COVID-19 DCS Frequently Asked Questions

Frequently asked questions about DCS policy and procedure in light of the COVID-19 outbreak.

This page will be regularly updated as new information becomes available.

• Will DCS offer a "waiver" from the service standards to allow providers to bill for telephone contact with clients in the event the client cannot be seen in person due to corona virus concerns?
• Is there a new protocol with these type of services in the community and our facilities? Are we supposed to suspend the visitations? It would be hard to prevent physical approach between parents and children during a supervised visitation.
• What is DCS’ recommendation for handling foster care placements when there are symptomatic household members and contractually-required visits are due?
• Are there any expected state level shutdowns that will impact the processing of invoicing and payments?  
• Will this effect the timeline of the RFP announcement and roll out?
• Can DCS approve supervision to be provided in non face-to-face methods during this time to lessen group gatherings?
• If we do a telemedicine session for something that is normally billed to Medicaid first, would DCS allow for teletherapy to be billed directly to DCS since Medicaid will not approve teletherapy?
• Under what circumstances should visitations be canceled?
• There has been much confusion around travel for foster children. It appears that some regions have implemented travel policies that are more stringent than the statewide policy. Can we get clarification on this?
• What is DCS’ stance on home visits for youth in residential treatment?  
• What is DCS’ stance on campus visits from family, referral sources, CFTM, guardian ad litem, etc.?
• What is the expectation for court visits? CFTM?
• Will there be ratio adjustments in the event this is needed?
• If staff and/or kids are infected, how does this affect referrals and placements?
• What are the precautions service providers should take when interacting with clients? Is DCS preparing any closures or foreseen issues with billing?
• May residential providers temporarily cease supervised visits in the community and require parents to visit on campus to limit youth’s travel in the community and possibly bring illness back to campus and infect others?
• CPR/first aid instructors have been told not to have people use the mannequins and have canceled. CPR/First Aid is a requirement for Indiana. Will we be given any leeway to submit a home without first aid? Can we submit a home now and be given a date to have for completion of CPR/First Aid?
• Will CFTMs be conducted electronically so as to maintain the appropriate “social distancing?”
• What information we should look for with our children or families when assessing if we should limit/stop weekend home visits or even outside visitors to campuses?
• When do we pull kids from their jobs? For instance, are we required to prohibit them from going to a job in the community if there is some connection between the location of their job (a gas station for instance) and a coworker or customer who is in quarantine? Short of a direct connection, are we to just rely on a prudent parenting standard?
• When do we pull youth from community outings? Is there a size of crowd we should avoid having them interact with?
• If a resident does contract the virus, how do we pull off a quarantine? Is staying in their room sufficient quarantine or would they be expected to be in a separate unit? 
• Any thoughts on when we would simply stop home visits all together? What if someone in the household has a fever? If they have no known connection to the coronavirus is a fever alone enough to stop visits?
• Is it possible to get permission from DCS on a case-by-case basis to implement video interface/phone conferences (so long as any federal obligations are met) to continue services? If so, what level DCS staff member can authorize this? An FCM, supervisor, LOD, other?

Will DCS offer a "waiver" from the service standards to allow providers to bill for telephone contact with clients in the event the client cannot be seen in person due to corona virus concerns?

Home visitations present a low risk of contracting the virus provided preventive measures are taken. When appropriate, call prior to the scheduled home visit to determine if anyone in the home is experiencing symptoms.

Providers should also ask the following questions:

1. In the last 14 days, have you or anyone in your household traveled to a country for which the CDC has issued a Level 2 or Level 3 travel designation?
2. Have you or anyone in your household come into contact with any person under investigation for exposure to the COVID-19 coronavirus (high-risk and medium-risk under the Indiana State Department of Health guidelines), or anyone with known COVID-19?
3. Do you have any symptoms of a respiratory infection (e.g., cough, sore throat, fever or shortness of breath)?

If a client answers no to Questions 1 and 2, providers are expected to continue to serve the client according to usual business practices, while following the established ISDH precautions. Symptoms of respiratory infection alone (indicated by a yes to Question 3) are not an acceptable reason to cease or interrupt service to the client.

If a client answers yes to Question 1 or 2 but no to Question 3 (they have not exhibited symptoms of a respiratory infection), you may determine whether or not services can be safely and effectively extended remotely via teleconference (Skype, Zoom, etc.) or telemedicine, if it is available, and providers may bill for these contacts as though they were completed face-to-face. If teleconference or telemedicine are not available, providers may use phone interventions. If any form of remote interventions are used (teleconference, skype, telephone, etc.), providers must notify the referring worker (FCM/PO) to gain their approval as they will be the best position to know the appropriateness of such interventions given the presenting case dynamics.

