Screen: Review Detail (REVD)
Program Code: Paragraph 8600 and 8700

Frequency Report: 1995 = 3; 1998 = 1; 1999 = 1; 2000 = 22; 2001 = 24; 2002 = 513

The program code checks for periodic review dates that occur after the latest removal date. It also moves spaces if the removal date is less than 6 months.

The State's program code should pick up a review date even if child has been in care for less than six months. Post site-visit analysis: State modified paragraph 8600 and removed the code to move spaces if the child has been in care for less than six months.

The program code checks for a “501, service/eligibility” review. The State indicated these are not periodic reviews and the code is no longer used. Recommend that the State remove this routine. Post site-visit analysis: State removed paragraph 8700, which checked for the “501” reviews.

The State needs to investigate why there are so many older dates reported for this element. Based on the case file findings, many of these children have been in care for more than six months and some up to ten years.

Case file review: 22 (33%) of the records analyzed did not match what was reported in AFCARS. There were 12 records that indicated “old” review dates reported to AFCARS. Nine records had review dates prior to 2003.

Screen: Person Detail (PERD)
Program Code: Paragraph 6450.

The frequency report indicates there are 471 (6%) records missing race information.

The data entry screen has fields for each of the minimum Federal race categories. Case workers can select all that apply.

The field for “unable to determine” is used for both race and ethnicity. The “unable to determine” field for race should not be used for ethnicity. Post site-visit analysis: The entry field has been modified, the “unable to determine” field will apply to race only.

Screen: Person Detail (PERD)
Program Code: Paragraph 6450.

The frequency report indicates the number of responses for “yes” is 420 (5%) and 7,190 (87%) for “no.”

The entry screen has only the option “yes” for workers to enter. The program code maps blanks to “no.” Also, the “unable to determine” field for race is used for ethnicity.

The State needs to modify the entry screen to allow for the options of “yes,” “no,” and “unable to determine.” Post site-visit analysis: A new code table was created and the program code was modified. The screen has been modified and “no” and "unable to determine” were added as options.

Screen: Special Needs Detail (SPND) and Client Maintenance Screen
Program Code: Paragraphs 6100 and 6200

The frequency report indicates there are 2,880 (35%) responses for “yes” and 5,411 (65%) for “no”.

KACT = Clinical assessment clinical team.

Initial health screenings are conducted within 30 days of a child's removal.

The program code initializes this field to “2.” This is a derived field from the disability category fields (FC #11-15). If none of the categories are selected, then the response remains a “2.” There is not an option of “no” or “not yet determined” for the worker to select. This approach may be giving a false “no” response. The State needs to create a way for workers to indicate whether a child has been examined by a doctor and if any diagnoses were made or not. Or, if the child has not been seen by a doctor, or the worker has not yet received the evaluation, then the worker should select “not yet determined.”

Screen: Special Needs Detail (SPND) and Client Maintenance Screen
Program Code: Paragraphs 6100 and 6200 and Program S472N846 (International Classification of Diseases, version 9 (ICD - 9) codes)

The SPND screen lists the following: Blind or Visually Impaired; Deaf or Hard of Hearing; Physically Disabled; Learning Disability; Mental Retardation; Emotionally Disturbed; Medical Condition; Special Medical Considerations; Alcohol Abuse; and, Drug Abuse. The case workers indicate all that apply with an “X.”

The ICD-9 information is accessed from the “medical summary screen.” This screen also contains information on immunizations.

The State has mapped all ICD-9 codes into AFCARS, but all of the codes are not appropriate for AFCARS reporting, especially those for the “other medical” category. The State needs to remove any disease that is treatable or not considered debilitating. In addition to the examples listed in the regulation, the State should refer to the AFCARS “Disability/Special Needs Code Table” for additional information. It can be found on the Children's Bureau web site at: http://acf.hhs.gov/programs/cb/dis/afcars/resources.

#15: The data entry screen has an option of “special medical consideration.” It is an appropriate category for the adoption “special needs” category, but not for the foster care collection of “disabilities.” The State should not map this item for foster care reporting. Instead, add more specific disabilities and map the information to the appropriate category. Alcohol and drug abuse should not be mapped to AFCARS.

