1. Chapter 257 of the Acts of 2008 Provider Engagement Session:
Youth Foster Placement, Adoption & Supports Services
August 8, 2012

2. 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
Many current rates within the POS system may not reflect consideration of these factors.
Chapter 9 of the Acts of 2011 establishes new deadlines for implementing POS rate regulation as well as requires that related procurements not go forward until after the rate setting process is completed.
Kelly/Katie
Jan 2012
Jan 2013
Jan 2014
Statutory Requirement: Percent of POS System with Regulated Rates
40%
30%
Spending Base Associated with Statutory Percentage (based on current projection of $2.278B POS Baseline to be implemented)
~ $880M
~ $660M

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:
Predictable, reimbursement models that reduce unexplainable variation in rates among comparable, economically operated providers
Incorporation of inflation adjusted prospective pricing methodologies
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
Kelly/Katie
Review/ Approval: Departments, Secretariat, and Admin & Finance
Public Comment and Hearing
Possible Revision / Promulgation

4. Service Class Overview
Agenda
Service Class Overview
Services
Procurement Plan
Foster Care Spectrum
DCF
DYS
Caregiver stipend levels
DDS
Product Based Adoption
Other Placement Services
Support Services
Next Steps & Logistics
Kelly/Katie

5. Youth Foster Placement, Adoption and Support Services Service Class
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.
Kelly/Katie

6. Youth Foster Placement, Adoption and Support Services Draft Procurement Proposal
100% of DYS providers are also DCF providers
Combined DYS and DCF purchased over $85M of contracted foster care and support services in FY11
DCF & DYS will jointly develop an RFR to create a master agreement with shared rate contracts for release in early 2013, following the promulgation of the Youth Placement & Adoption Rates.
Chapter 257 rates will be adopted with a target effective date of July 1, 2013 for DYS contracts.
DCF will complete their contracts with their current providers and these Chapter 257 rates throughout FY14 and rebid their contracts at a future date.
DMH currently purchases Intensive Foster Care using the DCF rates, planned to be included in the Caring Together with Families joint procurement with DCF
These rates will mirror the IFC rates as they change with this rate development
The Caring Together RFR will include language to reflect this process
Jeanne/Sandra

7. Service Class Overview
Agenda
Service Class Overview
Services
Procurement Plan
Foster Care Spectrum
DCF
DYS
Caregiver stipend levels
DDS
Product Based Adoption
Other Placement Services
Support Services
Next Steps & Logistics

8. Foster Care Administrative Budget: DCF IFC and DYS Traditional
DCF and DYS both develop their daily foster care rates considering both the administrative costs and stipends paid to caregiver families.
The chapter 257 rate development process will mirror the current methodology to review and evaluate the administrative (staffing) costs associated with providing foster care and the appropriate stipend levels to support the living and care needs of the foster youth in their care.
Model budgets, and resulting rates, will reflect the staffing necessary to support the 24/7 Provider Agency Services.
Sandra/Joy

9. Foster Care: DCF Enhanced (EFTC) and DYS Intensive
DCF Enhanced Intensive Foster Care clients and DYS Intensive Foster Care clients share many of the enhanced needs :
Model budgets, and resulting rates, will reflect the staffing necessary to support the increased 24/7 Provider Agency Services.
Stipend levels for caregivers of these more intensive clients will reflect the cost drivers associated with care provision for these youth.
Sandra/joy

10. Other Foster Care Services: Teen parent, Sibling, & Detention Alternative
Teen parent and sibling rates within the DCF IFC models are also being reviewed
Rates for teen parents and siblings will continue to consider the child and administrative costs associated with service provision
In addition to establishing standardized administrative and stipend rates for the Intensive and Traditional Foster Care programs, standard unit rates will be created for:
DYS Juvenile Detention Alternative Held & Filled Beds (Pilot Sites)
DYS Non-Guardian Care/Kinship
Joy/Sandra

11. Foster Care: Stipend Levels
DYS & DCF, along with DHCFP and EOHHS, are developing standardized stipend levels that will address the costs of caregiver supports and will be reflective of individual need levels.
These stipends will increase as client need level increases, to account for the additional care needs associated with some individuals.
These standardized rates will reflect consistent and transparent assessment of consumer acuity and need.
? Lucinda?

12. Service Class Overview
Agenda
Service Class Overview
Services
Procurement Plan
Foster Care Spectrum
DCF
DYS
Caregiver stipend levels
DDS
Product Based Adoption
Other Placement Services
Support Services
Next Steps & Logistics

13. DCF: Adoption Management and Support (AMSS)
DCF currently purchases product based adoption services and specialty contracts to support adoption.
Product Based Adoption includes an array of rates grouped into 6 service specifications, to address specific client needs and provide comprehensive services.
Six service groups - Consultation, Placement Case Management, Family Development, Recruitment, Intervention and Interstate.
Martha

14. Service Class Overview
Agenda
Service Class Overview
Services
Procurement Plan
Foster Care Spectrum
DCF
DYS
Caregiver stipend levels
DDS
Product Based Adoption
Other Placement Services
Support Services
Next Steps & Logistics

15. DCF Other Placement Services
DCF engages in single-provider contracts to address specific and specialized placement needs beyond IFC and ETFC.
These other placement services will be reviewed an specialized rates set to continue to best serve these specialized populations
Services included in this category:
IFC “Other”
Puerto Rico placements
Medical Family residential Services
Family residential services are a distinct cluster of services that can accommodate up to 6 children in a shared foster care setting
Family residential services will have their own distinct rates
Joy

16. Services included in this category:
DCF Support Services
Several single-contract support services will each receive distinct rates to address the diverse support needs of the DCF consumers.
Services included in this category:
Multiple accommodations model (Adoption and Post-adoption)
Youth Permanency Connections
Multiple foster services parent supports
Rates and rate methodology will differ among these rates to address specific programmatic and operational needs
Certain services will receive per diem unit rates while others will receive accommodation rates.
Martha

17. Service Class Overview
Agenda
Service Class Overview
Services
Procurement Plan
Foster Care Spectrum
DCF
DYS
Caregiver stipend levels
DDS
Product Based Adoption
Other Placement Services
Support Services
Next Steps & Logistics

18. Rates will be proposed to EOHHS leadership in August, 2012.
Next Steps & Logistics
The adoption and procurement of the Chapter 257 rates will not result in any billing and tracking system changes:
DCF will continue to use Family Net
DYS will continue to use JJEMS for tracking and PV for billing
DCF, DYS, HCFP and EOHHS will continue to work collaboratively to develop rates for the foster care spectrum, product based adoption services, other placement services and support services.
Rates will be proposed to EOHHS leadership in August, 2012.
A public hearing will be scheduled for Fall 2012.
Kelly/Katie