The Family First Prevention Services Act

Last Updated June 6, 2018

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Family First Prevention Services Act: Implementation Update

What You Should Do Now 

We are writing to give you an update on the timeline and next steps for the Family First Prevention Services Act (FFPSA).

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.

FFPSA 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. Because this is an entitlement program, adding these new allowable services and eligible individuals will increase the amount of funding that flows to the program. Further, to ensure that these new federal funds do not simply take the place of money states are currently spending on prevention services, they will only will be available for expenditures above states’ Fiscal Year (FY) 2014 spending levels on prevention services. FFPSA also enhances the requirements “child care institutions” which care for foster children must meet in order to be eligible for federal funding.

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.
  • 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.


Family First Prevention Services Act Becomes Law

On February 9, 2018, President Trump signed into law the landmark, bipartisan Family First Prevention Services Act as part of a bill funding the federal government. Lutheran Services in America supported this legislation when it was first introduced in 2016 because it strengthens federal policies aimed at improving child and family well-being, enhances support for programs serving vulnerable children and provides a new funding source for quality prevention services and programs.

Specifically, the law allows states to use funds derived from Title IV-E of the Social Security Act – the entitlement that pays for child welfare – for “time-limited” services aimed at preventing the use of foster care. These include services to address mental health challenges, substance abuse treatment and in-home parent skill-based programs for up to a year for children who are at imminent risk of entering foster care; their parents and relatives to assist the children; and pregnant or parenting teens. Additionally, access to these services would not be linked to the income of recipients. Currently, this funding is only available for spending on foster care placements and assistance to adoptive families.

The law also requires that, 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. If your organization operates residential treatment programs for children and is not currently accredited, you will need to pursue accreditation in order to receive reimbursement payments from the federal government through your state for serving this population beyond the first two weeks of care.

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.

You can also learn more about this new law from The Chronicle of Social Change or the Children’s Defense Fund.


Latest News

Family First Act Stripped from Cures Act, Strategy Shifts to CR

November 30, 2016 - Last night, during House Rules Committee consideration of 21st Century Cures, the Family First Act was removed from the legislative package.  Despite this setback, Family First still has a chance to become law, if it is attached to the one remaining ‘must pass’ bill this year.  Currently being negotiated, this potential vehicle is the short-term spending bill – known as a Continuing Resolution (CR) – that is expected to fund the government into 2017.  To avoid a lapse in federal government funding and operations, lawmakers must act before December 9 when the current CR expires. With such a tight timeline, your advocacy is more important than ever. Follow the Action Steps above and weigh in TODAY!

Family First Act Updated, Added to Bipartisan 21st Century Cures Act

November 28, 2016 - Thought to be dead after a significant portion of its offsets expired this fall, the Family First Prevention Services Act (Family First) has been given new life in the lame duck session.  Over the Thanksgiving recess, its congressional champions attached the bill to the larger 21st Century Cures Act (Cures Act), one of the few pieces of legislation expected to move before Congress adjourns for the year.  

The Cures Act is a comprehensive package designed to foster improvements and innovation throughout the US health system. It would invest millions in medical research and technology, and contains provisions to address the nation’s opiod epidemic; improve access to mental health services under Medicaid; and reauthorize the Temporary Assistance for Needy Families (TANF) program through September 2017.  It is on the coattails of this far-reaching legislation that lawmakers hope the Family First Act can finally ride to passage, after a surprisingly long and tumultuous debate.

To help improve its chances for success, the bill’s authors made several changes to Family First before attaching it to the Cures Act.  Among the updates designed to address stakeholder concerns are increased state flexibility and relaxed limitations on the use of federal funds for congregate care.  Importantly, the underlying principle of the original legislation  – to prioritize safe families for children - remains a key objective.   

The new version also includes adjustments to keep its price tag viable. Originally partially offset by a two year delay in the adoption assistance de-link, these savings expired on October 1.  Since all legislation must be cost-neutral in order to pass, this was thought to kill Family First, as it meant lawmakers would have to find new pay-fors in a short amount of time, a nearly impossible task. However, the bill’s authors did just that, achieving the necessary savings by further delaying the adoption funding by one year. 

