PROCEDURAL CHANGES TO EXCEPTIONAL FAMILY MEMBER PROGRAM (EFMP)
Date Signed: 6/1/2010 | MARADMINS Number: 308/10
MARADMINS : 308/10
R 011416Z JUN 10
UNCLASSIFIED//
MARADMIN 308/10
MSGID/GENADMIN,USMTF,2007/CMC WASHINGTON DC MRA MR//
SUBJ/PROCEDURAL CHANGES TO EXCEPTIONAL FAMILY MEMBER PROGRAM (EFMP)//
REF/A/MSGID:DOC/MCO P1754.4A/YMD:19970410//
REF/B/MSGID:DOC/MARADMIN 0068 09/040416ZFEB2009//
NARR/REF A IS MCO P1754.4A, EXCEPTIONAL FAMILY MEMBER PROGRAM SOP.  REF B IS MARADMIN 0068/09, PROCEDURAL GUIDELINES FOR DELIVERING RESPITE CARE FOR MARINE FAMILIES ENROLLED IN THE EXCEPTIONAL FAMILY MEMBER PROGRAM WHO REQUIRE ASSISTANCE WITH ACTIVITIES OF DAILY LIVING AND WHO ARE IMPACTED BY THE GLOBAL WAR ON TERROR (GWOT)//
POC/R. LAPORTE/PROGRAM MANAGER/UNIT:HQMC MRY-1/-/TEL:DSN 278-0298
/EMAIL:RHONDAVENA.LAPORTE@USMC.MIL//
GENTEXT/REMARKS/1.  BACKGROUND. USMC IS SENSITIVE TO EFMP FAMILY NEEDS.  TO HELP ENSURE A STEADY AND SEAMLESS CONTINUUM OF CARE AND SIMULTANEOUSLY ALLOW THE MARINE TO MEET HIS/HER CAREER OBLIGATIONS, RESPITE CARE IS PROVIDED TO ENROLLED FAMILIES.
2.  SITUATION. THIS MARADMIN IS AMPLIFYING PROCEDURAL GUIDELINES IN SUPPORT OF MARADMIN 0068/09 AND MCO P1754.4A, EXCEPTIONAL FAMILY MEMBER PROGRAM POLICY. THE EFMP RESPITE CARE PROGRAM IS INTENDED TO REDUCE STRESS ON SPONSOR FAMILIES BY PROVIDING TEMPORARY, SHORT DURATION REST PERIODS FOR FAMILY MEMBERS WHO CARE FOR THOSE WHO HAVE SPECIAL NEEDS.  ALL EFM SPONSORS WHO REQUEST USMC EFM FAMILY SUPPORT ARE ELIGIBLE FOR UP TO 40 HOURS OF RESPITE CARE PER MONTH, PER FAMILY, AT AUTHORIZED REIMBURSEMENT RATES.  RESPITE CARE PROGRAMS FUNDED BY STATE AND LOCAL AGENCIES OTHER THAN THE ARMED SERVICES, WILL NOT BE COUNTED AGAINST THE USMC EFMP RESPITE CARE PROGRAMS MONTHLY ALLOCATION OF HOURS. RESPITE CARE POLICIES ARE OUTLINED BELOW TO IMPROVE THE MARINE CORPS CONTINUUM OF CARE FOR ENROLLED FAMILIES.  IT IS RECOGNIZED; HOWEVER, THAT RESPITE CARE IS NOT REQUIRED BY ALL EFMP ENROLLED FAMILIES.
3.  CONCEPT OF OPERATIONS.
A.  RESPITE CARE PROGRAM DELIVERY. THE INSTALLATION EFM PROGRAM MANAGERS FACILITATE THE EFMP RESPITE CARE PROGRAM FOR FAMILIES WITH TWO BROAD RESPITE CARE OPTIONS.
(1)  AN INSTALLATION REIMBURSEMENT RESPITE CARE PROGRAM THAT CAN BE USED BY ALL LEVELS OF RESPITE CARE NEEDS.
