13 CSR 35-38.010 - Adoption and Guardianship Subsidy
(1) Definitions. For purposes of this
section, the following terms shall mean -
(A)
Division. The Missouri Department of Social Services, Children's
Division;
(B) Child or Youth. A
person within the state who is under the age of eighteen (18), or in the
custody of the Children's Division, who is in need of medical, dental,
educational, mental, or other related health services and treatment, or who
belongs to a racial or ethnic minority, who is five (5) years of age or older,
or who is a member of a sibling group, and for whom an adoptive home is not
readily available. A child or youth is also a person covered by an 18+ adoption
subsidy agreement as set forth in section (13) of this regulation;
(C) Subsidy Agreement. The agreement between
the adoptive parent(s) or the legal guardian(s) and the Children's Division to
delineate services which the Children's Division will provide to the child at
the time of adoption or guardianship until such time as the subsidy agreement
ends;
(D) Maintenance payments. The
amount that the division will contribute to cover the cost of food, clothing,
shelter, daily supervision, school supplies, a child's personal incidentals,
and liability insurance with respect to a child;
(E) Nonrecurring expenses. One (1)-time
expenses directly related to the adoption or legal guardianship of a special
needs child. Nonrecurring expenses include, but are not limited to, the
following: legal fees, private agency fees, and nonrecurring placement-related
expenses including, but not limited to, pre-placement transportation, lodging
and meal expenses, expenses for adoption studies, health and psychological
examinations, and supervision of the adoptive placement prior to the
finalization of the adoption up to a maximum amount provided in this
regulation;
(F) Youth with Elevated
Needs. A child meeting the criteria set forth in
13 CSR
35-60.070;
(G) Medical Foster Care. A licensed foster
home utilized to meet the needs of a child with extraordinary medical needs.
Medical foster parents must have a foster parent license and must receive
specific training from qualified medical care providers specific to the unique
medical needs of the child and meet the requirements set out in
13 CSR
35-60.070;
(H) Respite. The provision of periodic and/or
intermittent, temporary substitute care of children who are in the care and
custody of the Children's Division and placed in a licensed foster, relative,
or kinship resource home. Respite services may be approved as part of an
adoption or guardianship agreement;
(I) Intensive In-Home Services (IIS). A
short-term, intensive, home-based, crisis intervention program that combines
skill-based interventions with maximum flexibility so that services will be
available to families according to their individual needs. The goal of IIS is
to offer families in crisis the alternative of remaining together safely,
averting out-of-home placement of children whenever possible. IIS are, however,
offered solely to families that have a child or children at imminent risk of
removal from the home due to neglect, abuse, family violence, mental illness,
delinquency, or other circumstances when approved by the Children's Division.
Services provided assist with crisis management and restoration of the family
to an acceptable level of functioning;
(J) Residential Care. A facility providing
twenty-four (24) hour care in a group setting to children who are unrelated to
the person operating the facility and who are unattended by a parent or
guardian;
(K) Relative. A
grandparent or any other person related to another by blood or affinity or a
person who is not so related to the child but has a close relationship with the
child or the child's family. A foster parent or kinship caregiver with whom a
child has resided for nine (9) months or more is a person who has a close
relationship with the child. The status of a grand-parent shall not be affected
by the death or the dissolution of the marriage of a son or daughter.
(L) Licensed Foster Family. A private
residence of one (1) or more family members providing twenty-four- (24-) hour
care to one (1) or more but less than seven (7) children who are unattended by
a parent or guardian and unrelated to either foster parent by blood, marriage,
or adoption and licensed through the Children's Division.
(2) Eligibility Criteria for Adoption/Legal
Guardianship Subsidy.
(A) In order for a
child to qualify for an adoption or guardianship subsidy, the child shall meet
the following eligibility criteria:
1. The
child must be under the age of eighteen (18) at the time of adoptive or
guardianship placement; and
2. At
the time of planning for adoption or legal guardianship, the child must meet
one (1) of the following circumstances:
A. Be
in the custody of the Children's Division; or
B. Children placed in Missouri through a
private child-placing agency that are Title IV-E eligible are eligible for
Missouri adoption subsidy per
Title 42 U.S.C. Section
673(c) (2008). The applicant
for the adoption subsidy shall provide sufficient information to the division
to determine that the child is Title IV-E eligible; or
C. Be in the custody of a child-placing
agency licensed in accordance with sections
210.481 through
210.531, RSMo, the Division of
Youth Services (DYS), or the Department of Mental Health (DMH); and a "child
with special needs" as defined by the characteristics listed below:
(I) The child cannot or should not be
returned to the home of his or her parents. If the division has determined that
the child cannot or should not return home, and the child meets the statutory
definition of special needs with regard to specific factors or conditions, then
the division shall ask whether the prospective adoptive parent(s) are willing
to adopt without subsidy. If the adoptive parent(s) say they cannot adopt the
child without adoption subsidy, the requirement for a reasonable, but
unsuccessful, effort to place the child without providing adoption subsidy
under Title 42 U.S.C.
Section 673(c) (2008) shall
be satisfied;
(II) The division
determines, with respect to the child, that a specific condition or conditions
of the child exists, because of which it is reasonable to conclude that such
child cannot be placed with adoptive parent(s) or guardian(s) without providing
subsidy. A child to be determined as previously unadoptable and eligible for
subsidy shall meet one (1) or more of the following conditions:
(a) Physical Handicap. Any physical
abnormality or condition, whether congenital or not, which requires or is
likely to require treatment or the purchase of special equipment or
services;
(b) Intellectual
impairment mental development below an IQ of eighty (80) or other intellectual
dysfunction as documented by psychological testing;
(c) Racial or Ethnic Minority. The child's
ancestry is not Caucasian; and
(d)
Other Conditions.
I. Age. The child is five
(5) years old or older and has not reached the age of eighteen (18) years or
twenty-one (21) years if the child's condition requires extraordinary treatment
or rehabilitative services.
II.
Member of a sibling group. Two (2) or more children who are siblings and are
being placed with the same family.
III. Developmental disability. Any documented
physical or mental condition not otherwise listed which prevents the child from
functioning at the normal level for his or her age.
IV. A mental or emotional disturbance. A
diagnosed and documented condition which impairs the child's mental
functioning, including learning dysfunctions.
V. Social maladjustment. A severe behavioral
condition or inadequate social development which interferes with the child's
ability to form satisfactory relationships with others.
(III) The child has a history,
which includes circumstances such as long-term out-of-home care, incest, or
social or genetic complication in the family background, which provides other
impediments to adoption.
(B) Children who have a subsequent adoption
or guardianship because of the dissolution of their adoption or guardianship or
the death of their adoptive parent(s) or guardian(s) continue to be eligible
for assistance under Title IV-E or Missouri funded subsidy in a subsequent
adoption if they were previously eligible.
(C) Unless specifically authorized by federal
law, there shall be no income eligibility requirement (means test) for the
prospective adoptive parent(s) or guardian(s) in determining eligibility for an
adoption or guardianship subsidy.
