1. Continuum of Care Reform Key Issues for County Mental Health Preparation & Implementation December 12, 2016

2. Presentation Outline CCR Statewide Outreach Highlights
Preliminary Recommended Local Activities
Current Local Activities Needed
Short-Term Residential Programs (STRTPs)
Therapeutic Foster Care (TFC)
Child & Family Team (CFT) Meetings
Additional CCR Background Information

3. Statewide OUTREACH HIGHLIGHTS

4. Statewide CCR Regional Ideas and Transformation Exchange (RITE) Meetings
Northern, Bay, LA, Southern, Central, Northern
Small Counties—Tentatively February 2017
Another round in Spring

5. DHCS Medi-Cal 101 Regional Trainings for Providers
Central Region—Dec. 16, 2016
Documentation Manual
Billable Service/Intervention, including applicable travel time and documentation time for service
Other Regions TBD

6. Preliminary recommended LOCAL Activities

7. Foster Family Agencies (FFAs) FFA Therapeutic Foster Care Providers
Continuum of Care Reform Transitions: County Mental Health Plan Roles
Non-CWS Group Homes
Group Homes
Foster Homes
Resource Families
Short-Term Residential Treatment Programs
(STRTPS)
Foster Family Agencies (FFAs)
CCL Licenses FFA
MHP provides Medi-Cal Specialty MH Service Certification of FFA
MHP Contracts with FFA
MHP Oversees FFA
MHP Pays FFA for TFC
FFA Oversees and Pays TFC Resource Families
CCL Licenses (STRTP can immediately receive placements)
MHP or DHCS Program Approval and Medi-Cal Specialty MH Service Certification (≤1 yr.)
MH Assessment of Youth by MHP/LMHP
Interagency Placement Committee Approves Placement
CWS/Prob. Places Youth
MHP/Org. Provider provides Medi-Cal Specialty MH services to Youth (if/until STRTP receives Specialty MH Service Certification.
FFA Therapeutic Foster Care Providers
TFC Resource Families

8. Meet with Local Child Welfare and Probation Leaders
Project local Medi-Cal Specialty Mental Health Service (SMHS) needs:
Children and youth Foster Homes
Children and youth in RCL Group Homes transitioning to STRTPs
In and Out of County youth

9. Consider CWS and Probation Youth Placements in FFAs/County Homes
How many children placed in FFAs & County Homes?
How many receiving SMHS?
FFA Provider
Projected Resource Families & beds needed for step down from RCL Group homes?
Other Org. Provider
MHP Employees
Out of County MHP

10. Gather Information about Group Homes Transitioning to Short Term Residential Treatment Programs (STRTPs)
How many children in group home placements, at what RCL level?
How many children will transition to STRTPs?
How many children will step down to Resource Family Homes, including TFC Homes?
How many group homes requested extensions?
STRTPs –requested 6-24 months extension

11. Gather Information about Group Homes Transitioning to STRTPs, continued
How many beneficiaries are currently receiving Medi-Cal Specialty MH Services, provided in and out of county, by:
Group Home Providers?
Other Organizational Providers?
MHP placing county (in county)?
Host County MHP (out of county)?
STRTPs –requested 6-24 months extension

12. Inform CWS and Probation Partners of Dispute Resolution Process
How will MHP handle disputes regarding:
Quality
Access
Timeliness
Medical Necessity
Where are Notices of Action (NOAs)Sent?
Caregiver?
Placing Agency Worker?
Child’s Attorney/Public Defender?
Other?