(2)  AT AVAILABLE LOCATION(S), A NATIONALLY CONTRACTED RESPITE CARE PROGRAM TO ASSIST EFM FAMILIES WHO REQUIRE SPECIALIZED SUPPORT OR SKILLED NURSING CARE RESPITE.  NATIONAL RESPITE CARE IS DESIGNED TO SUPPORT LEVEL THREE AND FOUR MEMBERS ONLY AS DEFINED IN PARAGRAPH G.  NATIONAL RESPITE CARE CANNOT BE USED IN CONJUNCTION WITH INSTALLATION REIMBURSEMENT.  WHERE NATIONALLY CONTRACTED RESPITE CARE IS PROVIDED, INSTALLATION EFM PROGRAM MANAGERS WORK DIRECTLY WITH THE LOCAL CARE PROVIDING AGENCY TO REFER FAMILIES AND ENSURE THAT SERVICES ARE USED APPROPRIATELY.
B.  FAMILIES RECEIVE UP TO 40 CLOCK HOURS PER MONTH OF RESPITE SUPPORT AT AN HOURLY COST DESIGNED TO INCLUDE AGE-TYPICAL SIBLINGS IF NEEDED.  HOUR COUNTS DO NOT VARY IF MORE THAN ONE CHILD IS SUPPORTED.
C.  APPROPRIATED FUNDS ARE AUTHORIZED FOR THE INSTALLATION REIMBURSEMENT AND THE NATIONALLY CONTRACTED RESPITE CARE PROGRAMS.  RESPITE CARE USES THE UNIFORM FUNDING AND MANAGEMENT (UFM) PRACTICE IN THE EXECUTION OF APPROPRIATED FUNDS.
D.  INSTALLATIONS ESTABLISH PROGRAM PROCEDURES FOR REIMBURSEMENT TO SPONSORS FOR QUALIFYING CARE.  PAYMENT AMOUNTS ARE DETERMINED LOCALLY AND DO NOT EXCEED THE RATES BASED ON THE HOURLY REIMBURSEMENT FORMULA UTILIZING PARAGRAPH H. INSTALLATIONS MAINTAIN RECORDS AND PROVIDE REQUIRED REPORTS TO CMC (MRY-1) ON A QUARTERLY BASIS.
E.  IN ORDER TO PARTICIPATE IN THE EFMP RESPITE CARE PROGRAM, THE FOLLOWING IS REQUIRED:
(1)  EFMP ENROLLMENT AND/OR UPDATE MUST BE CURRENT AND THE EFM MUST LEGALLY RESIDE FULL TIME WITH THE SPONSOR.  IF UPDATE IS OVERDUE, COSTS ARE NOT REIMBURSED.  TO REINITIATE RESPITE, UPDATE MUST BE COMPLETED.  ANY COSTS INCURRED BY THE FAMILY DURING THE TIME OF INELIGIBILITY WILL NOT BE REIMBURSED.
(2)  FAMILIES WHO USE PROVIDERS WHO DO NOT PRESENT ADEQUATE DOCUMENTATION OF SKILL REQUIREMENTS ARE REIMBURSED AT THE APPROPRIATE LOWER LEVEL FOR 1 REPORTING PERIOD (30 DAYS) AND ARE NOT ELIGIBLE TO RECEIVE FURTHER REIMBURSEMENTS UNTIL PROVIDER QUALIFICATION REQUIREMENTS ARE MET.
(3)  FAMILIES WHO USED RESPITE CARE FOR ANY PURPOSE OTHER THAN THOSE ESTABLISHED WILL NOT BE REIMBURSED.
(4)  RESPITE CARE REIMBURSEMENT IS SUBMITTED MONTHLY TO ENSURE PROMPT REIMBURSEMENT.  FAMILIES WHO ELECT TO DELAY REIMBURSEMENT SUBMISSIONS FOR MORE THAN 60 DAYS FORFEIT REIMBURSEMENT.
(5)  RESPITE CARE REIMBURSEMENT REQUESTS MUST COMPLY WITH ADMINISTRATIVE CONTROL PROCEDURES.
(6)  THE SYSTEM USED TO ACCOUNT FOR THE COST OF SUPPORT WILL BE NO DIFFERENT THAN THE CURRENT SYSTEM USED BY MANAGEMENT OFFICIALS FOR NORMAL ADMINISTRATION AND CONTROL OF RESOURCES.
(7)  RESPITE CARE REIMBURSEMENT DOES NOT IMPACT LES OR BAH AND IS NOT CONSIDERED TAXABLE INCOME.