(3) Ineligible Children for Missouri Adoption
and Legal Guardianship Subsidy - The following children shall not be eligible
for adoption or guardianship subsidy:
(A)
Children being adopted internationally or children adopted from other states
who are not Title IV-E eligible and are in the custody of a private
child-placing agency;
(B) Children
in the custody of Missouri juvenile courts, even though they may receive a
payment while in other types of out-of-home care; or
(C) Children being adopted by a stepparent or
biological parent whose rights were previously terminated.
(4) Ineligible Placements for Missouri
Adoption and Legal Guardianship Subsidy - The following prospective adoptive
parent(s) or guardian(s) shall not be eligible to receive an adoption or
guardianship subsidy:
(A) Felony convictions
- Any person who has a felony conviction for child abuse or neglect, spousal
abuse, a crime against children (including child pornography), or a crime
involving violence, including rape, sexual assault, or homicide, but not
including other physical assault or battery; and
(B) Any person who in the past five (5) years
has had a felony conviction for physical assault, battery, or a drug-related
offense.
(5) Application
Process.
(A) Any prospective adoptive
parent(s) or legal guardian(s) who believe that he or she may be eligible to
receive a subsidy on behalf of a qualified child shall complete an application
on a form approved by the division.
(B) The division may require the prospective
adoptive parent(s) or legal guardian(s) to provide any documents or other
materials necessary to verify any information necessary to complete the
application process. The application shall be supplemented with such additional
information and documentation as the division may require or the applicant for
the subsidy may choose to submit for consideration. All information furnished
by an applicant for a subsidy shall be complete, accurate, and truthful. The
division may reject an application or reject renewal of an adoption subsidy or
guardianship agreement if the division determines that the applicant for the
subsidy has failed to provide complete, accurate, or truthful
information.
(C) For initial
applications, the burden of proof shall be on the applicant to establish
eligibility for the subsidy and that they are qualified to receive requested
services.
(6) General
Regulation Governing All Adoption and Guardianship Subsidy Agreements - The
following provisions will govern all agreements for adoption and guardianship
subsidy:
(A) Agreements approved to age
eighteen (18) will continue until the last day of the month of the child's
eighteenth birthday unless previously terminated in the manner provided by
law;
(B) All adoption and
guardianship subsidy agreements shall be in writing on a form provided by the
division. The division shall not be obligated to provide or pay for any
services, maintenance payments, or non-recurring expenses which are not
expressly and specifically set out in the agreement. The agreement will not be
effective unless and until it is signed by the director of the Children's
Division or the director's authorized designee and the adoptive parent(s) or
legal guardian(s);
(C) Unless
otherwise required by law, the Children's Division will not approve or pay for
any service through an adoptive or guardianship subsidy agreement which is
otherwise paid for or reasonably available at no cost or at reasonable cost
through any other sources and which the child or the adoptive parent(s) or
guardian(s) may be eligible to receive. Examples of other sources include, but
are not limited to, the following: any other governmental programs, programs
offered by schools and school districts, private insurance, any public
insurance programs (including Medicaid (MO HealthNet) programs), other
community-based services, and services and programs provided by not-for-profit
organizations;
(D) Under no
circumstances will the division or the state of Missouri pay for any services
which exceed the authorized amount for the service as set forth in the service
section of the agreement. Any amounts which may be due to a provider which
exceed the amount that the division is obligated to pay under the agreement
shall be the sole responsibility of the adoptive parent(s) or guardian(s). The
adoptive parent(s) or guardian(s) shall pay, be responsible for, and indemnify
the state of Missouri, the Department of Social Services, and the Children's
Division for any amounts which the division may be required to pay in excess of
the amounts set forth in the agreement;
(E) Except as otherwise provided in
subsection (6)(F) of this regulation, the division is not obligated to make
payments to a provider for services authorized through a subsidy agreement,
unless the division has a currently active contract with the provider. The
division shall not be obligated to pay for any service provided by the service
provider, unless the service provider provides an invoice satisfactory to the
division itemizing the date the service was provided, describing the nature of
the service provided, and stating the amount for the service. The division will
pay services directly to the provider. The use of contracted providers is
required when a contract may be established. All receipts submitted for
reimbursement must be submitted within one hundred eighty (180) days of the
service being provided. The division shall not be responsible for paying for
any service billed or invoiced to the department later than one hundred eighty
(180) days from the date that the service was provided.
(F) The division shall reimburse the adoptive
parent(s) or guardian(s) for payments made directly by the adoptive parent(s)
or guardian(s) to the provider where the provider of the service does not have
a contract with the division only if the division agrees in writing before the
service is provided to make the payment and if all of the following conditions
are met:
1. The service is one (1) which the
division has expressly agreed to pay in the subsidy agreement;
2. The adoptive parent(s) or guardian(s)
establishes that there is no service provider having a contract with the
division who is reasonably available to provide the service. In cases where the
adoptive parent(s) or guardian(s) identifies an appropriate provider who does
not have a contract with the division or the state, the division may decide, in
its sole discretion, whether or not to enter into a contract with the provider
and pay for the services directly, or whether to agree to reimburse the
adoptive parent(s) or guardian(s) under this paragraph;
3. The adoptive parent(s) or guardian(s)
provides timely documentation satisfactory to the division that the service has
actually been provided and that it was provided by a qualified provider of the
service. Documentation satisfactory to the division includes providing an
invoice and a receipt prepared by the provider; and
4. The adoptive parent(s) or guardian(s)
shall provide the invoice and paid receipt to the division no later than thirty
(30) days from the date that the service was provided and paid for by the
adoptive parent(s) or guardian(s), but under no circumstances shall the
division be obligated to reimburse the adoptive parent(s) or guardian(s) for
services provided later than ninety (90) days from the date that the services
were provided; and
(G)
Payment for nonrecurring adoption or guardianship expenses shall be made only
after the adoption or guardianship is final. The division will not pay for any
nonrecurring adoption or guardianship expenses which are not expressly set out
in writing in the adoption or guardianship subsidy agreement or in a separate
document executed by the adoptive parent(s) or guardian(s) and by the director
of the Children's Division or his/her designee. Under no circumstances shall
the division or the state of Missouri be obligated to pay any nonrecurring
adoption or guardianship expenses, based on any oral representations made by an
employee of the Children's Division or the Department of Social Services. These
expenses are not eligible for payment if applied for after final adoption or
guardianship. All expenses paid under the guardianship subsidy agreement will
only be paid after legal guardianship has been granted by the probate court to
a qualified relative in the manner authorized by law.
1. Under no circumstances will an adoption or
guardianship subsidy agreement or payment be made to reimburse the adoptive
parent(s) or guardian(s) for payment for services provided by the adoptive
parent(s) or guardian(s), or member of the adoptive parent(s) or guardian(s)
household.
2. The division will not
pay for services that are a duplication of other available services.
