HomeMy WebLinkAboutAgenda 04-04-2019 Item 2 - Health and Human Service Initiatives and County Impacts 1
ORANGE COUNTY
BOARD OF COMMISSIONERS
ACTION AGENDA ITEM ABSTRACT
Meeting Date: April 4, 2019
Action Agenda
Item No. 2
SUBJECT: Health and Human Service Initiatives and County Impacts
DEPARTMENT: Social Services, Health & Child
Support Services
ATTACHMENT(S): INFORMATION CONTACT:
Memorandum of Understanding Nancy Coston, 919-245-2802
Quintana Stewart, 919-245-2412
Erica Bryant , 919-245-2177
PURPOSE: To provide an update on various state initiatives impacting Social Services and
other human service departments, including Social Services Reform, Child Welfare Reform,
Medicaid Transformation, and the Memorandum of Understanding (MOU) between Orange
County and the North Carolina Department of Health and Human Services regarding
performance expectations. In addition, Social Services will provide information on current
workload and discuss impacts of these changes on future workload. The Health Director and the
Child Support Director will discuss the impacts of Medicaid Transformation and the MOU on
their departments.
BACKGROUND: In 2017, the North Carolina General Assembly approved Social Services
Reform legislation (House Bill 630). This legislation contains many components including: hiring
of a consulting firm to develop plans for reform; establishing a workgroup to develop
recommendations on creation of state regional offices; developing a plan for regionalization of
local offices; and implementing performance agreements between local social service agencies
and the state Department of Health and Human Services (DHHS).
The outside consulting firm, the Center for the Support of Families, is conducting research in
North Carolina, has completed Phase I of the work and has published its first recommendations
for Social Service Reform and for Child Welfare Reform. The Social Services Work Group,
facilitated by the UNC School of Government, has issued its first report on establishing state
regional offices and is now working on local agency regionalization plans.
Performance Agreements
On June 29, 2018, the Board of Commissioners approved the first performance agreement
(Memorandum of Understanding) with DHHS. The performance agreement section of the law
was effective July 1, 2018, but the actual tracking of the performance measures by DHHS
2
began in January 2019 with progressive corrective actions effective July 2019. A revised MOU
(attached) has now been executed and reflects recent negotiations to change how some of the
measures will be calculated. If counties have continued failures in performance after corrective
action, the Secretary of DHHS may assume control of service delivery. These agreements apply
to child welfare programs, adult protective services, adult guardianship services, child support
and all public assistance programs except Medicaid.
Although Medicaid is not included in the agreements, there is separate legislation with additional
sanctions for any performance issues with Medicaid eligibility. Orange County Department of
Social Services (DSS) has integrated Medicaid with other public assistance programs during the
intake process so performance among these programs is interrelated.
Social Services Reform
The Phase I report from the consulting firm has been published. Much of the report focuses on
the plan to provide support and supervision for counties through seven state regional offices.
Organization of county or regional offices will be addressed in Phase II.
Child Welfare Reform
The Phase I report from the consulting firm has been published. This report contains a long list
of recommendations including implementing a practice model that emphasizes trauma informed,
evidence based practice by social workers and strong state supervision.
Medicaid Transformation
North Carolina recently received approval for its waiver to move forward with integrated,
managed care for Medicaid participants. Although Social Services will continue to establish
eligibility, participants will also need to be informed about selecting a medical home. Other
impacts of managed care will be realized by all Medicaid providers, including county agencies
such as health and transportation. Orange County is in one of first regions scheduled to
implement managed care with some of the Medicaid clients.
During the work session, Social Services will provide additional information about each of these
critical changes as well as anticipated impacts from these changes.
FINANCIAL IMPACT: Although receiving this information does not have financial impacts,
failure to make progress on performance measures could result in additional County costs.
Medicaid transformation may impact some County agencies receiving Medicaid reimbursement
for services.
SOCIAL JUSTICE IMPACT: The following Orange County Social Justice Goals are applicable
to this item:
• GOAL: FOSTER A COMMUNITY CULTURE THAT REJECTS OPPRESSION AND
INEQUITY
The fair treatment and meaningful involvement of all people regardless of race or color;
religious or philosophical beliefs; sex, gender or sexual orientation; national origin or
ethnic background; age; military service; disability; and familial, residential or economic
status.
