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.

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.
A system of services to children that include definition levels of services.

A system of residential standards of care that define a range of services required for Texas public agency children served by residential contract providers.
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 contains levels of residential services available to children. These levels are referred to Basic, Moderate, Specialized and Intense Services.

The Basic Service Level consists of a supportive setting, preferably in a family, that is designed to maintain or improve the child’s functioning, including:

  1. Routine guidance and supervision to ensure the child’s safety and sense of security;
  2. Affection, reassurance, and involvement in activities appropriate to the child’s age and development to promote the child’s well-being;
  3. Contact, in a manner that is deemed in the best interest of the child, with family members and other persons significant to the child to maintain a sense of identity and culture; and
  4. Access to therapeutic, habilitative, and medical intervention and guidance from professionals or paraprofessionals, on an as-needed basis, to help the child maintain functioning appropriate to the child’s age and development.

The Moderate Service Level consists of a structured supportive setting, preferably in a family, in which most activities are designed to improve the child’s functioning including:

  1. More than routine guidance and supervision to ensure the child’s safety and sense of security;
  2. Affection, reassurance, and involvement in structured activities appropriate to the child’s age and development to promote the child’s well-being;
  3. Contact, in a manner that is deemed in the best interest of the child, with family members and other persons significant to the child to maintain a sense of identity and culture; and
  4. Access to therapeutic, habilitative, and medical intervention and guidance from professionals or paraprofessionals to help the child attain or maintain functioning appropriate to the child’s age and development.
  1. In addition to the description in subsection (a) of this section, a child with primary medical or habilitative needs may require intermittent interventions from a skilled caregiver who has demonstrated competence.

The Specialized Service Level consists of a treatment setting, preferably in a family, in which caregivers have specialized training to provide therapeutic, habilitative, and medical support and interventions including:

  1. 24-hour supervision to ensure the child’s safety and sense of security, which includes close monitoring and increased limit setting;
  2. Affection, reassurance, and involvement in therapeutic activities appropriate to the child’s age and development to promote the child’s well-being;
  3. Contact, in a manner that is deemed in the best interest of the child, with family members and other persons significant to the child to maintain a sense of identity and culture; and
  4. Therapeutic, habilitative, and medical intervention and guidance that is regularly scheduled and professionally designed and supervised to help the child attain functioning appropriate to the child’s age and development.
  1. In addition to the description in subsection (a) of this section, a child with primary medical or habilitative needs may require regular interventions from a caregiver who has demonstrated competence.

The Intense Service Level consists of a high degree of structure, preferably in a family, to limit the child’s access to environments as necessary to protect the child. The caregivers have specialized training to provide intense therapeutic and habilitative supports and interventions with limited outside access, including:

  1. 24-hour supervision to ensure the child’s safety and sense of security, which includes frequent one-to-one monitoring with the ability to provide immediate on-site response.
  2. Affection, reassurance, and involvement in therapeutic activities appropriate to the child’s age and development to promote the child’s well-being;
  3. Contact, in a manner that is deemed in the best interest of the child, with family members and other persons significant to the child, to maintain a sense of identity and culture;
  4. Therapeutic, habilitative, and medical intervention and guidance that is frequently scheduled and professionally designed and supervised to help the child attain functioning more appropriate to the child’s age and development; and
  5. Consistent and frequent attention, direction, and assistance to help the child attain stabilization and connect appropriately with the child’s environment.

In addition to the description in subsection (a) of this section, a child with developmental delays or mental retardation needs professionally directed, designed and monitored interventions to enhance mobility, communication, sensory, motor, and cognitive development, and self-help skills.
(c) In addition to the description in subsection (a) of this section, a child with primary medical or habilitative needs requires frequent and consistent interventions. The child may be dependent on people or technology for accommodation and require interventions designed, monitored, or approved by an appropriately constituted interdisciplinary team.

Emergency care was not specifically defined in the LOC Service System. Any child, at any care level, may require emergency care.

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.