BILL ANALYSIS Ó
-----------------------------------------------------------------
|SENATE RULES COMMITTEE | AB 403|
|Office of Senate Floor Analyses | |
|(916) 651-1520 Fax: (916) | |
|327-4478 | |
-----------------------------------------------------------------
THIRD READING
Bill No: AB 403
Author: Mark Stone (D), et al.
Amended: 9/4/15 in Senate
Vote: 21
SENATE HUMAN SERVICES COMMITTEE: 5-0, 7/14/15
AYES: McGuire, Berryhill, Hancock, Liu, Nguyen
SENATE APPROPRIATIONS COMMITTEE: 6-0, 8/27/15
AYES: Lara, Beall, Hill, Leyva, Mendoza, Nielsen
NO VOTE RECORDED: Bates
ASSEMBLY FLOOR: 79-0, 6/3/15 - See last page for vote
SUBJECT: Public social services: foster care placement:
funding
SOURCE: California Department of Social Services
DIGEST: This bill, effective January 1, 2017, establishes a
sunset for existing licensure, rate setting and other provisions
for group homes and Foster Family Agencies (FFAs), and
establishes interim provisions. It provides for licensure of
Short Term Residential Treatment Centers (STRTCs) and FFAs and
requires the California Department of Social Services (CDSS) to
develop a new payment structure for STRTCs and FFAs, as
specified. This bill establishes the framework for the
codification of a number of recommendations included in the CDSS
report, California's Child Welfare Continuum of Care Reform
(CCR).
Senate Floor Amendments of 9/4/15 add chaptering language
AB 403
Page 2
pertaining to SB 794 (Committee on Human Services), SB 238
(Mitchell), AB 899 (Levine), AB 1387 (Chu), and SB 484 (Beall),
add conforming language for STRTCs related to existing licensing
provisions for licensed facilities, and make other technical
corrections.
ANALYSIS:
Existing law:
1) Establishes CDSS as the "single state agency" required by
Title IVB and IVE of the federal Social Security Act to
distribute federal funds and supervise Californias county
administered child welfare system which includes child
protective services, foster care placement services, and
adoptions services.
2) Requires the state, through CDSS and county welfare
departments, to establish and support a public system of
child welfare services to protect and promote the welfare of
children. (WIC 10600 and 16500) Provides for the licensure of
group homes, defined as a residential facility providing
24-hour non-medical care and supervision to children,
delivered by employed staff in a structured environment.
Requires CDSS to establish a rate classification level (RCL)
structure for group homes with a corresponding rate structure
according to the level of care and services that will be
provided, as specified. (HSC 1502 and WIC 11462)
3) Permits group homes to be classified as an RCL 13 or 14 if
the program only accepts children with special treatment
needs and meets other requirements. Requires the California
Department of Health Care Services (DHCS) to certify group
homes annually seeking classification as RCL 13 or 14 and
permits such facilities to accept minor dependents who are
seriously emotionally disturbed if certain conditions are
met. (WIC 11469, WIC 4096.5 and HSC 1502.4)
4) Provides for licensure of FFAs, defined to mean an
organization engaged in the recruiting, certifying, and
training of, and providing professional support to, foster
parents, or in finding homes or other places for placement
for children for temporary or permanent care, as an
alternative to group care. (HSC 1502)
AB 403
Page 3
5) Establishes California's Medicaid program, Medi-Cal, though
which eligible low-income individuals receive health care and
mental health services, including foster youth, eligible
recipients of the Adoption Assistance Program, and Kin-Gap.
Under Medi-Cal, establishes the federal Early and Periodic
Screening, Diagnosis and Treatment (EPSDT) program to provide
comprehensive and preventive health services including
specialty mental health services to Medi-Cal beneficiaries
under the age of 21. (WIC 14000 et seq., 42 USC Section 1396
et seq and 42 CFR 435.145.)
6) Requires county mental health departments to provide
children served by county social services and probation
departments, who meet the definition of medical necessity,
with mental health screening, assessment, participation in
multidisciplinary placement teams and specialty mental health
treatment. (WIC 5867.5)
This bill:
1) Establishes legislative intent to improve California's child
welfare system by using comprehensive initial child
assessments, increasing the use of home-based family care and
the provision of services and supports to home-based family
care, reducing the use of congregate care placement settings,
and creating faster paths to permanency to shorten the
duration of a child's involvement in the child welfare and
juvenile justice systems.
