Attachment C: Special Expenses Payment

NOTE: Authority for approval of any of these expenses rests with the Regional Director (of the respective service county) except when delegated or otherwise specified. All other stipulations and the need for supervisory approval should be observed. Special expenses for a Child of a Youth in Alternative Care (CYAC) child must be invoiced using the CYAC parent's name and Department Client Number (DCN).

Medical and Dental Expenses not covered by the Missouri Medical/Dental Services program. All non-MO HealthNet expenses must be cleared through the Regional Office. CD will not pay any medical expense for children not in agency custody unless specific exceptions are noted in the Child Welfare Manual:

All necessary medical care, as determined by the county office, will be allowed. Staff must ensure that the Department of Health and Senior Services (DHSS) and the the MO HealthNet Division (MHD) resources are explored, as well as any other resources before utilizing HDN funds. Staff should instruct foster parents to request physicians to use MHD approved prescriptive medicine substitutes when possible. No payment will be made for vendor charges which exceed program maximums.
Any non-subsidy dental (including orthodontia) expense over $500.00 must be sent through supervisory channels with Regional Office approval to CD Central Office. The Program Development Specialist (PDS) responsible for receiving dental requests will review the packet of required information, and if all required documentation has been submitted, will forward the packet to MHD. If the required documents are not enclosed, the packet will be returned to the Regional Office.

The following information is required for prior authorization and should be included in the packet sent to Central Office.
- A written statement secured from the orthodontist who provides the following information:
  - A diagnosis and prognosis which includes an itemized listing with the procedural codes and an estimate of the number of months treatment will be required;
  - Orthodontic records which consist of a cephalometric x-ray, panoramic x-ray, or full-mouth survey, in addition to, dental study models, properly occluded and trimmed;
  - The amount of cost for the total treatment program; and
  - A statement from a medical doctor which indicates the treatment is medically necessary for other than cosmetic purposes.
  NOTE: Orthodontic treatment will be covered when determined medically necessary by the State Orthodontic Consultant.
  
  The State Orthodontic Consultant will either approve or deny the request and return the packet to the PDS. The PDS will return the information to the Regional Office for approval or disapproval. After the county has received approval from the Regional Office, a letter of agreement, which addresses the following, should be submitted to the orthodontist:
  1. The Children’s Division will be responsible for payment only when the Division has care and custody of the child and the child remains in an out-of-home setting. The Division will not pay for any treatment received under this agreement after custody is removed from the Division;
  2. The Division does not pay for any services in advance;
  3. A lump sum payment will be made to cover the cost of initial diagnosis, consultation, initial banding and treatment; and
  4. Any charges covered by MO HealthNet shall be billed to MO HealthNet.
  The orthodontist should bill the county office after the initial banding is completed. This usually includes all material and services from the initial diagnostic visit through the placement of bands. The amount shall be invoiced on the Children’s Services Integrated Payment System Invoice, CS-65.
  
  Related Subject: Section 4 Chapter 30 Attachment A Subsidy Coverage Limitations
Children's orthopedic shoes and the abduction rotation bar will be paid for as a special expense if it is documented that the service cannot be paid for with DMS funds:
NOTE: Both items are covered under the Durable Medical Equipment Program if the following conditions are met.
1. The recipient is eligible for Missouri Medical/Dental Services;
2. The provider is a participant in the program; and
3. The orthopedic shoes are attached with a brace.

Transportation Costs: Any allowable costs shall be paid to a foster parent at the current state mileage rate. Use the following options in priority sequence; that is, use a Children’s Treatment Services (CTS) provider if at all possible, if not, then reimburse a foster parent from Alternative Care Special Expenses:
1. Contracted transportation costs for certain areas and services:
  1. Using the SEAS Request and Eligibility Form, CS-67, and the SEAS Authorization Form, CS-67A, transportation costs for children receiving alternative care services may be authorized. To complete Forms CS-67 and CS-67A, staff must contact the provider to determine the estimated mileage and enter the number of units to be authorized.
  2. Transportation may be provided for medical care, counseling, parent education classes, visitation, or other services intended to support the case plan. If a foster parent transports the child, CD shall reimburse allowable transportation expenses.
  3. Transportation for child care services is not an allowable cost, even if such services are part of the child's case plan.
2. Transporting a child in alternative care via airplane, bus or train:
  1. All requests for tickets to transport a child in alternative care via airplane, train, or bus, must have Interstate Compact for the Placement of Children (ICPC) approval and go through the Payment Processing Planning at Central Office. Staff must complete the ticket request form and fax to Central Office for processing. Once received, the ticket will be purchased and arrangements will be made to have it waiting for the child upon arrival. All requests must be made at least 48 hours in advance of the date of travel. However, it is preferable that more advance notice be provided if the travel plans are definite. The cost of the ticket will be direct billed to Central Office, thus local staff should not have to take any steps to make payment.
3. Allowable costs will be paid via the Children’s Services Integrated Payment System (CSIPS) form CS-65, for the following purposes:
  1. Bus or train fare when this is used to move a child from one facility to another.
  2. Costs incurred to move a child while complying with the Interstate Child Placement Compact (ICPC).
  3. Parent/child visitation as approved by a Circuit Manager/designee.
    