Screen: Client Detail (CLTD)
Program Code: Paragraph 8950

The frequency report indicates 6,939 (84%) records marked as “unable to determine.”

This field was added to the “client detail screen” October, 2002.

The State needs to address data clean-up for this element. Staff should use the six-month periodic review as an opportunity to update the child's record.

Case file review: 33 (70%) of the records analyzed did not match what was reported in AFCARS and 42 are questionable. Many of the errors indicated “unable to determine” in AFCARS, but it was clear the child had never been adopted.

Screen: Client Detail (CLTD)
Program Code: Paragraph 8975

The program code calculates the age by subtracting child's date of birth from the date the adoption was legalized and then maps it to the appropriate age group.

See notes for foster care element #16.

“Services List” shows history of services, placement provider number, start and end dates.

Screens: Foster Care Detail (FOSD) and Adoption Detail (ADOD).
Program Code: Paragraph 3800

The program code selects the first “service start date.”

Case file review: 26 (34%) of the records analyzed did not match what was reported in AFCARS. The majority of the errors indicated an earlier date of removal than what was reported in AFCARS.

Screens: Services List (SERL) and Foster Care Detail (FOSD).
Program Code: Paragraphs 4000 and 8900

The program code checks for a “placement exit date” with an exit reason of “961, return home,” “962, transfer custody to other parent;” or “964, placement with suitable person” for a new foster care service that starts after the last return home. The program code needs to be modified to look at all the reasons for exit from care to determine the date of discharge from the last removal reason and the number of removals.

Case file review: 14 (21%) of the records analyzed did not match what was reported in AFCARS. There were three records that had different dates reported for the first and latest removal. However, the number of removals reported to AFCARS was one. The date of discharge from the prior removal episode was also missing. This may be due to the program code not checking all reasons for discharge.

Screens: Services List (SERL) and Foster Care Detail (FOSD).
Program Code: Paragraph 4000 (Discharge exit reason for current removal paragraph 4500)

Code checks for a “placement exit date” with an exit reason of “961, return home,” “962, transfer custody to other parent;” “964, placement with suitable person” with a new foster care service that starts after the last return home. The program code needs to be modified to look at all the reasons for exit from care to determine the date of discharge from the last removal reason and the number of removals. As modifications are made to capture more exit reasons in element #58, this element will also need to be modified.

Case file review: 17 (25%) of the records analyzed did not match what was reported in AFCARS. Three of the error records had different dates reported for the first and latest removal. However, the number of removal reported to AFCARS was one. The date of discharge from the prior removal episode was also missing.

Screens: Services List (SERL) and Foster Care Detail (FOSD).
Program Code: Paragraph 4200
The program code checks for an open foster care service case, then extracts the start date of the most recent removal episode.

When a child that is placed with a relative is moved to a different placement location, the “placement change” is treated as a new removal.

Children that return home and are placed back into foster care prior to six months are reported as new removals and not a continuation of the same foster care removal episode. This should be reflected as a placement change not a new removal.

Post site-visit analysis: ACF reviewed and provided the State comments on draft “SR 99F043.” This outlines the June 30, 2004 changes by the State.

Case file review: 21 (29%) of the records analyzed did not match what was reported in AFCARS; removals were being counted when they were actually placement changes (i.e. relative placements).

Screens: Services List (SERL) and Foster Care Detail (FOSD).
Program Code: Paragraph 3900

The program code checks for an active service date within the report period.

The program code does not use the adoption detail screen if there is a “finalized date.”

The program code does not check the provider to determine date of the current placement setting. Therefore, the date of placement may not be accurate and may be changing when it should not. The State needs to modify the program code to check for providers and if the status of the provider changes the date should not change.

The date of placement should reflect the date a child enters “runaway” status or when a child is returned home while still in the agency's responsibility for care, placement or supervision (placement setting of “trial home visit”).

Screens: Services List (SERL) and Foster Care Detail (FOSD).
Program Code: Paragraphs 4000 and 4300

The program code does not count placements based on the provider. Therefore, the number of placements may be over counted. The placement count should not include a return to the same placement setting from a “runaway,” “trial home visit,” or “acute stay hospitalizations.” The State needs to modify the program code to check for providers.

