As is custom, the House Appropriations Committee included important guidance and directives for some of the new and existing HHS funding. Some of these include:

CWA data elements into AFCARS. Mental Health Screenings for Foster Youth.

The Committee recognizes that States are required to develop a plan for the ongoing oversight and coordination of health care services for any child in a foster care placement and emphasizes the importance of including mental health as part of these screenings within the first 30 days of entering foster care. The Committee urges HHS to provide technical assistance to States as they incorporate mental health screenings into State oversight plans.

Adoption and Foster Care Analysis and Reporting System (AFCARS) Data Elements.

The Committee believes that collecting LGBTQ and Indian Child Welfare Act (ICWA) data would help HHS track and improve outcomes for foster youth and families living at the intersections of race, sexual orientation, gender, and tribal affiliation and encourages HHS to incorporate LGBTQ and ICWA data elements into AFCARS.

Community-Based Child Abuse Prevention (CB-CAP).

The Committee believes that communities can help build strong families and improve their capacity to nurture the healthy development of their children by providing ready access to online information about the full range of public and private resources available to them. The Committee encourages ACF to provide technical assistance to State lead agencies on how they may use funds provided under this account to help local governments and communities to develop (or maintain) websites that provide current and regularly updated information on family, youth, and community resources including programs and services provided through nonprofits; community organizations; the Federal Government; and State and local governments.

Child Abuse

The Committee continues to encourage HHS to explore the feasibility of including a category of animal abuse to the caregiver characteristics and environmental factors fields in NCANDS as an additional factor that could place a child at risk for maltreatment.

Addressing Racial Inequity in the Child Welfare System.

The Committee recognizes the need for reforms in the child welfare system and supports the request to provide $100,000,000 for a new competitive grant program to address racial inequity in the child welfare field and reorient systems towards a prevention-first model. This funding would allow State, local, and tribal child welfare agencies to partner with other government and community stakeholders across the education, health, human services, and early childhood sectors to advance comprehensive policy and practice reforms focused on advancing racial equity and safely reducing the number of children entering foster care, particularly in communities over-represented in the child welfare system.

Race Equity in the Child Welfare Workforce.

The Committee supports efforts to increase the hiring, retention, and leadership development of a racially diverse workforce at all levels of public and private child welfare agencies and provides an additional $2,000,000, as requested.

Social Determinants of Health.

The Committee includes an increase of $150,000,000 for investments in social determinants of health (SDOH) to improve health equity. The Committee includes funding to expand activities to address SDOH in States, local, tribal and territorial jurisdictions to improve outcomes among persons experiencing health disparities and inequalities, including, but not limited to, expanding and implementing Accelerator Plans, initiating a SDOH implementation program, providing technical assistance to communities and continuing to build the evidence base and advance data collection to better understand health disparities.

Social Determinants Accelerator Plans should include a description of the health and social outcome objectives; identify populations that would benefit from implementation of the plan, including Medicaid eligible individuals; and identify non-governmental, private, or public health organizations and community organizations that would participate in the development of the plan. Grantees may use a portion of grant funding to convene government entities, public and private stakeholders, and to engage qualified research experts in developing Social Determinants Accelerator Plans.

Trauma-Informed Interventions.

The Committee includes $5,000,000 for a demonstration project related to the implementation of a new and innovative approach to serving children in foster care by providing trauma-informed interventional programming, including evidence-based clinical services, foster parent training and curriculum, volunteer support services for foster parents, positive biological and birth family engagement to enhance family reunification, enrichment activities for the children and trauma-informed systems work. Eligible applicants should be nonprofit organizations with a demonstrated experience working with children in foster care who have experienced severe trauma. Applicants shall include Institutional Review Board-approved research supported by content area and epidemiological experts. The project should report regularly to ACF on findings, outcomes, and recommendations regarding sustainable funding and replicable programmatic models.

Mental Health Parity.

The Committee continues to be concerned that 12 years since enactment of the Mental Health Parity and Addiction Equity Act (MHPAEA), there is still a lack of oversight and compliance among insurance companies and health plans not adequately covering mental and behavioral health services and providers. In December 2019, the GAO reported that this lack of compliance extends beyond plans investigated by the Department of Labor (DOL) and includes plans over which HHS has oversight authority. The Committee urges the HHS Secretary, jointly with the Secretary of Labor and the Secretary of the Treasury, to establish a process through which employer-sponsored health plans and health insurance issuers subject to MHPAEA may submit a public report regarding nonquantitative treatment limitations while ensuring that any personal or confidential consumer information is protected. The Secretaries shall also report annually any auditing and enforcement of all plans and issuers within the jurisdiction of the respective Department.