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, Diagnostic, 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) (a) For (1) 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). Effective July 1, 1990, foster care providers licensed as group homes, as defined in departmental regulations, including public child care institutions, as defined in Section 11402.5, shall have rates established by classifying each group home program and applying the standardized schedule of rates. The department shall collect information from group providers beginning January 1, 1990, in order to classify each group home program.
(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. Notwithstanding paragraph (1), foster care providers licensed as group homes shall have rates established only if the group home is organized and operated on a nonprofit basis as required under subdivision (h) of Section 11400. The department shall terminate the rate effective January 1, 1993, of any group home not organized and operated on a nonprofit basis as required under subdivision (h) of Section 11400.
(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.
(D) (b) Provision for reduction or revocation of the rate in the event of the suspension, lapse, revocation, or other loss of accreditation, or failure to provide proof of that accreditation to the department upon request. A group home program shall be initially classified, for purposes of emergency regulations, according to the level of care and services to be provided using a point system developed by the department and described in the report, “The Classification of Group Home Programs under the Standardized Schedule of Rates System,” prepared by the State Department of Social Services, August 30, 1989.
(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) (c) (A) The Unless the Tiered Rate Structure established in subdivision (h) of Section 11461 applies to a child or nonminor dependent, initial interim rates developed pursuant to this section shall be effective January 1, 2017, to December 31, 2028, inclusive, or 24 months from the date required by paragraph (9) of subdivision (h) of Section 11461, whichever is later. rate for each rate classification level (RCL) has been determined by the department with data from the AFDC-FC Group Home Rate Classification Pilot Study. The rates effective July 1, 1990, were developed using 1985 calendar year costs and reflect adjustments to the costs for each fiscal year, starting with the 1986–87 fiscal year, by the amount of the California Necessities Index computed pursuant to the methodology described in Section 11453. The data obtained by the department using 1985 calendar year costs shall be updated and revised by January 1, 1993.
(B) (d) 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. As used in this section, “standardized schedule of rates” means a listing of the 14 rate classification levels, the single rate established for each RCL, and the rate floor for each RCL.
(C) (e) The initial interim rates set forth in written directives or regulations pursuant to paragraph (3) shall become inoperative on January 1, 2029, inclusive, or 24 months after the date required by paragraph (9) of subdivision (h) of Section 11461, whichever is later. standardized schedule of rates shall be phased in commencing July 1, 1990.
(2) (1) Consistent with Section 11466.01, for provisional and probationary rates, the following shall be established: In order to phase in the standardized schedule of rates, a “rate floor” has been established for each RCL.
(A) Terms and conditions, including the duration of the rate.
(B) An administrative review process for rate determinations, including denials, reductions, and terminations.
(C) (2) 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. The rate floor for fiscal year 1990–91 shall be 85 percent of the standard rate for each RCL. The rate floor shall be increased to 92.5 percent of the standard rate for fiscal year 1991–92 for each RCL, shall be equal to the standard rate for each RCL for the period July 1, 1992, to September 13, 1992, inclusive, and shall be 92.5 percent of the standard rate for each RCL for the period September 14, 1992, to June 30, 1993, inclusive.
(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. The rate floor for each RCL shall be 95 percent of the standard rate for each RCL for the 1993–94 fiscal year. The rate floor shall be equal to the standard rate for each RCL for the 1994–95 fiscal year and beyond.
(f) Except as specified in paragraph (1), the department shall determine the RCL for each group home program on a prospective basis, according to the level of care and services that the group home operator projects will be provided during the period of time for which the rate is being established.
(1) For a group home program for which the department established a rate effective prior to June 30, 1990, that took into account the program’s historical costs, the department shall establish the rate for fiscal year 1990–91 by determining the RCL on a retrospective basis, according to the level of care and services actually provided between July 1 and December 31, 1989, or between July 1, 1989, and March 31, 1990.
(d) (2) Group home programs that fail to maintain at least the level of care and services associated with the RCL upon which their rate was established shall inform the department. 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. regulations specifying procedures to be applied when a group home fails to maintain the level of services projected, including, but not limited to, rate reduction and recovery of overpayments.
(e) (1) Notwithstanding the rates established pursuant to subdivisions (a) to (c), inclusive, the care and supervision rate paid on behalf of a child or nonminor dependent placed in a short-term residential therapeutic program on or after the date required by paragraph (9) of subdivision (h) of Section 11461 shall be based on the Tiered Rate Structure established in subdivision (h) of Section 11461.
