[Federal Register Volume 64, Number 132 (Monday, July 12, 1999)]
[Notices]
[Pages 37544-37546]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-17655]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Administration for Children and Families
[99-01]
New Child Welfare Demonstration Project Proposals Submitted by
States for Waivers Pursuant to Section 1130 of the Social Security Act
(the Act); Titles 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 the guidance contained in Information Memorandum
ACYF-CB-IM-99-03 dated January 21, 1999, public notice of which was
given in the Federal Register of February 8, 1999, Vol. 64, No. 25,
page 6099.
Comments: We will accept written comments on these proposals, but
will not provide written responses to comments. We will 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
person listed for that project.
Comments on a proposal should be addressed to:
Laura Oliven, Children's Bureau, Administration on Children, Youth
and Families, 330 C Street, SW, Mary E. Switzer Building, Room 2058,
Washington, D.C. 20447. FAX: (202) 260-9345.
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.
The most recent expression of these policies and procedures may be
found in the January 21 Information Memorandum cited above, a copy of
which may be found at the ACF website at http://www.acf.dhhs.gov/
programs/cb/cww.htm or may be obtained from the National Clearinghouse
on Child Abuse and Neglect Information, (800) 394-3366, internet
address <[email protected]>. We are committed to a thorough and
expeditious review of state proposals to conduct child welfare
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 five new proposals received as of July 6, 1999. 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.
State: Colorado
Description: Colorado proposes to test the impact of contracting
with a single provider (or consortium of providers) under a case rate
financing model to achieve improved outcomes for children in the target
population. Under the case rate, the providers will have a defined
amount of resources to achieve case outcomes. Each of the six counties
participating in the project will individually negotiate their case
rate. One of the most critical aspects of the case rate structure is
that providers will be expected to meet child specific outcomes and
system performance targets. In addition to the case rate financing
structure, the provider will be able to use flexible title IV-E funds
to provide an expansive array of preventive and treatment intervention
services. To be eligible for the demonstration, the provider must have
access to such services as mental health, substance abuse,
transportation, education, post placement services and many more.
Because few providers have the full array of services ``under one
roof'' they will need to collaborate to ensure a comprehensive network.
The State seeks waivers of child welfare eligibility requirements and
restrictions on allowable expenditures for their proposed five year
demonstration.
The target population for the project would be children who are at
high risk of, or already experiencing ``placement drift'' and are at
significant risk of aging out of the system without a permanent
relationship with a family. The State hypothesizes that by converting
the financing from fee-for-service to risk-based, performance based
contracting, the State will produce improved safety, permanency and
well-being outcomes for this population and overall efficiencies in the
system. The State will analyze the impact of the project using a random
assignment evaluation design.
Contact Person: Marva Livingston Hammons, Director, Colorado
Department of Human Services, 1575 Sherman Street, 8th Floor, Denver,
Colorado 80203-1714, Phone: (303) 866-5700, Fax: (303) 866-4214.
State: Florida
Description: Florida proposes to test the effectiveness of
capitating payments and providing flexible use of title IV-E dollars to
support and incentivize locally controlled systems of care in select
districts to better meet the needs of abused and neglected children and
their families. This demonstration will assist the State in meeting its
1998 legislative requirement to develop a plan for privatizing the
entire child welfare system, with the exception of child protective
service intake and investigations, by the year 2003. Florida plans to
conduct this demonstration in at least 8 of its 15 districts. The
target population will be all title IV-E and non-title IV-E eligible
children and families in each of the demonstration sites who are
reported for abuse or neglect with some finding of maltreatment and
require services beyond those provided by the department during the
investigation phase. Each demonstration site will contract with
community-based, nonprofit agencies for the management and delivery of
services, using a lead agency community network model. These lead
agencies will assume the financial risk for providing all services for
all children referred and receive
[[Page 37545]]
financial bonuses and penalties linked to performance. In addition,
these flexible child welfare services will be coordinated with Medicaid
funded behavioral health services.
The State hypothesizes that providing expanded services through
community-based systems of care will improve access to services,
provide protection from harm for the children served, reduce the length
of stay in out-of-home care, reduce re-entry into the foster care
system, improve satisfaction ratings of services, and reduce
variability in performance across sites.
The State is requesting a waiver of eligibility requirements and
services that can be provided using federal title IV-E funds. The
evaluation of this five year demonstration will be based on county
comparisons.
Contact Person: Margaret Taylor, Florida Department of Children and
Families, 1317 Winewood Boulevard, Tallahassee, Florida 32399-0700,
Phone: (850) 922-0149, Email: Margaret__T[email protected]
State: Illinois
Description: The State of Illinois proposes to provide enhanced
alcohol and other drug abuse (AODA) and individualized services to
families affected by alcohol and other drugs. The purpose of the
demonstration is to improve permanency outcomes for children of parents
with AODA problems and to reduce the negative impact of parental AODA
on children by assisting the family in treatment and recovery.
Specifically the project is expected to result in higher rates of
reunification, a reduced number of days in foster care and fewer re-
allegations of abuse or neglect.
This project will involve two cohorts. Families in the first cohort
will be assigned Recovery Coaches who will conduct outreach and support
services. Following an additional planning year, families assigned to
the second cohort will receive services tailored to their individual
needs, in addition to the outreach and support provided by the Recovery
Coaches. These services may include medically-managed detoxification
and withdrawal, drug-free housing for families, graduated sanctions,
reunification/concurrent planning specialists, public health nurses and
parental involvement services. Existing aftercare services are
available for control group families; Recovery Coaches will access and
coordinate aftercare services for experimental group families.
