1. Commonwealth of Massachusetts Executive Office of Health and Human Services Chapter 257 of the Acts of 2008 Congregate Housing Services Coordination Provider Information & Dialogue Session May 4, 2010 www.mass.gov/hhs/chapter257

2. 2 Agenda Introductions and Overview Chapter 257 Implementation Infrastructure Service Classification System Setting Rational Rates Overview of Case Management Service Class Definition and Overview of Programs Timeline for Implementation and Procurement Review Discussion: Understanding Program Components and Cost Drivers Among Congregate Housing Services Coordination

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 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 current projection of $2.1B POS Baseline) ~ $215M~ $645M

4. 4 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 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 Maximize FY09 Develop Implementation Plan Develop Service Classes Cumulative Statutory Requirement Service Value FY10 10% of System $215M FY11 40% of System $860M FY12 70% of System $1.50B FY13 100% of System $2.15B Minimize

5. 5 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

6. 6 Agenda Introductions and Overview Chapter 257 Implementation Infrastructure Service Classification System Setting Rational Rates Overview of Case Management Service Class Definition and Overview of Programs Procurement Review and Timeline for Implementation Discussion: Understanding Program Components and Cost Drivers Among Congregate Housing Services Coordination

7. 7 Case Management: Congregate Housing Services Coordination Rate setting and procurement reform required an overall organizing structure for the classification of POS services From this need, POS and Purchasing Departments worked to create a Service Classification System that categorized services based on a number of attributes, including service components, staffing resources, and expected outcomes Congregate Housing Services Coordination was included under the Case Management service class, defined as, “Programs that provide the management, planning, or referrals of services delivered to an individual or family” This class also includes a number of other services purchased by Elder Affairs, the Department of Public Health, and the Department of Developmental Services

8. 8 Planned Timeline for Implementation and Procurement Review Implementation of regulated rates is scheduled for October 1, 2010 The Congregate Housing procurement released in 2004 contains contract language that will allow EOEA to adopt new rates without the need to re-procure.

9. 9 Agenda Introductions and Overview Chapter 257 Implementation Infrastructure Service Classification System Setting Rational Rates Overview of Case Management Service Class Definition and Overview of Programs Procurement Review and Timeline for Implementation Discussion: Understanding Program Components and Cost Drivers Among Congregate Housing Services Coordination

10. 10 Understanding Elder Affairs’ Congregate Housing Services Coordination Programs The following are discussion topics that will help facilitate our discussion: How are your programs currently structured in terms of program components and intended outcomes? What should the units of service be for the Congregate Housing service coordination (hour, day, month, etc)? What staff positions, qualifications and staff to client ratios are necessary to achieve the intended outcomes in each program? How do case management services fit within the spectrum of the purchase of service system (i.e. with ASAP Home Care services)? Are there interdependencies between these services and others in a continuum of care? How does capacity and case-mix (particularly when residents are also ASAP eligible) affect costs? What effect does geography have on costs?