SUPPORT Act: Opioid Recovery and Treatment

• Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, also known as the SUPPORT for Patients and Communities Act, is abbreviated as H.R. 6.
• Enacted on October 24, 2018.
• It amends titles IV-B and IV-E of the Social Security Act and the Child Abuse Prevention and Treatment Act (CAPTA).
• It makes public health reforms to combat the opioid crisis by advancing treatment and recovery initiatives, improving prevention, protecting communities, and bolstering efforts to combat illicit synthetic drugs.
• Designed to boost programs that fight, treat, and stop substance abuse and support access to mental health services.
• The Children’s Bureau offers guidance on section 8082(b) of this legislation in Program Instructions ACYF-CB-PI-18-09 and ACYF-CB-PI-18-10, both issued November 30, 2018.

Major Provisions of the SUPPORT Act

• Title IV-B was amended to require HHS to create a family recovery and reunification program replication project, appropriating $15 million for replication of a ‘recovery coach’ program for parents with children in foster care because of parental substance abuse.
• Title IV-E was amended so that receipt of prevention and family services and programs is not considered receipt of aid for the purposes of eligibility of any other program under the Social Security Act.
• Amended title IV-E so that it does not permit a State to reduce medical or other assistance available to a title IV-E prevention recipient.
• Clarified that if the cost of providing a title IV-E prevention service to an individual would have been paid from another public or private source if not for the enactment of P.L. 115-123, a title IV-E agency is not considered to be a legally liable third party for the cost of providing such a service to that individual.
• CAPTA was amended to authorize the Secretary of HHS to make grants to States to assist child welfare agencies and other service providers to facilitate collaboration in developing, updating, implementing, and monitoring plans of safe care.
• HHS is required to provide written guidance and technical assistance to support States in complying with and implementing plans of safe care and to improve the long-term safety and well-being of children.
• An interagency task force (to include the HHS Administration for Children and Families) was created to make recommendations regarding best practices to identify, prevent, and mitigate the effects of trauma on infants, children, youth, and their families and to better coordinate the Federal response to families impacted by substance use disorders and other forms of trauma
• The Secretary of HHS, in consultation with the divisions of HHS administering substance use disorder or child welfare programs, is required to develop and issue guidance to States that identifies opportunities to support family-focused residential substance use treatment programs.
• Title XIX (Medicaid) was amended to require States to ensure that former foster youth can keep their Medicaid coverage across State lines until age 26.
• The Secretary of HHS is required to award grants to develop, enhance, or evaluate family-focused residential treatment programs to increase the availability of such programs that meet the requirements for promising, supported, or well-supported practices specified in this act.
• The Abandoned Infants Assistance Act of 1988 was repealed.

Adoption and Safe Families Act of 1997

• H.R. 867
• Enacted November 19, 1997.
• The purpose is to promote the adoption of children in foster care and amend title IV-E of the Social Security Act

Major Provisions of the Adoption and Safe Families Act

• Reauthorized the Family Preservation and Support Services program which was renamed the Promoting Safe and Stable Families program.
• Extended categories of services to include time-limited reunification services and adoption promotion and support services.
• Defined ‘time-limited family reunification services’ as services and activities provided to a child removed from their home and placed in out-of-home care, and to the parents/primary caregiver, to facilitate safe and appropriate reunification within a timely fashion.
• Time-limited family reunification services are only provided during the 15-month period that begins when the child is considered to have entered foster care.
• Time-limited family reunification services include individual, group, and family counseling; inpatient, residential, or outpatient substance use treatment services; mental health services; and assistance to address domestic violence.
• Services are designed to provide temporary child care and therapeutic services for families, including crisis nurseries and transportation to or from any of those services and activities.
• Ensured safety for abused and neglected children by ensuring health and safety concerns are addressed when a State determines placement for abused and neglected children.
• Requires the U.S. Department of Health and Human Services (HHS) to report on the scope of substance use in the child welfare population and the outcomes of services provided to that population.
• Added ‘safety of the child’ to every step of the case plan and review process.
• Required criminal records checks for foster and adoptive parents who receive Federal funds on behalf of a child, unless a State has opted out of this requirement.
• Accelerated permanent placement of a child in foster care by requiring States to initiate court proceedings to free a child for adoption once that child had been waiting in foster care for at least 15 of the most recent 22 months, unless there was an exception.
• Allowed children to be freed for adoption more quickly in extreme cases.
• Promoted adoptions by rewarding States that increased adoptions with incentive funds.
• Requires States to use reasonable efforts to move eligible children in foster care toward permanent placements.
• Promoted adoptions of all children with special needs and ensured health coverage for adopted children with special needs.
• Prohibited States from delaying or denying placements of children based on the geographic location of the prospective adoptive families.
• Required States to document and report child-specific adoption efforts.
• Increased accountability by requiring HHS to establish new outcome measures to monitor and improve State performance.
• Required States to document child-specific efforts to move children into adoptive homes.
• Clarified ‘reasonable efforts’ by emphasizing children’s health and safety.
• Requires States to specify the circumstances when efforts to prevent foster placement or to reunify a child with his or her parents are not required.
• Required shorter time limits for making decisions about permanent placements by requiring permanency hearings to be held no later than 12 months after the child enters foster care.
• Requires States to initiate termination of parental rights proceedings after the child has been in foster care 15 of the previous 22 months, unless the child is in the care of a relative or severing the parent-child relationship is not in the child’s best interests.

