Central Florida Behavioral Health Network

Central FloridaBehavioral Health Network

“Achieving the dreamenvisioned in

single management strategies.”

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Why is the network initiative important?

Networks will be the lead entities for: Innovation Collaboration and care integration Contracting Purchasing of mental health and substance abuse

services.

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CSAT Technical Assistance Report to FloridaJanuary, 2000

Comprehensive continuation of accessible quality services in the most appropriate environment

Regulatory oversight of treatment system that ensures appropriate clinical care provided consistently and with prevailing standards

Training for personnel

Treatment system includes clinical assessment, individualized service planning, referral, progress review and follow-up

How it started…

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Characteristics and Featuresof a Well-Organized System of Care(From CSAT Technical Assistance Report to Florida – January, 2000)

Services are organized into a simple network of careNetwork services are available through multiple single entry pointsFormal linkages exist between mental health, substance abuse and primary careLocal networks are responsible for coordination of client servicesCase managers are identified to coordinate careServices are community-basedPrevention and intervention strategies are clearly definedStakeholders have direct input

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Characteristics and Featuresof a Well-Organized System of Care(From CSAT Technical Assistance Report to Florida – January, 2000)

Treatment available upon demand for special populations (pregnant women, IV drug users, individuals in family protection, dually-diagnosed, SPMI, etc.)

Individualized, client-centered and flexible programs

Flexible funding strategies, including fee for service and prospective payment mechanisms

Network-wide utilization management

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Florida Legislature passed SB1258 to meetthe service delivery needs for:

Control Costs Admission/Discharge with State

Hospitals Disseminate Data for Planning

Purposes Special ALF Services Reduction of Kids in Residential

Care Services to Kids under Court

Orders

Accountability Continuity of Care Early Diagnosis & TX Assess Local Needs Quality/Best Practices Cross – System Integration Creative Financing

Florida’s response…

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Service Delivery Goals 1258

Coordination, Integration & Management DCF/MH/SA and AHCA/Medicaid Unit Cost Contracting & Fee-For-Service Risk-Sharing Arrangements Managing Entities – Public/Private Promote Flexibility & Responsiveness Expand Waivers, Maximize Federal $$$, New

Procedure Codes or Certified Match

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Florida Legislature expanded the goals ofSB1258 with the passage of SB2404 in 2003which:

Creates the Substance Abuse and Mental Health Corporation Responsible for oversight of publicly funded substance abuse and

mental health systems, including marking policy and resource recommendations.

Requires DCF and AHCA to ensure Medicaid and Department funded services are delivered in a coordinated manner, using common service definitions, standards and accountability mechanisms.

Requires corporation to conduct annual evaluation and report the status of publicly funded mental health and substance abuse systems to Legislature.

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Amendment toChapter 394.9082

Provides direction for FMHI to continue the evaluation of strategies in SB1258 and SB2404 pilot projects

Requires report by December 31, 2006 that includes target dates for state-wide implementation

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Amendment to Chapter 409.912(Relating to Mandatory Medicaid Managed Care Enrollment)

Directs AHCA to work with DCF to ensure children and families in child protection system have access to mental health and substance abuse services.

Directs AHCA to seek Federal approval to contract with single management entities for all behavioral health services for Medicaid recipients in an AHCA area.

Directs AHCA and DCF to collaborate to jointly develop all policy, budgets, procurement procedures, contracts and monitoring plans for behavioral health and targeted case management programs.

Requires AHCA and DCF to contract with managed care entities or arrange to utilize capitated pre-paid arrangement for all inpatient and outpatient behavioral health services to all Medicaid recipients by 07/01/06.

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Specifies that in AHCA areas with less than 150,000 Medicaid eligible clients, AHCA must contract with a single managed care plan; in areas over 150,000 Medicaid eligible clients, AHCA may contract with more than one plan.

– Contracts must be competitively procured.– Both for-profit and not-for-profit entities are eligible to compete

Requires AHCA to submit a plan by October 1, 2003 providing full implementation of capitated behavioral health throughout the State.

– Plan must include provisions ensuring service accessibility for children and families in the child welfare and/or foster care system.

– Plan must include participation of community-based care lead agencies, community alliances, Sheriff’s Department and providers serving dependent children.

Requires implementation to begin in 2003 in areas of the State that are able to establish sufficient capitation rates.

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Allows AHCA to adjust capitation rates in any one area as necessary.

Directs AHCA to develop policies and procedures to allow for certification of local and state funds.

Excludes children residing in inpatient and DCF residential programs (BHOS) from enrollment into pre-paid plans.

Requires existing child welfare providers under contract with DCF be offered the opportunity to participate in any provider network for pre-paid behavioral health services.

Requires AHCA and DCF to develop a plan for new procedure codes for emergency and crisis care, supportive residential services and other services designed to maximize use of Medicaid funds for recipients needs.

