House committee substitute to the 1st edition makes the following changes. Amends Part II, as follows. Changes references from "children" to "youth" in findings.
Now requires the Department of Health and Human Services (DHHS), Division of Health Benefits (DHB), to convene a workgroup composed of county child welfare agencies, representatives with lived experience in child welfare, the nonprofit corporation Benchmarks, prepaid health plans, and local management entities/managed care organizations (LMEs/MCOs) to identify innovative Medicaid service options to address any gaps in the care of children receiving foster care services. Requires each LME/MCO to identify any innovative practices it is using that could be an innovative Medicaid service option and requires communicating with healthcare providers in its catchment area about the opportunity to submit concept papers to the workgroup to aid in the identification of these innovative Medicaid service options. Specifically, requires the workgroup to identify options that: (1) model community evidence-based practices that support a foster child returning to the child's family in a timely manner and divert from higher level foster care placements or (2) model short-term residential treatment options that serve children with high acuity needs that divert a child from higher level placements such as psychiatric residential treatment facility placement. Allows considering providing stepdown options from higher levels of care.
(Previously, DHB had to develop, to the extent allowed under the State Medicaid Plan [Plan], new “in-lieu-of” services under the Plan for children receiving foster care services no later than 90 days after the act becomes law to be implemented statewide and apply a Children and Families specialty plan if one is implemented. Required DHB to use Early and Periodic Screening, Diagnostic and Treatment (EPSDT) to ensure access to the recommended interventions and therapies for Medicaid beneficiaries not enrolled in managed care. Required DHB to partner with certain stakeholders to identify innovative service options to address any gaps in the care of children receiving foster care services. The Plan had to (1) identify models of community evidence-based practices that support a foster child returning to their family in a timely manner and diverting higher level foster care placements and (2) identify model short-term residential treatment options that serve children with high acuity needs that divert a child from higher level placements such as psychiatric residential treatment facility placement.)
Now requires DHB to begin distributing funding, as appropriated by the act and to the extent allowed under GS 108A-54.1A (amendments to State Medicaid Plan), through capitated contracts with LMEs/MCOs and through capitated prepaid health plan contracts under Article 4 of GS Chapter 108D, to be used for the innovative Medicaid service options identified by the workgroup no later than three months after the workgroup has completed its work. Permits the funding to be used for (1) new services identified by the workgroup that may be implemented regionally or Statewide or (2) expanding a service or modality to a county or region where the service or modality was not previously implemented. Requires DHB to require all of the following from any entity receiving such funding: (1) timelines for, and establishment of, first- and second-year deliverables for any service that may be a phased-in service; (2) identification of required funding, including start-up funding and a three-year budget, including projected revenue sources and amounts; and (3) specific outcome measures with the attestation of the timely submission of the data to the applicable prepaid health plan and DHB. Makes other conforming changes to account for new workgroup and LMEs/MCOs.
(Previously, required DHB to issue requests for proposal (RFPs) for any services identified through the Plan development process as lacking and targeted towards any geographic location with identified inadequate provider access by no later than three months after the Plan is developed. Permitted services to be phased in over a period of two years. Required that the RFPs be developed in partnership with the stakeholders developing the Plan and include the five following things: (1) the development of newly identified Medicaid services for foster children that may be implemented regionally or statewide; (2) expansion of a Medicaid service not located in the particular county or region; (3) timelines for, and establishment of, first- and second-year deliverables for any service that may be a phased-in service; (4) identification of required funding, including start-up funding and a three-year budget including projected revenue sources and amounts; (5) specific outcome measures with the attestation of the timely submission of the data to the responsible prepaid health plan and DHB. Set forth the review process for DHB review of the RFPs. Required DHB to train all county departments of social services and offer training to tribal welfare offices on the Medicaid services recommended for implementation by the stakeholders involved with developing the Plan, and to continue to provide status implementation within the impacted counties and region.)
Bill Summaries: H860 (2023-2024 Session)
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Bill H 860 (2023-2024)Summary date: May 16 2023 - View summary
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Bill H 860 (2023-2024)Summary date: Apr 25 2023 - View summary
Contains whereas clauses.