If a client answers yes to either Question 1 or 2 and is exhibiting symptoms similar to those of a respiratory infection, advise the client to remain at home and to contact their medical professional immediately. Alternatively, the client can be directed to the nearest emergency room for medical treatment and testing if symptoms warrant (e.g., shortness of breath). Notify the client to inform the receiving medical provider, transporter, or facility of a potential concern for COVID-19. This should be done in advance of arriving at the medical facility or being picked up by the medical transport so that these professionals can take proper precautions to prevent the spread of the disease.

In the event that a client requires medical attention for possible exposure to COVID-19, please inform DCS/Probation immediately (phone contact with the FCM/PO).

Remote interventions such as teleconference, skype, “FaceTime” and telephone may be used with these circumstances, and may be billed as if they are conducted face-to-face. As many DCS/probation cases present with child-safety concerns, however, providers must notify the referring worker that they intervening in this fashion and ensure that the referring worker is comfortable with this. Providers must also communicate regularly (at least weekly) with the referring worker about these types of cases, and discuss when regular face-to-face contacts should resume.

Is there a new protocol with these type of services in the community and our facilities? Are we supposed to suspend the visitations? It would be hard to prevent physical approach between parents and children during a supervised visitation.

Please see above and ask the questions listed. If the answers to 1 and 2 are “no,” please continue with the visit/service as usual, but following the precautions listed on the March 10 provider guide that was sent to our providers.

What is DCS’ recommendation for handling foster care placements when there are symptomatic household members and contractually-required visits are due?

Staff should initiate a short screening questionnaire prior to visiting the foster home and, if 1) someone has been in high risk foreign country within 14 days; 2) has been diagnosed or in close contact with someone diagnosed with COVID 19 in last 14 days; 3) has someone exhibiting symptoms consistent with COVID 19; we will not visit the home but will speak with a foster parent and placement via phone and conduct as much case management and safety assessment as possible via phone, documenting all clearly.

Providers should ask the three questions listed above, and follow the guidance listed depending on the answers received.

Are there any expected state level shutdowns that will impact the processing of invoicing and payments?  

Not at this time. DCS fiscal continues to operate as normal with invoices being processed for payment within 30 days of the invoice posting. If there is an impact due to COVID-19, DCS will inform providers.

Will this effect the timeline of the RFP announcement and roll out?

No. We do not believe this will impact RFP announcements, procurement of contracts, or roll outs of services.

Can DCS approve supervision to be provided in non face-to-face methods during this time to lessen group gatherings?

Yes. Given that group gatherings should be limited at this time, non-face-to-face methods may be utilized for supervision.  Please note this in your supervision notes. We will evaluate this approval monthly (will be re-evaluated on 4/16/20).

If we do a telemedicine session for something that is normally billed to Medicaid first, would DCS allow for teletherapy to be billed directly to DCS since Medicaid will not approve teletherapy?

DCS will check with OMPP on this question to ensure that Medicaid will not reimburse for teletherapy. If this is confirmed, yes, providers may bill DCS directly for these services, and should note this on their invoices. DCS plans on updating this as soon as OMPP has provided guidance.

Under what circumstances should visitations be canceled?

When considering canceling visits, providers should be asking the above three questions and be communicating with the referral source about the responses to those questions.  The Child and Family Team should communicate about whether it is appropriate to cancel visits given the information obtained from the questions. Court orders should also be considered when evaluating the appropriateness of canceling visits, and the court should be notified if decisions are made to cancel any court-ordered visits. Any rooms used for visitation should be deep cleaned after every visit.

There has been much confusion around travel for foster children. It appears that some regions have implemented travel policies that are more stringent than the statewide policy. Can we get clarification on this?

The official communication that was sent on March 11 reflects current policy around visits. It stated:

“Currently, the Indiana Department of Child Services (DCS) is still following the Out-of-Home Care Travel policy for instate and out-of-state travel.”

Also the CDC has released travel guidelines which should be taken into consideration.

There is not a restriction for travel for children in foster care. Non-essential travel for the state has been restricted. Essential travel still continues and is evaluated on a case-by-case basis in accordance with the courts. When considering traveling, follow the recommendations of the CDC. The CDC is now recommending that any gatherings that hold more than 50 people should be canceled for the next eight weeks. However, please use your best judgment. Events of any size should only be continued if they can be carried out with adherence to guidelines for protecting vulnerable populations, hand hygiene, and social distancing.  When feasible, organizers could modify events to be virtual.