13. Review Required CCR County Plans
Foster Parent Recruitment Retention and Support (FPRRS) Plan
Counties receiving FPPRS funds ($17.2 million in FY , $43.2 million in )
Funds may be used to assist MHPs with training foster parents
Some counties submitted joint CWS-Probation plans
Resource Family Approval (RFA) Implementation Plan
Plans were due to CDSS September 2016

14. Ensure Partners Know How to Access Mental Health Services in Your County
County MHP Access
Medi-Cal Fee-For-Service
Medi-Cal Managed Care Plans
Schools and LEA Medi-Cal
FQHC Community Clinics
District Attorney’s Office: Victims of Crime Services
Wraparound Services

15. Know CCR Funding for Mental Health
FY (Half Year Implementation January-June)
Child and Family Teams: $10 million (50% federal/50% state)
STRTP Assessments: $277,000 (50 federal/50 state)
FFA Medi-Cal Certs.: $435,000 (50 federal/50 state)
Training county MH staff: $3 million (50 federal IV-E/50 state)
Provision of TFC: $15.7 million (50 federal/50 county)
STRTP Medi-Cal Certs.: $350,000 (50 federal/50 state) DHCS
COUNTY ACCESS TO FUNDS BY SUBMITTING CLAIMS

16. DISCUSSION &QUESTIONS

17. Current local activities needed

18. STRTP Program Approval and Medi-Cal Certification
Determine whether MHP will conduct the STRTP Program Approval. If so, ALL of the following will be needed:
Program standards and oversight
Enforcement of standards
Issuance of Program Approval includes:
Provisional Approval as needed—see handout
Approval conducted annually
If MHP says yes to doing Program Approval, you are saying “yes” to….

19. STRTP Program Approval and Medi-Cal Certification
If Host County MHP conducts Program Approval:
MHP conducts Medi-Cal Cert at came time
If Host County MHP does NOT conduct Program Approval:
DHCS will conduct Program Approval & Medi-Cal Cert
MHP may “piggyback” on Medi-Cal Certification by DHCS
MHP may certify additional SMHS, as needed
I know MHP typically conducts Medi-Cal Certification in conjunction with Contract
That means the Prog Approval would also not be done till ready to contract
If not planning to contract with STRTP you may still conduct Prog Approval and Medi-Cal Cert
Most counties may choose not to do so—not required sd

20. Community Care Licensing SMHS Medi-Cal Certification
STRTP Requirements
Community Care Licensing
SMHS Medi-Cal Certification
STRTP Rate—$12,036
Current RCL remains until group home is licensed as STRTP
Extensions up to 24 mos.
Head of Service
Four SMHS Required:
Mental Health Services
Medication Support
Crisis Intervention
Targeted Case Management
Head of Service for STRTPs
MHRS allowed as minimum standard
Some counties require License
Advocacy Groups have an issue with MHPs adding higher standards—be prepared
Program Administrator (on site 20hrs x wk)—CCL/CDSS
Facility Manager (a FM must be on site whenever children are present)—CCL/CDSS
DHCS has not set parameters for number of sites or programs 1 Head of Service may oversee.
CDSS has, however set parameters
If 1 person is assigned to be the Program Director and the Head of Service, they may only oversee 1 STRTP Site
If the person is

21. STRTP Placements
Mental Health Assessment by LMHP identifies need for Specialty MH Services
Interagency Placement Committee (IPC) approves placement
Placement by CWS/Probation
If Emergency Placement, timeliness requirements:
Within 72 Hours of Placement: LMHP Assessment
Within 30 Days of Placement: IPC Approval
Statute does not state that the LMHP must be MHP staff
However, MHP is the signature on the IPC Approval

22. FFAs and Therapeutic Foster Care (TFC)
TFC originated from the Katie A. lawsuit settlement, but is a CWS priority for CCR implementation.
TFC is an additional Supplemental Service, along with Therapeutic Behavioral Services (TBS), Intensive Case Coordination (ICC) and In-Home Behavioral Supports (IHBS)

23. FFAs and TFC, continued Medi-Cal Certification Needed of the FFA Site
FFA Responsibilities Include:
Head of Service & Clinical Supervisor (May be same person)
Review program plan/TFC Resource Parents Oversight:
Trained, Supervised
Determine mtg. frequency, duration, availability of Supervisor 24/7, documentation, monitoring
FFA is Certified, not the individual Resource Family Home.
Head of Service can be paid via a contract, but they must be paid by provider, not the county.

