New Provider
Residential Services Orientation
Introduction
Presented By:
• Together Georgia (GAHSC)
• Department of Human Services (DHS)
- Residential Child Care (RCC)
- Office of Provider Management (OPM)
• Department of Juvenile Justice (DJJ)
Who Should Attend
Applicants for the Licensing of:
• Child Caring Institution – (Group Homes)
• Outdoor Child Caring Programs
• Child Placing Agency (Foster Care, Adoptions)
• Children Transition Care Centers (CTCC)
Who Should NOT Attend
• Day Care Center Operators
• Foster Parent wantabe’s
• Adult Personal Care Home
Applicants
• Psychiatric Hospital
Applicants
Steps to Provision of Services
Presentation Organization
1. Organizational Capacity and Needs Assessments
2. Licensure
3. Contracting with the State
4. Referrals and Payments
Organizational Capacity
and Assessment of Needs
www.gahsc.org ♦ office@gahsc.org ♦
404.572.6170
Perspective:
How Children/Youth Come into Care
State Placement
• Abuse
• Neglect / Deprivation
• Termination of Parental Right (TPR)
• Delinquency
Private Placement
Perspective:
Characteristics of Children in Care
DFCS Room Board and Watchful Oversight
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•
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•
•
Base / Traditional care
Base with Additional Watchful Oversight
Base with Maximum Watchful Oversight
Specialty Base Watchful Oversight
Specialty Maximum Watchful Oversight
Specialty Medically Fragile Watchful Oversight
https://www.gascore.com/content/page.cfm/12/out_of_home_care
Perspective:
Georgia’s Priorities
1.
2.
3.
4.
Family Stabilization
Least Restrictive
Community Based Services
Appropriate Length of Stays for out
of home care
5. Reunification whenever possible –
safety of the child
6. Permanency – minimize trauma
Perspective:
Georgia’s Preferred Out-of-Home
Placement Hierarchy
In-Home with Bio Family
Relative Kinship Care
Foster Care
Group Homes
Perspective:
Federal Review Oversight
Child and Family Services Review (CFSR)
•
•
•
Permanency
Safety
Well-being
Research Service Needs
Licensure does not ensure a contract or
placement of children
https://www.gascore.com/content/sitemap.cfm
Matching Needs with Services
Child Placing Agency– An agency that recruits,
supports and places children in foster homes
Child Caring Institution – Group home or other
congregate care environment where facilities are built
for the placement and care of children
Matching Needs with Services
Child Placing – An agency that recruits, supports and
places children in foster homes
• First placement priority for state.
• 75% of all foster children go into this
placement.
• Per Diem determined by level (basic to
therapeutic) Generally lowest paid per day
per child rates.
Matching Needs with Services
Child Caring Institution – Group home or other
congregate care environment where facilities are built
for the placement and care of children.
• This is last placement choice for children
with basic needs.
• Only 14% of all foster children are placed in
these facilities.
Matching Needs with Services
Outdoor Child Caring Programs – Programs using a
wilderness model for care and treatment of children.
• These are wilderness programs for children.
•
•
•
•
Most are considered treatment facilities.
Few of these facilities are being used for placement.
Requires over 500 acres in land.
State very reluctant to contract with new providers.
Matching Needs with Services
What License should I pursue?
Child Placing Agency (CPA)
(Foster Care)
• Private Family centered
Child Care
• Few Capital Costs
• Higher Reimbursement to
Cost ratio
• Higher Percentage of
children entering care
• Required to be “not-forprofit”
Child Caring Institution (CCI)
(Group Homes)
• Campus focused Child Care
• High Capital Costs
• Lower Reimbursement to
Cost ratio
• Lower percentage of
children entering care
• No requirement for “not-forprofit.”
Develop the
“BUSINESS PLAN”
The Plan versus Good Intentions
-Board
-Budgets
-Constituency
-Facilities
-Legal Issues
-Policies & Procedures
Is there a need for the service you are wanting to
provide in the geographical area you are
wanting to operate?
