Frequently Asked Questions

Service Package Details

Are all Child Placing Agency (CPA)/Foster Family Home T3C Service Packages eligible for the Add-On Services?

No. The Short-Term Assessment Support Services Package is not eligible for the Add-On Services.  

Are all CPAs and General Residential Operations (GROs) eligible to provide all Service Packages and Add-On Services?

No. CPAs are only eligible to provide the 9 Support Services Packages, including T3C Basic Foster Family Home Support Services, and the 3 Add-On Services. GROs are only eligible to provide the 9 Services to Support Community Transition Packages in GRO Tier I, including T3C Basic Childcare Operation, and the 6 Stabilization Services Packages in GRO Tier II.   

Will GRO facilities be able to provide more than one Service Package?

Yes. They can become Credentialed to provide as many Service Packages as they would like, so long as they meet all the qualifications for providing each of those Service Packages.

What Service Packages will Emergency Shelters be eligible to apply to provide?

The GRO Service Package that most closely aligns with the services offered by Emergency Shelters in the current system is the Tier I: Emergency Emotional Support & Assessment Center Services.     

Will foster homes be able to provide more than one Service Package?

Yes, as long as the CPA has been Credentialed to provide those Service Packages and Add-Ons, and the CPA has Credentialed the foster home to provide those Service Packages and Add-Ons according to their approved policy.

Are there supposed to be differences between the current Contract and Open Enrollments for Treatment Foster Family Care and QRTPs, and the T3C Treatment Foster Family Care and Tier II GRO Service Package requirements?

Yes, there are some minor differences.

Is Tier I considered Treatment services?

This varies by Service Package, but for Tier I the GRO must be able to provide Treatment Services for the following Service Packages:

  • Sexual Aggression/Sex Offender Treatment Services to Support Community Transition
  • Substance Use Treatment Services to Support Community Transition
  • Emergency Emotional Support & Assessment Center Services
  • Complex Medical Needs Treatment Services to Support Community Transition
  • Intellectual or Developmental Disability (IDD)/Autism Spectrum Disorder Treatment Services to Support Community Transition
  • Human Trafficking Victim/Survivor Treatment Services to Support Community Transition
  • Mental & Behavioral Health Treatment Services to Support Community Transition
Can you clarify the time frames for children that are 5 years old for the Short-Term Assessment Support Services Package?

For children age 5 and under, the CPA must coordinate and ensure that comprehensive assessments, evaluation, screenings, and treatment services are provided within 21 days of admission, including administering the CANS 3.0 Assessment. For children over the age of 5, the CPA must coordinate and ensure assessments and services are provided within 30 days of admission, including the CANS 3.0 Assessment. The maximum length of service and stay is 30 days for children age 5 and under. The maximum length of service and stay for children over the age of 5 is 45 days, with an option for one 15-day extension.   

What is the Logic Model?

A graphic depiction, developed by the provider, that presents the shared relationships among the resources, activities, inputs, outputs, outcomes, and impact for each Service Package and/or Add-On Service. A Logic Model depicts how the provider’s program will work, what it is expected to achieve, and identifies the components that will be used to inform provider program improvements through the continuous quality improvement process and is intended to change through this process.

Will you include resources or a list in the next Blueprint release that tell which treatment models are considered Evidence-informed?

At this time, DFPS is not intending to publish a listing of Evidence-informed Treatment Models in the April 2024 T3C System Blueprint. The T3C System is intentionally designed to allow providers flexibility in identifying the Evidence-informed or Evidence-based Treatment Model or Models that best serve as the framework or foundation for the agency or operation’s particular program based on the custom needs of the population served.

For the packages designed for those victims/survivors of human trafficking one of the training requirements states: "A Universal Human Trafficking Prevention Training specifically designed for victims/survivors of Human Trafficking is required for all staff and Direct Delivery Caregivers." Could you elaborate on what is meant by this?

