California
Welfare and Institutions Code – WIC § 11462
(a) The department shall commence development of a new payment structure for short-term residential therapeutic program placements claiming Title IV-E funding, in consultation with county placing agencies and providers.
(b) The department shall develop a rate system that includes consideration of all of the following factors:
(1) Core services, made available to children and nonminor dependents either directly or secured through formal agreements with other agencies, which are trauma informed and culturally relevant and include:
(A) Specialty mental health services for children who meet medical necessity criteria for specialty mental health services under the Medi-Cal Early and Periodic Screening, Diagnosis, and Treatment program.
(B) Transition support services for children, youth, and families upon initial entry and placement changes and for families who assume permanency through reunification, adoption, or guardianship.
(C) Educational and physical, behavioral, and mental health supports, including extracurricular activities and social supports.
(D) Activities designed to support transition-age youth and nonminor dependents in achieving a successful adulthood.
(E) Services to achieve permanency, including supporting efforts to reunify or achieve adoption or guardianship and efforts to maintain or establish relationships with parents, siblings, extended family members, tribes, or others important to the child or youth, as appropriate.
(F) When serving Indian children, as defined in subdivisions (a) and (b) of Section 224.1 , the core services described in subparagraphs (A) to (E), inclusive, which shall be provided to eligible children consistent with active efforts pursuant to Section 361.7 .
(G)(i) Facilitating the identification and, as needed, the approval of resource families pursuant to Section 16519.5 , for the purpose of transitioning children and youth to family-based care.
(ii) If a short-term residential therapeutic program elects to approve and monitor resource families directly, the program shall comply with all laws applicable to foster family agencies, including, but not limited to, those set forth in the Community Care Facilities Act (Chapter 3 (commencing with Section 1500 ) of Division 2 of the Health and Safety Code).
(iii) For short-term residential therapeutic programs that elect to approve and monitor resource families directly, the department shall have all the same duties and responsibilities as those programs have for licensed foster family agencies, as set forth in applicable law, including, but not limited to, those set forth in the Community Care Facilities Act (Chapter 3 (commencing with Section 1500 ) of Division 2 of the Health and Safety Code).
(2) The core services specified in subparagraphs (A) to (G), inclusive, of paragraph (1) are not intended to duplicate services already available to foster children in the community, but to support access to those services and supports to the extent they are already available. Those services and supports may include, but are not limited to, foster youth services available through county offices of education, Indian Health Services, or school-based extracurricular activities.
(3) Specialized and intensive treatment supports that encompass the elements of nonmedical care and supervision necessary to meet a child’s or youth’s safety and other needs that cannot be met in a family-based setting.
(4) Staff training.
(5) Health and Safety Code requirements.
(6) Accreditation that includes:
(A) Provision for all licensed short-term residential therapeutic programs to obtain and maintain in good standing accreditation from a nationally recognized accreditation agency, as identified by the department, with expertise in programs for children or youth group care facilities, as determined by the department.
(B) Promulgation by the department of information identifying that agency or agencies from which accreditation shall be required.
(C) Provision for timely reporting to the department of any change in accreditation status.
(7) Mental health certification, including a requirement to timely report to the department any change in mental health certificate status.
(8) Maximization of federal financial participation under Title IV-E and Title XIX of the Social Security Act.
(c) The department shall establish rates pursuant to subdivisions (a) and (b) commencing January 1, 2017. The rate structure shall include an interim rate, a provisional rate for new short-term residential therapeutic programs, and a probationary rate. The department may issue a one-time reimbursement for accreditation fees incurred after August 1, 2016, in an amount and manner determined by the department in written directives.
(1)(A) Initial interim rates developed pursuant to this section shall be effective January 1, 2017, through December 31, 2019.
(B) The initial interim rates developed pursuant to this paragraph shall not be lower than the rates proposed as part of the Governor’s 2016 May Revision.
(C) The initial interim rates set forth in written directives or regulations pursuant to paragraph (3) shall become inoperative on January 1, 2020, unless a later enacted statute, that becomes operative on or before January 1, 2020, deletes or extends the dates on which they become inoperative.
(D) It is the intent of the Legislature to establish an ongoing payment structure no later than January 1, 2020.
(2) Consistent with Section 11466.01 , for provisional and probationary rates, the following shall be established:
(A) Terms and conditions, including the duration of the rate.
(B) An administrative review process for rate determinations, including denials, reductions, and terminations.
(C) An administrative review process that includes a departmental review, corrective action, and a protest with the department. Notwithstanding the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code ), this process shall be disseminated by written directive pending the promulgation of regulations.
(3) Notwithstanding the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code ), the initial interim rates, provisional rates, and probationary rates and the manner in which they are determined shall be set forth in written directives until regulations are adopted.
(d) The department shall develop a system of governmental monitoring and oversight that shall be carried out in coordination with the State Department of Health Care Services. Oversight responsibilities shall include, but not be limited to, ensuring conformity with federal and state law, including program, fiscal, and health and safety audits and reviews. The state agencies shall attempt to minimize duplicative audits and reviews to reduce the administrative burden on providers.