Cfsafy10 Budget Questions Final

Child and Family Services Agency FY10 Budget Questions April 3, 2009

1. What is the total number of currently filled FTE positions identified for elimination? Please provide the title of each position and which program each position is in? Identify which positions are subject to collective bargaining? How will the loss of these staff impact service delivery? Is early retirement being offered to those individuals who are eligible? What was the impetus for the elimination of these positions? Some filled positions will be eliminated in FY 2010 however the exact number of positions has not yet been determined. Restructuring will occur as part of an effort to better align CFSA resources with its core services.

2. Provide the activities under the Policy Activity (Line 2050). The purpose of the Policy Activity is to develop and distribute agency policy, protocols, administrative issuances and business processes consistent with best practice and local and federal rules, regulations and laws. The policy activity also includes the Child Protection Register, the Office of Fair Hearings and Appeals and the function of the State Liaison Officer. 3. Please provide a detailed listing of how the agency plans to use stimulus funds? The FY 2010 budget request includes $2,432,000 in Title IV-E funding resulting from the provisions of the American Recovery and Reinvestment Act. Specifically, the increased funding reflects an increase in the Federal Financial Participation (FFP) reimbursement rate to the District of Columbia for program services. These services include subsidy payments made to foster and adoptive parents. The FFP rate is increased from 70% to 76.2%, and covers the time period of October 1, 2008 through December 31, 2010. It should be noted that this increase in FFP is for program services only and does not include reimbursement for administrative services, which is maintained at the 50% FFP rate. As such, all the funds will be used for services to children in foster care.

4. The following areas will see funding increases: ! !

Intake and Investigation Activity (Line 2020) =$2,440,000 Teen Services Activity (Line 2030) = $1,492,000

What specific activities will be implemented or expanded in each area receiving a funding increase? Does the increase in dollars represent increasing costs to maintain baseline or are these TRUE expansions? For the Intake and Investigations Activity, the increase is due primarily to increases in the activity’s personal services costs. These higher costs account for adjustments to employee salaries, including promotions. The increase also includes the costs for 5 FTEs, due to a reallocation of employees into this activity.

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Child and Family Services Agency FY10 Budget Questions April 3, 2009 For the Teen Services Activity, the increase is due primarily to the request of $819,959 for the one-time build-out cost for the new Youth Transition Center. Details of this initiative are presented below.

5. One of the policy initiatives identified in the proposed budget was the allocation of $818,959 in onetime funds for build-out cost of CFSA’s Office of Youth Development (OYD) and provide program space for the new Youth Transition Center (YTC). Will these funds be used to hire staff as part of the OYD build-out cost? If yes, how many employees will be needed to fully staff the office? Because this is a one-time funding allocation, will staffing positions be permanent or time-limited? Has a program space been identified for the Youth Transition Center? How much of the $818,959 will be used for build-out cost of the OYD and how much will be used for the YTC program space? Will this funding be adequate for the build-out cost of staff and program space or have additional funds been identified for these initiatives? When will the YTC be fully operational? Please provide a program description for the OYD and for the new YTC. The Office of Youth Development assists older youth in achieving permanency and to provide a coordinated, progressive series of activities and experiences that support their successful transition to adulthood. The $818,959 in the proposed FY 2010 budget is for the purpose of building out the Youth Transition Center (YTC), this includes the build-out for CFSA staff and the YTC program space. The location is the former Merritt School (5002 Hayes St NE, Washington, DC 2001). No additional staff will be hired with these funds. The YTC will be fully operational in the second quarter of FY 2010. The Youth Transition Center (YTC) will serve District youth, ages 16-24, in foster care and/or youth who are disconnected from school/work. Approximately 800 CFSA youth will be served by the YTC annually. The YTC will host the CFSA Office of Youth Development, other DC government agencies and community-based organizations that provide youth-focused services. The YTC model integrates work activities with classroom training, followed by job placement, follow-up, and ongoing education services. OYD’s Center for Keys (CKL) program will be located at the YTC and will provide a range of services including: life skills training, preparation for college and vocational training, payment and support of vocational training and college attendance, counseling, specialized training, socialization activities and individualized services. 6. What is Court Supervision (Line 1099) with zero expenditure for FY08 and FY09 and $665,000 in FY10? Court Supervision (Activity 1099) is related to the cost of the court monitoring contract with the Center for the Study of Social Policy (CSSP). Previously, this cost was included in the Performance Management activity. Cost associated with this contract in previous fiscal years are:

