Tracking# 2011-00677
FA/P 11/4/11, eff. 1/1/12 

I:/11061301.rtf
(I:/11061301.doc)

(12 CCR 2509-1) 

[Instructions: insert before line 1585539.] 
Revisions to Sections 7.406.2, 7.417.6, 7.419, 7.701.2, 7.705.1, 7.705.33, 7.705.42-7.705.43, 7.705.9-7.705.96, 7.714, 7.714.4, and 7.714.932 were final adoption following publication at the 11/4/2011 State Board meeting (Rule-making# 11-6-13-1), with an effective date of 1/1/2012. Statement of Basis and Purpose and specific statutory authority for these revisions were incorporated by reference into the rule. These materials are available for review by the public during normal working hours at the Colorado Department of Human Services, Division of Boards and Commissions, State Board Administration. 

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(12 CCR 2509-5) 

[Instructions: replace lines 1426990 through 1427001] 
7.406.2  THE STATE DEPARTMENT SHALL NOT REIMBURSE [Rev. eff. 1/1/12]
A.  Out-of-home placements for a child in Colorado who is in the custody of another state. The county shall bill the other state for reimbursement. 
B.  Receiving home or shelter care placements that exceed 90 consecutive days. 
C.  Out-of-home placements of children who do not meet the requirements of Section 7.304.51, Authority for Placement. 
D.  Out-of-home care in public child care institutions accommodating more than twenty-five (25) children. 
E.  Placements of children under the age of six (6) years in a specialized group facility or residential child care facility, except for children with documented exceptional needs which can be met only by the specifically identified facility. Documentation in the child's Family Services Plan shall include a description of the services available in that facility to address the child's specific needs. 
F.  Placements of children under the age of twelve (12) years in a specialized group facility or residential child care facility that exceed sixty (60) calendar days unless the child has documented special treatment needs that cannot be met in family foster care. Documentation in the Family Services Plan shall include a description of the services available in that facility to address the child's specific needs. 
G.  Placements in a specialized group home with a capacity in excess of ten (10) children unless there is written approval by the placing caseworker's supervisor. Such approval shall be based upon written documentation in the Family Services Plan that the child's needs can be met only by the specifically identified facility. The documentation shall include a description of the services available in that facility to address the child's needs. 
H.  Services provided by Residential Child Care Facilities or Child Placement Agencies which are reimbursable from other funding sources. 
I.  Respite care allowance paid to specialized group home or centers or for independent living. 
J.  Out-of-home care for the period of non-compliance with state rules in Section 7.306.14, Colorado Adoption Resource Registry (CARR) listing and exclusion requirements. 
K.  Out-of-home care if the county department does not forward the Colorado Adoption Resource Registry photo listing to the State Department within thirty (30) calendar days following the State's notification of Colorado Adoption Resource Registry exclusion denial. Reimbursement is not authorized for the period of non-compliance from the date the profile is due until the profile is received by the State. 

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[Instructions: replace lines 1427182 through 1427184.] 
7.417.6  (None) [Rev. eff. 1/1/12] 

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[Instructions: replace lines 1427244 through 1427255.] 
7.419  RESIDENTIAL CHILD CARE FACILITY (RCCF)PROVIDING MENTAL HEALTH SERVICES RATE SETTING [Rev. eff. 1/1/12]
A.  New Residential Child Care Facility (RCCF) Provider Rate Setting
A new Residential Child Care Facility shall receive a per diem rate (child maintenance, administrative maintenance, and services) equal to the most recent weighted average rate. This per diem rate shall remain in effect until new rates are established for all providers.
1.  A new Residential Child Care Facility means a facility not previously licensed as a RCCF or a facility that has been licensed as a RCCF. 
2.  RCCF's that have been previously licensed as a RCCF and have undergone a transfer of ownership are not considered new facilities. 
3.  New facilities shall be treated as established facilities for rate determination purposes at the next round of rate setting.
B.  A provider wishing to appeal that the provider rate was not established in accordance with these rules may appeal to the Department of Personnel and Administration, Office of Administrative Courts (OAC), within thirty (30) calendar days from issuance of the notice letter according to the State Administrative Procedure Act. At such a hearing, the Administrative Law Judge’s decision will be limited to determine whether RCCF provider rates were established in accordance with these rules.

