Chapter 6B. Healthy Early Childhood Development Programs.
§ 4–651.01. Definitions.
For the purposes of this chapter, the term:
(1) "Adverse childhood experiences" means stressful or traumatic experiences experienced by infants and toddlers, including housing instability, childhood abuse, family instability, substance abuse, mental illness, and family criminal involvements.
(2) "CFSA" means the Child and Family Services Agency.
(3) "Child development center" shall have the same meaning as provided in § 4-401(2).
(4) "Community-based social services" means services that address the social determinants of health and contribute to the well-being of families, communities, and populations.
(5) "Community health worker" means an individual who provides community navigation services.
(6) "Community navigation services" means the provision of assistance to individuals seeking to access health care services in the home and community by identifying and reducing barriers to obtaining health care services.
(7) "Community resource inventory" means a software platform accessible by health professionals and community-based social services providers, that consists of a web-based tool capable of screening individuals for trauma, developmental health, behavioral health, and social determinants of health needs.
(8) "DBH" means the Department of Behavioral Health.
(9) "DHCF" means the Department of Health Care Finance.
(10) "DHS" means the Department of Human Services.
(11) "DMHHS" means the Office of the Deputy Mayor for Health and Human Services.
(12) "DOH" means the Department of Health.
(13) "Early Head Start Home Visiting" or "Early Head Start" means a program established pursuant to section 645a of the Head Start Act Amendments of 1994, approved May 18, 1994 (42 U.S.C. § 9840a).
(14) "Healthy Futures Program" or "Healthy Futures" means the program administered by DBH that uses health professionals to provide child and family-centered behavioral health care services to families with infants and toddlers.
(15) "Healthy Steps" means a nationally recognized evidence-based approach to family-centered supports consisting of an interdisciplinary pediatric primary care program that uses a child development professional to assist families during well-child visits by providing guidance and information to promote healthy early childhood development.
(16) "Health professional" shall have the same meaning as provided in § 3-1201.01(8).
(17) "Home visiting" means a program that:
(A) Supports expectant parents, parents, or legal guardians with infants, toddlers, and children between 3 and 5 years of age, primarily in the home; and
(B) Provides access to health, social, and educational services through weekly or monthly home visits to promote positive child health and development outcomes, including healthy home environments, healthy birth outcomes, and a reduction in adverse childhood experiences.
(18) "Home Visiting Council" means the District of Columbia Home Visiting Council, an entity that includes representatives of District agencies, child advocacy organizations, home visiting providers, early childhood programs, and other stakeholders, that supports the sustainability of home visiting and promotes positive childhood health and development outcomes.
(19) "Home visitor" means a trained individual who, through a home visiting program, provides home visiting services, primarily in families' homes.
(20) "Home visit system" means activities designed to support and improve the quality and sustainability of home visiting programs, including:
(A) Home visiting quality and utilization;
(B) Data collection to measure the effectiveness of home visiting;
(C) Workforce and professional development services;
(D) Technical assistance; and
(E) Development and implementation of home visiting best practices.
(21) "Infant" means an individual younger than 12 months of age.
(22) "Interagency Coordinating Council" means the entity established pursuant to § 7-863.03(b).
(23) "International Board-Certified Lactation Consultant" means a health professional who provides lactation support services and possesses a current certification as a lactation consultant from the International Board of Lactation Consultant Examiners.
(24) "Lactation support services" means evidence-based services, including counseling or consulting services, provided on an out-patient basis by hospitals and birth centers to promote healthy breastfeeding.
(25) "Medicaid" means the medical assistance programs authorized by title XIX of the Social Security Act, approved July 30, 1965 (79 Stat. 343; 42 U.S.C. § 1396 et seq.), and by § 1-307.02, and administered by DHCF.
(26) "OSSE" means the Office of the State Superintendent for Education.
(27) "Patient-Centered Medical Home National Committee for Quality Assurance recognition" means the certification provided by the National Committee for Quality Assurance to acknowledge health professionals that implement the latest clinical procedures to ensure the delivery of quality comprehensive health care services.
(28) "Primary care provider" means a health professional who provides health care services, addresses a majority of personal health care needs, maintains a sustained partnership with patients, and practices in the context of family and community.
(29) "Quality Improvement Network Interagency Steering Committee" means the entity established to coordinate the provision of resources and comprehensive services to infants and toddlers in Quality Improvement Network programs.
(30) "SECDCC" means the State Early Childhood Development Coordinating Council established pursuant to § 38-271.07(a).
(31) "Social determinants of health" means the conditions in the environment in which people are born, live, work, and age that have a significant impact on health outcomes, including socioeconomic status, education, physical environment, employment, social support networks, and access to health care services.
