BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | AB 1997| |Office of Senate Floor Analyses | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- THIRD READING Bill No: AB 1997 Author: Mark Stone (D) Amended: 8/19/16 in Senate Vote: 21 SENATE HUMAN SERVICES COMMITTEE: 5-0, 6/28/16 AYES: McGuire, Berryhill, Hancock, Liu, Nguyen SENATE APPROPRIATIONS COMMITTEE: 6-0, 8/11/16 AYES: Lara, Bates, Beall, Hill, McGuire, Mendoza NO VOTE RECORDED: Nielsen ASSEMBLY FLOOR: 80-0, 6/1/16 - See last page for vote SUBJECT: Foster care SOURCE: The California Department of Social Services DIGEST: This bill cleans up elements of AB 403 (Stone, Chapter 773, Statutes of 2015), which implemented the Continuum of Care Reform effort. Included in this cleanup are changes to the requirements for mental health certification of a short term residential therapeutic program (STRTP) and modifications to probation placement oversight. It establishes additional protocols around the Resource Family Approval process, which moves from a pilot program to a statewide mandate in January 2017. It requires the basic rate paid to all families be the same regardless of approval process and other changes. This bill deletes the option to extend the provisional license of a foster family agency (FFA) or STRTP if it fails to obtain accreditation within specified time frames. It deletes statutory language that will become obsolete when this bill is enacted, such as licensure categories and requirements for group homes, changes AB 1997 Page 2 the name of the short term residential treatment center to the STRTP and makes other technical changes. Senate Floor Amendments of 8/19/16 resolve chaptering conflicts with AB 1762 (Campos), AB 741 (Williams), SB 524 (Lara), AB 2231 (Calderon), AB 1001 (Maienschein), AB 1688 (Rodriguez), SB 1336 (Jackson), AB 1702 (Stone), AB 2005 (Ridley-Thomas), AB 1838 (Ting), AB 1067 (Gipson), and AB 1849 (Gipson). ANALYSIS: Existing law: 1)Establishes a system of juvenile dependency for children who are or are at risk of being physically, sexually or emotionally abused, being neglected or being exploited to ensure their safety, protection and physical and emotional well-being. (WIC 300, et seq.) 2)Establishes the licensing category of STRTC -- effective January 1, 2017 -- and defines it as a residential facility licensed by California Department of Social Services (CDSS) and operated by any public agency or private organization that provides short-term, specialized, and intensive treatment, and 24-hour care and supervision to children. Requires care and supervision provided by a center be nonmedical, except as otherwise permitted by law. (HSC 1502 (a)(18)) 3)Provides for licensure of a FFA, defined to mean a public or private agency 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(a)(4)) AB 1997 Page 3 4)Establishes California's Medicaid program, Medi-Cal, though which eligible low-income individuals receive health care and mental health services, including foster youth. 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.) 5)Establishes the Resource Family Approval process to replace the existing multiple processes for licensing foster family homes, approving relatives and nonrelative extended family members as foster care providers, and approving adoptive families. The process includes a home study, psychosocial assessment, background check, and other elements. (WIC 16519.5) 6)Establishes in statute the basic rate for a foster child and codifies modifications to that rate. (WIC 11461) 7)Restricts the placement of children younger than 6 into a group home or STRTP, except in specified circumstances. Similarly restricts the placement duration of a child aged 6-12 years old to a treatment facility for no longer than six months with written authorization required to extend the stay. (WIC 361.2) This bill: 1)Makes changes to the STRTP and FFA structure, licensure and certification: a) Renames the STRTP from the former Short Term Residential Treatment Center (STRTC). AB 1997 Page 4 b) Requires an FFA or STRTP to include with an application a letter of recommendation from county placing agencies to identify a need for the program prior to licensure. c) Requires FFA social workers to meet core competencies to participate in the assessment and evaluation of an applicant, as specified, and clarifies that a social worker may obtain a degree more advanced than a master's degree. d) Defines components of an FFA's plan of operation including a demonstrated ability to support the needs of differing children and their families, a demonstrated ability to provide or obtain treatment services, and others. e) Prohibits an FFA from considering an applicant who has had a denial within the preceding year or a previous rescission, revocation or exemption denial, but permits an FFA to continue to review an application if it determines that the issue has been corrected or no longer exists. f) Deletes the ability of an FFA or STRTP to receive a provisional license in order to obtain accreditation, provides each FFA with a 24-month window to receive the accreditation and permits CDSS to revoke licensure if accreditation is not obtained in that time. 2)Clarifies probation department's role in placing youth into an STRTP: a) Requires that if a child is placed in an STRTP through the probation department, and is older than 13 years old, the chief probation officer must review and approve the placement if it exceeds 12 months and no less frequently than every 12 months thereafter. AB 1997 Page 5 b) Requires that a court review the placement decision of a probation department for necessity and appropriateness. 