Transcript Document 7786342

Commonwealth of
Massachusetts
Executive Office of Health and
Human Services
Chapter 257 of the Acts of 2008
Provider Information & Dialogue Session:
Adult Long-Term Residential Service Class
December 14, 2010
www.mass.gov/hhs/chapter257
[email protected]
Agenda
•
Chapter 257 Implementation and Status Update
•
Implementation Strategy
•
Setting Rational Rates
•
Service Classification System
•
Contract Reform
• Overview of Adult Long-Term Residential Service Class
•
Definition and Overview of Department Programs
•
Procurement Approach
•
Timeline for Implementation
• Facilitated Breakout Sessions
• Reporting Back and Concluding Comments
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 to EOHHS for the
development of CH 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
•
Some current rates within the POS system may 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.
Statutory Requirement: Percent of POS System with Regulated
Rates
Spending Base Associated with Statutory Percentage (based on
current projection of $2.1B POS Baseline to be implemented)
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FY10
FY11
FY12
FY13
10%
30%
30%
30%
~ $215M ~ $645M ~ $645M ~ $645M
The Cost Analysis and Rate Setting Effort has
Several Objectives and Challenges
Objectives and Benefits
Pricing Analysis, Rate Development,
Approval, and Hearing Process
• Development of uniform analysis for standard
pricing of common services
Data Sources Identified or
Developed
• 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
Provider Consultation
Cost Analysis & Rate Methods
Development
Provider Consultation
• Transition from “cost reimbursement” to “unit rate”
Challenges
Review/ Approval: Departments,
Secretariat, and Admin & Finance
• Ambitious implementation timeline
• Constrained resources for implementation
• Cross system collaboration and communication
Public Comment and Hearing
• Data availability and integrity (complete/correct)
• Coordination of procurement with rate development
activities
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Possible Revision / Promulgation
Chapter 257 Requires Successful Achievement of
Three Strategies
1. Create Service Classes
• 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
2. Develop Reimbursement
Methodology & Rates
FY09 Develop Implementation
Plan
Develop Service Classes
Cumulative
Service
Statutory
Requirement Value
FY10 10% of System $215M
FY11 40% of System $860M
FY12 70% of System $1.50B
FY13 100% of System $2.15B
• Improved reporting
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3. Reform Contracting
Establish new crossSecretariat organizational
and governance structure
Maximize
• Use of Master
Agreements
• Contracts w/
performance features
• Contracts shared across
departments
Minimize
• Number of different
POS contracts
• Cost reimbursement
contracts
The Chapter 257 Implementation Plan is Organized
by Newly Defined POS Service Classes
Why were Service Classes Created?
• Rate setting and procurement reform require an overall organizing structure for the
classification of POS services
• There were no Secretariat standards for categorizing or describing similar services
within or across Departments. The use and functionality of MMARS codes vary widely
from Department to Department– as a result, it is very difficult to report on the
performance, costs, and volume of services delivered across EOHHS.
How were Service Classes Created?
Working groups met with the EOHHS POS Policy Office
over the course of three months
Departments formed
POS Service
Classification
Working Groups
Current POS
Services
Reviewed,
Described, and
Catalogued
EOHHS
Suggested
Service
Groupings
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Departments
Verified /
Modified and
Developed
Definitions
Current MMARS
Codes were
“Mapped” to New
Service Classes
In Many Cases, Contract Reform is Necessary to
Implement Chapter 257
Today
Providers
Vision for FY13
Providers
Purchasing
Department
Secretariat or
Department
Master
Agreements
Purchasing
Department
Dept
Dept
• By Service Class
Dept
Purchasing
Department
• DHCFP rate
schedules
Dept
Purchasing
Department
• Panel of qualified
providers
Purchasing
Department
• Departments
purchase via rate
agreements
Dept
Dept
Dept
Purchasing
Department
• Thousands of individually negotiated contracts
• Reduced contract complexity and redundancy
• Multiple contracts within and across departments
with the same providers.
• Greater amendment flexibility for providers and
agencies
• Services with core similarities purchased
individually by agencies and regions
• Greater opportunity for provider engagement
• Low capacity for rate management, cross-agency
coordination, performance assessment
• Streamlined, centrally-managed procurement
cycles managed
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Master Agreements Simplify Management of the POS
System for Providers and Departments
•
•
Benefits to Providers
•
Single bidding cycle for similar services
•
Bid once – engage many times under a single bid
•
Standard reporting formats
•
Rate transparency
•
Potential to engage with new purchasing Departments
•
Streamlined contract management
Benefits to EOHHS Departments
•
Reduced procurement burden
•
Potential to expand pool of providers
•
Enable statewide coordination
•
Eliminate multiple procurements for the same service
•
Streamlined contract management
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Master Agreements: Approach, Opportunities, and
Decision Points
POS Contract Reform Goals: Efficiency, simplification,
departmental flexibility and governance authority
Initial
Procurement
Departmental
Selection Process
Contract
Management
Procurement
Management
• Goal: Replace multiple, individually-negotiated and procured contracts with a
single contract model that:
• Maximizes procurement and contract management efficiency for providers and
departments and
• Maintains necessary department decision making and governance authority
• Initial Procurement: EOHHS and Departments will develop the RFR to reflect
current program design(s) unless Departments elect to make changes
• Scope will be sufficiently broad to enable the addition of new service models and
segments over time as needed by departments
• The RFR will have a core of service requirements as well as secondary requirements
specific to the needs of participating departments
• The RFR and response requirements will be simple and streamlined
• Meeting the qualification threshold is not a guarantee that a provider will be selected by a
participating department to deliver services under the MA
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Contract Reform Goals: Administrative Simplification,
Flexibility, Departmental Governance
Departmental Selection Process:
• Once providers are qualified, participating Departments may employ a Departmentlevel selection process to engage any provider from the qualified list based on criteria
determined relevant to that department.
