[Federal Register Volume 60, Number 173 (Thursday, September 7, 1995)]
[Notices]
[Pages 46616-46620]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-22230]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Administration for Children and Families
New Child Welfare Waiver Demonstration Project Proposals
Submitted Pursuant to Section 1130 of the Social Security Act (the
Act); Title IV-E and IV-B of the Act; Public Law 103-432
AGENCY: Administration for Children and Families, HHS.
ACTION: Notice.
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SUMMARY: This notice lists new proposals for child welfare waiver
demonstration projects submitted to the Department of Health and Human
Services pursuant to Federal Register, Volume 60, No. 115, published
Thursday, June 15, 1995. Federal approval for the proposals has been
requested pursuant to section 1130 of the Social Security Act.
COMMENTS: We will accept written comments on these proposals. We will,
if feasible, acknowledge receipt of all comments, but we will not
provide written responses to comments. We will, however, neither
approve nor disapprove any new proposal for at least 30 days after the
date of this notice to allow time to receive and consider comments.
Direct comments as indicated below.
ADDRESSES: For specific information or questions on the content of a
project or requests for copies of a proposal, contact the State contact
listed for that project.
Comments on a proposal should be addressed to:
Michael W. Ambrose, Administration on Children, Youth and Families,
Children's Bureau, 330 C Street, SW.
Mary E. Switzer Building, Room 2068, Washington, D.C. 20201, FAX: (202)
205-9345
SUPPLEMENTARY INFORMATION:
I. Background
Under Section 1130 of the Social Security Act (the Act), the
Secretary of Health and Human Services (HHS) may approve child welfare
waiver demonstration project proposals with a broad range of policy
objectives.
In exercising her discretionary authority, the Secretary has
developed a number of policies and procedures for reviewing proposals.
On June 15, 1995, we published a notice in the Federal Register (Volume
60, No 115, page 31478) that specified (1) the principles that we
ordinarily will consider when approving or disapproving demonstration
projects under the authority in section 1130 of the Act; (2) the
procedures we expect States to use in involving the public in the
development of proposed demonstration projects under section 1130; and
(3) the procedures we ordinarily will follow in reviewing demonstration
proposals. We are committed to a thorough and expeditious review of
State requests to conduct such demonstrations.
II. Listing of New Proposals
As part of our procedures, we are publishing a notice in the
Federal Register of all new proposals. This notice contains summaries
of 14 proposals received by July 31, 1995, the date established for the
first round of proposals. Each of the proposals contains an assurance
that the proposed demonstration effort will be cost neutral to the
federal government over the life of the proposed effort; and each
proposal contains an evaluation component designed to assess the
effectiveness of the project.
The June 15, 1995 Federal Register Announcement indicated the
Department would give priority consideration to proposals received by
July 31, 1995. Further, if ten states had not been approved, additional
proposals would be accepted by September 30, 1995 and at the end of
each calendar quarter thereafter until ten waiver demonstration
projects have been approved. The next date for acceptance of any child
welfare waiver demonstration proposals is changed to December 31, 1995.
STATE: CALIFORNIA.
DESCRIPTION: California proposes to extend, and broaden to include the
use of federal funds, a planned State Partnership Demonstration Project
that will provide direct funding to counties for the implementation of
child welfare services. Participating counties would receive from the
State a single allocation of funds for family and children's services,
rather than using categorical funding streams.
The project would enhance the counties' abilities: to meet
families' needs more comprehensively; to increase the focus on
outcomes; to provide additional in-home services which will result in
less need for out of home care; and to contain costs.
The State anticipates that enhanced flexibility in the use of
federal funds, reduced administrative requirements and a new ``outcome-
oriented oversight role'' will improve outcomes for children and
families, including more effective prevention services that will reduce
the need for out of home care. The State is particularly interested in
promoting a whole family foster care program and long term options for
children in kinship care.