3)Revises the Resource Family Approval (RFA) Process in the following ways: a) Establishes the RFA as the only method to approving homes within a foster family agency, sunsets provisions that allow for certification of homes under the prior statute and requires an FFA to document various aspects of the RFA process. b) Requires an FFA to make an announced annual inspection visit, and authorizes inspection of resource family homes as often as necessary to ensure the quality of care. c) Requires CDSS to develop a basic rate that ensures that a child placed in a licensed foster family home, a certified family home, or with a resource family approved by a county or foster family agency is eligible for the same basic rate. 4)Makes the following changes to Mental Health components: a) Prohibits an STRTP from providing specialty mental health services without a current mental health program approval from the county mental health plan or state Department of Health Care Services (DHCS), and requires that a licensed STRTP that has not obtained a program approval to provide children in its care access to appropriate mental health services. b) Authorizes DHCS and county mental health plans to AB 1997 Page 6 suspend or revoke a mental health program approval, impose monetary penalties, place a mental health program on probation or require a program to prepare and comply with a corrective action plan. c) Authorizes DHCS and county mental health plans to issue a provisional mental health approval for up to one year and requires DHCS and CDSS to issue regulations defining due process for centers that are seeking to appeal any part of the licensure and program approval process. d) Requires out-of-state group homes to have a mental health program approval equivalent to California's to accept placement of California youth. e) Removes the requirement for FFAs to obtain a mental health certification or program approval and deletes references to treatment in FFAs throughout the bill. f) Replaces the requirement that an FFA document how it will provide treatment services, with the requirement that an FFA submit a copy of its program statement to all placing agencies. g) Requires DHCS and CDSS to identify a dispute resolution process to address disputed interagency placement committee assessments or determinations of a child's service need. Background Approximately 62,000 children and youth in California are in foster care or roughly 1 in 7 foster children nationwide. For more than a decade California has implemented prevention and early intervention efforts to strengthen families and reduce the number of children in out-of-home foster care placements, AB 1997 Page 7 resulting in a decline from more than 100,000 youths in foster care in 1999 to the current 62,000. About 85 percent were removed from their families due to neglect, 8 percent due to physical abuse, and 2 percent due to sexual abuse. The median length of time California children spent in foster care was about 15 months, as of 2012. At the same time the population was declining, there was a growing national consensus in the field of child welfare that institutionalized settings should be used sparingly. The placement of maltreated children in group care settings has been increasingly viewed as a temporary solution in instances where emergency or crisis treatment is warranted. Yet, as of January 2015, 48 percent of youth placed in group homes in California through the child welfare services system had been there more than two years, and 23 percent had been there more than five years Continuum of Care Reform effort. In 2012, CDSS convened a working group to recommend changes to the current rate-setting system, services, and programs serving children and families in the continuum of foster care settings. The three-year effort came in response to statutory requirements in budget trailer bill (SB 1013, Senate Budget Committee, Chapter 25, Statutes of 2012), which mandated the workgroup consider, at a minimum, reforms to programs provided by FFAand group homes, and how to ensure the provision of services in family-like settings, including after care services, when appropriate. In January 2015, the CDSS published the "California's Child Welfare Continuum of Care Reform" report. It outlined an interdependent approach to improving California's child welfare system by improving assessments of children and families, and centering support services for children in home-based family care settings rather than in group care. AB 403 (Stone). AB 403 enacted major components of the CCR effort. The bill eliminated the licensure category of children's AB 1997 Page 8 group homes and declared Legislative intent to improve California's child welfare system by using comprehensive initial child assessments, increasing the use of and the supports to home-based family care and relying less on congregate care. The bill targeted the delivery of appropriate treatment and services to the child regardless of living arrangement, rather than using the placement setting to drive decisions about services which historically has caused a child to "fail upwards" into higher levels of care. Overall, it emphasized the creation of supports for resource families to decrease group care. Short Term Residential Treatment Centers (STRTCs). AB 403 bill created a new licensure category to replace the eliminated group home category, effective January 1, 2017. All STRTCs are required to have national accreditation from an entity identified by CDSS as well as a mental health approval. Placement of a child into a STRTC is authorized only when the case plan specifies the need for, nature of, and anticipated duration of the identified treatment and includes a plan for transitioning the child to a less restrictive environment and the projected timeline. This bill clarifies the process for an STRTC to obtain mental health approval and makes continued licensure by CDSS contingent upon obtaining the mental health approval. It permits emergency placements of youth and children into STRTCs pending further evaluation. For children with behavioral challenges that are not diagnosed as needing