Guardian�s office is responding to medication approvals within 24 to 48 hours

○       Teresa Matthews is the new Assistant Guardian Administrator (312) 814-8600.  She should be contacted with any concerns about a pending approval.

○       Dr. Naylor now does the medication approvals and he explained his process.  Each denial is fully researched, is reasoned and reasonable.  95% are done within 4 hours and 99% in the same day.  The reviews for approvals/denials are only done by board certified child psychiatrists.  Dr. Naylor indicated he is willing to speak with any Dr. to discuss a denial.  His phone number is (312) 413-4567 or (877) 615-2713.

○       Jeannie Ortega-Piron indicated a written description of the process for medication authorizations is being developed and will be shared with providers and doctors when it is complete

○       Rule 325 on Guardianship approvals has been rewritten and will be released soon.  It calls for an Over-site Treatment Team to review special medication circumstances.

○       Jean Ortega-Piron noted that the longer wait was in the Central Region, and commented that she was continuing to push for standardization across regions and a centralized process for consents.

�      Sibling Visitation

Trish Fox discussed the outcome of the work group:                                                            

○       Conference call held 1/29

○       Some improvements noted, but there has not been a reduction of fines through 9/02

○       Additional education efforts were committed by ACR and POS providers

○       Noted that POS agencies do not access transportation as often as DCFS

○       Surveys forms are available for feedback on ACR reviews/reviewers

○       163 agency sanctions from 2/02 to 9/02

○       150-mile exception does apply to foster care, but visits are still required to occur every other month for a minimum of 4 hours and preferably overnight.

○       Before changes can be advocated for, there has to be significant improvement in compliance

○       Payments are late and the department is attempting to improve the timeliness

○       Melissa Ludington interested in receiving any ideas for improving Aristotle P performance

○       Group to meet again by phone in 3 months to review progress

�     Permanency and Stability Reconciliation/Bonus

Laura Feddersen of DCFS reported that:

○    FY�03 midyear reconciliation letters coming soon

○    Bonus payments were delayed; placed on system 2/21/03

○    GRF payments are currently taking at least 10 weeks

�     Rotation System Workgroup Update

Tricia Fox reported that:

○       Issues with cases getting around tracking system are being evaluated

○       Looking at impact on rotation of teams serving multiple field offices

○       Discussion on stability determination

○       Data shared of groupings of current children in care by provider into age categories. This is to begin getting a picture of age distribution comparisons to see if any impacts are seen on rotation assignments as well as stability factors. Initial evaluation by Jason House suggests little impact from age on stability. More evaluation being completed

○       Issue raised about 365-day rule in current rotation guidelines and possible conflict with Foster Parent preference for youth returning to care. Workgroup will look into this further, but interim guidance was that rotation would continue as in the past regarding case assignment, while placement decision would consider foster parent homes previously utilized regardless of how many days have passed.

�     Court Performance

Jeff Buhrmann reported that:

○       Decision memo has been submitted to Director and he has asked for a meeting next week

○       Developed form and procedures have been well supported

�     Children Absent From Placement

Jeff Buhrmann reported that:

○       Providers are reminded to report runaways immediately through 906 and to insure prompt completion of 1014

○       Must be certain a missing person report is filed and remains active with the police with LEADS, particularly for youth who are frequent runners. LEADS is cancelled whenever the police locate a child, so it has to be reestablished for every incident.

○       Downstate has been doing very well on runaway procedures compliance

○       Increased media attention to the issue of missing children was discussed

�     Title IV-E Reasonable Efforts to Achieve Permanency

Larry Chasey reported:

○       Reminder to providers to insure court orders documenting reasonable efforts are in all case records

○       Federal review will be doing a random sample from all cases active anytime during the period of April 2003 through September 2003. Reviews to follow shortly after.

○       Issue was identified regarding difficulty some providers are having getting copies of investigations that happened prior to the investigation that resulted in the placement. Larry Chasey to follow up with John Goad and Kathy Roman for resolution.

�     FY 04 PCD Contract Program Plan

Larry Chasey reported:

○       Same Contract work group from last year led by Bill Franklin will function again this year

○       Work group to have conference call with Melissa Ludington and Mary Sue Morsch week of March 8^th to discuss any issues for new contract

�     Other Issues

○       There was a Day Care audit finding that has resulted in the department having to go back to a more restrictive practice of following the established authorization rules more precisely. Among the changes, one that is significant is that regions will no longer be able to post-date day care reimbursement.  Providers need to make sure they seek authorization immediately when it is needed.

○       Issue raised regarding scheduling conflicts with ACR reviews. The attempt will be made for an ACR representative to participate in the next meeting.

○       Issue raised regarding Emergency Cash Assistance with family preservation contracts. New procedures should be out very soon. Basically the change is that these disbursements must follow the same guidelines as Norman cash assistance, and be used only for those situations where a family does not qualify for Norman. Confusion over the approval level will be brought to Support Services division for resolution.

○       Issue raised with proposed foster care Placement Restrictions and possible emergency rule. It was determined that the emergency rule was at the printers and will be out shortly. Comments on the proposed policy on Placement Restrictions are due 2/28/03.

�     Next Meeting Dates

○       Decision made to meet monthly for at least the next few months

○       Next Meeting 3/27 in Springfield, 1 to 3 pm, at the Springfield Field Office. (We thank Larry Chasey of DCFS and Trish Fox of Catholic Charities of Peoria for this report.) (MB)

DHHS ESTABLISHES RURAL ASSISTANCE CENTER

The Rural Assistance Center was established in 2002 as a rural health and human services �information portal.� The Rural Assistance Center program stems from the U.S. Department of Health and Human Services� Rural Initiative. RAC helps rural communities and other rural stakeholders access the full range of available programs, funding, and research that can enable them to provide quality health and human services to rural residents. To achieve its goals, RAC:

� Identifies and collects sources of rural health and human services research, support programs, funding, and related information;

� Archives and makes information accessible;

� Disseminates information and promotes the use of RAC�s service by rural communities, policymakers, researchers, and others; and

� Integrates information into policy-relevant and implementation-specific frameworks.

RAC offers many services to help inform decisions affecting rural health and human services. All services are provided free of charge. Web-Based Services include:

� Online clearinghouse � provides quick and easy access to a wide range of documents and federal programs.

� Congressional bill tracking � monitors and reports legislative developments in the rural health and human services arena.

� Calendar of events � lists conferences, workshops, and other events of interest to those concerned with rural health and human services.

� The Rural Monitor � provides quarterly up-to-date and in-depth coverage on issues concerning the well-being of rural America.

� RAC Listserv � offers subscribers a way to stay abreast of announcements, research findings, and late-breaking news.

Customized Assistance

RAC maintains a clearinghouse of rural health and human services resources. Our information specialists provide free customized assistance including:

� Performing database searches on rural health and human services topics and funding sources;

� Performing literature searches and furnishing relevant publications;

� Referring users to organizations or individuals that are best able to address their information needs. By putting callers with rural health and human service issues in contact with appropriate Department of Health and Human Services contacts, the RAC also serves as a single point of entry into the Department.

RAC is a collaboration of several top-rated rural health and human services organizations. RAC partners include:

Center for Rural Health (CRH)

The University of North Dakota Center for Rural Health serves as the lead organization for the Rural Assistance Center initiative. The Center for Rural Health researches rural health issues, analyzes health policy, strengthens local capacity in the health arena, develops community-based health care alternatives, and provides leadership in the field of rural health.

Welfare Information Network (WIN)

The Welfare Information Network of The Finance Project helps states and communities obtain information, policy analysis, and technical assistance to develop and implement welfare reforms that reduce dependency and promote the well-being of families and children. WIN maintains a web site and clearinghouse that provides access to more than 10,000 resources and covers more than 60 social service program and management issues.

Rural Policy Research Institute (RUPRI)

The Rural Policy Research Institute is a multi-state interdisciplinary research consortium, sponsored by Iowa State University, the University of Missouri, and the University of Nebraska. RUPRI�s mission is to provide objective analysis and facilitate public dialogue concerning the impacts of public policy on rural people and places.