3. The parties to the agreement may, by
mutual, written agreement amend the terms of the subsidy to better meet the
needs of the adoptive child. Under no circumstances shall a subsidy agreement
be amended without the consent of the adoptive parent(s) or legal guardian(s),
or amended in any manner which may be a violation of federal law. Adoptive
parent(s) or guardian(s) who wish to request that a subsidy agreement be
amended shall submit a written request to amend the agreement. The burden of
proof to amend the agreement shall be on the party seeking to amend the
agreement. The request shall include the following information: a copy of the
agreement, the specific provisions of the agreement they are seeking to amend,
a detailed statement of the factual basis for the request for amendment, and
include all documentation to support the request to amend the
agreement.
4. Overpayments - Any
amounts paid to the adoptive parent(s) or guardian(s) in excess of what is
required by the subsidy agreement shall be an overpayment which is and shall be
immediately due and payable to the division. The adoptive parent(s) or
guardian(s) have the duty to notify the division within ten (10) days when he
or she receives any information which would lead a reasonable person to believe
that an overpayment has been made. The adoptive parent(s) or guardian(s) must
promptly repay any overpayment and shall fully cooperate and promptly provide
any and all information that the division may require to investigate and
ascertain whether an overpayment has been made. If the division determines that
an overpayment has been made, the division shall notify the adoptive parent(s)
or guardian(s), in writing, specifying the amount of the overpayment, the
factual basis for the assessment of the overpayment, and the specific
provisions of the subsidy agreement, regulation, or law upon which the
assessment is based.
(7) Maintenance Payment.
(A) Each adoption or guardianship subsidy may
provide for a maintenance payment. The maintenance payment may be -
1. A continuous monthly payment for a sum
certain through the termination of the agreement; or
2. A continuous monthly payment towards the
child's care which periodically diminishes over a period of not longer than
four (4) years at which time it ceases; or
3. A continuous monthly payment for a sum
certain towards the child's care for a period of more than four (4) years;
or
4. A monthly payment for a sum
certain which is continued for a limited time after legal adoption, not
exceeding four (4) years. This payment is to aid the adoptive parent(s) in
integrating the care of the new child in their home.
(B) There shall be three (3) maintenance
rates for subsidy agreements: standard rate, medical rate, and rate for Youth
with Elevated Needs Level A.
1. The standard
rate is the default rate and shall not exceed the standard foster care
maintenance rate subject to appropriations. At the time of placement, no
payment may exceed the maintenance rate paid if the child had remained in
out-of-home care, even when used in combination with other benefits available
to the child.
2. A child shall
qualify to receive the medical foster care rate or Youth with Elevated Needs
Level A rate only if the adoptive parent(s) or the legal guardians(s) and child
meet the qualifications for the Youth with Elevated Needs regulations as set
forth in rule 13 CSR 35-60.070.
3. In order to qualify for the medical foster
care rate the adoptive parent(s) or guardian(s) must have the same
qualifications as a licensed medical foster parent as set forth in rule
13 CSR
35-60.070.
(8) Request for Medical Rate or Youth with
Elevated Needs Level A Rate.
(A) In
accordance with the procedures set forth below, any adoptive parent(s) or
guardian(s) may request an increase from the standard rate to the Medical or
Youth with Elevated Needs Level A maintenance rate.
(B) The adoptive parent(s) or guardian(s)
shall submit a written request to increase the rate. In the request, the
adoptive parent(s) or guardian(s) shall specifically describe the medical
condition or behavior of the child which the adoptive parent(s) or guardian(s)
believe qualifies the child for the higher maintenance rate. The adoptive
parent(s) or guardian(s) shall provide any and all information and
documentation to the Children's Division necessary to process the request for
the higher maintenance rate, including, but not limited to -
1. The names and full contact information and
reports for all medical care providers for the child for all relevant times,
including all physicians, hospitals, and clinics which have provided care,
diagnosis, or treatment for the child;
2. The names and full contact information and
reports for all mental and behavioral health care providers for the child for
all relevant times, including all therapists, licensed clinical social workers,
psychologists, hospitals, and clinics which have provided care, diagnosis, and
treatment for the child;
3. The
names, addresses, and full contact information and reports for all schools and
educational institutions which provided educational services and/or assessments
for the child;
4. The names,
addresses, and full contact information and reports for any other person who
may have information necessary to assess the medical, behavioral, and/or
developmental needs of the child;
5. The adoptive parent(s) or guardian(s)
shall provide the Children's Division with any written authorizations to
release information which the division determines is necessary and convenient
to process the request; and
6. The
adoptive parent(s) or guardian(s) shall have the burden to establish by a
preponderance of the evidence that the child meets the eligibility requirements
of Medical Level or Youth with Elevated Needs Level A.
(C) In order to qualify as a Youth with
Elevated Needs, the child must meet the same criteria as a child in alternative
care as required in 13 CSR 35-60.070, and the
adoptive parent(s) or guardian(s) shall meet the training requirements set
forth in 13
CSR 35-60.070. However, if the adoptive parent(s) or
guardian(s) reside out of state or were not licensed foster families with the
Missouri Children's Division -
1. They shall
have completed at least eighteen (18) hours of equivalent training specific to
the needs of the adopted child which has been approved by the Children's
Division;
2. The adoptive parent(s)
or guardian(s) shall provide the Children's Division with the name and the
address of the provider of the training program and a copy of the training
curriculum;
3. Once the training
has been approved, the division may reimburse the out-of-state adoptive
parent(s) or guardian(s) for training up to ninety dollars ($90) per hour if
there is a charge. A receipt must be provided to the division by the adoptive
parent(s) or guardian(s) prior to payment; and
4. The adoptive parent(s) or guardian(s) must
provide documentation of successful completion of the program.
(D) Adoptive parent(s) or
guardian(s) of children receiving the medical maintenance - In order to qualify
to receive the medical maintenance rate, the adoptive parent(s) or guardian(s)
shall receive individualized medical training provided by the child's health
care provider or other provider and approved by the division to enable the
adoptive parent(s) or guardian(s) to meet the specialized medical needs of the
child.
1. The training shall be
individualized to the child's specific health care needs.
2. The adoptive parent(s) or guardian(s) must
provide documentation of successful completion of the program.
(E) Subsidy agreements or
amendments to subsidy agreements which include maintenance payments at the
medical or Youth with Elevated Needs Level A shall be written to be reviewed
every two (2) years or to age eighteen (18) due to their condition being such
that they are not expected to improve. The Children's Division shall fully
review the needs of the child in cooperation with the adoptive parent(s) or
guardian(s). The Children's Division shall review and consider any and all
information that the adoptive parent(s) or guardian(s) may submit for review
and shall request information from all professionals who have provided
diagnostic care or treatment for the child. In the event that the child's needs
are such that the child no longer qualifies as a Youth with Elevated Needs, the
standard maintenance rate shall apply. However, the burden shall be on the
Children's Division to establish by a preponderance of the evidence that there
has been a substantial and continuing change in the medical or behavioral needs
of the child such that the child no longer meets the criteria of a Youth with
Elevated Needs. Nothing in this subsection shall apply to any adoption subsidy
agreement entered before the effective date of this regulation without the
consent of the adoptive parent(s) or guardian(s).