This was to distinguish the fact that the needs of children, youth, and young adults that have been victims or are survivors of Human Trafficking-have different needs that cannot be addressed by the “Universal Human Trafficking Prevention Training for all staff and Caregivers” that is being designed by DFPS, they require something more specialized to prevent re-victimization.

Can the Program Director/Treatment Director serve multiple service packages in the same respective role if they meet the requirements for each of those service packages?

Yes. The individual fulfilling the Staffing Requirement of the Program Director or the Treatment Director specific role for one Service Package can also fulfill the same role for other Service Packages at the same operation, as long as the individual meets all of the requirements/ qualifications in the Blueprint .

What Service Package would the biological child of a youth or young adult who is parenting and is placed in the Tier I: Services to Support Community Transition for Youth & Young Adults who are Pregnant or Parenting Service Package have?

In terms of the biological child/children, who is placed with the youth or young adult in the Tier I: Services to Support Community Transition for Youth & Young Adults who are Pregnant or Parenting Service Package, the rate for the youth’s placement already includes funds intended for the care and maintenance of their child.

If a teenager is in her third trimester of pregnancy, will she be categorized under the Tier I: Complex Medical Needs Treatment Services to Support Community Transition or Tier II: Complex Medical Services to Support Stabilization while residing in a general residential facility?

The youth or young adult’s optimal Service Package would be informed by the CANS 3.0 Assessment, the Application for Placement, and ultimately the knowledge and expertise of the youth’s permanency planning team.

If a provider is not credentialed for the Kinship Services Add-On, can the agency still license kinship families to provide Basic Foster Family Home Services? Or is the Add- On a requirement for all Kinship homes that are licensed?

Yes, as long as the CPA is credentialed for the T3C Basic Foster Family Home Support Service Package, they can still credential & license kinship families to provide that specific package – the Kinship Caregiver Support Add-On is not a requirement in order to license kinship homes, it is just intended as an optional added benefit for CPAs that have programming and are Credentialed to provide the Kinship Add-On Service.

Does the required paid leave for all Direct Delivery Caregivers include part-time employees?

The T3C System Blueprint states “The General Residential Operation must have a staff benefit package that, at a minimum, includes paid annual vacation and sick leave for all Direct Delivery Caregivers and/or Cottage Parents to support wellness and retention”. This was intended to support full-time (40 hours/week) Caregivers. However, providers are not prohibited from including part-time Caregivers in the staff benefit package.

In the T3C System Blueprint, both the GRO-Tier I and Tier II Service Packages state “The GRO must have a customized daily Recreation Schedule that supports the physical, social, and emotional well-being needs of children in a manner that is age and developmentally appropriate, and consistent with the operation’s Treatment Model.” Does that mean customized for the individual child, like what is required for a child receiving Treatment Services under Minimum Standards, or does that mean customized to be appropriate for all of the children receiving a particular Service Package?

This refers to a Recreation Schedule that is specific to the population of children served by a single Service Package, which is customized to support their unique physical, social, and emotional well-being needs. If an individual child qualifies for Treatment Services under Minimum Standards, the provider would need to have a Recreation Schedule that is personalized to that individual child’s needs in compliance with Minimum Standards, which may include aspects of the Recreation Schedule customized for the population of children served under that child’s Service Package. Further questions on ensuring compliance with Minimum Standards should be directed to the provider’s Licensing Representative.

Why isn’t “Childcare Services” identified as a required Programmatic Service type under the Permit Services for all of the Service Packages in the T3C System Blueprint?

All residential operations permitted by HHSC-CCR have to provide “Child Care Services". It was not listed under Permit Services, because it is required for all Permit Types.

The GRO Service Packages require the residential provider to have Permit Services for Transitional Living under the Programmatic Services if the provider will accept youth age 14 and older. Isn’t that counter to the intent when a child needs a more structured treatment program, particularly for the GRO- Tier II Service Packages?