The House Committee on Rules is scheduled to consider the bill tomorrow at 5:00 PM Eastern. Committee clearance would send the legislation as-is to the House floor for a vote as early as Wednesday. The package would then head to the Senate, where approval of the House-passed bill would enact the Family First Act. The new text of the Family First bill can be viewed by clicking here and searching the text of the Cures Act for “Division D – Child and Family Services and Support”.  These provisions are also summarized on pages 39-43 of the Cures Act summary.

Senate Adjourns, Fails to Pass Family First Act

September 29, 2016 – This afternoon, the Senate recessed for the November elections without passing the Family First Prevention Services Act of 2016.  As noted previously, Senate passage by September 30 -  the end of the current federal fiscal year – was critical, as a large portion of the bill’s offsets will expire on October 1.  The upper chamber's failure to act before leaving town ends any chance of passage this year, effectively killing the legislation. LSA is disappointed that lawmakers missed a critical opportunity to strengthen the child welfare system and improve outcomes for children and their families.  The bicameral, bipartisan Family First Act was widely supported throughout the child welfare advocacy and practitioner communities, and received unanimous approval in the US House of Representatives on June 21.  We thank all of the bill’s Congressional champions, and in particular applaud Senators Orrin Hatch (R-Utah) and Ron Wyden (D-Ore.), as well as Representatives Kevin Brady (R-Texas) and Sander Levin (D-Mich.) for their unwavering leadership.  Thank you to the LSA network for your support of the bill’s critical reforms, and for your advocacy on behalf of vulnerable children and families across the country.  We look forward to continuing to work together to advance policies that will ensure all children have the opportunity to reach their full potential, lead abundant lives, and contribute to their communities. 

Now is the Time: Take Action on the Family First Prevention Services Act 

September 27, 2016  - Time is running out to pass the Family First Prevention Services Act (H.R. 5456, S. 3065)! The House unanimously passed the legislation in June, and the Senate must act this week - before Congress recesses for the November elections – if it is to become law.  That’s because on October 1, the beginning of the new federal fiscal year, $400 million in funds that help pay for the package will be lost, effectively killing the bill. The most important thing you can do is take a minute now to call and email both of your US Senators and ask them to pass the FFPSA before they leave for recess later this week.  See today's email alert to learn more.

Tuesday, September 20 is Family First Prevention Services Act Day of Action!

September 20, 2016 - Your help is urgently needed to ensure passage of the Family First Prevention Services Act (HR 5456/S 3065). This bipartisan, bicameral legislation takes an important step forward in realigning federal child welfare funding with improved outcomes for vulnerable children and families. The House unanimously passed the bill in June, and the Senate must act this week - before recessing for the November elections - if the Family First Act is to become law. TODAY, September 20, join LSA and child welfare advocates across the country for a Day of Action to pass the Family First Prevention Services Act! Click here to learn how you can participate.   

Save the Date and Spread the Word! Day of Action to Pass the Family First Prevention Services Act

September 16, 2016 - Calling all child welfare advocates! We need your help to ensure the Family First Prevention Services Act (HR 5456, S 3065), a major bipartisan bill that would strengthen the child welfare system, is passed! The House passed the bill unanimously in June, and the Senate urgently needs to pass it by the end of next week - before Congress recesses for the elections - if it is to become law this year. On Tuesday, September 20th, join child welfare advocates across the country for a Day of Action to pass the Family First Prevention Services Act! We will send details for the day of action, including talking points and an email script, on Monday, September 19th. In the meantime, mark your calendars and spread the word using these sample social media posts and graphics. It is critical that Senators hear from as many constituents as possible!

Action Alert! Tell Congress to Help Vulnerable Children and Families 

September 14, 2016  - Senate Finance Committee Chairman Orrin Hatch (R-UT) and Ranking Member Ron Wyden (D-OR) are committed to passing the bipartisan, bicameral Family First Prevention Services Act (HR 5456/S 3065) this year, but time is running out! Strong support is needed to ensure the House-passed bill is prioritized in the Senate and receives a floor vote this month. Read LSA’s latest Action Alert to learn why the time to act is NOW, and how you can make a difference!

