Virginia Regulatory Town Hall
Agency
Department of Social Services
 
Board
State Board of Social Services
 
chapter
Additional Daily Supervision Rate Structure [22 VAC 40 ‑ 221]
Action Establish rate structuring for a component of foster care maintenance payments
Stage Proposed
Comment Period Ended on 4/1/2011
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5 comments

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2/24/11  2:04 pm
Commenter: Norman and Geneva Wilson, Therapeutic Foster/Adoptive Parents

Proposed VEMAT Restructuring
 

We completed the adoption of a 5 year old severely medically needy and catastropically impaired child in February, 2010 subject to an adoption subsidy agreement that was signed in August 2009, prior to the implementation of the VEMAT.  Additionally, we are in the process of adopting a second severely medically needy child with a proposed adoption date to be scheduled sometime before the end of the calendar year.  We are encouraged that the proposed revisions to the VEMAT will address the lack of equitable subsidies for children in the medically needy category.  However, we believe the proposal must also provide guidance on how the VEMAT will apply to prior adoptions, including adoptions that were completed and subsidy agreements that were entered into prior to the implementation of the VEMAT.  

CommentID: 15115
 

3/17/11  9:09 am
Commenter: Martha Pullen, Director, Amelia County DSS

Possible Unfunded Mandate
 

Are local social services agencies going to receive additional service administration monies for providing the social worker and supervisory 24/7 on call required by these regs?  If not, then I submit that the on call requirement of these regs is an unfunded mandate and should not be part of the regs.

CommentID: 16246
 

3/17/11  11:14 am
Commenter: Brad Bryant, People Places, Inc.

Feedback on the Proposed Regulations
 

The current regulation regarding use of the VEMAT to assess children’s needs and enhanced maintenance levels paid to caregivers has important strengths and some limitations. Since public comment is designed primarily to identify potential limitations, we address that area first.

 

There is a potential problem inherent in limiting the enhanced payment to caregivers for children placed on an emergency basis to 30 days. Often, children placed on an ‘emergency’ basis are new to the system and may come directly from their own homes from court and into foster care. Very little may be known about these children. For many, a thirty day assessment period will not be sufficient to adequately assess their needs. We would suggest a longer assessment period during which an enhanced maintenance stipend may be available to caregivers while a child’s needs may be more accurately determined.

 

Our understanding is that in general regulations that affect both foster care and adoption and public and private child-placing agencies should be congruent. The regulation does a reasonably good job here. It allows both public and private child-placing agencies to use the VEMAT to determine accurate levels of enhanced maintenance to caregivers for children whose needs are exceptional. The VEMAT can be used for children placed in treatment foster care whether the child-placing agencies are public or private. The regulation also allows for the VEMAT to be administered and enhanced maintenance payments to be made to non-TFC caregivers if specified supports are in place. The regulation allows this in both public and private sectors so long as the agencies involved are child-placing agencies. Such parity seems consistent with the general principle of regulatory congruence between public and private programs. It would be wise in any revision of the regulation to continue this parity but to emphasize that the child’s legal guardian – usually the local department of social services – be the entity in charge of administering the VEMAT, even if the child is referred to another child-placing agency.

 

Public-private parity, then, is for the most part well-articulated in the proposed regulations. However, the same congruence may not be reflected there with regard to foster care and adoption. Again, our understanding is that there should be relative regulatory parity between the two as far as is practical. We believe, then, that the VEMAT should also be used in helping to determine maintenance levels paid through adoption subsidy for adoption cases that already have been finalized. This adjustment would create more level ground between these two segments of the child welfare system.

 

CommentID: 16247
 

3/30/11  1:20 pm
Commenter: Rebecca Ricardo, Coordinators2inc

Applying this to finalized adoptions
 

I am not finding that this regulation is clear enough about applying this process to adoptive families. It does state it "shall be used to determine the daily supervision component of the foster care maintenence payment or the adoption assistance payment."  Then regulation then says very little about how this is to be applied to adoptive families.

I would propose that the regulation be clear that if the VEMAT tool is to be used for any adoptive family that it be used, by mandate, for ALL adoptive families.  If the Commonwealth is seeking to acheive greater consistency among all DSS and LCPAs in thier payments to families on behalf of children, everyone should be using the same tool and should be mandated to do so (a "shall" not a "may"). Even if a negotiation process is implemented with regards to Adoption Assistance, all families should start with the same tool to assess an amount from which to then negotiate.