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Child and Family Services Agency FY10 Budget Questions April 3, 2009 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

$ $ $ $ $ $ $ $ $ $

278,424 224,878 534,317 592,024 337,029 579,144 497,443 595,214 580,068 653,807

7. What specific resources will be allocated in FY10 to provide services to children in the APPLA category aside form the build-out of the Office of Youth Development and the Youth Transition Center? Youth with the goal of Alternative Planned Permanent Living Arrangement (APPLA) have access to the full range of services and supports provided by CFSA and our private agency partners. CFSA is committed to securing permanency for all children, and believes that whenever possible, children are best connected through a goal of reunification, adoption, guardianship, and or legal custody. In order to achieve this, CFSA is making a concerted effort to achieve permanence for youth with the goal of APPLA and to reduce the number of youth that receive this goal in the first place. APPLA Case Reviews In FY 2009 the cases of all youth with a goal of APPLA will be reviewed and in order to identify and secure permanent, legal relationships for youth who currently have a permanency goal of APPLA. For each youth, reviewers will examine the decisions leading to the goal of APPLA, the case history and whether all appropriate efforts toward achieving permanency have been made. Previously excluded options will be reassessed. The reviews will focus on identifying and resolving barriers to permanency and will result in the identification of potential permanency resources for the child or youth and/or recommendations and action steps for achieving permanency. Once the reviews have been completed, social workers will be engaging the identified potential permanency resources with the youth through a youth driven, family involved teaming process, where support outside of the agency for the youth is strengthened and potential goal changes from APPLA to reunification, adoption, or guardianship are explored. This work will continue in FY 2010. Permanency Services In FY 2009 and continuing in FY10, permanency specialists will be assigned to consult with social workers to support the plans developed through APPLA reviews. Youth with the goal of APPLA may also be referred to the Permanency Opportunities Program (POP) for intense permanency case work and support (i.e., assessment and planning, youth preparation, family location and preparation, placement preparation). LYFE Conferences In October 2008, CFSA implemented a protocol to decrease the number of youth assigned the goal of APPLA. Prior to a goal change to APPLA, a teaming meeting called “Listening to Youth and Families as Experts” (LYFE) is held. This process seeks to engage all potential family members and adults of importance to the youth to participate in the development of a safe and permanent plan for the youth. The purposed of the LYFE is to prevent a goal change to APPLA and to establish a plan for exiting care. In FY 2010, staff will continue to use

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Child and Family Services Agency FY10 Budget Questions April 3, 2009 the LYFE conferences as a means of ensuring that all possible family/supportive adults have been explored as a resource for the youth before considering a goal change of APPLA. 8. The following areas will see funding decreases: ! ! ! ! ! ! ! !

Foster Care Services (Line 2011) = -$851,000 Adoption Activity (Line 2040) = -$248,000 Child Placement Activity (Line 3010) = -$1,089,000 Health Services and Clinical Support Act (Line 3030) = -$5,909,000 Licensing and Monitoring Activity (Line 3040) = -$7,360,000 Adoption & Guardianship Activity (Line 4010) = -$18,203,000 Supported Service Activity (Line 5010) = -$169,000 Family Resources Activity (Line 3020) = -$75,000

What specific activities will be eliminated or transitioned in each program receiving a funding decrease? Will the decrease in funding have an impact on the delivery of services? !

Foster Care Services (Line 2011) = -$851,000

The reduction is primarily to a net reduction of 6 FTEs from this activity due to reallocation and/or reduction. The decrease will not have an impact on the delivery of services. !

Adoption Activity (Line 2040) = -$248,000

The reduction is primarily due to a net reduction of 3 FTEs from this activity due to reallocation and/or reduction. The decrease will not have an impact on the delivery of services. !