Case file review: 20 (28%) of the records analyzed did not match what was reported in AFCARS.

Screen: Client Detail (CLTD)
Code table: LGL - Legal Status of client
Program Code: Paragraph 4600

The rating factor and findings were changed due to analysis of the case file review findings and further discussions with the State staff.

This is a mandatory field. The State must have a court order to remove a child. Emergency removals are done by the police. State policy does allow voluntary placement agreements for 90 days only, as of July 1, 2003.

The program code extracts the current “legal status” that is entered by the worker. Prior legal status information is stored in the table “TXTHDR.” The program code does not extract data from this table. For example, if a child enters foster care under a voluntary placement agreement and continues in care (either after the 90 days or sooner if necessary) under a court order, the case worker enters the date of the court order in the “legal status” field. The prior status of “voluntary” is stored in TXTHDR. The information reported to AFCARS will now be “court ordered” when it should be “voluntary.” The State needs to modify the code to ensure that the original manner of removal “voluntary” continues to be reported for the child for his/her current removal episode.

Case file review: 5 (8%) of the records analyzed did not match what was reported in AFCARS.There were four records that were reported as “court ordered” and the reviewer indicated the removal was a “voluntary placement agreement.”

Screens: Adoption Detail (ADOD), Foster Care Detail (FOSD) and Removal From Home Detail (REMR).

Program Code: Paragraph 5000 and Program S472N846 (ICD - 9 codes)

The “foster care detail” screen must be completed prior to entering the “circumstances associated with removal.” Case workers indicate the primary removal reason with a “P” and all other reasons with an “X.”

The program code checks the removal reasons on all of the screens listed above. The original removal reasons are not locked and associated with the removal. Removal reasons are getting changed in regard to the placement changes. The State needs to modify and extract this data from the “REMR” screen only and ensure that this information cannot be updated.

The program code is incorrectly initialized to zero. Post site-visit analysis: The program code was modified by replacing the initialization with space and adding to each element an “else” statement for a “does not apply” response.

The mapping forms reference the ICD - 9 table and program code S472N846. This was due to the way the system was designed to look at the various screens. This will be corrected when the coding is changed to look only at the REMR screen. Post site-visit analysis: The State modified the program code S472N846 by removing the sections from working storage, modifying paragraph 4050, deleting paragraph 5020 and 5030; and, modifying paragraph 6010 in reference to these elements.

Case file review: In almost all of the error cases the element should have been marked as “applies” and it was not.

Code is incorrect, should be “166.” Post site-visit analysis: Code mapping corrected.

Case file review: In all of the error cases, the reviewers indicated “does not apply” and the AFCARS record indicated “applies.” This is likely attributable to the incorrect code used in the program.

Screens: Foster Care Detail (FOSD) and Adoption Detail (ADOD).
Code Table: LVL - Level of care
Program Code: Paragraph 5300 for “3,” “4,” “5,” and “6;” 5100 for “7;” 8900 sets value to “1” if the “service type” is “ADOD” and is “pre-subsidy.”

The program code includes “109, same day in/out shelter.” Placements that are less than 24 hours do not need to be reported for this element. Post site-visit analysis: State removed this line from paragraph 5300.

State has shelter care placements that are residential and may house up to 12 children or more. The State is mapping all of these settings to “group home.” Any facility with more than 12 children must be mapped to “institution.”

The program code contains the code “111, relative,” which is on the “preferred placement list” and is mapped to “foster family home, non-relative.” The State indicated the program code should only be extracting information from the “actual placement setting.” Post site-visit analysis: State removed the code “111” from the program code.

Paragraph 5300, LN 17520. The program code maps “pre-adopt” placements to “relative.” State will review this and will get back to CB with an explanation and decision regarding whether to remove or not. Post site-visit analysis: State modified the program code. If the “relative” flag is “yes” and the foster care setting is “3, non-relative foster home” it will re-map it to a “2, relative home.”

AFCARS codes for “pre-adopt,” “relative,” and “non-relative” placements are not set anywhere in the program code. The State's code “100” only refers to “foster home” and does not characterize the specific type of foster home. The State will review this and will get back to CB with an explanation and decision regarding whether to remove or not.

