Tracking# 2012-00xxx
Emergency 9/7/12, eff. 9/7/12 

I:/12050301.rtf 
(I:/12050301.doc) 

(12 CCR 2509-1) 

Instructions: insert before line 1585539.] 
Revision of Sections 7.003.3, 7.203.31, 7.203.42, 7.305.4, 7.311 through 7.311.1, 7.311.5, 7.311.6 through 7.311.63, 7.311.7 through 7.311.72, 7.311.81 through 7.311.82, 7.311.92, 7.402.1, 7.402.4, and 7.708.11 were adopted on an emergency basis at the 9/7/2012 State Board meeting (Rule-making# 12-5-3-1), with an effective date of 9/7/2012. 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, Office of Enterprise Partnerships, Division of Boards and Commissions, State Board Administration.

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Instructions: replace lines 2315102 through 2315114.] 
7.003.3  PURCHASE OF PROGRAM SERVICES [Rev. eff. 9/7/12]
A.  The purchase of program services:
1.  May or may not require a contract depending upon the specific service purchased.
2.  Does not require state department prior approval as long as the service is authorized by state rule.
B.  Authorized Non-Contractual Program Case Services
1.  Transportation for children in out-of-home care, limited to the following purposes:
a.  For return of runaways, who are in county department custody, to their Colorado home county.
b.  For a child in out-of-home care to receive services specified in the Family Services Plan that are directly related to visitation and reunification.
c.  To facilitate a permanent plan through the Interstate Compact.
d.  To access one-time physical, dental, and psychological examinations for children in out-of-home care who are not Medicaid eligible and have no other insurance.
2.  A one-time physical, dental, and psychological examination for children in out-of-home care who are not Medicaid eligible and have no other insurance.
3.  Case services authorized in the Adoption Services and Relative Guardianship Assistance Program sections that are specified in a current signed Adoption or Relative Guardianship Assistance Agreement.
4.  Other case services provided to children in out-of-home placement when such services are not a part of either room and board or Medicaid treatment or case management services.

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(12 CCR 2509-3) 

Instructions: replace lines 2288553 through 2288558.] 
7.203.3  CHILD WITH MEDICAID ONLY SERVICES
7.203.31  Target Groups [Rev. eff. 9/7/12]
A.  Children in foster care who have been determined Title IV-E eligible and have moved into or out of Colorado.
B.  Children for whom an adoption assistance agreement is in effect and who have moved into or out of Colorado. See Section 7.306.4 (12 CCR 2509-4) for details regarding children with adoption assistance. 
C.  Children with a Title IV-E Relative Guardianship Assistance agreement with a payment in effect and who have moved into or outside of Colorado.
D.  Children eligible for Home and Community Based Services or Home Health Care Services as defined in Section 8.500 of the Department of Health Care Policy and Financing's Medical Assistance manual (10 CCR 2505-10). Children enrolled in the Home and Community Based-Developmentally Disabled Waiver Program administered through Community Centered Boards and the Department of Human Services, Developmental Disabilities Services, are not eligible for services in this target group. 

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Instructions: replace lines 1860101 through 1860104.] 
7.203.42  County Department Procedures [Rev. eff. 9/7/12]
A.  The county department shall document in the case file all efforts at reunification for the children in this target group.
B.  The county department shall ensure that the Family Services Plan contains a plan for permanent placement with a relative, adoption, relative guardianship or legal guardianship/permanent custody, or other planned permanent living arrangement, as appropriate (see Section 7.301.24, N).
C.  When the permanent plan is not adoption the county department shall document in the case file why adoption is not appropriate.

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(12 CCR 2509-4) 

Instructions: replace lines 2308151 through 2308156.] 
7.305.4  CHAFEE FOSTER CARE INDEPENDENCE PROGRAM (CFCIP) – TITLE IV-E INDEPENDENT LIVING GRANT INITIATIVE [Rev. eff. 9/7/12]
The Chafee Foster Care Independence Program (CFCIP) is a federally funded statewide independent living program that is county administered. 
The purpose of the Chafee Foster Care Independence Program is to provide age appropriate independent living resources to youth in out-of-home care who are at risk of aging out of foster care. These services shall supplement existing independent living resources and programs in county departments, residential child care facilities and child placement agencies, and by federal statute, shall not replace or duplicate existing services. Chafee Foster Care Independence Program funds shall not be used for room and board for a youth under eighteen (18) years of age. The eligible population includes:
A.  Youth currently in out-of-home care, fifteen (15) up to eighteen (18) years of age, and in out-of-home care for a minimum of six (6) months. Consecutive months are not required;
B.  Age eighteen (18) to twenty one (21), who were in out-of-home care on their eighteenth (18th) birthday; and,
C.  Youth age sixteen (16) to twenty one (21) who meet requirements for relative guardianship assistance, and youth age sixteen (16) to twenty one (21) who meet requirements for adoption assistance or who met such requirements on or after their sixteenth (16th) birthday. 

