1. Commonwealth of Massachusetts Executive Office of Health and Human Services Chapter 257 of the Acts of 2008 Provider Information & Dialogue Session: Case Management Service Class December 15, 2009 www.mass.gov/hhs/chapter257

2. 2 Session Objectives Present an overview of the EOHHS Chapter 257 Implementation Discuss the Chapter 257 Implementation Plan for the Case Management Service Class Engage in dialogue with individuals representing provider organizations that currently deliver these services under contract with DCF, DPH Bureau of Family and Community Health, and DPH Bureau of Substance Abuse Services to: Gain a better understanding of programs and service features, particularly how units of service are defined and delivered Provide a forum to discuss ideas, recommendations, and concerns related to the Chapter 257 Implementation Plan for this Service Class.

3. 3 Agenda Chapter 257 Implementation and Status Update Infrastructure and Stakeholders Service Classification System Rate Regulation Process Contract Reform Overview of Case Management Service Class Definition and Overview of Involved Purchasing Department Programs Procurement Plan Timeline for Implementation Purchasing Department Facilitated Breakout Sessions Reporting Back and Concluding Discussion

4. 4 Chapter 257 of the Acts of 2008 regulates pricing for the POS system. Chapter 257 places authority for determination of Purchase of Service reimbursement rates with the Division of Health Care Finance and Policy. Chapter 257 requires that DHCFP consider the following criteria when setting and reviewing human service reimbursement rates: Reasonable costs incurred by efficiently and economically operated providers Reasonable costs to providers of any existing or new governmental mandate Changes in costs associated with the delivery of services (e.g. inflation) Substantial geographical differences in the costs of service delivery Some rates within the POS system do not reflect consideration of these factors. Additional funding was not appropriated to finance any potential cost increases associated with the law. The statute specifies a four year implementation timeframe. FY10FY11FY12FY13 Statutory Requirement: Percent of POS System with Regulated Rates 10%30% Spending Base Associated with Statutory Percentage (based on $2.3B FY10 POS Baseline) ~ $230M~ $690M

5. 5 Chapter 257 requires successful achievement of three strategies. Number of different POS contracts Cost reimbursement contracts 3. Reform Contracting Use of Master Agreements Contracts w/ performance features Contracts shared across departments 1. Create Service Classes Minimize Establish new cross- Secretariat organizational and governance structure Develop Service Class structure to group similar services & programs Build out process & technology to manage codes & classes Align activity codes to Service Classes Enabling Rate analysis and establishment Contract consolidation across agencies Improved reporting 2. Develop Reimbursement Methodology & Rates FY09Develop Implementation Plan Develop Service Classes Statutory Requirement Service Value FY1010% of system ~$230M FY1130% of system~$690M FY1230% of system~$690M FY1330% of system~$690M Maximize

6. 6 Case Management Overview Service Class Definition: Programs that provide individuals or families with management, planning, or service referrals. DepartmentActivity CodeProgram NameProjected FY10 Spending DCF FNLAFamily Networks Lead Agency $ 16,695,654 DPH 3300 ** Comprehensive Home Health $ 978,768 3379Supportive Case Management $ 2,304,082 3392Supportive Housing $ 1,690,574 3453Community Based Case Mgmt Services $ 514,096 4915 ** HIV/AIDS Corrections to Community Reintegration $ 1,123,155 4916 ** HIV/AIDS Client Services $ 8,310,124 4917 ** HIV/AIDS Residential Support Services $ 4,814,000 4918 ** HIV/AIDS Enhanced Medical Management Services $ 5,420,052 4935Family Focused Intervention & Care Coordination $ 219,620 4939Women’s Health Care Coordination (WHCC) $ 3,677,783 ELD 8011 ** Enhanced Community Options Programs$ 11,447, 335 8014 ** Home Care/Respite Care Case Mgmt & Adm $ 37,568,041 8015 ** Supportive Senior Housing $ 4,052,722 8017 ** Congregate Housing Services Coordination $ 2,070,010 8042 ** Protective Service Casework $ 12,526,248 DDS 3274 ** Corporate Rep Payee $ 203,587 Total Projected FY10 Spending$ 113,640,897 * * Projected spending subject to change given November 9c reduction impacts ** Separate forums will be scheduled at a later date for the DDS, DPH Office of HIV/AIDS, and Elder Affairs programs in this Service Class

7. 7 The Chapter 257 Implementation plan is organized by newly defined POS Service Classes Why were Service Classes Created? DHCFP cannot meet the mandated schedule by setting specific rates for all of the individually procured services purchased throughout the POS system Rate setting and procurement reform require an overall organizing structure for the classification of POS services There were no Secretariat standards for categorizing or describing similar services within or across Departments. The use and functionality of MMARS codes vary widely from Department to Department– as a result, it is very difficult to report on the performance, costs, and volume of services delivered across EOHHS. How were Service Classes Created? Departments formed POS Service Classification Working Groups Working groups met with the EOHHS POS Policy Office over the course of three months Current POS Services Reviewed, Described, and Catalogued EOHHS Suggested Service Groupings Departments Verified / Modified and Developed Definitions Current MMARS Codes were “Mapped” to New Service Classes

8. 8 The Service Classification System groups like POS programs together into “Service Classes” Every Service Class is describes with standardized “Descriptors” and “Service Elements”. Service Classes A grouping of programs with similar cost drivers, general outcome purposes, and sometimes service populations There are 32 Service Classes Service Classes contain programs from one or more agencies Descriptors Standard characteristics that describe a Service Class: desired outcomes, populations served, and service delivery locations. These allow for cross agency management and reporting for rate setting and contract reform. Service Elements Defined “components” of a given program Programs have multiple elements - not all programs within a Service Class have all the same elements Service elements facilitate pricing & differentiate programs within a Service Class The new Service Classification System groups POS programs in cross-secretariat Service Classes.