24. FFAs and TFC, continued
Current Joint State Guidance: CDSS ACIN I-52-16E (or) MHSUDS IN E
Enclosure: TFC Service Model (Draft)
Enclosure: TFC Parent Qualifications (Draft)

25. FFAs and TFC, continued FFA Resource Family Home Rate
Interim Base rate $889
Summer of 2017, the additional Levels of Care (LOC) will roll out
Small Work Group is reviewing additional support parameters within each life domain
TFC Interim Daily Rate
$87.40 per day

26. Child & Family Team (CFT) Meetings
MHP/designee is required to attend CFT Mtg when:
SMHS are being provided to beneficiary AND the meeting includes discussion regarding SMHS, mental health issues, symptoms, or concerns, etc.
Reimbursement is applied through the claiming process.
MHP/designee is encouraged to attend CFT Mtg when:
A referral for SMHS is being considered
Because funding is based on claiming, there is not a current mechanism to claim CFT Attendance when no case is opened.

27. DISCUSSION & QUESTIONS

28. CCR ADDITIONAL BACKGROUND Information

29. Key Online Resources
CBHDA Children’s System of Care Committee – Handouts
CCR CDSS ACIN/ACL and DHCS MHSUDS Information Notice Matrix
CCR Legislative Budget Supplemental Report Language 2016 Budget
CBHDA CCR State Budget Summary for Mental Health 2016 Budget Act
CBHDA CCR Implementation Timeline: County Mental Health Plans (MHPs)
CA Department of Social Services – Continuum of Care Reform
CA Department of Health Care Service – MHSUDS Information Notices

30. CCR Core Services and Supports
Medi-Cal SMHS for children and nonminor dependents who meet medical necessity criteria
Transition support services
Education; physical, behavioral, and mental health supports; extracurricular activities and social supports
Activities that support achieving successful adulthood
Services to achieve permanency
Mental Health Services are NOT the only Core Services, but part of them.

31. Resource Family Approval Program (RFA)
RFA is a new family-friendly and child-centered caregiver approval process that combines elements of the current foster parent licensing, relative approval, and approvals for adoption and guardianship processes and replaces those processes. The RFA Program replaces the existing processes for licensing foster family homes, certifying homes of licensed foster family agencies, approving relatives and NREFMs as caregivers, and approving legal guardians and adoptive families by combining the best elements of all the processes into a single approval standard. Counties were required to submit their implementation plans by September 1,

32. Level of Care (LOC) Resource Family Homes
A Resource Family rate structure is based on level of care and supervision needs of the child/youth & Services& Supports. Age is no longer sole factor for rate increases. Levels of Care (LOC) rates will be paid to All Resource Families and is no longer distinguished by funding and family types. The Level of Care (LOC) Protocol in development will be based on Five Domains: Physical, Health, Education, Behavioral/Emotional and Family Relations/Permanency. The Protocol is designed to interact with other assessment tools and uses a weighted scoring system to determine the rate. (LOC protocol is not an assessment tool) Before the final release, there will be a testing period and training will be offered. The goal is to have the LOC protocol ready for Phase II automation which could be finalized as early as April (subject to change)

33. Foster Parent Recruitment Retention and Support (FPRRS)
A multi-year effort to provide counties with additional resources to meet the increased need for foster parents. The amount of funding available to counties has increased significantly, from $17.2 million in FY to over $43.2 million this fiscal year. Fifty-four counties participated in the initial round of FPRRS funding during FY ; plans were made to use this funding for a variety of activities, including media outreach and community events, training for foster caregivers, increased family-finding efforts, and providing items either to support an initial placement (such as bedding or car seats) or to help children in care participate in normal childhood activities (such as bicycles, camp fees, or prom dresses). Thirty counties submitted joint child welfare/probation proposals, up from twelve during the initial round of funding. Counties will report to CDSS on the results of these activities in the fall of

34. Rate Classification Level (RCL) 13/14
In 1992, the Department of Mental Health, in concert with the California Mental Health Directors Association and provider organizations, previously developed a single statewide certification process with criteria for RCL 13 or 14 group homes that has been in effect since July 1, 1992, documented in DMH LETTER NO.: on April Once released, DHCS Program Approval/Medi-Cal Certification Protocol will replace DMH Let No.: for STRTPs.

