Foster Care Services for Youth with Elevated Medical Needs

PURPOSE: This rule defines foster care services for youth with elevated medical needs. (1) Definitions for the purpose of this regulation. (A) Youth with Elevated Medical Needs—a youth or child with medically diagnosed extraordinary medical condition(s) and or physical or mental disabilities as set forth in section (3) of this regulation. (B) Resource provider—a foster parent who has a current license issued pursuant to 13 CSR 35-60.010–13 CSR 35-60.110. (C) All other terms used in this regulation shall be defined consistent with 13 CSR 35-60.070. (2) Process for identifying Youth with Elevated Medical Needs. (A) The Children’s Division may conduct a medical needs assessment on the recommendation of the youth’s family support team, any member of the family support team, at the written request of the youth’s resource provider, or if ordered to do so by the court. (B) The written request shall include: a completed assessment tool on a form provided by the division and all supporting medical documentation. The medical documentation shall include, at a minimum, the name and address of each of the youth’s physicians. Any person submitting a request shall provide any additional documentation as requested by the Children’s Division to process the request. The person submitting the request shall have the burden to prove by a preponderance of the evidence that the youth meets the criteria for a youth with elevated medical needs as set forth in this regulation. (C) Upon receipt of the request, assessment tool, and all supporting documentation, the division will determine whether or not the youth is a youth with elevated medical needs as specified in this regulation. The Children’s Division will provide written notification of its decision to the person submitting the request. (3) Characteristics of a Youth with Elevated Medical Needs. In order to qualify as a youth with elevated medical needs, the youth must have a diagnosed medical or mental health condition that requires twenty-four- (24-) hour availability of a resource provider specifically trained to meet the elevated medical needs in order to successfully function in a foster family home setting and does not require placement in an institutional setting such as residential care or a hospital. A youth with elevated medical needs must meet the criteria outlined in subsection (A) or (B) below: (A) Youth with elevated medical needs will have at least one (1) of the following diagnosed conditions and that condition significantly and substantially impairs the youth’s ability to function on a daily basis: 1. Down Syndrome; 2. Trisomy 18 (Edward’s Syndrome); 3. Triple-X Syndrome; 4. Pierre Robin Syndrome; 5. Cystic Fibrosis; 6. Cancer; 7. Autism Spectrum Disorders; 8. Cri-du-Chat Syndrome; 9. Trisomy 13 (Patau’s Syndrome); 10. Fragile X Syndrome; 11. Epilepsy/Seizure Disorder; 12. Cerebral Palsy; 13. HIV positive status; 14. Fetal Alcohol Syndrome; 15. Klinefelter’s Syndrome; 16. Turner’s Syndrome; 17. Prader-Willi Syndrome; 18. Spina Bifida; 19. Sickle Cell Disease; 20. PKU (phenylketonuria); 21. Systemic Lupus Erythamatosus; 22. Hypoxic-Ischemic Encephalopathy (HIE) and at term (36 weeks gestation or more); 23. Short Gut Syndrome with Dependence on Parenteral Nutrition; 24. Visual Impairment which meets the following criteria: A. A medical diagnosis of visual acuity 20/70 or less in the better eye with maximum correction; or B. A very limited field of vision (20 degrees at its widest point); or C. A progressive disease leading to either of the above; 25. Congenital viruses/bacteria, herpes, syphilis, cytomegalovirus, toxoplasmosis, and rubella; 26. Cranio-facial anomalies (i.e., cleft palate, etc.); 27. Hearing impairments, which meets the following criteria: A. For children below five (5) years of age, inability to hear air conduction thresholds at an average of forty (40) decibels (db) hearing level or greater in the better ear; or B. For children five (5) years of age and above: (I) Inability to hear air conduction thresholds at an average of seventy (70) decibels (db) or greater in the better ear; or (II) Speech discrimination scores at forty percent (40%) or less in the better ear; or (III) Inability to hear air conduction thresholds at an average of forty (40) decibels (db) or greater in the better ear, and a speech and language disorder which significantly affects the clarity and content of the speech and is attributable to the hearing impairment; 28. Diabetes Mellitus Type I or Type II requiring daily glucose monitoring; 29. Hydrocephalus with Ventriculo-Peritoneal Shunt; 30. Cyanotic Congenital Heart Disease; 31. Developmental delays in at least one (1) area severe enough to qualify for First Steps of Missouri early intervention program as provided in 34 CFR 303.322: A. Cognitive development; B. Communication development; C. Adaptive development; D. Physical development, including vision, and hearing; or E. Social or emotional development; 32. Immobility; 33. Requires wheelchair and is dependent on mechanical support to be mobile; or 34. Has appliance for breathing, feeding or drainage (i.e., catheter, colostomy, gastrostomy tube, or tracheostomy). (B) Submission of written certification from the treating physician of a diagnosed serious or chronic medical condition that significantly and substantially impairs the foster youth’s ability to function on a daily basis in a foster family home setting. (4) Medical resource provider requirements for placement of youth with elevated medical needs. In order to qualify to receive the medical maintenance rate from the division, the resource provider shall— (A) Be licensed as required in 13 CSR 35-60.010–13 CSR 3560.110; (B) Enter into a contract with the Children’s Division to provide medical foster care; (C) Successfully complete and provide documentation of the completion of individualized medical training specific to the needs of the youth provided by the youth’s health care provider or other provider and approved by the division; and (D) Be currently providing placement for a youth who meets the criteria of a youth with elevated medical needs. (5) Reviews. After a youth has been identified as a youth with elevated medical needs, the Children’s Division shall periodically review the status of the youth to determine whether the youth continues to meet the criteria for youth with elevated medical needs. The division shall conduct reviews as often as the division determines is necessary to assess the elevated medical needs of the youth, however, the division shall review the elevated medical needs at least annually. (6) Termination. (A) The Children’s Division may terminate the youth’s status as a youth with elevated medical needs when the Children’s Division determines that the youth no longer meets the criteria as set forth in this regulation. (B) The Children’s Division will terminate the payment of medical rate maintenance to the resource provider when the youth no longer meets the criteria as set forth in this regulation or the criteria in section (5) are no longer met. AUTHORITY: sections 207.020, 453.073, and 453.074, RSMo Supp. 2014, and section 210.506, RSMo 2000.* Original rule filed Sept. 15, 2015, effective March 30, 2016. *Original authority: 207.020, RSMo 1945, amended 1961, 1965, 1977, 1981, 1982, 1986, 1993, 2014; 210.506, RSMo 1982, amended 1993, 1995; 453.073, RSMo 1973, amended 1978, 1981, 1982, 1985, 1997, 2001, 2005, 2008, 2014; and 453.074, RSMo 1985, amended 2014.