Board Development
(Not-for-Profit Only)
Should you be a Not-for-Profit (501 c 3)?
For-Profit
•Personal profit and benefit
•Personal management
•Ownership of assets
•Risk of own resources
Not-for-Profit
•Community ownership and
control
•Community support though
contributions
•Risk of community
resources
Board Development
(Those who are accountable for the organization)
Truism - An organization is as strong as its Board.
• Choose people who can provide expertise in a variety
of areas (finance, marketing, social services).
• Go beyond friends and family
(choose people who will provide open and honest feedback)
• Valued stakeholder in community
Not-for-profit Organization
(Nearly all are 501(c)(3)
• Internal Revenue Service (IRS) Regulations
for securing tax deductible contributions
• Takes at least 1 year to secure
• A knowledgeable person can do it without
lawyer
Executive Director
(One who manages the organization)
• Choose person of experience, integrity,
responsibility and history
– Balance of vision-focus and business
• Remember he/she will represent your
organization
• They will be held accountable to carry out
your policies and procedures
Staff & Personnel
(Your most valuable asset/liability)
Truism - Your program is as good as your
weakest link.
• A thorough background check is essential.
• “Would you let these folks care for your
child?”
Budgets and Budgeting
Budget Development
Expenses
• Staff--Base Pay
• Benefits
• Insurance--Property,
Casualty, & Liability
• Food
• Clothing
• Transportation
• Other
Income
• State Fees
• Contributionsnonprofit only
– Charity gifts
– Grants
– Endowments
Budgets and Budgeting
Medical Care Covered
by Medicaid –
Nearly all children in
residential care
qualify for Medicaid.
Budgeting/Rate Setting
Placement providers are paid a per diem for Room
and Board and Watchful Oversight (RBWO)
CCIs - Group Homes
Base
$104.87
AWO
$132.85
MWO
$187.30
Maternity home
$104.87
*Second Chance
$104.87
Teen Development
$111.46
*plus $62.97 for the infant, total of $167.69
Budgeting/Rate Setting
Placement providers are paid a per diem for Room and
Board and Watchful Oversight (RBWO)
CPAs – Child Placing Agencies
(Fixed Payment to Agency – excludes payment to
foster parent)
Traditional
$22.08
Base WO
$29.89
Max WO
$41.27
SBWO
$46.35
SMWO
$71.07
SMFWO
$83.43
Budgeting/Rate Setting
Placement providers are paid a per diem for Room
and Board and Watchful Oversight (RBWO)
CPAs – Child Placing Agencies
(Payment to Foster Parent based on age of child)
0-5 years of age
6-12 years of age
13+ years of age
$15.04
$17.00
$19.36
Budgeting/Rate Setting
Truism – Quality care resulting in good
outcomes will be your best option for
success
• Securing adequate funding remains one of the top
priorities for any administrator.
• Without money, services can not happen.
• The State is usually your #1 customer/payer
• In Georgia there are only a handful of For-Profit
agencies
Fundraising
Grants for Startup
• Very few
• Often only to Existing Groups
• Need 501(c)(3) status – Not-for-Profit
• Anticipate 18 months for start up
support
• Build constituency
Policies & Procedures
(Provides the why and how of the organization)
• Develop P&P around licensing and contract rules and
regulations.
• Consult someone who has successfully done
residential child care.
• They should make sense to all who must
operationalize them.
• Train on them.
• Follow your P&P in all ways at all times.
• Keep them current.