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Instructions: replace lines 1860708 through 2107094.] 
7.311  RELATIVE GUARDIANSHIP ASSISTANCE PROGRAM [Rev eff. 9/7/12] 
The Relative Guardianship Assistance Program provides assistance to a relative guardian in a defined and limited manner so that permanency is achieved for an eligible youth or child. Relative guardianship assistance is intended to help or remove financial or other barriers for a relative guardian, as defined in Section 7.311.1, of a Colorado youth or child by providing assistance to the relative guardian to care for and raise the youth or child. The Relative Guardianship Assistance Program elements are as follows: 
A.  Reunification and adoption efforts must have been exhausted and those goals have been ruled out based on individualized needs.
B.  The program is most appropriate for older youth who choose not to be adopted and who want to maintain familial ties while living safely and achieving permanency with a relative guardian.
C.  The program shall not supplant diligent reunification or adoption efforts.
D.  Youth who are twelve (12) years and older and who refuse adoption shall receive ongoing counseling by a professional who is knowledgeable about adoption and permanency issues.
E.  All requirements of this section relate solely to the Relative Guardianship Assistance Program and excludes any other type of guardianship.
7.311.1  ELIGIBILITY REQUIREMENTS [Rev. eff. 9/7/12]
Eligibility requirements for the prospective relative guardian and youth and/or child must be documented in the Family Services Plan in the State automated system and are as follows: 
A.  For the purpose of the Relative Guardianship Assistance Program, a relative is defined as: 
1.  An adult who is related to the youth or child in the fifth (5th) degree of kinship; 
2.  Related to the youth or child through marriage or adoption; 
3.  A person ascribed by the family as having a family-like relationship; or, 
4.  An individual that had a prior significant relationship with the youth or child. 
B.  The most recent removal occurred through a court order, or a voluntary placement agreement and subsequent court order for authority for placement that includes a judicial determination that continuation in the home would be contrary to the welfare of the youth or child; and,
C.  The prospective relative guardian was the certified kinship family foster care parent for the youth or child for a minimum of six (6) consecutive months while the youth or child resided in the home, excluding breaks in full certification due to provisional or probationary certificates being issued, or other adverse action taken regarding the certificate; and,
D.  Reunification and adoption are not appropriate permanency goal options for the youth or child; and,
E.  The youth or child demonstrates a strong attachment to the relative; and,
F.  Youth who are age twelve (12) or older are consulted about their expressed wishes to be placed in a relative guardianship (refer to Section 7.311.2, A); and,
G.  The prospective relative guardian has a strong commitment to caring for the youth or child permanently; and,
H.  The reason why permanent placement with a prospective relative guardian and receipt of a relative guardianship assistance payment is in the best interests of the youth or child.

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Instructions: replace line 2289227.] 
7.311.5  RELATIVE GUARDIANSHIP ASSISTANCE PROGRAM SERVICES [Rev. eff. 9/7/12]

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Instructions: replace lines 2289247 through 2289255.] 
C.  Applicable Groups for Relative Guardianship Assistance
1.  Youth or children who are in the custody of the county department.
2.  The county department requesting the assistance agreement is financially responsible for the care of the youth or child.
D.  County Department Requirements for Relative Guardianship Assistance
1.  While the Relative Guardianship Assistance agreement is in effect, a combined record for each youth or child and the relative guardian shall be maintained.
A combined record shall contain documentation about each youth or child and the relative guardian, which is relevant to the guardianship assistance agreement including, but not limited to, application, Structured Analysis Family Evaluation (SAFE) home study and applicable update(s) related to the relative guardianship, medical records, placement history, specific needs requiring purchase of services, confirmation of second opinions of professionals outside of the county department (licensed social worker, doctor, psychologist, or mental health specialist), annual school reports, and other applicable reports or evaluations.
2.  The county department shall prepare the documentation necessary for the youth or child for relative guardianship assistance on the State Department’s prescribed form no later than one calendar month prior to the court appointment of the relative guardianship.
3.  The county department shall review the information on the State Department’s prescribed form with the relative kinship guardian. All parties shall date, sign, and initial the document before the court appoints the relative guardian.
4.  The county department shall enter the legal relative guardianship information for each youth or child into the State Department’s automated system within thirty (30) calendar days following the date that the court appoints the relative guardian. The eligibility determination shall be completed in the Title IV-E module within forty-five (45) calendar days following the date that the court appoints the relative guardian. 

