Commonwealth of Massachusetts Executive Office of Health and Human Services Chapter 257 of the Acts of 2008 Provider Information and Dialogue Session: Youth Short Term Stabilization, Emergency Placement Services June 20,

2 Agenda Chapter 257 of the Acts of 2008 Overview of Youth Short Term Stabilization, Emergency Placement Services Definition and Overview of Programs Procurement Approach Review of Pricing Analysis and Methodologies Staffing titles and duties Proposed Model Ensuring maximum reimbursement Timeline and Key Milestones

3 Chapter 257 of the Acts of 2008 Regulates Pricing for the POS System Chapter 257 places authority for determination of Purchase of Service reimbursement rates with the Secretary Of Health and Human Services under MGL 118G. The Division of Health Care Finance and Policy provides staffing and support for the development of Chapter 257 pricing. Chapter 257 requires that the following criteria be considered when setting and reviewing human service reimbursement rates: Reasonable costs incurred by efficiently and economically operated providers Reasonable costs to providers of any existing or new governmental mandate Changes in costs associated with the delivery of services (e.g. inflation) Substantial geographical differences in the costs of service delivery Many current rates within the POS system may not reflect consideration of these factors. Chapter 9 of the Acts of 2011 establishes new deadlines for implementing POS rate regulation as well as requires that related procurements not go forward until after the rate setting process is completed. Jan 2012Jan 2013Jan 2014 Statutory Requirement: Percent of POS System with Regulated Rates 40%30% Spending Base Associated with Statutory Percentage (based on current projection of $2.278B POS Baseline to be implemented) ~ $880M~ $660M

4 The Cost Analysis and Rate Setting Effort has Several Objectives and Challenges 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 Ambitious implementation timeline Data availability and integrity (complete/correct) Unexplained historical variation in reimbursement rates resulting from long-term contracts and individual negotiations between purchasers and providers Constrained financial resources for implementation, especially where pricing analysis warrants overall increases in reimbursement rates Cross system collaboration and communication 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 Methods Development Provider Consultation Review/ Approval: Departments, Secretariat, and Admin & Finance Public Comment and Hearing Possible Revision / Promulgation

5 Youth Short Term Stabilization, Emergency Placement Services Service Class Definition: Programs that provide a child or adolescent a place of overnight housing in a specialized residential setting for a short term-period, generally less than 45 days, to promote stabilization, determine appropriate long-term placement, or provide integration and ongoing services. Services Encompass the full spectrum of detoxification and clinical care for adolescents: Adolescents (12-17) that require 24 hour/day, 7 days/wk, staff secure setting Medical detoxification/monitoring and therapeutic intervention to ensure stabilization of physical and mental state Biopsychosocial Assessment and Individualized Treatment Planning Individual and Group Counseling and Family Services Referral, Care Coordination, and Follow-up Civil commitments: Adolescents under Section 35 Average length of stay approximately 14 days ClusterService Class Agenc y Activity Code Program Name Total Spending Slated for Ch. 257 Regulation Youth Short-Term Stabilization, Emergency Placement DPH4928Youth Stabilization $ 1,000,000

6 DPH Youth Short Term Stabilization, Emergency Placement Services Procurement Plan DPH will issue an RFR to procure for Youth Short Term Stabilization, Emergency Placement services following adoption of the Chapter 257 rates. The procurement will be issued as a competitive bid. The new rates will become effective as of the start date of the contracts issued through the RFR. Current cost reimbursement contracts will be replaced by rate contracts. This is a much simpler contracting process. BSAS will notify providers of expected spending level for the fiscal year. No contract amendment is required.

7 DPH Youth Short Term Stabilization, Emergency Placement Services Proposed Model YSTS Youth Residential Programs (Capacity 24) Beds:24 Bed Days:8,760 SalaryFTEExpense Program Director1.00 $XX.XX Clinical Director1.00 $XX.XX Case Manager2.00 $XX.XX Psychiatrist/Physician1.00 $XX.XX Nurse Manager1.00 $XX.XX Nurse8.40 $XX.XX Counselor6.30 $XX.XX Recovery Specialists Supervisor1.00 $XX.XX Recovery Specialists (D.C Staffing)11.20 $XX.XX Relief3.09 $XX.XX Support1.64 $XX.XX Total Program Staff $XX.XX Expenses Unit Cost Tax and Fringe22.00% $XX.XX Total Compensation $XX.XX Occupancy $XX.XX Other Expenses $XX.XX Total Reimb excl M&G $XX.XX Direct Administrative Expenses$xx.xx $XX.XX M&G11.85%$xx.xx $XX.XX TOTAL $XX.XX CAF:7.51% $XX.XX UNIT RATE:TBD DPH provides these stabilization services to over 750 adolescents each year Model is based on 24 bed capacity Alternate models are being developed for 20 beds and 16 beds Alternate models are intended to address census concerns Staffing patterns reflect BSAS guidelines Tax and fringe (T&F) is 22% and Admin (M&G) is 11.85% Cost adjustment factor (CAF) of 7.51% ( CAF Source: Health Care Cost Review from Global Insight MA CPI-Forecast – Spring 2013),

8 Department Service Design Finalized: All service components, staffing ratios, staff qualifications, other program inputs have been decided by the purchasing department. Provider Sessions: For each rate setting project, EOHHS conducts an average of 2-3 provider input sessions prior to Executive Sign-Off and the Public Hearing Process to allow for greater depth in understanding core program components, cost drivers, and procurement considerations. Executive Sign-Off: Commissioner and C257 Executive Committee sign-off on draft rates and implementation plan. EO485 Submitted to ANF: Draft rate regulation to ANF; Will better align the rate regulation proposal with budget planning. Public Hearing: DHCFP and purchasing departments consider testimony in advance of rate adoption. Procurement Process: The procurement will be issued after the rates have been adopted. Rates Effective: Where possible, reimbursement under regulated rates will align with beginning of SFY to minimize mid-year contract amendments for both purchasing Departments and providers. Updated Implementation Timeline and Key Milestones for Youth Short Term Stabilization, Emergency Placement Services

9 Questions/Feedback Please Questions & Comments to: Please Visit the Chapter 257 Website: