May 8, 2000

SPECIAL NOTE: Copyright 2000. The Monday Report is produced each week as a benefit to the agencies that are members 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.

The Association will hold its' 36th Annual Meeting and Training Conference on June 1-2 at the Crowne Plaza Hotel in Springfield. Programs and registrations were mailed to you last week. We are very fortunate to have been able to schedule William Ryan as our featured speaker for the day. Mr. Ryan is a Cambridge-based consultant to non-profit organizations and foundations and is a Fellow at the Hauser Center for Non-Profit Organizations at Harvard University. He is currently investigating the effect of performance-based government contracting on non-profits, the growth of for-profit social service providers, and the prospects for creating new forms of non-profit governance. Mr. Ryan will specifically address: 1) Capacity and Mission, and 2) Capacity and the Market.

CCA will once again sponsor a Barbecue at the Springfield Island Bay Yacht Club on the evening of June 1st. This annual event has become a tradition with the membership and allows the opportunity to unwind and socialize with your peers. (Casual dress a must!!!)

The second day (June 2) Board-to-Member Focus Groups will meet in small break-out sessions from 9:15-10:15 a.m.. CCA Board members will be meeting with his/her "link" agencies to dialogue on the mission and ends of the Association and specifically on the needs and concerns of the membership in relation to the Association's agenda and the role of the CCA Board of Directors. After the focus groups, the Annual Business Meeting will start at 10:30 a.m. The two day meeting will adjourn after lunch and the CCA Board of Directors will meet at 1:00 p.m.

CCAI's ANNUAL MEETING AND TRAINING CONFERENCE
If you need an overnight reservation, please call the Crowne Plaza at 217-529-7777. They are holding rooms for our group only until May 10th. The room rate is $93.00 single or double occupancy. Be sure to say you are attending the Child Care Association meeting.

The Child and Family Service Review will measure states' compliance with achievement of 7 child-related and 7 system factor outcome areas. There will be a review of 30-50 cases in each state at 3 different sites. This means that some of CCA agencies will more than likely be involved since we serve 80% of the clients. The actual file and paper review will be accompanied by interviews with staff, foster parents, children, birth parents, court personnel and any other pertinent resource.

IEPA/MEPA compliance will be thoroughly monitored. Even private agencies are subject to extreme financial penalties for failing to comply with IEPA regulations.

All agencies should become acquainted with the federal regulations in order to prepare for possible audit involvement as well as to assure compliance. These can all be found on the DHHS web site: http://www.acf.dhhs.gov/programs/cb/policy/qsset1.htm (MB)

To repeat information from last week's (May 1) Monday Report, the summary of the HMR caseload ratio reduction is as follows: Caseload ratio size will be at l8: 1 with the opportunity to earn or buy the way to l5:l. Those agencies with caseloads above the l8:l mark will "buy" their way to the new caseload ratios via reductions in total caseload. Once at l8, the caseload will be recalibrated so that permanency and non-permanency rates will be based on the new adjusted caseload size and not on the overall caseload size from the initial performance contract. Finally, the system overall must acknowledge the total declining caseload via contract adjustments. DCFS projects intake sufficient to support only 38% of the current caseloads. Since the current agencies providing HMR Cook care all demonstrated performance rates above the required amount, there is a need for adjustment throughout the system. Although there will be recognition of consistent performance to earn caseload reductions, there will be a system adjustment to account for the unearned reductions at agencies due to sluggish intake. Each agency will see some reduction in overall paid caseload.

DCFS presented a procedural plan for helping agencies calculate the steps and costs necessary to reach the projected ratios. The initial FY'01 contract will be based on the adjustments reached via these calculations using FY '98 and FY '99 performance statistics. The first step is to revise the total caseload. An agency will fall into one of four categories: 1) Agency exceeded performance target both years; 2) Agency met performance target both years; 3) Agency fell short on year 1 but exceeded target in year 2; and 4) Agency met target year 1 and exceeded target year 2. The difference each year between actual permanencies and the 24% permanency goal are calculated against the starting caseload. This calculation yields an "earned reduction." The new caseload size is then set on any earned reduction. The earned reduction is calculated against the statewide average earned ratio of 20.23% to figure "ratio points. " The final contract adjustment is based on the ratio points. Number of BARCS will be recalculated as well as the number of cases per paid BARC that will be lost for those agencies that just met the target both years or fell short one year while exceeding another year.

