Monitoring Behavioral Health Services in South Florida

Transcription

1 FY Revised July 15, P age

2 Table of Contents I. Transparency in Operations... 4 II. System of Care Development and Management... 6 A. System of Care Integration:... 6 B. Federal Block Grants:... 8 C. Recipient Eligibility:... 8 D. Implementation of Children s and Adult s System of Care:... 8 E. Integration of Behavioral Health Services and Primary Care: F. Trauma Informed Care: G. Integration of Behavioral Health and the Child Welfare System H. Use of Evidence based Practices (EBPs): I. Cultural & Linguistic Competence J. Access to Appropriate Level of Care: III. Utilization Management Systems A) Utilization Management Overview: B) Housing Initiative: C) UM System Enhancements: D) Continuous Integrated System of Care and System Efficiencies: IV. Network/Subcontractor Management and Subcontractor Relations A) Procurement Process Overview: B) Request for Qualification (RFQ): C) Future Procurement Plan: D) Pre Contracting Process: E) Contract Management: F) Contract Accountability Division (Contract Monitoring) Overview: G) Monitoring Reports, Onsite Reviews, Investigations and Corrective Actions: H) Accountability for Performance and Quality of Services Overview: I) Invoice Validation: J) Cost Containment Activities: K) Outcome Performance and Data Submission: L) Incident Reporting and Resolution including the evaluation of individual served safety and need for intervention as applicable: P age

3 V. Continuous Quality Improvement Systems A) Network Accreditation: B) Subcontracted Provider CQI Program: C) System Improvements and Technical Assistance and Training: VI. Data Collection, Reporting and Analysis VII. Financial Management and Oversight A) Budget Oversight and Review: B) Redirection from Restrictive to Community Based: C) Securing diverse financial resources: D) Invoice Validation: E) Cost Containment Activities: F) Innovations Leading to Cost Efficiencies: P age

4 I. Transparency in Operations A. As required by State Law (s (7)(e), F.S.), South Florida Behavioral Health Network, Inc. (SFBHN) operates, in a transparent manner providing public access to information, notice of meetings, and opportunities for broad public participation in decision making. SFBHN promotes transparency in its dealing with the community. Transparencies in all operations are ensured by three basic requirements: 1. Board meetings will be open to the public, 2. Reasonable notice of such meetings will be given, and 3. The minutes of the meeting will be recorded and available to public inspections. XII. e. - SFBHN Policy - TRANSPARENCY.pdf B. South Florida Behavioral Health Network, Inc. contracts with qualified behavioral health organizations to provide an integrated, comprehensive continuum of behavioral health treatment services. Procurement is a component of SFBHN s System of Care and financing strategies. SFBHN promotes transparency in business as a basic tenet of procurement with of public funds. Transparency reduces the appearance of favoritism and inspires public confidence. Competitive solicitation aligns the performance goals and outcomes of SFBHN with improved quality of care and cost saving strategies. The goal is to meet community and consumers identified needs and improve cost efficiency and effectiveness. SFBHN s procurement plan, as approved by the Department on August 5, 2014, can be found by clicking on the link below: % %20revised% pdf?dl=0 C. In addition, SFBHN has established systems that promote community and stakeholder input into the decisions that affect community services. SFBHN s Quality Assurance Plan (QA Plan) is developed in accordance with the mission, vision and values developed by SFBHN s Board of Directors, as outlined in the Strategic Plan. Quality Assurance is not the responsibility of one individual or department, but is shared by all SFBHN staff members and the Board of Directors System of Care (SOC) and CQI Committee. SFBHN has established a number of committees that are integral to the QA process for SFBHN and for the network service provider. These committees include community, provider, consumer and other stakeholder participation and as such are used for dynamic communication and change management. Additionally, these committees in concert with data analysis allow SFBHN to identify service gaps, inform community needs and the need for specialized services. For more specific information regarding SFBHN QA Plan for fiscal year please click on the link below:..\quality Assurance Plan\QA Plan FY docx 4 P age