The State proposes, potentially, to waive a large number of
statutory (and regulatory) provisions, which would be based on
negotiations among federal, State and local child welfare services
officials regarding specific local waiver proposals. For each of many
statutory provisions, the state proposes conditionally to ``request
waiver of this section to the extent necessary to implement the
proposed demonstration project.'' Statutory items include certain title
IV-E State plan requirements, title IV-E income eligibility
requirements, statutory definitions (including definitions of eligible
facilities), requirements regarding adoption assistance payments,
required statistical reports, and Independent Living Program
eligibility requirements. Regulatory items proposed for waiver include
limitation on the sources of state match, cost allocation plan
[[Page 46617]]
requirements, general grant administration requirements, fiscal
regulations, the State allotment determination formula, payment review
and facility licensing standards, and regulations regarding the
withholding of federal funds.
CONTACT PERSON: Marjorie Kelly, Deputy Director, Children and Families
Services Division, California Department of Social Services, 744 P
Street M.S. 19073, Sacramento, CA 95814, (916) 657-2614, (916) 653-1695
(FAX).
STATE: DELAWARE.
DESCRIPTION: Delaware proposes a wavier project which has two
components. In the first, the State would use multi-disciplinary teams
composed of social workers and substance abuse counselors to address
the problem of parental substance abuse that creates risks for children
and families. This aspect of the project is designed to reduce the
number of children coming into out of home care; to delay entry into
care; or to reduce the amount of time spent in foster care. The second
component involves adding assisted guardianship to the permanency
continuum when adoption is not possible and a family has made a long-
term commitment to the child. This option is proposed as a cost saving
alternative to placing children in foster care.
In establishing a multi-disciplinary team to address parental
substance abuse issues, the State anticipates that the services will
prevent placement or significantly reduce the duration of placement for
50% of the children in the demonstration units that would come into
care because of parental substance abuse. In adding guardianship as a
continuum of care option, the State projects that 10 children/youth per
year who are currently maintained in long-term foster care will be
moved to the guardianship program.
The State proposes to contract with local substance abuse treatment
agencies to provide counselors to be co-located with child protective
services staff. This effort would provide multi-disciplinary assessment
and treatment services for approximately 180 families a year for a
period of three years.
The second component of the proposal would make guardianship an
available alternative to the caretaking families, thus enabling a
child's case to be closed while still making financial and other
services available to the family as needed. This option would be
considered when adoption is not possible and a family has made a long-
term commitment to the child/youth.
For the use of a multi-disciplinary team to provide assessment and
treatment services, the State is proposing to waive the prohibition on
the expenditure of title IV-E funds for services. For the guardianship
component, the State seeks to waive provisions governing eligibility
for title IV-E foster care maintenance payments, so that caretaking
guardians of children formerly in placement might receive payments
comparable to title IV-E foster care maintenance payments.
CONTACT PERSON: Kathryn J. Way, Director, Division of Family Services,
Delaware Department of Services for Children and Their Families, 1825
Faukland Road, Wilmington, DE 19805, (302) 633-2650, (302) 995-8290
(FAX).
STATE: DISTRICT OF COLUMBIA.
DESCRIPTION: The District of Columbia proposes to develop a community-
based therapeutic model of services to serve as an alternative to
placing children in more restrictive institutional settings, as well as
providing a transitional bridge for those children returning to the
community upon discharge from institutional care.
The flexible use of title IV-E and IV-B funds would allow for the
development and provision of a community-based model of therapeutic
services to prevent foster home and institutional placement and would
increase inter/intra agency and multi-system coordination of services.
The demonstration project would include the use of a ``managed
care'' approach through the use of rate setting procedures to include
articulated caps, and a system to provide comprehensive multi-system
social and support services. The community-based therapeutic approach
would include specialized emergency foster care homes; shared family
care; in-home treatment; use of professional surrogate parents; and
substance abuse treatment services.
The District of Columbia proposes title IV-E waivers to allow
payment for services, and to permit the support of alternatives to
foster home and institutional placement through use of a rate-setting
process to be established under the demonstration project.