Child Welfare Leaders Urge Senate Passage of the FFPSA

September 6, 2016 – Today, LSA joined over 400 national, state, and local, organizations in a letter to Senate Majority Leader Mitch McConnell (R-KY) and Minority Leader Harry Reid (D-NV), expressing support for the Family First Prevention Services Act (HR 5456, S 3065), and encouraging Senate passage this month. The Senate urgently needs to pass the bill in September, before Congress recesses for the November elections.

Congressional Leaders Agree – The FFPSA is a Better Way to Help Vulnerable Children and Families

September 6, 2016 - In a Washington Post editorial published today, Senate and House sponsors of the FFPSA  - Senate Finance Committee Chairman Orrin Hatch (R-UT), Ranking Member Ron Wyden (D-OR), House Ways and Means Committee Chairman Kevin Brady (R-TX), and Ranking Member Sander Levin (D-MI) – explain why the bill is “A better way to help vulnerable children and families”.  The editorial details how the bipartisan FFPSA will help children and families who are in or at risk of entering the child welfare system, and why the time to act is now. 

It's Not Too Late! Join Leading State and National Child Welfare Organizations in Urging Final Senate Passage 

August 4, 2016 - Senate Finance Committee Chairman Orrin Hatch (R-UT) and Ranking Member Ron Wyden (D-OR) are committed to passing the Family First Prevention Services Act (HR 5456), but strong support is needed at the national and state level to ensure HR 5456 is prioritized in the Senate and receives a floor vote when legislators return to Washington in September! To help move this important bill forward, please add your organization to the sign-on letter in support of HR 5456.  Over 130 national, state and local organizations have already joined the letter, urging Senate Leadership to bring HR 5456 to a vote when Congress returns in September. Please click here to view the letter and click here to add your organization

Congress in Recess, FFPSA Stalled Until September

July 18, 2016 - Last week, the Senate adjourned for a seven-week summer recess. Despite strong leadership from Senate Finance Committee Chairman Hatch and Ranking Member Wyden, efforts to pass the measure before the Senate left town were unsuccessful.  However, there is strong resolve from Senators Hatch and Wyden, advocates, and others to pass the bill when the Senate returns in September. 

Sen. Wyden Urges Senate Passage of the FFPSA after Recess 

July 14, 2016 – Senate Finance Committee Ranking Member Ron Wyden, said today said the Senate “can and must” pass the bipartisan Family First Prevention Services Act when Congress returns to its legislative agenda in the fall, as “[t]he weight of the status quo is severe, and it falls heaviest on the thousands of foster kids living in quiet struggle.” He also acknowledged there is both appetite and opportunity for improving the FFPSA, stating “this bill is not perfect, but no legislation is ever perfect.  I have been clear that there will be opportunities – both through the regulatory and legislative processes – to strengthen this legislation and build on it. But in my judgement, this bill gets us closer to a world where foster care is needed less often – a system where the priority is keeping children and families together.”  The full statement is available here

Leading Child Welfare Organizations Urge FFPSA Passage

July 12, 2016 – Earlier today, LSA joined more than 130 national and state organizations in a letter to Senate leaders urging passage of the bipartisan, bicameral FFPSA before they leave town for summer recess on July 15.  In part, the letter applauds the historic step the Act takes to invest in preventive services, as well as its increased supports to help older youth transition from foster care to adulthood.  The letter is available here

House Clears HR 5456, Sending Bill to the Senate for Further Action

June 21, 2016 - On Tuesday evening, the House passed the Family First Prevention Services Act (HR 5456) by voice vote.  Action now turns to the Senate, where adoption of the House-passed bill would send the bipartisan, bicameral package to the President's desk. The archived hearing and related materials are available here, and the committee-passed version of HR 5456 is available here.

New Resources on the Family First Prevention Services Act

June 21, 2016 - The Child Welfare and Mental Health Coalition, of which LSA is a member, has released a detailed summary of the Family First Prevention Services Act and is working on an implementation chronology that we will share shortly. The American Academy of Pediatrics, in collaboration with several other organizations, also released a fact sheet on the nursing and clinical staff standards in residential treatment programs as proposed in the FFPSA. 