specialty mental health services by a county mental health plan, this bill permits an STRTC to remain licensed and to provide children in its care access to appropriate mental health services. Foster Family Agencies (FFAs). Private FFAs are used by county placing departments for children who require more intensive care than a typical foster family home, but do not need the intensive services of a group home, or an STRTP. FFAs recruit, certify and train foster parents and provide social workers and other supports to the foster families. AB 403 maintained the licensure category of FFAs, but required all FFAs to become accredited, AB 1997 Page 9 mandated new rates be established, permitted probation departments to place youth into a certified home of an FFA and permitted mental health certification for programs that provide intensive services, according to law. This bill removes the requirement that an FFA seek and obtain mental health program approval, however an FFA may still secure mental health treatment for children living within the FFA's foster homes. Out of state placements. California statute requires that any out-of-state group home meet at least the same rigorous standards it would have to meet in California. It requires CDSS or its designee - typically a county child welfare agency - to perform initial and continuing inspections of out-of-state group homes in order to either certify that the out-of-state group home meets all licensure standards required of group homes operated in California or that the CDSS has granted a waiver to a specific licensing standard upon a finding that there exists no adverse impact to health and safety. AB 403 mandated that after January 1, 2017, the licensing standards applicable to out-of-state group homes be the same as those required of STRTCs, unless the out-of-state group home is granted an extension or waiver, as specified. In January 2016, there were 62 youths placed out-of-state from the child welfare system, and 252 from the delinquency system. This bill extends the requirement for mental health certification to out-of-state placements. Rates. With the establishment of new types of treatment and the new STRTC category, AB 403 required CDSS to create a new payment structure for STRTCs and for FFAs, effective January 1, 2017. These rates were expected to be released in March 2016, however CDSS was delayed in releasing them and they were unveiled with the May Revise. In response to stakeholder concerns about the methodology for creating the rates, the Senate and Assembly budget committees adopted special reporting language requiring CDSS to work with stakeholders through the summer of 2016, and to determine if rate adjustments are necessary. AB 1997 Page 10 Resource Family Approval. Prior to AB 403, the Legislature approved and CDSS enacted a pilot project to combine the review and approval processes of California's various foster care and adoption programs into a single approval process, the Resource Family Approval (RFA) Process. AB 403 made the pilot statewide, effective January 1, 2017. This bill clarifies the process for conducting an RFA for a family member who is sheltering a foster child. The typical RFA process requires a background check, psychosocial assessment and home study prior to the placement of a child in a foster home. However, since many family placements are done on an emergency basis, without the ability to establish approval prior to placement, this bill establishes a process for emergency placement with a relative, pending final approval through the RFA process. FISCAL EFFECT: Appropriation: No Fiscal Com.:YesLocal: Yes According to an analysis by the Senate Appropriations Committee, the 2016 Budget Act includes a total of $170.6 million ($129.3 million GF) in local assistance and state operations for implementation of CCR efforts. The changes made in this bill are addressed in the budget. The analysis also notes that the numerous changes to CCR implementation made in this bill would result in unquantifiable costs. To the extent that changes result in costs that are not included in the 2016 Budget Act, this bill would require additional General Fund costs. SUPPORT: (Verified8/12/16) California Department of Social Services (source) California Council of Community Behavioral Health Agencies California Department of Finance California State Association of Counties AB 1997 Page 11 County Welfare Directors Association of California Los Angeles Unified School District National Association of Social Workers, California Chapter OPPOSITION: (Verified8/12/16) None received ARGUMENTS IN SUPPORT: The California Department of Social Services, the bill's sponsor, writes that the department continues to work in close collaboration with county partners, stakeholders and advocate groups to further the CCR reform effort. "This initiative will enhance the lives of children and youth in foster care, increasing their chances to grow into self-sufficient, successful adults," writes the department's legislative director, Robert Smith. The author states that while most youth in foster care are placed with resource families about 3,000 youth live in group placements, where they often stay for years. Foster youth who live in congregate care settings are more likely to suffer a variety of negative short- and long-term outcomes, the author states. These can include lifelong institutionalized behaviors, and increased likelihood of involvement with the criminal justice system and low educational attainment. ASSEMBLY FLOOR: 80-0, 6/1/16 AYES: Achadjian, Alejo, Travis Allen, Arambula, Atkins, 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, Quirk, Ridley-Thomas, Rodriguez, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, AB 1997 Page 12 Wagner, Waldron, Weber, Wilk, Williams, Wood, Rendon Prepared by:Mareva Brown / HUMAN S. / (916) 651-1524 8/22/16 20:37:46 **** END ****