Child Placement Activity (Line 3010) = -$1,089,000

The reduction is primarily due to the transition the agency is undertaking in its Federal Medicaid and Foster Care claiming and ensuring that future claiming is done in a manner that maximizes Federal revenue while adhering to all Federal and District program rules. The agency anticipates that its revised claiming strategies under the Medicaid Rehabilitative Services Option during FY 2010 will address any potential funding shortfalls in support of the ongoing provision of services to children and families. !

Health Services and Clinical Support Activity (Line 3030) = -$5,909,000

The reduction is primarily due to the transition the agency is undertaking in its Federal Medicaid claiming and ensuring that future claiming is done in a manner that maximizes Federal revenue while adhering to all Federal and District program rules. The agency anticipates that its revised claiming strategies under the Medicaid for medical services provided by CFSA staff, as well as to children in residential treatment centers during FY 2010 will offset any potential funding shortfalls in support of the ongoing provision of services to children and families. !

Licensing and Monitoring Activity (Line 3040) = -$7,360,000

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Child and Family Services Agency FY10 Budget Questions April 3, 2009 The reduction is due the splitting of this activity into two new activities—the Family Licensing Activity (Activity 3041) and the Congregate Care Activity (Activity 3060). There will be no impact on the delivery of services due to this action. !

Adoption & Guardianship Activity (Line 4010) = -$18,203,000

The reduction is due the splitting of this activity into three activities—the Adoption and Guardianship Activity (Activity 4010), the Guardianship Subsidy Activity (Activity 4011) and the Grandparent Subsidy Activity (Activity 4012). There will be no impact on the delivery of services due to this action. !

Supported Service Activity (Line 5040) = -$169,000

This reduction is due to a decrease in projected decrease in funding for community services. There will be no impact on the delivery of services due to this action. !

Family Resources Activity (Line 3020) = -$75,000

The reduction is primarily due to a net reduction of 1 FTE from this activity due to reallocation and/or reduction. The decrease will not have an impact on the delivery of services. 9. Provide a detailed breakdown of plans to use the increase of $1.5 million for the In-Home program. The increase of $1,500,000 will support both In-Home Services and Adoption Subsidies: In-home Services: While the foster care population has remained about the same over last year, the Agency has experienced a 61 percent increase in its in-home population. In anticipation of this trend continuing, the proposed budget includes additional local funds ($500,000) to support in-home costs for such services as rental assistance, furniture and clothing vouchers, and other emergency assistance. Adoption Subsidies: In FY 2009, CFSA kicked-off new permanency initiatives associated with the LaShawn Stipulated Order. The Agency anticipates that work begun this year will be taken to scale in FY 2010 and that there will be an associated increase in demand for adoption subsidies for children reaching permanency through these initiatives. Additional funds ($1,000,000) included in the proposed budget will support (1) a projected increase in adoptions as a result of the initiatives and (2) the increased contractual costs of expanding these services to all children and youth with the goal of adoption. 10. What was the impetus behind the decision to eliminate Targeted Case Management (TCM) services through Medicaid? How will these services be provided if not through Medicaid? Will there be services that will not longer be available? Is it the expectation that local funding will be used to pay for TCM services and or other services that will no longer be provided under Medicaid? Provide a timeline for this transition.

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Child and Family Services Agency FY10 Budget Questions April 3, 2009 Recent internal audits of the CFSA’s Medicaid claiming resulted in significant disallowances for claims made under the Medicaid Targeted Case Management (TCM) and the Rehabilitative Option programs. Given these results and an examination of the Agency’s current Medicaid claiming practices, it became apparent that future disallowances would more than likely occur unless there was a substantial change in these practices. Therefore, CFSA has stopped claiming (as of January 31, 2009) for these services. These changes will not impact services to children. In addition to the increase in local funds ($19,415,079) in the proposed FY 2010 budget, we are now claiming eligible costs under Title IV-E. Finally, we are also working with the Department of Health Care Finance (DHCF) to restructure how we deliver and claim for services under the Rehabilitative Option. This work is slated to be complete in FY 2009 and we anticipate restarting claiming for these services by the second quarter of FY 2010.

