Lucia Maxwell, FADAA DCF System Redesign: Contracting with Community Managing Entities

Lucia Maxwell, FADAA DCF plans “system conversion” within two years A managing entity will be selected by competitive bid for each district or region. DCF will contract for SA and MH services with the Managing Entity rather than directly with providers. The role of district office staff will change to that of “Purchaser.” Parts of the DCF data system may be outsourced. NO changes in local match: amt, sources, ratio

Lucia Maxwell, FADAA What are DCF’s goals for the redesign? Recovery oriented services, individualized treatment Customer driven services Systems of care, not “silo-ed” agencies Assure best practices Quality improvement More flexible funding Reliable data system Preserve local $ contributions

Lucia Maxwell, FADAA Implicit Assumptions District offices do not have the resources to take on the level of care management desired. In a community/ provider driven system, providers must take responsibility to build systems of care. Goal is cost efficiency, not cost reductions. DCF will need a reliable data system to monitor outcomes. Managing Entity administration will be financed with a percentage of services dollars.

Lucia Maxwell, FADAA What will be the new role of district office staff? Negotiating and monitoring a single contract for a services system. Setting CQI measurable system goals for the Managing Entity to achieve (increase women’s services, decrease waiting lists, improve workforce development activities, increase detox capacity.) Enhanced focus on community planning. Increased communication with stakeholders Monitor ME mechanisms to ensure that services design and service delivery are consumer driven.

Lucia Maxwell, FADAA DCF Community Managing Entity Administrative Services Organization: Staff to carry out: Contracting Monitoring Finance Information Systems Quality Improvement Technical assistance Outreach to stakeholders Provider Sponsored Network: Service agencies governed by community boards, which together represent a continuum of care, form a corporation and select governance.

Lucia Maxwell, FADAA Models may vary across the state Florida Statutes includes these options: Local government as the ME contractor DCF contracts with an independent ASO, which forms a provider network.

Lucia Maxwell, FADAA DCF managed care model Not a Medicaid model: e.g. insurance plan, eligible beneficiaries, contracts with for-profit Managed Care Organizations licensed by the Department of Insurance Seeking to retain community based service system working in partnership with the State. Differences: more local determination, less restrictive eligibility, significant local funding, possible shared risk, insurance licensure and reserves not required.

Lucia Maxwell, FADAA Elements Important to Success Clear State commitment Time to build administrative capacity Follow through on redefinition of DCF role, re-training for district staff Compromise on Managing Entity goals and required capacities, which will be funded from service dollars

Lucia Maxwell, FADAA FADAA Supports Local determination of ME structure within State guidelines (allow separate SA networks initially.) ME should be a non profit, 501 © (3) Providers accountable as owners - ME must provide evidence that services are driven by client and community needs and preferences. ME contracts oriented to outcomes, not process: service capacity meets defined community need, appropriate placements, reduced waiting lists, client retention, more clients served. Braid Medicaid/ DCF funding through MEs.

Lucia Maxwell, FADAA DCF Managing Entities and Medicaid Reform Prepaid MH Plans and the CBC Specialty Network are not included in the Medicaid reform waiver. DCF Managing Entities could contract directly with Health Maintenance Organizations and Provider Service Networks to serve Medicaid recipients. MEs assume Medicaid role early: Local governments authorize MEs to coordinate new Medicaid services funded by local match: detox, intervention, aftercare. These services will never be added to managed care contracts.