CONTACT PERSON: Ricardo Lyles, Acting Administrator, Family Services
Administration, District of Columbia Department of Human Services, 609
H Street, NE, Washington, DC 20002, (202) 724-8756, (202) 727-9460
(FAX).
STATE: GEORGIA.
DESCRIPTION: Georgia proposes to use title IV-E funds to fund
preventive and supportive services for children and families at risk,
to eliminate the need for placement or reduce the time a child spends
in out of home care. Additionally, Georgia seeks to place children in
neighborhood settings; provide specialized living arrangements for
adolescents, and obtain special adoption assistance to expedite the
placement of children into adoptive homes.
The benefits for this demonstration project include removing
systems barriers, decreasing or avoiding the amount of time a child
spends in out of home care, providing more stable placements, expanding
preventive and family support service systems and increasing adoptive
placements by making resources available to adoptive families that
otherwise would not qualify.
The services to be provided under the demonstration project include
family support and prevention services, expansion of kinship care, and
community placement services.
Georgia proposes to expand title IV-E coverage to include placement
prevention and reunification services. The State also wishes to waive
some provisions of title IV-E eligibility determination when a child
comes into custody, provide a special waiver to provide adoption
assistance to pay for the purchase of services to expedite adoptive
placement, and provide funds for adoptive parents for one-time expenses
related to the placement of a specific child in the home. Georgia also
seeks a waiver to permit title IV-E funds to support a kinship care
assistance subsidy, and a waiver of some provisions of title IV-A to
allow families whose children are in foster care to continue receiving
food stamps, when reunification is expected to occur within 180 days.
CONTACT PERSON: Doris Walker, Foster Care Unit Chief, Georgia
Department of Human Resources, Division of Family and Children
Services, Two Peachtree Street, NW., Suite 12-300, Atlanta, GA 30303-
3180, (404) 657-3458, (404) 657-3415 (FAX)
STATE: ILLINOIS.
DESCRIPTION: Illinois is proposing a subsidized private guardianship as
a permanency planning option which would meet the needs of the long-
term kinship care population, in order to reduce the number of children
in long-term foster care and to reduce the number of disrupted
placements.
Illinois seeks to improve permanency outcomes for children in
healthy kinship care arrangements in cases where reunification and
adoption are not possible. The demonstration project
[[Page 46618]]
would reduce government intrusion in family life while creating support
and clinical management systems which minimize risk through annual
reviews of subsidized private guardianship and continuous promotion of
adoption options.
Illinois would provide a subsidized private guardianship program
(which parallels the adoption subsidy program) for a random group of
eligible caregivers.
The State proposes a waiver of title IV-E to permit withholding
subsidized guardianship from a randomly selected control group; a
waiver of certain provisions of the Adoption Assistance Program to
authorize subsidized guardianship for children who meet the eligibility
requirements of Section 673 and additional requirements set by the
State, in order to authorize payment of nonrecurring guardianship
expenses, and for guardianship assistance payments for children; a
waiver of eligibility requirements to limit assistance to special needs
children; a waiver that would permit federal financial participation in
amounts expended as guardianship support payments pursuant to
guardianship assistance agreements; and a waiver to authorize federal
financial participation in amounts expended on training and
administration for the subsidized guardianship program and a waiver of
the provision defining ``adoption agreement'' to allow that term to
include ``guardianship assistance agreement.''
CONTACT PERSON: Joe Loftus, Executive Deputy Director, Illinois
Department of Children and and Family Services, 100 West Randolph, 6th
Floor, Chicago, IL 60601, (312) 814-8741, (312) 814-6859 (FAX).
STATE: INDIANA.
DESCRIPTION: Indiana proposes to divert per diem funds from restrictive
(primarily institutional) placements to more community-based services
in order to create more home-based in-state placements for children,
placements which would be more supportive of family unity.
The effort would result in fewer high cost, out of state child
placements; fewer removals from home, and earlier reunification;
improved family functioning; expeditious adoptions; timely transitions
to independent living; and improved outcomes for children.