Comprehensive Addiction and Recovery Act of 2016

• S. 524
• Enacted July 22, 2016
• Aims to address various aspects of substance use disorders, particularly opioid use disorder.
• Includes provisions affecting multiple agencies and systems, including additional requirements regarding the Child Abuse Prevention and Treatment Act (CAPTA).
• Title V (Addiction and Treatment Services for Women, Families, and Veterans) is designed to help States address the effects of substance use disorders on infants, children, and families.
• The Children’s Bureau offers guidance on the provisions of this legislation in Information Memorandum ACYF-CB-IM-16-05, issued August 16, 2016; Program Instruction ACYF-CB-PI-17-02, issued January 17, 2017; and Program Instruction ACYF-CB-PI-17-05, issued April 10, 2017.

Major Provisions of the Act

• Amended CAPTA
• Requires the Secretary of Health and Human Services (HHS), through the national clearinghouse established under CAPTA to maintain and disseminate information about the CAPTA State plans and best practices related to plans of safe care for infants born and identified as being affected by substance use or withdrawal symptoms or a fetal alcohol spectrum disorder.
• Modified the CAPTA State plan requirement of 42 U.S.C. § 5106a for plans of safe care for infants born and identified as being affected by substance use or withdrawal symptoms or fetal alcohol spectrum disorder to add the following requirements for the State:
• Ensure the safety and well-being of infants following their release from the care of health-care providers by:
• Addressing the health and substance use disorder treatment needs of the infant and affected family member or caregiver
• Monitoring these plans to determine whether and how local entities are making referrals and delivering appropriate services to the infant and affected family member or caregiver (in accordance with State requirements)
• Develop plans of safe care for infants affected by all substance use (not just illegal substance use, as was the requirement prior to this change)
• Requires States to report the following, to the maximum extent practicable, in the National Child Abuse and Neglect Data System:
• Number of infants identified as being affected by (1) substance use or withdrawal symptoms resulting from prenatal drug exposure or (2) a fetal alcohol spectrum disorder
• Number of infants with safe care plans
• Number of infants for whom service referrals were made, including services for the affected parent or caregiver
• Requires the HHS Secretary to monitor States to ensure compliance with the requirements of section 42 U.S.C. § 5106a, with a specific focus on the policies and procedures related to plans of safe care, by conducting activities, in addition to the State plan review, such as:
• A comparison of activities carried out by the State to comply with the requirements of 42 U.S.C. § 5106a with the State plan most recently approved under § 432 of the Social Security Act (title IV-B, subpart 2)
• A review of information available on the State’s website relating to its compliance with the requirements of 42 U.S.C. § 5106a
• Site visits, as may be necessary to carry out such monitoring
• A review of information available in the State’s Annual Progress and Services Report

Justice for Victims of Trafficking Act of 2015

• Designed to provide justice for trafficking victims through grants to states.
• Aims to support child abuse investigation and prosecution programs.
• Supports services for victims of child pornography.
• Supports domestic child human-trafficking deterrence programs.
• Authorizes specialized training for law enforcement, first responders, healthcare, child welfare, juvenile justice personnel, prosecutors, and judicial personnel.
• Training focuses on identifying victims and acts of child human trafficking.
• Training aims to facilitate the rescue of child victims of human trafficking.

Patient Protection and Affordable Care Act

• Public Law 111-148
• H.R. 3590
• Enacted March 23, 2010
• Aims to amend the Public Health Service Act.
• Designed to provide better health-care coverage for all Americans.
• Intended to improve health-care services for underserved communities and for other purposes.
• The Children’s Bureau offers guidance on the provisions of this legislation in Program Instruction ACYF-CB-PI-10-10, issued June 7, 2010.

Major Provisions of the Act

• Provisions relevant to child welfare practice include:
• Extended Medicaid coverage to children formerly in foster care who are younger than age 26
• Required a State Children’s Health Insurance Program (CHIP) plan, beginning January 1, 2014, to use modified gross income and household income to determine CHIP eligibility
• Required a State to treat any child who is determined to be ineligible for Medicaid as a result of the elimination of an income disregard based on expense or type of income as a targeted low-income child eligible for CHIP
• Amended title V of the Social Security Act (Maternal and Child Health Services) to provide grants to eligible entities for early childhood home-visitation programs
• Required the case review system for children aging out of foster care and independent living programs to include information about the importance of having a health-care power-of-attorney for transition planning
• Reauthorized appropriations for health centers to serve medically underserved populations
• Reauthorized appropriations for fiscal years 2010-2014 for the expansion and improvement of emergency medical services for children who need treatment for trauma or critical care
• Authorized the award of grants and cooperative agreements for demonstration projects for the provision of coordinated and integrated services to special populations through the colocation of primary and specialty care services in community-based mental and behavioral health settings
• Established a Pregnancy Assistance Fund for grants to States to assist pregnant and parenting teens and women
• Increased from $10,000 to $13,170 the dollar limitation on the tax credit for adoption expenses and the tax exclusion for employer-provided adoption assistance, allowed an inflation adjustment to such limitation after 2010, and made the credit refundable

H.R. 6, also known as the SUPPORT Act, was enacted on October 24, 2018. It combats the opioid crisis through public health reforms. The act advances treatment, improves prevention, and protects communities by bolstering efforts to combat illicit synthetic drugs and substance abuse.