SECTION 340:75-8-9. Placement procedures in therapeutic foster care homes (TFC)

(a)   TFC is the least restrictive, community-based residential care placement setting. Children in Oklahoma Department of Human Services (DHS) custody or tribal custody served in TFC placements are 4 through 17 years of age, and determined by the Oklahoma Health Care Authority (OHCA) authorized reviewer to meet the medical necessity criteria for TFC services, per Oklahoma Administrative Code (OAC) 317:30-5-741.

(1)   The child was diagnosed with any Diagnostic and Statistical Manual of Mental Disorders (DSM) AXIS I primary diagnosis, with the exception of V codes and adjustment disorders, accompanied by a detailed description of the symptoms supporting the diagnosis.

(2)   The child's conditions are directly attributed to a mental illness or serious emotional disturbance as the primary need for professional attention.

(3)   It was determined by the inpatient authorization reviewer that the child's current disabling symptoms cannot be or were not managed in a less intensive treatment program.

(4)   There is evidence that the child's presenting emotional or behavioral problems prohibit full integration in a family or home setting without the availability of 24-hour crisis response, behavior management, and intensive clinical interventions from professional staff.

(5)   The child is medically stable and not actively suicidal or homicidal and not in need of substance use or abuse detoxification services.

(6)   The parent or the legal guardian of the child in DHS custody or tribal custody is afforded the opportunity to actively participate in the child's treatment and planning.

(b)   The Child Welfare Services (CWS) specialist and supervisor assess each child's treatment needs per OAC 340:75-6-40 and 340:75-6-85. The CWS specialist seeks TFC placement when the:

(1)   child's treatment needs can no longer be met in the child's own home, relative home, or traditional foster family setting;

(2)   child does not require a group home placement; and

(3)   child does not meet the medical necessity criteria for psychiatric treatment.

(c)   A child whose behavior requires 24-hour awake supervision or who poses a danger in a family setting is not appropriate for TFC placement.

(d)   The TFC contractor receives referrals for the placement of children from TFC placement coordinator, per OAC 340:75-8-12.

(e)   The TFC contractor requests a TFC authorization extension 30-calendar days prior to the expiration of the authorized length of stay. When the OHCA authorized reviewer denies the extension of services, the TFC contractor provides written notification within one-business day of the denial to the CWS specialist, or the Indian child welfare worker when the child is in tribal custody only, to initiate transition planning.

(f)   TFC contractors document in writing, an assessment of the agency's ability to serve a child 5 years of age or younger prior to placement. The written documentation is maintained for on-site review during program audits and includes:

(1)   the assessed diagnosis and proposed treatment plan for the child;

(2)   the credentials, experience, and training of the TFC contractor's staff documenting the staff's ability to develop an age-appropriate treatment plan and deliver clinical services to children, 5 years of age or younger, with emotional or behavioral problems; and

(3)   a description of the proposed TFC parent's:

(A)   age, availability, experience, and skills;

(B)   family structure;

(C)   ability to meet the needs of a child, including a child 5 years of age or younger; and

(D)   parenting responsibilities to other children in the home, children in foster care or TFC placement, any adopted children, and any birth children.

(g)   The TFC contractor does not place more than two children in a TFC home without prior written approval from TFC program staff on completed Form 04FT003E, Request for Third Placement. The TFC contractor submits the written request that includes:

(1)   primary treatment needs for the proposed placement of a third child and any subsequent children in the TFC home;

(2)   availability, placement history, skills, completed or planned corrective action, and additional contractor supports of the TFC parent identified for proposed placement of a third child;

(3)   risk factors considered and compelling reasons for proposed placement of a third child;

(4)   documentation of TFC contractor contact with CWS specialists or supervisors for each child in the home, involved professionals, and each TFC family member, regarding the impact of the proposed placement of a third child;

(5)   documentation of TFC contractor's review of any separated siblings placed in the proposed third placement. Guidance on when siblings may be separated is located in OAC 340:75-6-85; and

(6)   other information as requested by the CWS programs supervisor for TFC.

(h)   A home serving three or more children without prior written approval is subject to denial of payment above the foster care maintenance rate. Email approval from TFC program staff is considered valid written approval. A child respiting in the home beyond timeframes and processes for extensions, per OAC 340:75-8-11 is considered a placement in the home after 14-calendar days.

(i)   Title XIX payments for TFC services are not made for TFC parents who move out of Oklahoma.

(j)   A youth may remain in TFC placement on a voluntary basis after 18 years of age, per OAC 340:75-6-110.

(k)   The TFC contractor establishes practice modalities to support the placement of all children in DHS custody and tribal custody meeting criteria for TFC level of care in a fully-certified TFC home. Each child in placement receives services based on his or her individualized service plan to meet mental and behavioral health needs. Services provided support the child to move to a less restrictive level of care as quickly as possible.

(l)   Children in TFC are authorized for placement based on meeting specific criteria. The amount of reimbursement paid to the contractor and therapeutic parent are in accordance with Appendix C-20, Child Welfare Services (CWS) Rates Schedule.

(m)   Children are supported with TFC services to make progressive step downs and maintain stability in placement to reach traditional foster care level or achieve permanency goals.

(n)   When the TFC placement is not approved by OHCA because the placement need developed outside of OHCA business hours or the business day closed without a return call from OHCA, the contractor may assist with immediate placement of a child identified by DHS staff as in need of TFC level placement. These placements are documented and paid through the contractor's resource family partners contract for placement of traditional foster care placements or coordinated foster care contract. OHCA approval must be obtained the following business day after placement. The child is then admitted to TFC placement in the same home. When OHCA denies TFC approval, the contractor and CWS specialist immediately coordinate to ensure a new placement referral is initiated for placement in the appropriate level of care. The child may not remain in a TFC home more than three-business days when denied by OHCA for TFC placement.

[Source: Added at 18 Ok Reg 2309, eff 5-15-01 (emergency); Added at 18 Ok Reg 3067, eff 7-12-01; Amended at 19 Ok Reg 2258, eff 6-27-02; Amended at 22 Ok Reg 1242, eff 5-26-05; Amended at 24 Ok Reg 1044, eff 6-1-07; Amended at 26 Ok Reg 884, eff 5-15-09; Amended at 27 Ok Reg 1092, eff 3-26-10 (emergency); Amended at 27 Ok Reg 1865, eff 7-1-10; Amended at 31 Ok Reg 1839, eff 9-15-14; Amended at 33 Ok Reg 477, eff 2-29-16 (emergency); Amended at 34 Ok Reg 1587, eff 9-15-17; Amended at 35 Ok Reg 1695, eff 9-17-18]