Indiana would modify existing interagency agreements between the
Division of Family and Children Services and juvenile court judges to
include community partners such as mental health, education and the
Step Ahead Council. The local office of Family and Children Services,
the county probation office, community mental health center or the
school corporation seeking placement of a child would convene a meeting
of partners to develop alternatives to restrictive placement.
Indiana proposes to waive title IV-E to permit payment of proposed
services: even when a child has not been judicially removed from the
home; in order to prevent the placement of a child in out of home care;
and for the child in substitute care who is not categorically eligible
for title IV-E foster care.
CONTACT PERSON: James Hmurovich, Director, Division of Family and
Children, Family and Services Administration, Room W392, Government
Center south, 402 West Randolph Street, Indianapolis, IN 46204, (317)
232-4705, (317) 232-4490 (FAX).
STATE: MARYLAND.
DESCRIPTION: Maryland proposes to add federal guardianship assistance
as a permanency planning option which would more closely meet the needs
of the kinship care population.
This effort would result in reduced average length of stay in out
of home placement for children; increased stability for children, and
empowerment/support for the caretaking family.
Under this demonstration project in order to be eligible a child
would have to be committed to the local department of social services
as a child in need of assistance and to have been in a successful out
of home placement with the prospective guardian for a minimum of six
months. Reunification and adoption would have to be appropriately ruled
out as permanency planning options. Resources for the child (SSI,
Social Security Survivor's Benefits, etc.) would be transferred to the
guardian and deducted from the subsidy. Prospective guardians would be
required to sign a guardianship agreement which would require annual
renewal.
CONTACT PERSON: Fern Blake, Maryland Department of Human Resources, 311
West Saratoga Street, Baltimore, MD 21201-3521, (410) 767-7269, (410)
333-0099 (FAX).
STATE: MICHIGAN.
DESCRIPTION: Michigan proposes to increase its emphasis on family
preservation and family support services and decrease the need for and
reliance on out of home care by using title IV-E funds to provide
services.
The effort would result in controlled growth of title IV-E
maintenance expenditures; greater collaboration among federally-funded
programs; increased ability to provide services for families; and
decreased reliance on out of home care.
Michigan is proposing to treat title IV-E maintenance payments
(other than those for adoption subsidy) as a capped entitlement. The
State is proposing to use the funds for service provision, in some
cases augmenting funds now being expended under title IV-B Subpart 1
(Child Welfare Services) and Subpart 2 (Family Preservation and
Support). The funds would be used to expand grants to local communities
and to implement family preservation and support services more quickly.
Michigan is proposing to waive those provisions of title IV-E which
restrict States from expending these funds for the provision of
services. Michigan excludes title IV-E adoption assistance from its
waiver proposal.
CONTACT PERSON: David Berns, Director, Office of Children's Services,
Michigan Department of Social Services, 235 South Grand Avenue, P. O.
Box 30037, Lansing, MI 48909, (517) 335-6159, (517) 241-7047 (FAX).
STATE: MINNESOTA.
DESCRIPTION: Minnesota proposes to establish relative-based living
arrangements as an alternative to out of home care.
The results of this project would be enhanced permanency for
children including maintaining a continuity of relationships and a
sense of belonging; protection for children who are at risk; lessened
government intrusion into families; a greater connection for children
with their families and communities; support for kinship placements;
lessened time in substitute care; multiple placements will be reduced;
and expenditures for out of home placement will be contained.
The proposed demonstration project focuses on placement with family
members and would provide support for temporary relative guardianship;
permanent relative guardianship; voluntary relative foster care; and
court-ordered relative foster care.
Minnesota proposes waivers of provisions under title IV-E in order
to exclude grandparents from the foster care licensing requirements;
and approval of a financial support structure that allows differential
payments based on need. Specific services under this waiver project
would include guardianship subsidies, differential foster care support,
and specialized training for relative caregivers.