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(12 CCR 2509-8) 

[Instructions: replace line 2176999] 
7.701.2  DEFINITIONS [Rev. eff. 1/1/12]

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[Instructions: replace lines 2177033 through 2177039.] 
F.  Child Placement Agency
A "Child Placement Agency", defined at Section 26-6-102(2), C.R.S., means any corporation, partnership, association, firm, agency, institution, or person unrelated to the child being placed, who places, who facilitates placement for a fee, or arranges for placement any child under the age of eighteen (18) years with any family, person or institution for purposes of foster care, treatment and/or adoption. The natural parents or legal guardian of any child who places that child for care with any facility licensed as a "Family Child Care Home" or "Child Care Center" shall not be deemed to be a Child Placement Agency.
To arrange for placement is to act as an intermediary by assisting a parent or guardian or legal custodian to place or plan to place a child with persons unrelated to the child for twenty-four (24) hour care. 
Any agency from out of state placing a child within Colorado must be licensed as a child placement agency by the Colorado Department of Human Services unless the placement services are coordinated with and provided by a county department of social services or a child placement agency licensed by the department.
G.  Residential Child Care Facility
1.  "Residential Child Care Facility", defined at Section 26-6-102(8), C.R.S., shall provide twenty-four (24) hour residential group care and treatment for five (5) or more children between the ages of three (3) and eighteen (18) years old and for those persons to twenty-one (21) years old who are placed by court order prior to their eighteenth birthday. A residential child care facility must offer opportunities for a variety of experiences through a group living program and specialized services that can be used selectively in accordance with an individual plan for each child. A residential child care facility includes "Shelter Care Facilities", "Residential Child Care Facilities", and "Psychiatric Residential Treatment Facilities". 
2.  "Transition Program" may be a component of an RCCF program in which the child is residing in the RCCF part of the time and in a living situation that child is expected to move to after treatment in the RCCF is completed. The purpose of transition is to enable the child to transition to the home or a less restrictive setting in a manner that prepares the child for success in the new setting.
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[Instructions: replace/insert lines at 1131002 through 1131003.] 
7.705.1  DEFINITIONS [Rev. eff. 1/1/12]
A “residential child care facility (RCCF)" shall provide twenty-four (24) hour residential group care and treatment for five or more children, between the ages of three (3) and sixteen (16) years old and for children from sixteen (16)-eighteen (18) years old and for those persons to twenty-one (21) years old who are placed by court order prior to their eighteenth birthday. A residential child care facility shall offer opportunities for a variety of services that can be used selectively in accordance with an individual plan for each child. A residential child care facility is operated under private, public or nonprofit sponsorship. 
“Colorado Client Assessment Record (CCAR)” is a clinical instrument designed to assess the behavioral and mental health status of a medically eligible client. The CCAR is used to identify current diagnosis and clinical issues facing the client, to measure progress during treatment, and to determine mental health medical necessity. This instrument is used for children in the custody of a county department of human/social services or Division of Youth Corrections and for those children receiving mental health services in an RCCF through the Child Mental Health Treatment Act. 
“Licensed professional person” means the person responsible for determining medical necessity of the therapy services provided to child(ren) in care, on a monthly basis. Mental health services must be provided by either a licensed professional person or an individual who is in the process of obtaining a license and is being supervised by a licensed professional person. 
“Medical necessity” means that a covered service shall be deemed a medical necessity or medically necessary if, in a manner consistent with accepted standards of medical practice, it: 
A.  Is found to be an equally effective treatment among other less conservative or more costly treatment options; and,
B.  Meets at least one of the following criteria:
1.  The service will, or is reasonably expected to prevent or diagnose the onset of an illness, condition, primary disability or secondary disability.
2.  The service will or is reasonably expected to cure, correct, reduce or ameliorate the physical, mental, cognitive or developmental effects of an illness, injury or disability.
3.  The service will or is reasonably expected to reduce or ameliorate the pain or suffering caused by an illness, injury or disability.
4.  The service will or is reasonably expected to assist the individual to achieve or maintain maximum functional capacity in performing activities of daily living. 
“Mental health services” means beneficial activities, which aim to overcome issues involving emotional disturbance of maladaptive behavior adversely affecting socialization, learning, or development. These include and are limited to individual, group, family therapy, evaluation services and medication management. 
“Multidisciplinary team” means a group comprised of at least one licensed professional person and other staff responsible for the treatment of the child, and may include a staff member from the referral agency. 
“Referral agency” means the Division of Youth Corrections, county department of human/social services who has custody of a child, or a mental health agency (behavioral health care organization or community mental health center) that refers the child to the RCCF for the purpose of placement through the child Mental Health Treatment Act. 

