1. Commonwealth of Massachusetts Executive Office of Health and Human Services Chapter 257 of the Acts of 2008 DCF/DMH Youth Residential Joint Procurement Program and Pricing Information & Dialogue Session November 10, 2010 www.mass.gov/hhs/chapter257

2. 2 Agenda Review of Program Purpose and Rationale for Joint Procurement and Update Guiding Principles Program Models to be Included in Procurement Chapter 257 Implementation Approach Review of Preliminary Findings Discussion of Pricing Structure for STARR and IRTP Staffing Structure for Group Home (1:5), Independent Living, Teen Parenting Adjustments Next Steps Procurement and Rate Setting Regulatory Timeline

3. 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. 4 DCF and DMH programs included in system change and procurement Youth Intermediate-Term Residential Services DepartmentActivity CodeProgramProjected FY10 Spending DCF FNCO*Residential Schools $155,628,209 / 1,572 Beds FNGHFamily Networks Group Homes FNSTFamily Network STARR $40,800,289 / 400 beds RESGTeen Living Programs $9,104,970 / 172 Beds DMH 3075*Individualized Support, Residential $4,318,145 / 91 Beds 3079Child/Adolescent Residential Service $22,745,098 / 427 ** 3080Intensive Residential Treatment $15,256,911 / 85 Beds 3081Clinically 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 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. 5 Program Models Stabilization Assessment and Rapid Reintegration (STARR) 6-bed, 9-bed, 12-bed, 15-bed, 18-bed models Intensive Residential Treatment Program Group Home 1:3 Ratio (BTR) 1:4 Ratio 1:5 Ratio (Pre-Independent Living) Independent Living Teen Parenting Teen Living Acute, TLP, House Parent, STEP models Continuum

6. 6 Preliminary Analysis Calculated Daily Unit Cost Daily unit costs were calculated from FY2009 UFR data for DCF Group Homes, STARR, Teen Living and DMH Child/Adolescent Residential Services, Intensive and Clinically Intensive Residential Treatment

7. 7 Percent of total expenditures by Activity Code Bar cluster to the right reflects percent of total cost Bar cluster to the left reflects percent of staffing cost

8. 8 Major Cost Drivers - Staff All staffing unit cost

9. 9 Non-Specialized Direct Care Staffing Correlation for non-specialized direct staff – 81% - strong predictor of variation Other strong relationship observed for taxes and fringe and administrative unit costs

10. 10 Regional Variation Statistical tests* have been conducted to examine the effect of regional location on the following cost elements: –Total reported per bed-day unit cost –Occupancy unit cost –Non-specialized DC salary unit cost No significant differences were observed * (Analysis of Variance- ANOVA)

11. 11 DRAFT STARR Model Budget: 12 Bed Capacity Direct Care staffing reflects a 1:3 ratio (with 2 awake overnight). The model budget unit costs reflect measures of central tendency within the FY09 UFR data. FTEs based on Purchasing Agency design team recommendations. Family Partner may be purchased separately-TBD. Relief is calculated using a model of 15.8% of FTEs (based on 15 vacation days, 10 sick days, 13 holidays, 3 training days). The tax and fringe and indirect administrative allocation percentages reflect measures of central tendency from FY09 UFR data. A cost adjustment factor is applied to account for inflation between the FY09 base year and the two year prospective rate period through FY 13.

12. 12 DRAFT IRTP Model Budget: 15 Bed Capacity The model budget reflects 7 nursing care hours; 3 awake overnight with nursing/physician on-call. The model budget unit costs reflect measures of central tendency within the FY11 budget data. FTEs were determined by the Purchasing Agency design team. Family Partner may be purchased separately-TBD. Relief is calculated using a model of 15.8% of FTEs (based on 15 vacation days, 10 sick days, 13 holidays, 3 training days). The tax and fringe and indirect administrative allocation percentages reflect measures of central tendency from FY11 budget data. A cost adjustment factor is applied to account for inflation between FY11 base year and the two year prospective rate period through FY13.

13. 13 DRAFT Group Home 3 Staffing Model: The model reflects a 1:5 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).

14. 14 DRAFT Independent Living Staffing Model:

15. 15 DRAFT Teen Living Acute Staffing Model: 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).

16. 16 DRAFT Teen Parenting TLP Staffing Model: The model reflects a 1:5 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).

17. 17 DRAFT Teen Parenting House Parent Staffing Model: The model reflects a 1:5 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).

18. 18 DRAFT Teen Parenting STEP Staffing Model:

19. 19 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 Add-ons: Service specific add-on for special circumstances −Direct care or specialized staff

20. 20 Next Steps Written feedback - send to: EOHHSPOSPolicyOffice@state.ma.us November 23 rd Session: Models for remaining for feedback on pricing structure –Group Home (all levels) –Independent Living –Teen Parenting –Continuum

21. 21 Procurement and Rate Setting Regulatory Timeline 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.