​The Determination of Care or DOC

The Determination of Care or DOC is intended to offer additional support to families caring for children whose need exceed the expectations of “typical” children their age

There are Three Types of DOCs

•Ages 1 day thru 12 years
•Ages 13+ years
•Medically fragile​

Categories in the Non-Medically Fragile DOCs

Behavior Management
Documentation of how the behavior is managed is critical for this section. The use of charting, journaling, written schedules, etc. Emphasis on how the foster parent is intervening  with the child's behaviors, not just examples of the child's behavior.
Mental Health Participation
Documentation for this category comes from the therapist and/or psychologist notes.
This is not how much participation the child has with mental health services but how much the
Foster parent is involved with those services. 
Education Participation
Documentation for this category includes IEP’s, notes from teachers, school counselors, Etc. Journal and document conversations with teachers, time spent helping with homework, and times it is required for you to go to the school to intervene.
It is important to note that this is “beyond age appropriate expectations.” 
Transportation
It is important to note transportation does not include parenting visits, rides to school
Or school activities. Its focus is on health (ie therapy, allergy shots, specialists, doctor appointments).
Personal Care
Documentation for this category must include a diagnosis that directly impairs the child from being able to handle their own personal care BEYOND what is typically necessary. 
Medical Items/Diet​
If a child requires special medical items which are not covered by Medicaid and are required to thrive. You must save receipts to validate this category. 
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Medically Fragile DOC

This form is used when a child has a documented medical condition which threatens health, life, or independent functioning. Documentation of the medical condition must be in the case file.
Rather than Categories this DOC is divided into 3 sections.
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"If a DOC is not completed in a timely manner the foster parent should put their request in writing to the case worker and copy the supervisor.  If that does not work, forward the sent email to the county director and as a last resort send the request to the FC policy mailbox at Child-Welfare-Policy@michigan.gov"

DOC Policy

Michigan Foster Care policy FOM 903-03, FOB 2014-004, Dated 5-1-2014 clearly outlines the supplemental payment system for foster parents providing extraordinary care or incurring extraordinary expenses:
http://www.mfia.state.mi.us/OLMWEB/EX/FO/Public/FOM/903-03.pdf
“A determination of care (DOC) supplement may be justified when extraordinary care or expense is required of the foster parents or relative (foster care provider) who is eligible for a foster care payment. The appropriate DOC form is to be completed in MiSACWIS for every child in a paid foster home or relative placement. The supplement must be based on one or more of the following case situations where additional care is required of the foster care provider or an additional expense exists: · Physically disabled children for whom the foster care provider must provide measurably greater supervision and care. · Children with special psychological or psychiatric needs which require extra time and measurably greater amounts of care and attention by the foster care provider. · Children requiring special diets which are more expensive than a normal diet and which require extra time and effort by the foster care provider to obtain and prepare. · Children whose severe acting-out or antisocial behavior requires a measurably greater amount of care and attention of the foster care provider.”

“A DOC assessment must be completed in MiSACWIS at the initial case opening and at least every six months or if the child's care needs or level changes or the child moves. This includes all children in purchased foster care programs. This applies to all foster care providers eligible for payment, regardless of the funding source. Each DOC assessment must be filed in the child’s case record. The foster parent or relative placement must also be provided with a copy of the DOC assessment once it has been signed by DHHS. The DOC assessment contains the information regarding the foster parent or relative placement’s right to an appeal if they do not agree with the approved DOC.”

Policy Summary

As per this policy, a DOC form must be completed for every child in a paid foster home or relative placement at initial placement, every six months and if a level change is needed. A foster care provider or supervising agency/DHS staff may initiate a request for review of a DOC at any time. Foster Parents must be provided with a copy of the signed DOC assessment.