What is DCS’ stance on home visits for youth in residential treatment?  

Residential facilities who have youth with approval for home passes/visits should work with the referring worker (FCM/PO) to discuss any potential risks to the passes/visits occurring, and ensure that coronavirus precautions are followed should the passes/visits be deemed appropriate.

If there are clearly identified Coronavirus risks present in the environment in which the youth will be visiting (the above questions can be asked of the persons present in the environment in which the youth will be visiting), the residential facility should contact the referring worker to discuss potentially canceling the visit, or using things like Skype or FaceTime in lieu of the visit.  If youth are able to go off-campus for the pass/visit, the youth should be screened upon their return with the above three questions.

In addition, all facilities, programs and offices receiving regular in-person contact with members of the public should immediately develop policies to schedule and pre-screen over the telephone all visits by non-client/residents-or-staff entities, including families, attorneys, case managers and social workers, using the three questions above.

• Upon screening, if a potential visitor answers “Yes” to any of the three questions above, please politely instruct them not to visit the facility, program or office until the specific scenario can be further assessed.
• For those potential visitors who answer “Yes” to questions 1 OR 2, but “No” to question 3 (i.e., reports no symptoms of a respiratory infection), please also instruct them to contact their local Department of Health for further direction.
• For those potential visitors who answer “Yes” to questions 1 OR 2, AND also “Yes” to question 3, (i.e., reports having symptoms) please also instruct them to immediately contact their medical provider and Local Health Department, and to call 911 if they are experiencing serious symptoms (e.g., shortness of breath). Please also instruct the screened individual to notify the receiving medical provider and transporter in advance of potential concern for COVID-19.
• If upon screening, the unscheduled visitor answers “Yes” to any of the questions above, ask that they contact their own medical professional immediately. Alternatively, if symptoms warrant (e.g., shortness of breath) they may be referred to the nearest emergency room for immediate attention.
• If facilities/program providers receive unscheduled visitors, either politely instruct them to leave and call to schedule a visit, or screen them appropriately before allowing entrance into the facility/program.
• In all circumstances above, please also instruct the screened individual to notify the receiving medical provider and transporter in advance of potential concern for COVID-19.

PLEASE NOTE – Screening for current residents at facilities or residential programs in which there are DCS/Probation referred youth.

All residential facilities funded, licensed or regulated by DCS should be certain to also screen any incoming residents using the guidance above, and should respond accordingly if a resident is experiencing symptoms and responds “Yes” to questions 1 AND 2 above. If a current or incoming resident can answer “Yes” to questions 1, 2, AND 3:

Provide a mask for the recipient of services/resident;

Isolate the recipient of services/resident in a private room with the door closed if possible and ensure that they are kept separate from other tenants.

A program medical provider should then immediately assess the individual, if possible, or if no qualified program medical provider is available, the person should be asked to contact their own medical professional immediately. The programs should also contact the local Department of Health for further recommendations including transport to their recommended medical facility if necessary. Please also instruct the program to notify the receiving medical provider and transporter in advance of potential concern for COVID-19.  In addition, providers must immediately contact the youth’s referring worker, supervisor, Local Office Director, etc. to ensure that DCS/Probation is aware of this circumstance.

All residential facilities funded, licensed or regulated by DCS should continue to review their own emergency preparedness plans and assess for continued operation in case of an emergency.

All facilities and programs should assess both their facility and workforce capacity to accommodate the potential need for an increased number of isolation rooms and the potential decrease in staffing availability.

If as a result of the above assessment programs need to request changes to the programs or structure, providers must contact DCS Central Office (David Reed at David.Reed@dcs.in.gov or Matt Gooding at Matthew.Gooding@dcs.in.gov)

What is DCS’ stance on campus visits from family, referral sources, CFTM, guardian ad litem, etc.?

The above-mentioned protocols should be followed when visitors come to provider’s campuses.  FCMs and POs continue to have requirements around seeing their youth, and providers should work with these individuals to ensure that all necessary precautions are taken, but these visits, at this at this point, must continue to be allowed. Providers should follow the above guidance for other visitors, including any planned CFTMs that may be scheduled on your campuses.

What is the expectation for court visits? CFTM?

Providers should work with the youth’s referring worker on whether it is safe and appropriate for the youth to attend any scheduled court hearings, and should also work with them to notify the court if it is recommended that there be any deviation from court orders.

Will there be ratio adjustments in the event this is needed?

