CHILD WELFARE MANUAL

(Effective: 09/09/22)

7.2       Children’s Treatment Services (CTS)

Children’s Treatment Services (CTS) are intended to supplement, rather than supplant, the casework of the Children’s Service Worker. These services should be helpful in reducing risk and improving family functioning and are to be identified in the treatment plan.

CTS provide services across the Division’s continuum of care. All children and families served through CTS must have active involvement with the Division, such as an open child abuse/neglect (CA/N) investigation, family assessment, family centered service case, foster care or adoption.  CTS are purchased by the Division on behalf of the family and CTS should be used, as a payer of last resort, with children and families to prevent CA/N and to treat the negative consequences of CA/N occurrence.  These services are administered by third party providers, which may include the provision of counseling and therapy; parent aide and education services; and/or, intensive in-home services (family preservation).  Services are provided in order to keep children from entering out of home care as well as to return children safely to their homes or other permanency plan.

Children and families may present a multitude of problems, which may require a variety of services. Contracted services to an individual or family should be provided based on the goals developed by the Children’s Service Worker, family or individual, and the provider.

Since effective communication between all treatment agents is a prerequisite for successful intervention, the worker must carefully define the nature and scope of services to be delivered. All CTS authorizations should be entered and approved through local protocols.  All CTS payments should be processed as outlined in the FACES Financial Systems Payment Handbook.

CTS are established through contracts with vendors statewide to provide the following:

• Therapeutic services
• Non-Therapeutic services
• Intensive In-Home Services
• Intensive Family Reunification
• Crisis Funds Disbursement
• Language Translation and Interpretive Services for People with Hearing Loss
• Interpretative and Counseling Services for the Deaf
• Transportation
• Drug Testing
• Paternity Testing
• Medical Examinations (SAFE Network and Other Medical Examinations) Needed during a CA/N Investigation
• Legal Fees
• Paying for Medical Records
• Emergency medical examination services (related to CA/N investigations

7.2.1 Therapeutic Services

Therapeutic services are primarily intended to provide mental health assessments, psychological testing and treatment to children and families not otherwise eligible, covered, or receiving the specific mental health services by another entity.

The following should be considered prior to authorizing services under this contract:

• All children with an open foster care or adoption case must use a Medicaid provider for any type of behavioral health services. This includes individual and family counseling, testing and assessment, etc.
• If a non-Medicaid provider serves the client(s), a bill that includes CPT (current procedural terminology) codes must be submitted with the payment request. The CPT codes will be used to determine the amount that Medicaid would have paid. This is the maximum amount that will be paid for that service.
• Adult clients are not eligible for counseling under straight Medicaid. If they do belong to a Managed Care plan, they are eligible for counseling services, but only through the plan network. Staff should be sure to explore all these options before authorizing counseling through CTS.
• If counseling services are court ordered, workers still MUST use either a Medicaid provider or a provider who has a CTS contract to provide the specific service needed. Most court orders do not specify which provider is to be used. If a provider is used who does not have a CTS contract, payment will be denied or reduced to the current rate paid under Medicaid.
• The client receiving the counseling must have active/open CA/N, case management, or adoption involvement with the Division.

Therapeutic Services include the following:

• Assessment: The assessment is usually the first stage of a treatment process, but mental health assessments may also be used for other varying purposes. The assessment includes social and biographical information, direct observations, and data from specifically administered tests. An assessment is most commonly carried out for clinical and therapeutic purposes, to establish a diagnosis and formulation of the individual’s needs, to plan the individual’s care and treatment. Assessments may be performed in an in-patient, out-patient, or community setting.

 

• Specialized Clinical Assessment/Psycho-Sexual Evaluation: This is a specialized clinical assessment of adult and juvenile sex offenders, which are also referred to as a psycho-sexual evaluation. These assessments are generally performed by a psychiatrist or a psychologist; however may be performed by a Licensed Professional Counselor (LPC).       Psycho-Sexual Evaluations are generally court ordered and may be utilized for either an adult or juvenile sex offender (client) where the court is trying to determine any of the following:
  • • Risk of repeat behavior;
    • Interventions;
    • Specific risk factors;
    • Client’s willingness to participate in recommended treatments and/or interventions;
    • Identifying factors that may prevent engagement in treatment and/or interventions; or
    • Identifying strengths and protective factors

  Psycho-Sexual Evaluations may be used by judges and/or other parties to make informed decisions regarding the following:

  • Pre-sentencing in Adult or Juvenile Criminal Court;
  • Custody disputes in Family Court; or
  • Child Protection Cases

  Psycho-Sexual Evaluations shall not be used to determine the following:

  • Guilt or innocence;
  • Whether or not a client is a sex offender; or
  • Whether or not a client meets the profile of a sex offender.