Group Home and Children's Residential Facilities Reforms
2) Sunsets, effective January 1, 2017, existing laws pertaining
to group homes, including those permitting a group home to
accept children assessed as being seriously emotionally
disturbed (SED) and the existing rate classification
structure. Provides for one-year conditional extensions to
individual group homes and an interim rate structure.
3) Creates a new licensure category of STRTCs, on or after
January 1, 2017. Requires STRTCs to have national
accreditation from an entity identified by CDSS, as
specified.
AB 403
Page 4
4) Permits STRTCs to have a program that is certified by DHCS
or a county mental health plan, or a program that is not
certified, or both. Provides that if the program does not
have a certification, it may only serve children who are
assessed as SED and as meeting EPSDT medical necessity
criteria if it arranges for a Medi-Cal eligible child to
receive EPSDT specialty mental health services, or other
mental health services in all other cases.
5) Adds new statute, effective the same date, requiring STRTCs
that have a mental health certification to solely accept for
placement children who do not require inpatient care in a
licensed health facility, have been assessed as requiring the
level of services provided in the facility to maintain the
safety of the child or others, as specified, and who have
been assessed as meeting the medical necessity criteria for
specialty mental health services under the EPSDT program or
have been assessed as being seriously emotionally disturbed,
as defined.
6) Provides that STRTCs that do not have a mental health
certification shall soley accept for placement children who
do not require inpatient care in a licensed health facility,
have been assessed as requiring the level of services
provided in the facility to maintain the safety of the child
or others, as specified, and who meet one of the following
criteria:
a) Have been assessed as meeting the medical necessity
criteria for specialty mental health services under the
EPSDT program;
b) Have been assessed as being seriously emotionally
disturbed, as defined;
c) Have been assessed as requiring the level of services
to meet his or her specialized behavioral or therapeutic
needs, as described.
7) Requires CDSS to develop a new payment structure for STRTCs
and prohibits CDSS from establishing a rate for STRTCs or
FFAs unless the provider submits a recommendation from the
host county or the primary placing county that the program is
needed and that the provider is willing and capable of
AB 403
Page 5
operating the program at the level sought.
8) Authorizes CDSS to license a temporary shelter care facility
operated by a county or agency on behalf of a county, and
requires CDSS to consult with counties operating shelters to
develop a transition plan, as specified.
Foster Family Agency Reforms
9) Effective January 1, 2017, sunsets the existing rate-setting
system for FFAs and establishes an interim rate system for
FFAs that have been granted an extension.
10)Requires CDSS to develop a new payment system for FFAs that
provide treatment, intensive treatment and therapeutic foster
care programs which considers federally eligible
administrative activities social work activities, social work
and mental health services, as well as intensive treatment or
therapeutic services, core services, staff training,
licensing requirements, a process for accreditation, as
specified, mental health certification, populations served,
as specified.
11)Permits probation agencies to place probation youth into a
certified family home of an FFA.
12)Requires FFAs to have national accreditation from an entity
identified by CDSS, as specified. Provides CDSS the authority
to extend provisional licenses for FFAs for up to two years,
if it determines this additional time is required to secure
accreditation.
13)Permits FFAs to have a program that is certified by DHCS or
a county mental health plan, or a program that is not
certified, or both. Provides that a certified program shall
provide mental health services to children who do not require
inpatient care and have been assessed as SED or as meeting
medical necessity criteria for EPSDT. Provides that a program
that is not certified may provide access to mental health
services to children who do not require inpatient care and
have been assessed as SED or as meeting medical necessity
criteria for EPSDT if the program has interagency protocols
in place to arrange for specialty mental health services for
children who are Medi-Cal eligible, and in all other cases,
AB 403
Page 6
arranges for the child to receive mental health services.
14)Requires county probation departments to work with group
home providers to develop STRTCs that meet the needs of
probation-supervised youth in foster care and to work with
FFAs to develop strategies to recruit, retain, and support
specialized foster homes for probation youth. Additionally
requires county probation departments to work with CDSS on
strategies to identify, engage, and support relative
caregivers and to define probation youth outcome measures to
be collected and analyzed to assess implementation of this
act.
