DCF and DMH Shared Vision for Community-Based Residential Services May 13, 2010

1. DCF and DMH Shared Vision for Community-Based Residential Services May 13, 2010

2. 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

3. DCF and DMH programs included in system change and procurement * 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

4. 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.

5. 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

6. 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 Incentivesand reimbursement methodologies that support improved client outcomes. Performance measuresthat align with principles and reflect the primary desired outcomes. Maximum administrative efficiency through consolidation of structures, functions, and processes. Principles for Systems Level Change

7. 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

8. 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

9. DCF and DMH Integrated Out of Home Care Model Administration Community Based Alternative Group* Home Res* 766 BIRT / IRTP Provider Performance Management Access to Out of Home Management Family Empowerment Efficiency / Effectiveness CIRT STARR Utilization Management Basic Goals Accountability Quality Interagency Residential Operations Team Operational Lead: Integrated Operations Team DMH MassHealth DCF EHS Common Application Level of Care Criteria Census Data Electronic Record Review Telephonic Review Family Team Meeting Contract Compliance Quality of Care Outcomes *May be clinically enhanced

10. 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 * 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

12. C. 257 Implementation Strategy is well aligned with DCF / DMH Vision for Systems Change 3. Reform Contracting 1. Create Service Classes 2. Develop Reimbursement Methodology & Rates Establish new cross-Secretariat organizational and governance structure Develop Implementation Plan Develop Service Classes FY09 • Develop Service Class structure to group similar services & programs • Build out process & technology to manage codes & classes • Align activity codes to Service Classes Maximize Cumulative Statutory Requirement • Use of Master Agreements • Contracts w/ performance features • Contracts shared across departments Service Value FY10 10% of System $215M Enabling FY11 40% of System $860M • Rate analysis and establishment • Contract consolidation across agencies • Improved reporting FY12 70% of System $1.50B Minimize • Number of different POS contracts • Cost reimbursement contracts FY13 100% of System $2.15B

13. 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: Predictable, reimbursement models that reduce unexplainable variation in rates among comparable, economically operated providers Incorporation of inflation adjusted prospective pricing methodologies 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

14. 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

15. 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

16. 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.

17. 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