“Doc Fix” Includes Home Visiting & Demo’s On Therapeutic Foster Care

On Monday, March 31 the Senate followed up House action from the week before and approved the Medicare “doc-fix.” As a result they also gave approval to extend the Maternal, Infant and Early Childhood Home Visiting (MIECHV) program into 2015. The Senate vote on the measure (H.R. 4302) was 64 to 35 and it became P.L. 113-93 when the President signed it on Tuesday. It extends the home visiting program for half the fiscal year through the end of next March but provides a full year of $400 million in mandatory dollars. After passage, the House held a hearing on Home Visiting that is reported below.

The “doc fix” extension legislation also includes the bipartisan “Excellence in Mental Health Act,” which authorizes the creation of a 2-year pilot program to be awarded to 8 states that compete to create federally certified Community Behavioral Health Centers. The provision designates $900 million in the expansion of services to various populations in need of mental health services and establishes new standards for providers. One of those provider groups identified in the legislation are agencies licensed by the state to deliver therapeutic (or treatment) foster care (TFC). For the first time ever, TFC is defined under Medicaid (Social Security Act, Sec. 1905) as a reimbursable service provided by state licensed child placing agencies which are accredited by nationally recognized accrediting bodies.

The Foster Family-based Treatment Association (FFTA) has been working hard to strengthen the definition and the use of treatment foster care within Medicaid for several years. Traditional foster care and treatment foster care are distinct program models intended to serve different child populations. Children are referred to TFC programs to address serious levels of emotional, behavioral and medical problems. Treatment foster care is active and structured, and occurs in the foster family home. What people view as “traditional” foster care provides nurturing, safe, and custodial care for children who require placement outside of their family. The primary reason for placement in traditional foster care is the need for care and protection. The role of the foster parent is that of caregiver and nurturer. Treatment, if any, occurs outside of the foster home. Therapeutic care combines the treatment technologies typically associated with more restrictive settings and the nurturing, individualized family environment with foster parents who receive special training.

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A day after the “doc fix” extension became law, the House Ways and Means Subcommittee on Human Resources held a hearing on MIECHV. The Chair of the Subcommittee, Congressman Dave Reichert (R-WA) opened the hearing with a statement that said in part, “Our purpose today is to review what we know about the effects of this program, so we can begin thinking about next steps…we need to review whether the actual outcomes of this program are living up to its promise in terms of producing better outcomes for children and families. We also need to think about whether the program’s mix of supporting proven and promising approaches continues to makes sense. And we should consider whether this program should continue to have 100 percent federal funding, especially since some of the positive outcomes we hope to see will benefit our state partners.”

Witnesses included Crystal Towne, Nurse-Family Partnership; Sherene Sucilla, Former Nurse Family Partnership (NFP) program participant; Darcy Lowell, Child First; Jon Baron, Coalition for Evidence-Based Policy; and Rebecca Kilburn, RAND Corporation.

Crystal Towne described the NFP model explaining that it has served over 190,000 families and currently has over 28,000 first-time families enrolled in 43 states. She said that for every 100,000 families served research demonstrates that,

• 14,000 fewer children will be hospitalized for injuries in their first two years of life;
• 300 fewer infants will die in their first year of life;
• 11,000 fewer children will develop language delays by age two;
• 23,000 fewer children will suffer child abuse and neglect in their first 15 years of life; and
• 22,000 fewer children will be arrested and enter the criminal justice system through their first 15 years of life.

Jon Barton offered a strong endorsement for reauthorization summarizing:

• “MIECHV represents an important, bipartisan departure from the usual approach to social spending: it uses scientific evidence of effectiveness as a main factor in determining which activities to fund.
• This evidence-based design is important because there is great variation in the effectiveness of different home visiting program activities (“models”). Rigorous studies have identified several models that produce major improvements in the lives of children and mothers – such as 20-50% reductions in child maltreatment – as well as a larger number of models that produce no meaningful effects.
• MIECHV’s evidence-based design has succeeded, in part, in focusing funds on the subset of effective models; and, with a few modest revisions, it could do even better.”

To read all the testimony, go the Human Resources website. Organizations can still submit testimony for the record to the subcommittee by April 16. Directions for public submissions for the record can be found here.