Finance Senators Introduce Family First Prevention Services Act

June 17, 2016 - This week, Senate Finance Committee Chairman Orrin Hatch (R-Utah), Ranking Member Ron Wyden (D-Ore.), and Committee members Chuck Grassley (R-Iowa) and Michael Bennet (D-Colo.)  introduced the Family First Prevention Services Act (S. 3065).   The bill introduction follows an announcement from bipartisan Senate and House leaders that an agreement had been made on the legislation. It is the Senate companion to legislation reported by the House Ways and Means Committee on June 15, 2016. Read more from the Senate Finance Committee

Families First Child Welfare Bill Passes House Committee, Bicameral Goal to Move Quickly

June 16, 2016 - Yesterday, the House Ways and Means Committee passed the Family First Prevention Services Act (HR 5456). The next steps are for the bill to be moved to a floor vote by the full House as early as next week.  Senate leaders are expected to introduce the companion bill in the coming days.  The archived hearing materials are available here, and the committee-passed version of HR 5456 – which includes a new competitive grant program to help states support the recruitment and retention of high quality foster families - is available here.  

House Introduces Family First Prevention Services Act of 2016 

June 13, 2016 – Just days after they announced an agreement on bipartisan, bicameral legislation, House leaders officially introduced the Family First Prevention Services Act of 2016 (HR 5456). The Ways and Means Committee is scheduled to mark up the bill on on Wednesday, June 15.  

House, Senate Announce Bipartisan, Bicameral Deal on Child Welfare Legislation

June 10, 2016 –This evening, the House Ways and Means Committee and the Senate Finance Committee released the text of the bipartisan, bicameral Family First Prevention Services Act of 2016 (FFPSA). The bill builds upon the draft Family First Act outline and extends important child welfare provisions set to expire this year. The House Ways and Means Committee’s press release, as well as proposed legislative language and a short summary of the draft bill, are available here. With less than one month left before Congress leaves for an extended summer recess, lawmakers hope to introduce and move the bill without delay.  

LSA Resources

Below, please find a short summary of the FFPSA, and the Titles, Sections, and corresponding page numbers to help you find these provisions in the legislative text.  LSA is in the process of reviewing the draft language and will provide a more detailed analysis soon.  In the interim, we encourage you to reach out to LSA’s Director of Public Policy and Advocacy, Lindsey Copeland, with any feedback, position statements, or questions you may have.

What's In the Family First Prevention Services Act?

Key Aspects of the Family First Act that are Included in the Family First Prevention Services Act:

Keep children at risk of foster care placement safely with parents or relatives by making federal funds available for mental health and substance abuse prevention and treatment services and in-home parent skill-based programs. In regard to these services, the new bill carries over the Family First Act’s expansion of Title IV-E funding that is not tied to the 1996 AFDC program, but is linked instead to whether or not the child is “at-risk” of a foster care placement.  In such a case, a child and/or his/her parent/guardian/adoptive family would be eligible for services for up to 12 months for mental health, substance abuse, or in-home services.  The use of federal IV-E funding for these services would be optional for states, and phased-in, beginning in 2019. 

Encourage the placement of children in foster care in the most family-like settings appropriate to their special needs. The provisions relating to residential placements are very similar to what was proposed in the draft Family First outline.  In part, the new legislation specifies that after the first two weeks a child is in the foster care system, federal funding would be limited to the following group settings: (1) Qualified Residential Treatment Programs (QRTP) - defined as a program that has a trauma-informed treatment model and meets certain staffing, family outreach, discharge, and licensing requirements; (2) facilities for pregnant and parenting teens; and (3) independent living arrangements for youth 18 and older.  The legislation also includes the requirement that a QRTP have a licensed or registered nurse or licensed clinical staff on site during business hours and available 24 hours 7 days a week. These provisions would also take effect on October 1, 2019, but would not be optional for states.