(32) "Strong Start DC Early Intervention Program" or "Strong Start" means a District-wide, comprehensive, coordinated, multidisciplinary system that provides early intervention therapeutic and other services for infants and toddlers with disabilities and developmental delays and their families, as required pursuant to Part C of the Individuals with Disabilities Education Act, approved April 13, 1970 (84 Stat. 175; 20 U.S.C. § 1431).
(33) "Toddler" means an individual older than 12 months but younger than 36 months of age.
§ 4–651.02. Healthy Steps Pediatric Primary Care Demonstration Program.
(a) DOH shall establish and administer a Healthy Steps Pediatric Primary Care Demonstration Program ("Program"), in accordance with this section, for the purpose of providing grants to primary care providers to administer:
(1) Healthy Steps; and
(2) Co-located lactation support services within the facilities of primary care providers selected to participate in the Program.
(b) Primary care providers located in Wards 5, 7, or 8 that serve a population of 50% Medicaid-eligible families shall be eligible to participate in the Program.
(c) An eligible primary care provider seeking to participate in the Program shall submit an application to DOH that includes a detailed description of the applicant's:
(1) Current pediatric population, including the following demographic characteristics of patients:
(A) Race;
(B) Ethnicity;
(C) Income level of parents;
(D) Primary language spoken; and
(E) Location by ward;
(2) Approach to health promotion, screening, prevention, and wellness for families with infants and toddlers;
(3) Engagement with other health professionals, including referral relationships with community-based social service providers and home visiting programs;
(4) Plan to integrate a child development specialist and a community health worker into the applicant's practice to engage with families with infants and toddlers;
(5) Plan to refer, coordinate care, and share data with home visiting programs and early learning providers, including Early Head Start, the Quality Improvement Network, and Strong Start;
(6) Plan to coordinate with family support services to address social determinants of health;
(7) Plan to engage an entity with expertise in implementing Healthy Steps for initial and ongoing training of pediatric primary care staff;
(8) Plan to provide services to promote healthy early childhood development and address parenting challenges;
(9) Plan to offer lactation support services, including consultative services and individual and group education classes;
(10) Staffing plan for lactation support services;
(11) Plan to coordinate care and referrals to co-located lactation support services;
(12) Current follow through rate of patient behavioral health referrals;
(13) Plan to improve the health literacy of patients;
(14) Plan to screen infants and toddlers for adverse childhood experiences and incorporate findings into the practice; and
(15) Other information as may be required by DOH.
(d) Subject to appropriations, DOH shall provide funding to participating primary care providers to:
(1) Implement Healthy Steps;
(2) Obtain and maintain Patient-Centered Medical Home National Committee for Quality Assurance recognition ;
(3) Obtain the services of community health workers to provide community navigation services;
(4) Screen patients and their families for adverse childhood experiences, developmental health, behavioral health, and social determinants of health needs that affect health and behavioral health outcomes, including poverty, food insecurity, housing instability, and domestic and community violence;
(5) Provide families with community navigation services to address the findings of the screening process conducted pursuant to paragraph (4) of this subsection;
(6) Support the data collection and reporting required pursuant to [§ 4-651.03]; and
(7) Support organizational training, evaluation, and delivery of services.
(e) DOH shall coordinate with other District agencies and primary care providers selected to participate in the Program to identify and provide effective incentives to families to encourage the use of lactation support services and community-based social services.
(f) DOH shall determine the feasibility of co-locating clinics participating in the Special Supplemental Nutrition Program for Women, Infants, and Children, as established by section 17 of the Child Nutrition Act of 1966, approved September 26, 1972 (86 Stat. 729; 42 U.S.C. § 1786), with primary care providers selected to participate in the Program.
(g) Subject to appropriations, local funding provided to the Program shall be:
(1) A grant of $300,000 each fiscal year for one primary care provider selected to participate in the Program and an evaluation by the external evaluation contractor selected pursuant to § 4-651.03; provided, that no more than 20% of the grant shall be allocated for an external evaluation conducted pursuant to § 4-651.03;
(2) In Fiscal Year 2020, an amount for at least one additional primary care clinic selected to participate in the Program; provided, that no more than 20% of the grant shall be allocated for an external evaluation conducted pursuant to § 4-651.03;
(3) Not Funded.
(4) Not Funded.
(5) Not Funded.
§ 4–651.03. External evaluation contractor.
(a) By December 1, 2018, DOH shall select an external evaluation contractor to conduct a community-based evaluation of the effectiveness of the Program.
