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Effective: 4/22/2025

C7.7.2 Department for Community Based Services (DCBS) Medically Complex

Legal Authority

Introduction

​​​​​​​​A Department for Community Based Services (DCBS) medically complex foster or adoptive home meets the needs of a child(ren) who has been designated as medically complex per SOP C7.5 Designation as Medically Complex. DCBS foster and adoptive parents who have been approved as medically complex foster homes, per SOP C9.19.2 Medically Complex Approval, have received additional specialized training and have demonstrated the ability to meet the individual needs of a medically complex child, as well as work in partnership with the child’s medical team. There are three (3) levels of approval for medically complex homes. These homes allow children with the most extensive and critical medical needs to be placed with very experienced, skilled, medically complex foster parents, including parents who are healthcare professionals. The three (3) levels of approval are basic, advanced, and degreed. Advanced or degreed foster or adoptive homes may receive a higher per diem rate for children designated as specialized medically complex based on the severity of their needs. This designation is made by the Medical Support Section.​​​​​​​​​​​​​​​​​

Practice Guidance


  • In addition to approval as a medically complex home, the foster and adoptive parents must receive child-specific training from a health care professional or a resource parent who has been trained by a health care professional. The Child-Specific Training form documents the training and competency to meet the child's needs; 
  • Medically complex foster or adoptive parents may also care for children who are not medically complex. This allows siblings to be placed together, considering the maximum number of children permitted in a home. This also allows a child to remain in the same home even if the medically complex designation is later removed; ​
  • If possible, a child should not be moved because of the addition or removal of a medically complex designation. If a child is designated as medically complex while in the care of a caregiver who is not approved or licensed as medically complex, the worker and recruitment and certification (R&C) staff work together to obtain the needed approvals to promote placement stability if the caregivers are also willing and able;  
  • The following exception requests must be approved by the service region administrator (SRA) or designee, before placement in accordance with SOP C9.12.1 Placement Exception Requests: 
    • A one (1) parent foster/adoptive home that is caring for more than one (1) medically complex child; 
    • A two (2) parent foster/adoptive home that is caring is for more than two (2) medically complex children; and 
    • The home will have more than four (4) children, including the foster/adoptive parents' own children. 
  • The following exception requests must be approved by the director of the Division of Protection and Permanency (DPP) before placement: 
    • ​​Placement of a child designated as medically complex with a caregiver(s) who has not been licensed or approved for medically complex care; or
    • Primary caregiver of a child designated as medically complex who is employed outside of the home.

Procedure

The SSW:

  1. Seeks placement in a medically complex foster home for a child who has been designated as medically complex;
  2. Determines if a foster parent(s) is willing to complete the training and meet the medical needs of a child who is designated medically complex after being placed in a non-medically complex Department for Community Based Services (DCBS) foster home; 
  3. Requests any placement exceptions necessary for placement of a medically complex child;
  4. Works in partnership with the recruitment and certification (R&C)​ worker to support the child, foster parent, and medical team; and
  5. Assists medically complex foster parents in completion of the DPP-104C Medically Complex Monthly Report, collects, and provides a copy to the regional nurse consultant.
    ​


Documents

Revisions

​4/2025

A Department for Community Based Services (DCBS) medically complex foster or adoptive home meets the needs of a child(ren) who has been designated as medically complex per SOP C7.5 Designation as Medically Complex. DCBS foster and adoptive parents who have been approved as medically complex foster homes, per SOP C9.19.2 Medically Complex Approval, have received additional specialized training and have demonstrated the ability to meet the individual needs of a medically complex child, as well as work in partnership with the child’s medical team. There are three (3) levels of approval for medically complex homes. These homes allow children with the most extensive and critical medical needs to be placed with very experienced, skilled, medically complex foster parents, including parents who are healthcare professionals. The three (3) levels of approval are basic, advanced, and degreed. Advanced or degreed foster or adoptive homes may receive a higher per diem rate for children designated as specialized medically complex based on the severity of their needs. This designation is made by the Medical Support Section.


