441—156.9 (234) Rate of payment for foster group care.
	 156.9(1) In-state reimbursement. Effective November 1, 2006, public and private foster group care facilities licensed or approved in the state of Iowa shall be paid for group care maintenance and child welfare services in accordance with the rate-setting methodology in this subrule.
	  a.   	 A provider of group care services shall maintain at least the minimum staff-to-child ratio during prime programming time as established in the contract. Staff shall meet minimum qualifications as established in 441—Chapters 114 and 115. The actual number and qualifications of the staff will vary depending on the needs of the children.
	  b.   	 Additional payment for group care maintenance may be authorized if a facility provides care for a mother and her young child according to subrule 156.9(4).
	  c.   	 Reimbursement rates shall be adjusted based on the provider’s rate in effect on October 31, 2006, to reflect an estimate that group care providers will provide an average of one hour per day of group remedial services and one hour per week of individual remedial services. The reimbursement rate shall be calculated as follows:
	 (1) 	 Step 1. Annualize the provider’s combined daily reimbursement rate for maintenance and service in effect on October 31, 2006, by multiplying that combined rate by 365 days.
	 (2) 	 Step 2. Annualize the provider’s remedial services reimbursement rate for one hour per day of remedial services code 96153 (health and behavioral interventions - group), as established by the Iowa Medicaid enterprise, by multiplying that rate by 365 days.
	 (3) 	 Step 3. Annualize the provider’s remedial services reimbursement rate for one hour per week of remedial services code 96152 (health and behavioral interventions - individual), as established by the Iowa Medicaid enterprise, by multiplying that rate by 52 weeks.
	 (4) 	 Step 4. Add the amounts determined in Steps 2 and 3.
	 (5) 	 Step 5. Subtract the amount determined in Step 4 from the amount determined in Step 1.
	 (6) 	 Step 6. Divide 	the 	amount 	determined 	in 	Step 	5 	by 	365 	to 	compute 	the 	new 	combined
maintenance and child welfare service per diem rate.
	 (7) 	 Step 7. Determine 	the 	maintenance 	portion 	of 	the 	per 	diem 	rate 	by 	multiplying 	the 	new
combined per diem rate determined in Step 6 by 85.62 percent.
	 (8) 	 Step 8. Determine the child welfare service portion of the per diem rate by multiplying the new combined per diem rate determined in Step 6 by 14.38 percent.
Example:  Provider A has the following rates as of October 31, 2006:
	  ● 	 A combined daily maintenance and service rate of $121.45;
	  ● 	 A Medicaid rate for service code 96153 of $5.10 per 15 minutes, or $20.40 per hour;
	  ● 	 A Medicaid rate for service code 96152 of $19.92 per 15 minutes, or $79.68 per hour.
Step 1. $121.45 × 365 days = $44,329.25
Step 2. $20.40 × 365 days = $7,446.00
Step 3. $79.68 × 52 weeks = $4,143.36
Step 4. $7,446.00 + $4,143.36 = $11,589.36
Step 5. $44,329.25 - $11,589.36 = $32,739.89
Step 6. $32,739.89 ÷ 365 days = $89.70
Step 7. $89.70 × 0.8562 = $76.80 maintenance rate
Step 8. $89.70 × 0.1438 = $12.90 child welfare service rate
Provider A’s rates are $76.80 for maintenance and $12.90 for child welfare services.
	  d.   	 If the Iowa Medicaid enterprise has not made a determination by October 31, 2006, on the need for remedial services for a child who is in group care placement as of that date, the department service area manager may approve a payment from state funds for the estimated daily reimbursement rate for remedial services that was used in the calculation of the provider’s reimbursement rate under paragraph 156.9(1)“c.” The service area manager shall document the reason for the delay in the decision on the child’s need for remedial services.
	 (1) 	 The service area manager may approve such payment only until the time that the Iowa Medicaid enterprise is anticipated to issue the decision regarding the child’s need for remedial services. The service area manager shall not authorize payment from state funds if the Iowa Medicaid enterprise has determined that the child does not need remedial services.
	 (2) 	 The payment that the service area manager may authorize shall be based on a reimbursement rate calculated as follows:
Step 1. Annualize the provider’s reimbursement rate for one hour per day of remedial services code 96153 (health and behavioral interventions - group), as established by the Iowa Medicaid enterprise, by multiplying that rate by 365 days.
Step 2. Annualize the provider’s remedial services reimbursement rate for one hour per week of remedial services code 96152 (health and behavioral interventions - individual), as established by the Iowa Medicaid enterprise, by multiplying that rate by 52 weeks.