Your Facilities (CCI)
Fire Inspection - # 1 Problem Area
• Most Expensive to Correct
• State Regulations,
County Interpretations
and Enforcement
Your Facilities (CCI)
Community Support - # 2 Problem
Area
– Build Support Carefully
– If negative, hard to overcome
– Use community leaders to lead
Truism- Work hard to overcome “not in
my backyard” mindset
Your Facilities (CCI)
Zoning – The “Tip Off”
to the Community
-- Required before Licensing
-- Zone for “a licensed childcare institution for
six or more unrelated children”
-- Key Stakeholder of community can help with
this
Reporting Requirements
• Child Abuse Reporting Requirements
• Stuff will happen - Self-report
• The law requires you to report abuse and neglect
• Always report, even if not certain of issue.
• Preserve your relationship with State by dealing
with integrity
Additional Consideration
to Delivery of Services
• Performance Based Placement
• Deliverables and Outcomes
• Data Management, Documentation and Reporting
• Competition
• Experience
• Accreditation
Working with the State
Oversight
• Residential Child Care (licensing)
• Office of Provider Management (DFCS
contract)
• PEAS
• Kenny A (Fulton and DeKalb Counties)
Working with the State
• Some Steer
The State is our partner in
caring for children. Their role is
regulatory and contractual.
Respect it.
• Others Row
Our role is providing services to
children. Together we work to
provide the best care for
children.
Departments & Divisions
of State Agencies
Steps to Provision of Services:
Step Two - Licensure
New Provider Orientation
Presenter: Rhonda James, DHS—Office of the Inspector
General, Residential Child Care Unit
Presentation to: GAHSC New Provider Orientation
Date: Quarterly (2nd Tuesday of the Month)
Georgia Department of Human Services
Vision, Mission and Core Values
Vision
Stronger Families for a Stronger Georgia.
Mission
Strengthen Georgia by providing Individuals and Families access to services
that promote self-sufficiency, independence, and protect Georgia's
vulnerable children and adults.
Core Values
•
•
•
•
Provide access to resources that offer support and empower Georgians and
their families.
Deliver services professionally and treat all clients with dignity and respect.
Manage business operations effectively and efficiently by aligning resources
across the agency.
Promote accountability, transparency and quality in all services we deliver
and programs we administer.
Develop our employees at all levels of the agency.
DHS Office of Residential Child Care Services
• LICENSE CATEGORIES
• CCI--Child Care Institution also known as a group home.
• CPA--Child Placing Agency…foster care services and adoption (both
domestic and international)…Home study Only
• CTCC--Children Transition Care Center—medically fragile children.
• OCCP--Outdoor Child Caring Program—Wilderness Camp…requires
10acres of land per child.
• Maternity Homes/Second Chance Homes—home for pregnant mothers
and mothers and babies.
• Runaway and Homeless Youth Programs(RHYP)—a registered program.
• DETERMINE WHICH TYPE OF PROGRAM YOU WANT TO BE.
Applying for Licensure
• All CCI’s, CTCC’S. OCCP’S & MATH, RHYP—must obtain
local zoning and fire approval before submitting an
application.
• Download the application package @
https://dhs.georgia.gov/forms-and-applications
• Familiarize yourself with ORS rules and regulations and
develop a working knowledge of the meaning and intent of
the rules.
• Develop policies and procedures to address each rule.
• Prepare your agency for compliance with the rules and
regulations.
STAFF QUALIFICATIONS FOR CCI
• Director—master’s 2-years of related experience or
Bachelor’s degree and 4-years of related experience.
• Human Services Professional—provides the case
management…bachelor’s degree approved field and 2years of experience or a master’s degree in approved field
of study.
• Child Care Worker—must be at least 21 years of age and
have a HS Diploma or a GED.
PHYSICAL PLANT FOR CCI
• Water/Sewage…If the home operates on a septic tank
must submit Environmental Health Inspection or copy of
city water bill.
• Bedrooms--63 sq.ft. per resident for double occupancy and
75 sq.ft. for single occupancy.
• Must document space capacity to serve at least six
residents not to exceed 16.
• Must document a food service permit if providing care for
thirteen(13) or more residents.
PHYSICAL PLANT FOR CCI (cont.)
