chapter 257 of the acts of 2008
DESCRIPTION
Chapter 257 of the Acts of 2008 DCF/DMH Youth Residential Joint Procurement Program and Pricing Information & Dialogue Session November 23, 2010 www.mass.gov/hhs/chapter257 [email protected]. Agenda. Review of Program Purpose and Rationale for Joint Procurement and Update - PowerPoint PPT PresentationTRANSCRIPT
Commonwealth of MassachusettsExecutive Office of Health and Human Services
Chapter 257 of the Acts of 2008 DCF/DMH Youth Residential Joint Procurement
Program and Pricing Information & Dialogue Session
November 23, 2010
www.mass.gov/hhs/chapter257 [email protected]
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Agenda
• Review of Program Purpose and Rationale for Joint Procurement and Update
• Guiding Principles • Program Models to be Included in Procurement• Recent decisions
Chapter 257 Implementation Approach• Discussion of Draft Pricing Structure for
• Group Home
• Independent Living
• Teen Parenting
• Continuum
• Adjustments• Next Steps
• Procurement and Rate Setting Regulatory Timeline
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Guiding Principles
• Families, rather than individuals, are the focus of formal and informal services and supports
• Families and children experience smooth transitions between residential services and the child’s return home to their community
• Ensure the voices of youth and family are fully and meaningfully incorporated into Boards, programs and services
• A continuity of clinical approach across the service delivery system
• The system of residential services has a primary focus on supporting community living
• Permeability and portability between levels of service (including residential and community programs)
• Streamlined/interagency entry into services and oversight of services
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DCF and DMH programs included in system change and procurement
Youth Intermediate-Term Residential Services
Department Activity Code Program FY10 Spending
DCF
FNCO* Residential Schools $155,628,209 / 1,572 Beds
FNGH Family Networks Group Homes
FNST Family Network STARR $40,800,289 / 400 beds
RESG Teen Living Programs $9,104,970 / 172 Beds
DMH
3075* Individualized Support, Residential $4,318,145 / 91 Beds
3079 Child/Adolescent Residential Service $22,745,098 / 427 **
3080 Intensive Residential Treatment $15,256,911 / 85 Beds
3081 Clinically Intensive Residential Treatment $1,936,286 / 12 Beds
Total $249,789,908 / 2,759 Daily Units of Service
* OSD maintains statutory authority to set tuition prices for Chapter 766 approved private special education programs. Although the Chapter 766 components of DCF’s Residential School services (FNCO) and DMH’s Individualized Residential Support services (3075) will be included in the program design and procurement, the rates for these services will not be established under the POS rate regulations.
** a mixture of group congregate residential care and in-community intensive wraparound programs
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Program Models
•Stabilization Assessment and Rapid Reintegration (STARR)6-bed, 9-bed, 12-bed, 15-bed, 18-bed models
•Intensive Residential Treatment Program
•Clinically Intensive Residential Treatment
•Group Home•1:3 Ratio (BTR)•1:4 Ratio•1:5 Ratio (Pre-Independent Living)• Specialized/Outlier Programs
•Independent Living
•Teen ParentingTeen Parenting Enhanced, TLP, House Parent, STEP models
•Continuum•Res-Wrap•Future Development
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Recent Decisions
• Family Partner• Will be developed and purchased by the Agencies in a separate RFR• Timeframe for Family Partner RFR to be determined
• CIRT• Program model for 6-12 year olds will be included in the RFR• Design changes and pricing work is ongoing
• Third Party Billing • STARR – providers will not be allowed to subcontract with IHT providers
for family therapy services• Psychiatry – the Agencies plan to reimburse psychiatric consultation in
some program models
• Res-Wrap Models• DMH and DCF joint purchase
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DRAFT Group Home 1 Model Budget 1:3 Ratio
• All information is currently in draft form and subject to change.
• FTEs were determined by the Purchasing Agency design team.
• Family Partner removed; intention is to purchase separately.
• Relief is calculated using a model of 15.8% of FTEs (based on 15 vacation days, 10 sick days, 13 holidays, 3 training days). Formula currently under review.
• The tax and fringe and indirect administrative allocation percentages reflect measures of central tendency from FY09 UFR data and are consistent with STARR.
