Presentation on theme: "Agenda Chapter 257 Implementation and Status Update"— Presentation transcript:
0 www.mass.gov/hhs/chapter257 firstname.lastname@example.org Chapter 257 of the Acts of Provider Information and Dialogue Session: DCF/DMH Youth Residential Joint Procurement Program and Pricing June 3, 2011
1 Agenda Chapter 257 Implementation and Status Update Impact of Governor’s FY12 Supplemental Budget FilingUpdated Implementation Timeline and Key MilestonesComparison of Current and Future Approach to Residential ServicesContinuum Wrap ModelProgram DesignDraft Pricing StructureFollow Along and Stepping Out ModelsProcurement and Rate Setting Regulatory Timeline
2 Impact of Chapter 9 of the Acts of 2011 On April 11, 2011, the Governor signed into law Chapter 9 of the Acts of 2011, which amends the implementation timeline for Chapter 257 of the Acts of As amended, Chapter 257 will now require that a prospective rate setting process be implemented for not less than 40 percent of contracts with social service providers by January 1, 2012, 70 percent of such contracts by January 1, 2013, and for all contracts no later than January 1, 2014.EOHHS is developing communication to be posted on the Chapter 257 website and disseminated to departments and providers regarding the legislation, implementation plan, and activities that will be undertaken.
3 How will this legislation impact planned implementation? New implementation dates require meeting the current work schedule so that 40% of the POS system will have rates adopted by January 1, 2012.Delay reflects the amount of time needed to not only develop rate proposals, but to also plan for effective implementation.Allows for better alignment with the Commonwealth’s budget cycle; fiscal and client impact of proposed rates will be incorporated into Department spending plans and Governor’s budget proposal.Section 48 requires that departments not procure services, where procurement is necessary to implement regulated rates, prior to rate setting.New procurements may only be issued with the written approval of the Secretary based on a documented finding that the procurement is necessary to assure:Continuity of consumer health, safety, or access,Program integrity, where a new contract is necessary to replace an existing contract that terminated early due to unanticipated circumstances, orCompliance with a court order, settlement agreement, or statutory requirement.
4 Today and TomorrowCurrent residential POS contracts are structured so that:Services end with discharge from the residential facilityCommunity services post discharge are purchased separately, presenting a challenge for continuityProviders serving both DCF and DMH are held to different standards and requirementsThe planned contracting mechanism:Allows for integration of residential and community services within the same contractAllows for continuity of service post residential to promote successful transitionsCreates consistent standards and expectations for both purchasing Agencies.
5 Highlights of New Expectations contained in Joint Standards (Required for All Models) Family FocusIncreased family engagement and utilization of family partners in care planning and delivery. The family is the focus of the intervention and treatment: Voice and ChoiceIncreased use of peer leaders with older adolescents: Voice and ChoiceFocus on School AchievementRequirement for Board Members with “lived experience”Family part of CQI processQualityContinuous Quality Improvement:Supporting positive outcomes in education, permanency, health and wellnessOutcomes measured will reflect post discharge success in community tenure and school participationPerformance Based Contracting: Develop performance contracts with financial incentives to leverage performance relative to client and system outcomes. Financial Incentives and reimbursement methodologies that support improved client outcomes.Performance measures that align with principles and reflect the primary desired outcomes.Records and Documentation: Includes joint reporting requirements and documentation
6 Continuum Wrap ModelChild/youth at risk for residential placement and family identified as able to care for child at home (or work toward return home) with intensive supportsServices delivered by a wrap-team across levels of careServices designed to support youth in their homes and families in their care-giving roles, including:Care planning and coordinationIn-home family treatmentParent support, Peer mentoringYouth and family outreachCrisis supportFlex FundsLong-term and short-term out-of-home care if needed (e.g. group home, pre-independent living, foster care, respite)The Continuum emphasizes service integration and care continuity. The service can be provided by a community provider, a residential provider, or through subcontract as long as service continuity requirement is met.