11. Can you identify what services were previously eligible under Targeted Case Management and how these services will be delivered? Services that were claimed under TCM will continue to be delivered in the same fashion. The categories of services that may be claimed under TCM are: a) b) c) d) e)

Client Intake Assessment Case Planning Service Coordination and Monitoring Case Plan Reassessments

12. What are the documentation requirements for Medicaid? What are the documentation requirements for Title IV-E? What benefits do you expect to gain from making this transition? For Medicaid, the following must be documented: a) b) c) d) e) f) g)

Eligibility of child; Provision of a CMS-approved service; Description of the service; Date of service; Location of service provider; Qualifications of service provider; and Signed case plan with service recommendation.

To claim Title IV-E, the following must be documented: a) b) c) d) e)

Eligibility of child; Valid court ordered removal; AFDC eligibility; Judicial determination regarding permanency; and Licensed placement.

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Child and Family Services Agency FY10 Budget Questions April 3, 2009 While Medicaid requires verification of ongoing service provision criteria, Title IV-E primarily requires verification of one-time eligibility criteria. Therefore, once a child’s Title IV-E eligibility is established, it is maintained for the entire episode of the case. Regarding the transition in claiming Medicaid Rehab Option services, please explain the differences between the new methodology that will provide payment for specific discrete services and the current bundled methodology. Please itemize which services were previously bundled and which services will now be paid for individually. Do you anticipate that this will cause any disruption in the delivery of these services? The new methodology will require CFSA to unbundle services (listed below) and discretely identify units of rehabilitative services (in 15 minute increments, for example), and their associated costs for the purpose of billing. In addition, in order to adhere to CMS proposed regulations, CFSA will be required to redefine its rehabilitative services. CFSA is currently engaged with the D.C. Department of Health Care Finance (and consultant experts from George Washington University) to redefine rehabilitative services and to develop its new claiming methodology. The restructuring of rehabilitative services will not cause any disruption in service delivery to children. The bundled service consists of the following components: 1) 2) 3) 4) 5) 6) 7) 8)

Evaluation, Assessment and Plan of Care Development; Psychotherapy and Counseling; Medical Practitioners Evaluations; Crisis Intervention; Health Service Coordination; Medication Management; Behavior Management Services; and Plan of Care Reassessment and Revision

13. What internal inefficiencies has the agency identified regarding the Medicaid disallowances? What does the future look like for disallowances? Please walk through a case? Because CFSA has ceased claiming for services under the Medicaid Targeted Case Management (TCM) and the Rehabilitative Option programs, there will be no new disallowances associated with these programs going forward. A significant internal challenge related TCM and Rehab claiming was the accurate documentation of services. Going forward, to ensure appropriate documentation for Federal claiming, the agency will ensure that CFSA staff and private agency staff are appropriately trained in documentation methodology. 14. Under Cost Savings a total of 16 vacant non social worker positions were slated for elimination. Are these the only vacant positions identified for elimination? How long was each position vacant? Provide the title of each position and what unit each position in? Will the elimination of these positions have any impact on service delivery? A total of 34 vacant positions will be eliminated. This will not impact services.

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Child and Family Services Agency FY10 Budget Questions April 3, 2009 15. Under Policy Initiatives, $246,073 in one-time funding is allocated for build-out of the Special Abuse Unit of CFSA’s Child Protective Services program to co-locate at the new DC Children’s Advocacy Center (CAC). How many CFSA staff will be co-located to the new CAC? Will staff from other District government agencies be included in the co-location? If yes, provide which agencies and the number of staff from each. When will the co-location be completed? The CAC is a key partner in providing services to children who are the victims of physical and sexual abuse. In early 2011 when the new CACs opens at the former Bundy School, CFSA will co-locate two special abuse (19 FTE’s) units with the Multi Disciplinary Team (MDT). In addition to CFSA and the CAC, the MDT includes: ! ! ! !

