Family First Prevention Services Act: Implementation Update
On February 9, 2018, President Trump signed into law the landmark, bipartisan Family First Prevention Services Act (FFPSA) as part of a bill funding the federal government. Lutheran Services in America has supported this legislation since it was first introduced in 2016.
What You Should Do Now
This new law may have implications for your accreditation requirements. And it may impact reimbursement eligibility for services you currently provide or those that you may choose to provide in the future.
Specifically, the law broadens the allowable uses for Title IV-E funding (the entitlement which pays for the federal portion of foster care services) to include a number of services aimed at preventing the need for children to enter foster care. FFPSA also enhances the requirements “child care institutions” which care for foster children must meet in order to be eligible for federal funding. Beginning as early as October 1, 2019, if a child is placed by an agency into a “child care institution,” Title IV-E federal foster care payments can only be made after the first two weeks of care if the institution meets one of a small number of exceptions. One of those exceptions is being recognized as a “qualified residential treatment program.” To achieve this recognition, among other requirements for care and treatment models, organizations must be both properly licensed and accredited by an approved, non-profit independent accreditation organization.
Implementation timeline and action items:
- Right now/ongoing: States that elect to take advantage of this new use for Title IV-E money are re-writing the state plans for foster care they submit to the federal Department of Health and Human Services (HHS) to include prevention activities for eligible children and their parents/kin caregivers. (These activities are generally defined as mental health and substance abuse prevention and treatment services (offered by qualified clinicians) and in-home parent skill-based programs, including parenting skills training, parent education, and individual and family counseling.) States must describe the prevention services and programs they intend to use and demonstrate that they use a trauma-informed approach and meet certain evidence criteria defining them as “promising,” “supported,” or “well-supported.”
- Action Item: Providers who offer or may wish to offer these types of prevention services should engage with their relevant state agency to advocate that the state take advantage of this new funding opportunity and to ensure that they as providers meet the standards of evidence-based care to be included in the state’s plan. Lutheran Services in America can help connect you with the right people to speak with in your state.
- Action Item: Providers should also be able to demonstrate that their services are provided under an organizational structure and treatment framework that uses a trauma-informed approach.
- No later than Oct. 1, 2018: HHS will release guidance on the practice criteria required for the newly-eligible prevention services or programs, and a pre-approved list of services and programs that meet the requirements of promising, supported, or well-supported practices.
- Action item: As part of their overall engagement with their relevant state agencies, providers should encourage them to coordinate and engage with HHS as they rewrite their state plans.
- Starting Oct 1, 2018 (FY2019): States can begin to get Title IV-E reimbursement for up to 12 months for a child who has been placed with a parent in a licensed residential family-based treatment facility for substance abuse.
- Action item: Providers who wish to be eligible for funding for these services must be able to demonstrate that they incorporate trauma-informed parent education, parenting skills training and counseling as part of their substance abuse treatment.
- Starting Oct 1, 2019 (FY2020): States can begin to get Title IV-E reimbursement (at a 50 percent match rate) for up to 12 months of prevention services for children who are candidates for foster care, regardless of family income, if they also comply with new restrictions on which “child care institutions” are eligible for Title IV-E reimbursement. (States have the option to delay the new restrictions up to two years; however any state that does so must also postpone seeking Title IV-E prevention funds for the same period of time.) Compliance means that Title IV-E federal foster care payments would only be made after the first two weeks of a child’s care to institutions which are 1) foster family homes, 2) settings for pregnant or parenting youth in foster care, 3) independent living settings for youth age 18 and older, 4) settings providing high-quality residential care and supportive services to children and youth who have been found to be, or are at risk of becoming, sex trafficking victims or 5) Qualified Residential Treatment Programs (QRTP).
- Action item: Providers of non-family foster care who do not fall into one of the other reimbursable categories will need to ensure they meet the requirements to become a QRTP: be accredited; have a trauma-informed treatment model; have registered/licensed nursing and clinical staff onsite; facilitate outreach to a child’s family and their participation in a child’s treatment plan; and provide discharge planning and family-based after-care supports for at least six months after discharge. Approved accreditation organizations include The Commission on Accreditation of Rehabilitation Facilities (CARF), The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and The Council on Accreditation (COA). Lutheran Services in America is a sponsor organization for COA, so our members receive a discount on COA accreditation. In 2017, our members saved $65,000 by taking advantage of this discount.
- Starting Oct 1, 2026: States can begin to draw down their full Federal Medical Assistance Percentage (FMAP) rate for prevention services—this may be more than the 50% rate previously available.