• This procurement will employ the concept of “Consumer Choice”, which will drive the
provider selection process.
Contract Management:
• Departments can elect to use the MA as a rate agreement with or without providerspecific obligations in MMARS.
• Departments encumber and manage their own funds under the MA.
• Ready payment is optional but supported based on a departments choice.
Procurement Management
• MA procurements can reopened as needed to enable new providers to qualify.
• Re-opening may also involve amendment of the procurement to include a new
program model and/or regulated rate schedule.
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Agenda
•
Chapter 257 Implementation and Status Update
•
Implementation Strategy
•
Setting Rational Rates
•
Service Classification System
•
Contract Reform
• Overview of Adult Long-Term Residential Service Class
•
Definition and Overview of Department Programs
•
Procurement Approach
•
Timeline for Implementation
• Facilitated Breakout Sessions
• Reporting Back and Concluding Comments
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Adult Long-Term Residential Service Class
Service Class Definition: Programs that provide individuals a place of overnight housing for a longterm period of time in a specialized residential facility with necessary daily living, physical, social, clinical
and/or medical support. Transition to a less restrictive setting, while ideal, is not a common goal for
individuals receiving services in these settings.
Department
Activity
Code
MMARS Program Name
Percentage Mapped
to Service Class
Spending Mapped
to Service Class
MCB
2143*
Residential Day Services - SR
90%
$7,457,908
MRC
2226*
SHIP - Residential
99%
$19,222,150
3153
24 Hour Residential Services
100%
$522,132,705
3161
Blanket Residential
100%
$4,239,199
DDS
Total Service Class Spending
$553,051,962
*2226 and 2143 services that do not fall under the Adult Long-Term Residential service class will be
reclassified under new activity codes, which MRC and MCB are currently developing.
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The Adult Long-Term Residential Service Class is a
Strong Candidate for Procurement Reform
Why?
•
•
•
Sample of Provider Organizations Under
Contract with Multiple Departments
77% of MRC and 98% of MCB
spending in the Adult Long-Term
Residential Service Class goes to
providers under contract for longterm residential services with DDS
Bridgewell Inc
Brockton Area Multi-Services Inc
Advocates Inc
Each purchasing Department
operates on a different procurement
schedule– a coordinated
procurement would greatly simplify
RFR and contracting processes.
Berkshire County Arc Inc
Community Systems Inc
ServiceNet Inc
Waltham Committee Inc
The activities within this Service
Class share many cost drivers, client
populations, delivery locations, and
intended service outcomes for
residents.
North Suffolk Mental Health Associates
Institute Of Professional Practice
Comprehensive Mental Health
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Planned Timeline for Implementation
Fall 2010
Cost
Analysis
Winter 2011
Rate Options Development
Purch.
Agency
Sign-off
Spring 2011
EHS and ANF Review
and Approval
Summer 2011
Rates Adopted
Public Hearing
Effective
Provider
Sessions and Feedback
RFR Development, Review, and Approval
RFR Posting
and Response
Response Evaluation,
Recommendations, and
Selection
Contract
Execution
Implementation Challenges:
• Alignment with competing agendas and mandates- EOHHS, HCFP and Departments will be working closely
with one another to address the sequencing and coordination issues presented by competing procurement
deadlines, finance law requirements, and reform mandates
• Procurement simplification- EOHHS is working with Departments to minimize the administrative burdens for
joining a secretariat or cross-departmental master agreement, particularly for service providers who have
recently responded to departmental requests for proposals
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Agenda
•
Chapter 257 Implementation and Status Update
•
Implementation Strategy
•
Setting Rational Rates
•
Service Classification System
•
Contract Reform
• Overview of Adult Long-Term Residential Service Class
•
Definition and Overview of Department Programs
•
Procurement Approach
•
Timeline for Implementation
• Facilitated Breakout Sessions
• Reporting Back and Concluding Comments
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Breakout Session Discussion
Questions for Discussion:
How are the programs purchased by different Departments in this Service Class similar to
and different from one another from cost and contracting perspectives?
• What does the spectrum of care look like? What are the different needs of people
involved?
• What are the intended outcomes that service organizations work to achieve? Do these
vary by Department and/or program, site, client need?
• How are programs structured to reach intended outcomes? What activities are clients
involved in during the day, inside and outside the program?
• How do staff positions, professional qualifications, and level of staff intensity necessary
to achieve the intended outcomes vary by purchasing Department? How do residential
sites determine the appropriate type and number of staff for the program?
•
•
How do administrative and reporting requirements vary by Purchasing Department?
What other factors drive program costs and/or present fiscal challenges when providing
these services?
How does geographical region or setting affect program costs (transportation, occupancy,
etc)?
What affects a provider’s ability to receive SNAP, SSI, Section 8 and other offsets to client
costs? What other efficiencies are available or have been used to manage cost growth?
What other information do you think is important to consider when developing these rates?
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