Chapter 257 of the Acts of 2008

1. Chapter 257 of the Acts of 2008 DCF/DMH Youth Residential Joint Procurement Program and Pricing Information & Dialogue Session November 23, 2010 www.mass.gov/hhs/chapter257 eohhspospolicyoffice@state.ma.us

2. Agenda Review of Program Purpose and Rationale for Joint Procurement and Update Guiding Principles Program Models to be Included in Procurement Recent decisions Chapter 257 Implementation Approach Discussion of Draft Pricing Structure for Group Home Independent Living Teen Parenting Continuum Adjustments Next Steps Procurement and Rate Setting Regulatory Timeline

3. Guiding Principles • Families, rather than individuals, are the focus of formal and informal services and supports • Families and children experience smooth transitions between residential services and the child’s return home to their community • Ensure the voices of youth and family are fully and meaningfully incorporated into Boards, programs and services • A continuity of clinical approach across the service delivery system • The system of residential services has a primary focus on supporting community living • Permeability and portability between levels of service (including residential and community programs) • Streamlined/interagency entry into services and oversight of services

4. 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 rates for these services will not be established under the POS rate regulations. ** a mixture of group congregate residential care and in-community intensive wraparound programs

5. Program Models • Stabilization Assessment and Rapid Reintegration (STARR) • 6-bed, 9-bed, 12-bed, 15-bed, 18-bed models • Intensive Residential Treatment Program • Clinically Intensive Residential Treatment • Group Home • 1:3 Ratio (BTR) • 1:4 Ratio • 1:5 Ratio (Pre-Independent Living) • Specialized/Outlier Programs • Independent Living • Teen Parenting • Teen Parenting Enhanced, TLP, House Parent, STEP models • Continuum • Res-Wrap • Future Development

6. Recent Decisions • Family Partner • Will be developed and purchased by the Agencies in a separate RFR • Timeframe for Family Partner RFR to be determined • CIRT • Program model for 6-12 year olds will be included in the RFR • Design changes and pricing work is ongoing • Third Party Billing • STARR – providers will not be allowed to subcontract with IHT providers for family therapy services • Psychiatry – the Agencies plan to reimburse psychiatric consultation in some program models • Res-Wrap Models • DMH and DCF joint purchase

7. DRAFT Group Home 1 Model Budget 1:3 Ratio • All information is currently in draft form and subject to change. • FTEs were determined by the Purchasing Agency design team. • Family Partner removed; intention is to purchase separately. • Relief is calculated using a model of 15.8% of FTEs (based on 15 vacation days, 10 sick days, 13 holidays, 3 training days). Formula currently under review. • The tax and fringe and indirect administrative allocation percentages reflect measures of central tendency from FY09 UFR data and are consistent with STARR. • Estimated cost adjustment factor (Source: HIS Global Insights Massachusetts CPI Forecast-Spring 2010) is applied to account for inflation between the FY09 base year and the two year prospective rate period through FY 13. Subject to update.

8. DRAFT Group Home 2 Model Budget 1:4 Ratio • All information is currently in draft form and subject to change. • FTEs were determined by the Purchasing Agency design team. • Family Partner removed; intention is to purchase separately. • Relief is calculated using a model of 15.8% of FTEs (based on 15 vacation days, 10 sick days, 13 holidays, 3 training days). Formula currently under review. • The tax and fringe and indirect administrative allocation percentages reflect measures of central tendency from FY09 UFR data and are consistent with STARR. • Estimated cost adjustment factor (Source: HIS Global Insights Massachusetts CPI Forecast-Spring 2010) is applied to account for inflation between the FY09 base year and the two year prospective rate period through FY 13. Subject to update.

9. DRAFT Group Home 3 Model Budget Pre-Independent Living • All information is currently in draft form and subject to change. • The model reflects a 1:5 staffing ratio. Number of beds and Direct Care staffing FTEs updated to reflect this ratio. • Relief is calculated using a model of 15.8% of FTEs (based on 15 vacation days, 10 sick days, 13 holidays, 3 training days). Formula currently under review. • The tax and fringe and indirect administrative allocation percentages reflect measures of central tendency from FY09 UFR data and are consistent with STARR. • Estimated cost adjustment factor (Source: HIS Global Insights Massachusetts CPI Forecast-Spring 2010) is applied to account for inflation between the FY09 base year and the two year prospective rate period through FY 13. Subject to update.