• Behavioral Health Services: Behavioral Health Services is a clinical and/or therapeutic service provided to a client to meet their behavioral health needs which exceed the maximum allowable units provided by MO HealthNet. Behavioral Health Services are intended to help the child acquire functional skills in their community placement, to prevent hospitalization or placement disruption. The service is intended to address serious behavioral concerns including severe aggression and self-injury that traditional therapeutic techniques have been unsuccessful in treating. Behavioral Health Services may include but not be limited to:
  • Creating a behavior support plan, including the collection and analysis of data related to the child’s behavior.
  • Behavioral modification strategies to assist the child and family (teaching/modeling);
  • Development of coping strategies aimed at keeping the child in the foster/relative/kinship or adoptive/guardianship home; and,
  • Development of appropriate communication skills between the child and the parent/guardian.

 

• Crisis Intervention: Crisis intervention may be provided to a client in order to alleviate or diffuse a situation of immediate crisis. The situation must be of significant severity to pose an imminent threat to the client’s well-being or of such severity that the client poses a danger to others. Crisis intervention may be accessed when a family crisis is occurring which may result in child maltreatment.

 

• Family Therapy: The focus of this service is to correct family dysfunction so that the children of the family may remain in their home rather than being placed in alternative care or, if in placement, be reunited with the family. The service should be of limited duration, generally three (3) to six (6) months. Services shall include group therapy with the family, with the child present, as authorized, and occasional individual therapy sessions if recommended, including structured interaction led by the provider, communication exercises, role playing, task assignment and analysis, and parenting skills training.

 

• Group Therapy: This service is group therapy in the form of guidance and instruction through therapeutic interaction between the provider and a group consisting of at least three (3) but no more than ten (10) individuals, who are not all members of the same family.

 

• Individual Therapy: Individual Therapy is an intensive level of client specific therapeutic treatment services. Th focus of individual therapy is to correct client dysfunction so that the children of the family may remain in their home rather than being placed in alternative care or, if in placement, be reunited with the family.

 

• Speech Therapy: Speech Therapy is for clients who have speech, language or hearing impairments. The client’s need for this therapy must be determined in a speech/language evaluation conducted by a certified audiologist or a state certified speech therapist. Speech/language therapy (ST) is the evaluation and provision of treatment for the remediation and development of age appropriate speech, expressive and receptive languages, oral motor and communication skills. Speech therapy includes activities that stimulate and facilitate the use of effective communication skills. Speech/language therapy includes treatment in one or more of the following areas: articulation, language development, oral motor/feeding, auditory rehabilitation, voice disorders, and augmentative communication modes. Speech Therapy is a client specific treatment modality.

 

• Testing: Testing services include the administration and interpretation of an individual battery of one or more psychological/psychiatric tests appropriate to the needs of the client, the submission of a written report that includes the test results, a professionally appropriate analysis and interpretation of the result of the tests, and a recommendation for treatment. Though often performed directly following the completion of a mental health assessment, psychological/psychiatric testing services may be provided in lieu of or in addition to previously completed mental health assessments as warranted on a case specific basis. Testing services are often utilized to rule various mental health/personality disorders in or out and/or to reach a diagnostic determination.

 

• Vision Therapy: Vision Therapy is an individualized, supervised, treatment program designed to correct visual-motor and/or perceptual cognitive deficiencies. Vision Therapy sessions include procedures designed to enhance the brain’s ability to control:
  • Eye alignment;
  • Eye teaming;
  • Eye focusing abilities;
  • Eye movements; and
  • Visual processing.

Visual-motor skills and endurance are developed through the use of specialized computer and optical devices, including therapeutic lenses, prisms and filters. During the final stages of Vision Therapy, the clients newly acquired visual skills are reinforced and made automatic through repetition and by integration with motor and cognitive skills.

7.2.2 Non-Therapeutic Services

Non-therapeutic Services are intended to provide a way for the Division to offer a variety of services as needed based on the identified needs of children and families. The client or group of clients served through non-therapeutic services must have active/open CA/N, case management or adoption involvement with the Division. Services intended to prevent further incidents of child abuse and neglect, to meet the case specific needs of children, and families with open/active involvement with the Division.

The following is a listing of the types of non-therapeutic services:

• Day Treatment: This service includes therapeutic day treatment for emotionally disturbed, developmentally disadvantaged and abused or neglected children. Day treatment is an intensive service array of services provided in a structured, supervised environment designed to reduce symptoms of a psychiatric disorder and maximize functioning. Services are individualized based on the child’s needs. This service also includes support services for members of the child’s birth family, foster family, adoptive family or guardianship family. Services are intended to prevent out-of-home placement, placement disruption, and to return children to traditional child care or school settings as soon as possible. Children must be diagnosed within Axis I of the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders).