• GOAL: ENSURE ECONOMIC SELF-SUFFICIENCY
The creation and preservation of infrastructure, policies, programs and funding necessary
for residents to provide shelter, food, clothing and medical care for themselves and their
dependents.
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• GOAL: CREATE A SAFE COMMUNITY
The reduction of risks from vehicle/traffic accidents, childhood and senior injuries, gang
activity, substance abuse and domestic violence.
The programs covered by the MOU relate to these Social Justice Goals.
RECOMMENDATION(S): The Manager recommends the Board receive information about
changes impacting Social Services and discuss plans to address these changes.
4
t E srsTE Q,
of ,o.,>,r °°may NC DEPARTMENT OF ROY COOPER • Governor
W > HEALTH AND MANDY COHEN, MD, MPH • Secretary
HUMAN SERVICES MICHAEL BECKETTS • Chief of Policy, Planning and Special
*� Division of Social Services Populations
QUAH
March 4, 2019
Bonnie B. Hammersley, County Manager
Orange County Government
200 South Cameron Street
Hillsborough, NC 27278
Nancy Coston, Director
Orange County Department of Social Services
113 Mayo Street
Hillsborough, NC 27278
Dear County Manager and DSS Director:
Enclosed is the fully executed Modification Agreement to the Memorandum of
Understanding for SFY 2018-2019 between DHHS and Orange County as required in
Session Law 2017-41. We appreciate the attention your county has already given to
this body of work.
Thank you for your ongoing partnership with us in serving North Carolina's citizens with
critical support services. If you have any questions, please contact Paris Penny at 919-
855-4805 or email Paris.penny(a)-dhhs.nc.gov.
Sincerely,
Michael Becketts
NC DEPARTMENT OF HEALTH AND HUMAN SERVICES • DIVISION OF SOCIAL SERVICES
LOCATION:820 S.Boylan Avenue,McBryde Building,Raleigh, NC 27603
MAILING ADDRESS:2401 Mail Service Center,Raleigh,NC 27699-2401
www.ncdhhs.gov • TEL:919-527-6335 • FAx:919-334-1018
AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER
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Modification Agreement to the
MEMORANDUM OF UNDERSTANDING (FISCAL YEAR 2018-19) BETWEEN
THE NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES
AND
ORANGE COUNTY
The parties agree to modify the MOU as set forth below. The terms and conditions
set forth in the MOU are adopted by reference and fully incorporated as if set forth
herein. The terms of this Modification Agreement supersede and replace any
conflicting or contrary terms of the MOU.
2.1 Default and Modification
Performance Improvement/Corrective Action: Prior to the Department exercising its authority to
withhold State and/or federal funding for a failure to satisfy the mandated performance requirements or
failure to comply with the terms of this MOU, the steps set forth in Attachment X will govern. For this
MOU covering Fiscal Year 2018-2019,the Department will not initiate any actions set forth in Attachment
X on the basis of this MOU.Nothing contained in this MOU or Attachment X shall supersede or limit the
Secretary's authority to take any action otherwise set forth in N.C. Gen.Stat. § 108A-74.
12.0 Notice
The persons named below shall be the persons to whom notices provided for in this MOU shall be given.
Either Party may change the person to whom notice shall be given upon written notice to the other Party.
Any notice required under this MOU will only be effective if actually delivered to the parties named below.
Delivery by hand,by first class mail,or by email are authorized methods to send notices.
For the Department of Health and Human Services,Division of Social Services
IF DELIVERED BY US POSTAL SERVICE IF DELIVERED BY ANY OTHER MEANS
Michael Becketts,Assistant Secretary Michael Becketts
NC Department of Health and Human Services NC DHHS
2001 Mail Services Center Doretha Dix Campus,McBryde Building
Raleigh,NC 27699-2001 Phone:919-527-6338
E-mail:Michael.Becketts@dhhs.nc.gov
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14.0 Responsibilities of the County
The County hereby agrees that its responsibilities under this MOU are as follows:
(1) The County shall adhere to the mandated performance requirements for each social services
program as identified in Attachments I through IX.For a County Performance Measure designat d
in Attachments I through IX as a Growth Measure, the County's performance will be assess d
based on its achievement of this Growth Measure. The County will ultimately work towards
achievement of the Standard Measure.