Children’s National Medical Center (The Freddie Mac Child and Adolescent Protection Center); Metropolitan Police Department (Youth Investigations Branch and Special Victims Unit); (FTE’s Office of the Attorney General (Child Protection Section, Juvenile Section and Neighborhood Victim Services); and United States Attorney’s Office for the District of Columbia (Sex Offense and Domestic Violence Unit and the Victim/Witness Assistance Unit);

16. Under Policy Initiatives, $350,000 is allocated to cover the cost of operating the new CAC. What is the total funding amount for the completion of the new CAC? When will the CAC be fully operational? In addition to the $500,000 of baseline operating funding to the CAC, the Mayor’s proposed FY 2010 budget includes one-time funding ($246,073) for moving and build-out costs and an additional $350,000 in operating funds. These additional funds will support expanded child abuse prevention education and outreach, increased capacity for forensic interview and other key services. The new CAC will be fully operational in the second quarter of FY 2010. The total cost of the renovation of the Bundy School is $7.5 million.

17. The budget supported the continuation of the Grandparent Subsidy Program. How much funding will be provided for the program in FY10? Is this an increase in funding from FY09? How many families will be able to be serviced at the funding level? Will there be a cost of living increase above the 4% supported in the FY09 budget? The total amount of funding for the Grandparent Subsidy Program in FY 2010 is $4,844,000. This includes $178,500 for staff and administrative costs. In FY 2009, and program enhancement for a 4% cost of living increased the Grandparent Subsidy Program from $4,308,000 in FY 2008 to $4,408,320. The FY 2010 is proposed budget increases fund for subsidies to $4,665,033 which is an increase of $185,213. These funds will be used to expand the program capacity to 515 in FY 2010 from the current capacity which is 475 in FY 2009.

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Child and Family Services Agency FY10 Budget Questions April 3, 2009 18. Under the Mayor’s proposed FY09 budget a $2.5 million program enhancement was included to “fund continued and intensified development of a broader, more nuanced array of quality mental and behavioral services for District child welfare clients.” In the proposed FY10 budget under Protected Programs it states that the proposed budget will sustain the expansion of mental health services for youth. What is the FY10 allocation for mental health services for youth in care? How many additional youth were able to receive services under the FY09 program enhancement? What additional services were provided under the FY09 program enhancement? If the FY10 allocation is greater that the $2.5 million allocated in FY09 please provide detailed information on how the additional funding will be used. If the FY10 allocation is less that the $2.5 million allocated in FY09, please provide a rational for this decease and detailed information on how this funding loss will impact services? In FY 2009 CFSA received the $2,500,000 to expand child welfare mental health services via program enhancement. In FY09 these funds are being utilized to: !

Support crisis/emergency mobile response services for children in the child welfare system. Contract awarded on July 2008; services began October 2008.

!

Obtain crisis emergency respite beds. Contract awarded July 2008; services began October 2008.

!

Purchase the Trauma Symptom Checklist as the screening tool that will be used for children entering the foster care system.

!

Engage Choice Service Providers (Core Service Agencies) to provide an array of services for District child welfare children. Services will include training to enhance capacity for: 1. 2. 3.

Child Parent Psychotherapy for Family Violence (CPP-FV) Parent Child Interactive Therapy (PCIT) Family Functional Therapy (FFT)

Contracts will be awarded for training summer 2009. !

Fund Community Based Intervention (CBI) Training RFP released to solicit new vendors to become certified CBI providers and to provide refresher training for existing providers. RFP closes March 2008.

!

Provide Trauma-focused Cognitive Behavioral Therapy in collaboration with the Office of Victims Services through the Medical University of South Carolina. Training is offered citywide and will provide ongoing coaching for the Choice Service Providers. Orientation commenced in September 2008; learning sessions in March, June and October 2009.

!

Provide specialty services that are Evidenced Based Practice that are currently not Medicaid reimbursable and supports the treatment needs of CFSA children.

Since the beginning of FY09, we have served 239 families through ChAMPS (the mobile crisis response team) and have provided comprehensive diagnostic and assessment to approximately 142 CFSA children. The proposed FY10 budget includes the $2,500,000 that CFSA received via program enhancement in FY09. These funds will be used to:

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Child and Family Services Agency FY10 Budget Questions April 3, 2009 !