 

• Domestic Violence Batterer’s Intervention Program: Domestic Violence Batterer’s Intervention Program is a service intended to provide treatment for people who have used violence to exert power and control over another person. The intervention program is intended to help clients modify behavior patterns and break the cycle of violence by learning new skills around power and control, and accountability and communication. The program provides educational group sessions for people who are abusive in their relationships (abusive can be physical, emotional, mental, or sexual).

 

• Drug Testing: This service provides drug and alcohol testing for a Department client, at the request of the Department. Each client receiving drug testing services must be listed on an open case or investigation/assessment function. This drug testing service should only be utilized when the Office of Administration’s statewide drug testing contract with Guardian Medical Logistics (GML) cannot be utilized. The following drug tests are available through CTS:

• • Urine, Five Panel Test
  • Urine, Nine Panel Test
  • Urine, Ten Panel Test
  • Urine, Eleven Panel Test
  • Hair Follicle, Five Panel Test
  • Hair Follicle, Nine Panel Test
  • Hair Follicle, Ten Panel Test
  • Hair Follicle, Eleven Panel Test
  • Medical Review Officer Test Results Review
  • Drug Specimen Positive Confirmation Test
  • Alcohol testing; breathalyzer or urine
  • Oral fluid testing

For non-court ordered situations, the Children’s Service Worker may have reasonable suspicion that the child’s parent(s) or caretaker(s) are using an illegal substance and may request authorization from the Circuit Manager to request that the parent(s) or caretaker(s) submit to a drug-screening test. Without a court order the parent(s) or caretaker(s) may decline the drug-screening test, at which time the worker will document the reason for the request and the client’s refusal as a manual activity. If they decline, the test may NOT be pursued further without a court order.

• Family-Centered Services Case Consultation: Family-Centered Services Case Consultation is to provide consultation services to designated recipients regarding specific families and/or general family practice either in individual or group session formats. The services shall be reflective of a Family-Centered Model for accomplishing child protective services and in-home child welfare services.

  • This service is NOT to be authorized for participation in Family Support Team (FST) meetings. This service is for the provider to facilitate the meeting.

• Family-Centered Services Family Meeting: Family-Centered Services Family Meeting is to provide assistance to designated recipients with the purpose of enhancing the skills of the designated recipients in conducting/facilitating meetings regarding families involved with Department and to serve families. This may include intact families, families with children at imminent risk of out-of-home placement, and families with children in out-of-home care. The services shall be reflective of a Family-Centered Model for accomplishing child protective services and in-home child welfare services. Family meetings include, but are not limited to, family support team meetings, family staffing, family conference, and team decision meetings.

 

• Nursing Services: Nursing Services, also considered as private duty nursing, is professional nursing care for assigned pediatric clients in a home care environment. The contractor and/or personnel shall provide nursing services in accordance to the child’s individualized Plan of Care established by the child’s treating physician. The contractor evaluates, assesses, and documents the pediatric nursing process. Nursing Services do not take the place of the parent/guardian or placement provider’s supervision duties.

 

• Parent Aide: Parent Aide services include the placement of a trained parent aide in the home of a family authorized by the Department as part of the family/client’s case service plan. The family must have an open Family Centered Services and/or Family Centered Out of Home Care (FCOOHC) case with the Department. At least one (1) parent and one (1) child must be present. Services shall be provided primarily in the home of the family/client. The contractor may assist the parent(s) in the development of parenting and home management skills through both teaching and modeling, with a goal of reaching an acceptable level of family functioning and maintenance of the physical environment. The parent aide shall not be used to provide supervised visitation or transportation services.

 

• Parent Education and Training Program: The Parenting Education and Training Program is meant to bring evidence based, parent education and training to the clients of the Department. The purpose is to bring a consistent standard of quality services resulting in positive outcomes for children and families. It is desired that the parent be able to demonstrate one or more new skills taught by the contractor in their instructional program.

 

• Personal Assistance (Behavioral): Personal Assistance may provide services that include any activity of daily living (ADL) or instrumental activity of daily living (IADL) to a client of the Department. Such services may include, but are not limited to: bathing, toileting, transfer and ambulation, skin care, grooming, dressing, extension of therapies and exercise, care of adaptive equipment, meal preparation, feeding and incidental household cleaning and laundry. Services may also include assisting a client with shopping, banking, budgeting, using public transportation, social interaction, recreation, and leisure activities. Assistance may be given for accompaniment, cueing and minor problem-solving necessary to achieve increased independence, productivity and inclusion in the community.

