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Local Planning and Network Development (LPND)

Local Planning and Network Development (LPND). 2010 Template Training for LMHAs. General. Aim for concise communication of requested information Use bullet format whenever possible Limit completed plan to 25 pages DSHS will request additional information if needed

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Local Planning and Network Development (LPND)

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  1. Local Planning and Network Development(LPND) 2010 Template Training for LMHAs

  2. General • Aim for concise communication of requested information • Use bullet format whenever possible • Limit completed plan to 25 pages • DSHS will request additional information if needed • Note items that do not require response if an LMHA has no interested providers

  3. Local Service Area

  4. Basic Data • DSHS provides data table in MBOW: 2010 LMHA Area and Population Stats (in the General Warehouse folder)

  5. Major Population Centers • Major population centers provide context for evaluating feasibility of network development • Population center may be a city and/or county • List all counties if the LMHA has a compact service area with even population distribution • Refer to MBOW report for data

  6. Other Significant Information • Use bullets to provide any other significant information that affects service delivery • Include only those characteristics that set your local service area apart from most others • Consider cultural and demographic profile • Be selective

  7. Provider Availability Assessment

  8. Provider Recruitment • List steps taken to identify and recruit providers in past two years • Cycle I procurement • Other efforts to attract providers • Methods used to identify potential providers for Cycle II

  9. Provider Availability • List current contractors, written inquiries, providers listed on DSHS website • Summarize follow-up contact • Describe availability, services offered, and capacity

  10. Local Planning

  11. Guidelines for Community Input • Conduct provider assessment before gathering community input • Scope and focus of input will depend on availability of external providers • Seek guidance on network development based on knowledge of provider availability at the time • Limit content to information specific to network development

  12. Guidelines for Community Input • Local community determines how to develop the network • Ensure stakeholders understand rule’s mandate to expand network when providers are available • Engage stakeholders to develop plan for using available external capacity based on local needs and priorities

  13. Guidelines for Community Input • If you have no interested providers, focus input on other elements of the plan • Reducing barriers to new providers • Potential strategies to attract new providers • Improving choice and access • Note sections of the plan that do not require response if you have no interested providers

  14. Guidelines for Community Input • Use previous plan as the starting point for discussion, including procurement results • Before finalizing plan, review DSHS website to identify any additional providers

  15. Status of Provider Assessment • New providers may be identified after initial provider availability assessment • Decisions for network expansion based on community input and the additional provider information

  16. Community Engagement

  17. Community Engagement • List activities used to gather input • Document participants • Variety of formats may be used: in-person, telephonic, electronic • List surveys and similar activities first • List events in chronological order • Summarize input gained from each activity

  18. PNAC Involvement • PNAC must be actively involved • Reviewing community input and provider availability assessment • Recommending plan content • Reviewing draft plan • Reviewing public comment and response

  19. Provider Network Development

  20. Contract Expenditures

  21. Contract Expenditures • Document expenditures for FY 2009 and the first six months of FY 2010 • Total expenditures includes all service dollars: internal and contract • Separate tables for adult and children’s services • Expenditures broken out by grid category

  22. FY 2010 Provider Contracts • List current contractors and services provided • Indicate organization vs. individual practitioner • State dollars allocated: • total contract amount • any cap on billing under open enrollment (per provider or for all external providers)

  23. Network Development

  24. Network Development • Presents past, current, and planned procurement in one table • Separate tables for service packages and discrete services • Leave cells blank if NA or 0% • Enter service package capacity even if service packages not targeted for contract

  25. Network Development • Column A: Document current capacity for all service packages • Use footnote if projected capacity differs significantly • Determine capacity using MBOW report: PM Service Target LPND (Utilization Management: UM Service Delivery: PM Service Target LPND)

  26. Past and Current Contracting • Column B: Percent capacity contracted in 2009 (maximum possible) • Column C: Percent capacity served by contractors in 2009 (actual) • Column D: Percent current capacity contracted for 2010 (maximum) • Column E: Percent capacity served in first six months of 2010 (use 6 month figures in numerator and denominator)

  27. Planned SP Procurement • Columns F and G: Enter percent of SP capacity to be procured in 2010 and 2011 • Separate columns allow phased procurement • Leave blank if only discrete services will be procured • Column H: Available providers according to provider assessment

  28. Planned SP Procurement • Column I: Enter applicable condition to justify the level of service the LMHA will continue to provide • Conditions defined by the rule • Include all conditions that apply • Enter NA if 100% to be procured

  29. Condition 1 • Willing and qualified provider are not available. • No providers expressed interest. • Interested providers clearly not qualified. • One or more providers expressed interest on website, but follow-up discussion clarifies lack of interest in providing complete service package.