15)Requires, commencing January 1, 2018, CDSS in consultation
with the Chief Probation Officers of California, to assess
the capacity and quality of placement options for probation
youth in foster care, as specified.
16)Requires CDSS to provide an interim report to the
Legislature no later than January 10, 2019, and a final
report no later than January 10, 2021, to include specified
data and whether there is a continued need for probation
placement in group homes.
Other Foster Care System Reforms
17)Requires CDSS to provide available funding to counties for
the purpose of recruiting, retaining, and supporting foster
parents, relative caregivers, and resource families based on
CDSS approval of plans submitted by each county.
18)Sunsets, effective January 1, 2017, existing foster parent
training provisions and replaces statute with annual training
requirement of eight hours and other revised requirements and
structure.
19)Requires CDSS to work with stakeholders, including other
state departments, such as the DHCS, legislative staff,
counties, and advocates, to address critical issues and
specified subject areas in the initial and ongoing
implementation of this act. Requires the work with
stakeholders to include the development of timelines and key
milestones for implementation of this act, including a
process to monitor progress. Requires the CDSS, in
AB 403
Page 7
consultation with stakeholders, to measure and track changes
in the number of out-of-home placements that are available to
county placing agencies, as specified.
Background
Continuum of Care Reform Efforts. CDSS led a three-year
stakeholder effort in response to SB 1013 (Committee on Budget
and Fiscal Review, Chapter 35, Statutes of 2012), which called
for the department to establish a working group to develop
recommended revisions to the current rate-setting system,
services, and programs serving children and families in the
continuum of foster care settings. Early this year, the
department published a report entitled "California's Child
Welfare Continuum of Care Reform." which outlined a
comprehensive approach to improving California's child welfare
system by reforming the system of placements and services
directed at youth in foster care. The report envisions new
models of care for foster youth, including providing all foster
youth with access to a child and family team - instead of
relying solely on a single social worker - and empowering those
child and family teams to utilize a more consistent assessment
tool that identifies the needs of the child. Rather than leaving
a child to "fail upwards" into a group home before the child is
provided more intensive services, the report envisions providing
needed treatment and services in homes, and relying on group
homes only for short-term treatment placements.
Reforms Envisioned by AB 403. This bill reflects a substantial,
though incomplete, effort to begin implementation of the
ambitious "continuum of care reform" that is described in the
departmental report. This bill incorporates several primary
areas of reform:
Dismantles the existing rate classification structure,
licensure, and eligibility criteria for group homes, replacing
it with STRTCs that incorporate increased standards of care,
shortened duration of stay, and stricter criteria for initial
placement. This policy is likely to have the effect of
reducing the overall number of beds available for congregate
care, and will make it harder for placing agencies to place a
child who does not have a true clinical need for congregate
care. As a result counties will need to quickly increase the
availability of foster homes or relative caregivers.
AB 403
Page 8
Revises the existing licensure, rate structure and eligibility
criteria FFAs, which recruit, certify and provide services to
foster family homes. The new structure envisions a model of
FFAs that are prepared and funded to provide intensive
treatment level services (currently often unavailable outside
of a group home) in a foster home setting, enabling children
with emotional or behavioral health challenges to remain with
a family.
Seeks to progress toward implementation of Katie A. v Bonta
lawsuit which expanded the role of the child and family team
in guiding the development of a child's case plan, so that a
social worker is not making uniformed and unilateral decisions
about the care of a child. Existing use of child and family
teams has shown the model to be an important tool for flexibly
building a network of child welfare mental health and
educational services to best support the child and his or her
family.
Seeks to progress toward implementation of Katie A. v Bonta
lawsuit which called for expanded integration between mental
health services and child welfare services. By integrating
mental health certification as a component for licensure of
both STRTCs and FFAs, and including an EPSDT specialty mental
health assessment as one criteria for placement, this bill
seeks to encourage greater interdepartmental collaboration at
the local level, and increase providers' ability to provide a
more complete range of child welfare and mental health
services to the child.