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[Instructions: insert new section before line 1131170.] 
7.705.33  Client Eligibility for Mental Health Services in RCCF [Rev. eff. 1/1/12]
A.  To be receiving Colorado Medicaid fee for service mental health services in a RCCF, the child shall be:
1.  Medicaid eligible; and,
2.  Diagnosed with a psychiatric disorder; and,
3.  Assessed by a licensed mental health professional of the agency to which the child is referred using a current valid Colorado Client Assessment Record (CCAR) that supports medical necessity prior to the commencement of services; and,
4.  Determined in an initial assessment to be in need of and capable of benefiting from the mental health services as determined by a licensed professional person. 
B.  The provider shall use the CCAR to document any changes in diagnosis and, on an annual basis or at time of discharge, to determine the outcome of mental health services provided. 
C.  Mental health services shall be discontinued when: 
1.  The child has attained treatment goals; or,
2.  The child is no longer able to benefit from the mental health services, is no longer progressing toward therapeutic goals, or is referred elsewhere for treatment; or, 
3.  The child is discharged from the facility. 
D.  If a client is discharged during the first seventy-two (72) hours of admission and a service plan has not been completed, then the facility shall assure that available mental health information is included in the discharge summary. 
E.  Mental health services shall be identified in the plan of care and provided as indicated by the child’s need for: 
1.  Individual therapy sessions, which shall be provided as specified for the acuity level of care. Individual therapy sessions shall be conducted by a licensed professional person. 
2.  Group therapy sessions, which shall be provided as specified for the acuity level of care. Group therapy may include a therapeutic intervention provided to two or more children that assists in their ability to function. A licensed professional person shall conduct the group therapy sessions. 
3.  Family therapy sessions, which shall be provided as specified for the acuity level of care. The family therapy sessions shall be provided with a significant other and the child must be present unless contraindicated. Family therapy sessions shall be conducted by a licensed professional person. 
4.  Other mental health services needed and able to be billed on a fee for service basis to Medicaid, including crisis management and evaluation services. 
5.  Medication administration services.

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[Instructions: replace line 1131182.] 
7.705.42  Administrative Staff [Rev. eff. 1/1/12]

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[Instructions: replace lines 1131192 through 1131194.] 
B.  Assistant or Acting Administrator
1.  In each child care facility, there shall be a specifically designated staff member, age twenty-one (21) or over, capable of acting as a substitute for the administrator during his/her absence. The duties and responsibilities of the substitute administrator shall be clearly defined in order to avoid confusion and conflict among other staff and children.
2.  If the administrator is regularly absent from the facility more than fifty percent (50%) of his/her working hours, an assistant administrator shall be appointed who meets the same qualifications as the administrator found at Section 7.705.42, A.

