0. www.mass.gov/hhs/chapter257 eohhspospolicyoffice@state.ma.us
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 Filing
Updated Implementation Timeline and Key Milestones
Comparison of Current and Future Approach to Residential Services
Continuum Wrap Model
Program Design
Draft Pricing Structure
Follow Along and Stepping Out Models
Procurement 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, or
Compliance with a court order, settlement agreement, or statutory requirement.

4. Today and Tomorrow
Current residential POS contracts are structured so that:
Services end with discharge from the residential facility
Community services post discharge are purchased separately, presenting a challenge for continuity
Providers serving both DCF and DMH are held to different standards and requirements
The planned contracting mechanism:
Allows for integration of residential and community services within the same contract
Allows for continuity of service post residential to promote successful transitions
Creates consistent standards and expectations for both purchasing Agencies.

5. Highlights of New Expectations contained in Joint Standards (Required for All Models)
Family Focus
Increased family engagement and utilization of family partners in care planning and delivery. The family is the focus of the intervention and treatment: Voice and Choice
Increased use of peer leaders with older adolescents: Voice and Choice
Focus on School Achievement
Requirement for Board Members with “lived experience”
Family part of CQI process
Quality
Continuous Quality Improvement:
Supporting positive outcomes in education, permanency, health and wellness
Outcomes measured will reflect post discharge success in community tenure and school participation
Performance 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 Model
Child/youth at risk for residential placement and family identified as able to care for child at home (or work toward return home) with intensive supports
Services delivered by a wrap-team across levels of care
Services designed to support youth in their homes and families in their care-giving roles, including:
Care planning and coordination
In-home family treatment
Parent support, Peer mentoring
Youth and family outreach
Crisis support
Flex Funds
Long-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 service
Child leaves Residential
Component of Program, (if ever utilized)
Child/Fam assessed for community or residential
Wrap Team works with child and family regardless of whether child is in the home or in a placement
Child/Fam Discharged from entire program
Continuum Wrap Services include:
Care Coordination, Flexible Funds
In -Home Family Treatment
Parent Support, Peer Mentoring
Crisis Support
Youth and Family Outreach
Long and short term out-of-home care if needed

8. DRAFT Continuum Model Budget: Community Wrap
Slots: 30
Slot Days:
10,950
FTE
Expense
Management
2.00
11%
Medical and Clinical
Physician & Psychiatrist
0.10 2%
Occupational Therapy
0.50 3%
Social Worker - L.I.C.S.W.
1.00 5%
Direct Care
Peer Mentor
Clinical Care Manager (MA)
4.00
18%
Direct Care Staff
6.50
25%
Relief
0.49
Support
Prog Secretarial / Clerical
Total Program Staff
16.09
64%
Expenses
Factor
Tax and Fringe
23.42%
15%
Total Compensation
79%
Flex Funds
$ ,000
Occupancy 4%
Other Expenses
Additional Travel 1%
Total Reimb excl M&G
89%
Admin. Allocation
11.85%
TOTAL
100%
CAF:
5.39%
UNIT RATE:
TBD
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. 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 Continuum
CONTINUUM Model Budget - Group Home Intensive 1:3
Beds: 12
Bed Days:
4,380
FTE
Expense
Management
1.75
10%
Medical and Clinical
Physician & Psychiatrist
0.10 2%
Nursing (RN non-masters)
0.25
Occupational Therapy
0.50 3%
Social Worker - L.I.C.S.W.
1.00 5%
Direct Care
Clinical Care Manager (MA)
Direct Care Staff
13.20
40%
Relief
1.98 6%
Support
Prog Secretarial / Clerical 1%
Total Program Staff
19.53
70%
Expenses
Factor
Tax and Fringe
23.42%
16%
Total Compensation
86%
Occupancy
Other Expenses
Nutrition Offset
-1%
Total Reimb excl M&G
89%
Admin. Allocation
11.85%
TOTAL
100%
CAF:
5.39%
UNIT RATE:
TBD
This 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 1.00
Direct Care Staff reduced from 15.00
Relief calculated accordingly at 15% of Direct Care FTEs
Travel reduced to reflect reduced staffing

