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.
