1. Commonwealth of Massachusetts Executive Office of Health and Human Services Chapter 257 of the Acts of 2008 Provider Information & Dialogue Session: DMH Family Stabilization Service Class October 6, 2010 www.mass.gov/hhs/chapter257

2. 2 Session Objectives In this session: DMH will outline the programs and services it will purchase for which DHCFP will regulate rates under the Family Stabilization Service Class. EOHHS and HCFP will provide a forum to discuss the rate structures and methodologies that are in development for identified Family Stabilization services. DMH, EOHHS and HCFP will outline projected timelines for the DMH procurement and the rate regulation process.

3. 3 OUTLINE Chapter 257 Overview DMH Family Stabilization Services to be Rated DMH Family Systems Intervention Programs Family Systems Intervention Individual Youth Support Youth Group Support Collateral Contact/Consultation Flexible Funds/ Client Financial Assistance Timeline DMH Procurement Rate Regulation & Promulgation

4. 4 Family Stabilization Overview Service Class Definition: Programs that provide supports to enrolled individuals and families with the purpose of promoting stability, whether this involves preventing out-of-home placement, supporting transition between placements, or independent living. Department Activity Code Program NameProjected FY10 Spending DCF FNSSFamily Networks Supp & Stab $ 41,098,031 DDS 3176Family Support $ 27,176,293 DMH 3066Individual and Family Flexible Supports $ 14,737,426 MCB 2124Respite Care - Sr $ 251,100 2152Cooperative Funding - Sr $ 198,482 Total Projected FY10 Spending$ 83,461,332 Today’s discussion will focus on Family Stabilization services purchased by DMH.

5. 5 DMH & DCF Family Stabilization Rate Regulation and Service Definition DMH is redefining the services it will purchase under 3066 Individual and Family Flexible Supports in its new procurement. These services will transition from cost reimbursement to unit rates regulated by DHCFP.

6. 6 DMH Individual and Family Flexible Supports Service Components Family Systems Intervention: Family focused therapeutic interventions in a child’s home or other natural environment to improve the capacity of the family to better meet the needs of the child and of the child to function successfully within the context of his or her family and community. Staffed with a team of : A master’s level clinician trained in home-based intervention A paraprofessional who serves as a family partner Under the direct leadership of a licensed mental health clinician Individual Youth Support: Non-school hour mentoring to assist a youth to develop the emotional self-management abilities, social skills, communication skills, pre-vocational skills, and self-confidence that are a requisite for participation in age appropriate activities with peers. Mentoring usually takes place in the community, and may be activity based. Staffing: Mentors with training, clinical experience and behavior management skills working under the direction of a licensed mental health professional. Youth Group Support : Social emotional skill building and community integration through formally organized 6 to 8 week psych-educational groups of 6-12 youth. Family activity groups involving youth, their siblings and caretakers are also included in this category.

7. 7 DMH Individual and Family Flexible Supports Service Components (continued) Collateral Contact/Consultation: Collateral contacts by a clinician treating a child or adolescent to assure that there is a clinically coherent approach taken to the services provided to the child/adolescent. Collateral contacts may be with school staff and staff from other agencies providing services to a child/adolescent. Contacts may include: Meetings and telephone calls One-on-one Observation of a child in a classroom or other community setting Participation in team meetings. This component will not be authorized: For Youth receiving DMH Family Systems Intervention If care coordination is reimbursable through public or private insurance If collateral contacts and consultation are reimbursable through the individual or family’s public or private insurance. Flexible Funds/ Client Financial Assistance Limited sum of money for purchase of services or supports to the youth and family that are not available as part of this contract, through other DMH contracts, through other state agencies, and that are not reimbursable through insurance. The DMH Area will authorize expenditures of these flexible pool dollars, based on the needs of the youth and family and available funds Specialty consultations Academic tutoring Camperships Transportation expenses

8. 8 DMH Family Systems Intervention Programs Rate Development Unit of service: Enrolled client day Staff positions were split into the following general Staff Categories:

9. 9 DMH Family Systems Intervention Programs Rate Development This model budget is built around the example of a program serving 11 youth. The rate stays the same regardless of the number of youth a program is designed to serve. Client : FTE ratios reflect DMH’s specified staffing model for the Family Systems Intervention program. Percentages for tax and fringe and administrative allocation represent the median costs reported in FY10 DCF contract data for programs similar to the Family Systems Invention Model. Tax and Fringe percentage has increased from 20%, the median from FY09 UFR data, in response to provider feedback that the original percentage were inadequate. DCF may also purchase this model as one of their comprehensive models under this service class. The rate is adjusted for inflation with a Cost Adjustment Factor (CAF).

10. 10 Discrete Services: Individual Youth Support DMH Individual Youth Support Non-school hour mentoring to assist a youth to develop the emotional self- management abilities, social skills, communication skills, pre-vocational skills, and self-confidence that are a requisite for participation in age appropriate activities with peers. CBHI Therapeutic Mentoring Coaching, supporting, and training in order to ensure the youth’s success in navigating various social contexts, learning new skills, and making functional progress DMH’s Individual Youth Support service is comparable to the Therapeutic Mentoring service covered under the Children’s Behavioral Health Initiative. As such, the draft rate equals the CBHI rate at $12.98 per 15 min ($51.92 per hour) 114.3 CMR 52.00: Rates of Payment for Certain Children’s Behavioral Health Services.

11. 11 Discrete Services: Youth Group Support DMH specified the staffing model for this program Percentages for tax and fringe and administrative allocation were the median costs reported in FY10 DCF contract data for programs similar to the Family Systems Invention Model. Percentage for non-staff expenses was derived from existing contracts. The rate will be paid per 1.5 hour session regardless of how many youth attend. Transportation is not included in this rate. DMH, HCFP and EOHHS are working together to determine the best method of reimbursing providers for transportation services. In the meantime, transportation will be paid for out of Flexible Funding. The rate is adjusted for inflation with a Cost Adjustment Factor (CAF). DMH Youth Group Support Social emotional skill building and community integration through formally organized 6 to 8 week psycho-educational groups of 4-12 youth.

12. 12 Discrete Services: DMH Collateral Contact/ Consultation DMH Collateral Contact/Consultation Collateral contacts by a clinician treating a child or adolescent to assure that there is a clinically coherent approach taken to the services provided to the child/adolescent. Collateral contacts may be with school staff and staff from other agencies providing services to a child/adolescent. Contacts may include: Meetings and telephone calls One-on-one Observation of a child in a classroom or other community setting Participation in team meetings. This component will not be authorized: For Youth receiving DMH Family Systems Intervention If care coordination is reimbursable through public or private insurance If collateral contacts and consultation are reimbursable through the individual or family’s public or private insurance. The description of this service is very similar to the definition of Case Consultation in an existing DHCFP regulation. As such, the draft rate equals the Case Consultation rate of $36.61 per half hour, 114.3 CMR 6.00: Rates of Payment For Mental Health Services Provided in Community Health Centers and Mental Health Centers.

13. 13 Discrete Services: DMH Flexible funding/ Client Financial Assistance Flexible Funds/ Client Financial Assistance Limited sum of money for purchase of services or supports to the youth and family that are not available as part of this contract, through other DMH contracts, through other state agencies, and that are not reimbursable through insurance. The DMH Area will authorize expenditures of these flexible pool dollars, based on the needs of the youth and family and available funds Specialty consultations Academic tutoring Camperships Transportation expenses This rate is designed to cover the costs of the administrative of flexible funds. The cost of any case management provided in relation to a purchase would be covered under another service. Unit of service: Flexible funding transaction The rate assumes it would take a bookkeeper a half hour on average to complete a transaction.

14. 14 Projected Timelines for DMH Procurement and Rate Promulgation DMH will issue interim rates in the RFR. In the projected timeline, rates will be adopted before RFR responses are due. DMH Procurement Provider Involvement Rate Development