(2) (3) Provided all federal and state rate and licensing requirements are met, the per child per month care and supervision rate, as set forth in paragraph (3) of subdivision (h) of Section 11461, for a child or nonminor dependent placed in a short-term residential therapeutic program shall include a rate, according to the child’s or nonminor dependent’s tier, as determined by the child’s or nonminor dependent’s periodic IP-CANS assessment, for administrative and other activities described in paragraphs (1) and The department shall not reduce the rate, establish an overpayment, or take other actions pursuant to paragraph (2) for any period that a group home program maintains the level of care and services associated with the RCL for children actually residing in the facility. Determinations of levels of care and services shall be made in the same way as modifications of overpayments are made pursuant to paragraph (2) of subdivision (b) of Section 11460, according to the following tiered schedule: 11466.2.
(4) Beginning July 1, 1994, for group homes paid at rates below the standard rate established by subdivision (g), a group home program shall remain at its current RCL if it maintains at least the level of care and services associated with that percentage of the points required to be at that RCL that equals the percentage of the standard rate used to establish the group home’s rate. In no event, however, shall points per child per month be reduced more than 10 points below the minimum required for the current RCL. The RCL for a program shall not increase due to the operation of this paragraph absent any program changes approved by the department pursuant to subdivision (k).
Tier (5) 1: $1610 A group home program that substantially changes it staffing pattern from that reported in the group home program statement shall provide notification of this change to all counties that have placed children currently in care. This notification shall be provided whether or not the RCL for the program may change as a result of the change in staffing pattern.
Tier (g) 2: $2634 The standardized schedule of rates for fiscal year 1990–91 is:
Rate
Classification
Level | Point Ranges | |
|---|
| | |
|---|
| | Standard
Rate | Rate
Floor |
|---|
| | | |
|---|
|
|
| (85%) |
|---|
1 | Under 60 | $1,183 | $1,006 |
2 | 60–89 | 1,478 | 1,256 |
3 | 90–119 | 1,773 | 1,507 |
4 | 120–149 | 2,067 | 1,757 |
5 | 150–179 | 2,360 | 2,006 |
6 | 180–209 | 2,656 | 2,258 |
7 | 210–239 | 2,950 | 2,508 |
8 | 240–269 | 3,245 | 2,758 |
9 | 270–299 | 3,539 | 3,008 |
10 | 300–329 | 3,834 | 3,259 |
11 | 330–359 | 4,127 | 3,508 |
12 | 360–389 | 4,423 | 3,760 |
13 | 390–419 | 4,720 | 4,012 |
14 | 420 & Up | 5,013 | 4,261 |
Tier (h) 3: (1) $2634 [Ages 0-5] For fiscal year 1990–91, the standardized schedule of rates shall be implemented as follows:
Tier (A) 3+: $7213 [Ages 6+] Any group home program which received an AFDC-FC rate in the prior fiscal year below the standard rate for the fiscal year 1990–91 RCL shall receive their 1989–90 rate plus an amount equal to the California Necessities Index (CNI). The rate for fiscal year 1990–91 at which the state will participate shall not exceed the standard rate for the RCL.
(B) If the CNI increase to the group home program’s fiscal year 1989–90 rate does not raise the group home program to the rate floor for the RCL, the group home program shall receive a rate equal to the rate floor for the RCL.
(C) A group home program which received an AFDC-FC rate for fiscal year 1989–90 at or above the standard rate for the RCL for fiscal year 1990–91 shall continue to receive that fiscal year 1989–90 rate.
(2) For the 1996–97 fiscal year, commencing after October 31, 1996, and the 1997–98 fiscal year, the standardized rate for each RCL shall be adjusted by an amount equal to the California Necessities Index computed pursuant to the methodology described in Section 11453.
(A) Any group home program which received an AFDC-FC rate in the prior fiscal year at or above the adjusted standard rate for the RCL in the current fiscal year shall continue to receive that rate.
(B) A group home program which received an AFDC-FC rate in the prior fiscal year below the standard rate for the RCL in the current fiscal year shall receive that rate adjusted by an amount equal to the CNI. The rate for the current fiscal year shall not exceed the standard rate for the RCL and shall not be less than the rate floor for the RCL.
(3) Beginning with that portion of the 1996–97 fiscal year commencing November 1, 1996, the standardized schedule of rates shall be adjusted annually by an amount equal to the CNI computed pursuant to Section 11453, subject to the availability of funds.
(A) Any group home program which received an AFDC-FC rate in the prior fiscal year at or above the adjusted standard rate for the RCL in the current fiscal year shall continue to receive that rate.
(B) Any group home program which received an AFDC-FC rate in the prior fiscal year below the adjusted standard rate for the RCL in the current fiscal year shall receive the adjusted RCL rate.
(i) (1) (A) The rate for a new group home program of a new or existing provider shall be established at the rate floor for the new program’s projected RCL.
(B) On and after the operative date of this subparagraph, the department shall not, prior to July 1, 1993, establish a rate for a new group home program of a new or existing provider.
(2) The department shall not establish a rate for a new program of a new or existing provider unless the provider submits a recommendation from the host county, the primary placing county, or a regional consortium of counties that the program is needed in that county; that the provider is capable of effectively and efficiently operating the program; and that the provider is willing and able to accept AFDC-FC children for placement who are determined by the placing agency to need the level of care and services that will be provided by the program.
(3) The department shall encourage the establishment of consortia of county placing agencies on a regional basis for the purpose of making decisions and recommendations about the need for, and use of, group home programs and other foster care providers within the regions.
(4) The department shall annually conduct a county-by-county survey to determine the unmet placement needs of children placed pursuant to Sections 300 and Section 601 or 602, and shall publish its findings by November 1 of each year.
(j) The department shall develop regulations specifying ratesetting procedures for program expansions, reductions, or modifications, including increases or decreases in licensed capacity, or increases or decreases in level of care or services.
(k) (1) For the purpose of this subdivision, “program change” means any alteration to an existing group home program planned by a provider that will increase the RCL or AFDC-FC rate. An increase in the licensed capacity or other alteration to an existing group home program that does not increase the RCL or AFDC-FC rate shall not constitute a program change.
(2) (A) Prior to July 1, 1993, the rate for a group home program shall not increase, as the result of a program change, from the rate established for the program effective June 30, 1992. For rate increases as a result of a program change which became effective between July 1, 1992, and the effective date of this paragraph, the department shall adjust rates downward as necessary to comply with this chapter. Notwithstanding any other provisions of law, a group home provider shall be allowed to change a group home program to reflect a decrease in services due to the provisions of this paragraph.
(3) (B) Beginning July 1, 2028, and on July 1 of each fiscal year thereafter, the rate set forth in paragraph (2), shall be adjusted by the annual percentage change in the California Necessities Index applicable to the calendar year within which each July 1 occurs. For the 1993–94 fiscal year, the rate for a group home program shall not increase, as the result of a program change, from the rate established for the program effective July 1, 1993, except as provided in paragraph (3).
(C) For the 1994–95 fiscal year, the 1995–96 fiscal year, and through October 31, 1996, the rate for a group home program shall not increase, as the result of a program change, from the rate established for the program effective July 1, 1994, except as provided in paragraph (3).
(3) (A) For the 1993–94 fiscal year, the 1994–95 fiscal year, the 1995–96 fiscal year, and through October 31, 1996, the department shall not establish a rate for a new program of a new or existing provider or approve a program change for an existing provider that either increases the program’s RCL or AFDC-FC rate, or increases the licensed capacity of the program as a result of decreases in another program with a lower RCL or lower AFDC-FC rate that is operated by that provider, unless both of the conditions specified in this paragraph are met.
(i) The licensee obtains a letter of recommendation from the host county, primary placing county, or regional consortium of counties regarding the proposed program change or new program.
(ii) The county determines that there is no increased cost to the General Fund.
(4) (B) In addition to the care and supervision rate, provided a short-term residential therapeutic program is certified by the department as an immediate needs provider, a presumption exists that the placing agency will contract with the short-term therapeutic residential program to provide services and supports using the Immediate Needs Funding for a child who is eligible for the Immediate Needs Program established in Section 16562, and who is placed in the short-term residential therapeutic residential program, unless the placing agency determines it is in the best interest of the child to receive services and supports from another certified Immediate Needs Provider. Notwithstanding subparagraph (A), the department may grant a request for a new program or program change, not to exceed 25 beds, statewide, if (i) the licensee obtains a letter of recommendation from the host county, primary placing county, or regional consortium of counties regarding the proposed program change or new program, and (ii) the new program or program change will result in a reduction of referrals to state hospitals during the 1993–94 fiscal year, the 1994–95 fiscal year, the 1995–96 fiscal year, or through October 31, 1996.
( l) General unrestricted or undesignated private charitable donations and contributions made to charitable or nonprofit organizations shall not be deducted from the cost of providing services pursuant to this section.
(5) (m) 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 department may implement, interpret, or make specific this subdivision by means of all-county letters or similar written instructions, which shall be exempt from submission to or review by the Office of Administrative Law. These all-county letters or similar instructions shall have the same force and effect as regulations until the adoption of regulations no later than January 1, 2030. The department shall, by October 1 each year, commencing October 1, 1992, provide the Joint Legislative Budget Committee with a list of any new departmental requirements established during the previous fiscal year concerning the operation of group homes, and of any unusual, industrywide increase in costs associated with the provision of group care which may have significant fiscal impact on providers of group homes care. The committee may, in fiscal year 1993–94 and beyond, use the list to determine whether an appropriation for rate adjustments is needed in the subsequent fiscal year.
(n) This section shall become operative on July 1, 1995.