AN ACT to ensure trauma‑informed assessments and appropriate care for children and youth in foster care.

Whereas, supporting children, youth, and families served by the child welfare system requires a high level of multisector coordination aimed at preserving families and supporting reunification and permanency. In order to accomplish successful achievement of child outcomes, the health plans, care management agencies, service providers, and families and youth must be involved and committed to the use of evidence‑based practices; and

Whereas, agencies must utilize standardized tools, assessments, and training that address the trauma that these children and youth experience; Now, therefore,

The General Assembly of North Carolina enacts:

part i. trauma‑based standardized assessment

SECTION 1.(a)  Establishment; Purpose. – Children who are at risk of entry into foster care and children who are currently in foster care have experienced trauma warranting the involvement of the Division of Social Services and other child welfare agencies. As a result of the trauma, children are at a higher risk of needing behavioral health or intellectual or developmental disability services. To that end, the Department of Health and Human Services shall develop a trauma‑based standardized assessment in partnership in accordance with this section.

SECTION 1.(b)  Membership. – The partnership developing the trauma‑informed standardized assessment shall consist of all of the following members:

(1)        Representatives from all of the following Divisions of the Department of Health and Human Services: the Division of Social Services; Division of Health Benefits; Division of Mental Health, Developmental Disabilities, and Substance Abuse Services; and Division of Family and Child Well‑Being.

(2)        Health plans and primary care case management entities.

(3)        Representatives from the county departments of social services.

(4)        Benchmarks, LLC.

(5)        Individuals with lived experiences.

(6)        Others identified by the partnership based upon areas of expertise.

SECTION 1.(c)  Plan Development. – In developing the trauma‑informed standardized assessment, the partnership shall develop a rollout plan with a goal of implementing the trauma‑informed standardized assessment statewide in all 100 counties. The rollout plan shall include all of the following:

(1)        The development of the trauma‑informed standardized assessment template by December 31, 2023.

(2)        The finalized trauma‑informed standardized assessment template by June 30, 2023, including the standardized training curriculum, methodology for training, the selection of a vendor to manage and conduct the training and determine the process for the statewide rollout, and coordination with tribal jurisdictions.

(3)        The phased‑in approach of the trauma‑informed standardized assessment beginning on July 1, 2024, and operating statewide by June 30, 2025.

(4)        The establishment of a base rate for the trauma‑informed standardized assessment that supports the oversight, training, and monitoring of the fidelity to the trauma‑informed standardized assessment.

(5)        Establish a standardized workflow of notifications to the payers and child welfare agencies, including the following recommended service processes:

a.         Time lines for recommended access and implementation of services from date of referral.

b.         Network and provider capacity to meet expected time lines. In the event the behavioral health service provision is in a region served by a BH IDD tailored plan or in an LME/MCO catchment area that has a gap in provider capacity to meet the recommended time lines, the network shall be open to providers for additional provider enrollment.

(6)        Identify core outcomes to measure the success of the project and impact of youth receiving the standardized trauma‑informed assessments in a timely manner by a trained workforce.

(7)        Establish a statewide implementation training plan that includes oversight of fidelity to the trauma‑based standardized assessment for staff conducting the assessment within specified time frames. Medicaid managed care plans shall be required to open their provider networks to obtain the necessary number of trauma‑informed providers if the existing network cannot meet the needs of the community. The training plan shall be enacted and implemented within the same time lines established with the rollout schedule.

SECTION 1.(d)  In developing the trauma‑based standardized assessment and the rollout plan, the Department of Health and Human Services shall ensure the trauma‑informed standardized assessment includes, at a minimum, all of the following:

(1)        Ensure that juveniles between the ages of 4 and 17 being placed into foster care receive a trauma‑based standardized assessment within 10 working days of their referral.

(2)        Each juvenile who is included in any Medicaid children and families specialty plan, regardless of their type of placement, shall receive a trauma‑based standardized assessment.

(3)        Each trauma‑based standardized assessment may be administered in a face‑to‑face or telehealth encounter.

(4)        The county department of social services must make the referral for a trauma‑based standardized assessment within five working days of completing an assessment for a juvenile in accordance with G.S. 7B‑302.

(5)        After obtaining parental consent, a juvenile may receive a trauma‑based standardized assessment if the county department of social services makes the determination that a juvenile is at imminent risk for entry into foster care.

(6)        Allow for individuals between the ages of 18 and 20 to receive an assessment, if necessary.

(7)        Develop an evidence‑informed and standardized template and content for the assessment.

(8)        In the event the juvenile has an assigned care manager under the Medicaid program, the responsible care management entity shall be notified of the referral for the assessment and to whom.

SECTION 1.(e)  The Department of Health and Human Services shall also do all of the following in implementing the trauma‑based standardized assessment and rollout plan:

(1)        Leverage the expertise and lessons learned from the entities included in the partnership who have successfully implemented trauma‑informed assessments and training venues.