Step 3. Add the amounts determined in Steps 1 and 2.
Step 4. Determine the provider’s estimated daily rate for reimbursement of remedial services by dividing the amount in Step 3 by 365 days.
Example:  Provider B has the following rates as of October 31, 2006:
	  ● 	 A Medicaid rate for service code 96153 of $5.10 per 15 minutes, or $20.40 per hour;
	  ● 	 A Medicaid rate for service code 96152 of $19.92 per 15 minutes, or $79.68 per hour.
Step 1. $20.40 × 365 days = $7,446.00
Step 2. $79.68 × 52 weeks = $4,143.36
Step 3. $7,446.00 + $4,143.36 = $11,589.36
Step 4. $11,589.36 ÷ 365 days = $31.75 estimated daily rate for remedial services
	 156.9(2) Out-of-state group care payment rate. The payment rate for maintenance and child welfare services provided by public or private agency group care licensed or approved in another state shall be established using the same rate-setting methodology as that in subrule 156.9(1), unless the director determines that appropriate care is not available within the state pursuant to the following criteria and procedures.
	  a.   	 Criteria. When determining whether appropriate care is available within the state, the director shall consider each of the following:
	 (1) 	 Whether the child’s treatment needs are exceptional.
	 (2) 	 Whether appropriate in-state alternatives are available.
	 (3) 	 Whether an appropriate in-state alternative could be developed by using juvenile court-ordered service fund or wrap-around funds.
	 (4) 	 Whether the placement and additional payment are expected to be time-limited with anticipated outcomes identified.
	 (5) 	 If the placement has been approved by the service area manager or chief juvenile court officer.
	  b.   	 Procedure. The service area manager or chief juvenile court officer shall submit the request for director’s exception to the Bureau of Policy Analysis, Department of Human Services, Fifth Floor, Hoover State Office Building, Des Moines, Iowa 50319-0114. This request shall be made in advance of placing the child and should allow a minimum of two weeks for a response. The request shall contain documentation addressing the criteria for director’s approval listed in 156.9(2)“a.”
	  c.   	 Appeals. The decision of the director regarding approval of an exception to the rate determination in rule 441—152.3(234) is not appealable.
	 156.9(3) Supplemental payments for in-state facilities. Rescinded IAB 9/1/93, effective 8/12/93.
	 156.9(4) Mother-young child rate. When a group foster care facility provides foster care for a mother and her young child, the maintenance rate for the mother shall include an additional amount to cover the actual and allowable maintenance needs of the young child. No additional amount shall be allowed for service needs of the child.
	  a.   	 The rate shall be determined according to the policies in rule 441—152.3(234) and added to the maintenance rate for the mother. The young child portion of the maintenance rate shall be limited to the costs associated with food, clothing, shelter, personal incidentals, and supervision for each young child and shall not exceed the maintenance rate for the mother. Costs for day care shall not be included in the maintenance rate.
	  b.   	 Rescinded IAB 6/8/94, effective 6/1/94.
	  c.   	 Unless the court has transferred custody from the mother, the mother shall have primary responsibility for providing supervision and parenting for the young child. The facility shall provide services to the mother to assist her to meet her parenting responsibilities and shall monitor her care of the young child.
	  d.   	 The facility shall provide services to the mother to assist her to:
	 (1) 	 Obtain a high school diploma or general education equivalent (GED).
	 (2) 	 Develop preemployment skills.
	 (3) 	 Establish paternity for her young child whenever appropriate.
	 (4) 	 Obtain child support for the young child whenever paternity is established.
	  e.   	 The agency shall maintain information in the mother’s file on:
	 (1) 	 The involvement of the mother’s parents or of other adults.
	 (2) 	 The involvement of the father of the minor’s child, including steps taken to establish paternity, if appropriate.
	 (3) 	 A decision of the minor to keep and raise her young child.
	 (4) 	 Plan for the minor’s completion of high school or a GED program.
	 (5) 	 The parenting skills of the minor parent.
	 (6) 	 Child care and transportation plans for education, training or employment.
	 (7) 	 Ongoing health care of the mother and child.
	 (8) 	 Other services as needed to address personal or family problems or to facilitate the personal growth and development toward economic self-sufficiency of the minor parent and young child.
	  f.   	 The agency shall designate $35 of the young child rate as an allowance to the mother to meet the maintenance needs of her young child, as defined in her case permanency plan.
This rule is intended to implement Iowa Code sections 234.6 and 234.38.
[ARC 7741B, IAB 5/6/09, effective 7/1/09]