I was please to see that the "team" of people making the decision for the child is a "shall include" and not a may. I hope to see that their is oversite of this so that all children have the appropriate advocates for them sitting at the table making decisions.  I would not be supportive of agencies picking and choosing who they want on the team. Again, consistency across the state in this regard is important.

CommentID: 16322
 

3/31/11  2:34 pm
Commenter: Susan Clark, President, Virginia League of Social Services Executives

VEMAT Rate Restructuring
 

 

March 31, 2011
Dr. Aradhana Sood, Chair
Virginia Board of Social Services
VDSS Office of Legislative and Regulatory Affairs
801 East Main Street
Richmond, Virginia 23219-2901
 
Dear Dr. Sood,
As President of the Virginia League of Social Services Executives, I am writing to comment on the proposed VEMAT regulations before the Virginia Board of Social Services. The rate structure and VEMAT process has had a significant impact on our services for foster care youth since their implementation in October 2009. We appreciate the opportunity to give comment on those impacts. We would also like to acknowledge the importance of the collaboration that state staff has demonstrated in their work with the regulations work group.
Speaking to the rate structure process in general, the VLSSE supports maintaining the current policy of only mandating the process for Treatment (a.k.a., Therapeutic) Foster Care placements, while continuing to give the locality the option for its use in other foster care placements. Rate structure has historically been a part of TFC placement. There are, however, inherent concerns about making the VEMAT tool and this rate structure process a mandate for the entire foster care population. Tying the amount of payment to the youth’s emotional, behavioral, and physical function has the unintended consequence of creating a systematic financial disincentive for children to improve and, conversely, punishes foster parents when they do good work and the child’s functioning does improve. This is even more pronounced when the rate fluctuates (up or down) based on VEMAT reassessments. While a great majority of foster parents are caring for our youth for the right reasons, this is not a strengths based approach to serving our foster care youth. It has been shown that specialized foster care payments, independent of the VEMAT, provide the ability to assist our youth without the financial disincentives and payment fluctuation inherent in this rate structure process.
The rate structure process needs to undergo a review of the amount of the actual rates that are tied to the VEMAT assessment. That could be benchmarked by a review of similar systems in other states. Many of our rates are significantly high, and will have long term impacts on adoption subsidy and CSA costs that IV-E reimbursement may not offset. It is also important to continue to pursue support of increased basic maintenance rates for all of our foster parents. These maintenance rates should be continuously monitored to assure that they are in line with other states in our region.
Localities also have concerns about the specificity of the new on-call requirement in the proposed regulations. Currently local agencies do provide on-call support for foster care, most often through the staff who is working CPS on-call. Additional state administrative funds should be provided to local agencies for this on call activity if it is required in regulations, just as private agencies are reimbursed for this service in our TFC payments. It should also be noted that this level of on-call support is not a therapeutic support, but crisis intervention and information assistance to foster parents and youth.
We would also request that the department consider and support other changes to the proposed regulations. These changes have been discussed by all stakeholders in the regulations work group, and are based on the lessons learned from the initial implementation of this process. The required time frame to conduct the initial VEMAT should be 60 days instead of 30 day to mirror our foster care service planning process, and provide agencies and families with more time to prepare for the VEMAT. When a child moves from one home to another in the same private agency or with a different private agency the VEMAT should not have to be redone based on a change in agency. We also agree that the personal/physical domain on the VEMAT rating should be changed to allow for increased levels of assessed need for children who require major care due to physical disabilities but do not have behavioral or emotional needs that would be rated on the VEMAT. There is also very onerous notification requirements noted in the VEMAT Guidance Manual of Feb. 2011 that we believe should be reconsidered due to the clear burden this places on already taxed foster care staff. Finally, the period of time that a youth’s behavior needs to have escalated before a VEMAT reassessment is required should be changed from two weeks to four weeks. This will allow more sufficient time to assess whether the youth’s behavioral/emotional/physical needs are a temporary reaction to a specific event in their life or a pattern that will need to be more specifically address.
We appreciate the opportunity to be involved and give input on the changes that will be impacting our youth in the days ahead. If you have any questions, please do not hesitate to contact me for further information.
Sincerely,
 
Susan Clark, President
CommentID: 16379