 

• Personal Assistance (Medical): Personal Assistance Services activities may include any activity of daily living (ADL) or instrumental activity of daily living (IADL) to a client of the Department. Such services may include, but are not limited to, bathing, toileting, transfer and ambulation, skin care, grooming, dressing, extension of therapies and exercise, care of adaptive equipment, meal preparation, feeding and incidental household cleaning and laundry.

 

• Pervasive Developmental Services Coordinator: The Pervasive Developmental Services Coordinator provides assistance with treatment plan development, consultation, environmental manipulation and training to and for clients with developmental disabilities whose maladaptive behaviors are significantly disrupting their progress toward a successful family environment. The contractor shall locate services and assist in referrals to service providers as needed to help meet the client’s needs. The contractor will also provide training and consultation with the client’s caregivers and service providers as needed to assist in caring for the client. The Pervasive Developmental Services Coordinator will assist the client and/or the client’s caregivers in designing and implementing specialized programs to enhance self-direction, independent living skills, community integration, social, leisure, and recreational skills. The Pervasive Developmental Services Coordinator will evaluate the client’s setting, schedule, typical daily activities, relationships with others that make up the supports for an individual including their caregivers and any service providers. The Pervasive Developmental Services Coordinator will then develop and implement strategies to help teach the client skills to promote more positive interactions between the client and their support system.

 

• Respite Care: Respite Care is the provision of temporary care for children, from birth to 18 years of age. Respite may be utilized when families are experiencing crisis that would significantly elevate the risk of abuse or neglect. Respite also allows family members to have a break from each other. The client must have an open case function in order to be eligible for respite services. Respite services under the Children’s Treatment Services contract shall not be used for children in alternative care or for children under adoption or guardianship subsidy. Respite is not to be utilized as a substitute for child care. Periodic and/or intermittent, temporary substitute care for the purposes of this contract means a minimum of twelve (12) hours up to twenty-four (24) hours per child and no child shall receive respite care under this or any other contract for more than twelve (12) days (twenty-four (24) hour periods) in a state fiscal year.

 

• Service Delivery Coordination: Service Delivery Coordination is designed to coordinate the following:

 

• • Development, identification, and/or acquisition of resources for parents in need of a variety of services.
  • Assistance with case management activities which may include:
    • Supervising family visits;
    • Accessing resources for placement stability’
    • Behavioral management;
    • Child Care Services;
    • Public assistance;
    • Medical or mental health services; and/or
    • Additional resources as identified by the Department

This service is not to be used as a staff position beyond what is required above, unless approved in writing by the Department.

The Service Delivery Coordination shall not be used to provide transportation services.

• Substance Abuse Treatment Services: Substance Abuse Treatment Services include thorough client assessments and client specific treatment interventions designed to address alcoholism, drug dependence and addiction.

 

• Transportation: Transportation shall be utilized in direct alignment with the treatment plan goals as identified in Family Support Team (FST) meetings. Transportation for a parent(s) will assist in accessing community resources to alleviate the need for an open Family Center Services or Alternative Care case. Availability of handicap vehicles is preferred. Transportation shall only be used for the following:
  • Transporting a child(ren) to and from school
  • Transporting a child(ren) to and from medical appointments
  • Transporting a child(ren) from child care provider, school, or placement location to the location in which a visit will take place with siblings(s)/parent(s) or placement opportunity
  • Transporting parents to visits with their child(ren)
  • Transporting parents to meet with community resources as identified by the case manager which meet the treatment plan goals of the parent as identified in FST meetings
  • Transporting youth with handicap accessible needs as identified above; and/or
  • Other transportation services as approved by Department

 

• Transportation (Behavioral): Behavioral transportation is to be utilized for transporting youth who may be a danger to themselves and/or others.

  If restraints are required to transport a youth, CD will then obtain written approval from the court.

Therapeutic and Non-Therapeutic Service ReferralsThe Children’s Service Worker should submit a written referral summary to the provider before the provider initiates services with the family member(s). Verbal referrals should be followed up with a written referral.

The Children’s Treatment Services (CTS)/Medicaid Referral Summary (CS-13), is used by the Children’s Service Worker to inform the CTS provider of pertinent case information. In most instances, this form will provide the CTS/Medicaid provider with the necessary information to begin his/her delivery of services to the family.

Therapeutic and Non-Therapeutic Service Reporting Requirements

As case manager, the Children’s Service Worker must monitor the progress of the treatment plan, including the work of contracted providers. The worker shall be in regular contact with the contracted providers in addition to receiving regular written reports.