The Family First Prevention and Services Act also Includes the Following New Provisions: 

  • Seeks to offer additional support for relative caregivers by allowing a federal match for evidence-based Kinship Navigator programs, and by requiring states to document how their foster care licensing standards accommodate relative caregivers. 
  • Addresses the recent spike in out-of-home placements due to the opioid and heroin epidemic by reauthorizing and updating the Regional Partnership Grant (RPG) program, which funds state and regional grantees seeking to provide evidence-based services to prevent child maltreatment related to substance abuse. 
  • Amends the John H. Chafee Foster Care Independence Program to allow states to continue to assist former foster youth up to age 23, and to extend eligibility for education and training vouchers to youth to age 26. 
  • Encourages states to use electronic interstate case-processing systems to help expedite the interstate placement of children in foster care, adoption, or guardianship.
  • To assist youth aging out of foster care obtain Medicaid coverage up to age 26, the bill requires evidence that the child was previously in foster care be included in the document package they receive when leaving care
  • Extends for five years (FY17 – FY21) the Title IV-B Promoting Safe and Stable Families and Child Welfare Services programs, and eliminates the 15-month time-limit on the use of PSSF funds for reunification services.
  • Extends for five years (FY17 – FY21) the Adoption and Legal Guardianship Incentive Payment program.
  • Postpones for 2.5 years the Title IV-E Adoption Assistance “de-link” for the adoptions of infants and toddlers. The temporary delay is included as an offset, to help pay for the cost of the legislation.  

Where Can I Find these Provisions in the Legislative Text?

Below, please find a list of various Titles and Sections in the bill, with corresponding page numbers. Please note that these page numbers correspond with the pre-markup version of the House bill, available here.

TITLE I—Investing in Prevention and Family Services

Subtitle A—Prevention Activities Under Title IV–E (p. 4)

  • Sec. 111. Foster care prevention services and programs. (p. 4)
  • Sec. 112. Foster care maintenance payments for children with parents in a licensed residential family-based treatment facility for substance abuse. (p. 35)
  • Sec. 113. IV–E payments for evidence-based kinship navigator programs. (p. 38)

Subtitle B—Enhanced Support Under Title IV–B (p. 39)

  • Sec. 121. Elimination of time limit for family reunification services while in foster care and permitting time-limited family reunification services when a child returns home from foster care. (p. 39)
  • Sec. 122. Reducing bureaucracy and unnecessary delays when placing children in homes across State lines. (p. 40)
  • Sec. 123. Enhancements to grants to improve well-being of families affected by substance abuse. (p. 45)

Subtitle C—Miscellaneous (p. 54)

  • Sec. 131. Reviewing and improving licensing standards for placement in a relative foster family home. (p. 54)
  • Sec. 132. Development of a statewide plan to prevent child abuse and neglect fatalities. (p. 56)
  • Sec. 133. Modernizing the title and purpose of title IV–E. (p. 57)
  • Sec. 134. Effective dates. (p. 57)

TITLE II—Ensuring the Necessity of a Placement that is Not in a Foster Family 

  • Sec. 201. Limitation on Federal financial participation for placements that are not in foster family homes. (p. 60)
  • Sec. 202. Assessment and documentation of the need for placement in a qualified residential treatment program. (p. 70)
  • Sec. 203. Protocols to prevent inappropriate diagnoses. (p. 78)
  • Sec. 204. Additional data and reports regarding children placed in a setting that is not a foster family home. (p. 79)
  • Sec. 205. Effective dates; application to waivers. (p. 81)

TITLE III—Continuing Support for Child and Family Services 

  • Sec. 301. Supporting and retaining foster families for children. (p. 82)
  • Sec. 302. Extension of child and family services programs. (p. 83)
  • Sec. 303. Improvements to the John H. Chafee foster care independence program and related provisions. (p. 84)

TITLE IV—Continuing Incentives to States to Promote Adoption and Legal Guardianship

  • Sec. 401. Reauthorizing adoption and legal guardianship incentive programs. (p. 94)

TITLE V—Technical Corrections 

  • Sec. 501. Technical corrections to data exchange standards to improve program coordination. (p. 94)
  • Sec. 502. Technical corrections to State requirement to address the developmental needs of young children. (p. 96)

TITLE VI—Ensuring States Reinvest Savings Resulting from Increase in Adoption Assistance

  • Sec. 601. Delay of adoption assistance phase-in. (p. 97)
  • Sec. 602. GAO study and report on State reinvestment of savings resulting from increase in adoption assistance. (p. 98)