  • All medically complex consultations begin regionally between the SSW, medically complex liaison and the nurse consultant. The medically complex liaison contacts the Medical Support Section for any additional guidance. ​
  • In addition to approval as a medically complex home, the foster and adoptive parent must The foster/adoptive parent is required to receive child-specific training from a health care professional or a resource parent who has been trained by a health care professional. Documentation that they are competent to meet the medical needs of the child should be placed in the Provide file. ​The Child-Specific Training form documents the training and competency to meet the child's needs; 
  • The following exception requests must be pre-approved by the SRA or designee before placement in accordance with SOP C19.12.1 Placement Exception Requests:
  • A two (2) parent foster/adoptive home caring is for more than two (2) medically complex children (please see  SOP 12.11.1 Placement Exception Requests); and ​
  • The following exception requests must be pre-approved by the director of the Division of Protection and Permanency (DPP) before placement: 
    • Non-medically complex placements; and 
    • Working outside of the home. ​
  • Placement of a child designated as medically complex with caregiver(s) who has not been licensed or approved for medically complex care; or
  • Primary caregiver of a child designated as medically complex who is employed outside of the home.
  • ​The SSW may consult with the medically complex liaison, who in turn consults with the central office Medical Support Section or Out of Home Care Branch if a medically complex placement is not located after a medically complex determination has been made. 
  • When a medically complex child is hospitalized, DCBS staff should be available to receive regular updates and to meet with hospital staff regarding the child’s medical treatment plan. The hospital should have access to a DCBS representative at all times, even on weekends, holidays and after hours. 
  • When a foster parent, SSW or private agency staff are not available to stay with the child: 
    • A biological relative may be considered (on a case-by-case basis); or 
    • A contract with an agency may be initiated in order to have a responsible adult remain with the child (e.g. a sitter from a nursing pool or home health agency. The sitter does not have to provide direct medical care, but is to be in the room to facilitate access to medical personnel and provide support to the child, when needed). 
  • The medically complex liaison may consult with the Medical Support Section if there are questions regarding the child’s medical treatment. 
  • The SSW may contact the designated Commission for Children with Special Health Care Needs (CCSHCN) nurse for consultation at any point during the case. 
  • ​It is recommended that the SSW and CCSHCN Nurse attend medical appointments involving a medically complex child when decisions regarding treatment plans are discussed.
    ​​
  1. Considers a child for a possible medically complex designation if the child has a medical condition diagnosed by a physician which includes: 
    1. Significant medically oriented care needs related to a serious illness or condition diagnosed by a health professional that may become unstable or change abruptly resulting in a life-threatening event; 
    2. A chronic condition that is expected to be life-long and progressive and will require additional oversight; or 
    3. A severe disability that requires the routine use of medical devices or assistive technology to compensate for the loss of a vital body function needed to participate in activities of daily living and significant and sustained care to avert death or further disability. 
  2. Obtains documentation of the child's medical condition from a physician and other healthcare providers; 1 
  3. Consults with the following people to determine if the child has a medical condition that meets medically complex criteria:
    1. Current medical providers; 
    2. The Family Services Office Supervisor (FSOS); 
    3. The regional Medically Complex Liaison; 
    4. The Medical Support Section; and 
    5. CCSHCN nurse consultant; 
  4. Completes the following documentation when requesting a medically complex designation: 
    1.  The DPP-106B Initial Physical and Behavioral Health History; 
    2. M-001 CCSHCN Verbal Release of Information; 
    3. Copy of the custody order; and 
    4. Any other supporting medical documentation. 
  5.  Once approval has been granted for a medically complex designation: 
    1.  The m​edically complex liaison, forwards the documents listed in procedure #4 to the Medical Support Section; 
    2. The SSW seeks placement for the child in an approved medically complex home; and 
    3. The SSW verifies that the foster/adoptive parents are willing to continue to care for the medically complex child, if placement occurred prior to designation; 
  6. The SSW or medically complex liaison contacts the CCSHCN nurse to provide case information prior to the first home visit and the individual health plan (IHP) meeting.
The Medically Complex Liaison:

  1. Assists the assigned Commission for Children with Special Health Care Needs nurse with arranging the initial individualized health plan meeting within thirty (30) days of the medically fragile complex determination.​

Contingencies and Clarifications

If a medically complex child becomes hospitalized, the SSW completes the following tasks:

  1. Notifies the medically complex liaison, who in turn, notifies the Medical Support Section within seventy-two (72) hours; and 
  2. Ensures that the child has a responsible adult, excluding hospital staff, present at all times. 2 
  3.  When a child is placed in the home of a relative or out of state, the SSW: 
    • Ensures that the placement provider submits documentation from a medical provider that they are able to meet the medical needs of the child; 
    • Collects the DPP-104C Medically Complex Monthly Report and provides a copy to the Medically Complex Liaison and Medical Support Section.
Footnotes​

  1. Phone verification with the physician, nurse or hospital social worker is acceptable documentation for confirmation of the child’s diagnosis. The Commission for Children with Special Health Care Needs may be contacted to assist with securing this information if the SSW encounters issues. 
  2. If the child is in an intensive care unit, a responsible adult is not required to be present at all times.​​​