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ATTACHMENT I—MANDATED PERFORMANCE REQUIREMENTS:
Child Welfare-CPS Assessments
Standard Measure County Performance Measure Rationale and Authority
I The County will DHHS will work with the Ensure that allegations of abuse,neglect
initiate 95%of all county to identify a performance and dependency are initiated timely.The
screened-in reports measure for FYI 9-20 based on timeframes for initiating an investigation
within required time the prior fiscal year's of child maltreatment are defined in state
frames performance. law as,immediately,within 24 hours,or
within 72 hours depending on the nature
and severity of the alleged maltreatment.
NC General Statutes §713-302;
l0A NCAC 70A .0105;
NCDHHS Family Services Manual:Vol.
1,Chapter VIII:Child Protective
Services,Section 1408-Investigative&
Family Assessments
2 For all children who DHHS will work with the Ensure that children who have been
were victims of county to identify a performance substantiated as abused,neglected or
maltreatment during a measure for FY19-20 based on dependent are protected from further
twelve-month period, the prior fiscal year's harm.
no more than 9.1% performance.
received a subsequent National Standards for State Performance
finding of on Statewide Data Indicators established
maltreatment by the Children's Bureau to determine
conformity with Title IV-B and IV-E of
the Social Security Act and the Child and
Family Services Review.
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ATTACHMENT II—MANDATED PERFORMANCE REQUIREMENTS:
Child Welfare-Foster Care
Standard Measure County Performance Rationale and Authority
Measure
1 The County will ensure DHHS will work with Ensure the ongoing safety of children and the
that 95%of all foster the county to identify a engagement and well-being of families.
youth have face-to-face performance measure
visits by the social worker for FYI 9-20 based on Child and Family Services Improvement Act of
each month. the prior fiscal year's 2006(Public Law 109-288,section 7)amending
performance. Section 422(b)of the Social Security Act( 2 USC
622(b))
2 The County will provide DHHS will work with Ensure that children in out-of-home placem nts
leadership for ensuring the county to identify a are able to obtain safe and permanent home as
that 40.5%of children performance measure soon as possible after removal from their h rne.
who enter foster care in a for FYI 9-20 based on
12-month period are the prior fiscal year's
discharged to permanency Performance` National Standards for State Performance o
within 12 months of Statewide Data Indicators established by the
entering foster care. Children's Bureau to determine conformity with
Title IV-B and IV-E of the Social Security Act
and the Child and Family Services Review.
3 The County will provide DHHS will work with Ensure that children existing foster care are in
leadership for ensuring the county to identify a stable homes so that they do not re-enter foster
that of children who enter performance measure care.
foster care in a 12-month for FY19-20 based on
period who were the prior fiscal year's CFSR: Safety Outcome 1:Children are,firs and
discharged within 12 performance. foremost protected from abuse and neglect.
months to reunification, National Standards for State Performance o
kinship care,or Statewide Data Indicators established by the:
guardianship,no more Children's Bureau to determine conformity with
than 8.3%re-enter foster Title IV-B and IV-E of the Social Security Act
care within 12 months of and the Child and Family Services Review.
their discharge.
4 The County will provide DHHS will work with Ensure that children who are removed from their
leadership for ensuring the county to identify a homes experience stability while they are in foster
that of all children who performance measure care.
enter foster care in a 12- for FYI 9-20 based on
month period in the the prior fiscal year's CFSR:Permanency Outcome 1: Children have
county,the rate of performance. permanency and stability in their living situations.
placement moves per National Standards for State Performance o
1000 days of foster care Statewide Data Indicators established by the
will not exceed 4.1%. Children's Bureau to determine conformity with
Title IV-B and IV-E of the Social Security Act
and the Child and Family Services Review.
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period of time is defined as three consecutive months,or five months out of a twelve-
month period measured beginning with the first month after which the performance
improvement plan is signed.
b. The corrective action plan shall include,at a minimum:
i. A strategy to ensure regular supervisory oversight of the social services program
at issue;
ii. A detailed strategy to ensure the issue central to the non-compliance is addressed
and corrected;
iii. A strategy to ensure program and case documentation is both sufficient and
completed within time frames prescribed by law,rule or policy;and
iv. A plan for the continuous review of the corrective activities by both the County
Director of Social Services,the County DSS Governing Board,and the
Department.
c. The corrective action plan will be signed by the Department and the County DSS
Director.A copy of the corrective action plan will be sent to the Chair of the DSS
Governing Board,the County Manager,and the Chair of the Board of County
Commissioners.