(F) At the time of placement, the amount paid
is determined by information obtained from the adoptive parent(s) or
guardian(s) as to what financial assistance they need to meet the needs of the
child and the resources available to the child such as OASDI, VA, SSI,
etc.
(9) Medical and
Dental Care.
(A) A child eligible for adoption
subsidy or guardianship subsidy shall be eligible to receive MO HealthNet
benefits to the extent authorized by law.
(B) The Children's Division shall not pay for
any services which are covered by the MO HealthNet program. Notwithstanding any
provision of an adoption subsidy agreement, any services paid for by the MO
HealthNet program shall constitute payment in full for those services, and the
Children's Division shall not be responsible for or liable to pay for any
amounts in excess of the amount paid by MO HealthNet. Services covered by MO
HealthNet do not require special approval by the Children's Division in the
service section of the agreement; however, nothing in this subsection shall be
construed to supersede the requirements of the MO HealthNet program, and the
requirements of the MO HealthNet program for preapproval of services shall
apply for any services administered by the MO HealthNet program.
1. Adoptive parent(s) or guardian(s) are
encouraged, but not required, to add their adopted child or ward to their
private insurance. Payment for an insurance deductible as prescribed by their
private health insurance plan is the responsibility of the adoptive parent(s)
or guardian(s). If an adoptive parent(s) or guardian(s) has added the adopted
child or ward to their private health insurance, they must use their private
health insurance, if the child is covered in their policy, before using MO
HealthNet. However, the adoptive parent(s) or guardian(s) must indicate to the
provider that the child is also eligible for MO HealthNet coverage.
2. The Children's Division will not pay for
any medical or dental services in whole or in part received from non-MO
HealthNet providers without prior approval by signature of the director of the
Children's Division to the subsidy amendment.
3. The Children's Division may agree to pay
for orthodontic services through adoption or guardianship subsidy when the
services are determined to be medically necessary by the MO HealthNet Division
according to eligibility criteria of the MO HealthNet program, but only if a MO
HealthNet provider is not located within one hundred (100) miles round-trip of
the residence of the child. The Children's Division will not pay any amounts in
excess of the MO HealthNet rates for orthodontic services under this section.
The children's division will not be responsible for payment of orthodontic
services without prior written approval of the division. The adoptive parent(s)
or guardian(s) will be responsible for any costs for orthodontic care obtained
prior to written approval from the division.
(10) Childcare.
(A) Eligibility for subsidized childcare
shall be determined by Department of Elementary and Secondary Education (DESE)
and governed by the regulations of DESE.
(B) The division or child-placing agency may
provide referrals to DESE or DESE's authorized representatives to apply for
subsidized childcare.
(11) Nonrecurring Adoption or Legal
Guardianship Expenses.
(A) The Children's
Division may include in an adoption or guardianship subsidy agreement a
provision to pay reasonable nonrecurring adoption or legal guardianship
expenses. The expenses that the division will pay shall be listed specifically
in the agreement. The division will not pay for any expenses which are not
specifically provided for in the agreement. All receipts submitted for
reimbursement must be submitted within one hundred eighty (180) days of service
completion. Any nonrecurring adoption or guardianship expenses, including, but
not limited to, attorney fees, court costs, and litigation expenses incurred by
the adoptive parent(s) or guardian(s) in excess of the amount set forth in the
agreement shall be the sole responsibility of the adoptive parent(s) or
guardian(s). Nonrecurring adoption or legal guardianship expenses which may be
covered are the following:
1. Nonrecurring
placement-related expenses may be reimbursed up to one thousand dollars
($1,000) and are limited to -
A.
Pre-placement transportation: This expense is paid at the current customary
rate established by the Children's Division for use of a personal automobile or
the charge of air or ground transportation; and
B. Lodging and food: Reimbursed using
division travel guidelines for both instate and out-of-state travel;
2. Legal fees include attorney's
fees, court costs, publication expenses, and Guardian Ad Litem (GAL) costs for
the adoptive parent(s) or guardian(s) in adoption or the guardianship case
filed in a court of competent jurisdiction.
A. Attorney's fees will be reimbursed at a
rate not to exceed one hundred dollars ($100) per hour to a maximum of one
thousand five hundred dollars ($1,500) in non-contested adoption cases and up
to three thousand dollars ($3,000) in a contested case. Legal fees for
guardianship subsidies may be reimbursed up to one hundred dollars ($100) per
hour to a maximum of five hundred dollars ($500) in non-contested guardianship
cases and up to one thousand five hundred dollars ($1,500) if the guardianship
is contested.
B. The attorney's
fees, court costs, and litigation expenses which the Children's Division may
agree to cover under a subsidy agreement shall only include those fees, costs,
and litigation expenses which are reasonably necessary to pay for the adoption
count of the adoption petition. Nothing in this regulation shall be construed
to require the division to pay for attorney's fees, costs, or litigation
expenses related to the termination of parental rights or other portions of any
legal proceedings involving the child. Nothing in this regulation shall be
construed to require the division to pay for the attorney's fees, litigation
expenses, and court costs for any other person, including the natural or legal
parent(s) to defend the petition for adoption or guardianship
petition;
3. Private
agency fee reimbursement up to three thousand five hundred dollars ($3,500).
Such costs may include the adoption study, including health and psychological
examination, and supervision of the placement prior to adoption finalization;
and
4. Payment for nonrecurring
expenses shall not include those paid for or provided through resources
available to the adoptive parent(s) or guardian(s), court, or the agency
facilitating the placement. Examples of these resources include -
A. A private agency waives the cost of the
family assessment (home study) or the placement support services;
B. The adoptive parent(s) claimed the
Missouri adoption tax credit for nonrecurring adoption expenses;
C. The adoptive parent(s) or guardian(s) has
private insurance providing payment for certain services included in an
adoption/guardianship; and
D. A
service provider has waived the cost for the service.
(12) Additional
Services - An adoption or guardianship subsidy agreement may include provisions
for the Children's Division to provide the following:
(A) The division may offer available
Intensive In-Home Services (IIS) or other services to the adoptive parent or
guardian for the family who is in need of intervention that may reduce the risk
of the child entering out-of-home care;
(B) For all existing adoption and
guardianship subsidy agreements amended on or after June 25, 2024, and for all
adoption and guardianship subsidy agreements executed or amended on or after
June 25, 2024, payment for care and treatment of a child in a residential
setting (hereinafter referred to in this regulation as "residential treatment")
(all levels) may be included in a subsidy agreement or added to the subsidy
agreement through an amendment only as provided in this subsection. The
amendment must be approved and signed by the authorized signature of the
Department of Social Services before payment for such services is made.