• Estimated cost adjustment factor (Source: HIS Global Insights Massachusetts CPI Forecast-Spring 2010) is applied to account for inflation between the FY09 base year and the two year prospective rate period through FY 13. Subject to update.
Number of Beds: 12 Days: 365 Bed Days: 4,380
FTE Expense %Direct Management 2.00 9%Medical and Clincial
Physician & Psychiatrist 0.15 2% Nursing (RN non-masters) 0.25 1% Occupational Therapist 0.50 3% Social Worker LICSW 1.00 4%Direct Care
Case Worker / Manager (MA) 1.00 4% Direct Care Staff 13.40 33% Relief 2.11 5%Support
Prog Secretarial / Clerical 0.25 1%Sub-Total Direct Care Staff 20.66 62%
FactorTaxes & Fringe 22.44% 14%
Total Staffing Cost 75%
Occupancy 8%Other Program Expenses 6%
Total Reimbursable Expense, excl admin 89%
Admin. Alloc. (M&G) 12.25% 11%
TOTAL 100%
CAF 5.05%Unit Rate TBD
GROUP HOME 1- 1:3 MODEL
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DRAFT Group Home 2 Model Budget 1:4 Ratio
• All information is currently in draft form and subject to change.
• FTEs were determined by the Purchasing Agency design team.
• Family Partner removed; intention is to purchase separately.
• Relief is calculated using a model of 15.8% of FTEs (based on 15 vacation days, 10 sick days, 13 holidays, 3 training days). Formula currently under review.
• The tax and fringe and indirect administrative allocation percentages reflect measures of central tendency from FY09 UFR data and are consistent with STARR.
• Estimated cost adjustment factor (Source: HIS Global Insights Massachusetts CPI Forecast-Spring 2010) is applied to account for inflation between the FY09 base year and the two year prospective rate period through FY 13. Subject to update.
Number of Beds: 12 Days: 365 Bed Days: 4,380
FTE Expense %Direct Management 2.00 11%Medical and Clincial
Nursing (RN non-masters) 0.25 2%Direct Care
Case Worker / Manager (MA) 1.00 4% Direct Care Staff 11.90 35% Relief 1.88 6%Support
Prog Secretarial / Clerical 0.50 1%Sub-Total Direct Care Staff 17.53 59%
FactorTaxes & Fringe 22.44% 13%
Total Staffing Cost 72%
Occupancy 9%Other Program Expenses 7%
Total Reimbursable Expense, excl admin 89%
Admin. Alloc. (M&G) 12.25% 11%
TOTAL 100%
CAF 5.05%Unit Rate TBD
GROUP HOME 2- 1:4 MODEL
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DRAFT Group Home 3 Model Budget Pre-Independent Living
• All information is currently in draft form and subject to change.
• The model reflects a 1:5 staffing ratio. Number of beds and Direct Care staffing FTEs updated to reflect this ratio.
• Relief is calculated using a model of 15.8% of FTEs (based on 15 vacation days, 10 sick days, 13 holidays, 3 training days). Formula currently under review.
• The tax and fringe and indirect administrative allocation percentages reflect measures of central tendency from FY09 UFR data and are consistent with STARR.
• Estimated cost adjustment factor (Source: HIS Global Insights Massachusetts CPI Forecast-Spring 2010) is applied to account for inflation between the FY09 base year and the two year prospective rate period through FY 13. Subject to update.
Number of Beds: 10 Days: 365 Bed Days: 3,650
FTE Expense %Direct Management 1.00 10%Medical and Clincial
Nursing (RN non-masters) 0.10 1%Direct Care
Case Worker Manager 1.00 7% Direct Care Staff 5.00 28% Relief 0.79 4%Support
Prog Secretarial / Clerical 0.25 1%Sub-Total Direct Care Staff 8.14 52%
FactorTaxes & Fringe 22.44% 12%
Total Staffing Cost 63%
Occupancy 14%Other Program Expenses 12%
Total Reimbursable Expense, excl admin 89%
Admin. Alloc. (M&G) 12.25% 11%
TOTAL 100%
CAF 5.05%Unit Rate TBD
GROUP HOME 3- 1:5 MODEL
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DRAFT Independent LivingModel Budget
• All information is currently in draft form and subject to change.