(8)  PERSONNEL TRAVEL, TRANSPORTATION, PER DIEM AND OTHER PERSONNEL EXPENSES, TRANSPORTATION OF SUPPLIES, CONSUMABLE MATERIALS, MATERIALS, AND EQUIPMENT ARE NOT A COMPONENT OF EFMP RESPITE CARE AND ARE NOT AUTHORIZED FOR REIMBURSEMENT.
(9)  THE INSTALLATION REIMBURSEMENT REQUEST FORM WILL INCLUDE DETAILED DATES/HOURS WHEN SERVICE WAS PROVIDED, WHO THE SERVICE WAS PROVIDED TO, SPONSORS SIGNATURE, PROVIDERS SIGNATURE AND CONTACT INFORMATION, THE LOCATION(S) OF THE SERVICE, HOURS USED, AND A STATEMENT NOTING THAT USMC EFMP RETAINS THE RIGHT TO VERIFY THE PROVISION OF EFMP RESPITE CARE AND THERE IS LEGAL RECOURSE FOR FRAUDULENT REPORTING.
(10)  THE EFMP INSTALLATION PROGRAM MANAGER WILL REPORT CONCERNS ABOUT FRAUDULENT REIMBURSEMENT REQUESTS TO INSTALLATION AUTHORITIES FOR INVESTIGATION.  RESULTS OF INVESTIGATION WILL BE FORWARDED TO CMC (MRY-1).
F.  EFMP ENROLLED FAMILIES ARE RESPONSIBLE FOR SCREENING AND SELECTING A QUALIFIED PROVIDER FOR LOCAL RESPITE.
(1)  FAMILIES MUST INCLUDE PROVIDER DOCUMENTATION OF QUALIFICATIONS FOR LEVEL THREE AND LEVEL FOUR REIMBURSEMENT.  INSTALLATION PROGRAM MANAGERS WILL REVIEW DOCUMENTATION PROVIDED TO DETERMINE THAT PROVIDERS MEET REQUIREMENTS FOR THE APPROPRIATE LEVEL OF REIMBURSEMENT. LEVEL THREE AND LEVEL FOUR PROVIDERS MUST BE OVER 18 YEARS OF AGE.
(2)  FAMILY MEMBERS ARE ELIGIBLE TO SERVE AS PROVIDERS.
(3)  RESPITE CARE IS TYPICALLY PROVIDED IN THE FAMILY MEMBERS HOME OR THE PROVIDERS HOME AND NOT IN A PUBLIC LOCATION.
(4) RESPITE CARE PROVIDERS SHOULD NOT TRANSPORT THE EFM TO ACTIVITIES OR PROVIDE HOUSEHOLD CHORES OTHER THAN PROVIDING MEALS OR SNACKS AS PER PARENTAL DIRECTION.
(5)  RESPITE CARE IS NOT INTENDED TO PROVIDE MEDICAL OR CUSTODIAL CARE.  FOR ADULTS OR LONG-TERM CARE.  LONG-TERM CARE IS NOTED AS SERVICE FOR MORE THAN 6 HOURS CONSECUTIVELY.
(6)  EFM ADULTS CAN USE RESPITE CARE IN CONJUNCTION WITH CARE FOR CHILDREN.  REIMBURSEMENT WILL BE ACCORDING TO THE EFM'S LEVEL AS ADDRESSED PARAGRAPH G.
G.  REIMBURSEMENT RATE OF CARE.  THE MARINE CORPS RESPITE CARE FORMULA IS DETERMINED BY CMC (MRY-1) USING THE BASE CHILD DEVELOPMENT CENTER (CDC) HOURLY RATE. THE REIMBURSEMENT RATE FORMULA ESTABLISHES THE MAXIMUM ALLOWABLE RATE. REIMBURSEMENT RATES MAY IN FACT BE LESS THAN THE MAXIMUM IN SOME CASES DUE TO CONSIDERATION OF LOCAL STANDARDS AND CARE REQUIREMENTS.  MARINE CORPS-PROVIDED RESPITE CARE REIMBURSEMENT MAY NOT COVER ALL COSTS EXPENDED BY THE FAMILY AND THEREFORE SHOULD BE CONSIDERED AS A SUBSIDY FOR CARE AND NOT AN ENTITLEMENT.  AGE-TYPICAL SIBLINGS WHO ARE NOT ENROLLED IN EFMP AND WHO ARE 12 YEARS OLD AND UNDER MAY BE INCLUDED WITH THE RESPITE CARE PROVIDED.  RESPITE CARE LEVELS DO NOT NECESSARILY ALIGN WITH EFM CATEGORIES.  THE INSTALLATION EFMP MANAGER WILL DETERMINE THE APPROPRIATE REIMBURSEMENT RATE PER HOUR BASED ON THE BELOW CRITERIA AND FORMULAS:
(1) RESPITE CARE LEVELS ARE DETERMINED DURING MEDICAL SCREENING.  EFM SITUATIONS MAY CHANGE AND REQUIRE A CHANGE IN IDENTIFIED LEVEL.  CMC (MRY-1) WILL MAKE LEVEL CHANGES WHEN REQUESTED BY THE INSTALLATION EFMP MANAGER USING AN EVIDENCE-BASED DETERMINATION PROCESS.  AN ENROLLMENT UPDATE, OR ADDITIONAL INFORMATION, MAY BE REQUIRED TO APPROVE A CHANGE IN RESPITE CARE LEVEL.