• Bathrooms--one sink/toilet per 8 residents and 1 shower
per 10 residents.
• There must be a separate bathroom for staff.
• A staff member may not enter into a resident bedroom to
access the bathroom
• An initial on-site inspection is completed and observed for
SAFETY FIRST—INSIDE AND OUTSIDE.
STAFF QUALIFICATIONS FOR A CPA
• Director--must have a bachelor’s degree and 2-years of
related experience unless they are providing the clinical
case supervision.
• Case Worker Supervisor (Social Service) Master’s Degree
and 2-years of related experience in a CPA.
• Case Worker—Bachelor’s degree
• There are no physical plant requirements for a CPA.
STAFF QUALIFICATIONS FOR CTCC
• Director--Master’s degree or higher in nursing; social work
or other health related fields and two years of experience
working with medically fragile children.
• A licensed registered nurse, physician, other licensed
health care professional with at least five years of
experience working with medically fragile children.
Staff Qualifications for CTCC cont.
• Human Services Professional—bachelor’s degree in social
work with two years experience or a master’s degree.
• There shall be sufficient staff members on duty at all times
to assure each child proper care according to his/her
needs. When children are present at the center, there shall
be at least one awake RN on duty.
Physical Plant for CCTC
• Water/Sewage…If home operates on a septic tank must
submit Environmental Health Inspection or copy of city
water bill.
• Bedrooms--63 sq.ft. per resident for double occupancy and
75 sq.ft. for single occupancy.
• Bathrooms--one sink/toilet per 6 residents.
• One shower per 6 residents.
• Separate bathroom for staff.
Physical Plant for CCTC (cont.)
• Staff may not enter into a resident bedroom to access the bathroom.
• All centers serving residents dependent on a wheelchair or other
device for mobility shall have:
--At least two exits, remote from each other, accessible
to child with easily negotiable ramps.
--All doorways and halls shall accommodate
wheelchairs.
--At least one bathroom of sufficient size to
accommodate a wheelchair and assisting staff.
Maternity Home (Basic and Second Chance Services)
•
Maternity home--is an agency providing care within any six-month period, to more
than one (1) pregnant woman, either before, during or within two (2) weeks after
childbirth. Providing care to pregnant youths through 21 years of age. Services
are limited to eight weeks of services…unless providing Second Chance Home
Services.
•
Second chance home--means a licensed maternity home that provides full-time
residential care, support and supervision to pregnant and parenting youth through
21 years of age and their child(ren) that is expected to last for more than an eight
(8) week period following delivery. Program services include parenting skills, such
as child development, education, job training, transitioning to independent living,
family budgeting, health and nutrition, and other skills to promote residents’ longterm independence and the well-being of their child(ren).
Maternity Home (Basic and Second Chance Services)
•
The director must possess a Masters or RN Degree and two years of related
experience or a Bachelor’s Degree and four years of related experience.
•
The Human Services Professional (HSP) Must possess a Master’s Degree in social
work, psychology, childhood education, education counseling and psychology,
nursing or healthcare, or a related field or a bachelor's degree and either have two
(2) years experience in a field related to the type of residents served or be
supervised by another human service professional with a master's degree in one(1)
of the above disciplines.
•
There shall be at least one HSP for every 16 residents in care including the infants.
Maternity Home (Physical Plant)
•
The sleeping room shall not be less than 75 square feet per resident in single
rooms, and not less than 63 square feet per resident in multiple rooms
•
There shall be at least one (1) lavatory with hot and cold water, one (1) toilet and a
bathtub and/or shower for every four residents.
•
A nursery is not required by these rules, however, maternity homes that include
nurseries must meet the following additional requirements:
The nursery shall be large enough to allow a minimum of 30 square feet of floor
space and 300 cubic feet of air space per infant.
•
There shall be separate toilet and bath facilities for the residents and staff.