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Network Administration

What is a Network?– Two or more agencies with a formal agreement to

manage or deliver behavioral health services. What is the purpose of a Network?

– Improve access to care– Improve quality– Improve efficiency and effectiveness– Assist providers/members

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Unique Features ofCommunity-Based Networks

Strengths Community governance and oversight Shared risk with providers Comprehensive service delivery and ability to

provide integrated services Consumer involvement Community re-investment Coordination with collateral systems Opportunity for gradual transition

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Unique Features ofCommunity-Based Networks

Vulnerabilities Historical preservationists

- May be slow to change practice standards- May be difficult to move from program-focused planning to

person-focused planning

Lack of capacity for utilization management, $$ required for IS development and capitation risk pools, RFP grant response/marketing, provider accreditation, administrative capabilities

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Not-for-Profit Provider-Sponsored Networks

Services are based on needs of persons served and stakeholders

Demonstrated opportunity for consumer choice

Timely services

Services are culturally sensitive

Mission is communicated and embraced by all members

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A common set of indicators is applied– Access - Efficiency– Effectiveness - Consumer satisfaction

Indicators are used for quality improvement, performance assessment and corrective actions

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Individual provider and aggregate performance outcomes

Review of service patterns

Utilization of data to improve efficiency, effectiveness and customer satisfaction

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Coordination of a system of care for a person receiving services from more than one provider or levels/types of care includes: Planning of individual services Delivery of services Evaluation of services Service review and revision as needed Formal information sharing process

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A prerequisite for membership in the Network is a demonstrated commitment to and the history of client advocacy and collaborative practice.

Non-profit providers Contracts with the State SAMH Program Office Medicaid provider

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Accreditation, licensing, certification

Fiscal stability and responsibility

Commitment to community-based care principles– Commitment to consumer choice– Rehabilitative principles of care

Ability to provide access to treatment

Ability to deliver service

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Network Benefits

Examples of benefits the Network strives to offer include:

Enhancement of core competencies Ability to share administrative functions and associated costs Improved continuity of care Improved linkages with non-ADM services Development of best practices Maximization of revenues Joint marketing efforts Stronger advocacy efforts Ability to shift contract funds between providers Shared knowledge

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Core Administrative Functions

Provider network management Strategic planning Customer services Quality management Utilization management Financial management Information management

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Provider Network Management

Planning and identifying network components– Defining continuum of care- Community planning– Determination of type, number and provider qualifications

Selection of providers/networks– Open or competitive bidding - Selection criteria– Evaluation - Approval process

Credentialing– Documentation of licensure - Accreditation– Professional credentialing

Management of provider network– Communication - Community input– Assessment of continuum of care– Training and technical assistance

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Strategic Planning

Annual review of:– Services– Utilization data– Access standard– Outcomes

Gap analysis Needs assessment Member satisfaction Provider input

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Customer Services

Customer relations– Board members - Providers– Consumers - Funding sources– Advocacy groups - Community stakeholders– State/local agencies

Members– Benefits and services - Member advocacy– Rights and responsibilities - Grievances and appeals

Coordination with other systems– Child welfare - Education– Juvenile justice - Corrections– Health c are

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Leadership commitment– Accreditation– Board structure and management

Quality management goals– Focus on persons served

Enhance access and quality of behavioral health services– Improve coordination of care within geographic areas– Promote effective, efficient and economical use of resources

Quality Assurance, Continuous Quality Improvement, Performance Improvement

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Quality Improvement Committee– Comprised of QI personnel from all providers

Performance improvement reviews– Case file review– Medical record review– Customer survey– Data/outcomes review– Service validation review

Performance measures– State mandated outcomes– High risk– High volume– Problem prone

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Quality assurance– Continuous quality improvement– Performance improvement– Utilization review– Risk management

Data driven– What, how, when to measure– How to use what is measured– Is system in management tool for improving quality

Treatment– Screening/assessment– Placement criteria– Continuing care criteria– Services individualized to client’s need/client driven– Continuums of care– Alignment of resources and utilization

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Prior authorization– Define covered services requiring prior authorization– Medical necessity– Lead restrictive level of care

Concurrent review– Continued medical necessity– Level of care appropriate– Continued stay criteria

Retrospective review– Emergency admissions– Sample of cases to establish provider profile

Reviews decrease with provider readiness

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Financial Management

Regulatory compliance– Legal– Contract– Grants management

Accounting– Safeguard assets– Monthly, quarterly and annual financial statements– Surplus/deficit and provider utilization reports– Annual budgets and forecasts

Integration of clinical and financial data– Cost analysis– Clinical analysis– Rate setting