  30. Condition 2 • The external network does not provide minimum levels of consumer choice. • Use this condition if only one external provider is interested in contracting with the LMHA

  31. Condition 3 • The external network does not provide equivalent access to services. • Use this condition if access is the only reason the LMHA will not use all of the available external capacity. • Applicability of this condition will probably be made after procurement.

  32. Condition 4 • The external network does not provide sufficient capacity. • Use this condition if the LMHA will use all of the available external provider capacity and directly provide the balance of current capacity.

  33. Condition 5 • Critical infrastructure must be preserved during a period of transition. • Use this condition if the LMHA will not use all of the available external provider capacity. • This allows the LMHA to plan a phased transition to full utilization of external provider capacity, increasing the volume of contracted services over two or more planning cycles.

  34. Condition 6 • Existing agreements restrict LMHA’s ability to contract services OR • Under existing circumstances, LMHAs would lose substantial revenue if service contracted to external providers

  35. Procuring Discrete Services • Enter discrete or crisis services with past and or current contracting, or planned procurement • Current service capacity is average monthly capacity based on service data from FY 2009 and FY 2010 through most recent closed quarter • Express capacity as units of service delivered

  36. Rationale for LMHA Service Delivery • Describe overall rationale for: • Services selected for procurement • Volume to be procured • Services not selected for procurement • Discuss adults and children/adolescents separately • Certain conditions require additional information

  37. Rationale for Condition 3 • Condition 3: Network does not provide equivalent access • Describe basis for determination • Identify source of data • Maintain supporting documentation

  38. Rationale for Condition 4 • Condition 4: Network does not provide sufficient capacity • Capacity needed • External provider capacity (based on provider assessment) • Information and method used to determine external network capacity

  39. Rationale for Condition 5 • Condition 5: Protection of critical infrastructure • Planned transition period • Year in which LMHA anticipates procuring the full external provider capacity currently available • Only one entry is required if the same transition period planned for all services

  40. Rationale for Condition 6 • Existing agreements restrict procurement or procurement would result in substantial revenue loss • Describe each agreement or circumstance • Note agreement end date • Describe any steps taken to amend agreements or alter circumstances

  41. Rationale for Volume to Preserve Financial Viability • Applicable only if the specified volume is due to the need to preserve financial viability • Related to economies of scale • Consider ability to share resources with other services • Explain budget rationale • Maintain supporting documentation

  42. Strategies to Protect Critical Infrastructure • Describe strategies to protect critical infrastructure and promote a stable, successful provider network • LANAC compiled list of possible strategies (will be posted on DSHS website when finalized) • Provider education and support • Appropriate standards and oversight • Advance arrangements to rebuild lost capacity

  43. Time to Re-establish Lost Service Capacity • List services separately if time varies • Consider use of external providers • Discuss external provider ability and willingness to expand capacity during provider availability assessment

  44. Procurement

  45. Structure of Procurement

  46. Structure of Procurement • Identify geographic area and percent of clients living in the area • Rationale must address: • Method of procurement • Procurement of discrete services • Bundling of services or service packages • Service area (entire service area vs. selected counties, choice of counties)

  47. Fidelity and Continuity of Care • Rule prefers procurement of service packages to preserve continuity of care and fidelity • If discrete services will be procured, present plan to preserve fidelity, avoid fragmentation and promote seamless service delivery • Address complications of multiple providers and multiple service locations, as applicable

  48. Enhanced Staff Qualifications • Complete only if you require an individual practitioner type to meet qualifications that exceed the DSHS requirements

  49. Consumer Choice

  50. Single Provider • Identify services to have only one provider and rationale (economic factors or other) • Single provider services do not default to LMHA • Enter NA if no interested providers

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