10. CONTINUUM Model Budget - Group Home 1:4
DRAFT Continuum Model Budget: Residential GH 1:4 Adjusted for Continuum
CONTINUUM Model Budget - Group Home 1:4
Beds: 12
Bed Days:
4,380
FTE
Expense
Management
1.75
12%
Medical and Clinical
Nursing (RN non-masters)
0.25 2%
Social Worker - L.I.C.S.W.
0.50 3%
Direct Care
Clinical Care Manager (MA)
1.00 5%
Direct Care Staff
11.20
41%
Relief
1.68 6%
Support
Prog Secretarial / Clerical 1%
Total Program Staff
16.63
70%
Expenses
Factor
Tax and Fringe
23.42%
16%
Total Compensation
86%
Occupancy
Other Expenses
Nutrition Offset
-1%
Total Reimb excl M&G
89%
Admin. Allocation
11.85%
11%
TOTAL
100%
CAF:
5.39%
UNIT RATE:
TBD
This 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 13.00
Relief calculated accordingly at 15% of Direct Care FTEs
Travel reduced to reflect reduced staffing
Additional residential models can be paired with the Community Wrap piece using the standard pricing model.

11. DRAFT Continuum Pricing: Sample Blended Per Diem Rate
Program
Community Wrap
GH1 Adjusted
IFC
Total Served in
Continuum
# of Slots 30 12 1
Unit Rate
Community Wrap Unit Rate
$100
Total Cost
Cost1 =
Wrap Unit Rate x 30
Cost2 =
GH Adj Unit Rate x 12
$100 x 1
Sum of Costs
Blended Unit Rate:
Sum of Costs/ 30 Slots
The 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).

12. Introduction to Follow Along & Stepping Out

13. Community Reintegration Follow Along
Follow Along – Residential Schools and Group Homes
Services begin when family ( including kin, foster, etc) resource is ready to begin visitations
Home based reintegration work 1 to 3 sessions per week
After return home – sessions continue along with on-going access to groups and activities at res program
24/7 consultation to family
Respite as needed at program
Follow 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 Along
Events during Residential Component of Program Events during Follow Along Component of Program
__A_____B_______C________D__________E_____
Child enters Residential
Component of Program
Family Identified (if not identified at intake)
Child/Fam ready to begin reunification
Child leaves Residential
Component of Program
Child/Fam Discharged from entire program
Follow Along Services include:
Home Based Treatment, ~ 2 sessions/week (more during “peak” times)
Continued access to groups/activities at residential program
Respite as needed at residential program
24/7 access for consultation
Joint Planning with school

15. DRAFT Follow Along Model Budget: Home-Based Services
Slots: 3
Slot Days:
1,095
FTE
Expense
Management
0.25
19%
Medical and Clinical
Social Worker - L.I.C.S.W.
17%
Direct Care
Direct Care Staff
10%
Relief
0.02 1%
Support
Prog Secretarial / Clerical
0.08 3%
Total Program Staff
0.84
51%
Expenses
Factor
Tax and Fringe
23.42%
12%
Total Compensation
63%
Flex Funds
$ ,000 4%
Additional Travel
$ ,872 8%
Other Expenses
14%
Total Reimb excl M&G
89%
Admin. Allocation
11.85%
11%
TOTAL
100%
CAF:
5.39%
UNIT RATE:
TBD
Follow 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 Living
Provides continuation of residential casework/manager function through the transition period in order to assist youth
Stepping 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 Residential
Component of Program
Family / Lifelong Connection Identified (if not identified at intake)
Youth ready to begin transition to independence
Youth leaves Residential
Component of Program
Youth Discharged from entire program
Stepping Out Services Include:
Continuation of Casework Management Function
Continued access to groups/activities at residential program
24/7 access to consultation

18. DRAFT Stepping Out Model Budget: Home-Based Services
Slots: 6
Slot Days:
2,190
FTE
Expense
Management
0.25
14%
Direct Care
Case Worker Manager
0.60
23%
Support
Prog Secretarial / Clerical
0.13 4%
Total Program Staff
0.98
41%
Expenses
Factor
Tax and Fringe
23.42%
10%
Total Compensation
51%
Flex Funds
$ ,000 6%
Additional Travel
$ ,872
12%
Other Expenses
20%
Total Reimb excl M&G
89%
Admin. Allocation
11.85%
11%
TOTAL
100%
CAF:
5.39%
UNIT RATE:
TBD
Stepping 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.