1. The division may approve payment, in whole
or in part, for residential treatment of a child in a subsidy agreement only if
all of the following criteria and conditions are met:
A. The division has determined that care and
treatment of the child out of the home in a residential setting is the least
restrictive setting and the program is necessary and appropriate to meet the
child's needs. The division may require that the child and family exhaust all
reasonably available, less restrictive treatment modalities for the child
before entering into an agreement to pay for residential treatment;
B. The division has determined that it is
necessary for the child to receive treatment at a particular level of care in a
residential setting;
C. The child
has been accepted for treatment by a residential facility that is licensed by
the state to provide the treatment, and the facility is either an enrolled MO
HealthNet provider, an enrolled provider of the Medicaid program in the state
in which the child is located, or a facility contracted with the state of
Missouri for payment for the services;
D. Except as provided in subparagraph
(12)(B)1.G. below, the child has received an approved prior authorization for
treatment in the identified residential treatment facility. The approved prior
authorization must be in writing and include a determination that the child
requires residential treatment at a particular level of care to a reasonable
degree of professional certainty according to the eligibility standards
specified in this regulation.
(I) For
children covered by a subsidy agreement, who are residents of the State of
Missouri and are participants in the MO HealthNet program, the prior
authorization must be provided by the MO HealthNet Division or the provider
contracted with the MO HealthNet Division to make those determinations.
(II) For children covered by a
subsidy agreement who are not residents of the state of Missouri, but who are
participants in the MO HealthNet program, then the prior authorization must be
provided by the MO HealthNet Division or the managed care provider contracted
with the MO HealthNet Division to make those determinations.
(III) For children who are not residents of
the state of Missouri, who are not current participants in the MO HealthNet
program, and are participants in another state's Medicaid program, prior
authorization shall be provided by the Medicaid program from the other
state.
(IV) For children who are
not residents of the state of Missouri, who are not current participants in the
MO HealthNet program, and are either not participants in another state's
Medicaid program or the other state's Medicaid program does not pay for
residential treatment, then the division will use the exception procedure in
subparagraph (12)(B)1.G. below to determine eligibility for subsidized
residential treatment;
E. Every child receiving payment for
residential treatment through a subsidy agreement shall have a current written
plan of care;
F. The division will
only enter into a subsidy agreement to pay for residential treatment if the
facility is the closest available facility to the child's home that provides
the array of services that the division determines are necessary for the child
at a contract price for those services agreeable to the division;
G. In exceptional, extraordinary, and unusual
circumstances, the division may, in its discretion, waive the requirement in
subparagraph (12)(B)1.D. of this regulation that the child has received prior
authorization for payment through a subsidy agreement for residential
treatment, but only if all of the following criteria are met:
(I) All of the other criteria for eligibility
for payment for treatment in a residential care facility have been met;
(II) Either the adoptive parent or
guardian has filed an appeal of the denial of prior authorization, or the child
is a resident of a state whose Medicaid program does not include payment for
the necessary residential treatment;
(III) The child's treating or examining,
psychiatrist, psychologist, physician, advanced practice psychiatric nurse,
marital and family therapist, nurse practitioner, licensed professional
counselor, or licensed clinical social worker certifies to a reasonable degree
of medical certainty in writing that treatment in a residential facility at the
indicated level of care is necessary. The division may at any time, in its
discretion, require the child to be examined and the certification and child's
records reviewed by other licensed medical professionals for an independent
assessment of the necessity for residential treatment. The division will
determine what weight shall be given to conflicting opinions of medical
experts;
(IV) The division
determines that funds are available to pay for the treatment in a residential
facility;
(V) The duration of the
waiver shall be determined as follows:
(a) In
the case where the waiver was triggered by a request for administrative review
of the denial of a request to approve residential treatment, the waiver shall
extend until the appeal has been decided on administrative review. The division
may extend the waiver period if there is a request for judicial review of the
administrative decision; or
(b) In
the case where the waiver was necessary because the child is a resident of a
state whose Medicaid program does not include payment for the necessary
residential treatment, the waiver shall be subject to the continuing care
reviews as provided in this regulation; or
(c) The division determines that treatment in
a residential facility is no longer necessary, such as where the child is
discharged from residential treatment; and
(VI) The division determines that the child
may be a danger to self or others.
2. Responsibilities of the adoptive parent or
guardian. The implementation of a subsidy agreement to subsidize payment for
residential treatment does not and shall not absolve the adoptive parent or
guardian of any and all of the duties and responsibilities that they may have
toward the child under law. The fact that the division has entered into a
subsidy agreement for payment for residential treatment does not mean that the
child is or has been placed in the legal or physical custody of the division.
A. The adoptive parent or guardian shall be
responsible for researching and exhausting all reasonably available, less
restrictive, community-based care and treatment modalities before the division
will approve subsidized residential treatment. The division may provide
referrals and information to support the adoptive parent or guardian in that
effort.
B. The adoptive parent or
guardian shall remain responsible for the support of the child throughout the
child's residential treatment and making arrangements for the physical care,
custody, and placement of the child when treatment in a residential care
facility is no longer necessary. This duty of support shall include both
financial support and exercising all duties of a parent or guardian, including
but not limited to making decisions for the child, visiting the child, actively
participating with the provider in all aspects of the management of the child's
care and treatment, and engaging in active efforts to enable the child to
return home.
C. If the adoptive
parent or guardian is unable or unwilling to exercise these efforts or does not
actively demonstrate a desire for the child to be returned to their home, then
the division may take one (1) or more of the following actions:
(I) Decline to authorize payment for
residential treatment under a subsidy agreement;
(II) Institute any available remedy for the
modification or termination of the subsidy agreement, in whole or in part;
(III) Take any other action
authorized by law, including a referral to the juvenile officer or the child
welfare authorities of another state for investigation, assessment or other
appropriate action.
D.
The adoptive parent or guardian shall provide all required documentation
necessary for determining eligibility, and continuing eligibility, for
residential treatment to MO HealthNet or MO HealthNet's contracted Managed Care
provider, the Residential Treatment Provider, and the division.
This includes but is not limited to executing Health Insurance Portability and Accountability Act (HIPAA) and Family Education Rights and Privacy Act (FERPA) compliant consents to authorize the release of all information and records deemed necessary.
3. Residential treatment that is eligible for
payment under a subsidy agreement.
A. The
subsidy agreement may include payment on behalf of a child who is the subject
of a subsidy agreement in a residential treatment facility for -
(I) The reasonable and necessary cost for
room and board for the child at the rate specified in the contract between the
division and the provider of residential treatment;
(II) If the division has granted a waiver as
provided in subparagraph (12)(B)1.G., then the division will pay the provider
the agreed-upon amount for necessary residential treatment specified in the
contract between the division and the provider of residential treatment;
or
(III) Discharge planning. The
division may, but is not required to, pay for residential treatment for a
limited period of time specified in the subsidy agreement to allow the family
to establish and implement the necessary in-home or community-based treatment
for the child, provided that the parent and guardian exercise diligent and
active efforts to implement and complete the discharge plan within the time
specified in the subsidy agreement. Discharge planning extensions shall be
reviewed monthly or more frequently as necessary.