(b) Beginning January 1, 2020, and annually thereafter, primary care providers selected to participate in the Healthy Steps Pediatric Primary Care Demonstration Program ("Program") established pursuant to § 4-651.02 shall report to an external evaluation contractor, selected by the grantee, and approved by DOH:
(1) A schedule of well-infant visits;
(2) The percentage of infants and toddlers who are up-to-date on their immunizations;
(3) The percentage of infants and toddlers who are up-to-date on their lead screenings, pursuant to § 7-871.03(b);
(4) The number of infants and toddlers placed in a home visiting program;
(5) The number of infants and toddlers that were not placed in a home visiting program due to a lack of available slots;
(6) The number of referrals of patients to Strong Start, developmental health, behavioral health, and community-based social services providers;
(7) The number of patients screened for behavioral health and social service needs;
(8) The number of patients referred to lactation support services;
(9) The number of breastfeeding patients served;
(10) Breastfeeding initiation and duration rates; and
(11) Other qualitative outcome and performance mechanisms chosen by primary care providers selected to participate in the Program to measure healthy early childhood development.
(c) Beginning January 1, 2020, and annually thereafter, DOH, in coordination with primary care providers selected to participate in the Program and an external evaluation contractor selected pursuant to subsection (a) of this section, shall submit a report to the Mayor, Council, Quality Improvement Network Interagency Steering Committee, Interagency Coordinating Council, and OSSE evaluating the information submitted pursuant to subsection (b) of this section.
§ 4–651.04. Help Me Grow. [Not Funded]
Not Funded.
§ 4–651.05. Home Visiting Program.
(a) There is established a Home Visiting Program ("Program"), which shall be administered by DOH in accordance with this section.
(b) Subject to appropriations, the Program shall be funded from the following sources:
(1) In Fiscal Year 2019, an amount of $710,566 in local funds;
(2) In Fiscal Year 2020, an amount of $2 million in local funds;
(3) Federal grants; and
(4) Private donations.
(c) The funds in the Program shall be used to support the provision of home visiting services and home visit system activities.
§ 4–651.05a. First-Time Mothers Home Visiting Pilot Program.
(a)(1) DOH shall award a competitive grant in an amount not to exceed $150,000 to a home visiting provider to support the development of a pilot program that provides evidence-based home visiting services exclusively to eligible first-time mothers in the District.
(2) The grant issued in accordance with this subsection shall be limited to a home visiting provider that receives at least $500,000 of its funding from private sources.
(3) In Fiscal Year 2022, DOH shall provide an amount not to exceed $150,000 to the home visiting provider who was awarded the competitive grant pursuant to paragraph (1) of this subsection.
(4) In Fiscal Year 2023, DOH shall provide an amount not to exceed $150,000 to the home visiting provider who was awarded the competitive grant pursuant to paragraph (1) of this subsection, to be expended for the purposes set forth in that paragraph.
(5) In Fiscal Year 2024, DHCF shall provide an amount not to exceed $225,000 to the home visiting provider who was awarded the competitive grant pursuant to paragraph (1) of this subsection, to be expended for the purposes set forth in that paragraph.
(b) For the purposes of this section, the term "eligible first-time mother" means a pregnant woman preparing to give birth to her first child who has enrolled in the pilot program prior to their 28th week of pregnancy and:
(1) Has an individual income that is less than 60% of the area median income for the Washington, D.C. metropolitan area according to the statistics of the United States Department of Housing and Urban Development; or
(2) Is eligible for Medicaid.
§ 4–651.06. Home visiting reports.
(a) By April 30, 2019, and every 5 years thereafter, DOH, in coordination with other District agencies as necessary, shall conduct a comprehensive needs assessment of home visiting in the District. This assessment shall include:
(1) A neighborhood-level analysis of the number and location of families who would most benefit from home visiting;
(2) A determination of the capacity of existing home visiting programs to meet the need for home visiting services; and
(3) An assessment of the capacity of District agencies to support the implementation of additional home visiting services.
(b)(1) By January 1, 2019, and annually thereafter, DOH, in coordination with other District agencies as necessary, the Home Visiting Council, and home visiting programs, shall publish a report regarding the funding, scope, placement rate, success rate, and other similar statistics of home visiting services in the District.
(2) Not Funded.
(c) By December 31, 2019, DOH, in coordination with other District agencies as necessary, the Home Visiting Council, and home visiting programs, shall conduct and publish a study of home visitors. This study shall include an analysis of qualitative and quantitative data pertaining to home visitors, including the:
(1) Number of home visitors;
(2) Workload, retention rate, and attrition rate of home visitors;
(3) Impact of home visitor attrition on families and home visiting programs;
(4) Factors contributing to the retention and attrition of home visitors; and
(5) Challenges to hiring and educating home visitors.
§ 4–651.07. Early Head Start.
(a) Not Funded.
(b) Not Funded.
§ 4–651.08. Lactation Certification Preparatory Program.
(a) Beginning October 1, 2019, there is established a Lactation Certification Preparatory Program ("LCPP"), which shall be administered by DOH in coordination with an institution of higher education, as that term is defined in § 38-2402.01(3), and an existing provider of a lactation consultant preparatory course.