5 SFBHN conducts various activities to determine community needs. These include running a variety of qualitative reports including, but not limited to trends, penetration rates, provider performance, and treatment gaps. SFBHN submits quarterly to the DCF local office a CQI quarterly report that outlines various community activities and needs. These quarterly reports are shared at various planning committees including, but not limited to: SFBHN s SOC/QI Committee, the Board of Directors, ASOC Providers & Stakeholders, CSOC Providers & Stakeholders, and DCF local Office for public (community) comments. Feedback from the various committees/planning bodies are taken and incorporated into SFBHN s activities. Additionally annually, SFBHN then reviews the annual data sets to determine trends and identify gaps. This analysis is shared at community planning meetings and with the Department. The results and feedback from the community planning meetings are then incorporated into SFBHN s Strategic Plan and goals. The Strategic Plan and goals are monitored regularly and reviewed at the various committee and community meetings described above to determine progress and make adjustments if necessary. SFBHN conducted Community Needs Meetings during the second and third quarter to elicit community/stakeholder input. These meetings were held throughout Miami Dade County on the following dates: November 25, 2014, December 17, 2014, December 18, 2014, February 18, 2015, February 24, 2015, and February 25, A community needs meeting was also conducted in Monroe County on January 12, In addition to the meetings, SFBHN released a survey to gather input. The findings from the meetings and the survey went to inform SFBHN s Strategic Plan. A revised three year Strategic Plan has been developed for FY Strategic goals based on the input from the community needs meetings have been incorporated into the plan...\..\..\quality Management\Community Needs Assessment\BOD Meeting \ Community Needs Assessment presentation at SFBHN BOD meeting.pdf D. Policy on Contractual Lapsed Dollars (Sweeps) It is the policy of South Florida Behavioral Health Network, Inc. (SFBHN) to, on a regular basis, monitor Providers expenditure patterns based on agency billing records and data in order to minimize the occurrence of lapse dollars and maximize the utilization of funds available for community services. Lapse funds will be identified on a timely basis so they may be transferred internally to other needed services within the funded Provider agency, to the extent allowed by regulations and/or contractual restrictions, or transferred to a different agency to provide services within the contract year. SFBHN s policy on the distribution of contractual lapse dollars can be found my clicking on the link below: lars.docx?dl=0 During the sweep process a determination is made on how much funds are available for redistribution. A mini-bid application is prepared detailing the availability and restrictions of the funds. This request is sent to all qualified providers within the network. A team of SFBHN subject matter experts review all proposals with recommendations to CEO and EVP/CFO. These recommendations are subsequently ratified by the Executive Committee. 5 P age

6 II. System of Care Development and Management A. System of Care Integration: South Florida Behavioral Health Network has adopted the following System of Care (SOC) principles which are consistent with the Department s and have been embedded within the delivery system including subcontracts: 1) Family/Consumer Driven 2) Youth Guided (as appropriate) 3) Cultural and Linguistic Competence 4) Community Based Services SFBHN has also embraced the system of care values and is working to ensure that the values are rooted throughout the entire continuum of care: 1) Family members and youth are active members of the board 2) The system of care values are clearly delineated in all provider contracts 3) The SOC values are embedded within the contract monitoring tools 4) The Contract Monitoring and Oversight Department conducts all contract reviews and provides feedback to the program staff 5) Conduct fidelity checks throughout the subcontracts. the FACES evaluation team to then be expanded to all subcontracts As the managing entity SFBHN is able to: 1) Subcontract state and federal dollars with community providers for services quickly and seamlessly 2) Develop a continuum of coordinated service aimed at addressing the needs of the children, youth, families and adults served by individual providers 3) Encourage the development of partnerships to strengthen the availability of community supports 4) Utilize continuous quality assurance process to identify system wide and provider specific challenges 5) Utilizes data to drive funding allocation 6) Utilize data from various sources (CFS, SAMHIS, KIS, ODH and FSFN) as a component of the monitoring and CQI process. SFBHN has developed and manages an integrated network of behavioral health services that is accessible and responsive to individuals in need of services, along with their families and community stakeholders. Support across all levels is necessary to ensure integration throughout the system of care. SFBHN is committed to managing a system of care that is supported by individuals served, families, community stakeholders, providers and other resources. SFBHN maintains Memorandum of Understandings (MOUs) with multiple system partners to ensure integration of behavioral health with multiple systems. For the integration with the Child Welfare System, SFBHN has continued to partner and maintain an MOU with Our Kids, Inc. which is the CBC for Circuits 11 and 16 in accordance with Incorporated Document 23 of Contract KH225. As the lead agency for services that oversees an integrated system of foster care and appropriate related services, Our Kids has joined with SFBHN in a collaborative agreement to meet the goals of behavioral health and wellness for these children and their foster families. Promoting the safety and well being of children includes many services that are inter related between the Managing Entity for Mental Health and Substance Abuse and the Lead 6 P age