7 Continuum Wrap Model __A_____B_______C________D__________E_____ Events during Continuum Wrap Program__A_____B_______C________D__________E_____Child may utilize out-of-home or respite serviceChild leaves ResidentialComponent of Program, (if ever utilized)Child/Fam assessed for community or residentialWrap Team works with child and family regardless of whether child is in the home or in a placementChild/Fam Discharged from entire programContinuum Wrap Services include:Care Coordination, Flexible FundsIn -Home Family TreatmentParent Support, Peer MentoringCrisis SupportYouth and Family OutreachLong and short term out-of-home care if needed
8 DRAFT Continuum Model Budget: Community Wrap Slots:30Slot Days:10,950FTEExpenseManagement2.0011%Medical and ClinicalPhysician & Psychiatrist0.102%Occupational Therapy0.503%Social Worker - L.I.C.S.W.1.005%Direct CarePeer MentorClinical Care Manager (MA)4.0018%Direct Care Staff6.5025%Relief0.49SupportProg Secretarial / ClericalTotal Program Staff16.0964%ExpensesFactorTax and Fringe23.42%15%Total Compensation79%Flex Funds$ ,000Occupancy4%Other ExpensesAdditional Travel1%Total Reimb excl M&G89%Admin. Allocation11.85%TOTAL100%CAF:5.39%UNIT RATE:TBDFTEs reflect staffing models recommended by the joint program design teams. Relief calculated at 7.5% of Direct Care Staff FTEs. Tax & Fringe, Admin Allocation percentages are consistent with other community residential models. Flex funds calculated as $1000 per slot. An estimated cost adjustment factor (Source: HIS Global Insights Massachusetts CPI Forecast-Spring 2011) is applied to account for inflation between the FY09 base year through the prospective rate period FY12-FY14.
9 CONTINUUM Model Budget - Group Home Intensive 1:3 DRAFT Continuum Model Budget: Residential GH 1:3 Adjusted for ContinuumCONTINUUM Model Budget - Group Home Intensive 1:3Beds:12Bed Days:4,380FTEExpenseManagement1.7510%Medical and ClinicalPhysician & Psychiatrist0.102%Nursing (RN non-masters)0.25Occupational Therapy0.503%Social Worker - L.I.C.S.W.1.005%Direct CareClinical Care Manager (MA)Direct Care Staff13.2040%Relief1.986%SupportProg Secretarial / Clerical1%Total Program Staff19.5370%ExpensesFactorTax and Fringe23.42%16%Total Compensation86%OccupancyOther ExpensesNutrition Offset-1%Total Reimb excl M&G89%Admin. Allocation11.85%TOTAL100%CAF:5.39%UNIT RATE:TBDThis model budget starts with the Group Home 1:3 and adjusts various resources considered included in the Community Wrap pricing to avoid double payment.The following adjustments include:Clinical Care Manager FTE reduced from 1.00Direct Care Staff reduced from 15.00Relief calculated accordingly at 15% of Direct Care FTEsTravel reduced to reflect reduced staffing
10 CONTINUUM Model Budget - Group Home 1:4 DRAFT Continuum Model Budget: Residential GH 1:4 Adjusted for ContinuumCONTINUUM Model Budget - Group Home 1:4Beds:12Bed Days:4,380FTEExpenseManagement1.7512%Medical and ClinicalNursing (RN non-masters)0.252%Social Worker - L.I.C.S.W.0.503%Direct CareClinical Care Manager (MA)1.005%Direct Care Staff11.2041%Relief1.686%SupportProg Secretarial / Clerical1%Total Program Staff16.6370%ExpensesFactorTax and Fringe23.42%16%Total Compensation86%OccupancyOther ExpensesNutrition Offset-1%Total Reimb excl M&G89%Admin. Allocation11.85%11%TOTAL100%CAF:5.39%UNIT RATE:TBDThis model budget starts with the Group Home 1:4 and adjusts various resources considered included in the Community Wrap pricing to avoid double payment.The following adjustments include:Direct Care Staff reduced from 13.00Relief calculated accordingly at 15% of Direct Care FTEsTravel reduced to reflect reduced staffingAdditional residential models can be paired with the Community Wrap piece using the standard pricing model.
11 DRAFT Continuum Pricing: Sample Blended Per Diem Rate ProgramCommunity WrapGH1 AdjustedIFCTotal Served inContinuum# of Slots30121Unit RateCommunity Wrap Unit Rate$100Total CostCost1 =Wrap Unit Rate x 30Cost2 =GH Adj Unit Rate x 12$100 x 1Sum of CostsBlended Unit Rate:Sum of Costs/ 30 SlotsThe example above is based on a model for 30 children that includes the Community Wrap and assumes on a typical day 12 children are in a Group Home 1:3 residential program and 1 child is in Intensive Foster Care (rate set under CMR 11.00). Blended rate is calculated by taking the sum of the total costs (Cost1+Cost2+$100) for each component and dividing by the total number of slots (30).