The inclusion of Transitional Living as a part of the Permit Services offers assurance that the operation has the skill, knowledge, and experiential learning programming available, as a part of the all-inclusive Service Package to meet the needs of youth while they are in the provider’s care. While Transitional Living is a Permit Programmatic Service required to become Credentialed to provide the Service Package to youth 14 and older, it does not serve as the entire basis for the Package. Standards and the T3C Blueprint emphasize adjusting/adapting transitional living services based on the custom needs of the child, which may vary based on age, development, length of stay, clinical needs, supervision needs, and where the individual youth is in relation to their own treatment. Providers are encouraged to reach out to their Licensing Representative if they have questions about how best to structure their program and policies to comply with all of the relevant Minimum Standards.

What does care look like under T3C?

What are the required child caregiver ratios?

The Licensing Minimum Standards include the mandated child to staff caregiver ratios. T3C includes ratio guidelines that informed the rate methodology and vary based on an operation’s specific Evidence-informed Treatment Model, and dependent on the complexity of the caseload.

Can provider case managers have dual roles, i.e. a child’s case manager can also act as the child’s aftercare case manager once the child is discharged?

Yes.

Some service packages have expectations around therapists per a specified number of children. If the therapists are engaging in Medicaid billable activities, what is accounted for in the rate?

Licensed therapists are included in many of the Service Packages to oversee treatment and service planning for children, youth, and young adults.

Credentialing Process

Will a residential provider have to undergo a separate Credentialing process with DFPS and the SSCCs (Single Source Continuum Contractor), or even with each SSCC?

No. DFPS is in the process of establishing a single-streamlined Credentialing process, where once Credentialed, the provider will be eligible to provide the distinct Service Package(s) to any child or youth in DFPS Conservatorship, or young adult in Extended Foster Care. Separate from the Credentialing process, providers will still be required to enter into contracts with DFPS and/or the SSCCs to deliver the services.

Will DFPS have to review and credential each of a CPA's homes?

No. Once a CPA becomes Credentialed to provide one or more of the Service Packages and/or Add-On Services, the organization will be required to have a process (which will be evaluated as a part of the CPA’s Credentialing process) in place to assess individual foster homes and Caregivers to provide the CPA’s Credentialed services. 

Do all foster homes have to be Credentialed for T3C Basic Foster Family Home Support Services, as well as any additional Service Packages that they actually want to provide?

No. Foster homes providing the Short-Term Assessment Support Services and T3C Treatment Foster Family Care Support Services Packages are not required to be Credentialed in T3C Basic Foster Family Home Support Services.

Can a foster home be Credentialed to provide the T3C Treatment Foster Family Care Services Package, the Mental & Behavioral Health Support Services Package, and the Human Trafficking Victim/ Survivor Support Services Package, depending on the referrals they receive?

Yes, so long as the CPA has been Credentialed to provide those Service Packages, and the CPA has Credentialed the foster home to provide those Service Packages according to their approved policy.

Do all GRO Tier I operations have to be Credentialed for T3C Basic Child Care Operation Service Package, as well as any additional Service Packages that they actually want to provide?

No.

Does a residential provider have to get Credentialed to provide Supervised Independent Living (SIL) Services?

No.

Does T3C follow current minimum standards?

Yes. The Permit Type(s) and Permit Service(s) are based on current RCCR (Residential Child Care Regulation) Minimum Standards requirements and are included to show what type of Permit and/or Services would be required to become Credentialed to provide a particular Service Package. 

Do Add-On Services need to be listed on the Permit?

Yes. In order to become Credentialed the Child Placing Agency will need their Permit to reflect the corresponding Permit Services as listed for the particular Add-On Service in the T3C System Blueprint.

Will providers need new permits?

A new permit is not required, unless the provider is seeking to become Credentialed for a Service Package(s) that requires a different type of permit than what the organization is operating under today.

Are new policies and procedures required for T3C?

Yes. Updated or revised policies/procedures will need to be submitted as part of the Credentialing process.

CANS 3.0 Assessment

Who administers the CANS 3.0 Assessment?