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Instructions: replace line 2107137.] 
7.311.6  RELATIVE GUARDIANSHIP ASSISTANCE AGREEMENT SERVICES [Rev. eff. 9/7/12]

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Instructions: replace lines 2107145 through 2289258.] 
H.  Relative guardianship assistance services may be provided for youth and children who meet the requirements, and:
1.  The payment may not exceed the foster care reimbursement.
2.  A binding relative Guardianship Assistance Agreement shall be negotiated and a copy provided to the relative guardian.
3.  The relative guardian may renegotiate the agreement if the needs of the youth or child, or the circumstances of the relative guardian, change.
I.  The amount of the assistance agreement and the manner that the payments will be provided shall be documented on the State prescribed forms. 
7.311.61  Title IV-E Relative Guardianship Assistance [Rev. eff. 9/7/12]

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Instructions: replace lines 2289266 through 2289275.] 
C.  After a youth or child has been determined eligible for Title IV-E relative guardianship assistance payments and/or Title IV-E Medicaid benefits, Title IV-E eligibility continues while there is a relative guardianship assistance agreement in effect; and,
1.  Eligibility continues as long as the youth or child meets the requirements regardless of the relative guardian’s state of residence.
2.  Title IV-E relative guardianship assistance benefits and/or Title IV-E Medicaid benefits must continue until the expiration of the original agreement unless all parties to the agreement are in concurrence. This includes, but is not limited to, a situation where the relative guardian fails to complete and return paperwork related to the three-year review of the assistance agreement. 
3.  If the previous relative guardian is deceased, a copy of the death certificate must be provided. 
D.  Eligibility Determination for Medicaid in Title IV-E Relative Guardianship Assistance
1.  A youth or child who is eligible to receive a Title IV-E payment is categorically eligible for Medicaid. A relative guardianship assistance payment is required to extend Medicaid coverage.
2.  Medicaid eligibility shall continue for Title IV-E eligible youth and children who are out of the home for more than thirty calendar days unless it is determined that they are eligible for Medicaid under another program by completing the State Department’s prescribed form (see county responsibility, Section 7.402.2).
3.  Medicaid eligibility for the youth or child shall be re-determined annually only if the youth or child continues to be eligible for Medicaid. Complete the State Department’s prescribed form or a form letter stating that the youth or child continues to be eligible for Medicaid. This document shall be sent to other states by the county department to ensure continuation of Medicaid for a youth or child who is residing out of state. 
7.311.62  State-County Relative Guardianship Assistance (Non-Title IV-E) [Rev. eff. 9/7/12]
A.  Non-Title IV-E relative guardianship assistance services may be provided to a youth or child who does not meet eligibility criteria as determined in the Title IV-E module, and: 
1.  The youth or child was not Title IV-E eligible in foster care.

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Instructions: replace lines 1860827 through 1860833.] 
7.311.63  Negotiation of Relative Guardianship Assistance Agreements [Rev. eff. 9/7/12]
A.  The county department shall:
1.  Establish a policy regarding the criteria used for calculating the relative guardianship assistance agreements. The agreements shall be established in accordance with the written policy.
2.  Determine specific needs of the youth or child and eligibility for relative guardianship assistance.
3.  Utilize financial information regarding the relative guardian’s family including assets, liabilities and insurance benefits in negotiating the initial agreement, and any subsequent increases in relative guardianship assistance.
4.  Not include a statement in the relative guardianship assistance agreement that Title IV-E relative guardianship assistance payments and/or services are subject to the appropriation of state funds.
5.  Make a good faith effort to negotiate a relative guardianship assistance agreement with the relative guardian and base the negotiation on the needs of the youth and child and the circumstances of the relative guardian. If the parties cannot agree, the county department shall establish the amount. If the relative disagrees with the decision, a fair hearing may be requested. 