4. Failure to Complete Corrective Action Plan/Urgent Circumstances
a. In the event a County DSS fails to complete the corrective action plan or otherwise fails
to comply with the terms of the corrective action plan,the Department may exercise its
authority under the law,and this MOU,to withhold federal and/or state funding.
b. In circumstances of continuous extended non-compliance or other urgent circumstances,
the Secretary may also exercise her statutory authority to assume control of service
delivery in the County pursuant to N.C.G.S. 108A-74.
**In the event the performance requirement or term of the MOU falls outside of the authority of the County
DSS, the notification of non-compliance will be sent to the County, and all subsequent steps contained
herein shall be followed by the County.
Effective Date: This Modification Agreement shall become effective upon the date of execution by both
parties and shall continue in effect until June 30,2019.
Signature Warranty:Each individual signing below warrants that he or she is duly authorized by the
party to sign this Modification Agreement and to bind the party to the terms and conditions of this
Modification Agreement and the MOU.
Orange County North Carolina Department of Health and
Human Services
BY:Name BY: r �---
/►�
TITLE:k4t C Ltd O e✓ Name
DATE: TITLE: t
DATE:
Page 14 of 14
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ATTACHMENT X—CORRECTIVE ACTION
For this MOU covering Fiscal Year 2018-2019,the Department will not initiate any actions set forth in
Attachment X on the basis of this MOU..
1. Non-Compliance with performance requirements or terms of the MOU
a. In the event a County Department of Social Services(County DSS)** fails to satisfy a
performance requirement for three consecutive months or fails to comply with a term c f
this MOU,the Department will provide the County DSS with written notification
identifying the relevant performance requirement or term and how the County DSS failed
to satisfy it.
b. Upon receipt of notification,the County DSS shall promptly provide the Department w th
written acknowledgment of receipt.
c. If the County DSS does not agree that it failed to satisfy the performance requirement o
comply with the terms of the MOU,it shall set forth,in writing,the basis for its
disagreement.If the County DSS believes its failure to adhere to a mandated performan e
requirement or term of this MOU is due in whole or in part upon the failure of the
Department to meet any of its responsibilities under this MOU or other external factors
(i.e., limited court dates,continuances,etc.),the County DSS shall set forth in writing
how the failure of the Department or external factors to meet its responsibility to the
County DSS contributed to the inability of the County DSS to meet the mandated
performance standard or other term of this MOU. This notice shall be received by the
Department,along with all supporting documentation,within 10 business days of the
County DSS' receipt of the Department's written notification of non-compliance.
d. If written notice is received in accordance with subsection(c)of this section,the
Department will provide the appropriate division director with the all documentation
received. Following a review of all documentation,the division director will provide the
county with a decision to proceed in developing the performance improvement plan or t
rescind the notice of non-compliance.
2. Performance Improvement Plan
a. The County DSS and Department shall work together to develop a performance
improvement plan to address the non-compliance.The Parties will consider and address
the County DSS's written disagreement with the identified non-compliance,if any,in the
development of the performance improvement plan.
b. The performance improvement plan shall include,at a minimum:
i. The role and responsibility of DHHS in providing support to the County DSS to
address the non-compliance.
ii. The specific actions the County DSS will take to address the non-compliance and
ensure ongoing compliance.
c. The performance improvement plan shall be signed by the Department and the County
DSS Director.A copy of the performance improvement plan will be sent to the chair of
the DSS Governing Board.
3. Continued Non-Compliance
a. In the event a County DSS continues to fail to satisfy a performance requirement or
comply with the terms of the MOU for an extended period of time and is not meeting th
terms of the performance improvement plan,the County DSS and the Department will
enter into a corrective action plan,not to exceed a period of twelve months.An extended
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ATTACHMENT IX—MANDATED PERFORMANCE REQUIREMENTS:
Child Care Subsidy
Standard Measure County Performance Rationale and Authority
Measure
1 The County will process 95% The County will Ensure that families can place their children
of Child Care Subsidy process 95%of Child in quality child care without undue delay.
applications within 30 Care Subsidy
calendar days of the applications within 30 North Carolina Child Care Development
application date. calendar days of the Fund State Plan
application date.