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[Instructions: replace line 1131198.] 
7.705.43  Medical, Health, and Clinical Staff [Rev. eff. 1/1/12]

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[Instructions: insert new paragraph before line 1131202.] 
C.  Clinical staff who provide mental health services shall be a licensed professional person and shall be qualified as a physician licensed pursuant to Article 36 of Title 12, C.R.S., a psychologist licensed pursuant to Part 3 of Article 43 of Title 12, C.R.S., a clinical social worker licensed pursuant to Part 4 of Article 43 of Title 12, C.R.S., a marriage and family therapist licensed pursuant to Part 5 of Article 43 of Title 12, C.R.S., a marriage and family therapist licensed pursuant to Part 5 of Article 43 of Title 12, C.R.S., a professional counselor licensed pursuant to Part 6 of Article 43 of Title 12, C.R.S., a social worker licensed pursuant to Part 4 of Article 43 of Title 12, C.R.S., that is supervised by a licensed clinical social worker, or a mental health professional provisionally licensed pursuant to Part 2 of Article 43 of Title 12, and shall provide therapy services to children in care. 

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[Instructions: remove lines 1131414 through 1131477; Sections 7.705.9-7.705.96 deleted from rules.] 

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[Instructions: replace lines 1135012 through 1135014.] 
7.714  QUALITY STANDARDS FOR 24-HOUR CHILD CARE [Rev. eff. 1/1/12]
All rules in Section 7.714 will be known and hereinafter referred to as the Quality Standards for 24-Hour Child Care and will apply to all child care applicants and licensees subject to licensing as a specialized group facility, residential child care facility, shelter residential child care facility, or psychiatric residential treatment facility.
It is the policy of the Colorado Department of Human Services (“the Department”) to promote the provision of safe and adequate 24-hour care of children in an environment designed to meet the physical, emotional, cognitive and social needs of the children at those times in the life of such children when the child's family of origin is unable or unwilling to provide adequate care. It is also the policy of the Department to require 24-hour care providers to meet standards and conditions for the well-being and protection of the children in their care. In furtherance of the foregoing policy considerations, the proper enforcement of these rules requires thorough and ongoing appraisal of the 24-hour child care facility where care is provided, the staff members providing the care, and the nature and quality of the care provided.

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[Instructions: replace line 1208010.] 
7.714.4  PROGRAM DESCRIPTION AND INDIVIDUAL CHILD'S PLAN [Rev. eff. 1/1/12]

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[Instructions: insert new item “F” before line 1135177.] 
F.  In addition to A-E, the following is required for an Individual Child’s Plan in a Residential Child Care Facility that provides mental health services: 
1.  The licensed mental health professional responsible for providing care shall develop the mental health component of the Individual Child’s Plan. 
2.  The multidisciplinary team shall include the Individual Child’s Plan within its child specific case file. 
3.  The multidisciplinary team shall develop and finalize a comprehensive Individual Child’s Plan of care (as covered in Section 7.714.4, D, 1, a-g) within fourteen (14) calendar days after the determination that mental health services are required. The plan shall be signed and dated by the child, the referral agency, the licensed mental health professional, and the parent/guardian. If a provisionally licensed mental health professional is providing the services, that person and his/her licensed supervisor shall also sign the Individual Child’s Plan of care. The plan of care shall: 
a.  Address all areas listed at Section 7.714.4, C, together with mental health services and other needs including the child’s presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 
b.  Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow-up services criteria to be met for termination of treatment, and specific treatment goals including, but not limited to: 
1)  Expected resolution of the problem that necessitated mental health services and the specific functional achievement to be obtained in measurable terms. 
2)  Indications that planned services can reasonably be expected to improve the client’s condition. 
c.  Specify the type, frequency, and duration of mental health services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child’s specific mental health service goals.
d.  Specify that all RCCF mental health services are necessary to meet the needs of the child and that the mental health services are necessary to treat the child’s current diagnosis.
e.  Identify the provision of, or the referral for, services other than RCCF mental health services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. 
f.  Be provided in all situations except emergency situations. 
4.  The RCCF shall ensure that the child and the legal guardian participate in the formulation, review, and revision of the Individual Child’s Plan of care including, but not limited to, the mental health services portion of the plan. If the child or legal guardian is unable to participate or when his or her participation is clinically contraindicated, the RCCF shall document the reasons in the child’s record. Any decision to not involve the family or guardian shall be approved by the referral agency. In addition, other persons selected by the child, the family or guardian, the referral agency or the multidisciplinary team may be included in the formulation, review, and revision of the plan care.
5.  There shall be monthly review of each plan to evaluate whether the short-term and long-term goals have been achieved and not achieved. The plan shall be revised as appropriate. 
6.  There shall be documentation of the client’s response to treatment approaches and changes in the Individual Child’s Plan of care with the reasons for such changes. 