The State also proposes waivers of certain provisions of title IV-A
in order
[[Page 46619]]
to apply the special child standard of assistance in situations where
the child is living in one of a range of relative care arrangements;
and flexibility to use emergency assistance funds to help relative
caregivers meet minimum health and safety standards. Specific services
under this waiver would include guardianship, subsidies and alternative
care grants.
CONTACT PERSON: Robert DeNardo, Supervisor, Family and Children's
Service Division, Minnesota Department of Human Services, 444 Lafayette
Road North, St. Paul, MN 55112-3831, (612) 296-5288, (612) 297-1949
(FAX).
STATE: NEW YORK.
DESCRIPTION: New York proposes to use a managed care approach to child
welfare services to recapture revenue for reinvestment in preventive
and aftercare services in local communities.
The benefits of this effort would be an accelerated decline in the
foster care population; an increase in the level of services; and a
reduction in the length of stay in foster care.
New York proposes to apply the principles of managed care to its
foster care and adoption assistance programs by identifying preset
payments for a range of services for a specified population over a
predetermined period of time (capitated payments) and adjusting
treatment regimens in light of outcomes so that the client receives the
necessary services to continue to make progress toward the stated goals
of intervention (care management). The State also proposes to increase
the availability of child welfare services so that pre-placement
preventive and aftercare services can be intensified.
New York proposes to waive: title IV-E requirements regarding the
eligibility of children and of foster care facilities; the definition
of ``special needs'' for which title IV-E funds may be used; the
circumstances under which these funds may be claimed; and certain
requirements concerning title IV-E administration and training.
CONTACT PERSON: Fred Wulczyn, Office of Family and Children Services,
Division of Services and Community Development, New York State
Department of Social Services, 40 North Pearl Street, Albany, NY 12243-
0001, (518) 486-3431, (518) 474-9004 (FAX).
STATE: NORTH CAROLINA.
DESCRIPTION: North Carolina proposes outcome-based management of foster
care, in which foster care funding is tied to specific outcomes related
to diverting children from foster care whenever possible and moving
quickly to achieve permanence for children.
The benefits from this demonstration effort would: link funding and
outcomes and measure the effect on service delivery system performance;
demonstrate and evaluate the effectiveness of a comprehensive outcome-
based approach; decrease the amount of time children spend in foster
care, reduce the number of new entries into foster care, and promote
collaborative planning and coordination of services with several other
initiatives currently underway in the State.
The proposed demonstration effort has two parts. Part I is designed
to encourage the development of effective community-based
reunification, adoption and aftercare services. Part II is designed to
achieve a paradigm shift that allows local programs to move resources
from treatment to prevention.
The waiver requests the use of title IV-E foster care funds on
behalf of children not presently eligible: to allow local social
service agencies to use a capitated rate structure with incentives for
achieving specified outcomes; to allow local social service agencies to
contract with public, private non-profit and private for profit
entities as needed to develop an effective community network of
services; and to allow participating agencies to reinvest savings
realized from performance excellence in child welfare services.
CONTACT PERSON: Chuck Harris, North Carolina Department of Human
Resources, Division of Social Services, 325 Salisbury Street, Raleigh,
NC 27603, (919) 733-9467, (919) 715-0024 (FAX).
STATE: OHIO.
DESCRIPTION: Ohio proposes to reduce child removals and/or time of
children in placement and associated costs through the use of managed
care technology to provide a broader array of services to children and
their families.
The benefits of this effort would include decreasing placement
costs, increasing the level and quality of services; strengthening
local partnerships; and expediting the permanency planning process.
The proposed demonstration effort represents a partnership between
public children's service agencies (PCSAs), the Ohio Department of
Human Services (ODHS), and managed care entities (MCE). Decision making
and risk will be shared among the PCSAs, ODHS and the MCE. ODHS's role
is that of coordinator, facilitator and provider of training and
technical assistance. The PCSAs' role is primarily as purchasers of
services, and they may or may not provide all the direct service
functions themselves. The MCE will be responsible for administrative
and management functions, medical/clinical reviews, utilization
management and service authorization, developing and operating a
management information system, developing contracts with providers and
payers, and consumer satisfaction-related duties.