(2)  LEVEL ONE.  INCLUDES EFMP FAMILIES WITH CHILDREN 12 YEARS OLD OR YOUNGER WITH MILD SPECIAL NEEDS.  THE RATE OF CARE MAY NOT EXCEED THE INSTALLATION CDC RATE.  CALCULATIONS FOR HOURLY REIMBURSEMENT FOR LEVEL 1 EFM ARE AS FOLLOWS:
(A)  WHEN RESPITE CARE IS PROVIDED FOR 1 LEVEL 1 EFM, THE RATE WILL NOT EXCEED THE HOURLY BASE CDC RATE.
(B)  WHEN RESPITE CARE IS PROVIDED FOR 2 OR MORE EFMS, THE RATE WILL NOT EXCEED THE BASE CDC RATE X 2.
(C)  WHEN RESPITE CARE IS PROVIDED FOR 1 EFM AND 1 AGE-TYPICAL SIBLING, THE RATE WILL NOT EXCEED THE BASE CDC RATE X 1.5.
(D)  WHEN RESPITE CARE IS PROVIDED FOR 1 EFM AND MULTIPLE AGE-TYPICAL SIBLINGS, THE RATE WILL NOT EXCEED THE BASE CDC RATE X 3.
(3)  LEVEL TWO.  INCLUDES EFMP FAMILIES WITH CHILDREN 18 YEARS OLD OR YOUNGER, WITH MODERATE SPECIAL NEEDS WHO REQUIRE A HIGHER LEVEL OF RESPITE CARE THAN PROVIDED AT THE INSTALLATION CDC.  CALCULATIONS FOR HOURLY REIMBURSEMENT FOR LEVEL 2 EFM ARE AS FOLLOWS:
(A)  WHEN RESPITE CARE IS PROVIDED FOR 1 LEVEL 2 EFM, THE RATE WILL NOT EXCEED THE HOURLY BASE CDC RATE X 2.
(B)  WHEN RESPITE CARE IS PROVIDED FOR 2 OR MORE EFMS, THE RATE WILL NOT EXCEED THE BASE CDC RATE X 3.5.
(C)  WHEN RESPITE CARE IS PROVIDED FOR 1 EFM AND 1 AGE-TYPICAL SIBLING, THE RATE WILL NOT EXCEED THE BASE CDC RATE X 2.5.
(D)  WHEN RESPITE CARE IS PROVIDED FOR 1 EFM AND MULTIPLE AGE-TYPICAL SIBLINGS, THE RATE WILL NOT EXCEED THE BASE CDC RATE X 4.5.
(4)  LEVEL THREE.  INCLUDES EFMP FAMILIES WITH CHILDREN 18 YEARS OLD OR YOUNGER, WITH SEVERE SPECIAL NEEDS THAT REQUIRE TRAINED SUPPORT FROM PROVIDERS TO STAY SAFE IN THEIR HOME. CALCULATIONS FOR HOURLY REIMBURSEMENT FOR LEVEL 3 EFM ARE AS FOLLOWS:
(A)  WHEN RESPITE CARE IS PROVIDED FOR 1 LEVEL 3 EFM, THE RATE WILL NOT EXCEED THE HOURLY BASE CDC RATE X 3.
