Safe at Home Questions and Responses. Question: Would agencies in the non-pilot counties need to apply for funding now or at a later date?

Safe at Home Questions and Responses Question: Would agencies in the non-pilot counties need to apply for funding now or at a later date? Response: This Funding Announcement is for the phase 1 counties listed only. Applications to serve other counties will not be accepted or reviewed. Question: Is there a possibility we would be awarded, but for a smaller amount than the amount we request? Is there a possibility that we would be awarded a smaller number of care coordinators than we request? Response: Yes to both questions. The Department would negotiate with the applicant on the number of coordinators which would impact the amount of the start-up grant awarded. Question: Will we be able to bill $136 per day the child/family is in our care, or only for the days that we actually provide services? Response: The daily rate will be paid for each day the youth/family are participating in Safe at Home Wraparound. Question: Will all the youth in program be youth in state s custody? Response: Yes, for the initial referrals priority will be given to youth in residential care in and out of state. These youth would be in DHHR custody. Later referrals will be made to prevent youth from going into placement. These youth may not be in DHHR custody, but must be an active child welfare case. Question: Will we be able to bill for therapy for the youth/families in the program? Response: If the youth/family is eligible for Medicaid/private insurance the agency providing therapy would bill Medicaid or private insurance. If the youth/family is not eligible for Medicaid/private insurance, the lead coordinating care agency could use the Safe at Home daily rate of $136 to cover the therapy costs. Question: If a Safe at Home youth is placed in foster care, shelter care, or residential care during their time of care coordination, is this to be paid for by the Safe at Home daily rate? Response: If a youth referred is in residential or shelter care, the regular per diem will be paid to the agency providing that service just as it is now. The Safe at Home daily rate would continue to be paid to the care coordinating agency for as long as the youth/family participate in wraparound. 1

Question: If there are multiple care coordinators within a geographic region, how will referrals be assigned? Response: The Department will ensure that all agencies receive referrals. Question: Will the services provided in Care Coordination be time limited? (i.e. one year) Response: West Virginia Safe at Home wraparound is structured in four phases, each with recommended time frames, for up to a total of 18 months before the final transition to natural supports. The needs of each family will be unique. The time frame for each individual family s wraparound plan will be based on the assessed needs of each member. However research indicates most families are transitioned to natural supports within a year. Question: Should the initial budget that is submitted with the application reflect only care coordination related costs (as outline in the RFA) or should the proposed budget also include the income and expense related to the per diem (daily rate)? Response: The budgets should not include the daily rate of $136 for Safe at Home since that will be paid in addition to the start-up grants. The startup grants are for the costs related to the care coordinators to help agencies get started with Safe at Home wraparound. The Safe at Home daily rate will sustain the wraparound model in the future and allow for increasing the number of care coordinators as demand warrants. The Announcement specifies that the $70,000 includes salary, fringe benefits, supervision, supplies, equipment, space, training, travel, and administrative costs for each care coordinator. Question: If an agency is interested in providing care coordination in both Region 3 (Berkeley, Jefferson, Morgan) and Region 2 (Cabell, Wayne, Mason, Putnam, Lincoln, Logan, Boone, Kanawha) should they submit separate proposals? Response: Separate proposals for Regions II and III are preferred for ease of review but as long as the proposal details how each criterion will be met for each area in which they will provide services, proposals to serve both regions will be accepted and reviewed. Question: Will any of the training for care coordinators involve out of state training and travel that should be built into the budget? Response: There is the possibility that some information will need to be obtained through attendance at out-of-state conferences or meetings and training but the start-up grant funds should cover those costs during the pilot. Future training costs would be covered by the Safe at Home daily rate of $136. 2

Question: If a youth returns to residential care does the Care Coordinator continue to be involved? Response: Yes, the care coordinator will follow the youth if youth is treated for short periods of time in residential care. Question: What sort of things are to be covered by the Per Diem? Response: Services not billable to other sources like Medicaid, private insurance or behavioral health. Examples of services that may be paid by the daily rate include peer support, tutoring, individual parenting education and transportation costs. Question: For the first year, will the numbers to be served (that were outlined in the RFA) remain the same? Response: The numbers used in section I under Geographic Focus are based on the youth who meet the requirements of the target population in residential care from the pilot counties. The Department anticipates referrals will likely be higher rather than lower. Question: Within the target population (4 categories) with the initial priority being those out of state and those in care away from their community stay the same for the first year, or will the at-risk categories of the target population be added sometime during the first year? Response: as stated in the Section II Target Population of the Funding Announcement, priority will be given to those youth in residential care initially but it is anticipated that referrals will expand to the at risk population during the pilot. Referrals could exceed projections in the Announcement. Question: Will care coordination organizations (if there are multiple ones in a geographic area) be expected to cooperate in the development of community based services? Response: Yes, care coordination agencies will be expected to cooperate and collaborate on the development of community based services where they are needed but do not exist. The funding announcement under Section III. B states: Applicants must provide information on services and community supports that are currently available in the county/counties the applicant desires to serve. If such services and supports are currently available, applicants must describe the collaboration with other service providers and community stakeholders; 3

