H.B. 860
GENERAL ASSEMBLY OF NORTH CAROLINA
Apr 25, 2023
SESSION 2023 HOUSE PRINCIPAL CLERK
H D
HOUSE BILL DRH30302-NBa-142
Short Title: Protect Our Youth in Foster Care. (Public)
Sponsors: Representative K. Baker.
Referred to:
1 A BILL TO BE ENTITLED
2 AN ACT TO ENSURE THE USE OF TRAUMA-INFORMED, STANDARDIZED
3 ASSESSMENTS AND APPROPRIATE CARE FOR CHILDREN AND YOUTH IN
4 FOSTER CARE.
5 Whereas, supporting children, youth, and families served by the child welfare system
6 requires a high level of multisector coordination aimed at preserving families and supporting
7 reunification and permanency. In order to accomplish successful achievement of child outcomes,
8 the health plans, care management agencies, the service providers, and families and youth must
9 be involved and committed to the use of evidence-based practices; and
10 Whereas, agencies must utilize standardized tools, assessments, and training that
11 address the trauma that these children and youth experience; Now, therefore,
12 The General Assembly of North Carolina enacts:
13
14 PART I. TRAUMA-INFORMED, STANDARDIZED ASSESSMENT
15 SECTION 1.(a) Establishment; Purpose. – Children who are at risk of entry into
16 foster care and children who are currently in foster care have experienced trauma warranting the
17 involvement of the Division of Social Services and other child welfare agencies. As a result of
18 the trauma, children are at a higher risk of needing behavioral health or intellectual or
19 developmental disability services. To that end, the Department of Health and Human Services
20 shall develop a trauma-informed, standardized assessment in partnership in accordance with this
21 section.
22 SECTION 1.(b) Membership. – The partnership developing the trauma-informed,
23 standardized assessment shall consist of all of the following members:
24 (1) Representatives from all of the following divisions of the Department of
25 Health and Human Services: the Division of Social Services, Division of
26 Health Benefits, Division of Mental Health, Developmental Disabilities, and
27 Substance Abuse Services, and the Division of Family and Child Well-Being.
28 (2) Prepaid health plans, as defined in G.S. 108D-1, and primary care case
29 management entities, as defined in 42 C.F.R. § 438.2, that serve children at
30 risk of entry into foster care and children who are currently in foster care.
31 (3) Representatives from the county departments of social services.
32 (4) Benchmarks, a nonprofit corporation.
33 (5) Individuals with lived experiences.
34 (6) Others identified by the partnership based upon areas of expertise.
35 SECTION 1.(c) Plan Development. – In developing the trauma-informed,
36 standardized assessment, the partnership shall develop a rollout plan with a goal of implementing
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1 the trauma-informed, standardized assessment statewide in all 100 counties. The rollout plan
2 shall include all of the following:
3 (1) The development of the trauma-informed, standardized assessment template
4 by December 31, 2023.
5 (2) The finalized trauma-informed, standardized assessment template by June 30,
6 2024, including the standardized training curriculum, methodology for
7 training, the selection of a vendor to manage and conduct the training and
8 determine the process for the statewide rollout, and coordination with tribal
9 jurisdictions.
10 (3) The phased-in approach of the trauma-informed, standardized assessment
11 beginning on July 1, 2024, and operating statewide by June 30, 2025.
12 (4) The establishment of a base rate for the trauma-informed, standardized
13 assessment that supports the oversight, training, and monitoring of the fidelity
14 to the trauma-informed, standardized assessment.
15 (5) The establishment of a standardized workflow of notifications to the payers
16 and child welfare agencies, including the following recommended service
17 processes:
18 a. Time lines for recommended access and implementation of services
19 from date of referral.
20 b. Network and provider capacity to meet expected time lines. In the
21 event the behavioral health service provision is in a region served by
22 a BH IDD tailored plan or in an LME/MCO catchment area that has a
23 gap in provider capacity to meet the recommended time lines, the
24 network shall be open to providers for additional provider enrollment.