As the system recalibrates, those agencies that just met the target both years, or that fell short one year will lose cases per BARC as the system readjusts. Additionally, agencies that exceeded the target any year and elected the Cash Bonus will see a buydown at a rate of 3:l. For every 3 cases above the permanency mark upon which the cash option was paid, the agency's paid caseload for next year will be reduced by one case.

The recalibration system will mean that a number of agencies will be in what is called the "buydown" category. This means that their earned caseload ratios based on past performance have not yet yielded the required 18:1 caseload ratio. These agencies will need to "buy their way down" to the agreed ratio. The earned performance total will show each agency how many cases per BARC will be in the "buydown" category. The question is: Do agencies transfer these cases or go on intake hold until the buydown is complete? The Cook work group discussed recommendations that will be given to the larger Infrastructure Work Group. The recommendations are: 1) Agencies will need to look at their buydown status individually and make appropriate business decisions. 2) Agencies may choose to transfer cases to secure the required caseload ratio. 3) Agencies may choose to keep the extra cases and withdraw from new intake until the "buydown" is complete and the required caseload ratio is achieved. 4) The cases transferred as a result of the recalibration strategy will be referred to existing agencies on a voluntary basis. Those agencies choosing to accept these transferred cases do so in addition to accepting regular random new intake, but use the opportunity to add to the total caseload and slightly reduce their overall shrinkage. 5) Agencies which choose to transfer cases out as part of the "buydown" strategy will not be eligible for receipt of any other transferred recalibration cases. They, however, will be required to accept new random intake once their buydown has been completed and the ratio recalibrated.

DCFS staff presented work sheets for helping agencies estimate their earned caseload and estimate next year's contract amounts. Step 1 is to review FY'98 and FY'99 base, permanency goal, actual permanency performance, and calculation of excess permanencies. These figures translate into a combined earned permanency percentage. Step 2 is to determine which category the agency is in a) meets target both years; b) falls short l year, exceeds target year 2; c) meets target year l and exceeds target year 2; or d) exceeds target both years. This step will help the agency understand how the permanency rate effect is carried across years to assure maximum fairness. Step 3 is to compare the agency'' earned permanency percentage against the system-wide average earned ratio. These calculations then yield the agency's own current ratio and can then predict how far the agency will need to go to reach the 18:1 requirement (in effect to "buy down to the 18:1.) The number of cases per BARC to be adjusted can then be determined. These are the cases which the agency will need to decide to transfer or to take an intake hold. Step 4 is to estimate the total cases for contract reduction. This will depend on the number of cases in the buydown category. Step 5 is to predict the amount of contract decrease percentage and the subsequent payment category for FY'01. (l8:l, l7:l, 16:l, or 15:l with highest payment for l5:l.) Again, agencies are reminded that the entire HMR caseload is shrinking, so that DCFS will no longer pay for cases that aren't materializing. Everyone's contract will shrink at least slightly depending on performance. The rate per case, however, will increase, depending on the current earned ratio.

CCA is preparing a detailed instruction sheet as a companion piece for the DCFS worksheets. The instruction sheet and worksheets should make the above description of recalibration much clearer. These will be mailed to all Cook HMR agencies next week. Any agency that would like a head start on calculating can request a fax copy of the sheets from the CCA office as of Tuesday (May 9) morning.

The group also discussed the status of DCP transfer cases. DCP staff reported that an internal memo had been issued for all DCP investigators alerting them to the fact that a full clothing voucher is to be issued for new children in custody. Additionally, when requested by the private agency, an equipment voucher for infants should also be issued. ERC can also issue vouchers is the agency is picking up the child from ERC. Still unresolved is the length of time it takes to receive the vouchers thus causing safety concern for infants without cribs and car seats. Since the regional and DCP have not yet been able to resolve this issue, the work group chairs will ask for assistance via the CWAC process.

The group also discussed the continued delays in subsidized guardianship hearings and finalizations. Even those agencies following Judge Bishop's instructions to the GAP meeting to ask for earlier court dates are not finding success. Agencies in this predicament need to write a brief report or memo of concern to Judge Bishop relating to the delay, and should copy both Mike Shaver of DCFS (fax: 312-814-3255) and Marge Berglind (312-819-1951.) Finally, DCFS staff alerted agencies that the Research Triangle Institute has been contracted by DHHS to study foster care resources across the states. Agencies may be getting calls from the survey field reps to provide information for the survey.