10. DRAFT Independent LivingModel Budget • All information is currently in draft form and subject to change. • FTEs were determined by the Purchasing Agency design team. • The tax and fringe and indirect administrative allocation percentages reflect measures of central tendency from FY09 UFR data and are consistent with STARR. • Estimated cost adjustment factor (Source: HIS Global Insights Massachusetts CPI Forecast-Spring 2010) is applied to account for inflation between the FY09 base year and the two year prospective rate period through FY 13. Subject to update.

11. DRAFT Teen Parenting Enhanced Model Budget • All information is currently in draft form and subject to change. • The model reflects a 1:4 staff ratio. • FTEs were determined by the Purchasing Agency design team. • Relief is calculated using a model of 15.8% of FTEs (based on 15 vacation days, 10 sick days, 13 holidays, 3 training days). Formula currently under review. • The tax and fringe and indirect administrative allocation percentages reflect measures of central tendency from FY11 budget data and are consistent with STARR. • Estimated cost adjustment factor (Source: HIS Global Insights Massachusetts CPI Forecast-Spring 2010) is applied to account for inflation between the FY11 base year and the two year prospective rate period through FY 13. Subject to update.

12. DRAFT Teen Parenting TLP Model Budget • All information is currently in draft form and subject to change. • FTEs were determined by the Purchasing Agency design team. • Relief is calculated using a model of 15.8% of FTEs (based on 15 vacation days, 10 sick days, 13 holidays, 3 training days). Formula currently under review. • The tax and fringe and indirect administrative allocation percentages reflect measures of central tendency from FY11 budget data and are consistent with STARR. • Estimated cost adjustment factor (Source: HIS Global Insights Massachusetts CPI Forecast-Spring 2010) is applied to account for inflation between the FY11 base year and the two year prospective rate period through FY 13. Subject to update.

13. DRAFT Teen Parenting House Parent Model Budget • All information is currently in draft form and subject to change. • FTEs were determined by the Purchasing Agency design team. • Relief is calculated using a model of 15.8% of FTEs (based on 15 vacation days, 10 sick days, 13 holidays, 3 training days). Formula currently under review. • The tax and fringe and indirect administrative allocation percentages reflect measures of central tendency from FY11 budget data and are consistent with STARR. • Estimated cost adjustment factor (Source: HIS Global Insights Massachusetts CPI Forecast-Spring 2010) is applied to account for inflation between the FY11 base year and the two year prospective rate period through FY 13. Subject to update.

14. DRAFT Teen Parenting STEP Model Budget • All information is currently in draft form and subject to change. • FTEs were determined by the Purchasing Agency design team. • Relief is calculated using a model of 15.8% of FTEs (based on 15 vacation days, 10 sick days, 13 holidays, 3 training days). Formula currently under review. • The tax and fringe and indirect administrative allocation percentages reflect measures of central tendency from FY11 budget data and are consistent with STARR. • Estimated cost adjustment factor (Source: HIS Global Insights Massachusetts CPI Forecast-Spring 2010) is applied to account for inflation between the FY11 base year and the two year prospective rate period through FY 13. Subject to update.

15. DRAFT Continuum Wrap Model: • FTEs were determined by the Purchasing Agency design team. • Relief formula currently under review. • Wrap model has no residential component built in – will add based on selection of appropriate residential models.

16. Potential Adjustments to Rates • Offset: • Department of Education Nutrition Funding Proposing a standard off-set built into rate for models where resource is available: STARR Group Home 1:3 Group Home 1:4 Will adjust for <100% eligibility and associated administrative functions • Housing Vouchers for certain Teen Parenting programs Additional Modeling: • Staff travel to maintain community connections • CIRT • Specialized/Outlier Programs • Utilization Factors to be applied

17. Written Feedback • Written feedback - send to: • eohhspospolicyoffice@state.ma.us • By November 30th

18. Procurement and Rate Setting RegulatoryTimeline DCF/DMH plans to issue RFR in February for contracts effective on July 1, 2011 POS rate regulations will be adopted in mid winter 2011, but will not be effective until contracts are executed in July 2011.