The State hypothesizes that children in the experimental groups
will spend fewer average days in foster care, will be safely reunited
with their parents at higher rates, and revictimized at lower rates
than children in the control group. The state also postulates that
parents in the demonstration groups will successfully complete AODA
treatment at a higher proportion than do parents in the control group.
Target populations in Cook County are: (1) custodial parents with a
child who enters placement after September 30, 1999; and (2) parents
who deliver substance exposed infants. The demonstration will operate
for five years. The State will randomly assign families to experimental
and control groups following AODA assessment.
The State is requesting a waiver to allow title IV-E funds to be
used for services not normally eligible including the maintenance and
provision of services to the parent of the ward as well as to operate
this demonstration project in selected parts of the state.
Contact Person: Jess McDonald, Director, Illinois Department of
Children and Family Services, 100 West Randolph, 6th Floor, Chicago, IL
60601, Phone: (312) 814-4650, Fax: (312) 814-3255.
State: Maryland
Description: The State of Maryland proposes two distinct components
for a five year Child Welfare demonstration: intensive substance abuse
treatment and supportive services for substance-abusing women; and a
child welfare managed care project for children placed in out-of-home
care through the Baltimore City Department of Social Services.
The first project would provide gender specific substance abuse
treatment in combination with intensive supports and case management
from a Family Support Services Team (FSST) to substance abusing mothers
whose children are in foster care, or at risk for being placed in
foster care. The FSST will consist of Chemical Addiction Counselors
(CAC), mentors, parent aides, agency staff and treatment providers. The
program is designed to provide a comprehensive and seamless support
system to incentivize women to enter into, and complete successful drug
and alcohol treatment. The purpose of the project is to prevent
unnecessary out-of-home placements and reduce the length of stay of
children already placed in foster care. The project would be conducted
in Baltimore City and Prince George's County, two jurisdictions in
Maryland that experience a high number of foster care placements due to
parental substance abuse.
The second project would implement a child welfare managed care
pilot initiative for 1,000 of the children in paid out-of-home
placement and committed to the Baltimore City Department of Social
Services (BCDSS) by the Baltimore City Juvenile Court. This initiative
focuses on accountability and quality outcomes with reimbursement
linked to performance. The project proposes to reshape the contractual
relationship between the public agency and the private agencies from
one of ``payment of care'' to a ``reward for results'' system.
Providers will be asked to propose outcome improvements that exceed the
State outcome goals and current benchmarks. Providers that do not meet
the benchmark outcomes will risk financial loss. Those who improve on
outcomes will be given the flexibility to redirect cost savings to
innovative and enhanced services for project participants. The State
expects to produce an increase in permanency with a reduction in the
number of foster care days; a decrease in the restrictiveness of
placements provided; and a reduction in re-entry into foster care.
Contact Person: Linda D. Ellard, Executive Director, Social
Services Administration, 311 West Saratoga Street, Baltimore, MD 21201,
Phone: (410) 767-7216, Fax: (410) 333-0127.
State: West Virginia
Description: West Virginia proposes a substance abuse initiative
that would allow a child to remain in his/her home or be placed in a
temporary setting while the child's mother receives 30-60 day in-
patient and/or residential treatment for alcohol or drug abuse. Where
possible, the child would be placed in close proximity to the treatment
center to enable visitation between the mother and child. The State
hypothesizes that by placing the child in a temporary care setting, and
avoiding the ``formal'' foster care system, mothers receiving treatment
will be more likely to enter into, and complete, successful treatment.
The State expects to reduce the number of children entering into the
State's formal foster care system due to parental substance abuse;
increase the number of family reunifications after treatment; and
increase the number of mothers completing short-term treatment. The
State intends to partner with the West Virginia Department of Health
and Human Resources, responsible for the care of the state's foster
children, with the Division of Alcoholism and Drug Abuse, to assist
mothers in overcoming barriers to substance abuse treatment. Following
treatment, multidisciplinary teams including Substance Abuse Outreach
Specialists and social workers
[[Page 37546]]
will continue to provide services to the families to ensure the
children's safety and work towards successful reunification.
The State plans to operate this demonstration project in rural
counties including Boone, Cabell, Clay, Jackson, Roane, Kanawha,
Lincoln, Mason, Mingo, Putnam, and Wayne. The target population
includes all youth ages 0-18 who would likely enter formal foster care
if their parents do not receive substance abuse treatment, according to
formal risk assessments.
The State is requesting a waiver of the placement standards and
eligibility requirements. West Virginia plans to assess the impact of
the five year demonstration using a random assignment evaluation
design.
Contact Person: Ann Burds, Director, Bureau for Children &
Families/Office of Social Services, Department of Health and Human
Resources, State Capital Complex, Building 6, room 850, Charleston,
West Virginia 25305, Phone: (304) 558-7980, Fax: (304) 558-8800.
Dated: July 7, 1999.
Patricia Montoya,
Commissioner, Administration on Children, Youth and Families.
[FR Doc. 99-17655 Filed 7-9-99; 8:45 am]
BILLING CODE 4184-01-P