Post site-visit analysis: It appears the only time “pre-adopt” placements are reported are at the time of the finalized adoption. Please confirm with ACF if this is the case. Paragraph 8900 includes the following:
IF SERVIC-CODE-SERV-TYPE = 'ADOD' AND
WS-ADOP-SETTING-SW-Y
...
MOVE 1 TO OUT-FCR-TYPE-OF-PLACEMENT

The State is not reporting non-paid relative placements. As of July 1, 2004, the State will implement a new screen “out of home placement.” This will capture information on children placed with relatives where the agency retains care and placement responsibility. State provided ACF with a copy of the new screen. Post site-visit analysis: ACF reviewed and provided the State comments on draft “SR 99F043.” This outlines the June 30, 2004 changes by the State.

Screen: Initial Assessment Detail (INAD)
Code table: PRM - Permanency plan goals
Program Code: Paragraph 5400. Paragraph 8900: If service type is “ADOD” the goal is set to “adoption.”

Frequency Report: There were 2,746 (33%) records with “case plan goal not yet established.”

The screen from which the code extracts this information is not the most appropriate screen. The worker is required to enter the case plan goal into the system at the time of the initial review, even though it may have been determined earlier. The State needs to evaluate which screen would be most appropriate to enter this information.

Spaces are mapped to “case plan goal not yet established.” This should be mapped to spaces after 60 days.

The State staff indicated this has not always been a mandatory field. Now a case plan goal is required when a case review is entered.

The State is considering adding an alert to the system to remind workers at 60 days that a case plan goal must be established.

Case file review: 20 (27%) of the records analyzed did not match what was reported in AFCARS. The majority of the errors were due to AFCARS indicating “not yet established” and the child had been in care for more than 60 days. Two children had been removed in June 2003, four in February 2003, one in January 2003, and four had been in care for more than a year. Only six cases were correctly reported with a case plan goal “not yet established.”Also, the reviewers indicated in nine records case plan goal should have been “long-term foster care.” In one record what was reported to AFCARS was “guardianship” and in the others the goal was “reunify.”

Screens: Relationship Detail (RELD); Relationship List (RELL); and, Person Detail (PERD)Program Code: Paragraphs: 7000, 7100, 7150, 7300 and 7400

Frequency Report: There were 2,164 (26%) records indicating a “caretaker family structure” as “unable to determine.”

Program code defaults to “unable to determine” and maps missing information to blanks. Post site-visit: Default has been removed from paragraph 7400. Missing data should now be reported as blanks.

Information related to relationship of members in the household and to those involved in the case is recorded on the “relationship detail” screen.

Program code LN7400 - Combinations of dad/mom and step-parent are mapped to “unmarried couple.” State created relationships based on the way the Temporary Assistance to Needy Families (TANF) program looks at household. All possible combinations are not listed. State needs to remove the combinations and extract the family structure from whom the child was removed, similar to the manner used for “foster parent family structure.”

Case file review: 10 (16%) of the records analyzed did not match what was reported in AFCARS. In six of the error cases, the information reported to AFCARS was “unable to determine” and the reviewer found the information. In one of the cases not analyzed the reviewer indicated “mother/stepfather” and the AFCARS information indicated “single male.”

Screen: Person Detail (PERD)
Program Code: Paragraph 7500

Frequency Report: There were 1,894 (23%) records missing a date of birth.

Female is usually first caretaker.

Case file review: 12 (21%) of the records analyzed did not match what was reported in AFCARS. See the notes in the case file findings. In most cases, the reviewers were able to identify the dates of birth of the caretaker. In one instance, there was a date for the caretaker, but the family structure was reported as “unable to determine.”

Screen: Person Detail (PERD)

Frequency Report: There were 5,821 (70%) records missing a date of birth. (Some of these are correct in that there was only one caretaker reported.)

Case file review: 13 (24%) of the records analyzed did not match what was reported in AFCARS. See the notes in the case file findings. In most cases, the reviewers were able to identify the dates of birth of the caretaker. In one instance, there was a date for the caretaker, but the family structure was reported as “unable to determine.”