35. Interim Licensing Standards (ILS)
Written instructions authorized by Assembly Bill 403 (Chapter 773, Statutes of 2015) for the California Department of Social Services to implement the Continuum of Care Reform Provisions that govern Foster Family Agencies on and after January 1, The ILS pertaining to the Resource Family Approval Program shall have the same force and effect as regulations. The ILS begin with Article 9 which incorporates the new Continuum of Care Reform mandates that all Foster Family Agencies shall comply with.

36. Residentially Based Services (RBS) Reform Project
Assembly Bill (AB) 1453 (Soto; Statutes of 2007) authorized a five-year pilot demonstration project to transform the State's current system of long-term congregate group home care into a system of Residentially Based Services (RBS) programs. These RBS programs seek to reduce the length of time in group care and improve permanency outcomes for youth by combining short-term residential stabilization and treatment with follow-along community-based services to reconnect youth to their families and communities. The law requires RBS to be cost neutral with respect to the State General Fund for payments under the Aid to Families with Dependent Children-Foster Care (AFDC-FC) program.

37. Foster Family Agency (FFA)
County placement agencies use licensed private FFAs for the placement of children who require more intensive care as an alternative to group homes. By statute, FFAs are organized and operated on a non-profit basis and are engaged in the following activities: recruiting, certifying, and training foster parents, providing professional support to foster parents, and finding homes or other temporary or permanent placements for children who require more intensive care. There are two types of FFA programs, "treatment foster care," and "nontreatment foster care." The California Department of Social Services (CDSS) has statutory responsibility for developing, implementing, and maintaining a rate setting system for FFAs receiving AFDC-FC funds.

38. CDSS Quarterly Reports Due to Legislature (Effective January 2017)
Update on the Transition of Providers to the CCR Service Model. With a focus on changes over time, status updates on the transition of providers to the CCR service model. Data reporting under this paragraph may occur quarterly rather than monthly and shall include the following:
Number applications, accreditations, licenses granted to STRTPs and FFAs.
Number of license extension requests from group homes received by probation and child welfare agencies.
Primary reasons why group home license extensions are necessary.
Rate of FFAs and group homes not pursuing a new license under CCR standards and the current licensed capacity of those providers.
Number and identification of counties with licensed temporary shelter care facilities.

39. Quarterly Reports to the Legislature, continued
Update on Capacity to Provide Mental Health Services. With a focus on changes over time, status updates on the capacity of all involved providers to provide mental health services. Data reporting under this paragraph may occur quarterly rather than monthly and shall include the following:
Number of STRTPs with mental health plan contracts to provide mental health services and identification of the counties with which the STRTPs have contracts.
Number of FFAs with mental health plan contracts to provide mental health services and identification of the counties with which FFAs have contracts.
Number of FFAs electing to provide placements in TFC homes.

40. State/County Implementation Team
CCR Implementation Framework
State/County Implementation Team
CDSS, DHCS, CWDA, CPOC, CBHDA, CSAC
County Representatives
Stakeholder
Implementation
Advisory Committee
Providers, Youth, Caregivers, Tribes, Advocates, Counties, Legislative Staff and others
CCR Implementation Workgroups
Program & Licensing
Rate Structures
Oversight
Framework
Resource Family Approval
Training
Mental Health
Probation
Deliverables
Program Instructions
Interim Standards
Regulations
ACLs/ACINs/CFLs
Forms
RFA Written Directives
Capacity Building Activities
County and Provider Implementation Guides
Training Gap analysis
Training Curricula
Child Welfare Assessment Tool
Accountability & Oversight
Accreditation Process
License application review process
Oversight framework/measures
Provider Performance dashboard
Consumer Survey

41. Contact Info
Kirsten Barlow, Executive Director, CBHDA
Kim Suderman, Consultant, CBHDA