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Members tracking

Utilization management

Claims

Quality

- Enrollment/eligibility- Admission/authorization- Continued stay- “Seamless” care across levels of care and

providers- Integration of assessments and

treatment planning

- Aggregate reporting- Utilization

- Billing, processing, reconciliation

- Provider performance- Reporting- Outcomes analyses- Utilization analyses


Information Management

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Revenue Maximization

Develop and define services to be covered Reimbursement consistent with level of service and cost to

provide service Payment methodologies

– FFS, capitation, rates, unit cost, case rates, etc. Use of multiple revenue streams to support treatment

– TANF– Medicaid– Private insurance– Corrections– General revenue

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Transition Planning for Networks

Planning Process

Significant changes to the management and financing of systems of care require careful planning

Changes should be implemented in stages over time

Transition planning team is focal point for identifying issues and developing detailed implementation strategies

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Current System

Performance Based/Unit Cost/Cost Center-based ADM Contracts

TANF system with cumbersome and expensive administrative requirements.

CFBHN subcontracts with providers on same basis.

Complicated and expensive billing and data systems.

Delays in receipt of funds.

Interim System

Contracts based on OCA categories for identified number of persons to be served (similar to District 1 Prepaid Aggregate Fixed Sum Contract)

Payment on 1st day of month, actual advance funding.

Reconciliation based simply on number of persons served.

Utilize PIDS Manual and DCF Guide to SB1258 Contracting for ADM Services

Ideal System

Risk or shared risk-based or other types of contracts based on valid actuarial data and models.

Permit subcontracts to be on risk or shared-risk basis, case rate or other strategies to be developed.

If indicated, utilize profit and loss risk corridors.

Current System

Program Monitoring by ADM and CFBHN

Administrative and contract monitoring by CPU, ADM and CFBHN

Licensure monitoring by ADM and AHCA

Medicaid compliance by AHCA

CPA Audits

Accreditation for most providers

Interim System

Use accreditation in lieu of monitoring as described in SB1258 (Ch394)

CFBHN performs interim monitoring as described in SB1258 (Ch394)

ADM and CPU review CFBHN’s monitoring reports

Utilize CPA audits to replace certain items in the monitoring instruments

Develop process to redefine/reduce items to be monitored

Ideal System

Accreditation for all providers and networks

Move from system that focuses on monitoring to one that focuses on leadership & management development, development of organizational competencies, refinement of quality and performance improvement strategies and practices, best practices, improvements to system integration, and staff training and development

Development of legislative budget requests jointly by CFBHN and ADM/DCF based upon identified needs of Suncoast Region.

Current System

IDS, HomeSafeNet, etc.

Data validity problems, some of which are based on matching services to enrollments

Lack of timely mechanisms to correct inefficiencies and problems

Limited utility of database by providers

Interim System

Suncoast and CFBHN become additional demonstration project for PIDS, currently be developed and implemented in District 1

Would include participation in Unity One system and ability to access other state data systems

Ideal System

The ideal integrated database (s) has yet to be defined, but at a minimum it should eliminate all double or triple entries. It (they) should be efficient to use and effective for the state, CFBHN and subcontractors

Transition Planning for NetworksContract Financing

Management, Monitoring and Oversight

Data Collection and Reporting

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Transition Planning Team Consistsof Three Separate Teams

Regional TransitionPlanning Team

ContractDevelopment

Team

MIS & DataTeam

System ofCare Team

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Transition Planning TeamAt a minimum, team consists of representatives of the following parties and other appointed by team.

DCF SAMH Program Office DCF Contract Manager ASO Provider Network representative/Board member Representative from AHCA and any prepaid plan, if

established Representative from community-based care agency Consumer representative Ad hoc representation from identified stakeholders as

required

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Transition Planning TeamMIS & Data Team

Responsible for analyzing all data and management information issues

Provides data need by Contract Development Team for preparation of the contract

Includes representatives from State MIS, ASO, providers, Regional SAMH Program Office, system consultant

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Transition Planning TeamContract Development Team

Addresses the changes to the contract between the Department and the Network’s ASO

Development of prepaid, fixed sum or risk-based contract

Development of provider contract requirements– Incorporates provider application process– Incorporates provider credentialing process– Incorporates recommendations from MIS and System of Care

Teams

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Transition Planning TeamSystem of Care Team

Addresses the array of services to be provided

Addresses access to care requirements

Addresses clinical protocols, clinical pathways, etc.

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Central FloridaBehavioral Health Network

CFBHN is a not-for-profit network of community

providers incorporated to ensure and enhance an

array of behavioral health and other human

service needs for the citizens of our community.