7 Agency for Community Based Services. Our Kids and SFBHN have worked together for the betterment of well being of children for the past several years. In an effort to further enhance this integration, SFBHN has funded a position that is fully dedicated to improving the integration of both systems. SFBHN is responsible for the implementation and administration of a Child Welfare Integration Coordinator who will operationalize the responsibilities of this position between the CBC, DCF, SFBHN, subcontracted providers and MSS. In addition, SFBHN also maintains an MOU with the Department Child Protective Investigators (CPI) for collaboration on cases with CPI involvement. SFBHN has worked with Our Kids to: 1) Maintain a Memorandum of Understanding 2) Establish a Data Sharing Agreement between SFBHN and Our Kids 3) Provide training and technical assistance regarding families, children and substance abuse to Our Kids Case Managers and other staff 4) Coordinate referrals for care through Utilization Management of SFBHN 5) Provide consultation to Our Kids on issues related to Behavioral Health practices and other services 6) Provide education and resource information on the behavioral health system of care to youth aging out of the foster care system Specific examples of collaboration between Our Kids and SFBHN include: 1) Development of Psychotropic Medication Training by SFBHN s Medical Director to be included in Our Kids training curriculum. 2) Our Kids embedding SFBHN s SOC principles into their prevention contracts and agreement to include in their service contracts once there are eligible for recontracting. 3) Our Kids serves as an active member on SFBHN s Families and Communities Empowered for Success (FACES) Initiative Board and Program Subcommittee providing feedback into the service delivery system. 4) Partnership to include SFBHN s training (i.e. Wraparound, Motivational Interviewing (MI)) into Our Kids training curriculum. 5) Participation in staffing for individuals served with complex needs that need access to behavioral health services. (i.e. SIPP, CSEC, Residential Level II) 6) Participation in weekly Multi Disciplinary Team (MDT) staffing. 7) Interagency Motivational Support Program (MSP) staffing with SFBHN, the Regional DCF SAMH Program Office, Our Kids, Protective Investigations (PI), and MSP Provider to meet the needs of the Department and the PIs. (The MSP program was formally known as the FIS program). 8) Continuous Substance Abuse Training for PI, MSP, Our Kids Staff, and Our Kids subcontracted providers, through the Child Welfare Integration Coordinator. SFBHN will continue to partner with Our Kids to address the needs to of the Child Welfare System and expanded system capacity as possible within existing resources. It is noted that Our Kids has the Department s SAMH monies that could be redirected to expand capacity within the System of Care. SFBHN is in the process of entering into a MOU between SFBHN, Our Kids and a selected number of network providers of each of the entities, to provide support and services to mutual individuals served in an effort to develop a system of care that aims to treat the total person while at the same 7 P age