Screen: Court Detail (FCTD)
Program Code: Paragraph 8800

The rating factor was changed during post-site visit analysis to be consistent with the finding in the adoption file. The State indicated the date the TPR order is filed is what should be reported instead of the hearing date.

Post site-visit analysis: State indicated in the documentation submitted June 25, 2004 the following: “Changed extraction of TPR date for mother and father to pull CRTDTL-DATE-ADJUDICATE (date filed) instead of the court event date.”

Screen: Court Detail (FCTD) and Person Detail (PERD)

State terminates parental rights on legal father only. State does not recognize putative fathers.

The rating factor was changed during post-site visit analysis to be consistent with the finding in the adoption file. The State indicated the date the TPR order is filed is what should be reported instead of the hearing date.

Post site-visit analysis: State indicated in the documentation submitted June 25, 2004 the following: “Changed extraction of TPR date for mother and father to pull CRTDTL-DATE-ADJUDICATE (date filed) instead of the court event date.”

Screen: Provider Person Detail (PRPD)
Program code paragraph number: 6900

Initializes to zero.

Mapping “separated” to “single.” Need to map “separated” to “married.”

Screen: Provider Person Detail (PRPD)
Program Code: Paragraph 6300

The data entry screen has fields for each of the minimum Federal fields. Worker can select all that apply.

The field for “unable to determine” is used for both race and ethnicity. The “unable to determine” field for race should not be used for ethnicity. Post site-visit analysis: The entry field has been modified, the “unable to determine” field will apply to race only.

Screen: Provider Person Detail (PRPD)
Program Code: Paragraph 6300

The entry screen only has the option “yes” for workers to enter. The program code maps blanks to “no.” Also, the “unable to determine” field for race is used for ethnicity.

The State needs to modify the entry screen to allow for the options of “yes,” “no,” and “unable to determine.” The program code needs to be modified to map and extract these options. Post site-visit analysis: A new code table was created and the program code was modified. The screen has been modified and “no” and "unable to determine” were added as options.

Screen: Provider Person Detail (PRPD)
Program Code: Paragraph 6400

The data entry screen has fields for each of the minimum Federal fields. Worker can select all that apply.

The field for “unable to determine” is used for both race and ethnicity. The “unable to determine” field for race should not be used for ethnicity. Post site-visit analysis: The entry field has been modified, the “unable to determine” field will apply to race only.

Screen: Provider Person Detail (PRPD)
Program Code: Paragraph 6400

The entry screen only has the option “yes” for workers to enter. The program code maps blanks to “no.” Also, the “unable to determine” field for race is used for ethnicity.

The State needs to modify the entry screen to allow for the options of “yes,” “no,” and “unable to determine.” The program code needs to be modified to map and extract these options. Post site-visit analysis: A new code table was created and the program code was modified. The screen has been modified and “no” and "unable to determine” were added as options.

The screen requires the worker to do a “look-up” to enter an exit reason. This was done to force the worker to think about the reason for “exiting” a placement and making sure they enter an actual outcome discharge reason.

“Transfer to another agency” is not an option for the State due to organizational structure.

Paragraph number 4500: The program code maps “change in placement,” “level of care,” and “placement with a suitable person” to reunification. Map these codes to “not applicable.” Post site-visit analysis: State changed the mapping of “968, change in placement,” and “969, level of care,” to “not applicable.”

“Placement with a suitable person” is still mapped to “reunification.” This needs to be mapped to “not applicable.”

When a child runs away the agency maintains the placement for 14 days. The State generally maintains an open custody on these children until they age out but may get a court order to discharge them from care and placement responsibility. If this occurs, the worker should record the exit reason as “runaway.” Otherwise, if there still is an open care and placement order, a placement of “runaway” should be mapped to “not applicable” for discharge reason since the child is still in the agency's responsibility for care and placement. Post-site visit analysis: “Runaway is now mapped to “0, not applicable.”

“Independent Living” is mapped to “emancipation” and should be mapped to “not applicable.” This is a service code and not a discharge code. Post site-visit analysis: State changed the mapping of “965, independent living to “0, not applicable.”