If service development is required to provide Safe at Home WV, Applicants must explain what additional services are needed, how current services may need to be enhanced, and how the applicant will collaborate with existing stakeholders to develop what is needed, including barriers, (i.e., isolated locations, funding factors, lack of workforce, etc.) Question: Is the indirect cost of 10% capped for the $136 daily rate? Response: Indirect costs are only applicable to startup grants for the care coordinator costs. The $70,000 start- up costs should cover all costs as stated in the funding announcement: The $70,000 includes salary, fringe benefits, supervision, supplies, equipment, space, training, travel, and administrative costs for each care coordinator. Indirect costs are no longer capped at 10 percent. The Safe at Home daily rate of $136 is the rate that will be paid to the lead care coordination agency for each day for each youth/family participating in Safe at Home Wraparound in addition to the funds received from the startup grants. Question: Are indirect costs included in the $70,000/care coordination or is the 10% in addition for the budget? Response: Yes, all costs are included in the $70,000 figure for each care coordinator. Question: What is the number of children in Foster Care, natural homes, residential in state, and residential out of state? Response: For relevant data for the implementation of care coordination, please refer to the target population in the grant announcement. Question: Is the budget just for the startup cost for the care coordinators and expenses? Response: The $70,000 start- up costs should cover all costs associated with the care coordinators as stated in the funding announcement: The $70,000 includes salary, fringe benefits, supervision, supplies, equipment, space, training, travel, and administrative costs for each care coordinator. The line item budget should be limited to this. Question: Is there any limit on how many pages the grant can be? Response: No there is no limit on the number of pages. Applicants should concisely address all the requirements of the funding announcement. 4

Question: Where does the salary for the project supervisor come from? Would it come out of the $70,000 per Care Coordinator? Response: Yes funding for supervisory costs would come from the $70,000 for each care coordinator. The funding announcement states: The $70,000 includes salary, fringe benefits, supervision, supplies, equipment, space, training, travel, and administrative (indirect) costs for each care coordinator. Question: If $136 per child per day is not spent on each child, could the money be held to pay for other expenses or for a future expense, or, is this daily rate paid on an expense reimbursement basis? Response: Yes it could be used for another youth, it is anticipated that some youth/families will require more purchased services than others. Question: Page 1 references a daily rate of $136 for each child while page 12 references payment for each family served. Is the payment a per diem per child or per family? If there is more than one identified child in a family, will a $136 per diem payment be received for each child? Response: The case rate includes the provision of case coordination services to the family unit, not just one member. Question: When does the provider s responsibility end for the children/families referred? Response: After the transition phase has ended, reports are distributed and discharge letters are sent, the case may be closed; the agency will have completed its service obligations. However, there will be requirement for postservice follow-up which will be outlined within the statements of work. Question: When does the $136 per diem payment start and stop? Response: When the referral is accepted by the agency and service provision begins. Service provision can mean any case work in which the agency engages on the behalf of the implementation of wraparound. The payment stops when the transition phase ends, final reports and documentation is complete and the case is closed. Question: Are there any restrictions on what services or hard goods the $136/day per diem is spent on supporting safety at home? Response: No, other than services which are billable to another source. 5