(b) LCPP shall offer the following types of services:
(1) Instruction in the standards and procedures necessary to become an International Board-Certified Lactation Consultant;
(2) Assistance with obtaining any required clinical experience in lactation consulting; and
(3) Mentorship from International Board-Certified Lactation Consultants to assist in preparation for the International Board-Certified Lactation Consultant exam and a career in lactation consulting.
(c) DOH shall offer a subsidy to individuals participating in the LCPP to offset the cost of participation.
§ 4–651.09. Community Resource Inventory Program.
(a) Beginning October 1, 2018, there is established a Community Resource Inventory Program ("CRIP"), which shall be administered by DHCF, in consultation with OSSE, FEMS, community partners engaged in resource inventory development, and stakeholders identified by the 2018 State Medicaid Health IT Plan, to develop, design, and deploy a web-based, bi-directional community resource inventory that:
(1) Is accessible to health and social support organizations and District government agencies;
(2) Has the capacity to allow participating entities to communicate and track referrals;
(3) Includes all District-operated and District-funded programs;
(4) Operates in a publicly accessible, non-proprietary, machine-readable, and interoperable data format;
(5) Screens residents for behavioral health, developmental health, and social determinants of health needs;
(6) Shares screening results with the database established pursuant to § 4-651.04(b); and
(7) Refers residents to appropriate federal, District, and community resources to address their health care needs, including to primary care providers participating in the Healthy Steps Pediatric Primary Care Demonstration Program established pursuant to § 4-651.02.
(b) DHCF shall designate a point of contact for the CRIP to coordinate with other District agencies and community partners to leverage existing data assets and establish interoperability with existing information systems.
(c) Within 180 days after October 30, 2018, DHCF shall submit a report to the Mayor and the Council that describes the implementation of the CRIP and its plan to leverage existing resource data assets and establish interoperability between the community resource inventory and existing information systems.
(d) Not Funded.
§ 4–651.10. Healthy Futures.
(a) Beginning October 1, 2019, and annually thereafter until Fiscal Year 2023, DBH shall expand the number of child development centers participating in either Healthy Futures or another evidence-based program that provides behavioral health care services by an additional:
(1) 75 child-care centers in FY 2020;
(2) Not Funded.
(3) Not Funded.
(b) By August 1, 2019, DBH shall submit a plan to the Mayor, Council, Interagency Coordinating Council, SECDCC, and the Quality Improvement Network Interagency Steering Committee to expand Healthy Futures or another evidence-based program that provides behavioral health care services to support the mental health of infants, toddlers, and their families.
§ 4–651.11. Reimbursement for home visiting services.
(a) By July 1, 2025, health insurance coverage through Medicaid or the DC HealthCare Alliance and the Immigrant Children's Program shall cover and reimburse eligible home visiting services provided by an eligible home visiting program; except, that no Medicaid payment shall be made until such time that CMS approves the Medicaid state plan amendment described in subsection (b) of this section.
(b)(1) By March 31, 2025, DHCF shall submit for approval from CMS an amendment to the Medicaid state plan to authorize the Medicaid payments described in this section.
(2) While preparing the Medicaid state plan amendment application, DHCF shall:
(A) In consultation with organizations providing home visiting services and other relevant entities, establish criteria and processes for billing and reimbursement of eligible home visiting services, including:
(i) Establishing coverage and eligibility criteria to include at least the covered population;
(ii) Establishing a payment methodology based on monthly payments per individual or family receiving eligible home visiting services so that the payment results in adequate reimbursement;
(iii) Developing program support and training for home visitors to facilitate billing; and
(iv) Assessing the viability of incentive payments to home visitors whose clients attend postpartum appointments with a medical provider; and
(B) In consultation with DOH and other relevant entities, issue rules to determine eligibility for reimbursement by Medicaid, the DC HealthCare Alliance, and the Immigrant Children's Program.
(c) For purposes of this section, the term:
(1) "CMS" means the Centers for Medicare & Medicaid Services.
(2) "Covered population" means:
(A) First-time expectant parents; and
(B) Families, and expectant parents, who have children under the age of 5 and meet 3 or more medical, behavioral, or social risk factors, as determined by DHCF.
(3) "Eligible home visiting program" means a home visiting program that conforms to a home visitation model that has been in existence for at least 3 years and:
(A) Is research-based and grounded in relevant empirically based knowledge;
(B) Has demonstrated program-determined outcomes;
(C) Is associated with a national organization, institution of higher education, or other organization that has comprehensive home visitation program standards to ensure high quality service delivery and continuous program quality improvement;
(D) Meets the U.S. Department of Health and Human Services' criteria for evidence of effectiveness as determined by a Home Visiting Evidence of Effectiveness review or meets substantially equivalent criteria for evidence of effectiveness as determined by a credible, independent academic or research organization; and
(E) Employs registered nurses as home visitors.
