1. Commonwealth of Massachusetts Executive Office of Health and Human Services Chapter 257 of the Acts of 2008 Provider Information and Dialogue Session: Adult Placement & Adoption Services & Supports June 20, 2011 www.mass.gov/hhs/chapter257 eohhspospolicyoffice@state.ma.us

2. 2 Agenda Chapter 257 of the Acts of 2008 Overview of Adult Placement & Adoption Supports & Services Definition and Overview of Programs Rate Considerations Feedback from May 23, 2012 Session Timeline and Key Milestones

3. 3 The 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 Ambitious implementation timeline Data availability and integrity (complete/correct) Unexplained historical variation in reimbursement rates resulting from long-term contracts and individual negotiations between purchasers and providers Constrained financial resources for implementation, especially where pricing analysis warrants overall increases in reimbursement rates Cross system collaboration and communication 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 Methods Development Provider Consultation Review/ Approval: Departments, Secretariat, and Admin & Finance Public Comment and Hearing Possible Revision / Promulgation

4. 4 Updated timeline reflects critical milestones in meeting statutory requirements. Department Service Design Finalized: All service components, staffing ratios, staff qualifications, other program inputs have been decided by the purchasing department. Provider Input Sessions: For each rate setting project, EOHHS conducts an average of 3 provider input sessions prior to Executive Sign-Off and the Public Hearing process to allow for greater depth in understanding core program components, cost drivers, and procurement considerations. 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 Issuance: Where a procurement is warranted, the procurement will be issued after the rates have been adopted. Rates Effective: Where possible, reimbursement under regulated rates will align with beginning of SFY to minimize mid-year contract amendments for both purchasing Departments and providers. Implementation Year Department Service Design and Provider Input Executive Sign-Off EO 485 Submitted to ANF HCFP Rate Regulation Proposal Public HearingAdoption Procureme nt Issued Rates Effective Year 3 Winter / Spring 2012 Jul - 2012Aug 2012Sept- 2012Oct - 2012Jan - 2013 Jul - 2013 Year 4 Winter / Spring 2013 Jul - 2013Aug 2013Sept - 2013Oct - 2013Jan - 2014 Jul - 2014

5. 5 Agenda Chapter 257 of the Acts of 2008 Overview of Adult Placement & Adoption Supports & Services Definition and Overview of Programs Rate Considerations Feedback from May 23, 2012 Session Timeline and Key Milestones

6. 6 Adult Placement & Adoption Services & Supports Service Class Definition: Programs that provide a continuum of services relating to foster care, shared living placements and adoption, including recruitment, placement, and supports to individuals, families, and caregivers to promote stability in the temporary or permanent family placement. Service ClassAgency Activity Code Program Name Total Projected Program Spending Placement and Adoption Services and Supports DDS3150Placement Services Tier 2 $34,775,000 DDS3288Placement Services Tier 1 $4,158,000 MCBTBDResidential / Day Services$1,600,000 Total Spending$40,533,000

7. 7 Feedback from May 23, 2012 Provider Consultation session Individual Client Need & Assessment Tool Consumer needs will remain the focus in the development of and use of an assessment tool. An evaluative tool will be designed to target and appropriately determine these needs. This tool should also provide a means to allow the parties to take account of important characteristics and needs that might fall outside of those specifically included in the basic assessment instrument. Clients will be assessed based upon their personal skill ability in a variety of living domains. DDS/MCB are considering how to integrate behavioral and mental health needs. The scoring and weight of critical questions, including the additional behavioral and mental health considerations, will be expansive enough to identify individuals with highly acute and enhanced care needs. This scoring will result in multiple ‘levels’ of care; these levels will be driven in significant part by staff to client ratios of case managers, placement coordinators, clinicians and direct care workers.

8. 8 Proposed Additional Mental Health Questions Person experiences mental health diagnosis/diagnoses per Diagnostic and Statistical Manual: (triple point weight) 1. At least one diagnosis on Axis I 2. At least one diagnosis on Axis I and personality disorder on Axis II 3. At least two diagnoses on Axis I with or without an Axis II diagnosis of personality disorder 4. Three or more diagnoses on Axis I with or without an Axis II diagnosis of personality disorder Impact of mental illness on person’s life (triple point weight) 1. Individual is able to function with minimal interference in her or his life 2. Individual is affected with moderate interference in her or his life. 3. Individual is affected with significant interference in his or her life. 4. Individual is unable to participate in meaningful work, maintain relationships and has experienced frequent hospitalizations and or has been assessed for forensic/risk purposes in the past year.

9. 9 Model budgets will be developed including: –Salary levels –Tax and Fringe rates –Other cost drivers and expenses Data sources in consideration for model budget development include: –DDS contract data from 2011 Contract Data and EIM attendance data –Salary information from Bureau of Labor & Statistics, Salary.com, etc. –Other market cost data Caregiver Training will be included as a factor in the models. Staff: Client ratios will vary by the level of intensity of client need Model budgets are a pricing tool, not a mandated directive of staffing structures or salary levels A goal of the implementation process is to maintain access to services. Placement and Adoption Supports & Services Budget Development

10. 10 Feedback from May 23, 2012 Provider Consultation session Stipend Levels DDS & MCB are working with DHCFP and EOHHS to develop standardized stipend levels that address the costs of caregiver supports and are responsive to individual need levels.

11. 11 Charges for Care Charges for care will be managed centrally at the agency level Agency will collect 75% of SSI and any other recurring monthly income. Agency will use the collected charges for care primarily as an offset to the cost of the caregiver stipends

12. 12 Adult Placement & Adoption: Draft Model Budget A level 1 needs driven model assumes a caseload of 32 clients. Rates will be derived on a per client per day basis. Salaries reflect salaries from FY11 contract data and considerations for an equivalent direct care salaries from the Bureau of Labor & Statistics and other market sources. Level 1 model does not include Clinical Director or Nursing hours. Higher level models will reflect these positions. Includes all reported cost drivers from contract data Taxes & Fringe and Admin Allocation reflect median percentages Other Expense and Direct Administrative costs represent contract averages. The Cost Adjustment Factor (CAF) is 3.93% to represent the calculated inflationary impact of through the FY15 rate period

13. 13 Agenda Chapter 257 of the Acts of 2008 Overview of Adult Placement & Adoption Supports & Services Definition and Overview of Programs Rate Considerations Feedback from May 23, 2012 Session Timeline and Key Milestones

14. 14 Department Service Design Finalized: All service components, staffing ratios, staff qualifications, other program inputs have been decided by the purchasing department. Provider Sessions: For each rate setting project, EOHHS conducts an average of 3 provider input sessions prior to Executive Sign-Off and the Public Hearing Process to allow for greater depth in understanding core program components, cost drivers, and procurement considerations. 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. Public Hearing: DHCFP and purchasing departments consider testimony in advance of rate adoption. Procurement Process: The procurement will be issued after the rates have been adopted. Rates Effective: Where possible, reimbursement under regulated rates will align with beginning of SFY to minimize mid-year contract amendments for both purchasing Departments and providers. Updated Implementation Timeline and Key Milestones for Adult Placement & Adoption Services & Supports July 1

15. 15 Questions/Feedback Please Email Questions & Comments to: eohhspospolicyoffice@state.ma.us Please Visit the Chapter 257 Website: www.mass.gov/hhs/chapter257