Form Soc 501 - Levels Of Care (Loc) Rate Determination Matrix (Page 2 of 6) in pdf

Levels of Care (LOC) Rate Determination Matrix

Definition

Core Domain

Behavioral/

Physical

Physical Domain is defined as actions in which the Resource Family must engage in or model daily living needs, such as eating, clothing, hygiene, community/social functioning, and

Behavioral/Emotional domain is defined as actions in which the Resource Family must engage to promote resilience and emotional well-being for the child/youth, as well as encourage the

Emotional

extracurricular activities, including teaching age-appropriate life skills even when developmental delays are present. This does not include specific medical activities (see Health Domain).

child/youth to engage in prosocial behavior and activities developing healthy relationships. This does not include medication management for psychotropic medications (see Health Domain).

Resource Family provides

Resource Family redirects,

Resource Family implements a

Resource Family implements a therapeutic

Resource Family helps develop and implement a

direct supervision and

prompts, and/or diffuses

therapeutic intervention plan as

intervention plan as outlined by the

daily therapeutic intervention plan to address their

support to address

beyond what is

outlined by the child/youth's therapist

child/youth's therapist and/or the CFT Plan

identified therapeutic and well-being needs as

behaviors that are

age/developmentally

and/or CFT Plan at least three days

at least four days a week.

outlined by the child/youth's therapist and/or the CFT

age/developmentally

appropriate at least two

a week.

plan for a child which is necessary to maintain them

appropriate.

days a week.

And/or

safely in a family-based setting.

And/or

Resource Family arranges, facilitates,

And/or

Resource Family arranges,

provides and/or participates in therapeutic

And/or

Resource Family arranges,

facilitates, provides and/or consults

supports at least 4 times a month, including,

Resource Family is engaged in and supports the

Resource Family arranges,

facilitates, provides and/or

with therapist and/or other

but not limited to outpatient and/or in-home

child receiving WRAP, TBS, or other family-based

facilitates, provides and/or

consults with therapist

professionals at least 3 times a

therapeutic services.

therapeutic interventions, in addition to

consults with therapist

and/or other professionals

month and participates in

monitoring/observing, redirecting, prompting, and/or

and/or other professionals

at least 2 times a month

services/activities as recommended.

And/or

documenting.

at least 1 time a month.

and participates in

Resource Family provides structured

services/activities as

And/or

support for expected/unexpected life

And/or

recommended.

Resource Family provides structured

stressors with severe symptoms and

Resource Family arranges, facilitates and/or provides

support for expected/unexpected life

behaviors; including monitoring/observing,

up to 24 hr. observation/line-of-sight. Resource

And/or

stressors with moderate symptoms

redirecting, prompting, and/or documenting.

Family may require assistance in providing this

Resource Family supports

the child through expected

And/or

and behaviors; including monitoring,

supervision.

life stressors.

Resource Family may

observing, redirecting, prompting,

And/or

provide enhanced

and/or documenting.

Resource Family provides line-of-sight

observation.

during waking hours and limited night

And/or

supervision such as episodic checks as

Resource Family provides

needed, and may require assistance in

observation during waking hours.

providing this supervision.

Points

● Training: Resource Families are expected to participate in child-specific training/coaching/mentoring based on the needs of the child/youth placed in their home.

● If the minor/NMD is pregnant or parenting, consider the Infant Supplement. The Resource Family may need to provide support to the minor/NMD in managing emotional health.

SOC 501 (12/17)

Form Soc 501 - Levels Of Care (Loc) Rate Determination Matrix Page 2

Related Articles

Related forms

Related Categories