The contractor shall not make changes in the treatment plan including goals, objectives, and specific individual tasks without prior consultation with and concurrence of the Children’s Service Worker.

For any therapeutic service that requires a license to practice as issued by the Division of Professional Registration, and/or any non-therapeutic services, the CTS provider must complete and submit the following reports: :

• Initial progress report within thirty (30) days after services are initiated and shall include, at a minimum, the following information:
  • An explanation of any diagnostic or assessment procedure and service provision used at the inception of service delivery, identification of any assessment tools or test(s) administered and the results of any such test(s) or procedure(s), and any specific problems identified;
  • A summary of the proposed service plan including any specific tasks or objectives the client is expected to attain or accomplish and the expected achievement date; and
  • Results of any drug testing conducted, if applicable.

• Subsequent follow-up reports at least every sixty (60) days during the authorization period or within seven (7) days prior to the authorization end date for service authorization periods of less than thirty (30) days. Subsequent follow-up reports shall include, at a minimum:
  • A summary of the client’s progress since the last report;
  • Any change(s) to the treatment plan or expected achievement date(s) specified in the initial report; and
  • Any changes to the treatment plan based on the client’s progress toward their expected achievement or attainment of specified goals or objectives since the last report

7.2.3 Intensive In-Home Services and Intensive Family Reunification Contracts                 

7.2.3.1 Intensive In-Home Services

Intensive In-Home Services (IIS) are intensive in nature, provided in the home setting and designed to prevent the unnecessary out-of-home placement of children. These services are provided only to families authorized by the state agency where the following conditions exist:

• • There is a child abuse or neglect situation or a child who has committed a status offense. (Some projects also accept referrals on delinquent children and children with severe emotional disturbances);
  • One or more child(ren) will be placed in out-of-home care within 48 hours unless the family crisis can be resolved; and
  • The family will accept Intensive In-Home Services and the safety of the child(ren) and In-Home Specialist is reasonably assured.

The model represents a psycho-educational crisis intervention approach which emphasizes teaching and skill building during periods when the family is in crisis and most susceptible to change. As the current crisis is resolved, the family is taught alternate responses to minimize future problems.

There are no waiting lists for the provision of services. Families referred for these services are accepted for assessment on a first-come, first-serve basis.  The contractor accepts all referrals for assessment unless the caseload of the specialist will not allow for the provision of immediate services.  If available to provide services, the specialist must see the family within 24 hours of the initial referral.  Upon determination that the family is appropriate for IIS, the specialist completes a family assessment that evaluates the safety of the children and of all family members.  A treatment plan is developed with the family that sets achievable and measurable goals.

Specialists are available to the family 24 hours per day, seven (7) days per week. Depending upon the needs of the family, the IIS specialist delivers a wide variety of educational and counseling services.  Specialists must also, if necessary, transport clients, complete household chores, and obtain additional community services for families.

A crisis intervention fund is maintained for dispensing funds as authorized by CD to provide concrete services to meet the basic or emergency needs of families receiving IIS. When no other resources exist, this fund is used to pay reasonable immediate expenses for families to assist them in resolving the crisis that might otherwise result in removal of a child.  Funds are dispensed upon the approval of the Division.  The types of expenses covered may include, but are not limited to, rent, clothing, utilities, auto repair, gasoline, pest control, laundry cost, food, etc.

If the assessment determines a family is not appropriate for IIS, the contractor is reimbursed for their time spent screening the family for services.

The essential elements of the IIS Program Include:

• • One or more children in the family must be at imminent risk of out-of-home placement;
  • No waiting list for services;
  • Specialists’ availability within 24 hours of referral;
  • Home-based service orientation;
  • Focus on the entire family as the service recipient;
  • Intensive intervention, up to 20 hours per family (or more, if needed), per week;
  • Specialists’ availability to family 24-hours per day, seven days per week;
  • Specialists’ delivery of both concrete and counseling services;
  • Regular staffing conducted between the specialist, supervisor, referral agent, follow-up provider and other pertinent individuals;
  • Crisis intervention fund available for family emergency needs and treatment enhancement;
  • Time limited (six week maximum) service period;
  • Specialists’ caseloads limited to two families;
  • Coordination of IIS follow-up services;
  • Specialists possess specific educational and training requirements; and,
  • Intensive In-Home Services are available statewide for the benefit of all Missouri families.

7.2.3.2 Intensive Family Reunification Services Contract

The Intensive Family Reunification Services (IFRS) Contract is similar to IIS, except that the intensive services are focused on efforts to reunify children to their families.