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ATTACHMENT VIH—MANDATED PERFORMANCE REQUIREMENTS:
Special Assistance(SA)
Standard Measure County Performance Rationale and Authority
Measure
1 The County will process 85% DHHS will work with the Ensure eligible individuals
of Special Assistance for the county to identify the receive supplemental payments o
Aged(SAA)applications County's performance support stable living
within 45 calendar days of the measure for FYI 9-20 based arrangements.
application date. on the County's
performance for the Timely application processing o
preceding state fiscal year SAA benefits is essential to an
individual's proper care and
treatment.
10A NCAC 71P.0604
2 The County will process 85% DHHS will work with the Ensure eligible individuals
of Special Assistance for the county to identify the receive supplemental payments o
Disabled(SAD)applications County's performance support stable living
within 60 calendar days of the measure for FY19-20 based arrangements.
application date. on the County's
performance for the Timely application processing o
preceding state fiscal year SAD benefits is essential to an
individual's proper care and
treatment.
1 OA NCAC 71P.0604
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ATTACHMENT VII—MANDATED PERFORMANCE REQUIREMENTS:
Adult Protective Services(APS)
Standard Measure County Performance Rationale and Authority
Measure
1 The County will complete DHHS will work with the Responding quickly to allegations
95%of APS evaluations county to identify the of adult maltreatment is essential
involving allegations of County's performance to case decision-making to protect
abuse or neglect within 30 measure for FY19-20 based the adult. State law requires that a
days of the report. on the County's prompt and thorough evaluation is
performance for the made of all reports of adult
preceding state fiscal year maltreatment.
NCGS 108A-103
2 The County will complete DHHS will work with the Protecting a disabled adult from
85%of APS evaluations county to identify the exploitation is critical to ensuring
involving allegations of County's performance their safety and well-being.State
exploitation within 45 days measure for FY19-20 based law requires a prompt and
of the report. on the County's thorough evaluation is made of all
performance for the reports of adult exploitation.
preceding state fiscal year
NCGS 108A-103
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ATTACHMENT VI—MANDATED PERFORMANCE REQUIREMENTS:
Food and Nutrition Services
County
Standard Measure Performance Rationale and Authority
Measure
1 The County will process 95%of The County will Ensure all expedited FNS applicatioris are
expedited FNS applications within process 95%of processed within required timeframe .
4 calendar days from the date of expedited FNS
application. applications within 4 7 CFR§273.2
calendar days from FNS Manual:Section 315
the date of FNS Administrative Letter 1-2015
application.
2 The County will process 95%of The County will Ensure all regular FNS applications are
regular FNS applications within process 95%of processed within required timefrarne .
25 days from the date of regular FNS
application. applications within 25 7 CFR§273.2
days from the date of FNS Manual:Section 315
application. FNS Administrative Letterl-2015
3 The County will ensure that 95% The County will Ensure that eligible families have their
of FNS recertifications are ensure that 95%of recertification benefits processed in a timely
processed on time,each month. FNS recertifications manner without interruption.
are processed on
time each month. 7 CFR§273.14
4 The County will ensure that 90% The County will Ensure allegations of fraud are addressed
of Program Integrity claims are ensure that 90%of promptly.
established within 180 days of the Program Integrity
date of discovery. claims are established 7 CFR§273.18
within 180 days of
the date of discovery.