8 time, eliminates duplication of services, improves communication among and between service providers, streamlines interagency referrals, and in general, improves the effectiveness and efficiency of services to shared individuals served. Another component being added to the Child Welfare Integration plan is the incorporation of Mental Health and Substance Abuse consultants at each of the three CPI Hubs. These consultants will assist CPI s in staffing cases that may have indicators of Substance Use or Mental Health Disorders. They will also facilitate the appropriate linkages to services for individuals served that are identified as needing services by coordinating with Our Kids, MSP and FITT. B. Federal Block Grants: Those Subcontracted Providers who enter into agreement with the Managing Entity for federal block grant funds are contractually required to comply with all of the requirements of the Substance Abuse Prevention and Treatment or Community Mental Health Block Grants Subparts I and II of Part B of Title XIX of the Public Health Service Act, s. 42 U.S.C. 300x 21 et seq. (as approved September 22, 2000) and the Health and Human Services (HHS) Block Grant regulations (45 CFR Part 96). Additionally, the Subcontracted Provider is expected to submit required reports as defined within Exhibit A, Required Reports. If identified during the Scope Development Meeting, federal block grant set aside requirements may be monitored, during on site monitoring visits conducted by the Contract Accountability Division. The monitoring tool ensures compliance with the requirements and restrictions of the Block Grant funds and are specific to the priority populations and services identified by the federal government. Further, each Subcontracted Provider is required to demonstrate compliance in through their annual financial and compliance audits which are to be submitted to the Managing Entity one hundred eighty (180) days after the conclusion of their fiscal year or thirty (30) calendar days after its completion whichever comes first should the provider meet the requirement pursuant to OMB Circular A 133 and/or Section , F.S., and other applicable state rules and regulations. For subcontracted providers that do not meet the requirements above are required to submit a Certification indicating that recipient expended less than $500,000 ($750,000 in Federal Awards for fiscal years beginning on or after December 26, 2014) in State Awards during the fiscal year. In addition, the providers are required to submit the financial audits as stipulated in Rule 65E 14 F.A.C., agency prepared financial statements (balance sheet and statement of activity). C. Recipient Eligibility: By entering into the contract, each Subcontracted Provider agrees that all persons meeting the target populations identified within the contract and further defined in s are eligible for services. Crisis stabilization, substance use detoxification, and addiction receiving facility services shall be provided to all persons meeting the criteria for admission. Recipient eligibility is reviewed during the Subcontracted Provider s monitoring visit to ensure the Subcontracted Provider s compliance with the contract requirement. D. Implementation of Children s and Adult s System of Care: System of Care (SOC) is a service delivery approach that builds partnerships to create a broad, integrated process for meeting individuals served' multiple needs. This approach is based on the principles of interagency collaboration; individualized, strength based care practices; cultural competence; community based services; accountability; and full participation of individuals served, families and youth at all levels of the system. SFBHN partners with the Department and multiple stakeholders to continually review the SOC and ensure meeting the community s and the 8 P age

9 individuals served needs and identification of service gaps. This has been participatory process which has engaged all system partners (individuals served, providers, and stakeholders) to: 1) Develop and communicate new policies and changes in existing policies 2) Develop processes 3) Address Challenges 4) Identify Solutions 5) Communicate opportunities to improve the SOC as found through monitoring s, CQI reviews, and evaluation of performance measures SFBHN participates and/or conducts various planning meetings for continuous feedback into the SOC. These planning meetings include: Monthly Miami Dade County Addictions Services Board (ASB) Coordinated Outreach Meeting (Homeless Trust)CBC Alliance Meeting Drug Court Meeting (Juvenile & Dependency) Executive Committee (EC) Meeting FACES Program Subcommittee FACES Evaluation Subcommittee Beyond Empowerment Program Subcommittee Beyond Empowerment Evaluation Subcommittee FACES Policy Workgroup HIV/AIDS Partnership Committee Re Entry Partnership Committee Miami Dade HIV AIDS Partnership, Strategic Planning Committee Correct Care (formerly Geocare) Discharge Planning Meeting Data Liaison Meetings (via conference call) with Tallahassee Bi Weekly Consumer Network Meeting MSP and FITT Meetings Bi Monthly Board of Directors Meeting FACES Governance Board Meeting Data Group Meetings Quarterly Adult System of Care (ASOC) Planning Meetings with the Department Children s (CSOC) & Prevention System of Care Planning Meetings with the Department ASOC Provider/Stakeholder Meeting CSOC Provider/Stakeholder Meeting Cultural and Linguistic Competence (CLC) Workgroup FACT Advisory Committee Peer Specialist Training and Support Meeting Regional Prevention Meeting South Florida State Hospital Stakeholders Meeting 9 P age