• FTEs were determined by the Purchasing Agency design team.
• The tax and fringe and indirect administrative allocation percentages reflect measures of central tendency from FY09 UFR data and are consistent with STARR.
• Estimated cost adjustment factor (Source: HIS Global Insights Massachusetts CPI Forecast-Spring 2010) is applied to account for inflation between the FY09 base year and the two year prospective rate period through FY 13. Subject to update.
Number of Beds: 12 Days: 365 Bed Days: 4,380
FTE Expense %Direct Management 1.00 14%Direct Care Case Worker Manager 2.00 20% Prog Secretarial / Clerical 0.25 2%Sub-Total Direct Care Staff 3.25 36%
FactorTaxes & Fringe 22.44% 8%
Total Staffing Cost 44%
Occupancy 25%Other Program Expenses 20%
Total Reimbursable Expense, excl admin 89%
Admin. Alloc. (M&G) 12.25% 11%
TOTAL 100%
CAF 5.05%Unit Rate TBD
INDEPENDENT LIVING MODEL
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DRAFT Teen Parenting Enhanced Model Budget
• All information is currently in draft form and subject to change.
• The model reflects a 1:4 staff ratio.
• FTEs were determined by the Purchasing Agency design team.
• Relief is calculated using a model of 15.8% of FTEs (based on 15 vacation days, 10 sick days, 13 holidays, 3 training days). Formula currently under review.
• The tax and fringe and indirect administrative allocation percentages reflect measures of central tendency from FY11 budget data and are consistent with STARR.
• Estimated cost adjustment factor (Source: HIS Global Insights Massachusetts CPI Forecast-Spring 2010) is applied to account for inflation between the FY11 base year and the two year prospective rate period through FY 13. Subject to update.
Number of Beds: 12 Days: 365 Bed Days: 4,380
FTE Expense %Direct Management 2.00 10%Medical and Clincial Nursing (RN non-masters) 0.25 2%Direct Care Case Worker / Manager (MA) 2.00 7% Direct Care Staff 11.50 33% Relief 1.81 5%Support
Prog Secretarial / Clerical 0.40 1%Sub-Total Direct Care Staff 17.96 59%
FactorTaxes & Fringe 22.44% 13%
Total Staffing Cost 72%
Occupancy 12%Other Program Expenses 6%
Total Reimbursable Expense, excl admin 89%
Admin. Alloc. (M&G) 12.25% 11%
TOTAL 100%
CAF 3.08%Unit Rate TBD
TEEN PARENTING 1- ENHANCED MODEL
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DRAFT Teen Parenting TLP Model Budget
• All information is currently in draft form and subject to change.
• FTEs were determined by the Purchasing Agency design team.
• Relief is calculated using a model of 15.8% of FTEs (based on 15 vacation days, 10 sick days, 13 holidays, 3 training days). Formula currently under review.
• The tax and fringe and indirect administrative allocation percentages reflect measures of central tendency from FY11 budget data and are consistent with STARR.
• Estimated cost adjustment factor (Source: HIS Global Insights Massachusetts CPI Forecast-Spring 2010) is applied to account for inflation between the FY11 base year and the two year prospective rate period through FY 13. Subject to update.
Number of Beds: 12 Days: 365 Bed Days: 4,380
FTE Expense %Direct Management 2.00 13%Medical and Clincial Social Worker LICSW 0.13 1%Direct Care Case Worker Manager 1.00 4% Direct Care Staff 8.50 31% Relief 1.34 5%Support
Prog Secretarial / Clerical 0.25 1%Sub-Total Direct Care Staff 13.22 55%
FactorTaxes & Fringe 22.44% 12%
Total Staffing Cost 67%
Occupancy 15%Other Program Expenses 7%
Total Reimbursable Expense, excl admin 89%
Admin. Alloc. (M&G) 12.25% 11%
TOTAL 100%
CAF 3.08%Unit Rate TBD
TEEN PARENTING 2- TLP MODEL
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DRAFT Teen Parenting House Parent
Model Budget
• All information is currently in draft form and subject to change.
• FTEs were determined by the Purchasing Agency design team.