B. The subsidy agreement shall not include,
and the division is not required to pay through a subsidy agreement for, any
one (1) or more of the following:
(I)
Residential treatment and other services that are covered by MO HealthNet or
the Medicaid program of any state;
(II) Residential treatment that is covered by
any policy of insurance that provides coverage for the child;
(III) Residential treatment that is not
necessary;
(IV) Residential
treatment that is beyond the scope of the participant's plan of care or
discharge plan;
(V) Residential
treatment that is available to the child through other government or privately
funded programs, including but not limited to schools and school districts,
community-based services, and services provided by not-for-profit and religious
organizations;
(VI) Residential
treatment provided after the approved length of stay or after the child is
discharged from the facility;
(VII) Residential treatment on behalf of a
child to a provider who does not have a contract to provide the service with
the state of Missouri; or
(VIII)
Residential treatment and other services that are provided by a provider who is
not qualified and licensed to provide the treatment in the location where the
treatment is provided.
4. Payments for residential treatment shall
be made directly to the provider of the residential treatment pursuant to a
contract between the state of Missouri and the provider. The adoptive parent or
guardian and child shall not be a party or be a third-party beneficiary of the
contract between the state of Missouri and the provider. No payments shall be
made to a provider that is not currently licensed in good standing to provide
the care and treatment. No payments shall be made directly to the adoptive
parent or guardian. No payments shall be made to a provider who is either not
an enrolled Medicaid provider or who does not have a contract with the state of
Missouri to provide the service. The laws and regulations governing contracting
with the state of Missouri shall govern all contracts for services under this
regulation.
5. For the division to
determine that residential treatment at a specific level of care is necessary,
all of the criteria in sub-paragraphs (12)(B)5.A.-H. must be met, subject to
the definition of "medical condition" specified in subparagraph (12)(B)5.I.
A. The child's medical condition must satisfy
all of the eligibility requirements of
13 CSR
35-38.010(12)(B).
B. The child must have one (1) or more
current diagnosed medical condition(s), injury, or illness. The diagnosis may
be final or provisional.
C. The
diagnosis must have been made by a medical professional who is licensed and
qualified by law to make that diagnosis.
D. Care and treatment in a residential
facility for the child's diagnosis meets the generally accepted standard for
care and treatment for the child's diagnosed condition.
E. Care and treatment in a residential
setting is not experimental and is not mainly prescribed for the convenience of
the child or the child's parents or guardian.
F. Care and treatment in a residential
setting is reasonably necessary to protect the life, safety, and health of the
child.
G. The care and treatment
is not optional or for purely cosmetic purposes.
H. Treatment at home or in a lower level of
care for the medical condition has been ruled out by a medical professional who
is licensed and qualified to determine whether the treatment is medically
inappropriate.
I. In this
regulation the phrase "medical condition" includes a diagnosed physical,
psychiatric, psychological, and/or developmental condition.
6. The following documentation
shall be submitted to determine whether residential treatment is necessary:
A. A report of a full assessment by a
licensed and qualified health care professional using the most recent version
of the Daily Living Activities (DLA-20) assessment process and tool. If a
DLA-20 assessment process and tool is not available, the division may, in its
discretion, accept an assessment using an equivalent, current assessment tool,
provided that the assessment and tool is evidence-based, objective, generally
accepted, and actually used in the medical community as a tool used for
assessments for care and treatment in residential facilities. The assessment
must be completed by a clinician licensed in the state in which the tool is
administered who is trained and qualified to use the tool. The assessment and
tool must be the most recent version of the tool as of the date of the
assessment. Other tools that may be used when a DLA-20 assessment is not
available may include the Level of Care Utilization System (LOCUS) for youth
over age eighteen (18), the Child and Adolescent Level of Care/Service
Intensity Utilization System (CALOCUS-CASII) for children aged six to eighteen
(6-18), and the Early Childhood Service Intensity Instrument (ESCII) for
children aged zero to five (0-5);
B. Any relevant child/youth
psychiatric/behavioral health diagnoses;
C. The most recent psychiatric evaluation
completed by a psychiatrist, psychologist, or advanced practice nurse, if one
is available;
D. A statement
detailing the rationale for residential treatment at the requested level of
care;
E. Documentation of previous
treatment history and outcome of treatment, if applicable and available;
F. Documentation of the name,
address, telephone number, email address, and all other contact information for
the adoptive parent or legal guardian of the child;
G. A discharge plan when available. Discharge
planning shall start at admission and shall be continuously developed and
evaluated throughout the child's stay in residential treatment;
H. The child's parent or guardian shall
complete and submit a Residential Treatment Referral, CS-9, to the best of
their ability in cooperation with the assigned subsidy worker. The adoptive
parent or guardian shall sign the form and certify that the information that
they have provided is true, complete, and accurate to the best of their
personal knowledge, information, and belief.
7. The adoptive parent or guardian shall have
the burden of proof to establish by a preponderance of the evidence that the
child is eligible for both initial and continuing treatment in a residential
care facility at a particular level of care.
8. Except as otherwise provided elsewhere in
these regulations, the division shall not approve payment for residential
treatment in a residential care facility in a subsidy agreement for more than
six (6) consecutive months. The division may enter into subsequent amended
subsidy agreements that include payment for treatment in a residential setting
following the continuing stay review procedures.
9. Continuing stay reviews. All subsidy
agreements that include residential treatment services shall be subject to
continuing stay reviews. The purpose of the continuing stay review is to
determine whether ongoing residential treatment is necessary. All continuing
stay reviews must include evidence that clearly supports the need for ongoing
treatment at the requested level of care and must clearly identify why the
child's treatment needs can't be treated at a lower level of care. The same
procedures, standards, and criteria for initial approval of residential
treatment services shall apply to continuing stay reviews.
A. The division may accept the continuing
stay review decision of the primary payer for the purpose of approving
continued subsidized residential treatment if all other eligibility
requirements of this regulation are met.
B. When the division approves a prior
authorization waiver, the division will conduct the continuing stay review to
determine continued eligibility for subsidized residential treatment services.
(I) The division will conduct a continuing
stay review within thirty (30) days prior to the expiration of the approved
residential treatment services, and more frequently as the division determines
necessary.
(II) Documentation. The
child's adoptive parent or guardian shall be responsible for providing all of
the documentation to determine whether ongoing residential treatment of the
child is necessary at a specified level of care. The adoptive parent or
guardian may request the division to provide assistance in gathering the
required documentation, provided that the request is made in a timely manner
and the adoptive parent or guardian executes any required authorizations for
the release of information. The documentation shall be the most current
available information and shall include -
(a)
The child's plan of care since last review; and
(b) Treatment progress notes, to include any
progress notes from the child's treating psychiatrist, psychologist, physician,
and/or therapists; and
(c) Family
therapy progress notes since last review, or detailed documentation to
establish whether family therapy sessions are not occurring or have been
excused; and
(d) Any updates to
the child's diagnoses and prognosis; and
(e) Medications prescribed to the child,
including any changes to medications; and
(f) The child's discharge plan to include any
details currently available including any established outpatient providers,
appointment dates and times, recommended treatment level of care; and
(g) The efforts that the adoptive
family or guardian have engaged in to participate in the child's care,
treatment, and discharge plan; and
(h) A new DLA-20, or equivalent assessment of
whether treatment in a residential setting is necessary by a clinician trained
and qualified to perform the assessment, if requested by the residential
treatment provider, the payer of coverage for residential treatment, the
adoptive parent or guardian, or the division.
