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Background of Program Changes: The Transition from Level of Care (LOC) to Room, Board and Watchful Oversight (RBWO)

The federal agency, Centers for Medical and Medicaid Services (CMS), recently mandated that Georgia eliminate the bundled Therapeutic Residential Intervention Services (TRIS) per diem rate which contained costs charged for a mix of child behavioral health services. This program in Georgia was known as the Level of Care (LOC) Program.

Instead, CMS favors a system in which various behavioral health care services to children are individually authorized and billed to Medicaid. Therefore, the state has been transitioning to the separation of room, board and watchful oversight of children in state care and the behavioral health services they require.

Child Behavioral Health Services (CBHS)

Beginning July 1, 2007, the Department of Human Services (DHS), Division of Mental Health, Developmental Disabilities, and Addictive Diseases (DMHDDAD) will be solely responsible for the management of all child behavioral health services, or those which are therapeutically and medically necessary. As Georgia moves to a fee-for-service behavioral health model, DMHDDAD will operate a single point of entry (SPOE) for services as they develop a comprehensive system of care for children and adolescents in Georgia.

Room, Board and Watchful Oversight (RBWO)

Also beginning July 1, 2007, the DHS, Division of Family and Children Services (DFCS), Office of Provider Utilization and Outcomes Management (OPUOM) (formerly the Provider Relations Unit and Treatment Services Unit, which managed CBHS up until 2007), will focus on what was "unbundled” from the TRIS per diem rate--room, board and watchful oversight (RBWO) of children, in its charge of prevention, protection, and placement of children and adolescents in out-of-home care.

During the transition process, OPUOM, in conjunction with the provider community, has established a new Room, Board and Watchful Oversight (RBWO) Program for Child Caring Institutions (CCI) and Child Placing Agencies (CPA) which includes the following new designations for children in care. Click here to read more about the new program guidelines.

New RBWO reimbursement rates have been established and become effective on July 1, 2007, as OPUOM works diligently to ensure all existing service providers are securely under contract for Fiscal Year 2008, so that the children in placements on 6/30/07 see a seamless transition.


Moving Forward


The leadership of OPUOM and a portion of its staff will continue to be located in the state office at Two Peachtree Street in Atlanta. OPUOM has regional offices located around the state to assist case managers, families, and current and potential providers with services for their children and to help agencies that are serving children in Out-of-Home Care or seeking to become approved as Out-of-Home Care providers, a licensing process that OPUOM will continue working on in conjunction with the Office of Regulatory Services (ORS). Visit the ORS website to read more about Georiga’s residential child care regulations.


The Office of Provider Utilization and Outcomes Management will focus on supporting providers and will continue aiding DFCS Field Operations by:

  • Holding providers accountable for the care of children through monitoring and inspections
  • Approving and suspending (as appropriate) DFCS private foster care agencies
  • Forecasting child program needs and soliciting new programs
  • Developing, measuring and enforcing provider contract deliverables
  • Mediating provider concerns
  • Assisting in placement, removal, step-downs and hospitalizations of children
  • Approving waivers for CPAs and Specialized Foster Care (SFC) per diems
  • Re-engineering the placement protocol
  • Supporting data systems such as KidSTAR, Georgia Shines, and IDS
  • Acting as a liaison to DHS & DFCS for provider and child placement initiatives and concerns

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