The next Cook performance based meeting is scheduled for May 24. (MB)

CHILD WELFARE EDUCATION AND TRAINING ADVISORY COMMITTEE (CWETAC) MEETS--DCFS PROPOSES NEW WORKER TRAINING PROCESS
The Child Welfare Education and Training Advisory Committee met last Friday. Among items on the agenda were: 1) A report was given on the results of the advanced testing period that began on March 15 and runs through May 31 that allows individuals both from DCFS and private agencies to take the child welfare employee licensure test without taking the review sessions. As of April 28, 2013 participants have taken the licensure examination. There were1986 participants who passed the examination and 27 failures. This is a 1.35% failure rate--a lower rate than was expected. Up until May 15, 4113 have registered for the licensure examination--however, from May 16-May 31, there is only availability to test 2000 participants. 2) The comment period for Rule 412 ended on April 17, 2000. The Department received comments from numerous agencies and individuals. The Department is in the process of reviewing those comments before submitting a revised version to JCAR. 3) DCFS indicated that there are still many openings for the paid placement program that has been developed to encourage new social worker students to choose a career in child welfare. For more information about this program, call Paulette Baqi at 312-328-2839.

The major discussion at the meeting was a presentation by Director McDonald on a proposed Child Welfare Foundation Training Program. The goal of the effort is to have a model of foundation training that is competency-based, job-relevant, consistent in content and application, accessible and timely, and required for all foster care workers. (Please note: the information we have at this time indicates that this is applicable only to foster care/HMR workers.) This effort will be funded by at least two million dollars which is being transferred from the Children's Services line into this program. The training will be presented in a twenty day, classroom-based program delivered by the colleges and universities who are a part of the Education Partners program. The delivery model will be designed to meet the needs of these staff by providing preparation programs in various locations throughout the state in frequent and regular intervals. Staff will come out of this training CERAP certified and licensed.

While there are many specifics of this program that are not specified and, at this point, unclear, the general perimeters appear to be that DCFS will pay agencies for the time that new foster care/HMR workers are enrolled in this training. In some manner this will be controlled to address the issue of the variance in turnover between agencies--in other words, how is the process controlled so that agencies with extremely high turnover don't utilize all of the money. For those agencies that are able to control their turnover and have lower rates of staff needing this training, once they have trained their new workers, if there are funds remaining, those agencies will be able to use those funds for other training for other staff--at their discretion.

At this point, there are many questions and little information about how many staff will be covered under this effort? How many staff are leaving the field entirely and how many are transferring to other agencies? Where are those staff located? What are the accurate levels of turnover? What factors impact turnover and how do we make this process equitable between agencies? What should be the curriculum for this effort and how will it be developed? What would be the level of staff payment for this effort? Even with this payment, will agencies be able to allocate staff internally to cover for staff in training? What will be the oversight arrangement for this effort between the Universities, private agencies, and DCFS?

The Universities had only just learned of this proposal and while they are on board with this effort, they appear to have many questions as well about their role, responsibilities, etc.

To begin to move this effort forward, three working groups have been formed: 1) to look at the curriculum content--this committee will be comprised of representatives from the schools, from the private sector, and DCFS; 2) to look at the logistics of this effort--numbers of staff that will be impacted? Which staff are specifically covered by this effort? Levels of turnover? Where do these staff go upon leaving? (The level of staff leaving the field as against the level of staff transferring to other agencies will have a major impact on the size of this effort and the resources needed to fund it.) This committee will also be comprised of representatives from the school, private sector, and DCFS; 3) Financing--this committee will be comprised at the point where there is better information as to the number of staff impacted and the impact on agencies, etc.

While we are very supportive of the effort to insure training for new staff coming into the field, there are many questions to be answered as we begin exploring this specific proposal. We will certainly keep the membership appraised of developments. (RHM)

MEDICAID ADVISORY WORKGROUP
The Medicaid Advisory Committee met in March and scheduled an additional meeting in April to review further proposed changes by DHS to the Medicaid rule. Co-chair of the group, Tom Finnegan gave a report on the future vision of DCFS and how this would impact the current Medicaid program. DCFS is considering identifying Specialized Foster Care case managers as Targeted Case Managers. For Medicaid eligible clients, all case management services would be billed through the TCM rather than using the current fee-for-service per diem model. Use of a revolving fund would eliminate funding and cash flow gaps and establishing the size of the foster care caseload for next year. Tom also discussed issues around residential services which included: 1.) proposal by DOC to set up an agreement similar to the one that DCFS has recently set up with the County Probation; 2.) proposal by DHS of adding Individual Care Grant children into residential Medicaid programs. 3.) High conversions of approximately 40 residential contracts with per diem rate of $150 per day or higher to Medicaid to enable the DCFS to access additional Federal Financial Participation resources. 4.) Determine the need of future of residential beds in discussions with DOC, DHS, ISBE and providers. 5.) DCFS is also looking at the usability of systems in Missouri and Ohio which have categorical contract definitions for residential programs. There was also discussion around provider profiling. Since the summer of 1999, DCFS has been engaged in a Rule Revision process with DHS. The proposed Rule revisions focused on the areas of post-payment reviews and comprehensive services. Comments were being solicited for submission to DHS prior to the official submission of the rule to the Illinois Register. See the following article for further detail on the proposed rule changes. There will still be a comment period for the rule once it has been filed.

