1. Commonwealth of Massachusetts Executive Office of Health and Human Services Chapter 257 of the Acts of 2008 Provider Information and Dialogue Session: Competitive Integrated Employment Services May 13, 2013 www.mass.gov/hhs/chapter257 eohhspospolicyoffice@state.ma.us

2. 2 Agenda Chapter 257 of the Acts of 2008 Overview of CIES Definition and Overview of Programs Procurement Approach Review of Pricing Analysis and Methodologies Component Based Rates at DTA and MRC Readiness and Training Employment Supports Hourly and Interim rates for Ongoing Support Timeline and Key Milestones

3. 3 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 Secretary Of Health and Human Services under MGL 118G. The Division of Health Care Finance and Policy provides staffing and support for the development of Chapter 257 pricing. Chapter 257 requires that the following criteria be considered 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 Rates that have undergone Chapter 257 rate setting processes are subject to review every 2 years. Rate reviews will reflect: Changes to the service since the preceding review Any systemic or programmatic changes desired by purchasing agencies Any updated or new data brought forth to support rate adjustments These rate reviews will all engage in the public hearing process

4. 4 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 Review/ Approval: Departments, Secretariat, and Admin & Finance Public Comment and Hearing Possible Revision / Promulgation

5. 5 Agenda Chapter 257 of the Acts of 2008 Overview of CIES Definition and Overview of Programs Procurement Approach Review of Pricing Analysis and Methodologies Component Based Rates at DTA and MRC Readiness and Training Employment Supports Hourly and Interim rates for Ongoing Support Timeline and Key Milestones

6. 6 Competitive Integrated Employment Services Service Class Definition: Programs that provide individuals with employment services to attain competitive work and sustainable income, including job support and job retention services. Services encompass the full spectrum of CIES models including: Intake, Evaluation & Assessment, Educational & Skills Training, and Job Development & Placement at DTA and MRC Ongoing Supports for employed individuals (hourly) at MRC and DDS Service ClassAgencyCodeProgram Name FY 2012 Program Spend Competitive Integrated Employment DDS3180Comprehensive Integrated Employment Services 1,043,995 DTA2885M2 Employment Training and Ed 1,004,048 DTA2886M3 Employment Supports 1,640,610 MCB2184Competitive Integrated Employment Services 98,608 MRC5100VR CIES COMPONENTS 6,836,918 MRC5200CIES Component Procurement 2,247,088 MRC5300Partnership Plus 97,906

7. 7 CIES Procurement / Recontracting Plan RFR EOHHS reopened the CIES procurement on March 20, 2013 in order to secure additional vendors or programs to fill geographical and program needs. Vendors that were not already qualified under the CIES procurement had the opportunity to apply at this time. Responses were due April 30, 2013. EOHHS is now completing the evaluation process. Contracts The original CIES RFR was issued in February 2009 and contracts were executed on 7/1/09. The initial CIES contract term expires on June 30, 2013. EOHHS has offered qualified providers a two-year contract amendment (expires on 6/30/2015). Amended contracts were emailed to qualified providers on May 8 th. Please sign and complete the contracts forms and return to EOHHS by May 24, 2013. A response by this date will allow the participating agencies to complete Statements of Work for FY2014 with providers that have a signed contract renewal package. Please contact EOHHS if you are a qualified provider and did not receive the amended contract: eohhspospolicyoffice@state.ma.us or call 617-573-1717

8. 8 Agenda Chapter 257 of the Acts of 2008 Overview of CIES Definition and Overview of Programs Procurement Approach Review of Pricing Analysis and Methodologies Component Based Rates at DTA and MRC Readiness and Training Employment Supports Hourly and Interim rates for Ongoing Support Timeline and Key Milestones

9. 9 CIES: Component Based Rates DTA and MRC purchase CIES for 3861 (mrc) consumers through 4 component based rates with 8 payment points at each component’s initiation and completion. Intake, evaluation and assessment: Each Individual engages in services, articulates initial goals, and commits to a service plan. Job-targeted Skills Development & Education Activities: Each Individual is prepared to enter job search and placement for initial employment in a competitive environment or is prepared to reach stabilization in a targeted work environment, with additional supports as necessary. Job Development & Placement (1-30 days): Initial competitive employment is retained for at least 30 calendar days. Initial Employment Supports (31-90 days): Individual makes progress toward stability and confidence in job duties and workplace relationships and has retained employment for 90 calendar days.

10. 10 CIES: Ongoing and Interim Supports DDS and MRC provide ongoing and interim hourly CIES to approximately 1,000 consumers each year to maintain stable employment for consumers. Consumers receive a 1:1 support Billable activities include: Job Coaching / Training Meetings with employer / supervisor Services on behalf of consumer Pre-negotiated services that are directly related to the consumer’s employment situation

11. 11 CIES: Component Based Rates at MRC

12. 12 CIES: Component Based Rates at DTA DTA currently purchases 2 of the 4 CIES components: DTA will develop rates for the all four CIES components.

13. 13 Agenda Chapter 257 of the Acts of 2008 Overview of CIES Definition and Overview of Programs Procurement Approach Review of Pricing Analysis and Methodologies Hourly rates at DDS and MRC Component Based Rates at DTA and MRC Readiness and Training Employment Supports 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 2-3 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 Competitive Integrated Employment Services

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