Addresses some barriers to achieving an adequate supply of
relative and foster family homes. This bill continues
implementation of the Resource Family Approval (RFA) Program,
which was established as a permanent statewide program through
SB 1013 (Committee on Budget and Fiscal Review, Chapter 35,
Statutes of 2012). Under the program, CDSS is required to
implement a unified, family friendly, and child-centered RFA
process to replace the existing multiple processes for
licensing foster family homes, approving relatives and
nonrelative extended family members as foster care providers,
approving guardianships, and approving adoptive families. This
model is currently being implemented as a five county pilot;
however it is anticipated to take effect statewide July 2017.
AB 403
Page 9
This bill modernizes foster parent training programs, making
curriculum more flexible according to the specialized training
needs of individual children and families.
By building on the establishment of "core services" that the
foster care system is intended to provide, including specialty
mental health services, and by enabling FFAs to approve and
serve all resource families this bill is likely to enable
counties to better support foster parents and relative
caregivers with the services needed to maintain stable
placements and prevent the need for STRTC placement.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: Yes
According to the Senate Appropriations Committee:
Major initial investments in the tens of millions of dollars
(General Fund*) annually over a number of years to local
agencies for increased costs for activities such as
comprehensive initial child assessments, recruitment,
retention, and support services for home-based family care
providers, increased services costs for higher rates for
wraparound services, FFAs, and STRTCs, performance and outcome
measurement and data collection, and accelerated statewide
implementation of the RFA process.
The 2015 Budget Act includes initial funding to support
recommendations in the CCR report consisting of $20.3 million
($17.2 million General Fund) to increase foster parent and
relative caregiver recruitment, retention, and training
efforts, and $7.3 million ($4.3 million General Fund) to fund
a 15 percent increase in FFA social worker rates.
Significant one-time and ongoing costs (General Fund) for the
development of revised rate structures, multiple sets of
regulations for new and revised licensing categories and RFA
due process procedures, stakeholder workgroup activities,
development and implementation of a system of governmental
monitoring and oversight, the development of revised training
curricula, and automation system changes.
AB 403
Page 10
Significant one-time costs (General Fund) to DHCS to
promulgate regulations regarding program standards, oversight,
enforcement, and due process for the mental health
certification of STRTCs and FFAs, and to collaborate with CDSS
on a monitoring and oversight program.
Major costs potentially in the millions to tens of millions of
dollars (Federal Funds/Local Revenue Fund 2011(Behavioral
Health Subaccount)) annually for increased EPSDT/specialty
mental health services and administration for both new and
existing cases, to the extent this bill's reforms result in
more appropriate placements and assessments of need for
children entitled to these services. Pursuant to 2011
Realignment, responsibility for specialty mental health and
EPSDT services rests with the counties.
Unknown, potentially significant future cost savings to the
child welfare and juvenile justice systems to the extent the
reforms result in better-informed and appropriate initial
placements provided with targeted services, coupled with
greater use of family-based care and declining use and
duration of congregate care placements and costs, resulting in
shorter and/or fewer stays in the child welfare and juvenile
justice systems.
Provides that to the extent this legislation has an overall
effect of increasing the costs already borne by a local agency
for programs or levels of service mandated by 2011
Realignment, it shall apply to local agencies only to the
extent that the state provides annual funding for the cost
increase.
SUPPORT: (Verified9/24/15)
California Department of Social Services (source)
California Alliance of Child and Family Services
California Coalition for Youth
California State Association of Counties
California State PTA
California State Foster Parent Association
AB 403
Page 11
Chief Probation Officers of California
County Behavioral Health Directors Association of California
County of Yolo, Board of Supervisors
County Welfare Directors Association of California
National Center for Youth Law
Orange County Board of Supervisors
Youth Law Center
OPPOSITION: (Verified9/4/15)
Beta Foster Care
ASSEMBLY FLOOR: 79-0, 6/3/15
AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom,
Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang,
Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle,
Daly, Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina
Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez,
Gordon, Gray, Grove, Hadley, Harper, Roger Hernández, Holden,
Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder,
Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Medina,
Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Olsen,
Patterson, Perea, Quirk, Rendon, Ridley-Thomas, Rodriguez,
Salas, Santiago, Steinorth, Mark Stone, Ting, Wagner, Waldron,
Weber, Wilk, Williams, Wood, Atkins
NO VOTE RECORDED: Thurmond
Prepared by:Sara Rogers / HUMAN S. / (916) 651-1524
9/24/15 15:29:13
**** END ****