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Instructions: replace lines 1860858 through 1860866.] 
7.311.7  MEDICAL PAYMENTS IN RELATIVE GUARDIANSHIP ASSISTANCE AGREEMENTS [Rev. eff. 9/7/12]
A.  Medical payments in relative guardianship assistance agreements may be used to supplement any other available resource such as a relative guardian’s private insurance that pays part but not all of the treatment (physical, mental, and emotional) for the youth or child.
1.  Payments are made directly to relative guardians for a service already received or to a vendor for the treatment of physical, developmental disabilities, or an emotional disturbance.
2.  Shall relate directly to the barrier(s) identified at the time the initial agreement is approved.
B.  The payments are not available for treatment of any physical, developmental disability, or emotional disturbance diagnosed after the court appointment of the relative guardianship.
C.  The payments may only be used for Medicaid cases if the service requested is a service that is not covered under the state Medicaid plan and relates to a need identified at the time the youth or child is placed in relative guardianship.
D.  The payments for medical services shall reflect the reasonable costs of those services in the community where the youth or child resides.
7.311.71  Reimbursable and Non-Reimbursable Relative Guardianship Assistance Case Services [Rev. eff. 9/7/12]
Case services are a type of purchased program services that support a case plan for youth and children in relative guardianship assistance. 

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Instructions: replace lines 1860882 through 1860883.] 
[A.] 5.  Special Medical Equipment
Special medical needs/equipment, as prescribed by a physician, may be reimbursable. For a youth or child who is severely physically challenged; special exceptions should not exceed two thousand dollars ($2,000) without a supervisor's written authorization.

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Instructions: replace lines 2107165 through 2107166.] 
7.311.72  Non-Recurring Relative Guardianship Expenses [Rev. eff. 9/7/12]
A.  The relative guardian shall be reimbursed for the total costs of non-recurring expenses associated with obtaining relative guardianship, not to exceed two thousand dollars ($2,000) per youth or child in order to facilitate achievement of the guardianship for: 

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Instructions: replace lines 2107179 through 2107185.] 
7.311.81  Review of Eligibility for All Ongoing Relative Guardianship Assistance Agreements [Rev. eff. 9/7/12]
A.  The county department shall initiate the written notice of the review for relative guardianship assistance sixty (60) days prior to the three (3) year anniversary of the agreement.
B.  The relative guardian may request a review of the agreement prior to the three-year review if changes in the needs of the child or family circumstances occur.
C.  Any changes in the needs of the youth or child shall relate to the original barrier(s), identified at the time the decision was made that relative guardianship assistance was needed. The county department shall not include additional needs for relative guardianship assistance payments after the court appointment of the guardianship unless genetic in nature.
D.  The county department shall review school attendance annually.
Relative guardianship assistance files must contain documentation of school attendance or reasons for the inability to attend. Documentation must be updated annually to assure that each youth and child who is eligible for relative guardianship assistance and who has attained the minimum age for compulsory school attendance is:
1.  Enrolled (or in the process of enrolling) an elementary or secondary education institution, 

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Instructions: replace lines 2107189 through 2107192.] 
7.311.82  Procedures for Relative Guardianship Assistance Payment When a Youth or Child is in Out-of-Home Care or Committed to the Division of Youth Corrections [Rev. eff. 9/7/12]
A.  Medicaid eligibility shall continue for Title IV-E eligible youth or children who are out of the home for more than thirty (30) calendar days unless it is determined that they are eligible for Medicaid under another program by completing the State Prescribed form (see County Responsibility, Section 7.402.2). 
B.  When a youth or child with a non-Title IV-E relative guardianship assistance agreement is placed in out-of-home care for more than thirty (30) days, the county department shall discontinue the relative guardianship assistance payment until the youth or child returns to the relative guardian’s home. This includes a commitment to the Division of Youth Corrections.
C.  When non-Title IV-E eligible youth or child resides outside of Colorado with the relative guardian who has a relative guardianship assistance agreement and the youth or child is in out-of-home placement longer than thirty (30) calendar days, the relative guardianship assistance payment and relative guardianship case services shall be discontinued. A state/county non-Title IV-E agreement may only be resumed when the youth or child is returned home and the out-of-home placement has been discontinued on the State Department's automated system. 

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Instructions: replace line 1860946.] 
7.311.92  Right to Appeal [Rev. eff. 9/7/12]

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Instructions: replace line 1860949.] 
C.  The relative guardian has the burden of proving extenuating circumstances and relative guardianship assistance eligibility at a state level fair hearing. The state and/or its designee can provide factual information to assist the family in establishing eligibility for Title IV-E relative guardianship assistance.