Question: Who is responsible for any non-medicaid eligible placement costs? Response: Placement costs are outside the scope of this grant announcement. Question: Please define other sources as described on page 12 (Section IV, second paragraph: payment for services Medicaid and other sources ; ) and services covered by these. Response: Services not billable to other sources like Medicaid, private insurance or behavioral health. Examples might include the lead coordinating agencies contracting with another agency to provide youth coaching services, peer support, tutoring, or parenting education services. Question: For example, will existing funds for Socially Necessary services be available in addition to the $136 per diem payment? Response: No, agencies providing Safe at Home wraparound will not be able to bill the Department for socially necessary services in addition to the Safe at Home daily rate of $136. Question: What authority will the Care Coordinators have in decision making (for example; placement moves, types and timing, service intensity, etc.) What authority or influence will DHHR have on these types of decisions? Response: Decisions will be made by the family team and the MDT. Please visit the National Wraparound Initiative s website for more information about a high fidelity wraparound model. http://nwi.pdx.edu/ Question: For care coordinators hired to be prepared to accept referrals October 1, how do you anticipate the selection and timing of referrals or are you asking applicants to propose a plan? Response: The Bureau s internal processes for the selection and timing of its referrals for wraparound are still being developed but the Department will work with the care coordination agencies to time referrals so the number of referrals does not exceed the care coordinating agencies capacity. Question: Will a Care Coordinator s caseload be built up over time to allow for a diversity of needs and stages of care in the caseload? Response: Please visit the National Wraparound Initiative s website for more information about strategizing caseloads for case coordinators. http://nwi.pdx.edu/ 6

Question: If applying for counties in which the provider does not currently have a behavioral health license, will an exception be allowed while application is pending? Response: No. The application process cannot wait until licensure is sought. Applicants must possess a current behavioral health license for the counties designated for the pilot. Question: Will consideration be given to transitioning existing DHHR homes to provider(s) awarded the grant in order to assist with strengthening a continuum of community based supports upon which to draw in transitioning/maintaining children safely? Response: This question is outside the scope of the funding announcement and application process. Question If current DHHR homes will not be transitioning will DHHR allow access to DHHR homes to support community-based transition? Response: This question is outside the scope of the grant announcement and application process. Question: Please provide more detail on the numbers table (Page 2: Table of projected number of cases). The 25 in Berkeley, for example. Where are they currently placed (type of placement, reimbursement rate, Medicaid funded or not, placement provider s name, county and city)? Response: The table represents the anticipated number of youth in Level 2, 3 residential care in state, group care out of state, and psychiatric residential treatment who also meet the requirements for the target population for Safe at Home on any given day from the pilot counties. This population changes daily. Question: Of the specific numbers listed for each county, how many families does that represent? How many other children are in the family homes (if not included in the numbers provided)? Response: Focusing on these specific data sets may not be beneficial. The focus should be on achieving permanency for each child involved in wraparound, which may or may not include biological families. Question: What responsibility is there for other children in the family of a referred child? How will these other children affect outcomes, per diem payments, responsibility for placement costs, etc.? 7

Response: The case rate includes the provision of case coordination services to the family unit, not just one member. Question: Page 9 indicates the grant budget is for the cost of Care Coordinators only. Please confirm that the budget is not to include the costs related to the $136 per diem per child. Response: The budget for the startup grant must not include the Safe at Home daily rate of $136. Question: Is the budget to reflect the costs of one Care Coordinator only and then that would be extended out in the event the applicant is awarded multiple Care Coordinators? Response: The budget should include the costs for the number of coordinators the applicant wishes to have for the counties served. Question: Is the $70,000 per care coordinator a single line item on the budget or is the $70,000 for each care coordinator to be broken down into the seven direct cost categories and indirect costs? Response: The funding announcement states: The $70,000 includes salary, fringe benefits, supervision, supplies, equipment, space, training, travel, and administrative costs for each care coordinator. Therefore the funds should be broken down into the line item budget categories. Question: If indirect costs are budgeted, is a copy of the documentation supporting one of the three mandatory criteria listed in Section II of the Budget Instructions required to be attached to the application? Response: Although the line item budget instructions direct applicants to identify the source of the approval for the indirect cost proposal: Cognizant federal agency, State or Local Agency, or independent accounting firm, it would be helpful to include the documentation with the application. Question: What specific expenditures by the agency, by service and amount and purpose are to be included in the financial reports (Section III D; page 10)? For example is it only the $136 per diem expenditures? Response: Any revenue other than the grant funds used for the provision of Safe at Home and expenditures made for Safe at Home wraparound. Question: If an applicant does not have a Federal Indirect Rate, but has an independent auditor s report on compliance for major federal programs required by 8

