Commonwealth of MassachusettsExecutive Office of Health and Human Services

DCF and DMH Shared Vision for Community-Based Residential

Services

May 13, 2010

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Agenda

• Purpose and Rationale for Joint Procurement of Residential Services• Alignment with CBHI strategic plan for integration of behavioral health services

• Guiding Principles

• Core Elements of Program Design, Administration and Operations

• Client and System Goals

• Department Program Models to be Included in Procurement

• Chapter 257 Implementation & Procurement Approach• Overview of Modification to Chapter 257 Implementation Strategy for

Youth Intermediate-Term Stabilization Services

• Setting Rational Rates

• Contract Reform

• Master Agreement Contracting

• Communication Plan and Timeline for Implementation

• Open Q & A

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DCF and DMH programs included in system change and procurement

Youth Intermediate-Term Residential Services

Department Activity Code Program Projected FY10 Spending

DCF

FNCO* Residential Schools $155,628,209 / 1,572 Beds

FNGH Family Networks Group Homes

FNST Family Network STARR $40,800,289 / 400 beds

RESG Teen Living Programs $9,104,970 / 172 Beds

DMH

3075* Individualized Support, Residential $4,318,145 / 91 Beds

3079 Child/Adolescent Residential Service $22,745,098 / 427 **

3080 Intensive Residential Treatment $15,256,911 / 85 Beds

3081 Clinically Intensive Residential Treatment $1,936,286 / 12 Beds

Total $249,789,908 / 2,759 Daily Units of Service

* OSD maintains statutory authority to set tuition prices for Chapter 766 approved private special education programs. Although the Chapter 766 components of DCF’s Residential School services (FNCO) and DMH’s Individualized Residential Support services (3075) will be included in the program design and procurement, the DHCFP POS Pricing Unit will not establish rates for these services.

** a mixture of group congregate residential care and in-community intensive wraparound programs

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CBHI Mission

The Children’s Behavioral Health Initiative is an interagency initiative of the Commonwealth’s Executive Office of Health and Human Services

• Executive Team:• EOHHS

• MassHealth

• Department of Mental Health

• Department of Children and Families

• Department of Youth Services

• Department of Public Health

• Family Representatives

To strengthen, expand and integrate Massachusetts state child behavioral health services into a comprehensive, coordinated community-based system of care

Policies, financing, management and delivery of publicly-funded behavioral health services will be integrated to make it easier for families to find and access effective services, and to ensure that families feel welcome, respected and receive services that meet their needs, as defined by the family.

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Supporting the CBHI Vision Through Ch. 257 Procurement

• Implement a structure for cross agency governance, administration

and operations of residential services that supports future integration

with home and community-based services, including those provided

under the Children’s Behavioral Health Initiative.

• Jointly design, price and procure residential program models that best

support client and system outcomes.

• Implement performance based contracts that utilize fiscal incentives

where feasible to leverage desired outcomes

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• A unified point of entry into Youth Residential services through multiple DCF and DMH portals.

• Provide client-centered and family focused services which are consistent with their needs, integrating evidence based practice approaches and models to maximize the likelihood of a youth’s return home, post-residential care.

• Financial Incentives and reimbursement methodologies that support improved client outcomes.

• Performance measures that align with principles and reflect the primary desired outcomes.

• Maximum administrative efficiency through consolidation of structures, functions, and processes.

Principles for Systems Level Change

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Core Design Elements

• Unified Application and Placement Determination: Develop common assessment and level of service criteria

• Bed Tracking: Utilize technology enabled real-time provider census information in order to quickly and efficiently locate services

• Joint UM: Implement a single system of utilization management that will eliminate duplication of administrative processes between the agencies

• Integrity and Accountability: Implement a single system of quality monitoring and quality improvement that is data driven, transparent and consistent

• Performance Based Contracting: Develop performance contracts with financial incentives and penalties to leverage performance relative to client and system outcomes that are consistent with the goals of CBHI

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Client and Systemic Outcomes

• Client Outcomes• Improved rates of successful discharge to a home or stable and

enduring community placement• Improved Placement Stability• Improved Safety through prevention of restraint and seclusion• Improved Functioning• Emotional / Behavioral Conditions• Educational Advancement• Engagement in Treatment and Community• Self Sufficiency (academic / vocational / employment)• Stable and Appropriate Living Environment • Engagement in Healthy Living Practices

• Systemic Outcomes• Improved interagency coordination of residential services• Improved integration of community based care and out of home care• Maximize the Commonwealths’ fiscal resources through efficient

oversight of out of home services

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DCF and DMH Integrated Out of Home Care Model

Interagency Residential Operations TeamOperational Lead: Integrated Operations TeamDMH MassHealthDCF EHS

Administration

Family Empowerment

Efficiency / Effectiveness

Quality

Accountability

Basic Goals

STARRGroup*Home

Res* 766BIRT / IRTP

Access to Out of Home Management

Utilization Management

Common Application

Level of Care Criteria

Census Data

Telephonic Review

Electronic Record Review

Outcomes

Provider Performance Management

Contract Compliance

Quality of Care

CIRT

Family Team Meeting

*May be clinically enhanced

Community Based

Alternative

Service System

Management

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Agenda

• Purpose and Rationale for Joint Procurement of Residential Services• Alignment with CBHI strategic plan for integration of behavioral health services