(2)        Complete any required documentation and, as applicable, leverage all federal revenues for such activities, including opioid settlements, Medicaid, federal block grant funds, and social services or behavioral plans or grants.

(3)        Amend any existing contracts with entities who have the expertise to manage the trauma‑based standardized assessment, rollout plan, create the training plan, or monitor implementation to ensure the fidelity of the service and delivery are maintained.

(4)        Create a Division of Social Services Statewide Dashboard representing the status of the trauma‑based standardized assessment implementation and rollout plan, updated monthly, that includes all of the following:

a.         Referrals.

b.         Case management.

c.         Assessments.

d.         Lag between referrals, assessments, and service initiation.

e.         Youth personal outcomes, not based on process, but instead focused on supporting permanency.

f.          Any other elements identified by the partnership.

PART II. MEDICAID

SECTION 2.(a)  The General Assembly finds that children receiving foster care services through the county child welfare agencies are entitled to evidence‑based, trauma‑informed interventions and therapy. The Department of Health and Human Services, Division of Health Benefits (DHB), shall develop and, to the extent allowed under G.S. 108A‑54.1A, implement new in‑lieu‑of services under the Medicaid State Plan for children receiving foster care services. These in‑lieu‑of services shall be developed to be implemented statewide and shall apply a Children and Families specialty plan if one is implemented. For Medicaid beneficiaries not enrolled in managed care, DHB shall utilize Early and Periodic Screening, Diagnostic and Treatment (EPSDT) to ensure access to the recommended interventions and therapies.

In order to develop the new in‑lieu‑of services required by this section, DHB shall partner with county child welfare agencies, representatives with lived experience in child welfare, the nonprofit corporation Benchmarks, prepaid health plans, and local management entities/managed care organizations (LME/MCOs) to identify innovative service options to address any gaps in the care of children receiving foster care services. The plan shall be developed no later than 90 days after this act becomes law. The plan developed shall address all of the following:

(1)        Identification of models of community evidence‑based practices that support a foster child returning to their family in a timely manner and diverting higher level foster care placements.

(2)        Identification of model short‑term residential treatment options that serve children with high acuity needs that divert a child from higher level placements such as psychiatric residential treatment facility placement (PRTF). These services may also provide stepdown options from higher levels of care.

SECTION 2.(b)  No later than three months after the plan is developed under subsection (a) of this section, DHB shall issue a request for proposals (RFPs) for any services identified through the plan development process as lacking and targeted towards any geographic location with identified inadequate provider access. Services may be phased in over a period of two years. The RFPs shall be developed in partnership with the stakeholders involved with developing the plan, as required under subsection (a) of this section. Each RFP shall include the following:

(1)        The development of newly identified Medicaid services for foster children that may be implemented regionally or statewide.

(2)        Expansion of a Medicaid service that is not located in the particular county or region.

(3)        Time lines for, and establishment of, first‑ and second‑year deliverables for any service that may be a phased‑in service.

(4)        Identification of required funding, including start‑up funding and a three‑year budget including projected revenue sources and amounts.

(5)        Specific outcome measures with the attestation of the timely submission of the data to the responsible prepaid health plan and DHB. These outcomes shall be aligned with child welfare safety and permanency measures and support positive childhood outcomes.

DHB shall review the RFPs and award provider contracts to the accepted RFPs within six months of the submission due date of the RFP being awarded. DHB may prioritize implementation of the RFP awards based upon areas in the greatest need as identified by the stakeholders involved with developing the plan, as required under subsection (a) of this section.

DHB shall train all county departments of social services and offer training to tribal welfare offices on the Medicaid services recommended for implementation by the stakeholders involved with developing the plan, as required under subsection (a) of this section, and continue to provide status implementation within the impacted counties and region.

part iii. appropriation

SECTION 3.(a)  There is appropriated from the General Fund to the Department of Health and Human Services the nonrecurring sum of seven hundred fifty thousand dollars ($750,000) in each year of the 2023‑2025 fiscal biennium for the development of the foster care standardized assessment.

SECTION 3.(b)  There is appropriated from the General Fund to the Department of Health and Human Services, Division of Health Benefits, the sum of twenty million dollars ($20,000,000) in recurring funds for the 2023‑2024 fiscal year and the sum of twenty million dollars ($20,000,0000) in recurring funds for the 2024‑2025 fiscal year to implement Part II of this act. These funds shall provide a State match for thirty‑eight million seven hundred thousand dollars ($38,700,000) in recurring federal funds for the 2023‑2024 fiscal year and thirty‑eight million seven hundred thousand dollars ($38,700,000) in recurring funds for the 2024‑2025 fiscal year. Those federal funds are appropriated to the Division of Health Benefits to pay for costs associated with the implementation of Part II of this act.

Part iv. Effective date

SECTION 4.  Part III of this act becomes effective July 1, 2023. The remainder of this act is effective when it becomes law.