10. Residential referral process.
The procedures in this sub-section shall govern all requests for payment for
services, care, and treatment in a residential setting through an adoption or
guardianship subsidy agreement.
A. At any
time, the adoptive parent or guardian may request residential services. The
division may refer the case to an IIS provider. If the division determines that
IIS is appropriate, the division may provide IIS rather than residential
services.
B. Community resources
are to be researched by the adoptive parent or guardian, with the assistance of
their division caseworker and the child's care manager (if applicable), and
efforts documented prior to making a residential treatment referral.
C. In the event that IIS is ineffective in
remedying the situation and other community resources have not produced the
necessary change in the family unit and/or adoptive parent or guardian are
reasonably unable to access alternative resources to prevent placement in
residential care, the adoptive parent or guardian must provide information
necessary to evaluate the needs of the child to determine eligibility for
placement in residential care.
D.
The adoptive parent or guardian shall obtain the necessary documentation
regarding the child's condition from appropriate professionals (psychological,
psychiatric, etc.).
E. The
adoptive parent or guardian shall make diligent efforts to place the child in
close proximity to their home to allow involvement by the adoptive parent or
guardian in the child's treatment.
F. The adoptive parent or guardian are
responsible for making arrangements for actual placement into the residential
facility.
11. Any
adoptive parent or guardian who believes that they are aggrieved by an adverse
decision regarding or prior authorization that is made by the MO Health
Division, the managed care provider contracted with the MO HealthNet Division
to make that decision, or the Medicaid program of another state shall first
exhaust his or her administrative and judicial remedies under that program;
(C) The provisions of
this subsection shall apply to all adoption and guardianship subsidy agreements
executed prior to June 25, 2024.
1.
Residential care services (all levels) may be included in a subsidy agreement
or added to the subsidy agreement through an amendment, but only if residential
care is the least restrictive treatment setting and program appropriate to meet
the child's needs. The amendment must be signed by the director of the
Children's Division before payment for such services may begin. All amendments
and proposed amendments covering residential care and treatment services to
adoption and guardianship subsidy agreements existing prior to June 25, 2024,
are governed by subsection (12)(B) above and not this subsection.
2. Residential referral process.
A. At any time, the adoptive parent or
guardian may request residential services. The division may refer the case to
an IIS provider. If the division determines that IIS is appropriate, the
division may provide IIS rather than residential services.
B. Community resources are to be researched
by the adoptive parent or guardian, with the assistance of their division
caseworker, and efforts documented prior to making a residential treatment
referral.
C. In the event that IIS
is ineffective in remedying the situation and other community resources have
not produced the necessary change in the family unit or the adoptive parent or
guardian is unwilling to utilize alternative resources to prevent placement in
residential care, the adoptive parent or guardian must provide information
necessary to evaluate the needs of the child to determine eligibility for
placement in residential care.
D.
The adoptive parent or guardian shall obtain the necessary documentation
regarding the child's condition from appropriate professionals (for example,
psychological or psychiatric).
E.
Efforts shall be made to place the child in close proximity to their home to
allow involvement by the adoptive parent or guardian in the child's treatment.
F. The adoptive parent or guardian
is responsible for making arrangements for actual placement into the
residential facility.
F. The
adoptive parent or guardian is responsible for making arrangements for actual
placement into the residential facility.
G. Once a child has been approved for
residential treatment, the adoptive parent or guardian shall be referred to the
out-of-home care program. A Family Centered Services (FCS) case may be opened
to provide services to work toward reintegration.
H. If the adoptive parent or guardian is
unwilling to be a part of this process and has no desire for the child to be
returned to their home, residential treatment may not be authorized through
subsidy, and other permanency options shall be discussed with the family. If
the child enters the custody of the Children's Division, the division will
pursue child support from the adoptive parent or guardian.
3. The Children's Division will
not pay for residential services at a more intensive treatment level and at a
higher rate unless the director of the Children's Division agrees in writing to
pay for the more intensive treatment level. To request approval to pay at a
higher rate for a more intensive treatment level in the residential setting -
A. The adoptive parent or guardian shall
submit a written request and state in detail the reasons that it is necessary
for the child to be placed at a more intensive treatment level. The adoptive
parent or guardian shall provide any and all documentation that the division
may require to ascertain whether the more intensive treatment level is
necessary; and
B. The
documentation submitted must include current records and reports no more than
ninety (90) days old and include an estimated discharge date and prognosis,
monthly treatment summary, explanation of a continued need for residential
treatment, and a description of parental involvement with the facility's
treatment plan;
(D) Youth with Elevated Needs Level B-A child
may be placed in a Youth with Elevated Needs Level B Home if this service is
determined necessary for the child by the Children's Division in conformity
with the procedures and eligibility criteria set forth in
13 CSR
35-60.070 and a Level B Home is available and has
accepted the child for placement. The Elevated Needs Level B Home is for the
purpose of treating a child's behavioral issues so they may be successfully
reintegrated into the adoptive or guardianship home.
1. The adoptive parent or guardian is to be
referred to the out-of-home care program, a voluntary case is to be opened, and
services are to be offered in order to work towards reintegration into the
adoptive or guardianship home.
2.
Youth with Elevated Needs Level B placements may be authorized for only six (6)
months at a time. Upon the sixth month, the need for placement and level of
care must be reviewed in a Family Support Team (FST) meeting.
3. An amendment requesting funding for Youth
with Elevated Needs Level B placements shall be submitted to the division for
approval. The amendment must be signed by the director of the Children's
Division before Youth with Elevated Needs Level B services may begin and
payment for such services made.
4.
With regard to agency liability of an adopted or guardianship child voluntarily
placed in a Youth with Elevated Needs Level B placement, any legally recognized
parent (biological or adoptive parent or guardian) is liable for the actions of
his/her child as long as that adoptive parent or guardian has not been relieved
of legal custody. If the division does not have legal custody of a child, the
division is not liable for the child;
(E) Respite. Adoptive parent or guardian may
receive respite as a special service on a case-by-case basis through subsidy
when a documented need exists to age eighteen (18). Respite care shall be
provided according to any regulations promulgated by the division governing
respite care.
1. The adoptive parent or
guardian shall provide a letter requesting this service describing in detail
the child's need for respite.
2.
All paid receipts submitted for reimbursement must be submitted within one
hundred eighty (180) days of the service being provided.