The current system of services will continue but with managed care
options being considered at decision making points. A policy consortium
will be created to develop and implement policy and practices that
support permanency planning and provide guidance to the local PCSAs.
The terms and conditions developed by the Consortium will bind the
provider agencies to uniformly implement the agreed upon practice
criteria and to ensure consistency for evaluation purposes across the
waiver sites.
Ohio proposes to waive a number of title IV-E provisions that
relate to restrictions on child eligibility, and prohibitions on the
use of title IV-E funds for the provision of services.
CONTACT PERSON: Isaac Palmer, Deputy Director, Office of Child Care and
Family Services, Ohio Department of Human Services, 30 East Broad
Street, Columbus, OH 43266-0423, (614) 466-1213, (614) 466-9247 (FAX).
STATE: OREGON.
DESCRIPTION: Oregon proposes to use title IV-E funds for services
including but not limited to prevention and support services,
protective services, crisis intervention and reunification services.
The State also proposes to develop a kinship foster care rate that
would be individually determined based on the needs of the child.
The demonstration project would provide flexible funding for abused
and neglected children and their families and/or caregivers to receive
individual services, regardless of where the chid is placed. Specific
outcomes expected would include decreasing the length of foster care
placement, increasing the number of children remaining safely in their
homes, increasing the use of relative caretakers for children who must
be placed out of the home, having more appropriate foster care
resources and better utilization of community resources.
The proposed demonstration project would provide support to
biological, foster and kinship caretakers through a myriad of services.
The State proposes to shift toward a statewide system of in-home care
services delivery, insure a match between the child's needs and the
skill of the caretakers, establish mechanisms that will refocus the out
of home care systems and move closer to implementation of a ``first
placement/
[[Page 46620]]
only placement'' objective for children who are unable to remain with
their parent(s).
Oregon proposes to waive those provisions of title IV-E: that
require a State to make foster care maintenance payments; that require
that foster care maintenance payments be made only on behalf of a child
who resides in a foster family home or a child care institution; and
that concern the conditions for federal reimbursement for voluntary
placements.
CONTACT PERSON: Richard Schoonover, State Office of Services for
Children and Families, Oregon Department of Human Resources, 500 Summer
Street, NE, Salem, OR 98310-1017, (503) 945-6882, (503) 328-3800 (FAX).
STATE: WEST VIRGINIA.
DESCRIPTION: West Virginia will create a comprehensive, decentralized,
specialized system to determine a child's potential eligibility for all
funding resources for child welfare programs.
The proposed system would maximize the State's child welfare funds
by identifying and accessing additional financial resources available
to children in care. The new system would emphasize parental obligation
and encourage parental participation.
A resource development unit will be created to identify, pursue and
produce accurate claims for all sources of funds to which a child in
care may be entitled, e.g., child support, SSI, Black Lung, Railroad
Retirement, third party medical, SSA, Veterans's Benefits and titles
IV-A, IV-B and IV-E.
West Virginia is requesting a waiver of the title IV-E limit of
fifty percent for Federal Financial Participation in a State's
administrative costs.
CONTACT PERSON: Mary Jarrett, West Virginia Department of Health and
Human Resources, Office of Social Services, Bldg. 6, Room B-850, State
Capitol Complex, Charleston, WV 25305, (304) 558-7980, (304) 558-8800
(FAX).
III. Requests for Copies of a Proposal
Requests for copies of a Child Welfare Waiver Demonstration Project
proposal should be directed to the appropriate State at the telephone
number given above. Questions concerning the content of a proposal
should be directed to the State contact listed for the proposal.
(Catalog of Federal Domestic Assistance Program, No. 93.645, Child
Services--State Grants; 93.658, Foster Care Maintenance; 93.659,
Adoption Assistance)
Dated: August 31, 1995.
Joseph A. Mottola,
Acting Commissioner, Administration on Children, Youth and Families.
[FR Doc. 95-22230 Filed 9-6-95; 8:45 am]
BILLING CODE 4184-01-P