Levels of Care Overview

Purpose

Levels of Care (LOCs) are required by 922 KAR 1:360 as a method for making the funding for private child care and child placing (PCC) services proportional to the levels of needs or levels of support required by children who are committed to the Cabinet for Health and Family Services. The criteria for LOCs are specified by 922 KAR 1:360 (section 4):

Level 5 = severe impairment, disability or need: severe risk of causing harm to self or others.
Level 4 = moderate problems: moderate risk of causing harm to self or others.
Level 3 = occasional problems requiring flexible levels of intervention from low to moderate
Level 2 = minor but frequent problems
Level 1 = adequate functioning

Schedule

• Levels of Care are initiated by the DCBS worker in preparation for an out-of-home placement that requires LOC funding (SOP 7E.1.5).
• Once a child is in a PCC placement the provider is responsible for maintaining the LOC by reporting the child's needs and services every three months (residential) or every six months (foster care). For DCBS foster care the DCBS worker is responsible for maintaining the LOC every six months (SOP 7E.1.4).

Protocol

• Initial Levels of Care are the responsibility of the DCBS worker in preparation for an out-of-home placement in DCBS foster care or a PCC program.
• Emergency LOCs may be requested by the DCBS worker.
• Reassignment of the LOC is necessary, if a LOC is not used for a placement in six months. Then, it expires and cannot be used for another placement. The DCBS worker must apply to have the LOC renewed or "reassigned". Alternatively, 922 KAR 1:360 (Section 13 (1b)) allows PCCs to accept children with expired LOCs, if within 30 days of admission the PCC submits to CRP their own assessment and CBCL (if four years or older and IQ is 70 or above). The per diem obtained in this manner is retroactive to the day of admission. To initiate this method of reassignment, the DCBS worker must make arrangements with the PCC at or before admission.
• Disagreements about an LOC may be initiated by a DCBS worker or PCC provider by submitting new information to CRP for a LOC "redetermination."
• DCBS foster home placement of a child with a LOC means that the DCBS worker is responsible for maintaining the LOC through periodic reporting of the child's services and needs (CRP-003).
• PCC residential or foster home placement of a child means that the PCC provider is responsible for maintaining the LOC through periodic reporting of the child's services and needs (CRP-001 or 003).
• Hints for writing "successful" progress reports (CRP-001 or 003) are available. Most inaccurate LOCs result from incomplete or inaccurate progress reports.
• Specific payment dates are associated with Levels of Care and their reauthorization (utilization review).
• When a LOCs expires due to not being used for a placement for six months or not being submitted for a utilization review, the PCC may ask for the LOC to be reassigned either by (a) the DCBS worker submitting to CRP a LOC packet or (b) within 30 days of admission by the PCC submitting to CRP the PCC assessment of the child and the CBCL (if age four or older and if IQ is 70 or above). The LOC will be retroactive to the date of admission.