9. 9 The HCFP-led cost analysis and rate setting effort has several objectives and challenges. Objectives and Benefits Development of uniform analysis for standard pricing of common services Rate setting under Chapter 257 will enable: A.Predictable, reimbursement models that reduce unexplainable variation in rates among comparable, economically operated providers B.Incorporation of inflation adjusted prospective pricing methodologies C.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

10. 10 In many cases, contract reform is necessary to implement Chapter 257 TodayVision for FY13 Thousands of individually 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 Purchasing Department Providers Reduced contract complexity and redundancy Greater amendment flexibility Improved capacity for rate management Streamlined, centrally-managed procurement cycles managed Dept Providers Secretariat Master Agreements By Service Class DHCFP rate schedules Secretariat Master Agreements Panel of qualified providers Departments purchase via rate agreements

11. 11 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

12. 12 Putting it all together: How will this work? Departments Form Service Class Strategy Teams (Staffed by EOHHS) Iterative proposal and review of procurement models and approaches to implemented contract and rate reform Service Class Strategy Teams Work Through a Number of Considerations Discussion of program strategies, content, trends and Department vision Determine procurement plan and pricing approach Pricing Analysis, Rate Development, Approval, and Hearing Process As necessary, RFR and Procurement Plan Developed (possible types of activities) Data sources identified or developed Cost analysis & rate option development Provider Consultation Dept/EOHHS/ ANF Review/ Approval Public Comment and Hearing Possible Revision / Promulgation Program definitions / outcomes defined RFR Development Provider Consultation Public Information Session RFR Posting and Response New Contracts Reference C.257 Rates

13. 13 Provider Session A Agenda Chapter 257 Implementation and Status Update Infrastructure and Stakeholders Service Classification System Setting Rational Rates Contract Reform Overview of Case Management Service Class Definition and Overview of Involved Purchasing Department Programs Procurement Plans Timeline for Implementation Purchasing Department Facilitated Breakout Sessions Reporting Back and Concluding Discussion

14. 14 Case Management Overview Service Class Definition: Programs that provide individuals or families with management, planning, or service referrals. DepartmentActivity CodeProgram NameProjected FY10 Spending DCF FNLAFamily Networks Lead Agency $ 16,695,654 DPH 3300 ** Comprehensive Home Health $ 978,768 3379Supportive Case Management $ 2,304,082 3392Supportive Housing $ 1,690,574 3453Community Based Case Mgmt Services $ 514,096 4915 ** HIV/AIDS Corrections to Community Reintegration $ 1,123,155 4916 ** HIV/AIDS Client Services $ 8,310,124 4917 ** HIV/AIDS Residential Support Services $ 4,814,000 4918 ** HIV/AIDS Enhanced Medical Management Services $ 5,420,052 4935Family Focused Intervention & Care Coordination $ 219,620 4939Women’s Health Care Coordination (WHCC) $ 3,677,783 ELD 8011 ** Enhanced Community Options Programs$ 11,447, 335 8014 ** Home Care/Respite Care Case Mgmt & Adm $ 37,568,041 8015 ** Supportive Senior Housing $ 4,052,722 8017 ** Congregate Housing Services Coordination $ 2,070,010 8042 ** Protective Service Casework $ 12,526,248 DDS 3274 ** Corporate Rep Payee $ 203,587 Total Projected FY10 Spending$ 113,640,897 * * Projected spending subject to change given November 9c reduction impacts ** Separate forums will be scheduled at a later date for the DDS, DPH Office of HIV/AIDS, and Elder Affairs programs in this Service Class

15. 15 Case Management Procurement Plan Purchasing Departments will procure these services independently and will use a Departmental Master Agreement contract wherever possible because: Only 7% of all spending in this Service Class is attributable to providers under contract with multiple purchasing Departments The intensity and clinical nature of staffing for Case Management Services varies greatly between purchasing Departments and programs There is a wide range of client populations, delivery locations, and intended outcomes within this Service Class There is significant variation in how units of service and defined and delivered DCF has an existing Master Agreement procurement in effect since 2006 and re-procurement is not necessary DDS and DPH BFCH procurement timelines will be coordinated with Chapter 257 rate adoption with a target contract execution by Fall, 2010. DPH BSAS and DPH OHA procurement timelines will be coordinated with a target contract execution of July, 2011

16. 16 Planned timeline for implementation For Departments Issuing RFRs:

17. 17 Provider Session A Agenda Chapter 257 Implementation and Status Update Infrastructure and Stakeholders Service Classification System Setting Rational Rates Contract Reform Overview of Case Management Service Class Definition and Overview of Involved Purchasing Department Programs Procurement Plan Timeline for Implementation Purchasing Department Facilitated Breakout Sessions Reporting Back and Concluding Discussion

18. 18 Breakout Sessions: Understanding Case Management Discussion of core program components, the range of intensity and types of services, and how providers structure programs to achieve an array of outcomes. Questions for Providers: What are the units of service? What are the impacts of the service delivery location (i.e. in-home vs. other setting)? What types of staff, intensity of staff, professional requirements, work processes and interactions are necessary to achieve the intended outcomes in each programs? What non-staffing program components are necessary to achieve the intended outcomes in each program? What changes in program operations and business models do providers anticipate, if any, given potential changes in reimbursement structure?