25 (6) The identification of core outcomes to measure the success of the project and
26 impact of youth receiving the trauma-informed, standardized assessments in
27 a timely manner by a trained workforce.
28 (7) The establishment of a statewide implementation training plan that includes
29 oversight of fidelity to the trauma-informed, standardized assessment for staff
30 conducting the assessment within specified time frames. Medicaid managed
31 care plans shall be required to open their provider networks to obtain the
32 necessary number of trauma-informed providers if the existing network
33 cannot meet the needs of the community. The training plan shall be enacted
34 and implemented within the same time lines established with the rollout
35 schedule.
36 SECTION 1.(d) In developing the trauma-informed, standardized assessment and
37 the rollout plan, the Department of Health and Human Services shall ensure the trauma-informed,
38 standardized assessment includes, at a minimum, all of the following:
39 (1) Ensure that juveniles between the ages of 4 and 17 being placed into foster
40 care receive a trauma-informed, standardized assessment within 10 working
41 days of their referral.
42 (2) Each juvenile who is included in any Medicaid children and families specialty
43 plan, regardless of their type of placement, shall receive a trauma-informed,
44 standardized assessment.
45 (3) Each trauma-informed, standardized assessment may be administered in a
46 face-to-face or telehealth encounter.
47 (4) The county department of social services must make the referral for a
48 trauma-informed, standardized assessment within five working days of a
49 determination of abuse or neglect of the juvenile in accordance with
50 G.S. 7B-302.
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1 (5) After obtaining parental consent, a juvenile may receive a trauma-informed,
2 standardized assessment if the county department of social services makes the
3 determination that a juvenile is at imminent risk for entry into foster care.
4 (6) Allow for individuals between the ages of 18 and 21 to receive an assessment,
5 if necessary.
6 (7) Develop an evidence-informed and standardized template and content for the
7 assessment.
8 (8) In the event the juvenile has an assigned care manager under the Medicaid
9 program, the responsible care management entity shall be notified of the
10 referral for the assessment and to whom.
11 SECTION 1.(e) The Department of Health and Human Services shall also do all of
12 the following in implementing the trauma-informed, standardized assessment and the rollout
13 plan:
14 (1) Leverage the expertise and lessons learned from the entities included in the
15 partnership who have successfully implemented trauma-informed,
16 standardized assessments and training venues.
17 (2) Complete any required documentation and, as applicable, leverage all
18 available federal revenues for such activities, including opioid settlements,
19 Medicaid, federal block grant funds, and social services or behavioral plans
20 or grants.
21 (3) Amend any existing contracts between the Department and entities who have
22 the expertise to manage the trauma-informed, standardized assessment and the
23 rollout plan to include the creation of a training plan and requirements to
24 monitor implementation of the assessment and rollout plan to ensure the
25 fidelity of the service and delivery are maintained.
26 (4) Create a Division of Social Services Statewide Dashboard representing the
27 status of the trauma-informed, standardized assessment implementation and
28 the rollout plan, updated monthly, that includes all of the following:
29 a. Referrals.
30 b. Case management.
31 c. Assessments.
32 d. Lag between referrals, assessments, and service initiation.
33 e. Youth personal outcomes, not based on process, but instead focused
34 on supporting permanency.
35 f. Any other elements identified by the partnership.
36
37 PART II. MEDICAID
38 SECTION 2.(a) The General Assembly finds that children receiving foster care
39 services through the county child welfare agencies are entitled to evidence-based or
40 evidence-informed, or both, trauma-informed interventions and therapy. The Department of
41 Health and Human Services, Division of Health Benefits (DHB), shall develop and, to the extent
42 allowed under G.S. 108A-54.1A, implement new "in-lieu-of" services under the Medicaid State
43 Plan for children receiving foster care services. These "in-lieu-of" services shall be developed to
44 be implemented statewide and shall apply a Children and Families specialty plan if one is
45 implemented. For Medicaid beneficiaries not enrolled in managed care, DHB shall utilize Early
46 and Periodic Screening, Diagnostic and Treatment (EPSDT) to ensure access to the
47 recommended interventions and therapies.