10 Statewide Consumer Network Grant Advisory Committee Trauma Informed Care Meeting Housing Initiative Meeting Employment Initiative Meeting Florida Certification Board Advisory Council Meeting Baker Act/Crisis Intervention Team (BA/CIT) Advisory Committee Meeting Florida Certification Board Advisory Council Meeting Targeted Case Management Meeting Geocare Liaison Meeting Protection and Advocacy for Individuals with Mental Illness (PAIMI) Council Meetings for Disability Rights Florida Behavioral Health/Primary Care (Integrated Care) Meetings SOC/QI Board Subcommittee Meeting STAR Program Discharge Planning Meeting Bi Annual Forensic Stakeholders Meeting CSU/Detox Program s Directors Meeting Annual/ Ad Hoc DCF Planning Council Data Group Meeting SFBHN and its contracted providers ensure that community residents that are eligible for public services receive treatment quickly without running a bureaucratic maze. In collaboration with SFBHN, the network providers ensure that their services move individuals and families toward selfsufficiency and to be productive, integrated members of the community A full description of all the substance abuse and mental health services purchased from the network providers for FY can be found in the link below: M:\DCF Assignments\Provider Inventory\FY \FINAL FY SFBHN Network Service Provider Catalog of Care.xlsx SFBHN has been successful in enhancing the SOC by acquiring and managing multiple grants. These grants serve to assist in the transformation of our system of care while supplementing funding streams, integrating services, and/or enhancing best practices. These grants also aid in the coordination of care with multiple system stakeholders by enhancing collaborations. In efforts to continuing to enhance our SOC, the Peer Services Manager and Specialist serve to develop, maintain, and improve processes advocating for consumer rights and system of care access. The staff in this position has established procedures, developed and disseminated the Consumer and Family Services Manual, assisted individuals served in choosing network providers, and developed work and social opportunities for individuals served and families. 10 P age

11 SFBHN is continually evaluating the SOC as described in the CQI Program Plan to ensure services are responsive to individuals served and families individualized needs ensuring the best value for the community, the State, and the individuals served. SFBHN submits quarterly CQI Reports to the Department documenting and highlighting trends within our System of Care. E. Integration of Behavioral Health Services and Primary Care: It is the goal of the ME to ensure the integration of behavioral health services and primary care services to all the individuals served in care. The integration will be ensured through linkage of the behavioral health provider with the primary health care provider of the consumer through an electronic health record or other means of contact (phone, in person, etc). Referral and linkage processes will be necessary for all individuals served who do not have a primary health care provider at entry into the system of care. Follow up and coordination of services are essential to meeting consumer health and behavioral health needs. Many individuals with behavioral health issues have chronic health conditions and may have neglected their primary health needs for some time. The ME and its network of providers are committed to developing an integrated system of care that incorporates comprehensive screening and monitoring tools that identify those affected by chronic health conditions and a system of care that meets their needs. Network Providers will be implementing Integrated Primary and Behavioral Health techniques and initiatives to meet this need. This initiative will be addressed through a continuous quality improvement plan or component in the existing agency wide continuous quality improvement plan that delineates participation in the Health Integration Initiative. As part of the plan or component of the plan must include the following: i. Identification of the Federally Qualified Health Center or other medical facility where individuals served who have been identified as needing primary health care services are referred to or the process established by the Network Provider to coordinate services with individuals served private primary health care provider should such exist. ii. iii. iv. A process to track and report outcomes of successful referrals and linkages of individuals served of behavioral health services to primary health care services. In addition to tracking and reporting outcomes of individuals served referred for behavioral health services by a primary health care provider to the Network Provider. The outcomes must be reported in the semi annual Continuous Quality Improvement Updates. Identification of at least two Integrated Healthcare Champions at the beginning of the contract term and submit the names of the individuals when requested by ME staff. Provide an annual action plan by August 31, 2015, which outlines all of the components/activities identified in your agency s most recently completed Behavioral Health and Primary Health Integrated Care Initiative self assessment. v. Participation in the regional Healthcare Integration Committee meetings to develop the processes and training germane to this initiative. vi. Attendance of appropriate staff at the regional trainings regarding Integrated Healthcare, as requested by the ME staff. Participation in the trainings will be documented in the Continuous Quality Improvement Updates. 11 P age