Runaway and Homeless Youth Programs
Effective July 1, 2011, RCC is also authorized by law to
register Runaway and Homeless Youth Programs
(RHYP)
(O.C.G.A. § 49-5-160 et. seq.)
• Runaway and Homeless Youth Programs (RHYP) currently licensed child welfare agencies or 501(c)(3)
organizations that serve children under 18 years old who
have run away and/or are homeless.
Runaway and Homeless Youth Programs
• The agency must submit a description of the range of services
provided, the manner in which those services are provided to youth
and a statement that the Services that are provided to youth, are
limited to 72 hours.
• The agency must submit operational policies and procedures.
• Must have at least one staff member who is licensed.
• There is an annual registration fee of $25.
Criminal Records Check Law
• The director and owner of each license type must both document a
satisfactory criminal records check (fingerprints—live scan)
• All other employees must be in compliance with the law.
• If any employee’s check reveals any crime, person cannot be hired
until resolved and cleared through the Office of Inspector General’s.
• Any person acting in the absence of the director must meet the
qualifications of the director and document a satisfactory CRC.
Waivers & Variances
• The department at its discretion may grant a waiver or
variance of specific rules upon application being filed.
• A variance may be granted upon the applicant showing that
a particular rule or regulation would cause an undue
hardship.
• A waiver may dispense entirely with the enforcement of a
rule or regulation upon showing that the purpose of the rule
or regulation is met through equivalent standards.
Licensure Process
• Self Assess for rule compliance and completed application
materials.
• Submit application with all necessary local approvals if
required. (zoning, fire inspection, CO, etc.)
• Initial on-site Inspection scheduled—an office conference
for a CPA. If approved, a Temporary License is issued for
12 months.
• Annual re-licensing inspections
• Follow-up Inspections
• Complaints/ Self-reported incidents
LICENSURE
•
Obtaining a license through the Office of
Residential Child Care does NOT guarantee a
contract with other state agencies or departments
to serve children and adolescents.
Break
Steps to Provision of Services:
Step Three - Contractual
Process for Providers
New Provider Orientation
Presenter: DFCS, Office of Provider Management
Presentation to: GAHSC New Provider Orientation
Date: October 8, 2013
Georgia Department of Human Services
Vision, Mission and Core Values
Vision
Stronger Families for a Stronger Georgia.
Mission
Strengthen Georgia by providing Individuals and Families access to services
that promote self-sufficiency, independence, and protect Georgia's
vulnerable children and adults.
Core Values
•
•
•
•
Provide access to resources that offer support and empower Georgians and
their families.
Deliver services professionally and treat all clients with dignity and respect.
Manage business operations effectively and efficiently by aligning resources
across the agency.
Promote accountability, transparency and quality in all services we deliver
and programs we administer.
Develop our employees at all levels of the agency.
Becoming a New RBWO Provider
• The RBWO Provider process is handled through the
Department of Families and Children Services
(DFCS) Office of Provider Management (OPM)
• The process applies to agencies seeking to obtain a
RBWO Provider contract as a Child Placing Agency
(CPA) or Child Caring Institution (CCI)
• Agencies seeking a RBWO Provider contract with
DFCS must have an applicable CCI or CPA license
from the Residential Child Care
New RBWO Contract Deadlines and Effective Dates
• As of April 2013, the start of FY2013, The Office of Provider
Management established new contract deadlines and
effective dates.
– There are two (2) contract lifecycles within a fiscal year:
• July 1st
• October 1st
Provider Deadline to Submit Application and
supporting documents
OPM Review and Approval
Deadline
Contract Effective Date
November 30th
January 31st
July 1st
February 28th
April 30th
October 1st
How To Become A RBWO Provider?
www.gascore.com
How To Become A RBWO Provider?
Provider Information Sheet
• Interested providers should review the applicable
New Provider Information Sheet.
