Overview of MIECHV Law & Policy

1. Overview of MIECHV Law & Policy Prepared by the MIECHV Reauthorization Committee

2. MIECHV Law

3. Statewide Needs Assessment • 42 USC 711 § 511(b) • Purpose: • Identify at-risk communities • Evaluate quality and capacity of existing programs • Asses state capacity to treat substance abuse in families • Required coordination with: • MCH • Head Start • Child Abuse Prevention & Treatment Act • Submit to the Secretary assessment results & description of state’s plans to address results The needs assessment was only required once in 2011. Could it be beneficial to conduct a new assessment to ensure MIECHV grants are still serving high-risk communities?

4. Grant Awards • § 511(c) • Secretary has authority to award grants • Portion of grants may be used for planning/implementation during first 6 months of grant • Secretary determines grant duration • Secretary provides for technical assistance to grantees • Will Congress allow the Secretary of Health & Human Services to retain such broad discretion over grant awards? • Most comparable grant programs have grant duration, award criteria, minimum awards, etc. outlined in the law • Notice the law does not specify whether the grants should be awarded competitively or by formula • A rewrite of the law would likely open these issues for Congressional debate

5. Home Visiting Program Requirements • § 511(d) • Grantee must establish 3- and 5-year benchmarks • 6 benchmark areas listed: • Improved maternal and newborn health • Prevention of child injuries, child abuse, neglect, or maltreatment, and reduction of emergency department visits • Improvement in school readiness and achievement • Reduction in crime or domestic violence • Improvements in family economic self-sufficiency • Improvements in the coordination and referrals for other community resources and supports

6. Home Visiting Program Requirements • Report on benchmark improvement required after 3 years: • Must show improvement in at least 4 benchmarks • Corrective action plan with regular progress reports triggered if 4 benchmarks unmet • Secretary provides for TA and an advisory panel to help grantees comply with corrective action plan • Secretary can terminate grant upon failure to improve or submit progress reports • Final benchmark reports submitted by 12/31/15 • Requirement to produce improvements in relevant outcomes for individual families based on individualized assessment

7. Home Visiting Program Requirements • 7 participant outcomes identified: • Improvements in prenatal, maternal, and newborn health, including improved pregnancy outcomes • Improvements in child health and development, including the prevention of child injuries and maltreatment and improvements in cognitive, language, social-emotional, and physical developmental indicators • Improvements in parenting skills • Improvements in school readiness and child academic achievement • Reductions in crime or domestic violence • Improvements in family economic self-sufficiency • Improvements in the coordination of referrals for, and the provision of, other community resources and supports for eligible families, consistent with State child welfare agency training

8. Home Visiting Program Requirements • Models must meet threshold for evidence-based program or qualify as a promising practice • No more than 25% of grant can be used on promising practices • Secretary establishes criteria for evidence of effectiveness • Additional requirements: • Adhere to consistent model that is evidence-based and can meet benchmark and outcome measures • Employ well-trained staff and provide ongoing, model-specific training • Establish home visitor competencies • Demonstrate strong implementation capacity • Create referral networks with other community resources • Maintain model fidelity • Priority given to high-risk populations in 9 categories

9. Home Visiting Program Requirements • Definition of “evidence-based model” • conforms to a clear consistent home visitation model that has been in existence for at least 3 years and • is research-based, • grounded in relevant empirically-based knowledge, • linked to program determined outcomes, • associated with a national organization or institution of higher education that has comprehensive home visitation program standards that ensure high quality service delivery and continuous program quality improvement, and • has demonstrated significant, positive outcomes in the benchmark areas and participant outcomes • evaluated using well-designed and rigorous: • randomized controlled research designs with results published in peer-reviewed journal or • quasi-experimental research designs.

