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
Youth Intermediate-Term Residential Services
Department
Activity Code
Program
Projected FY10 Spending
DCF
FNCO*
Residential Schools
$155,628,209 / 1,572 Beds
FNGH
Family Networks Group Homes
FNST
Family Network STARR
$40,800,289 / 400 beds
RESG
Teen Living Programs
$9,104,970 / 172 Beds
DMH
3075*
Individualized Support, Residential
$4,318,145 / 91 Beds
3079
Child/Adolescent Residential Service
$22,745,098 / 427 **
3080
Intensive Residential Treatment
$15,256,911 / 85 Beds
3081
Clinically Intensive Residential Treatment
$1,936,286 / 12 Beds
Total
$249,789,908 / 2,759 Daily Units of Service
* 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. Principles for Systems Level Change
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 Incentives and reimbursement methodologies that support improved client outcomes.
Performance measures that align with principles and reflect the primary desired outcomes.
Maximum administrative efficiency through consolidation of structures, functions, and processes.

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
Management
Interagency Residential Operations Team
Operational Lead:
Integrated Operations Team
DMH MassHealth
DCF EHS
Common Application
Access to Out of Home Management
Level of Care Criteria
Census Data
Electronic Record Review
Basic Goals
Utilization Management
Telephonic Review
Family Team Meeting
Family Empowerment
Contract Compliance
Provider Performance Management
Quality of Care
Efficiency / Effectiveness
Outcomes
Quality
Service System
Accountability
STARR
Group*
Home
Res* 766
BIRT /
IRTP
CIRT
Community Based Alternative
*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
Youth Intermediate-Term Residential Services
Department
Activity Code
Program
Projected FY10 Spending
DCF
FNCO*
Residential Schools
$155,628,209 / 1,572 Beds
FNGH
Family Networks Group Homes
FNST
Family Network STARR
$40,800,289 / 400 beds
RESG
Teen Living Programs
$9,104,970 / 172 Beds
DMH
3075*
Individualized Support, Residential
$4,318,145 / 91 Beds
3079
Child/Adolescent Residential Service
$22,745,098 / 427 **
3080
Intensive Residential Treatment
$15,256,911 / 85 Beds
3081
Clinically Intensive Residential Treatment
$1,936,286 / 12 Beds
Total
$249,789,908 / 2,759 Daily Units of Service
* 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
1. Create Service Classes
2. Develop Reimbursement Methodology & Rates
3. Reform Contracting
Develop Service Class structure to group similar services & programs
Build out process & technology to manage codes & classes
Align activity codes to Service Classes
FY09
Develop Implementation Plan
Develop Service Classes
Establish new cross-Secretariat organizational and governance structure
Maximize
Cumulative Statutory Requirement
Use of Master Agreements
Contracts w/ performance features
Contracts shared across departments
Service Value
FY % of System $215M
Enabling
FY % of System $860M
Rate analysis and establishment
Contract consolidation across agencies
Improved reporting
FY % of System $1.50B
Minimize
FY13 100% of System $2.15B
Number of different POS contracts
Cost reimbursement contracts

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. Contract reform is necessary to implement this vision
Today
Vision for FY13
Purchasing Department
Providers
Providers
Secretariat Master Agreements
By Service Class
DHCFP rate schedules
Panel of qualified providers
Departments purchase via rate agreements
Dept
Dept
Dept
Dept
Dept
Dept
Today’s Contract Primary Features
Over 250 individually DCF and DMH negotiated contracts
Multiple contracts within and across departments with the same providers.
Services with core similarities purchased individually by agencies and regions
Low capacity for cross-agency coordination, performance assessment
FY 13 & Beyond Contract Primary Features
Benefits for Children and Families
Access to right service at right time for right duration
Improved quality of services
Improved outcomes
System Benefits
Reduced contract complexity and redundancy
Greater amendment flexibility
Improved capacity for rate management
Streamlined, centrally-managed procurement cycles

15. 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

16. Broader use of Master Agreements will simplify POS procurement and contracting processes
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.

17. 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.

18. Communication Plan and Upcoming Events
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:
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