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ATTACHMENT V—MANDATED PERFORMANCE REQUIREMENTS:
Work First
Standard Measure County Performance Rationale and Authority
Measure
1 The County will collect DHHS will work with the Ensure that all work-eligible
documentation from 50%of all county to identify the individuals are engaged in
Work-Eligible individuals that County's performance federally countable work
demonstrates completion of the measure for FYI 9-20 based activities.
required number of hours of on the County's
federally countable work performance for the TANF State Plan FFY 2016-
activities. preceding state fiscal year 2019
NCGS 108A-27.2(10)
NCGS 108A-27.6(1)
NCGS 108A-27.13(a)
NCGS 108A-27.14 a- b
2 The County will collect DHHS will work with the Ensure all work-eligible two-
documentation from 90%of county to identify the parent families are engaged in
two-parent families with Work County's performance federally countable work activities
Eligible individuals that measure for FY19-20 based for the required number of
verifies that the they have on the County's participation hours.
completed the required number performance for the
of hours of federally countable preceding state fiscal year TANF State Plan FFY 2016-
work activities. 2019
NCGS 108A-27.2(10)
NCGS 108A-27.6(1)
NCGS 108A-27.13(a)
NCGS 108A-27.14 a- b
3 The County will process 95% The County will process Ensure that eligible families
Work First applications within 95%Work First receive Work First benefits in a
45 days of receipt. applications within 45 days timely manner.
of receipt.
TANF State Plan FFY 2016-
2019
NCGS 108A-31
4 The County will process 95% The County will process Ensure that Work First families
Work First recertification no 95%Work First continue to receive assistance and
later than the last day of the recertifications no later than benefits without unnecessary
current recertification period. the last day of the current interruption.
recertification period.
TANF State Plan FFY 2016-
2019
NCGS 108A-31
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ATTACHMENT IV—MANDATED PERFORMANCE REQUIREMENTS:
Energy Programs
Standard Measure County Performance Rationale and Authority
Measure
1 The County will process The County will process
95%of Crisis Intervention 95%of Crisis Ensure that eligible individuals in a
Program(CIP)applications Intervention Program household without a heating or cooling
within one(1)business day (CIP)applications source receive relief as soon as possible.
for applicants with no heat within one(1)business
or cooling source. day for applicants with 42 USC §§ 8621-8630
no heat or cooling l0A NCAC 71 V
source.
2 The County will process The County will process Ensure that eligible households who are i
95%of Crisis Intervention 95%of Crisis danger of losing a heating or cooling
Program(CIP)applications Intervention Program source receive financial assistance to
within two(2)business (CIP)applications avert the crisis.
days of the application date within two(2)business
for applicants who have a days of the application 42 USC §§ 8621-8630
heat or cooling source. date for applicants who 10A NCAC 71 V
have a heat or cooling
source.
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5 The county will meet DHHS will work with the county to Measuring total child support collections
its annual goal of total identify the County's performance is an important measure of the program
child support measure for FYI 9-20 based on the because it encompasses the strength of
collections. County's performance for the the laws,practices,and fiscal effort to
preceding state fiscal year determine its effectiveness.
42 USC§652(g)(1)(A)
42 USC§658a(b)(6)(E)
NCGS 110-129.1
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ATTACHMENT III—MANDATED PERFORMANCE REQUIREMENTS:
Child Support
Standard Measure County Performance Measure Rationale and Authority
1 80%of paternities DHHS will work with the county to
established or identify the County's performance Paternity establishment is an esse tial
acknowledged for measure for FYI 9-20 based on the component in obtaining and enforcing
children born out of County's performance for the support orders for children.
wedlock. preceding state fiscal year
42 USC§652(g)(1)(A)
42 USC§658a(b)(6)(A)
NCGS 110- 129.1
2 80%of child support DHHS will work with the county to A court order creates a legal obligation
cases have a court identify the County's performance for a noncustodial parent to provide
order establishing measure for FYI 9-20 based on the financial support to their children.
support obligations. County's performance for the
preceding state fiscal year 42 USC§652(g)(1)(A)
42 USC§658a(b)(6)(B)
NCGS 110- 129.1
3 80%of current child DHHS will work with the county to The current collections rate is an
support paid. identify the County's performance indicator for the regular and timely
measure for FYI 9-20 based on the payment of child support obligations.
County's performance for the
preceding state fiscal year 42 USC §652(g)(1)(A)
42 USC§658a(b)(6)(C)
NCGS 110- 129.1
4 80%of cases received DHHS will work with the county to Collection of child support has been
a payment towards identify the County's performance shown to reduce child poverty rates and
arrears. measure for FYI 9-20 based on the improve child well-being.
County's performance for the
preceding state fiscal year 42 USC§652(g)(1)(A)
42 USC§658a(b)(6)(D)
NCGS 110- 129.1
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