LEGISLATIVE SERVICES AGENCY OFFICE OF FISCAL AND MANAGEMENT ANALYSIS 200 W. Washington St., Suite 301 Indianapolis, IN 46204 (317) 233-0696 iga.in.gov FISCAL IMPACT STATEMENT LS 7075 NOTE PREPARED: Feb 24, 2022 BILL NUMBER: SB 266 BILL AMENDED: Feb 24, 2022 SUBJECT: Department of Child Services Matters. FIRST AUTHOR: Sen. Ford Jon BILL STATUS: 2 nd Reading - 2 nd House FIRST SPONSOR: Rep. Jeter FUNDS AFFECTED:XGENERAL IMPACT: State & Local DEDICATED XFEDERAL Summary of Legislation: (Amended) Outlier Payments: This bill requires the Office of Medicaid Policy and Planning (FSSA) to review methods of calculating outlier payments in relation to final reimbursement amounts. Civil Liability: The bill limits the civil liability of contractors that provide specified services under a contract with the Department of Child Services (DCS). Volunteers, Employees, and Contractors: It provides that an individual may be employed by a child care provider before the state-mandated criminal history check of the individual is completed if the following conditions are satisfied: (1) The individual's: (A) fingerprint-based check of national crime information data bases; (B) national sex offender registry check; (C) in-state local criminal records check; and (D) in-state child protection index check; have been completed. (2) If the individual has resided outside Indiana at any time during the five years preceding the individual's date of hire, the individual's: (A) out-of-state child abuse registry check; and (B) out-of-state local criminal records check; have been requested. (3) The individual's employment before the completion of the state-mandated criminal history check is limited to training during which the individual: (A) does not have contact with children who are under the care and control of the child care provider; and SB 266 1 (B) does not have access to records containing information regarding children who are under the care and control of the child care provider. (4) The individual completes an attestation, under penalty of perjury, disclosing: (A) any abuse or neglect complaints made against the individual with the child welfare agency of a state other than Indiana in which the individual resided within the five years preceding the date of the attestation; and (B) any contact the individual had with a law enforcement agency in connection with the individual's suspected or alleged commission of a crime in a state other than Indiana in which the individual resided within the five years preceding the date of the attestation. Residential Treatment Service Provider (RTSP) Payment Rate: The bill establishes a process by which a child caring institution, group home, or secure private facility (RTSP) may request a review of base rates and other cost-based rates approved by the DCS. It allows the DCS to consider approval of costs that: (1) are proven by a residential treatment provider to have been previously approved by the DCS; or (2) relate to accreditation, staff safety, child safety, or a DCS requirement. Augmentation: The bill augments the amount of money appropriated to the DCS for purposes of providing grants to RTSP for costs associated with increased wages for direct service staff. The bill requires the DCS to report specified information regarding the grants provided. Effective Date: Upon passage; July 1, 2022. Explanation of State Expenditures: Augmentation and RTSP Payment Rate: The bill will increase the rate paid to RTSPs by allowing costs that may have been previously disallowed. Any change in an RTSP's reimbursement rate will be based on the disallowed costs coming from one of the categories that the DCS is to consider. Also, the bill adds funding for reimbursement of direct service staff, with current year increases not to be disallowed in future rate setting. The bill appropriates an additional $15 M from the state General Fund to pay RTSP costs associated with increased wages for direct services staff. (Revised) The DCS will have increased workload to report on the use of grants given and to review and amend its rules to conform with provisions of the bill as needed. Also, the DCS’s workload will increase to provide notices to the RTSP and post it on the DCS website. Volunteers, Employees, and Contractors: The bill could potentially increases the number of workers who may begin training to work or volunteer at licensed child-caring institutions, group homes, and child-placing agencies by providing modifications to the background check requirements. If these RTSPs have more employees, reimbursement rates may increase. Outlier Payments: Generally, the increase of the base payment to 130% of the Medicaid rate, has reduced the amount of the outlier reimbursement under the current method of calculation. Outlier reimbursement pays for inpatient stays that exceed a monetary threshold set by the Family and Social Services Administration (FSSA). If the FSSA were to make adjustments that eliminate the negative impact of the calculation method, costs for inpatient stays will increase. Additionally, FSSA may have a workload increase to amend the state plan amendment approved November 10, 2021, which is expected to be within their resources. SB 266 2 Additional Information - Annual expenditures of $222.7 M between FY 2017 and FY 2021 from state funds are 76% of the total expenditures for RTSP. Utilization decreased 43% between FY 2017 and FY 2021, from 4,520 to 3,160 placements. Any expenditure outside of those allowed by Title IV-E programs would be a state expense. Explanation of State Revenues: Explanation of Local Expenditures: Explanation of Local Revenues: A RTSP of a local unit could receive additional reimbursement, but any increase will be based on the differences between current rules and the requirements of the bill. State Agencies Affected: Department of Child Services; Family and Social Services Administration. Local Agencies Affected: Information Sources: Sarah Faulkner; Aaron Atwell; DCS, Rate Setting Process Overview 11.22.21, presented to the Child Services Oversight Committee on November 22, 2021. Fiscal Analyst: Karen Rossen, 317-234-2106. SB 266 3