Office of Rural Health Policy (ORHP)

The Rural Assistance Center is supported by a grant from the Health Resources and Services Administration�s Office of Rural Health Policy. ORHP promotes better health care service in rural America. Established in 1987, ORHP is located in the Health Resources and Services Administration, U.S. Department of Health and Human Services and is charged with informing and advising the Department on matters affecting rural hospitals and health care; coordinating activities within the Department that relate to rural health care; working with states, private associations, foundations and other organizations to find solutions to rural health care delivery problems; and maintaining a national information clearinghouse. For more information, call (301) 443-0835 or visit http://www.ruralhealth.hrsa.gov. The web site is: www.raconline.org. (MB)

FAMILY CENTERED SERVICES STEERING COMMITTEE

The Family Centered Services Steering Committee met through video conferencing on March 6, 2003 at the Chicago and Springfield sites.  It was reported at the meeting that it is expected that the Family Centered Services program would maintain its current level of funding for next fiscal year at $5 million.  Presentations were made by a Chicago LAN and a downstate LAN with information regarding how the efforts toward targeting referrals from DCP were going since the requirement of the programs are that 50% of the referrals should be from DCP.  The downstate LAN appeared to have developed a process to address the referrals from DCP which earlier in the program year were not occurring.  The Chicago area LAN indicated that there needed to be further development of the relationship between DCP and the family centered services providers.  DCFS also collected information from Sept. through December 2002 regarding the number of referrals, number of children served and parents served.  Not all programs submitted information during this first reporting period depending on their start up date for the year.  The total number of children served during this time period by those providers that reported was 2582.  The number of DCP referrals was less than the 50% requirement.  The next meeting of the group will be June 5, 2003.  (JMS)

CCA MEMBERS WITH ORPHANAGE ACT PROGRAMS

Please write or call your local state senators regarding Senate Bill 1333, sponsored by Susan Garrett.  This legislation replaces the full funding requirement that was removed from the Orphanage Act during budget negotiations last year.  The bill is now on 2^nd reading in the Senate.  In 1994, the private and public sectors worked together to address the problem of deficits in the cost of educating DCFS wards.  Our proposed legislation unanimously passed the General Assembly at that time.  It is critical that CCA and its members support school districts� current efforts to obtain 100% of the costs of educating the children who are in the DCFS system (BRH).

BUSH WANTS HIPAA ENFORCEMENT FUNDS

The Centers for Medicare and Medicaid Services would receive $10 million in fiscal year 2004 to begin activities related to enforcement of HIPAA�s transactions and code sets, security and identifier rules, under President Bush�s proposed budget for the Department of Health and Human Services. Such activities would include the promulgation of a HIPAA enforcement rule, according to a briefing paper, available at: www.hhsgov/budget/docbudget.htm.

�In order to enforce the HIPAA standards, CMS will assemble an enforcement staff, write an enforcement regulation that outlines the enforcement program, implement the enforcement system and begin to accept complaints,� according to the briefing paper.  �CMS intends to provide education and technical assistance to covered entities to help them achieve compliance, rather than seeking out noncompliant entities and imposing fines on them.  If a covered entity is found to be noncompliant, CMS will work with them to achieve compliance and will only impose civil monetary penalties if these efforts fail.�

The proposed HHS budget includes $34 million in total spending for the Office of Civil Rights, which will enforce the HIPAA privacy rule.  That spending level is only $1 million more than the office�s 2003 budget.  It is unclear how much funding the office will have for privacy rule enforcement.  (JMS)

HIPAA PRIVACY ISSUES

As agencies move forward with development and implementation of the privacy policies required to comply with HIPAA, there are specific state privacy issues that will need to be addressed.  Three categories that the state privacy issues could fall into are: 1.) Some states require that consumers can view their information and do not allow the �threat to self, threat to others clause� as reason to deny access to records.  State law always supercedes when it is more stringent. 2.) Sometimes states have longer timeframes for archiving records (HIPAA says 6). 3.) Some states allow minors to be the signatory in certain therapeutic relationships.   There could be others also.  Agencies need to review with an attorney to assess where state law is more stringent than HIPAA.  At the training that CCAI had provided to members it was reported that a preemption report on Illinois privacy requirements was being completed.  We hope to determine how copies might be obtained.  (JMS)

DHS RULE AMENDMENTS FOR ALCOHOLISM AND SUBSTANCE ABUSE PROVIDERS TO INCLUDE HIPAA

DHS proposed amendments for �Alcoholism and Substance Abuse Treatment and Intervention Licenses� (77 Ill Adm code 2060) to establish procedures for licensees to follow in compliance with the federal Health Insurance Portability and Accountability Act (HIPAA).  The HIPAA and its regulations are designed to protect patient and client confidentiality and also require health care providers to account for protected health information disclosures for 6 years.  This rulemaking specifies that licensed organizations shall establish policies and procedures to comply with HIPAA regulations and give written notice to patients concerning the use and disclosure of their protected health information and how such information is maintained.  Licensees must also specify procedures for filing a complaint with the licensee or the federal Office of Civil Rights in connection with an alleged violation of HIPAA privacy provisions.  Small businesses, small municipalities, and not-for-profit corporations affected by these amendments include licensed alcoholism and substance abuse treatment providers serving DHS clients.  For copies of the rule or to submit comments, you have until 4/14/03.  They should go to Karl Menninger, DHS, 100 S. Grand Ave. E. 3^rd Fl., Springfield, IL  62762.