Provide ongoing services and coaching of prior training for: 1. 2. 3. 4.

!

Trauma Focus Cognitive Behavioral Therapy Child Parent Psychotherapy for Family Violence Parent Child Interactive Therapy Functional Family Therapy

Enhance Choice Service Provider service array in the provision of: 1. 2. 3. 4.

Anger Management Therapy Grief Counseling Play Therapy Expressive Therapies

19. Please explain the increases in Object Code 32 in Table RLO-3 on page E-20. The increase in this line (Rent) is due to projected increases in rent at the three facilities CFSA currently occupies. Please note the projections are provided by the Office of Property Management. The three facilities are: ! ! !

400 6th Street, SW 702 H Street, NW 955 L’Enfant Plaza, SW

20. Please explain the decreases in Object Codes 40, 41, 50, and 70 in Table RLO-3 on page E-20. Object Class 40—Other Services and Charges The decreases in Object Class 40 are due primarily to reductions in the Agency’s staff travel, printing and duplication, and recruitment travel budgets. Object Class 41—Contractual Services The decreases in Object Class 41 are due primarily to reductions in the Agency’s use of personal services contracts and a reduction in the agency’s health services contract. Object Class 50—Subsidies and Transfers The decrease in Object Class 50 is due primarily to the Agency’s revised claiming strategies under the Medicaid for medical services provided by CFSA staff, as well as to children in residential treatment centers during FY 2010. It is anticipated that these efforts offset any potential funding shortfalls in support of the ongoing provision of services to children and families. Object Class 70—Equipment and Equipment Rental The decrease in Object class 50 is due primarily to the reduction in the Agency’s computer hardware and office furniture purchases.

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Child and Family Services Agency FY10 Budget Questions April 3, 2009 21. Please explain the increases and decreases in Object Codes 11-15 in Table RLO-3 Personal Services on page E-20. Object Classes 11 (Regular Pay), 12 (Regular Pay, Other) and 13 (Additional Gross Pay) The changes in these object classes are due to fully supporting the salary costs of the Agency’s 892 FTEs for FY 2010. Object Class 14—Fringe Benefits The increase in this object class is due to an increase in the salary lines noted above. The calculated benefits rate for the agency is 19.8%. Object Class 15—Overtime Pay The increase in this object class is due to the historic use of overtime in the Agency. 22. Are funds available under "The Fostering Connections to Success and Increasing Adoptions Act of 2008" for FY09? If yes, does CFSA need to make significant changes in policy and practice to comply with any new requirements in order to access this funding? Yes. This week, CFSA submitted a Title IV-E State Plan Amendment that will allow us to claim Title IV-E federal reimbursement for guardianship assistance payments for children/youth under the age of 18 years. This is a prospective opportunity for guardianships that were finalized on or after January 1, 2009, and federal reimbursement is not available for children/youth whose guardianships were finalized prior to that date. These guardianships will continue to be funded with local dollars exclusively. As with the Title IV-E foster care and adoption assistance programs, the Title IV-E reimbursement for guardianship assistance payments will be contingent on each child’s eligibility. CFSA will need to align its practice with federal requirements in order to ensure that we maximize reimbursements under this funding stream. Because this is a prospective program, the entering cohort will be small for FY 2009 (somewhere between 10 and 25 eligible children, we estimate). Reimbursements as a percentage of expenses will grow in subsequent years as locally-funded children age out of guardianship and as the entering cohort (of potentially federallyfunded guardianships) becomes more robust. Fostering Connections legislation also introduced funding for Family Connections Grants, which were to come available during FY 2009. However, our counterparts at the Administration for Children and Families informed us last week that as of now there is no timetable for their release. 23. In the FY09 budget as part of the Child Placement Activity $511,988 was provided for the Family Team Meeting Initiative. The proposed FY10 budget supports sustaining this initiative. How much funding has been allocated for this program in FY10? The FY 2010 funding for the Family Team Meeting initiative is $504,062. The funding will support two teams, totaling 9 staff members for this initiative.