• Guiding Principles

• Core Elements of Program Design, Administration and Operations

• Client and System Goals

• Department Program Models to be Included in Procurement

• Chapter 257 Implementation & Procurement Approach• Overview of Modification to Chapter 257 Implementation Strategy for

Youth Intermediate-Term Stabilization Services

• Setting Rational Rates

• Contract Reform

• Master Agreement Contracting

• Communication Plan and Timeline for Implementation

• Open Q & A

11

DCF and DMH programs included in system change and procurement

Youth Intermediate-Term Residential Services

Department Activity Code Program Projected FY10 Spending

DCF

FNCO* Residential Schools $155,628,209 / 1,572 Beds

FNGH Family Networks Group Homes

FNST Family Network STARR $40,800,289 / 400 beds

RESG Teen Living Programs $9,104,970 / 172 Beds

DMH

3075* Individualized Support, Residential $4,318,145 / 91 Beds

3079 Child/Adolescent Residential Service $22,745,098 / 427 **

3080 Intensive Residential Treatment $15,256,911 / 85 Beds

3081 Clinically Intensive Residential Treatment $1,936,286 / 12 Beds

Total $249,789,908 / 2,759 Daily Units of Service

* OSD maintains statutory authority to set tuition prices for Chapter 766 approved private special education programs. Although the Chapter 766 components of DCF’s Residential School services (FNCO) and DMH’s Individualized Residential Support services (3075) will be included in the program design and procurement, the DHCFP POS Pricing Unit will not establish rates for these services.

** a mixture of group congregate residential care and in-community intensive wraparound programs

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C. 257 Implementation Strategy is well aligned with DCF / DMH Vision for Systems Change

• Number of different POS contracts

• Cost reimbursement contracts

3. Reform Contracting

• Use of Master Agreements

• Contracts w/ performance features

• Contracts shared across departments

1. Create Service Classes

Establish new cross-Secretariat organizational and governance structure

• Develop Service Class structure to group similar services & programs

• Build out process & technology to manage codes & classes

• Align activity codes to Service Classes

Enabling

• Rate analysis and establishment

• Contract consolidation across agencies

• Improved reporting

2. Develop Reimbursement Methodology & Rates

Maximize

FY09 Develop Implementation Plan

Develop Service Classes

Cumulative Statutory

RequirementService Value

FY10 10% of System $215M

FY11 40% of System $860M

FY12 70% of System $1.50B

FY13 100% of System $2.15B

Minimize

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DHCFP-led Cost Analysis and Rate Setting Effort

Objectives and Benefits

• Development of uniform analysis for standard pricing of common services

• Rate setting under Chapter 257 will enable:

A. Predictable, reimbursement models that reduce unexplainable variation in rates among comparable, economically operated providers

B. Incorporation of inflation adjusted prospective pricing methodologies

C. Standard and regulated approach to assessing the impact of new service requirements into reimbursement rates

• Transition from “cost reimbursement” to “unit rate”

Challenges

• (Extremely) fast paced timeline

• Constrained resources for implementation

• Cross system collaboration and communication

• Data availability and integrity (complete/correct)

• Coordination of procurement with rate development activities

Pricing Analysis, Rate Development, Approval, and Hearing Process

Data Sources Identified or Developed

Provider Consultation

Cost Analysis & Rate Option Development

Provider Consultation

Review/ Approval: Departments, Secretariat, and Admin & Finance

Public Comment and Hearing

Possible Revision / Promulgation

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Master Agreements Simplify Management of the POS System for Providers and Departments

• Benefits to Providers:

• Single bidding cycle for similar services

• Bid once – engage many times under a single bid

• Standard reporting formats

• Rate transparency

• Potential to engage with new purchasing Departments

• Benefits to EOHHS Departments

• Reduced procurement burden

• Potential to expand pool of providers

• Enable statewide coordination

• Eliminate multiple procurements for the same service

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• The “Master Agreement” is an existing, more flexible OSD purchasing and contract management framework.

• For a MA, EOHHS will issue one request for responses (RFR) with core requirements for multiple programs included in a single Service Class.

• The RFR will also contain department or program-specific requirements that address unique purchasing or reporting needs of purchasing departments.

• In responding to the EOHHS RFR, providers affirm their agreement and capability to meet the requirements specified by purchasing departments.

• Competition for “Qualification” on the MA will be fair and open. Once they are qualified, providers can be engaged (at their option) by any department to deliver any services on the MA over the term of the procurement.

• Provider selection for department service engagement is not different than the traditional RFR -> award process that has historically resulted in a “max ob” contract.

• Departments can still commit a funding level to a provider without using a “max ob” contract to do so.

Broader use of Master Agreements will simplify POS procurement and contracting processes

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Master Agreement Management

• Master Agreement procurements will be re-opened and amended from time to time to add service models or seek qualification bids from new providers.

• Under Chapter 257, DHCFP will establish and regulate rates on the Master.

• A single Master Agreement will likely have a schedule of rates, reflecting the multiple services included in the Service Class.

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Communication Plan and Upcoming Events

Communication Plan

• Regional informational and dialogue sessions with providers and families

• Request for Information

• Topic-focused working groups on policy, financing, and administrative structure

• Technical assistance groups and consultative sessions for providers

• Regular posting of materials on: www.comm-pass.comwww.mass.gov/hhs/chapter257

Broad Timeline

• Issue RFI: June 2010

• Regional Engagement Sessions with Families and Providers: June – August

• Rate Proposal: December / January 2010

• Issue RFR: January / February 2011

• Implementation: July 2011