• Relief is calculated using a model of 15.8% of FTEs (based on 15 vacation days, 10 sick days, 13 holidays, 3 training days). Formula currently under review.
• The tax and fringe and indirect administrative allocation percentages reflect measures of central tendency from FY11 budget data and are consistent with STARR.
• Estimated cost adjustment factor (Source: HIS Global Insights Massachusetts CPI Forecast-Spring 2010) is applied to account for inflation between the FY11 base year and the two year prospective rate period through FY 13. Subject to update.
Number of Beds: 6 Days: 365 Bed Days: 2,190
FTE Expense %Direct Management 1.00 14%Medical and Clincial
Social Worker LICSW 0.13 1%Direct Care
Case Worker Manager 1.00 9% Direct Care Staff 3.20 25% Relief 0.50 4%Sub-Total Direct Care Staff 5.83 53%
FactorTaxes & Fringe 22.44% 12%
Total Staffing Cost 65%
Occupancy 16%Other Program Expenses 8%
Total Reimbursable Expense, excl admin 89%
Admin. Alloc. (M&G) 12.25% 11%
TOTAL 100%
CAF 3.08%Unit Rate TBD
TEEN PARENTING 3- HOUSE PARENT MODEL
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DRAFT Teen Parenting STEP Model Budget
• All information is currently in draft form and subject to change.
• FTEs were determined by the Purchasing Agency design team.
• Relief is calculated using a model of 15.8% of FTEs (based on 15 vacation days, 10 sick days, 13 holidays, 3 training days). Formula currently under review.
• The tax and fringe and indirect administrative allocation percentages reflect measures of central tendency from FY11 budget data and are consistent with STARR.
• Estimated cost adjustment factor (Source: HIS Global Insights Massachusetts CPI Forecast-Spring 2010) is applied to account for inflation between the FY11 base year and the two year prospective rate period through FY 13. Subject to update.
Number of Beds: 4 Days: 365 Bed Days: 1,460
FTE Expense %Direct Management 0.20 8%Direct Care
Case Worker Manager 1.00 28%Sub-Total Direct Care Staff 1.20 36%
FactorTaxes & Fringe 22.44% 8%
Total Staffing Cost 44%
Occupancy 31%Other Program Expenses 14%
Total Reimbursable Expense, excl admin 89%
Admin. Alloc. (M&G) 12.25% 11%
TOTAL 100%
CAF 3.08%Unit Rate TBD
TEEN PARENTING 4- STEP MODEL
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DRAFT Continuum Wrap Model:
• FTEs were determined by the Purchasing Agency design team.• Relief formula currently under review.• Wrap model has no residential component built in – will add based on selection of appropriate residential models.
Number of Slots: 18 Days: 365 Slot-Days: 6,570
FTEDirect Management 1.75Medical and Clincial
Physician/Psychiatrist 0.10 Occupational Therapist 0.50Direct Care
Case Worker / Manager (MA) 3.00 Direct Care Staff 4.50Support
Prog Secretarial / Clerical 0.25Sub-Total Direct Care Staff 10.10
CONTINUUM MODEL - WRAP
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Potential Adjustments to Rates
Offset:• Department of Education Nutrition Funding
Proposing a standard off-set built into rate for models where resource is available:STARRGroup Home 1:3 Group Home 1:4
Will adjust for <100% eligibility and associated administrative functions
• Housing Vouchers for certain Teen Parenting programs
Additional Modeling:• Staff travel to maintain community connections• CIRT• Specialized/Outlier Programs• Utilization Factors to be applied
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Procurement and Rate Setting RegulatoryTimeline
Summer 2011Spring 2011Summer 2010 Fall 2010 Winter 2011
RFR Development, Review, and ApprovalResponse Evaluation,
Recommendations, and Selection
RFR Posting and Response
Cost Analysis
Agency Review
EHS/ANF Review & Approval Public Hearing
RatesAdopted Rates Effective
Provider Sessions and Feedback
Rate Options Development
Contract Execution
DCF/DMH plans to issue RFR in February for contracts effective on July 1, 2011
POS rate regulations will be adopted in mid winter 2011, but will not be effective until contracts are executed in July 2011.