10. Home Visiting Program Requirements • This section could draw significant Congressional attention: • Some in Congress believe the threshold for evidence-based programs is too low • Some think MIECHV should focus on models that improve health outcomes because the law was originally scored as a cost saver based of the savings realized by health-focused models • Kevin Brady(R-TX) is the new Chairman of House Ways & Means Committee: • Ways & Means is the new committee of jurisdiction in the House for MIECHV • SpeakerRyan has a reputation as a budget hawk, but in his book on poverty, home visiting was one of the few social programs he discussed favorably

11. Grant Application Requirements • Description of populations to be served • Must prioritize low-income families and high-risk communities • Models selected and explanation for decision • Explanation of how selected populations and models are consistent with needs assessment • Benchmarks grantee will establish • Must obtain model specifications to ensure model fidelity • Procedures to ensure voluntary participation and individualized service • Must submit annual reports on program activities and participate in data collection required by Secretary • Description of other state home visiting programs including those funded by Title V, Child Abuse Prevention & Treatment Act, and Head Start • Other information the Secretary requires

12. Evaluation • Independent, expert advisory panel will: • Review design for evaluation • Advise Secretary on progress of evaluation • Comment on Secretary’s report on evaluation • Secretary will evaluate needs assessments and grants including: • State-by-state analysis of needs assessments and response • Effect of home visiting on child & parent outcomes • Effectiveness of programs on different populations • Potential of program activities to improve the health system • Report on evaluation submitted to Congress by 3/31/15 Evidence-based policy can be a double-edged sword. MIHOPE results can validate or discredit certain models or MIECHV as a whole. HRSA’s final report on MIECHV is due to Congress by 12/31/15 (see § 511(d)).

13. Other Provisions • MCH Bureau & ACF required to collaborate • Grants to Tribes and nonprofits: • Requirements for grants must be as consistent as possible with state requirements • Needs assessment required • 3- and 5-year benchmarks required • Research & evaluation requirements outlined • Final report to Congress must include: • Grantees’ improvements in benchmark areas • Information on TA provided to grantees • Recommendations on legislative and administrative action

14. Appropriations • MIECHV funded through April 2017 at $400 million per year • 3% set aside for Tribes • 3% set aside for TA, research, and evaluations • Grants available for use for 2 fiscal years • Unused funds revert to grants for nonprofits • MIECHV has been fortunate to win past extensions with flat funding, BUT… • There are those in Congress who believe MIECHV funding should be reduced, perhaps substantially • The reauthorization process will also bring scrutiny on how efficiently past funds have been used • Was there a significant amount of grant money returned? • Was the 3% TA/research/evaluation set aside necessary? • Can funding be cut since infrastructure has already been created?

15. MIECHV Policy

16. Where are policies found? • MIECHV is subject to few regulations • Most policies governing MIECHV implementation are sub regulatory policies issued by HRSA • These policies are issued in conjunction with Funding Opportunity Announcements (FOA), Notices of Award (NOA), and grant application guides • MIECHV is also subject to laws and regulations governing grants in general, such as: • Audits – 45 CFR 75, Subpart F • Federal Financial Reports - SF-425 • Transparency Act Reporting Requirement

17. Policies issued with grant announcements: • FOA – Funding Opportunity Announcement • Needs assessment requirements • Grant application requirements • Detailed instructions on how to complete & submit both • NOA – Notice of Award • Performance requirements for specific grants • Reporting requirements & forms detailed

18. Policies issued with grant announcements: • Updates to needs assessments can be required in successive FOAs without the usual notice and comment process • Changes to the funding structure can similarly be announced in an FOA, e.g. new caps on infrastructure spending; MOUs • The way these policies are made could change drastically if they are written into a reauthorization bill • Each NOA is unique to the grantee and incorporates the results of the needs assessment completed by that grantee

19. Benchmarks, constructs, and other reporting requirements • Changes in reporting requirements must be approved by the Office of Management & Budget (OMB) • HRSA & ACF publish a notice of the proposed changes in the Federal Register • Grantees and stakeholders have 30-60 days to submit comments • OMB considers these comments when making final decision to approve/disapprove changes • Final product is not a rule/regulation published in the CFR, but a policy distributed to grantees through FOAs & NOAs

20. Benchmarks, constructs, and other reporting requirements • OMB began reviewing proposed changes to “significant” guidance documents in July 2007. That is why OMB is currently reviewing HRSA’s proposed changes to the MIECHV constructs and the new quarterly data request that the Data Collection Committee addressed this fall. • “Significant” guidance is any policy that affects the economy by more than $100 million, the actions of other agencies, non-discretionary programs, or raises new policy issues. • This level of review by OMB makes changes to guidance more accessible to grantees and stakeholders and gives them both a voice in the process.