Part I
Recognizes that children both at risk of entering the foster care system as well as those within the system have experienced trauma. Further recognizes that trauma results in those children being at higher risk of needing behavioral or developmental/intellectual disability services. Requires the Department of Health and Human Services (DHHS) to develop a trauma-informed standardized assessment in partnership with the following individuals: (1) representatives from DHHS’s Divisions of Social Services; Health Benefits (DHB); Mental Health, Developmental Disabilities, Substance Abuse Services; and Family and Child Well-Being; (2) prepaid health plans, as defined in GS 108D-1, and primary care case managers, as defined in 42 CFR Sec. 438.2, that serve children at risk of entry into foster care or who are in foster care; (3) representatives from the county departments of social services; (4) benchmarks, a nonprofit corporation; (5) individuals with lived experiences; and (6) others identified by the partnership based upon areas of expertise (collectively, the Partnership). Requires the Partnership to develop a rollout plan designed to ensure that the trauma-informed standardized assessment is implemented statewide in all 100 counties. Sets forth eight components that the rollout plan must include and related deadlines. Directs that the trauma-informed assessment must include at minimum, the following: (1) ensures that juveniles between the ages of 4 and 17 being placed into foster care receive a trauma-informed standardized assessment within ten working days of their referral; (2) each juvenile who is included in any Medicaid children and families specialty plan, regardless of their type of placement, shall receive a trauma-informed standardized assessment; (3) each trauma-informed standardized assessment may be administered in a face-to-face or telehealth encounter; (4) the county department of social services must make the referral for a trauma-informed standardized assessment within five working days of a determination of abuse or neglect of a juvenile; (5) after receiving parental consent, a juvenile may receive a trauma-informed standardized assessment if the county department of social services makes the determination that a juvenile is at imminent risk for entry into foster care; (6) allow for individuals between the ages of 18 and 21 to receive an assessment, if necessary; (7) develop an evidence-informed and standardized template and content for the assessment; and (8) in the event the juvenile has an assigned care manager under the Medicaid program, the responsible care management entity will be notified of the referral for the assessment and to whom. Specifies four things that DHHS must do in implementing the trauma-informed assessment and rollout plan, including implementing lessons learned from those in the Partnership who have already implemented trauma-informed, standardized assessments and training venues; complete all required documentation and leverage all available federal revenues for these activities; amend any existing contracts with entities who have the experience to manage the trauma-informed standardized assessment, rollout plan, create the training plan, or monitor implementation to ensure the fidelity of the service and delivery are maintained; and create a DHHS dashboard representing the status of the trauma-informed standardized assessment implementation with six listed things to track, including any elements identified by the Partnership.
Part II
Finds that children receiving foster care services through the county child welfare agencies are entitled to evidence-based, or evidence-informed, or both trauma-informed interventions and therapy. Requires DHB to develop, to the extent allowed under the State Medicaid Plan [Plan], new “in-lieu-of” services under the Plan for children receiving foster care services no later than 90 days after the act becomes law to be implemented statewide and will apply a Children and Families specialty plan if one is implemented. Requires DHB to use Early and Periodic Screening, Diagnostic and Treatment (EPSDT) to ensure access to the recommended interventions and therapies for Medicaid beneficiaries not enrolled in managed care. Requires DHB to partner with certain stakeholders to identify innovative service options to address any gaps in the care of children receiving foster care services. The Plan must (1) identify models of community evidence-based practices that support a foster child returning to their family in a timely manner and diverting higher level foster care placements and (2) identify model short-term residential treatment options that serve children with high acuity needs that divert a child from higher level placements such as psychiatric residential treatment facility placement (PRTF). These services may also provide stepdown options from higher levels of care.
Requires DHB to issue requests for proposal (RFPs) for any services identified through the Plan development process as lacking and targeted towards any geographic location with identified inadequate provider access by no later than three months after the Plan is developed. Permits services to be phased in over a period of two years. Requires that the RFPs be developed in partnership with the stakeholders developing the Plan and must include the five following things: (1) the development of newly identified Medicaid services for foster children that may be implemented regionally or statewide; (2) expansion of a Medicaid service not located in the particular county or region; (3) timelines for, and establishment of, first- and second-year deliverables for any service that may be a phased-in service; (4) identification of required funding, including start-up funding and a three-year budget including projected revenue sources and amounts; (5) specific outcome measures with the attestation of the timely submission of the data to the responsible prepaid health plan and DHB. Directs that the outcomes must be aligned with child welfare safety and permanency measures and support positive childhood outcomes. Sets forth the review process for DHB review of the RFPs. Requires DHB to train all county departments of social services and offer training to tribal welfare offices on the Medicaid services recommended for implementation by the stakeholders involved with developing the Plan, and to continue to provide status implementation within the impacted counties and region.
Part III
Appropriates $750,000 for each year of the 2023-25 biennium from the General Fund to DHHS for the development of the foster care standardized assessment. Appropriates $20 million in recurring funds for the 2023-24 fiscal year from the General Fund to DHB and $20 million in recurring funds for the 2024-25 fiscal year to implement Part II of the act. Specifies that the funds provide a State match for $38.7 million in recurring federal funds for the 2023-24 fiscal year and $38.7 million for the 2024-25 fiscal year. Directs that the federal funds are appropriated to DHB to implement Part II of the act. Effective July 1, 2023.