The Human Resources Subcommittee of the House Ways and Means Committee held a hearing, The Opioid Crisis: Implementation of the Family First Prevention Services Act July 24 and has produced a video recording of the hearing (about 1:40 in length). Acting Commissioner of the Administration of Children, Youth and Families (ACYF), Jerry Milner, was the sole witness. Read his opening comments online. The Alliance for Strong Families and Communities Policy Team attended the hearing and offers the brief recap below, which highlights issues that have been discussed as priorities by and for Alliance members.

FFPSA Part I: Prevention Activities Under IV-E  

Program Instruction for the IV-E prevention provisions will include information about financing and will be released from HHS in the late fall. The Department of Health and Human Services (HHS) does not yet have answers to the more involved, technical questions, such as those related to financing. However, it is anticipated that the upcoming Program Instruction will provide answers to questions about financing, including the Maintenance of Effort (MOE). In addition, ACYF is coordinating with other HHS agencies including the Substance Abuse and Mental Health Administration, Health Resources Services Administration, and Centers for Medicare and Medicaid Services (CMS). In particular, ACYF’s Children’s Bureau and CMS are working to sort out the payments between Medicaid and IV-E. More generally, at this point in the process, ACYF is compiling the list of finance-related issues that need to be resolved.

The Evidence-Based Clearinghouse is expected to be established by Oct. 1. Final guidance on identifying and approving evidence-based services will be issued late fall once the clearinghouse is established. Milner stated that HHS, intends to, “open the ‘promising door’ as wide as it can” so as to continuously broaden the array of evidence-based services that are included in the clearinghouse and approved for IV-E reimbursement.

As promised during the hearing, HHS issued a Request for Comment on national licensing standards on Aug. 1, 2018 with a due date of Oct. 1, 2018. As a reminder, FFPSA requires HHS to “identify reputable model licensing standards with respect to the licensing of foster families” by no later than Oct. 1, 2018. Thereafter, by April 1, 2019, states must demonstrate how state standards are in accord with the national model standards or give a reason(s) why the state believes the model is not appropriate for the state. Rep. Terri Sewell (D-Ala.) submitted National Association for Regulatory Administrations Model Family Foster Home Licensing Standards for the record.

State declaration of delay. In the Program Instruction issued to states July 9, HHS requested that states indicate by Nov. 9 whether they plan to take the option to delay implementation of FFPSA for all or part of the two years allowed. In the hearing, it was clarified that the declaration that the state submits is not binding and is merely for planning purposes. States can continue to draw up their state plans, then change their declaration after Nov. 9 if necessary.

No further definition beyond what is in current statute will be issued from HHS for “candidate for care” or “imminent risk.” States have the flexibility to further define the term.

FFPSA Part IV: Provisions for Placement and Treatment Settings

Accreditation a very big concern for HHS. Milner acknowledged that the accreditation requirement for Qualified Residential Treatment Programs (QRTPs) is a tough issue for some states. He stated that there is no flexibility to allow for pending accreditation status nor is he aware of IV-E funds that could be used by states to pay for accreditation. He also shared that HHS is developing a strategy and a plan, including meeting with different organizations that could be potentially be involved in addressing the issue, but concluded by saying, “Frankly, it is a very big concern.” (Rep. Jackie Walorski (R-Ind.) posed the questions on accreditation at 29:00 in the recording.)

Further definition of the setting and the terms related to sex trafficking. Milner reported that the intention is to allow states the flexibility to define the term sex trafficking beyond what is in current statute. He stated that the type of setting is defined in statute. Rep. Dave Reichert (R-Wash.) raised this question and requested a follow up conversation with Milner to consider how the definition of sex trafficking is managed by HHS. (Rep. Reichert raised this question at 1:14 in the video recording of the hearing.)  

Flexibility for county-administered states. While the state is required to make the decision whether to opt in or out of the IV-E prevention provisions, Milner interprets that implementation of the prevention provisions may be differentiated across the state. However, adherence to the congregate care provisions are required statewide. (Rep. Judy Chu (D-Calif.) raised these questions at 1:19 in the recording.)  

Transition Support for Waiver Jurisdictions. HHS supports establishing a form of transitional authority to assist IV-E waiver jurisdictions with a transition to FFPSA implementation. Milner mentioned his work with Los Angeles County and the county’s success with the waiver. He acknowledged that FFPSA does not offer the breadth of flexibility that a waiver provides. He spoke to a, “strong need for us to do this (IV-E waiver transition) in an orderly fashion in a way to help states plan thoughtfully as they move to implementation of FFPSA.” (Rep. Judy Chu (D-Calif.) spoke to IV-E waiver at 44:13 in the recording.)  

Communications with Public Agencies. During the hearing, Milner described the three in-person and five teleconference listening sessions that are being held for public agencies and tribes. The Alliance has uplifted the need for the voices of community-based provider organizations, likewise the information needs these organizations have, to Associate Commission Milner and others who are organizing the listening sessions. We continue to seek and identify opportunities that may be provided to community-based organizations to pose questions and provide input. As a reminder, Associate Commissioner Milner will join the 2018 Alliance National Conference, to be held Oct. 15-17 in Denver, for a workshop on primary prevention that is open to all conference attendees. Register for the conference today

General Comment from Milner on FFPSA Implementation. HHS is committed to timely implementation of the FFPSA and to doing it well. Consistent with previous public comments, Milner stated, “I am far more interested in seeing states truly move the culture and the foundation of their child welfare systems to one that is designed to strengthen families against the outcomes that Family First contemplates, as opposed to a purely technical implementation that may not, in fact, improve the outcomes for children and families.”  

Of note, there is an ongoing need to educate policymakers on how a system that is focused on primary prevention works and what it can accomplish. There is an exchange between Rep. Brad Wentstrup (R-Ohio) and Milner is particularly interesting, as it offers a window in to the need for members of Congress to much better understand how systems and programs work to protect children and keep them safely with their families, and to better understand what may bring a child to the attention of the child welfare system. It demonstrates the need for Alliance members to be engaged in educating policymakers, including hosting site visits for members of their congressional delegation and other state and local decisionmakers, as FFPSA is implemented. During the exchange, Milner advocates for a system of child and family well-being that prevents child maltreatment and works to explain how that is different than what we have today. (The dialogue begins at 50:23 in the recording.)