12 F. Trauma Informed Care: Many individuals with behavioral health issues have experienced trauma that affects their development and adjustment. The ME and its network of providers are committed to developing a system of care that incorporates comprehensive assessment tools that identify those affected by trauma and a system of care that meets their needs. Network Providers will be implementing the Trauma Informed Care (TIC) initiative through a continuous quality improvement plan or component in the existing agency wide continuous quality improvement plan that delineates participation in the TIC initiative. As part of the plan or component of the plan must include the following: i. Identification of at least two TIC Champions at the beginning of the contract term and submit the names of the individuals when requested by ME staff. ii. iii. iv. By 03/01/2016 Completion of an annual agency wide self assessment using the Fallot Assessment Tool. The results of the self assessment must be submitted by April 1, Provide an annual action plan which outlines all of the components/activities identified in agency s annual self assessments for the TIC initiative. Participation in the regional TIC meetings to develop the process for identifying and responding to those affected by trauma. v. Attendance at the regional trainings regarding TIC as applicable. Applicable trainings will be documented in the Continuous Quality Improvement Updates. vi. Participation in all TIC related activities to ensure staff and agency become competent in all areas of trauma informed care. G. Integration of Behavioral Health and the Child Welfare System The coordination of efforts between the CBC, the ME and Network Providers is essential to the efficient service delivery for child welfare involved families in behavioral health treatment. The ME and the Network Providers are committed to developing an integrated system of care that meets the needs of children and their families as there is significant overlap between individuals served. Network Providers will be implementing the Child Welfare Integration (CWI) initiative through a continuous quality improvement plan or component in the existing agency wide continuous quality improvement plan that delineates participation in the CWI initiative. The plan must include the following: i. Identification of at least two CWI Champions and submit the names of the individuals when requested by ME staff. ii. iii. iv. Participation in the CWI meetings to develop the process for identifying and responding to child welfare involved families. Attendance at trainings regarding CWI when notified by the ME. Attendance to the trainings will be documented in the Continuous Quality Improvement Updates. Participation in all CWI related activities to ensure staff and agency become knowledgeable of the Child Welfare system. 12 P age

13 H. Use of Evidence based Practices (EBPs): SFBHN has facilitated the implementation of various Evidence based Practices through community wide initiatives and system implementation including Motivational Interviewing (MI), the Global Appraisal of Individual Needs (GAIN), WrapAround, Wellness Recovery Action Plan (WRAP), Seeking Safety, Functional Family Therapy (FFT), RESPECT, and Healthy Living for People Living with AIDS. In addition to the EBPs listed above, SFBHN subcontractors have implemented additional EBPs within the network. These EBPs include, but are not limited to: Cognitive Behavioral Therapy (CBT), Trauma Focused CBT, Dyadic Therapy, Brief Strategic Family Therapy (BSFT), Life Skills, Motivational Interviewing, Theatre Troupe, Too Good for Drugs, Too Good for Drugs and Violence, Adolescent Community Reinforcement Approach (ACRA). Providers continually identify best practices which are relevant to the work being implemented at their agency and meet the need of the individuals they serve. SFBHN requires providers to report which EBPs are being utilized at their agency and are reported as part of their contract requirements through their Agency Program Descriptions. In efforts to continue expanding the use of EBPs in our community, on March 4, 2015, SFBHN released Invitation to Negotiate Solicitation #004, Prevention of Substance Abuse, Promotion of Positive Mental Health and Related Consequences and Evaluation of the System for implementation in the fiscal year. SFBHN s goal is to fund evidence based substance abuse prevention practices that reduce the prevalence and consequences of underage drinking and other substance use/abuse related problem behaviors, as well as promoting positive mental health. Through this solicitation, SFBHN will fund applicants that develop and operationalize strategies to deliver substance abuse prevention services, as well as an evaluation of the Prevention system, which include mental health promotion components. These components must be rooted in evidence based practices, resulting in positive outcomes at the community level and consistent with the community s Comprehensive Community Action Plan (CCAP) and Logic Models. All programs funded through this solicitation will promote a comprehensive approach to behavioral health, seeing prevention as part of an overall continuum of care and expect that coordination with other Prevention efforts in the community are integrated into the application strategies. I. Cultural & Linguistic Competence SFBHN has experience working with diverse populations. Within the Southern Region, it is essential to have linguistic competency in at least three languages (English, Spanish and French/Creole). SFBHN staff has competency in all three languages. Part of cultural competency is to ensure that staff at the provider agency is culturally and linguistically responsive to the individuals served. As part of the subcontracting process, providers are required to submit Civil Rights Compliance Checklists which identify staff and consumer compositions. Contract language identifies that network providers shall ensure that services meet linguistic and cultural needs of recipients, and provide communication services such as sign language or translators (as example). It additionally identifies that the Subcontracted Provider have Auxiliary Aids and Services Plan to meet the requirements pursuant to Title II of the Americans with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act. 13 P age

