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Chapter 257 of the Acts of 2008 Stakeholder and Provider Engagement Session:

Chapter 257 of the Acts of 2008 Stakeholder and Provider Engagement Session: Community Based Flexible Supports August 5, 2013 www.mass.gov/hhs/chapter257 eohhspospolicyoffice@state.ma.us. Agenda. Chapter 257 of the Acts of 2008 Review of Pricing Analysis and Methodologies

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Chapter 257 of the Acts of 2008 Stakeholder and Provider Engagement Session:

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  1. Chapter 257 of the Acts of 2008 Stakeholder and Provider Engagement Session: Community Based Flexible Supports August 5, 2013 www.mass.gov/hhs/chapter257 eohhspospolicyoffice@state.ma.us

  2. Agenda • Chapter 257 of the Acts of 2008 • Review of Pricing Analysis and Methodologies • Community Based Flexible Supports (CBFS) service class definition • Stakeholder Discussion • Encounter & Housing Surveys • Key Inputs for a successful CBFS • CBFS Core Services • Association for Behavioral Health (ABH) Presentation • CBFS Case Mix: Impact of Enrollment and Dis-enrollment • Enrollment/Disenrollment Data • Timeline and Key Milestones • Regional Dialogue Sessions

  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 Center for Health Information and Analysis (CHIA) 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 • 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.

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

  5. Community Based Flexible Supports • Service Class Definition: • In-Home Basic Living and Personal Care Supports, Training and Skills Development: Programs that provide individuals and/or families daily living support and/or basic living skills & training to promote health, safety, community integration, and self-sufficiency to allow individuals to live as independently as possible at the individual’s place of residence. • and • Adult Intermediate-Term Transitional Residential: Programs that provide individuals a place of overnight housing in a residential or hospital setting in order to enable and empower the individual to transition to a less restrictive, community-based residential, or own-home setting. Programs provide a variety of supports to promote health, safety, community integration, employment, and self-sufficiency. • Service Class Background: DMH has 44 contracts with contract specific rates.

  6. Community Based Flexible Supports Proposed Timeline May 2013 Survey Results Contract Data Summer 2013 Model Development Rate considerations Input and Questions Regional Dialogues Fall 2013 Incorporating Stakeholder Input October 2013 Rates shared with public November 2013 Winter 2014 CBFS Pricing Analysis, Rate Development, Approval, and Hearing Process Data Sources Identified or Developed Provider & Interested Stakeholder Consultations Cost Analysis & Rate Methods Development Review/ Approval: Departments, Secretariat, and Admin & Finance Public Comment and Hearing Possible Revision / Promulgation

  7. Community Based Flexible Supports:Encounter & Housing Surveys • An Encounter Survey was conducted to study of the number and types of clients in CBFS received over a two week period. • 100% of CBFS providers responded to the survey and reported data on 11,507 clients (over 95%). • A Housing Survey was conducted to gather FY 2012 cost data on residential sites that provide CBFS services • All 19 contracted providers responded to the survey, representing 461 sites and 3,613 beds across Massachusetts More information and results from the surveys can be found in the CBFS Provider Engagement Session presentation dated July 22, 2013, which is posted on the Chapter 257 website: www.mass.gov/hhs/chapter257

  8. Community Based Flexible Supports:Stakeholder Discussion • What are the key inputs (staffing, supports, etc.) for a successful CBFS program? • How does your agency define the ‘core services’ of a CBFS? • What has been your agency’s experience with enrollment of new people in CBFS? • How have these enrollments impacted your agency’s case-mix? • What has been your agency’s experience with dis-enrollment?

  9. Community Based Flexible Supports:Stakeholder Discussion CBFS Key Inputs (Staff/Supports)& Core Services ABH Presentation

  10. Community Based Flexible Supports:Stakeholder Discussion CBFS Case Mix: Impact of Enrollment and Dis-enrollment

  11. Community Based Flexible Supports:Enrollment/Disenrollment Data In the previous provider session, we heard feedback regarding the volume of enrollment/disenrollment of clients. The following slides display analysis of enrollment and disenrollment data by quarter for Fiscal Year 2013.

  12. Community Based Flexible Supports:Disenrollment Data

  13. Community Based Flexible Supports:Disenrollment Data

  14. Community Based Flexible Supports:Disenrollment Data The majority of people who disenroll from CBFS are receiving CBFS for one year or more.

  15. Community Based Flexible Supports:Enrollment/Disenrollment Data

  16. Community Based Flexible Supports:Enrollment/Disenrollment Data Data shows that the rate of enrollment and disenrollment from CBFS is relatively consistent.

  17. Community Based Flexible Supports:Regional Meetings – Save the Date These meetings are intended to encourage participation and input of clients served and interested parties, regarding CBFS core services and programs. • More information regarding location and time will be posted on C257 website and CommPass as available. • At least two of these sessions will be held in the evening to accommodate those who are unable to attend the day sessions.

  18. Community Based Flexible Supports:Next Steps Next Stakeholder and Provider Engagement Session to be held: Monday, September 30, 2013 Worcester Recovery Center and Hospital 9:30am-11:30am The meeting notice will be Posted on Chapter 257 website tomorrow, August 6, 2013: www.mass.gov/hhs/chapter257 Comments and questions regarding Chapter 257 process can be sent to: EOHHSPOSPolicyOffice@state.ma.us

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