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Child and Family Services Agency FY10 Budget Questions April 3, 2009

24. In the Transfers Out section of the proposed budget CFSA will transition services for medical screening from hospital-based services to agency-based clinic services. Agency-based medical professional will provide immediate medical screenings. Please provide detailed information about the transition and how it will work to ensure timely medical screenings. Do you anticipate a budget impact as a result of this transition? Please walk through a case? In FY 2010, consistent with CFSA’s commitment to ensuring the well-being, we will move forward in implementing an innovative model medical care management model for medical, dental, and mental health services for children within the foster care system. The model will be supported by both local funds and Medicaid reimbursement. This new approach will not only improve children’s access to these critical services but help to address the well-being issues which are often a barrier to permanency. The on-site screening for the pre-placement evaluations will significantly streamline the process where children are removed, medically screened and placed. Currently, children receive medical pre- and replacement screens at THEARC, or at the Children’s National Medical Center. THEARC screenings are available Monday to Friday 7:30am to 7:30pm. CNMC screenings are available evenings, weekends and holidays. Medical legal and acute psychiatric evaluations are seen in the CNMC Emergency Department. When a child is removed from their home, she is transported to THEARC or to CNMC – depending on the day and time; neither site is designed exclusively to provide pre-placement screening evaluations for children coming into care initially or being replaced into another home therefore wait times are extensive, averaging 2-3 hours but can be longer depending on the existing patient load at either site The process of being removed from families and enduring long wait times in unfamiliar environments with strangers compounds stress and serves to further traumatize children. Under the proposed model, when a child is removed, she will be brought to the CFSA On-Site Prescreening Health Project and be seen immediately by an experienced clinician sensitive to child welfare concerns. Additional benefits will include: ! Early and up close engagement of social workers regarding immediate health care needs of the child; ! Ability for clinicians to communicate with foster parent prior to and following placement of child as needed; ! Early engagement of biological family for medical information. 25. Provide additional information on the new payment rate structure for Psychiatric Residential Treatment Facilities. The Medicaid State Plan Amendment (SPA) related to psychiatric residential treatment facilities (PRTFs) proposes to: ! clarify the appropriate provider type and payment rationale for psychiatric inpatient services provided to adolescent children; and ! implement a payment rationale and increase. The payment rate will be equal to either the average Maryland Medicaid rate or for an out-of-District provider, the state Medicaid rate where the PRTF is located.

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Child and Family Services Agency FY10 Budget Questions April 3, 2009 Additionally, this amendment would make the necessary name changes in the Medicaid State Plan to conform to CMS guidelines regarding PRTFs, as well as ensure that the District would obtain the federal matching share for inpatient psychiatric services provided to children through the PRTFs. Lastly, this SPA would also modify the PRTF payment system to ensure that reimbursement for these services keeps pace with the increased cost of services in the District. The PRTF SPA is currently under review by the federal Centers for Medicare and Medicaid Services (CMS). The D.C. Department of Health Care Finance, as the single state Medicaid agency, is the lead department for this SPA. 26. Is there money in the FY10 proposed budget for employee parking? If yes, is this an increase or decrease from FY09? There are no additional funds for employee parking in FY 2010. 27. Have all positions within contracting and procurement been filled specifically the position of Director. If no, have any of these vacant positions been eliminated? As of 3/30/09, CFSA has hired an Administrator for the Contracts and Procurement Administration. There are currently two vacancies within the administration; no vacancies will be eliminated in FY 2010. 28. In the proposed budget $664,039 in cost saving was identified within the Child Information Services Administration by using staff resources to support information technology needs. Provide a program description for the Child Information Services Administration and a listing of activities within this program? Please specify the source of this cost savings. Will staff be required to take on additional duties? CFSA’s Child Information Systems Administration (CISA) has two areas of responsibility. First, CISA is responsible for maintaining FACES.NET, the District’s Statewide Automatic Child Welfare Information System (SACWIS). The FACES.NET application is a comprehensive case management system that supports each of CFSA’s four basic functions of (1) Child Protective Services (2) Out-of-Home/Foster Care (3) InHome/Supportive Family Services and (4) Permanence. Second, CISA maintains and supports the Agency’s hardware, software, and network operations. CISA consists of two program areas: ! Application Team: Responsible for the FACES.NET operations; ! Technical Team: Responsible for technical tasks related to the network infrastructure, personal computers, printers, network administration, and technical user support. Additionally, the District contracts with Deloitte Consulting for software and Crystal reports development resources and some project management. The $664,039 reflects a reduction in the amount budgeted for the FACES.NET operations contract. The current contract with Deloitte Consulting includes both application maintenance and development along with information management report development. CFSA will issue a solicitation for application maintenance and