(JMS)

HHS ADOPTS FINAL SECURITY STANDARDS UNDER HIPAA

On February 13, 2003, HHS Secretary announced the adoption of final security standards for protecting individually identifiable health information when it is maintained or transmitted electronically.  At the same time he also announced the adoption of modifications to a number of the electronic transactions and code sets adopted as national standards. Both final regulations are required as part of the administrative simplification provisions included in the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Overall, these national standards required under HIPAA will make it easier and less costly for the health care industry to process health claims and handle other transactions while assuring patients that their information will remain secure and confidential.  The security standards in particular will help safeguard confidential health information as the industry increasingly relies on computers for processing health care transactions.

Under the security standards announced today, health insurers, certain health care providers and health care clearinghouses must establish procedures and mechanisms to protect the confidentiality, integrity and availability of electronic protected health information.  The rule requires covered entities to implement administrative, physical and technical safeguards to protect electronic protected health information in their care.

The security standards will be published as a final rule in the Feb. 20 Federal Register with an effective date of April 21, 2003.  Most covered entities will have two full years � until April 21, 2005 � to comply with the standards.  CMS (Centers for Medicaid and Medicare Services�) is responsible for implementing and enforcing the security standards, the transactions standards and other HIPAA administrative simplification provisions, except for the privacy standards.  HHS� Office for Civil Rights is responsible for implementing and enforcing the privacy rule.  For additional information and a full copy of this rule go to: www.hipaadvisory.com/news/2003/0213hhs.htm. (JMS)

CCAI CONGRATULATES PHIL WARTH, JR ON HIS INDUCTION INTO THE 2002 CHICAGO AREA ENTREPRENEURSHIP HALL OF FAME

The Institute for Entrepreneurial Studies at the University of Chicago selected Phil Warth, CEO of First Nonprofit Insurance Company, for its� 2002 induction.  The Child Care Association of Illinois has worked in partnership with First Nonprofit for several years.  Thirty percent of CCAI members are insured with First Nonprofit and have saved significant dollars over the years through their plans.  (SKA)

CUNNINGHAM CHILDREN�S HOME TO HOST TCI TRAINER�S UPDATE

Cunningham Children�s Home in Urbana is hosting a TCI Trainer�s Update on July 21-22.  The focus will be on adapting TCI concepts and techniques for persons with Developmental Disabilities. For information contact Alan Oathout at 217/367-3728 or email Alan at [email protected].  (SKA)

MARK YOUR CALENDAR FOR CCAI�s ANNUAL MEETING

The association will hold its� Annual Membership Meeting, and Barbecue on June 4-5 at the Crowne Plaza in Springfield.  Be sure to mark your calendar and hold those dates.  (SKA)

CALENDAR

March 20 � CCAI Spring Membership Meeting, Hickory Ridge Conference Center, Lisle

March 29 - Workshops on Learning Disabilities, Attention Deficit Disorder, and Behavioral

                  and Emotional Disabilities by Patrick Schwarz, Bev Johns, and Sue Greene,

                  Howard Mohr Community Center, 7640 Jackson Blvd., Forest Park IL, contact

                  Family Resource Center on Disabilities (312) 939-3513

April 8 � Dr. Larry Brendtro and Dr Nicholas J. Long; for information please contact Dave

              McKenna (847) 245-6393 or [email protected]

April 9 & 10 � Life Space Crisis Intervention 2-Day Foundation Skills; for information please

              contact Dave McKenna (847) 245-6393 or [email protected]

April 9,10, and May 6, 7, 8 � Life Space Crisis Intervention Certification Training; for

              information please contact Dave McKenna (847) 245-6393 or

              [email protected]

June 4-5 � CCAI�s Annual Training, Membership Meeting and Barbecue, Crowne Plaza,

                  Springfield.

July 21-22 - TCI Trainer�s Update, Cunningham Children�s Home, Urbana.  For more

                    information contact Alan Oathout at 217.367.3728, or email

                    [email protected].

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