OMB Circular A-133 and its indirect rate is under 10%, will the applicant be allowed to include Indirect Expenses? Response: Yes Question: The target population is 12-17 year olds, so, can they be served up until their 18 th birthday under this program and just not enrolled to start after their 17 th birthday? What about those who need transition services up to age 21? Response: Youth will be served after his or her 18 th birthday based on the youth s transition plan in accordance with child welfare policy. Question: Are indirect costs capped at 10% even when we have a negotiated and approved indirect cost rate agreement with WVDHHR at 21.92% of all expenses? Since the indirect cost rate is established based on actual administrative expenses, where will the rest of that funding come from? Response: Indirect costs are no longer capped at 10%? Question: Is there a page limit for the application or formatting instructions and if so, where can I find them? Response: There is no limit on the number of pages for the application, Formatting instructions can be found online in the Submission Guide and on page 13 of the funding announcement. Question: How many projects will be funded? Is there a maximum amount of funding available for each organization or each county? Response: Number of projects funded will depend on the number of applications selected for funding. There is no maximum amount available for each organization or each county Question: Is the $136 per day an amount that may change periodically (like the per diem) or will that always remain the same? Response: The daily case rate will be monitored as part of the evaluation of Safe at Home pilot. Question: If we receive a referral, but the family isn t willing to participate, what do we do? 9

Response: The referring DHHR caseworker is responsible for making sure the youth/family is willing to work with Safe at Home before making a referral. Question: Page 1 references a daily rate of $136 for each child while page 12 references payment for each family served. Is the payment a per diem per child or per family? If there is more than one identified child in a family, will a $136 per diem payment be received for each child? Response: The daily case rate is based on the referral of one youth. It includes the provision of care coordination services to the family unit, not just one member. If two youth from the same family are referred for Safe at Home, then the daily rate would be paid for both youth. Question: When does the provider s responsibility end for the children/families referred? Response: After the transition phase has ended, reports are distributed and discharge letters are sent, the case may be closed; the agency will have completed its service obligations. However, there will be a requirement for postservice follow-up which will be outlined within the statements of work for the startup grants. Question: When does the $136 per diem payment start and stop? Response: When the referral is accepted by the agency and service provision begins. Service provision can mean any case work in which the agency engages on the behalf of the implementation of wraparound. The payment stops when the transition phase ends, final reports and documentation is complete and the case is closed. Question: 283 children are identified from various counties who would be the first candidates for the wrap around project. The application describes eligible youth 12-17, with severe emotional or behavior disturbance that impedes daily functioning. What diagnoses match up to these criteria as well as the criteria that describe the functioning? Response: The criteria for a youth to be eligible will be based on DSM-IV, DSM-V diagnoses, trauma-based diagnoses and ID/D diagnoses and involvement in two or more child serving systems. 10

Question: The additional description of the selection criteria states for kids out of state who cannot return without extra support and linkages and then the same is said for kids in state who can t be reunited for the same reason. What have been the extra supports and linkages that have been lacking? Response: Those would be unique to each county. Question: Is my reading of the phases of service delivery lasting ultimately up to 2 years? Response: Potentially, but research indicates most youth/families can be transitioned to informal/natural supports within a year. Question: Is the case rate paid every day the kid is on one s case load or specific to dates of client contact or is there other methods Response: The daily rate of $136 will be paid for each day the youth/family participate in Safe at Home wraparound. Question: When working with multiple kids in a family does the case rate apply to the family or each individual kid in the family identified as clients Response: The daily rate is for each youth/family participating in Safe at Home wraparound. The family is the client. Question: This is a further down the line question. What if a kid has been identified who doesn t qualify for Medicaid and the family has an insurance that won t pay or won t pay first for needed services. Will the Department issue a special medical card? Response: At this time, the focus will be on current foster children who are eligible for Medicaid. Question: Are the projected number of cases on page 2 inclusive of youth currently in out-of-home placement and those at-risk of placement, or do these numbers only include youth currently in out-of-home placement? If they include both currently placed and at-risk youth, can we have the breakdown of youth currently placed versus youth atrisk of placement? Response: The table on page two of the funding announcement provides the number of youth projected to meet the target population in residential placement including Level 2 and 3 in state, group care out of state, and in psychiatric residential treatment. It does not include the number of at risk youth. 11