The essential elements of the IFRS Program Include:

• • One or more children in the family must be at imminent risk of out-of-home placement;
  • No waiting list for services;
  • Specialists’ availability within 24 hours of referral;
  • Home-based service orientation;
  • Focus on the entire family as the service recipient;
  • Intensive intervention;
  • Specialists’ availability to family 24-hours per day, seven days per week;
  • Specialists’ delivery of both concrete and counseling services;
  • Regular staffing conducted between the specialist, supervisor, referral agent, follow-up provider and other pertinent individuals;
  • Crisis intervention fund available for family emergency needs and treatment enhancement;
  • Time limited service period;
  • Coordination of IFRS follow-up services;and
  • Specialists possess specific educational and training requirements.

7.2.4 Crisis Funds Disbursement Contract

Crisis Funds Disbursement Contracts, formerly known as Crisis Intervention Services, are contracted with other governmental entities to provide immediate funds to an individual or family in order to alleviate or diffuse a situation of immediate crisis. These funds allow the Division to address the critical financial and resource needs of families served by the Division.  The funds are utilized for families being investigated for child abuse/neglect who are receiving services. The service is accessed only when other resources to alleviate the crisis have been fully explored.  Eligible services include home repair, child safety items, health related purchases, employment/school supplies, household items, rent/mortgage arrears, and transportation.

7.2.5 Language Translation and Interpretive Services for People with Hearing Loss Contracts

The State of Missouri contracts with several agencies to provide interpretive services for people with hearing loss. Staff should only use those providers who are contracted for interpretive services. To obtain a copy of the contract that contains a list of the providers and their rates, staff should call Contract Management.

If a provider is used who is not contracted and it is anticipated they will be paid over $3,000 in a year, staff should call Contract Management to obtain a contract.

7.2.6  Interpretative and Counseling Services for the Deaf

Services under this contract provide special services for deaf persons. Persons eligible for these services include:

• Abused and neglected deaf children;
• Deaf members of their families; and
• Deaf applicants for, or recipients of, public assistance benefits for CD.

7.2.7 Transportation Contract

Contractors must provide round trip transportation service for clients between their residence, and other designated location. In addition, the contractor must also transport authorized members of client’s family or foster family.  A member of the client’s family or foster family will either be accompanying the client or, together with the client, be accessing services as a family group.

Clients under the age of twelve (12) years will be accompanied by authorized members of their family or foster family.

Service codes for these services are:

TRAN – Transportation

TRMD – Transportation, Medical

TROM – Transportation, Other

Contractors shall only transport those clients for whom they have received prior written authorization from the state agency.

Purchase of transportation, by miles traveled, to transport clients to and from services, e.g. to medical appointments, counseling sessions, etc.

Services above are available on a statewide basis. MO HealthNet is used in lieu of CTS, when available.

7.2.8 Statewide Drug Testing Contract

The Children’s Division may conduct drug or alcohol testing services of clients (e.g. parents, caretakers or children in out-of-home care) to comply with court orders. These services may also be utilized without a court order with circuit manager approval when deemed appropriate during child abuse/neglect investigations or family assessments or with open FCS, FCOOHC or adoption cases.

All data, information, and results related to client drug testing are confidential. Disclosure of information will only be to those individuals whose official business duties necessitate disclosure or as required by law.

Funding for this service is available through a variety of sources, including the Juvenile Office, Drug Courts, a substance abuse treatment facility, MO HealthNet, Managed Care or through the client’s own insurance. CTS funding should be utilized as a last resort after all other funding sources have been pursued.  CTS funding is primarily for court ordered drug testing, but this contract may also be used for non-court ordered drug testing, but only with the Circuit Manager’s approval.

Drug testing can be accessed through the Office of Administration’s statewide drug testing contract with Guardian Medical Logistics (GML). Staff should attach an itemized bill with the CPT (current procedural terminology) codes; and submit to Central Office. Reimbursement for the screenings will be made at MO HealthNet or State contracted rates. In the event that GML is unavailable, staff can access drug testing through other CTS contracts as outlined in Sec. 8, Ch. 7.2.2 above.

7.2.9 Paternity Testing Contract

In most instances FSD will be able to schedule and pay for genetic parentage testing. However, FSD will not schedule or pay for testing when the legal paternity of a child has been established. For FSD purposes, “Legal paternity” is established when:

• An administrative or judicial order determines a man to be a child’s father, or
• Father named on the birth certificate, or
• The parents completed an Affidavit Acknowledging Paternity on the Missouri–born child after July 1, 1997, or
• The parents acknowledged paternity of the out–of–state–born child on an affidavit, filed the affidavit in the state where the child was born, and that state’s law provides that a paternity acknowledgment by affidavit establishes a legal finding of paternity.