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[Instructions: replace line 1135438.] 
7.714.932  Records [Rev. eff. 1/1/12]

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[Instructions: replace lines 1135449 through 1135463;  editorial note: beginning at item C, 8.] 
8.  Copies of educational records, including the Individualized Educational Plan (IEP) where applicable, and reports of school work, including scholastic performance, certificates of achievement or award, and extracurricular interests. 
9.  The Individual Child’s Plan (ICP) and Family Service Plan (FSP) when developed or Individualized Treatment Plan (ITP) for committed youth, a summary of the periodic evaluations of the child's progress and resultant changes in the ICP, FSP or ITP. 
10.  Summary recording of significant contacts with parent(s), guardian(s) and other involved agencies.
11.  Documentation of all transfers and reasons for transfers within the authorized facility. 
D.  Clinical Record Requirements for RCCFs Providing Mental Health Services 
In addition to 7.714.932, A-C, an RCCF shall maintain current organized, legible, chronological, treatment record for each client. Treatment records shall include: 
1. A mental health diagnosis; 
2.  Copies of any CCARs pertaining to the client’s current need for mental health services; 
3.  All plans of care and revisions for the current treatment episode; 
4.  Documentation of client’s attendance at, participation in and outcomes of RCCF mental health services; 
5.  Documentation that the client and/or the legal guardian was provided a copy of the plan of care; 
6.  Correspondence to and from agencies and individuals involved in the client’s treatment; 
7.  An explanation whenever any member of the multidisciplinary team, client, parent or guardian, does not sign the plan of care; 
8.  The name of the licensed mental health professional responsible for the formulation, implementation, review and revision of the client’s plan of care; 
9.  Signed releases of information when necessary; 
10.  Documentation of any unplanned discharges without advance notice and any discharges against the agency’s or licensed mental health professional’s advice; 
11.  Treatment entries that are signed and dated by the person providing treatment/therapy, including title or position of the person providing the treatment/ therapy. If the clinical services are provided by a provisionally licensed therapist, the supervisor must also sign the entries; 
12.  All changes in diagnoses need to be documented with changes to the CCAR; 
13.  All members of the clinical staff shall be trained annually in the development and review of plans of care, and there must be documentation of such; 
14.  Clinical supervisors who are providing supervision to provisionally licensed therapists (P‑LCWS, P-LPC, P-LMFT, psychologist) must document supervision hours provided to supervisees. 
E.  Within five (5) business days of when a child is removed from placement, the facility shall complete and send to the placing agency a summary of the child's discharge from the facility which includes at a minimum: 
1.  The date of the discharge of the child from the facility.
2.  Where the child was placed following discharge.
3.  A summary of the services provided to the child during care.
4.  Goals met/not met during treatment.
5.  The treatment goals and assessed needs which remain to be met and alternate service possibilities which might meet those goals and needs.
6.  A statement of an aftercare plan and identification of who is responsible for follow-up services and aftercare.
7.  If the discharge was planned or unplanned.
8.  The circumstances which led to an unplanned discharge.
F.  Copies of a child's file, including discharge information but excluding all medical information covered by HIPAA, shall be provided to parent(s) or guardian(s) upon request or to others by written consent pursuant to Section 7.714.931.
G.  A copy of all policies and dated revisions developed by the facility shall be maintained for at least three years.

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