Youth for Tomorrow
History & Overview
The Level of Care Service System
This overview describes the Texas Level of Care (LOC) Service System
that existed in Texas from September 1, 1988, until August 31, 2003. During FY '03, this
system was substantially revised by the Texas Department of Family and Protective
Services. The Texas Service System changes went into effect on September 1, 2003. Copies of the current Texas Service System standards are available from DFPS Residential Contract
Managers (RCM) within each Region. These
Standards are also contained in the DFPS Handbook.
The History to the Texas LOC Service System
The Texas Health and Human Services Coordinating Council (THHSCC) was
established in 1983 to coordinate planning and policy making for 19 Health and Human
Service agencies in Texas. The Council was chaired by the Governor; the Lieutenant
Governor and Speaker of the House served as co-chairs. Council membership included State
Senators, Representatives, Board Chairs of State agencies, and members of the general
public.
In 1984, the Legislative Budget Board required that the Council undertake a study of
residential contract child care in Texas. During the next four (4) years, a group
referred to as the THHSCC Treatment and Care Work Committee developed a system of care
that met the criteria established by the Legislative Budget Board. This system of care is
called the Texas Level of Care (LOC) Service System and was implemented throughout Texas
on September 1, 1988, and included the following components.
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A Common Application for agencies to use when placing children in
residential care facilities that includes a mechanism to determine the appropriate level
of care for each child. This form replaced all payer and provider admission forms.
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A system of services to children that included definitons for six (6)
levels of services.
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A system of residential standards for six (6) levels of care that
define a range of services required for Texas public agency children served by
residential contract providers.
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Child-care provider cost reports and database to assist in
determining the median cost of care.
The Level of Care Service System
The LOC Service System contained six (6) levels of residential
services available to children.
Level 1 care was the least restrictive level of care. These children require parenting in
a normal family environment.
Level 2 care was also provided in a normal family environment with the availability of
additional structure and guidance to meet the child's individual needs.
Level 3 care was provided in residential care facilities or therapeutic family homes.
These children require structured, supportive care with the availability of therapeutic
counseling as necessary.
Level 4 care was provided in residential care facilities or highly skilled therapeutic
family homes. These children require a structured, individualized treatment program that
includes regular therapeutic counseling.
Level 5 care was provided in residential treatment facilities. These children have severe
problems that require a highly structured treatment program including intensive
therapeutic counseling and 24-hour supervision.
Level 6 care was provided in highly structured residential treatment facilities licensed
to provide inter-disciplinary treatment services to children who are severely impaired
and require constant supervision, treatment, and care in a limited access area.
Emergency care was not specifically defined in the LOC Service System. Any child, at any
care level, may require emergency care.
Effective September 1, 2003, the Department of Family and Protective Services implemented substantial changes to the Texas LOC Service System. One of the major changes converted the six (6) levels of care to four (4) levels of service. The new services are referred to Basic, Moderate, Specialized and Intense Services.
LOC Service System Residential Monitoring Process
There was an interagency process for monitoring the Level of Care
Service System of contracting residential facilities by Texas public agencies. The
monitoring process focused on the quality of care provided to children. The results of
on-site LOC Service System reviews were included with other information in the routine
management of residential contracts.
Cost Reporting Process
In 1991, the Council was abolished and some of its responsibilities
were transferred to the Health and Human Services Commission. One of the Commission's
responsibilities was to set maximum reimbursement rates (or ceilings) for the purchase of
residential services for children based upon the Commission's unpublished guidelines. The
Texas Department of Protective and Regulatory Services reimbursed residential child care
providers according to published reimbursement methodology rules. These reimbursement
rates were statewide by level of care and are related to services delivered to
children.