In these situations, FSD will not schedule or pay for genetic parentage testing. Additional FSD policy on this topic can be found in CSE Procedural Manual, Section IX, Chapter 6. When legal paternity has not been established for the child, FSD will continue to schedule and pay for genetic tests on cases referred by CD staff.

PROCEDURES FOR REFERRALS TO FSD:

When FSD is able to schedule and pay for genetic parentage testing, CD staff should proceed as follows:

• Mail the completed CS-201AC along with court order(s) for genetic testing to the Family Support Division, P.O. Box 6790, Jefferson City, MO 65102-6790, or
• Email completed CS-201AC along with court order(s) for genetic testing to FSD.IntakeCenter@dss.mo.gov. 

The CS-201AC instructions have been updated to include the list of required documents. Eligibility Analysts submitting the CS-201AC should ensure all fields are complete and indicate “not applicable” or “N/A” in any section of the form that does not apply.

PROCEDURES WHEN CD IS RESPONSIBLE FOR SCHEDULING GENETIC TESTING

When FSD is able to schedule and pay for genetic parentage testing, CD staff should proceed as follows:

• Send to the CD Regional Liaison the following:
  • Completed Referral/Information For Child Support Services/AC (CS-201AC)
  • Court Order(s) for genetic testing
  • Additional documents if applicable:
    • Protective Custody Order
    • Marriage Certificate
    • Divorce Decree
    • Out-of-State Birth Certificate
    • Adoption Order
    • Genetic Testing Order
    • Any Juvenile Court Order Requiring Parents to Pay Child Support
• CD Regional Liaison will verify based on the packet that it is a FSD case for genetic testing and log the case on an Excel spreadsheet with the participant names, DCNs, case manager, date received, case number, county, date sent packet to FSD, date test results are received, date test results sent to case manager.
  • In the event the CD Regional Liaison determines it is not a FSD case due to a father being listed on the birth certificate, the CD Regional Liaison will request a Paternity Scheduling Request (CD-37).
• CD Regional Liaison will keep an electronic copy of the packet and then submit packet to FSD by one of the two methods:
  • Mail the completed packet to Family Support Division, P. O. Box 6790, Jefferson City, MO 65102-6790,
  • Email completed CS-201AC along with court order(s) for genetic testing to FSD.IntakeCenter@dss.mo.gov
• CD Regional Liaison will email case manager with the date and method (mail or email) the CS-201AC was sent to FSD
• FSD will send all correspondence to the Regional Liaison to include but not limited to:
  • Requests for any missing or changed information in regards to addresses
  • Testing results
• CD Regional Liaison will:
  • Correspond with the case manager on any missing or changed information,
  • Will send test results, and
  • Maintain an electronic copy of the test results.

The CS-201AC instructions have been updated to include the list of required documents. Eligibility Analysts submitting the CS-201AC should ensure all fields are complete and indicate “not applicable” or “N/A” in any section of the form that does not apply.

PROCEDURES WHEN CD IS RESPONSIBLE FOR SCHEDULING GENETIC TESTING

When CD requests or is court ordered to seek a genetic test and FSD is not able to schedule or pay for genetic testing, CD will be responsible for scheduling the test. In these cases, CD staff should work directly with the assigned CD Regional Liaison and complete the following steps:

Send to the CD Regional Liaison the following:

• Paternity Testing Scheduling Request (CD-37), with identifying information including DCN’S and social security numbers for child, alleged father(s) and mother, addresses, and with whom they want the child tested.
  • All participants must have DCNs for the referral to be accepted, this includes an alleged father who may or may not be part of a case plan.
  • When possible the Case Manager should include the mother in all genetic testing. This is important in that when the mother is also tested it gives a much higher validity to the test.
• Birth certificate of the child(ren) to be tested
  • This is to verify that it should be a CD case (father listed on birth certificate) and not an FSD case (no father listed on birth certificate)
• Copy of court order(s)

Case managers will be responsible for the following:

• Ensure the individuals that need to be tested receive written notification of the testing date, time, location, and address
  • DO NOT provide copies of the CD-37 as it contain confidential information on other individuals that should not be shared
• Inform the individuals of the following information for day of testing:
  • Bring a photo ID/birth certificate with them to the testing location
  • DO NOT eat or drink for 30 minutes prior to testing
  • All alleged fathers who are minors must have a parent/guardian present at testing
    • If the mother is a minor but has a child, she is considered emancipated

Regional Liaison Steps for Genetic Testing

CD Regional Liaison will complete the following steps:

• Review documents to ensure that the case is a CD case and doesn’t require the CD-201AC for FSD
  • In the event there is not a father listed on the birth certificate, Regional Liaison will request case manager to complete the CS-201AC and submit documents so that a packet can be sent to FSD for genetic testing
  • For CD cases the Regional Liaison will then schedule the appointments for testing and will update the CD-37 with the testing appointment information to include:
    • Date, time, location, and address 
  • Regional Liaison will then send the CD-37 to the case manager via fax, scan and email, or hand delivery for the case manager to send the appointment information to the parties listed on the CD-37
  • Regional Liaison will maintain an electronic copy of the following:
    • Original CD-37 Paternity Scheduling Request
    • Copy of the court order
    • Copy of the complete referral sent
    • Test results
  • Maintain an Excel spreadsheet of all referrals made for the Region to include at a minimum:
    • Participant names
    • DCNs
    • Case manager name at time of referral (any case manager changes)
    • Date received
    • Case Number (assigned by the contracted genetic testing contractor)
    • County
    • Date initiated
    • Date tested
    • Date concluded
    • Date test results sent to case manager

Payment of Testing and Copy of Results

• • The contractor will send invoice for payment and results of the test to the respective CD Regional Liaison to the address provided.
  • Upon receiving the results the Regional Liaison will send the results to the referring Case Manager.
  • The Regional Liaison will process the invoice for payment.
  • Regional Liaison will keep a copy of the referral form in the Regional Office.

7.2.10 Medical Examinations (SAFE Network and Other Medical Examinations)

Medical Examinations needed during a CA/N Investigation

Related subject: Section 2 Chapter 4 1.3.1 Investigations Involving Reported Injuries and Sexual Maltreatment

SAFE Network (Sexual Assault Forensic Examination Network): This is a group of medical professionals who provide comprehensive examinations of child victims of sexual assault.  All examinations by SAFE Network physicians are reported on a uniform medical report form and are performed through established protocol.  The rate is reimbursed by completing the payment request in FACES with a copy of the itemized bill submitted it to Central Office for second level approval, if the child is not eligible for Medicaid.

The Division pays for medical examinations related to child abuse investigations when other payment resources (e.g., Medicaid, private insurance, direct payment by parents, etc.) are not available. Medical payments for Sexual Assault Forensic Exams as a result of a child abuse and neglect investigation are paid at the established Medicaid rate.

7.2.11 Legal Fees

When paying legal fees directly to an attorney for a child in the custody of the Division, the fees should be reimbursed to the attorney or adoptive parent/guardian. If the provider needs to be assigned a vendor number, staff should assign a vendor number according to the instructions in the FACES Financial System Payment Handbook.

If the child has not been in CD custody or the court has ordered CD to pay for legal fees for a natural parent, payments must be entered in Central Office. Please be sure to attach a copy of the court order to the Payment Request, along with a signed W9 Form if the provider does not have a vendor number.  The service code in both situations is LEGL.

Guardianship payments for children in CD custody are paid as vendor type UN and program area AC with a service code of LEGL. For children not in the custody of the Division prior to guardianship, these are paid using CT/CT and service code of LEGL.  The maximum reimbursement is $500 per child.

7.2.12 Paying for Medical Records

Fees for copies of medical records are made on a Payment Request using CT-CT, service code RCRD. If the provider to be paid does not have a vendor number, staff will assign a vendor number according to the instructions in the FACES Financial System Payment Handbook. Attach the bill to the Payment Request and send the Payment Request and attachments to the FACES Payment Unit.  Payments for medical records for AC children and CA/N investigations should never be paid via a DBF-14.

The maximum reimbursement rates for paying providers for medical records were changed effective February 1, 2020.  The new amounts are:

• A copying fee of $26.06 and $0.60 cents per page for the cost of supplies and labor for copies provided in paper form
• An additional fee of $24.40 if the records are maintained off-site
• Copies provided electronically (e.g. disc, fax, email) have a maximum copying fee of $114.17 total, whichever is less
• Postage to include packaging and delivery cost

These rates are per State Statute 191.227 RSMo. In accordance with the law, effective February first of each year, the fees listed shall be increased or decreased annually based on the annual percentage change in the unadjusted, U.S. city average, annual average inflation rate of the medical care component of the Consumer Price Index for All Urban Consumers (CPI-U). The department of health and senior services shall report the annual adjustment and the adjusted fees authorized in this section on the department’s internet website by February first of each year.

CTS Catalog of Services: http://dss.mo.gov/bids/

Related Practice Points and Memos:

1-10-20 – CD20-05 – Children’s Treatment Services

9-22-20 = CD20-45- Medical Record Fees