Other items discussed at the meeting included the Medicaid Billing System, Reconciliation Reports and Medicaid Training needs. With the processing for the first six months of billing for the fiscal year completed, shortfalls and error rates are up for both fee-for-service and comprehensive programs. If all errors are corrected, the overall shortfall for all programs combined would still be 19%. Infant Parent Institute will be contacting those agencies in shortfall to help problem solve the identified billing problems. The process to draft a new Reconciliation Report is nearing completion. Once a draft has been completed, it will be sent to the committee for feedback. (JMS)

DISCUSSION OF MEDICAID RULE CHANGES
Post-payment reviews were being added to the Medicaid rule for mental health services by DHS. Post-payment reviews are on-site documentation reviews through which money is recouped from Medicaid providers for any services that are deemed out of compliance. DHS had been conducting Post-Payment Reviews for several years; however, DHS' legal department is not comfortable conducting this type of review without explicit Part 132 support. DHS' impetus for opening Part 132 to revision was to add Post-Payment Review language into rule. The current proposed revisions allow DCFS the discretion to conduct these reviews or not. It was noted that DCFS already has several procedures in place by the Infant Parent Institute that monitor this type of information, so why should DCFS even consider this portion of the rule. Some provider agencies have already experienced this form of audit from DHS. It was reported that reviewers disallowed service documentation for a number of reasons up to and including the content of the narrative not supporting the specific services billed. Concern was also expressed about the appeals process described in the rule. As written, an agency is required to pay back money for services deemed out of compliance prior to any appeals. If appeal determined that the review findings were not supported, the agency would be reimbursed for the amount of the any payment. An additional meeting was scheduled of the workgroup for discussion of these type of reviews and how the rule would implemented by DCFS.

Changes made to the rule for Comprehensive Mental Services included: 1.) A new definition was added for Admission Note; 2.) Under Fiscal and Statistical, comprehensive billing is differentiated from fee-for-service billing; 3.) Under Clinical Records, shift treatment summary and non-milieu service documentation requirements are defined; 4.) Also time frames and requirements around Admission notes, initial Mental Health/Rehabilitative Assessments, and initial Individual Treatment/Rehabilitative Services are defined. (JMS)

SACWIS
The SACWIS committee met with DCFS and their technical representatives to discuss the Application Development and Implementation RFP. Sam has been working closely with CMS to finalize the AMS contract. It is hoped that the contract can be signed on May 8th. Once AMS is under contract he will ask them to demonstrate the New Mexico SACWIS.

Sam reported that he and Kevin Velten have been appointed to a committee to review Internet and Intranet content. This committee will hold its first meeting on May 22nd. The committee will develop a set of protocols to be used by the Department in its Internet/Intranet sites. The DCFS Intranet site implementation date is not yet known. The DCFS Internet site is the second most hit site in Illinois government.

The committee reviewed equipment platforms and SACWIS architecture. The private agency members unanimously agreed that the Terminal Server solution is an acceptable strategy for POS desktop integration, with the understanding that POS and DCFS work together to develop funding to support the strategy. This was agreed to by Sam Traylor, with the understanding that he must obtain approval to collaborate on the funding issues. (RJS)

Applicants are encouraged to obtain a complete application kit from the Department's home page on the world-wide web. The address is: www.state.il.us/agency/dhs. Follow the instructions for downloading the files. Interested applicants who do not have Internet access may obtain a printed copy of the application kit at a bidders conference or call 217-524-8612. Bidders conferences will be held in Chicago and Springfield. The one in Chicago will be on Monday, May 22 at 160 North LaSalle, Room C-500 at 12:00 p.m. and in Springfield on Wednesday, May 24 at Illinois State Museum Auditorium (Basement Level), Spring and Edwards Streets at 10:00 a.m. (JMS)