– New CCI Provider Information Sheet
– New CPA Provider Information Sheet
3 Ring Binder
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•
•
•
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•
•
RBWO Application
RCC License
Agency’s Policies & Procedures
Agency’s Training Plan
Organizational Chart
Budget
W-9
Evidence of Criminal Records Check
Vendor Form (along with voided check)
Insurance ($1 million per occurrence/$3 million aggregate policy limits)*Exception
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–
–
–
–
Malpractice/Professional Liability
Commercial General Liability
Commercial Umbrella Policy
Workers Compensation Insurance (if plans are to employ 3 or more employees)
Business Auto Policy (*$1million per occurrence/$1 million aggregate policy limits)
Available Resources
– RBWO Provider Service Needs List
– FY2014 RBWO Minimum Standards for CPAs and
CCIs
– DHS Map of Counties by Region
– RBWO Contract Deadlines and Effective Dates
Memo
– Previous Trainings and Upcoming Trainings
Contact Information
After reviewing the Becoming a New Provider
Information online,
interested providers with questions
should contact:
The Office of Provider Management
via email opmrequests@dhr.state.ga.us
Questions & Answers
Department of Juvenile Justice
Division of Community Services
Serves to Protect the Citizens of Georgia by Providing
Prevention Services, Court Services and Supervision,
Treatment and Rehabilitation of Youthful Offenders.
DEPARTMENT OF JUVENILE
JUSTICE
Avery D. Niles, Commissioner
MISSION:
Our Mission is to protect and serve the citizens of
Georgia by holding young offenders accountable for
their actions through the delivery of services and
sanctions in appropriate settings and by supporting
youth in their communities to become productive and
law-abiding citizens.
VISION:
OFFER HOPE AND YOUTH CHANGE.
DJJ will lead the nation in preparing young people in
its care to develop and sustain productive lives.
Division of Community
Services
4 DJJ Regions – NW, NE, SW, SE
Regional Placement Specialists: Direct Oversight
of all Contracted Residential Providers licensed
as Child Caring Institutions & Child Placing
Agencies
NW – Margaret Cawood
SW – Archie Herman
NE – Victor Roberts
SE – Jeffery Alligood
http://www.djj.state.ga.us/FacilitiesPrograms/fpDistrictsMain.shtml
Characteristics of
Children in DJJ’s Care
• Average Age - 13 (range is from 10-22)
• Mostly Males
• Most Common Offenses - Property & Status
• Oppositional - Lack Impulse Control
• Common Mental Health Diagnoses - Conduct
Disorder, Depression, PTSD
• Substance Abuse Issues
Services to Children in
DJJ’s Care
• During FY 2010 – 44,502 and FY
2011 - 40,226 youth were served by
the Department of Juvenile Justice.
Private Placements
www.gahsc.org ♦ office@gahsc.org ♦ 404.572.6170
Services Purchased
• Agency determines what services to sell (or give away)
to the private individual or corporation
(usually another state.)
• The nature of these services is determined on the
ability to provide those services within the Licensing
framework and approved levels of care.
Characteristics of Children
in Private Placement
• Determined by agency’s mission and ability to
care for the child.
• And Agency’s ability to serve
Approval Process of
Vendors and Marketing
• Client Application Process-- Licensing
allows an agency to provide out-of-home
services. Within the rules of Licensing, each
agency develops their own application
process.
• Contract Approval Process -- There is no
approval process save Licensure.
Private Placements
Referrals and Payments
• Referrals - Referrals are made by private
individuals or agencies or another state. This
referral network is determined by the agency.
• Payments - Payments are negotiated with
each referring party.
Referrals and
Payments
Private Placements usually include:
•
•
•
•
a charity basis
another State
Insurance
private pay
In Conclusion:
Steps to Provision of Services
1. Organizational Capacity and Needs Assessments
2. Licensure
3. State Approval Process for Vendors
4. Marketing to Referral Sources,
DFCS, DJJ, Private Sector