(B)  WHEN RESPITE CARE IS PROVIDED FOR 2 OR MORE EFMS, THE RATE WILL NOT EXCEED THE BASE CDC RATE X 5.
(C)  WHEN RESPITE CARE IS PROVIDED FOR 1 EFM AND 1 AGE-TYPICAL SIBLING, THE RATE WILL NOT EXCEED THE BASE CDC RATE X 3.5.
(D)  WHEN RESPITE CARE IS PROVIDED FOR 1 EFM AND MULTIPLE AGE-TYPICAL SIBLINGS, THE RATE WILL NOT EXCEED THE BASE CDC RATE X 6.
(5)  LEVEL FOUR.  INCLUDES EFMP FAMILY MEMBERS OF ALL AGES, WITH PROFOUND SPECIAL NEEDS WHO REQUIRE NURSING CARE SERVICES AS DOCUMENTED BY QUALIFIED MEDICAL PROVIDERS, TO STAY SAFE IN THEIR HOME.  CALCULATIONS FOR HOURLY REIMBURSEMENT FOR LEVEL 4 EFM ARE AS FOLLOWS:
(A)  WHEN RESPITE CARE IS PROVIDED FOR 1 LEVEL 4 EFM, THE RATE WILL NOT EXCEED 45.00 DOLLARS PER HOUR.
(B)  WHEN RESPITE CARE IS PROVIDED FOR 2 OR MORE EFMS, THE RATE WILL NOT EXCEED 60.00 DOLLARS PER HOUR.
(C)  WHEN RESPITE CARE IS PROVIDED FOR 1 EFM AND 1 AGE-TYPICAL SIBLING, THE RATE WILL NOT EXCEED 45.00 DOLLARS PER HOUR.
(D)  WHEN RESPITE CARE IS PROVIDED FOR 1 EFM AND MULTIPLE AGE-TYPICAL SIBLINGS, THE RATE WILL NOT EXCEED 60.00 DOLLARS PER HOUR.
(6)  ADDITIONAL CONSIDERATIONS REGARDING EFMP RESPITE CARE.
(A)  SPECIAL CIRCUMSTANCE REQUESTS REQUIRE CMC (MRY-1) REVIEW (EXAMPLE, MORE THAN 3 EFM(S)).
(B)  BASE CDC RATE IS DETERMINED IN COLLABORATION WITH CMC (MRY-1) FOLLOWING ANNUAL DOD GUIDELINES.
(C)  EFM LEVEL:  DETERMINED BY CMC (MRY-1)
(D)  IF THERE IS MORE THAN ONE EFM, THE HIGHER LEVEL IS USED FOR FORMULA CALCULATIONS.
(E) IN CASES WHERE THE EFM IS THE SPOUSE WHO HAS AGE-TYPICAL CHILDREN, THE HOURLY BASE CDC RATE WILL BE USED FOR THE 1ST CHILD PLUS .5 X HOURLY BASE CDC RATE FOR EACH ADDITIONAL CHILD, NOT TO EXCEED HOURLY BASE CDC RATE X 2.5.
H. EFMP FAMILIES RELY ON THE SERVICES PROVIDED THROUGH THE EFMP RESPITE PROGRAM AND THEREFORE IT IS CRITICAL THAT RESOURCES BE SAFEGUARDED AND ACCESS TO RESPITE CARE IS MANAGED CAREFULLY.  THIS BENEFIT IS PART OF EFMP ENROLLMENT AND THE PROVISION OF THIS SERVICE SHOULD NOT BE WITHHELD FROM AN ENROLLED FAMILY WITHOUT CAUSE.  LOCAL INSTALLATIONS MUST COORDINATE SUCH ACTION WITH CMC (MRY-1) AND SHOW JUSTIFICATION FOR ANY STRUCTURE OR DECISION THAT WOULD TERMINATE RESPITE SERVICE.
4.  THIS MARADMIN WILL APPLY WHEN DETERMINING RESPITE CARE REIMBURSEMENT FOR EFM.
5.  THESE PROCEDURAL CHANGES WILL NOT APPLY RETROACTIVELY.
6.  THESE PROCEDURAL CHANGES ARE APPLICABLE TO THE TOTAL FORCE.
7.  RELEASE AUTHORIZED BY LTGEN RICHARD C. ZILMER, DEPUTY COMMANDANT FOR MANPOWER AND RESERVE AFFAIRS.//