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CurrentOrganizational Capacity

The mission, values and principles ensure highly-effective, family-focused services are provided in a fiscally sound manner

A provider-sponsored network that has demonstrated commitment to and treatment of client advocacy and collaborative practice

Encourages network membership and provider development in a manner that is representative of both geographic and specific service needs of clients and their families

Currently provides the following services for five major funders:

– Administrative services

– Systems and network development

– Quality oversight

– Training, education and clinical development

Serves over 6000 clients annually, has 19 member agencies and 28 service providers under contract

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Network Goals

Provide identified regions in the state with a well-managed and

integrated behavioral health delivery system to:

Increase access to care

Improve continuity of care to vulnerable populations

Prevent duplication of effort

Reward efficiencies

Encourage exemplary practices

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Organizational Structure

In May, 2002 Bylaws revised to reflect significant changes in the organizational leadership and Board structure

Changes implemented to meet the Network’s need for the Board to be more representative of the expanded geographic area

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Organizational Structure

Board President represents substance abuse agencies

President Elect represents mental health agencies

The two offices rotate annually between substance abuse and mental health systems to ensure both areas are adequately represented

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Executive Committee

Executive Committee is comprised of the President, President Elect and one representative selected by each of the four designated Network regional councils

The four regional councils include:– Hillsborough County– Pinellas/Pasco Counties– South Region (Manatee, Sarasota and DeSoto

Counties)– District 14 (Highlands, Hardee and Polk Counties)

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Regional CouncilResponsibilities

Nominate Executive Committee regional representative

Design and coordinate a localized system of care for each business activity identified for that region

Establish and maintain local planning forums of members, vendors, stakeholders and partners to formulate and articulate services delivery strategies and plans for inclusion in the Corporate Business Plan

Develop and implement regional business plans

Facilitate the implementation of behavioral health services that are responsive to the needs and institutions of their respective communities

Develop vendor recommendations

PINE

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Inclusiveness & Provider Relations

Communities, funders, persons served and providers are integral partners in the design, evaluation and support of the Network’s services and service delivery structure

CFBHN is a provider-sponsored network striving to meet the needs of its members by providing outstanding services and value-added benefits that clearly demonstrate the advantages of membership

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Network Membership

ACTS Boley Center for Behavioral

Health Care Centre for Women Coastal Recovery Center Directions for Mental Health DACCO First Step of Sarasota Gulf Coast Community Care The Harbor Behavioral

Healthcare Institute Human Services Associates

Manatee Glens Mental Health Care Northside Mental Health

Center Operation PAR Peace River Center PEMHS Suncoast Center for

Community Mental Health Tri-County Human Services Winter Haven Hospital

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TANF

Provide management and oversight for all ADM TANF-funded services throughout the Region and District 14 Co-location of outreach at One-Stop centers in some child welfare community-

based care lead agencies Partner with Family Safety/diversion clients Partner to provide Dependency Court services Service provider for Welfare-to-Work/Hillsborough County Workforce Board Contract with Workforce Development Lead Agencies to provide support and

outreach Enhance supportive employment opportunities throughout Network area Collaborate with the Spring for domestic violence outreach Manage funds throughout the Suncoast Region and District 14 17 agencies provide services Allow full utilization of benefits for TANF-eligible persons

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Co-Occurring

2001 Project to develop capacity of mental health and substance abuse agencies to treat persons with co-occurring disorders

Federal SAMHSA Grant – Center for Mental Health Services (CMHS) Community Action Grant on co-occurring disorders

2002 New GP Wood funding to Network to implement community action plan for integration of services for persons with co-occurring disorders

Agency action plans Goals for additional resources Systems integration and development Research capability and agreement to share information with

Florida Health Partners

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Co-Occurring

2003 - Systems Coordinator works with providers to “move”

action plans- Funding to agencies to enhance co-occurring services- Co-occurring capability for all Family Intervention

services- Expansion of model throughout Network

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Family Safety

Mental health dollars targeted to community-based care needs

Additional resources for intervention with caretakers and reunification with clinical support to co-locate staff

Additional resources for adoption stabilization needs, clinical support and co-location of staff

Specialty services for abused children

Family Intervention services co-located throughout Suncoast Region and District 14

Dependency Court services in District 14

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Family Safety

Assist in level of care decisions Specialty network developed for HKI for:

– Psychological evaluations– Domestic violence evaluations– Parenting classes

8 agencies participating with HKI

6 agencies participating with the Partnership for Safe Children

Pilot diversionary program developed for Sarasota Family YMCA

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Bibliography

Network Development, Thomas E. Lucking, Ed.S.,Lucking Consulting, [email protected]

Brave New World of Managed Care, National Council for Community Behavioral Health Care, Troy Baily, Neal Cash, Colette Croze, Jeff Jorde

Administration & Policy in Mental Health, Volume 29, Number 1, September, 2001

CSAT Technical Assistance Report, January, 2000

OPPAGA Report, 2001

mailto:[email protected]

Health & Medicine

Central Florida Behavioral Health Network