State needs to add the value “living with other relative.” Currently, if a child exits care and placement responsibility of the agency these would get recorded as “discharge to a suitable person,” which is mapped to “reunification.”

Post site-visit analysis: ACF reviewed and provided the State comments on draft “SR 99F043.” This outlines the June 30, 2004 changes by the State.

Screen: Monthly Payment Detail (MPAY)
Program paragraph number 8450.

State does use TANF funds for foster care. State is mapping TANF to “none” and it should be mapped to FC element #61.

Post site-visit analysis: Program code change completed.

Screen: Monthly Payment Detail (MPAY)
Frequency Report: Applies = 1,522 (18%); Does not apply = 6,769 (82%)

The State maps “SSBG” to Medicaid, it should be mapped to #65, “none of the above.”
The program code checks for a Medicaid payment instead of eligibility.

Case file review: There were a significant number of records (25%) that the response should have been “applies” according to the reviewers.

Post site-visit analysis: The State made modifications to check for Medicaid eligibility. If the Medicaid flag in the FNDSRC (fund source) table is “yes” then element #63 will be set to “applies.” The State added two new routines, paragraph 7700 and 7500.

Screen: Monthly Payment Detail (MPAY)
Program Code: Paragraphs 8450 and 8900.

See notes in #61 and #63.

Post site-visit analysis: SSBG is now mapped to this element.

Screen: Monthly Payment Detail (MPAY)
Program Code: Paragraph 7900

The program code includes “special payment issuance,” which may include both one-time payments to foster parents as well as other sources of payments for the foster care maintenance payment. State needs to make a modification to only calculate those payments made for foster care maintenance.

Post site-visit analysis: State has modified the program code by removing special issuance payments and is only extracting foster care maintenance payments.

Screen: Person Detail (PERD)
Program Code: Paragraph 2500

The program code only checks for “male.” The State should modify the code by taking out the “else” statement and check for codes of “female.” Post site-visit analysis: Program code at paragraph 2500 modified by removing the “else” statement and directly mapping the codes for “male” and “female.”

Screen: Person Detail (PERD)
Program Code: 3100 and 4550

The data entry screen has fields for each of the minimum Federal fields. Case workers can select all that apply.

The field for “unable to determine” is used for both race and ethnicity. The “unable to determine” field for race should not be used for ethnicity. Post site-visit analysis: The entry field has been modified, the “unable to determine” field will apply to race only.

Case file review: Of the 27 records analyzed there were several that were marked with errors. The most common finding was the reviewer identifying a race for the child and the AFCARS report indicated “unable to determine.” Also, there were a couple instances where the child was bi-racial.

Screen: Person Detail (PERD)
Program Code: 3100 and 4550

The entry screen only has the option “yes” for workers to enter. The program code maps blanks to “no.” Also, the “unable to determine” field for race is used for ethnicity.

The State needs to modify the entry screen to allow for the options of “yes,” “no,” and “unable to determine.” The program code needs to be modified to map and extract these options. Post site-visit analysis: A new code table was created and the program code was modified. The screen has been modified and “no” and "unable to determine” were added as options.

Screen: Special Needs Detail (SPND)
Program Code: Paragraph 3800

Frequency Report: “Yes” = 269 (46%); “No” = 314 (54%). The frequencies for this element are significantly lower than those reported in element #35, “is the child receiving a subsidy?” The number of “yes” responses for that element is 439 (75%)

If no reasons for special needs are selected, this is mapped to “no.”

Case file review: 12 (44%) of the records analyzed did not match what was reported in AFCARS. The most significant finding indicated there was a response of “no” in the AFCARS report, but the response to #35 (receiving a monthly subsidy) was “yes.” The reviewers confirmed that the child was special needs.

Screen: Special Needs Detail (SPND)
Program Code: Paragraph 3800

Frequency Report: Not applicable = 298 (51%); Race = 1 (.17%); Age = 6 (1%); Sibling group = 0; Medical, etc. = 278 (8%)

The screen has fields for each of the categories. There is also an option “delinquent,” which is correctly mapped to “other state defined special needs.” The worker indicates the primary basis with a “P.”