48 In order to develop the new "in-lieu-of" services required by this section, DHB shall
49 partner with county child welfare agencies, representatives with lived experience in child welfare,
50 the nonprofit corporation Benchmarks, prepaid health plans, and local management
51 entities/managed care organizations (LME/MCOs) to identify innovative service options to
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1 address any gaps in the care of children receiving foster care services. The plan shall be developed
2 no later than 90 days after this act becomes law. The plan developed shall address all of the
3 following:
4 (1) Identification of models of community evidence-based practices that support
5 a foster child returning to their family in a timely manner and diverting higher
6 level foster care placements.
7 (2) Identification of model short-term residential treatment options that serve
8 children with high acuity needs that divert a child from higher level
9 placements such as psychiatric residential treatment facility placement
10 (PRTF). These services may also provide stepdown options from higher levels
11 of care.
12 SECTION 2.(b) No later than three months after the plan is developed under
13 subsection (a) of this section, DHB shall issue a request for proposals (RFPs) for any services
14 identified through the plan development process as lacking and targeted towards any geographic
15 location with identified inadequate provider access. Services may be phased in over a period of
16 two years. The RFPs shall be developed in partnership with the stakeholders involved with
17 developing the plan, as required under subsection (a) of this section. Each RFP shall include the
18 following:
19 (1) The development of newly identified Medicaid services for foster children
20 that may be implemented regionally or statewide.
21 (2) Expansion of a Medicaid service that is not located in the particular county or
22 region.
23 (3) Time lines for, and establishment of, first- and second-year deliverables for
24 any service that may be a phased-in service.
25 (4) Identification of required funding, including start-up funding and three-year
26 budget, including projected revenue sources and amounts.
27 (5) Specific outcome measures with the attestation of the timely submission of
28 the data to the responsible prepaid health plan and DHB. These outcomes shall
29 be aligned with child welfare safety and permanency measures and support
30 positive childhood outcomes.
31 DHB shall review the RFPs and award provider contracts to the accepted RFPs within
32 six months of submission due date of the RFP being awarded. DHB may prioritize
33 implementation of the RFP awards based upon areas in the greatest need, as identified by the
34 stakeholders involved with developing the plan, as required under subsection (a) of this section.
35 DHB shall train all county departments of social services, and offer training to tribal
36 welfare offices, on the Medicaid services recommended for implementation by the stakeholders
37 involved with developing the plan, as required under subsection (a) of this section, and continue
38 to provide status implementation within the impacted counties and region.
39
40 PART III. APPROPRIATION
41 SECTION 3.(a) There is appropriated from the General Fund to the Department of
42 Health and Human Services the nonrecurring sum of seven hundred fifty thousand dollars
43 ($750,000) in each year of the 2023-2025 fiscal biennium for the development of the foster care
44 trauma-informed, standardized assessment.
45 SECTION 3.(b) There is appropriated from the General Fund to the Department of
46 Health and Human Services, Division of Health Benefits, the sum of twenty million dollars
47 ($20,000,000) in recurring funds for the 2023-2024 fiscal year and the sum of twenty million
48 dollars ($20,000,000) in recurring funds for the 2024-2025 fiscal year to implement Part II of
49 this act. These funds shall provide a State match for thirty-eight million seven hundred thousand
50 dollars ($38,700,000) in recurring federal funds for the 2023-2024 fiscal year and thirty-eight
51 million seven hundred thousand dollars ($38,700,000) for the 2024-2025 fiscal year. Those
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1 federal funds are appropriated to the Division of Health Benefits to pay for costs associated with
2 the implementation of Part II of this act.
3
4 PART IV. EFFECTIVE DATE
5 SECTION 4. Part III of this act becomes effective July 1, 2023. The remainder of
6 this act is effective when it becomes law.
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