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Child and Family Services Agency FY10 Budget Questions April 3, 2009 development in FY 2009. The information management report development portion of the current contract will not be included in the RFP. These services will be provided through CISA and/or OCTO. 29. Under the Cost Savings the Collaborative Council contract was reduced by $544,055 to focus on documentation, quality assurance, evaluation and training supports to the Collaboratives. Provide detailed information on how the agency plans to support improvements in these areas? What is the total funding allocated to the Collaboratives in FY 10? In FY 2010, CFSA will reduce the Collaborative Council’s scope of work. The new scope of work will focus on quality assurance and training. The FY 2010 contract will include performance based language that will help to focus their efforts in fulfilling the revised scope of work. CFSA will provide continuous technical assistance and support to both the Council and the Healthy Families Thriving Communities Collaboratives through the CFSA Collaborative Liaison Office. The total funding to the Collaboratives (including the Collaborative Council) in FY 2010 is $13,424,946. 30. Please specify how the agency plans to use the American Recovery and Reinvestment Act, which will provide $2,500,000 in Title IV-E federal funding to support services to children in foster care, training for social workers and staff, training for current or prospective foster and adoptive parents, and other eligible services. How much funding will be used for each of the above mentioned activities? Will this funding represent and increase or decrease from funding allocated for each activity in FY09? After the one-time stimulus funding has been spent, will the agency look for ways to annualize these services? The FY 2010 budget request includes $2,432,000 in Title IV-E funding resulting from the provisions of the American Recovery and Reinvestment Act. Specifically, the increased funding reflects an increase in the Federal Financial Participation (FFP) reimbursement rate to the District of Columbia for program services. These services include subsidy payments made to foster and adoptive parents. The FFP rate is increased from 70% to 76.2%, and covers the time period of October 1, 2008 through December 31, 2010. It should be noted that this increase in FFP is for program services only and does not include reimbursement for administrative services, which is maintained at the 50% FFP rate. As such, all the funds will be used for services to children in foster. The other services mentioned are either covered under the administrative FFP of 50% or under the enhanced match rate for training services that are budgeted for under the agency’s Child Welfare Student Training and Education-to Practice program for $358,037. 31. The proposed budget allows for the sustaining of the co-location of social worker support units in the community. What is the total funding allocated for co-location in FY 10? Does this amount represent and increase or decrease from FY 09? Are there plans to have workers assigned to cases according to geographic location? The total funding allocated for co-location in the FY 2010 budget is $514,043, which is no change from the FY 2009 budget. In-Home social workers are currently assigned cases by geographic location. 32. The FY09 budget included $357,000 in funding in the development of the Child Welfare Student Training and Education-to-Practice (STEP) program. The FY10 proposed budget supports sustaining

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Child and Family Services Agency FY10 Budget Questions April 3, 2009 this initiative as a way to promote retention and recruitment. How much funding is be allocated for this program in FY10? To date, how many students are in this program? How many students to you anticipate in FY10? The FY 2010 budget request for the Child Welfare Student Training and Education-to Practice program is $358,037. Eight students are currently in the program. In FY 2010 the program has the capacity to serve 20 students. 33. In the FY09 budget the “Work of the Heart” Respite Program Initiative received $150,000 in funding. The FY10 proposed budget supports sustaining short-term respite care for foster care families. How much funding has been allocated for this program in FY10? The FY 2010 budget includes $150,000 for respite care services for foster care families. 34. How much funding have you allocated for travel in the proposed FY10 budget? Local travel (Object 401)—FY 2010 budget request is $138,175. Out-of-City Travel (Object 402)—FY 2010 budget request is $44,000.

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