13 Community Reintegration Follow Along Follow Along – Residential Schools and Group HomesServices begin when family ( including kin, foster, etc) resource is ready to begin visitationsHome based reintegration work 1 to 3 sessions per weekAfter return home – sessions continue along with on-going access to groups and activities at res program24/7 consultation to familyRespite as needed at programFollow Along services emphasize service integration and care continuity. They can be provided by the residential provider, by a network of providers, or through subcontract as long as service continuity requirement is met.
14 __A_____B_______C________D__________E_____ Residential School, Intensive Group Home and Group Home Services with Follow AlongEvents during Residential Component of Program Events during Follow Along Component of Program__A_____B_______C________D__________E_____Child enters ResidentialComponent of ProgramFamily Identified (if not identified at intake)Child/Fam ready to begin reunificationChild leaves ResidentialComponent of ProgramChild/Fam Discharged from entire programFollow Along Services include:Home Based Treatment, ~ 2 sessions/week (more during “peak” times)Continued access to groups/activities at residential programRespite as needed at residential program24/7 access for consultationJoint Planning with school
15 DRAFT Follow Along Model Budget: Home-Based Services Slots:3Slot Days:1,095FTEExpenseManagement0.2519%Medical and ClinicalSocial Worker - L.I.C.S.W.17%Direct CareDirect Care Staff10%Relief0.021%SupportProg Secretarial / Clerical0.083%Total Program Staff0.8451%ExpensesFactorTax and Fringe23.42%12%Total Compensation63%Flex Funds$ ,0004%Additional Travel$ ,8728%Other Expenses14%Total Reimb excl M&G89%Admin. Allocation11.85%11%TOTAL100%CAF:5.39%UNIT RATE:TBDFollow Along developed for children in Residential Schools, Group Home 1:3, and Group Home 1:4. FTEs reflect staffing models recommended by the joint program design teams. Relief calculated at 7.5% of Direct Care Staff FTEs. Tax & Fringe, Admin Allocation percentages are consistent with other community residential models. Flex funds calculated as $1000 per slot. Travel calculated from 90 miles per child per week, reimbursed at $0.40 per mile. A cost adjustment factor is applied to account for inflation between the FY09 base year through the prospective rate period FY12-FY14.
16 Community Reintegration Stepping Out Stepping Out – Pre-Independent and Independent LivingProvides continuation of residential casework/manager function through the transition period in order to assist youthStepping Out provides service integration and care continuity. They can be provided by the residential provider, by a network of providers, or through subcontract as long as service continuity requirement is met.
17 Pre IL and IL Services with Stepping Out Events during Residential Component of Program Events during Stepping Out Component of Program__A_________B_________C___________D_____________E___Child enters ResidentialComponent of ProgramFamily / Lifelong Connection Identified (if not identified at intake)Youth ready to begin transition to independenceYouth leaves ResidentialComponent of ProgramYouth Discharged from entire programStepping Out Services Include:Continuation of Casework Management FunctionContinued access to groups/activities at residential program24/7 access to consultation
18 DRAFT Stepping Out Model Budget: Home-Based Services Slots:6Slot Days:2,190FTEExpenseManagement0.2514%Direct CareCase Worker Manager0.6023%SupportProg Secretarial / Clerical0.134%Total Program Staff0.9841%ExpensesFactorTax and Fringe23.42%10%Total Compensation51%Flex Funds$ ,0006%Additional Travel$ ,87212%Other Expenses20%Total Reimb excl M&G89%Admin. Allocation11.85%11%TOTAL100%CAF:5.39%UNIT RATE:TBDStepping Out, a less intensive model, developed for children in Pre-Independent Living and Independent Living. FTEs reflect staffing models recommended by the joint program design teams. Tax & Fringe, Admin Allocation percentages are consistent with other community residential models. Flex funds calculated as $1000 per slot. Travel calculated from 90 miles per child per week, reimbursed at $0.40 per mile. A cost adjustment factor is applied to account for inflation between the FY09 base year through the prospective rate period FY12-FY14.
19 Implementation Timeline and Key Milestones for DCF Family Stabilization Services Service Design Finalized: All service components, staffing ratios, staff qualifications, other program inputs have been decided by the purchasing departments and approved by Commissioners.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.Procurement: DCF/DMH issue RFR and conduct procurement activities.Rates Effective: July 1, 2012.