ABH Principles of CBFS Rate Development

1. ABH Principles ofCBFS Rate Development August 5, 2013

2. CBFS Rate Development Process • Complex process – both the ABH CBFS Policy and Services Committees have attempted to use different methodologies to develop a framework for the establishment of rates • This planning document establishes principles for developing rates for the two CBFS contract components: • congregate living settings • team service delivery • To maximize service flexibility, ABH proposes that CBFS contracts would be comprised of a blended unit rate of these two components ABH Principles of CBFS Rate Development - August 5, 2013

3. Key Points • ABH supports and embraces the CBFS core services description outlined in the DMH RFR issued on December 18, 2008 • We support the ongoing transformation of DMH’s adult community-based system of care into one that embraces the values of recovery and resiliency, with emphasis on rehabilitation and person-centered care • As stated in the RFR, ABH supports the DMH tenet that each CBFS provider has the responsibility and authority for making decisions about utilization, resource allocations and service delivery in order to meet the Department’s goals • The ability to use CBFS funding flexibly to meet the individual needs of persons served is one of the strengths of this service ABH Principles of CBFS Rate Development - August 5, 2013

4. CBFS Congregate Living Setting Component • ABH proposes that the previously-established methodology used by EOHHS to develop Chapter 257 rates for other congregate living settings be adopted to address CBFS congregate living staff and non-personnel costs. We applaud EOHHS and CHIA leadership which has built rates based on realistic assumptions for: • Actual occupancy costs • Direct service and direct service specialty staff costs • Direct care relief costs • Fringe rates ABH Principles of CBFS Rate Development - August 5, 2013

5. ABH proposes adopting a similar framework previously established by EOHHS to develop Chapter 257 rates for other congregate living settings (based on capacity, staff:client ratios and special needs) for residential programs with distinct categories, such as: • Basic • Intermediate • Medical • Specialty ABH Principles of CBFS Rate Development - August 5, 2013

6. CBFS Team Service Delivery Component • ABH proposes that our Typical Team Profile for staffing and non-personnel costs be considered to ensure that CBFS services are optimally designed to meet the needs of persons served by each team • It is important to note that a CBFS team staffing pattern may vary from the Typical Team Profile based on the unique needs of the individuals served and additional or specialty staffing required to meet those needs • The Typical Team Profile staffing pattern and costs are based on a CBFS team providing servicesto 100 individuals with a wide range of needs for rehabilitation, support, supervision, housing/room and board, supported employment (IPS), health promotion activities, care coordination and peer support • Salary costs would be based on comparable state positions • Team resources would be pro-rated based on the number of people served by a CBFS contract ABH Principles of CBFS Rate Development - August 5, 2013

7. Team staffing patterns were designed: • To ensure that the core services identified in the RFR would be implemented to meet the CBFS contract goals • To ensure that the use of evidence-based and evidence-informed practices were incorporated into service delivery to address individuals’ needs and achieve quality outcomes. These include practices such as Motivational Interviewing, Illness Management and Recovery, Dialectical Behavior Therapy (DBT), Cognitive Behavioral Therapy (CBT), Individual Placement and Support (IPS), and Integrated Dual Diagnosis Treatment ABH Principles of CBFS Rate Development - August 5, 2013

8. ABH Principles of CBFS Rate Development - August 5, 2013

9. ABH Principles of CBFS Rate Development - August 5, 2013

10. ABH Principles of CBFS Rate Development - August 5, 2013

11. Reimbursement Rate • Consistent with the RFR, ABH supports the Department’s requirement that providers be compensated for CBFS services rendered on a unit rate basis • ABH proposes that the congregate living staff and non-personnel costs be combined with the teamservice delivery staff and non-personnel costs into a single blended rate for the contract as a whole ABH Principles of CBFS Rate Development - August 5, 2013

12. Contract Implementation • In order to efficiently implement new rates, contracts should be structured in a manner that allow providers flexibility in utilizing funding, and does not require unnecessary re-computation of rates based on changes in a contract’s service composition • ABH supports DMH conducting an annual contract review to ensure that changes within each contract over the prior year such as enrollment volume, housing/congregate living changes, and perhaps the most significant change, that of housing subsidies, are identified and addressed in the following contract year ABH Principles of CBFS Rate Development - August 5, 2013

13. Conclusion • In summary, ABH hopes that these planning principles serve to create a foundation to assist DMH, EOHHS and CHIA in developing CBFS rates under the Chapter 257 process • ABH welcomes the opportunity to continue to work together to establish CBFS rates to achieve optimal outcomes for the people we serve through our CBFS contracts ABH Principles of CBFS Rate Development - August 5, 2013