2015 BUSINESS AND SERVICES MANAGEMENT NETWORK PROGRAM DESCRIPTIONS

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1 2015 BUSINESS AND SERVICES MANAGEMENT NETWORK PROGRAM DESCRIPTIONS Contents N etwork... 2 Business Network... 3 Services Management Network... 4 Eligibility for Accreditation and Applicable Standards Business and Services Management Network Program Descriptions 1

2 Network A network seeking accreditation consists of two or more organizations with formal agreements to manage, deliver, or fund services. The purposes of a network can include: Improved access to services for the persons served. Improved quality based on the expectations of the persons served and other stakeholders. Improved efficiency and effectiveness of service delivery. Assistance to the providers regarding network plans, services provided, and geographical area served as well as the development, improvement, and sanctioning of provider members. A relationship to support the sharing of personnel, direct service efforts, facilities, case records, individual planning, and contracting for services not found in a single organization s capabilities. Networks create systems for accountability, continuous quality improvement, and reporting of network outcomes to identified stakeholders. The goal is to deliver ever-improving value to customers and stakeholders. Services may be revised based on input from the persons served, input from stakeholders and members of or contractors within the network, and the results of the network s outcomes management system. Information from the outcomes system is used to inform the community of the value of the network and its members and advocate with decision makers and the community for continued or increased funding and new service arrangements. Network membership and operating characteristics may vary significantly from one network to another. For example, one network may be formed to establish efficient business arrangements to provide for shared risk and promote the financial benefits of the arrangement to the members. This concept is known as a Business Network. Another type of network is often created as a funding authority that provides for the contracting of services in an area of influence and responsibility, as designated by a governmental authority or other funding entity. This design is known as a Services Management Network Business and Services Management Network Program Descriptions 2

Improved efficiency and effectiveness of service delivery.

3 Business Network A network for business focuses on the benefits of shared risk and opportunities in service delivery and design. The Business Network focuses on costs, financial trends, business trends, and financial solvency of its members, developing remediation plans if needed. The network creates efficiency for its members through shared purchasing, contract negotiations, shared information systems, and administrative business functions and promotes economic benefits to all of its members. The Business Network has specified written arrangements in place for the relationship among members of the network, including governance, service delivery, and quality assurance standards. All members are accredited by CARF, by a CARF-recognized accrediting body, or have a plan in place to become accredited within three years; and are committed to the same or complementary service delivery and operating philosophy. They are in general agreement regarding clinical and quality standards. Agreements among the network members focus on providing services to the person served. The network defines itself by identifying the geographic service areas, programs and services offered, and populations served. These services are continuously improved by the use of a common outcomes management system and use of the resulting information for performance improvement Business and Services Management Network Program Descriptions 3

The network creates efficiency for its members through shared purchasing, contract negotiations, shared information systems, and administrative business functions and promotes economic benefits to

4 Services Management Network The Services Management Network is an entity that manages and disperses funds, including to other providers of services, for achievement of individual outcomes for persons served. These include disbursements to individuals as employers for services and supports (including faithbased service providers), organizations either for profit or nonprofit, other governmental entities, or eligible providers under voucher systems. In contrast to the Business Network, there may be no shared financial rewards or financial incentives among the contracted entities. Providers in the Services Management Network are committed to achieving identified outcomes for persons served. Services are provided in a seamless manner, coordinated by its contracted services providers. The Services Management Network defines eligibility for providers, including one of the following: 1. Proof of accreditation by CARF or a CARF-recognized accrediting body. Evidence of provider accreditation would need to be submitted to CARF prior to the survey or presented to the survey team at the time of the site visit. (See Note regarding requirements for accreditation.) 2. Evidence of a provider plan to become accredited within three years of the network s accreditation or within three years of joining the network. 3. Demonstration that providers of service whose contracts or annual reimbursement for services eligible for accreditation under the CARF standards exceeds $35,000, meet the standards in Section 5. Standards for Unaccredited Providers. The CARF survey process for the Services Management Network will include survey visits to a sampling of these providers that are not accredited or preparing for accreditation in order to verify conformance to Section 5. Standards for Unaccredited Providers. NOTE: In addition to meeting these standards, unaccredited providers serving three or more unrelated persons served and whose annual reimbursement for services eligible for accreditation under CARF standards exceeds $350,000 and/or other government-defined threshold(s) must, under most circumstances, have a plan in place to become accredited by CARF or a CARFrecognized accrediting body within three years. As there may be fluctuation in annual reimbursement amounts, for purposes of determining whether a provider meets this threshold, an average of the last three-year historical fiscal performance should be used. A government or funding entity requiring accreditation at a lower threshold or in a shorter time period would take precedent. The Services Management Network provides timely accounting and other accountability requirements to government authorities. Among these responsibilities is accounting of funds for individual service accounts, including utilization management. Services Management Networks can be a payment agent or fiscal intermediary for persons served, a contract agent with providers of services and supports, or a reimbursement agent for service providers under a voucher or feefor-service system Business and Services Management Network Program Descriptions 4

These include disbursements to individuals as employers for services and supports (including faithbased service providers), organizations either for profit or nonprofit, other governmental entities,

5 Eligibility for Accreditation and Applicable Standards The following must be met by a network seeking accreditation: Section 1. ASPIRE to Excellence (must be applied). Standards in this section are applied only to personnel and facilities of the network and any persons served directly by the network, as in the case of a network with an access center. Section 2. Network Administration (must be applied). The network should provide well-developed service agreements with its agency providers that clearly define the responsibilities of both the managing entity and the service provider. The service agreement should be compliant with current federal, state, provincial, and local laws and regulations as well as those of specific funders (e.g., Medicaid). Stakeholders should have input into the service delivery of the network. Input may be obtained through the service delivery system. Certain standards in Section 2 may not have applicability, such as group purchasing (2.B.7.c.) and group insurance (2.B.7.e.). Section 3. Service Access (may apply). Services Management Networks (SMNs) that directly run a service access center must either accredit the center at the time of the network survey or may choose to have them surveyed as a stand-alone program by CARF or another national accrediting body recognized by CARF within three years of the network accreditation. For SMNs that do only screening and authorization, only Sections 3.A. and 3.B. would be applied. Please call the CARF office if you have questions about the applicability of this set of standards. Section 4. Case Management/Services Coordination (may apply). A Services Management Network providing case management/services coordination may choose to have these services surveyed as part of its network accreditation survey or may choose to have them surveyed as a stand-alone program by CARF or another national accrediting body recognized by CARF. Section 5. Standards for Unaccredited Providers (may apply). This section applies to most providers of services eligible for accreditation whose contract or annual service reimbursement amount exceeds $35,000. The network must demonstrate either through its own quality management mechanism or through its contracts or provider eligibility requirements that it is providing the education and support to the unaccredited providers to assist them in their preparation and implementation of the standards contained in Section Business and Services Management Network Program Descriptions 5

Network Administration (must be applied).

State Notes TOPICS OF LEGISLATIVE INTEREST Spring 2016

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