The SSCC or DFPS (in areas not yet under Community-Based Care) will be responsible for administering the CANS 3.0 Assessment.

How will providers know the results of the CANS 3.0 Assessment?

The enhanced CANS 3.0 Assessment results will continue to be entered into eCANS by the CANS Assessor staff and will be accessible to medical and behavioral health providers through STAR Health, as well as residential provider staff with Health Passport access.

When is the CANS 3.0 Assessment completed?

All children ages 3 years and older will receive an initial CANS 3.0 assessment within 30 days of removal, and annually thereafter. For children receiving therapeutic services, a CANS 3.0 assessment will be required every 90 days from the date of the initial CANS 3.0 assessment. A CANS 3.0 assessment will also be required at the time of a child’s placement change or at the request of the SSCC or DFPS (if still under legacy) caseworker.

Is the CANS 3.0 Assessment recommendation for a Service Package the sole determining factor for where the child is placed?

No. When determining placement for a child under T3C, the process considers the following:

  • The CANS 3.0 Assessment, which will provide a recommended Service Package;
  • The child’s removal affidavit and current Application for Placement, which will provide more details on the child’s needs, history, and family functioning; and
  • The knowledge and professional judgment of the SSCC or DFPS staff working to secure placement based on the individual child’s needs and best interest. 
What happens if a child, who is brand new to conservatorship, is placed under a Service Package to meet a particular need that was identified in the child’s Application for Placement, but the CANS 3.0 Assessment recommendation does not match that Service Package?

The CANS 3.0 Assessment will identify the Service Package recommendation based on the child’s most challenging primary need; if the CANS 3.0 Assessment results in a recommendation that does not match the initial Service Package selection for the child’s placement, then:

  • First it needs to be determined whether the current residential provider is Credentialed for the recommended Service Package. If so, then the child will remain in the same placement, but the Service Package can be updated to match the recommendation.
  • If the child’s current placement is not Credentialed to provide the recommended Service Package, then the DFPS or SSCC staff and the child’s various stakeholders need to determine whether remaining in the current placement is in the child’s best interest, or if a different placement should be sought to better meet the child’s needs.

Making the Transition

Under the T3C System, will General Residential Operations and Foster Family Home no longer be reimbursed according to the child’s Level of Care?

That’s correct. DFPS will no longer reimburse the SSCC or DFPS Residential Contractors in accordance with the Service Level System.

When do providers need to start planning the transition?

Providers should initiate the planning process now.

Is the T3C System Blueprint the Contract requirements for residential provider operations to provide T3C?

The T3C System Blueprint is not intended to replace or encompass all contractual terms and conditions, but it does lay out the framework and parameters that will be requirements when they are incorporated into the DFPS RCC Contract and the DFPS-SSCC Contracts.

Does a residential provider have to use the Universal Human Trafficking Prevention Training created by DFPS and disseminated through a "Train the Trainer" model?

No, providers may choose to adopt this model and train their staff and Caregivers on the Universal Training, or they may submit for review and approval, as a part of the Credentialing process, a different model and training that they intend to use to meet this requirement under T3C.     

Can a residential provider still utilize a Treatment Model that they have developed?

Yes. The provider’s Treatment Model can be one that they have developed independently or one that they have purchased, so long as it is Evidence-informed and meets the core elements identified throughout the T3C System Blueprint for each Service Package for which the provider becomes Credentialed.  The T3C Treatment Model should be based on certain qualifying assumptions around the specific population (as defined by the Service Package and/or Add-On Service(s)) served and must be customized to treat and provide care based on these unique needs.  All provider staff and Caregivers must be trained in and actively practice the organization’s Treatment Model. 

The T3C System Blueprint emphasizes that therapy services should be authorized and paid for through STAR Health, but can a residential provider have the majority of therapists utilized on staff and pay them a salary or contract directly with them?

Medicaid eligible services should be sought through STAR Health.