The program code primarily pulls conditions associated with a “medical,” “mental,” “physical,” or “emotional” disabilities indicated in the record.

If no special needs are found, AD element #10 is mapped to “not applicable” and #9 is mapped to “no.” This is giving a false “no” response to these elements.

Case file review: 12 (44%) of the records analyzed did not match what was reported in AFCARS. See the notes for AD element #9.

Screen: Special Needs Detail (SPND) and Client Maintenance Screen
Program Code: Paragraphs and Program S472N846 (ICD - 9 codes)

The SPND screen lists the following: Blind or Visually Impaired; Deaf or Hard of Hearing; Physically Disabled; Learning Disability; Mental Retardation; Emotionally Disturbed; Medical Condition; Special Medical Considerations; Alcohol Abuse; and, Drug Abuse. The caseworkers indicate all that apply with an “X.”

The ICD-9 information is accessed from the “medical summary screen.” This screen also contains information on immunizations.

The State has mapped all ICD-9 codes into AFCARS, but all of the codes are not appropriate for AFCARS reporting for the disability category, especially those for the “other medical” category. The State needs to remove any disease that is treatable or not considered debilitating. In addition to the examples listed in the regulation, use the AFCARS “Disability/Special Needs Code Table” as an additional reference. It can be found on the Children's Bureau web site at: http://acf.hhs.gov/programs/cb/dis/afcars/resources.

Some of the ICD - 9 codes may be appropriate in regard to Adoption element #10, “other State defined special need.” The option “special medical consideration” data entry screen should not be mapped to adoption element #15, but may be mapped to element #10 as “other State defined special need.”

Alcohol and drug abuse could be mapped to adoption element #10, “other State defined special needs.”

The rating factor was changed for this element based on the case file review. The State should ensure that workers enter this data if it is known.

Case file review: 6 (29%) of the records analyzed did not match what was reported in AFCARS. In general, the reviewers found a date of birth and the field was blank in AFCARS.

Screen: Client Detail (CLTD)
Program Code: Paragraphs 6500 and 7500

There is a field on the “client detail screen” for this element that specifies the “marital status of the birth parents at the time of the child's birth.” The program code is pulling the current marital status instead of the marital status at the time of the child's birth. Post site-visit analysis: The program code was modified in paragraphs 6500 and 7500. The program code now checks responses on the client detail screen. Mapping of marital status is correct.

Case file review: 4 (17%) of the records analyzed did not match what was reported in AFCARS. In general, the finding indicated that the reviewer was able to determine the information, but the AFCARS report indicated “unable to determine.”

Screens: Court Detail (FCTD), Person Detail (PERD) and Event List (EVEL)
Program Code: Paragraph 6600

The State indicated that the date the TPR order is filed is what should be reported instead of the hearing date. Post site-visit analysis: State indicated in the documentation submitted June 25, 2004 the following: “Changed extraction of TPR date for mother and father to pull CRTDTL-DATE-ADJUDICATE (date filed) instead of the court event date.”

Screens: Court Detail (FCTD), Person Detail (PERD) and Event List (EVEL)
Program Code: Paragraph 6600

The State indicated that the date the TPR order is filed is what should be reported instead of the hearing date. Post site-visit analysis: State indicated in the documentation submitted June 25, 2004 the following: “Changed extraction of TPR date for mother and father to pull CRTDTL-DATE-ADJUDICATE (date filed) instead of the court event date.”

Screens: Person Detail (PERD) and Relationship Detail (RELD)
Program Code: Paragraphs 4500 and 7550

Frequency Report: There were 23 (4%) of the records with missing data. For adoptive parents, there should not be any missing data.

State statute does not allow for unmarried couples to adopt. One person is the legal adopting parent.

Correction to rating factor was made as a result of post site-visit analysis.

Screens: Person Detail (PERD) and Relationship Detail (RELD)
Program Code: Paragraphs 4500 and 4550

The data entry screen has fields for each of the minimum Federal fields. Worker can select all that apply.

The field for “unable to determine” is used for both race and ethnicity. The “unable to determine” field for race should not be used for ethnicity. Post site-visit analysis: The entry field has been modified, the “unable to determine” field will apply to race only.