3. Respite shall be approved in accordance
with maintenance approval; if a child receives traditional maintenance to age
eighteen (18), respite may be approved to age eighteen (18) as well. If a child
receives medical or Youth with Elevated Needs Level A maintenance to age
eighteen (18) due to their condition being such that they are not expected to
improve, respite may also be approved to age eighteen (18). However, if medical
or Youth with Elevated Needs Level A maintenance is only approved for a two-
(2-) year time period, respite should only be approved for two (2) years;
and
(F) If the child has
a disabling condition as defined by the Americans with Disabilities Act, the
Children's Division within its discretion may include in an adoption or
guardianship subsidy agreement a provision to pay for minor modifications of
the residence of the child or vehicle used to transport the child under the
following conditions:
1. The modification
must be necessary for the child to effectively function in the home or vehicle;
2. The adoptive parent or guardian
must be unable to acquire these services independent of the subsidy and have
exhausted all available private and public community resources;
3. All expenses, modifications, and services
shall be approved for payment pursuant to procurement laws and regulations
including but not limited to
1 CSR
40-1.010 through
1 CSR
40-1.090; and
4. The division will pay for the least
expensive, appropriate alternative to meet the needs of the child.
(13) 18+ Adoption
Subsidy Agreement. The Children's Division may approve an adoption subsidy to
continue beyond the age of eighteen (18) up to the age of twenty-one (21) when
the child has an extraordinary documented physical, dental, or mental health
need that requires care beyond the age of eighteen (18). These 18+ Adoption
Subsidy Agreements are negotiated on an annual basis with the adoptive
parent(s) according to the youth's current needs and with the intent of
transitioning the youth from subsidy services to adult community services to
ensure all necessary services are in place for the youth's success when subsidy
is no longer available.
(A) Six (6) months
prior to a youth covered by an adoption subsidy agreement's eighteenth
birthday, the adoptive parent(s) may make a request in writing to the
Children's Division for the division to assess whether or not the child is
eligible for an 18+ adoption subsidy agreement. The division will make a
determination as to whether or not the youth has an extraordinary documented
physical, dental, or mental health need that requires care through a subsidy
agreement beyond the age of eighteen (18). Documentation of need from the
youth's physician, psychiatrist, psychologist, or dentist shall be obtained and
submitted as supporting documentation of need.
(B) The adoptive parent(s) shall be made
aware of the need to transition the youth from adoption subsidy to adult
community services to meet the youth's needs and provide referral information
and assistance with obtaining these services as needed. The adoptive parent(s)
shall be advised they are required to apply for and participate in all such
programs and services as may be reasonably necessary to meet the needs of the
youth as indicated in the contract.
(C) The Children's Division will not approve
an 18+ adoption subsidy agreement for any child whose mental, physical, or
dental needs may be met or otherwise paid for or reasonably available at no
cost or at reasonable cost through any other services and which the child or
the adoptive parent(s) or guardian(s) may be eligible to receive on behalf of
the child.
(14)
Termination of an adoption or legal guardianship subsidy agreement shall take
place if any of the following events occur:
(A) The child has attained the age of
eighteen (18) and there is no 18+ adoption subsidy agreement or the maximum age
of twenty-one (21) if there has been an 18+ agreement in effect; or
(B) The division determines that the adoptive
parent(s) or guardian(s) are no longer legally responsible for support of the
child; or
(C) The division
determines that the adoptive parent(s) are no longer providing any support to
the child; or
(D) The adoption
subsidy agreement expires.
(15) Administrative and Judicial Review.
(A) Scope and Purpose. This establishes the
procedures for the resolution of disputes involving the delay, overpayment,
denial, amount, or type of adoption or guardianship subsidy for applicants for
or participants in the adoption and/or guardianship subsidy program.
(B) Notice of Case Action. The division shall
provide a written notice of case action to an applicant or participant of any
decision on an application for subsidy and any decisions relating to an
existing subsidy agreement to delay, deny, and/or modify the amount or type of
the subsidy. The notice shall state the date of the decision and -
1. State generally the factual and legal
basis for the division's action;
2.
State the effective date of the action, if applicable; and
3. Notify the applicant or the subsidy
participant of his or her right to administrative review. Attaching a copy of
this regulation to the division's notice of case action shall be sufficient
notice to comply with this subsection.
(C) Right to Administrative Review. Any
person who believes that he or she is aggrieved by any delay in the adoption or
guardianship subsidy process, or believes that he or she is aggrieved by the
division's decision regarding the denial, amount, or type of adoption or
guardianship subsidy program shall have the right to request administrative
review following the procedures set forth in this regulation.
(D) Standard of Review and Burden of Proof.
The decision shall be based on competent and substantial evidence on the whole
record as in administrative hearings in contested cases. The preponderance of
evidence standard shall apply. For initial applications and for requests for
amendments to existing subsidy agreements, the burden of proof shall be on the
applicant for subsidy or amendment to the subsidy agreement.
(E) Process for Administrative Review.
1. Requests for Administrative Review. A
request for administrative review must be received by the division no later
than thirty (30) days from the date of the division's decision. The request for
administrative review shall be in writing and shall set out, generally, the
reasons why the applicant or participant believes he or she is aggrieved by the
decision. If there is a current adoption subsidy agreement in place, at the
request of the adoptive parents, the division shall stay implementing its
decision and keep the existing agreement in place until a final decision on the
request for administrative review has been made. If the division's decision is
finally affirmed, the division may seek reimbursement for any amounts overpaid
to the adoptive parents pending the final decision.
2. First Level Review. Within thirty (30)
days of the receipt of a request for administrative review, the division shall
convene a panel of three (3) persons who are employees of the division, at
least one (1) of whom is not responsible for the case management of, or the
delivery of services to, either the child, the adoptive parent(s) or the
prospective adoptive parent(s), guardian(s), or the prospective guardian(s).
The panel shall review the request for administrative review, the materials
submitted with the request, the division's file, and any written materials
submitted by the division. At the request of the person seeking administrative
review, the panel may convene an informal meeting which shall be open to
participation by the applicant, the child, and/or the child's adoptive parents.
The meeting shall be an informal settlement conference, the rules of evidence
shall not apply, and no record of the meeting shall be kept. The panel may
affirm, reverse, or modify the initial agency decision, or it may refer the
case to a formal administrative hearing. If the person(s) requesting the
hearing is not satisfied by the first level review, they may request in
writing, within thirty (30) days of the decision of the panel, the referral of
the case for an administrative hearing.
3. Administrative Hearing. In the event that
the request for review is not resolved at the first level of review, the person
requesting the review may request a hearing before a hearing officer of the
Division of Legal Services of the Department of Social Services. The hearing
shall be on the record and the rules of evidence shall apply as in
administrative hearings in contested cases. The parties shall be afforded the
right to adduce relevant evidence, to call witnesses, and to compel the
attendance of witnesses by subpoena.
4. Hearing decision and right to judicial
review. The hearing officer shall issue a written decision setting forth his or
her findings of fact, conclusions of law, and decision after hearing, which
shall be the final decision of the division. The written decision shall notify
the parties of their right to request judicial review pursuant to section
536.100, RSMo.
Notes
*Original authority: 210.506, RSMo 1982, amended 1993, 1995; 453.073, RSMo 1973, amended 1978, 1981, 1982, 1985, 1997, 2001, 2005, 2008; and 453.074, RSMo 1985.
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