Can a residential provider continue to utilize Microsoft Word and Excel documents through the operation’s shared Google Drive as their Information Technology (IT) System?

Residential providers are required to have an Information Technology (IT) System(s) that allows for data collection to support quality assurance, Continuous Quality Improvement, case management documentation, billing/invoicing, reporting, and child-level outcome tracking processes. The provider must have the ability to track placement referrals, admissions, and discharge data by child, youth, or young adult, broken out by referral source (whether SSCC or DFPS), by the number and percentage of referrals that did and did not result in admission, the reasons for denial of admissions based on referrals, and for children that were admitted, the average Length of Service, based on the time from admission to discharge.

What does the transition of CPAs and their Foster Homes look like?

During the transition, DFPS will maintain a centralized Credentialing system and CPAs, once Credentialed by DFPS for the provision of certain Service Packages, will then be able to utilize their approved policy to Credential each of their foster homes for one or more Service Packages, based on the individual foster home’s specialty or interests. 

How are CPAs with multiple branches supposed to address the Generally Appropriate Staff to child ratios? Does each branch need to meet that same approximate staff ratio for each Service Package, or does the total number of all specific staff positions that serve that Service Package across all branches need to meet that same ratio?

It is based on the total number of children, youth and young adults who the CPA serves in a certain Service Package(s) across all branches.

Will T3C completely replace the Service Levels System?

Yes.

Will Providers need new DFPS contracts?

The plan is for DFPS to amend DFPS contracts with Residential Contractors and SSCCs to include the Service Package(s) and Add-On Service(s) requirements based on the type(s) of service(s) the individual provider is Credentialed to provide.

How long does it take for a residential provider to obtain an additional Permit Service in order to be eligible for offering a Service Package?
The Permit process is managed by the HHSC-Child Care Regulation Division, so DFPS encourages providers to initiate the process by reaching out to their Licensing Representative to discuss the addition. HHSC-CCR estimates that the process takes an average of a month for review and approval.

The Placement Process

Once a residential provider is Credentialed, will all children who are already placed under that provider automatically convert from a Service Level to a T3C Service Package?

 Once a provider is Credentialed in one or more service packages, all of the children placed under the provider will need to receive a CANS 3.0 Assessment; CPAs will have an additional step of Credentialing all of their foster homes for any or all of the Service Packages that the CPA is Credentialed to provide, according to the CPA’s approved policy.  If the child, youth, or young adult’s CANS 3.0 Assessment recommends a Service Package that is not offered in the current placement, the SSCC or DFPS permanency planning team and provider will work together to determine the appropriate Service Package.

So, can a child remain placed with the same residential provider and be transitioned to T3C when the provider becomes Credentialed, without having to move?

Yes.

When a child is brand new to conservatorship, what Service Packages would be eligible to accept the child before the CANS 3.0 Assessment is complete?

T3C envisions that most children coming into care will be placed in a foster home Credentialed for T3C Basic Foster Family Home Support Services or Short-Term Assessment Support Services, or if GRO services is the preference, then either T3C Basic Child Care Operation or Emergency Emotional Support & Assessment Center Services. However, if there are specific details of the child’s needs in the Application for Placement that indicate an apparent need for a particular Service Package, for example a Complex Medical Needs or Medically Fragile Support Services foster home or a Human Trafficking Victim/Survivor Treatment Services to Support Community Transition Service Package GRO, then the DFPS or SSCC staff can work with the Placement Team to identify an appropriate provider .

Will SSCC’s still receive blended rates and be able to determine rates for their network providers for children that are placed with network providers that are not yet Credentialed to provide T3C?

DFPS will reimburse the SSCC the methodological rate for the corresponding Service Package. The SSCC’s will continue to negotiate the terms and conditions of their contracts, including customized rates with their network providers.

Can a child that qualifies for Treatment Services under Minimum Standards be placed in either a Support Services Package in a foster home or a Services to Support Community Transition Package in a GRO Tier I?

Yes.