Question: On page 6, the description of the Engagement and Planning Phase states that the child is in the home when services begin. Does this mean that the child has already returned from out-of-home placement, or will we work with kids who are transitioning out of out-of-home placement? Response: Initial referrals will be for youth in residential placement the first phase will be the Pre Community Integration Phase for these youth. The Engagement and Planning Phase will be the first phase for youth when referrals begin for the at risk population. Question: We are licensed and approved to provide behavioral health services in three counties. Can we apply to serve children from other counties with the Wraparound program, or are we limited to the three counties covered by our license? Response: Agencies must have a current behavioral health license to provide behavioral health services in the designated pilot counties. Question: Is the daily rate of $136 a per diem (billed 7 days a week) rate or only for days that services are provided? Response: The daily rate will be paid for each day the youth/family receives wraparound. It will be paid seven days a week as long as the family participates in Safe at Home. Question: Is the daily rate of $136 a shared rate among all providers serving the youth, Or is it for the use of the care coordination agency only? If this is a shared rate, how can we budget for the other provider s share? Response: The Safe at Home $136 daily rate will be paid to lead care coordination agency for the youth/families for whom the agency provides care coordination. However, the care coordination agency will be expected to use the daily rate to pay for services not billable to other sources and cover all costs after the start up grants end. Question: Can the supervisor of the Wraparound program supervise agency employees working in other programs (such as behavioral health) or must the supervisor be dedicated to supervising only Wraparound care coordinators? Response: A supervisor must have superior knowledge of high fidelity wraparound. If the supervisor can meet the mentoring, educational and support needs of the care coordinators and other staff, without compromising the fidelity of the model, agencies can determine their internal employment structures. Question: For the Behavioral Health Provider number, do you need the Behavioral Health license number, the Medicaid provider number, or both? 12

Response: The funding announcement requires the behavioral health license number. Question: After the grant period ends, will the $136 daily rate have to sustain the care coordinator s wages? Response: It is anticipated that the $136 daily rate will cover all costs not billable to other sources after the startup grants end including staff costs for the lead care coordination agencies. Care coordinators are limited to 8-10 families at any given time. Once agencies are fully staffed with each coordinator carrying 8-10 families at a daily rate of $136 each care coordinator will generate payment in an amount between $397,120 and $496,400 annually. The Department anticipates the volume of referrals will allow agencies to carry close to the maximum number of cases, therefore, the Department believes the daily rate will sustain staff and the cost of services not billable to other sources. Question: A detailed line item budget with care coordinator costs is requested on page 6. Should this budget reflect the $70,000 per care coordinator start-up grant only? Response: Yes, the only line item budget requested is for the care coordinator costs. The daily rate should not be included in the line item budget. Question: Or should the budget include the costs that comprise the $136 daily rate? Or should we submit two budgets, one for start-up care coordinators and one for the $136 rate? Response: see above response. Do not submit a budget that includes the Safe at Home daily rate of $136. Question: Is it possible to get a breakdown of the county of origin of the out of home placements? For our purposes it would be good to have some sense of how many kids are from the counties where we are proposing to provide services. Response: The table for the number of youth in placement on page 2 of the funding announcement represents the number of youth estimated to meet the criteria for Safe at Home in residential care (level 2, 3, and psychiatric residential treatment facilities in and out of state) from the pilot counties. It does not include youth in level 1 facilities or at risk youth. Question: Is the $70,000 startup coordinator amount per care coordinator? Per county? Per awardee? Response: The $70,000 per care coordinator is the figure applicants should use to develop the line item budget for number of care coordinators. If there are multiple applicants for the same counties and more care coordinators than the Department believes is necessary, the Department reserves the right to negotiate changes to the application as stated on page 17 of the Funding Announcement. 13

Question: Will there be a lead agency that will make the referrals to the Local Coordinating Agencies, using the Wraparound Referral Form? Response: Safe at Home Referrals will be made by the Department to the lead coordinating agencies. Each coordinating agency will make referrals within their own provider networks. Lead care coordinating agencies may contract with some of the same agencies in their communities for needed services. Question: The Evaluation section of the AFA (pp. 14-17) contains lists of criteria. Are applicants expected to address each criterion in a question and answer format or should they merely ensure all criteria are generally addressed in the narrative? Response: Criterion in the evaluation should be addressed in the body of the application in a narrative and follow the required format which includes Applicant Capability/Experience, Work Plan/Narrative, and Budget with narrative. Question: The summary requires that the applicant include a copy of their business license and behavioral health license. Please confirm that these licenses are not counted as part of the two-page limit. Response: The licenses are not included in the two page summary. Question: Are all of the cases (youth) shown by county on page 2 of the AFA currently in congregate care in state or out of state? Response: The table on page two of the funding announcement provides the number of youth projected to meet the target population in residential placement including Level 2, 3, and psychiatric residential treatment facilities in and out of state. It does not include the number of at risk youth. 14