Any request for a waiver of required ratios should be submitted in writing to DCS Central Office (David Reed or Matt Gooding) for program-specific consideration. These requests should describe how the program will continue to ensure resident safety and meet the behavioral health needs of the youth placed at the facility.

If staff and/or kids are infected, how does this affect referrals and placements?

If providers have any staff or youth who are positive for COVID-19, the provider must immediately notify DCS Central Office (David Reed or Matt Gooding) to discuss next steps (and also follow the above guidance including notifying the Department of Health).  No new admissions should be accepted until authorized by DCS Central Office.

What are the precautions service providers should take when interacting with clients? Is DCS preparing any closures or foreseen issues with billing?

Providers should follow the guidance sent to them on March 10. At this time, DCS does not foresee any issues with billing.

May residential providers temporarily cease supervised visits in the community and require parents to visit on campus to limit youth’s travel in the community and possibly bring illness back to campus and infect others?

Please see previous responses. Providers must work with Child and Family Teams and referral sources to discuss what is most appropriate for a specific circumstance.

CPR/first aid instructors have been told not to have people use the mannequins and have canceled. CPR/First Aid is a requirement for Indiana. Will we be given any leeway to submit a home without first aid? Can we submit a home now and be given a date to have for completion of CPR/First Aid?

If a provider wishes to receive a waiver (even a temporary one) of a required training, they must submit this waiver request in writing to DCS and discuss in the request how they plan to ensure the learning that would have been obtained from this required training will still occur.  Requests for such waivers should be submitted to the assigned DCS licensing worker.

Will CFTMs be conducted electronically so as to maintain the appropriate “social distancing?”

See previous responses. If there are no identified specific coronavirus risks, CFTMs can continue to occur following the established precautions that have been sent to providers previously.  Specific Child and Family Teams should discuss amongst themselves what the best format is for CFTMs for their team. If a team feels that conducting a CFTM electronically is most appropriate, this is allowable.

What information we should look for with our children or families when assessing if we should limit/stop weekend home visits or even outside visitors to campuses?

Please see above responses about appropriate screening. Any deviation from planned visits/passes/etc. should be discussed with the referring worker, with the above guidance informing how decisions should be made around these circumstances.

When do we pull kids from their jobs? For instance, are we required to prohibit them from going to a job in the community if there is some connection between the location of their job (a gas station for instance) and a coworker or customer who is in quarantine? Short of a direct connection, are we to just rely on a prudent parenting standard?

If there are specifically identified coronavirus risks associated with a youth’s employment, this should be discussed with the youth’s referring worker (FCM or PO) to determine if the youth should continue to work assigned shifts. If there are no clearly identified risks, the youth should be educated on proper coronavirus precautions that have been previously detailed (see the Indiana State Department of Health website for additional details on these precautions), but should be allowed to continue to work.

When do we pull youth from community outings? Is there a size of crowd we should avoid having them interact with?

Please see above responses. Also, please educate youth on coronavirus precautions described in previous correspondence and also provided by the CDC listed here.

If a resident does contract the virus, how do we pull off a quarantine? Is staying in their room sufficient quarantine or would they be expected to be in a separate unit?  

Please see responses above, and also contact DCS Central Office (David Reed or Matt Gooding) to discuss additional steps should a resident be positive for coronavirus. Providers must also notify the Indiana State Department of Health. Contact information for ISDH can be found here.

Any thoughts on when we would simply stop home visits all together? What if someone in the household has a fever? If they have no known connection to the coronavirus is a fever alone enough to stop visits?

DCS is not planning to stop home visits altogether, as we must all continue to work to ensure the safety and well-being of our children.

Is it possible to get permission from DCS on a case-by-case basis to implement video interface/phone conferences (so long as any federal obligations are met) to continue services? If so, what level DCS staff member can authorize this? An FCM, supervisor, LOD, other?

Please see above responses. Note:  Remote interventions such as teleconference, skype, “FaceTime” and telephone may be used with these circumstances, and may be billed as if they are conducted face-to-face.  As many DCS/probation cases present with child-safety concerns, however, providers must notify the referring worker that they intervening in this fashion and ensure that the referring worker is comfortable with this. Providers must also communicate regularly (at least weekly) with the referring worker about these types of cases, and discuss when regular face-to-face contacts should resume.

Communication around the approved usage of remote contacts/interventions must be in writing and approved by the referring worker, and these remote contacts should only be requested if there are clearly identified coronavirus risks.  If there are not clearly identified coronavirus risks, home visiting should continue with the previously described precautions being followed.