Screens: Person Detail (PERD) and Relationship Detail (RELD)
Program Code: Paragraphs 4500 and 4550

The entry screen only has the option “yes” for workers to enter. The program code maps blanks to “no.” Also, the “unable to determine” field for race is used for ethnicity.

The State needs to modify the entry screen to allow for the options of “yes,” “no,” and “unable to determine.” The program code needs to be modified to map and extract these options. Post site-visit analysis: A new code table was created and the program code was modified. The screen has been modified and “no” and "unable to determine” were added as options.

Screens: Person Detail (PERD) and Relationship Detail (RELD)
Program Code: Paragraphs 4500 and 4550

The data entry screen has fields for each of the minimum Federal fields. Worker can select all that apply.

The field for “unable to determine” is used for both race and ethnicity. The “unable to determine” field for race should not be used for ethnicity. Post site-visit analysis: The entry field has been modified, the “unable to determine” field will apply to race only.

Screens: Person Detail (PERD) and Relationship Detail (RELD)
Program Code: Paragraphs 4500 and 4550

The entry screen only has the option “yes” for workers to enter. The program code maps blanks to “no.” Also, the “unable to determine” field for race is used for ethnicity.

The State needs to modify the entry screen to allow for the options of “yes,” “no,” and “unable to determine.” The program code needs to be modified to map and extract these options. Post site-visit analysis: A new code table was created and the program code was modified. The screen has been modified and “no” and "unable to determine” were added as options.

Screen: Provider Person Detail (PRPD)
Program Code: Paragraphs 4500, 5600 and 5800

Initialized to zero.

The State only reports one relationship. The State should modify the program code/screen to allow caseworkers to select more than one relationship.

Screen: Provider Person Detail (PRPD)
Program Code: Paragraphs 4500 and 5800

Initialized to zero.

The State only reports one relationship. The State should modify the program code/screen to allow caseworkers to select more than one relationship.

Case file review: 6 (22%) of the records analyzed did not match what was reported in AFCARS. There were five records that the responses in #30 and #32 were reversed. The reviewer found that the adoptive parent was a relative, but the AFCARS indicate “other non-relative.” There does not appear to be a problem with the program code. This may have been a data entry error.

There were three records that could have been marked as “other relative” in addition to the reported “foster parent” information.

Screen: Provider Person Detail (PRPD)
Program Code: Paragraphs 4500 and 5800

Initialized to zero.

The State only reports one relationship. The State should modify the program code/screen to allow caseworkers to select more than one relationship.

Case file review: There were eight records that “foster parent” could have been selected in addition to what was reported to AFCARS.

Screen: Provider Person Detail (PRPD)
Program Code: Paragraphs 4500 and 5800

Initialized to zero.

The State only reports one relationship. The State should modify the program code/screen to allow caseworkers to select more than one relationship.

Case file review: 6 (22%) of the records analyzed did not match what was reported in AFCARS. There were five records that the responses in #30 and #32 were reversed. The reviewer found that the adoptive parent was a relative, but the AFCARS indicate “other non-relative.” There does not appear to be a problem with the program code. This may have been a data entry error.

There were three records that could have been marked as “other non-relative” in addition to the reported “foster parent” information.

Screen: Adoption Detail (ADOD)
Program Code: Paragraph 2500

The State needs to modify the options for the worker to select for “State of origin” field to ensure that they can report “another State” and “another county.”

Program code: Paragraph 2500

The State hard codes “public agency.” This must be changed in order to collect those adoptions done by a private agency. The State must be able to report all AFCARS values. This may need to be a field on the screen.

Screen: Adoption Detail (ADOD)
Program Code: Paragraphs 2200 and 2500

Initialized to “yes.” Remove the initialization.

The program code does not check for a Medicaid-only subsidy. The State will the modify code to check for Medicaid-only subsidies.

Post site-visit analysis: The initialization to “yes” in paragraph 2200 was removed and a new paragraph 6900 was added to check for Medicaid-only subsidies.

Case file review: 5 (19%) of the records analyzed did not match what was reported in AFCARS. In the error cases, the response in AFCARS was “no,” but the reviewer found an adoption agreement with an amount specified.