    NOTE: Costs for a Title IV-E Alternative Care eligible child must be charged against IV-E funds.
  4. Transportation may be provided for parent education classes, visitation, or other services intended to support the case plan if DMS Resources are not available. Transportation may also be provided for medical care and counseling.
4. Escorting a child/ICPC plan:
  1. The CSW must obtain approval/written authorization through supervisory lines for out-of-state travel. (Forms for this purpose can be obtained through the Children's Division.) In emergency situations, approval can be obtained after the fact.
  2. CSIPS Form CS-65 with the proper receipts attached, should be used to authorize payment for the child's expenses.
Medical Expenses for Infants Released for Adoption at Birth. Costs will be paid if the following conditions are met:
NOTE: Biological parents are expected, when at all possible, to meet the mother and the newborn's hospital and medical care costs even though the child is relinquished for adoption.
1. The child must be in Children’s Division (CD) custody.
2. The natural parents and other resources should be contacted first to assess the ability to meet the cost of care.
3. Hospital expenses for time delays between date of birth and date of custody transfer to the Division may be covered.
4. The maximum allowable cost is determined by DMS guide-lines for these costs.
5. All claims must be sent to the CD Deputy Director, through supervisory channels, for evaluation of cost appropriateness, and payment, if approved.
Child Care Costs for Children in Foster Family Care:
Related Subject: Section 3 Chapter 5 Attachment E: Protective Services Child Care
1. This is an allowable cost if it is deemed as a necessary part of the case plan or the foster parent needs child care due to employment, schooling, or training.
2. Costs are to be paid through the use of Protective Service child care funds.
Special Education Costs: Special education costs should be met by the local school district except for tutorial plans which are intended to support a child's special education plan. Schools should be helped, as needed, to seek the assistance of the Department of Elementary and Secondary Education (DESE) in meeting the cost of a child's special education needs.
Legal Fees: Agency payment for court costs relating to Termination of Parental Rights (TPR) hearings and adoption proceedings, including attorney fees for the birth parent, according to Administrative Rule, 13 CSR 40-30.020 Attorney Fees in Termination of Parental Rights Cases, allows the following fees:
1. Any attorney shall, at the conclusion of representation be compensated at a rate not exceeding one hundred dollars ($100) per hour. Attorneys may be reimbursed, at the conclusion of the representation for expenses reasonably incurred, including the costs of transcripts authorized by court.
2. The compensation to be paid for representation at trial shall not exceed one thousand dollars ($1,000) for uncontested matters and seven thousand dollars ($7,000) for contested matters.
3. For representation in an appellate court, the compensation shall not exceed three thousand five hundred dollars ($3,500) at one hundred dollars ($100) per hour.
4. At any time an attorney believes that the cost of representation will surpass the limits provided, they must provide notice to the Children’s Division that they may exceed the current maximum fee and this amount must be approved by the court.
Behavioral Foster Care (BFC) Incentive/Reinforcement Payments: The BFC foster parent may receive up to $100.00 per month of incentive/reinforcement payments:
1. An amount equal to $15.00 per week but not to exceed $60.00 per month will be paid to the BFC foster parent for completion of the weekly chart package and other required documentation. Should the BFC foster parent complete the chart package for a time increment less than one (seven day) week, payment will be prorated and equivalent in ratio to $15.00 per week (e.g., $2.14 per day).
2. In order to receive the payment, the completed charts must be received or verified by the BFC CSW within fourteen (14) calendar days of the completion date.
3. After the weekly record keeping payments have been made, the balance may be used to pay for planned reinforcers for the BFC child.
4. The BFC parent will provide the reinforcer and bill the Division for the expense. To ensure prompt reimbursement, receipts or invoices are required before payment is approved.
5. Payment for the incentive/reinforcements is generated via the completion of a CSIPS form, CS-65.
Exceptions: Exceptions to any of the above or allowances for any unusual costs for children in alternative care must be approved by the Regional Director and submitted to the CD Deputy Director, for processing.

Chapter Memoranda History: (prior to 1/31/07)

CS04-64, CD04-79

Memoranda History:

CD07-44, CD08-68