The High Need Child Care Rate: Information for High Need Specialists

1. The High Need Child Care Rate:Information for High Need Specialists

2. Objectives DHS High Need Specialists will understand: • The High Need Child Care Rate, • Their role in referral and payment processes, • The High Need Rate payment process, and, • How they coordinate with the Inclusive Child Care Program.

3. Inclusive Child Care Program Goals • Increase access to child care for families of children with disabilities, emotional/behavioral disorders or special health care needs; And 2) Help children to be in inclusive child care and after school settings with their peers.

4. One way we do this is through the DHS High Need Rate and subsidy funds we manage for families not eligible for ERDC. Our other services include consultation to child care providers, etc for more info- visit our website at www.oregoninclusivecc.org

5. What Is the DHS High Need Child Care Rate? • DHS established the High Need Child Care Rate in 2000 to support child care for eligible children and youth with exceptionally high care and supervision needs. • The High Need rate is different for each child. It is based on an individual assessment of the child’s specific needs in the child care setting. • The Inclusive Child Care Program completes assessments needed to determine the rate.

6. DHS Special Need Rate and High Need Rate: Not the same High Need Rate Special Needs Rate Individualized & different for each child. ICCP assessment required. ------------------------------------------------- A District High Need Specialist refers to ICCP for a High Need assessment. ------------------------------------------- Paid through DPU using the special pay system ---------------------------------------------- Is added to the Special Need rate • Fixed amount for each group area and type of care. ---------------------------------------------- • A family’s DHS caseworker can authorize the Special Needs Rate. --------------------------------------------- •  Paid through the regular CCB/JCCB voucher

7. Key features of the High Need Rate • Individualized • For significantly higher levels of care, supervision, accommodations or supports • Based on ICCP Assessment • Added to special needs rate

8. Eligible children and youth: • Birth through 17 years of age • Have physical or developmental disabilities, emotional/behavioral disorders, or special health care needs And • Need supports, accommodations, or higher levels of care and supervision

9. Indicators of need • Difficulty finding care • Current placement at risk • History of losing child care placements • Young people over 12 still needing care

10. Why supports are needed (118 children served by High Need Rate or ICCP supplemental subsidy, Jan – June 2013) • 74% - Challenging or highly unsafe behaviors. • 40% - Direct assist with communication • 36% - Direct assist to safely and appropriately interact with their peers. • 31% - Direct assist with tasks, instructions, or participation • 24% - Direct assist with basic care (eating, toileting, hygiene). • 15% - High level of care and supervision for medical needs. • 8% - Direct assist with mobility. Percentages total more than 100% because most children had more than one area of need.

11. Partners working together Parents/Providers/Caseworkers DHS High Need Specialists Inclusive Child Care Program DPU Staff

12. What you do: District High Need Specialists • Make referrals to the Inclusive Child Care Program for assessments; • Be the link between ICCP and DHS caseworkers; • Inform staff and share information about the HN program within your branch and district; • Help answer questions regarding high need rate payments; and • Confirm that the SNR has been coded correctly.

13. What we do: High Need Child Care Assessments • Receive assessment referrals from DHS district High Need Specialists. • Contact parents and child care providers to schedule and complete high need child care assessments. • Make a recommendation to DHS on the following: • 1) whether or not an individualized rate is needed for safe and appropriate care; • 2) the amount of the High Need Rate; and, • 3) the start date for the High Need Rate. The recommendation is made in writing to DHS Direct Pay Unit (DPU). DPU is responsible for issuing the approval and completing the payment.

14. Who does the assessment? ICCP staff (3 people) • CCR&R subcontractors: • Baker, Grant, Harney, Malheur Union & Wallowa • Jackson, Josephine, Klamath & Lake • Coos & Curry • Lane & Douglas • Linn & Benton • Crook, Deschutes & Jefferson

15. Determining the RateChild Care Accommodations & Supports Assessment • What does the provider need to do? • Differently for this child as compared to others of the same age • Beyond reasonable accommodation • Why? • Child’s functional abilities and needs…Not diagnosis • How do we know? • Parent and provider information • Documentation (IEP, IFSP, medical or mental health eval)

16. Calculating the Rate • Assessment findings are converted, through weighted scores, into a dollar amount. • Amounts are different for each child. • Maximum High Needs Rate: $5/hr. or $840/mo.

17. How is the funding used?Individualized for each child Examples: • Smaller group • Accommodations or adaptations • Training/consultation as a necessary accommodation • Extra person if necessary

18. CCR&R Subcontracts • In districts with CCR&R subcontracts, someone from the CCR&R program may complete the High Need Child Care assessments. • If a CCR&R person does the assessment, ICCP staff review and approve the recommended rate before sending the assessment to DPU. CCR&R staff do not handle payment questions. Those go to ICCP.

19. We do:Annual Review • For children continuing to receive a high need rate, reassess the child’s needs annually. • Reassessments may occur prior to one year by parent or provider request.

20. High Need Referral Procedures A child is identified as potentially needing additional care and attention

21. Parent/Provider/Caseworker This referral can be initiated by the caseworker, parent, provider, partner or an Inclusive Child Care Program (ICCP) specialist. • Has the client been determined eligible for child care benefits (ERDC, TANF, JOBS)? • Is there indication that the child needs a higher level of care due to their disability, emotional/behavioral disorder or special health care needs? The child is referred to the High Needs (HN) Specialist.

22. District High Need Specialist HN Specialist reviews to determine if referral for HN assessment is appropriate: • Is the eligible child coded with the Special Needs Rate (SNR)? (There may be reasons a child is not yet coded SNR. If otherwise indicated, do not delay a referral due to no SNR coding.) • HN Specialist completes the DHS High Need Child Care Rate Assessment Referral(SDS 0676) form and sends it to “Contact ICCP” in Outlook. (Staff are: Melinda Benson, Shannon James and Amy Kirby.)

23. Inclusive Child Care Staff • ICCP staff review the SDS 0676, then contact parent and provider to schedule an assessment. • As part of the assessment, and with prior written parent permission, ICCP staff will obtain third party documentation to verify the child’s care needs. This may include copies of documents, interviews with professionals serving the child, or both. • Once the assessment is completed, ICCP staff sends the recommended rate and start date to DHS Central Office (DPU) for approval.

24. DPU staff • DHS Central Office (DPU) reviews the assessment and checks our math • Then notifies HN Specialist and ICCP of approved HN Rate or that the rate is not approved. • ICCP staff notify parents and providers.

25. ICCP & DPU • Monthly, ICCP checks on voucher payments, once processed, ICCP completes a HN Payment worksheet and sends to DPU • DPU then completes a 437 and makes the special cash payment High Needs payment should be processed within 5 business days after the voucher payment.

26. Summary: Team DHS • Refer to ICCP for High Need assessments (District Rep) • Complete High Need assessment and recommend HN rate (ICCP) • Approve High Need Rates (DPU) • Make High Need payments to providers (DPU)

27. Questions???CallUs DHS Child Care Policy Analysts Annette.L.Palmer@dhsoha.state.or.us 503-945-6110 Karen.B.Collette@dhsoha.state.or.us 503-945-6247 Jennifer.J.Irving@dhs.state.or.us 503-945-5729 The Inclusive Child Care Program contact.iccp@state.or.us 971-673-2286

28. Remember…… You’re Not In This Alone