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(12 CCR 2509-5) 

Instructions: replace lines 1585592 through 1585608.] 
7.402  MEDICAL RESOURCES
7.402.1  PROVISION OF SERVICES [Rev. eff. 9/7/12]
Subject to certain income and resource limitations, medical assistance through the Colorado Medicaid program must be provided to certain children and youth receiving child welfare services as follows:
A.  Children and youth for whom the county department is assuming full or partial financial responsibility.
1.  Children and youth in foster care, including those who are in independent living situations subsequent to being in foster care;
2.  Youth committed to the Department of Human Services, Division of Youth Corrections, who are placed in a non-secure community based residential facility or in independent living situations;
3.  Children and youth who have a current, signed subsidized adoption agreement;
4.  Children and youth receiving Core services who otherwise would be in foster care;
5.  Children and youth in subsidized adoption, including adoption placements out of state, who are IV-E eligible or where the state option is in effect until the receiving state can provide Medicaid;
6.  Children and youth from Colorado placed in an out of state out-of-home placement by a Colorado county. IV-E eligible children receive Colorado Medicaid until the receiving state can provide Medicaid;
7.  Children and youth eligible for Supplemental Security Income, even if they are not receiving cash benefits, who are placed in an out of state foster care setting until the receiving state can provide Medicaid. 
8.  Children and youth who are eligible for the Relative Guardianship Assistance Program, including relative guardianship assistance placements out of state who are Title IV-E eligible. 
B.  Certain children and youth from other states who are placed in Colorado by that state.
1.  Children and youth eligible for adoption assistance placed in Colorado by another state;
2.  Children and youth placed in an out-of-home placement in Colorado by another state;
3.  Children and youth who are eligible for Supplemental Security Income placed in an out-of-home placement in Colorado by another state. 
4.  Children and youth who are eligible for relative guardianship assistance placed in Colorado by another state and who are Title IV-E eligible. 
C.  Children and youth who are receiving child welfare services, living in their own home or the home of a designated relative, and the county department is not assuming full or partial financial responsibility for their care, may be eligible for coverage under other Colorado Medicaid programs for families and children.
D.  Former foster care or adoption assistance youth who emancipated from foster care or adoption assistance at age eighteen (18) or after and are under age twenty-one (21), and for whom the state made foster care or adoption assistance payments in the month the youth turned eighteen (18) years of age. 

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Instructions: replace lines 1585633 through 1585642.] 
7.402.4  MEDICAID FOR CHILDREN AND YOUTH COVERED BY THE INTERSTATE COMPACT ON ADOPTIONS AND MEDICAL ASSISTANCE (ICAMA) [Rev. eff. 9/7/12]
A.  Children and youth moving to Colorado: 
1.  The county department shall establish eligibility for Medicaid for children and youth moving from another state into Colorado who have a current adoption assistance agreement or a Title IV-E Guardianship Assistance Agreement in effect from the state of origin. The state of origin shall provide completed Interstate Compact on Adoptions and Medical Assistance forms and a copy of the current adoption assistance agreement or the Guardianship Assistance Agreement. The letter of verification shall contain the date of discontinuation of medical assistance from the state of origin.
2.  Medicaid eligibility in Colorado shall begin the month following the discontinuation of medical assistance by the state of origin.
B.  Children and youth moving from Colorado: 
1.  IV-E Adoption Assistance
For children and youth who have a current adoption assistance agreement who are moving out of state, the county department shall provide the state adoptions program staff with duplicate copies of the completed ICAMA forms and a copy of the current adoption assistance agreement. 
2.  For children and youth who have a current Relative Guardianship Assistance Agreement who are moving out of state, the county department shall provide the state adoptions program staff with duplicate copies of the completed ICAMA forms and a copy of the current adoption assistance agreement. 
3.  Non-Title IV-E Adoption Assistance
a.  For children and youth who are moving to a reciprocal state and have a current adoption assistance agreement, the county department shall provide the State adoptions program staff with duplicate copies of the completed ICAMA forms and a copy of the current adoption assistance agreement.
b.  For children and youth who are moving to a state that is not reciprocal with Colorado’s non-Title IV-E Medicaid, the county shall provide medical insurance for the child or youth. This arrangement shall be negotiated with the family as to how the insurance will be provided. 

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(12 CCR 2509-8) 

Instructions: replace line 2301985.] 
7.708.11  Definitions [Rev. eff. 9/7/12]

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Instructions: replace line 2301991.] 
“Kinship family foster care” is a family foster care home with a kin provider that is certified by either a county department or a child placement agency upon the request and approval of the county department with custody of a child or youth. The purpose is to provide twenty-four (24) hour care for a child or youth under the age of eighteen (18) years of age and may continue up to twenty-one (21) years of age when ordered by the court. Kin are relatives, persons ascribed by the family as having a family-like relationship, or they may be individuals that have a prior significant relationship with the child or youth. These relationships take into account cultural values and continuity of significant relationships. 

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Instructions: replace line 2301995.] 
“Therapeutic foster care” means a program of foster care that incorporates treatment for the special physical, psychological, or emotional needs of a child placed with specially trained foster parents. 

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