PENDING FEDERAL LEGISLATION ON RESTRAINTS AND SECLUSION
Last fall the Senate approved language addressing the use of restraints and seclusion in its passage of S.976, the Youth Drug and Mental Health Services Act, an important bill which reauthorizes the Substance Abuse and Mental Health Services Administration. It is expected that the House will try to pass similar legislation sometime this year. Congress needs to hear from providers how the pending legislation would affect policy and practice at the agency level. Information from CWLA indicated that the House Commerce Committee may consider S. 976 in the very near future. Overall, S. 976 is a good bill and its passage affects our nation's mental and substance abuse programs. However, Part H of S. 976 must be modified to keep children and others safe from possible injuries and death without pushing children our of community-base programs and into more restrictive settings. We are urging members to write your congressional delegation and Illinois members of the Commerce Committee, including the Chair, Rep. Thomas Bliley (R-VA) and the Committee's Ranking Member, Rep. John Dingell (D-MI). A copy of CWLA's latest position paper on restraint and seclusion was sent out to all CCA member agencies. If you have any questions or need additional information, please contact Jan Schoening at CCA. (JMS)

FEDERAL FUNDING ALERTS
Several federal grants were announced previously to CCA members related to the Substance Abuse and Mental Health Services Administration. One of these was called the Integrated Health and Behavioral Health Care for Children, Adolescents and Their Families and had a deadline for the middle of May 2000. CWLA has recently provided additional information about the following two announcements through SAMHSA.

The SAMSHA Parenting and Family Strengthening Prevention Interventions: A Dissemination of Innovations Initiative will make awards from $80,000 to $100,000 for up to 2 years. The deadline for application is June 13, 2000. The purpose is to support the Family Strengthening Program by increasing the capacity of local communities to deliver best practices in effective parenting and family programs in order to reduce or prevent substance abuse; documenting the decision-making processes for the selection and testing of effective interventions in community settings, and determining the impact of intervention on the target families within this study. Application forms may be obtained on line at http://www.samsha.gov/Grant/0100titles.htm. The address and phone number are P.O. Box 2345, Rockville, MD 20857, 800/729-6686.

The SAMSHA Community Initiated Prevention Interventions will make awards from $250,000 - $350,000 for up to 3 years. The deadline for application submission is September 10, 2000. The purpose is to support Knowledge Development with At-risk Populations by soliciting studies that field test effective substance abuse preventions that have been shown to prevent, delay or reduce alcohol, tobacco, or other illegal drug use and/or associated social, emotional, behavioral, cognitive and physical problems among at-risk populations in their local communities and/or other domains (the individual, the family, the school, the health care provider and the workplace). Application forms can be obtained at the same web site and address mentioned in the above paragraph. (JMS)

Cook County sessions will take place at the Illinois Institute of Technology Research Institute, 10 West 35th Street, Chicago. Dates are May 5, May 12, June 6, June 15, June 16, July 10, July 17 and July 21. Additional training dates for August through December will be posted in mid-summer.

Registration forms must be submitted in advance. A copy of the form can be obtained by contacting Karen Evans-Thomas at 312-328-2828 or by calling the general Training and Development Services number at 312-328-2970. As a reminder, CERAP certification is required by Senate Bill 1357 and will be one of the requirements of the Direct Employee Services License.

TRAIN THE TRAINERS OPPORTUNITY RE: SUBSTANCE AFFECTED FAMILIES
There are still slots available for the remaining SAF training dates. DCFS will be sponsoring a series of 2 day training sessions, geared for trainers or supervisors on Substance Affected Families and DCFS policy guide 99.13. Private agencies are invited to send two supervisors or managers to the training. There is no charge for the training but each agency is responsible for travel expenses. Day one is from 9:30 a.m. to 5:00 p.m. and day two is from 8:30 a.m.- 4:00 p.m. All will be held at the DCFS IITRI Training Center, 10 W. 35th Street, Chicago. The sessions are open to any private child welfare agency program. The dates are: May 15 and 16; and May 17 and 18. For a registration form contact: Northern Illinois University at 800-637-1396. (MB)

DOWNSTATE PERFORMANCE BASED WORK GROUP
The next meeting of the Downstate Performance Based Work Group is scheduled for Thursday, May 18, 2000, 11:00 a.m.-1:30 at DCFS, 628 E. Adams, Springfield.

Calendar:
May 8 � CCA Education Committee Meeting, 10-2, Springfield
May 9 � Meeting with DHS Mental Health Division to discuss Individual Care Grants
May 17 � CCA Board of Directors Meeting, Springfield
JUNE 1-2 � CCA'S TRAINING AND ANNUAL MEMBERSHIP MEETING, CROWNE PLAZA, SPRINGFIELD
June 8 � GAP Meeting, Chicago

For further information on any of the above, contact the staff member noted in parentheses at the end of the text:

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