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Title IV-E

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

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Title IV-E

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  1. Title IV-E

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

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

  4. 2nd Quarter FY IV-E CWCR Error Rates

  5. 1st to 2nd Quarter Changes • Number of cases reviewed • Q1 = 648 Cases Reviewed • Q2 = 681 Case Reviewed • Federal Error Percentage decreased 3.06% • 14.51 % to 11.45% • AFDC Eligibility decreased 3.59% • 10.49% to 6.90% • Safety Requirements decreased 1.28% • 2.16% to 0.88% • Total number of errors found • Q1 = 113 errors • Q2 = 82 errors

  6. 2nd Quarter FY IV-E Ongoing Error Rates

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

  8. 2019 Federal Review • On-side Review – September 23rd through the 27th, 2019 • Period Under Review – October 1, 2018 through March 31, 2019. • 80 cases randomly selected (20 oversample) • The cases that are determined for the review are selected from the Adoption and Foster Care Analysis and Reporting System (AFCARS). • Any case that had at least one IV-E foster care maintenance payment made during the PUR is eligible to be reviewed.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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