14 SFBHN has implemented a Cultural and Linguistic Competence (CLC) Initiative by implementing The National Standards for Cultural and Linguistically Appropriate Services (the National CLAS Standards). The National Culturally and Linguistically Appropriate Services (CLAS) Standards in Health and Health Care are intended to advance health equity, improve quality, and help eliminate health care disparities by establishing a blueprint for health and behavioral health care. In order to accomplish this task Network Providers will accomplish the following: i. Identification of at least two CLC Champions at the beginning of the contract term and submit the names of the individuals when requested by ME staff. ii. iii. Participation in the regional CLC meetings. Complete an annual Cultural and Linguistic survey when directed by the ME. The survey must be completed by multiple staff at various levels of the agency; iv. Update the annual Cultural and Linguistic Competence Action Plan by August 31, v. Submit the final agency specific Cultural and Linguistic Competence Action Plan based on the National Standards for Culturally and Linguistically Appropriate Services (the National CLAS Standards). The plan will outline tasks and objectives that the provider must address during the fiscal year. The action plan must focus on the implementation the CLAS standards and how to improve culturally and linguistically competent service delivery, coaching and training, and evaluation and assessment in a way that can enhance the system of care and achieve positive outcomes for individuals served; vi. vii. Collaborate with SFBHN to identify and utilize the Network Provider s data to (1) identify sub populations (i.e., racial, ethnic, LGBTQI 2S, minority groups) vulnerable to disparities and (2) implement strategies to decrease the differences in access, service use, and outcomes among sub populations. These strategies should include the use of the enhanced National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care; Implement effective language access services to meet the needs of their limited Englishproficient individuals served, and increase their access to behavioral health care by providing sign language, translation, and interpretive services required to meet the communication needs of individuals served, including English, Spanish and Creole. Services will meet the cultural needs and preferences of the populations served. SFBHN is further committed to engaging a wide array of diverse stakeholders who reflect the unique multicultural community we serve in the Southern Region. Based on the results of the on the CLC self assessments, SFBHN will continue to facilitate trainings to address specific topics that are pertinent to all the network providers. Within the monitoring process, SFBHN identifies and addresses the provider s ability to meet the needs of the diverse population served at each agency, based the Federal enhanced Culturally and Linguistically Appropriate Services (CLAS) Standards. Furthermore, in order to implement the CLAS Standards, and meet the needs of the population they serve, each provider has developed a (CLC) plan. The Contract Accountability Division includes as part of its regular monitoring activities a monitoring tool specific to the Culturally and Linguistically Appropriate Services Standards, Title VI of the Civil Rights Act of 1964, 65 Federal Register , ADA and Section 504 of the 14 P age

15 Rehabilitation Act. CQI processes including investigations further monitor compliance and quality of same for agencies. SFBHN continues to provide CLC technical assistance (TA) to the provider network. The CLC Coordinator provides technical assistance to the community on overall CLC system issues, support and education providers plans, and specialized TA for providers as needed. J. Access to Appropriate Level of Care: SFBHN ensures that behavioral health services are coordinated and developed into an integrated network of services accessible and responsive to individuals in need of substance abuse and mental health services, families, and community stakeholders. Network Providers are contractually required to ensure individuals need treatment services, depending on severity of individual need, consistent with industry standards for distance and time. Management of access to care is found within the Consumer and Family Services Manual which includes: a) services provided by the SOC and how to access the services, including a provider directory; b) Emergency services and what to do in case of a psychiatric or medical emergency; c) the individuals served rights and information on how to file complaints or grievances; d) information regarding available auxiliary aids and services, and how to requests these services; e) cost sharing and fee payment requirements; and f) information regarding how to select a practitioner or change practitioners if the consumer served wishes to. Additionally, SFBHN established an 800 call in number ( ) to assist individuals served in contacting the ME for assistance which is noted in the Manual. Consumer and Families Services Manual: This is also located on the SFBHN website: and procedures/ SFBHN has also developed and implemented a Care Coordination and Utilization Management Manual which describes current methods to access services presently being managed by SFBHN. The Care Coordination and Utilization Management Manual is located on the SFBHN website: and procedures/ SFBHN has implemented various CQI activities to monitor providers compliance with access performance measures as specified in the contract. These activities include, but are not limited to: the Provider Report Card, Secret Shopper Calls, Client Satisfaction Surveys, Census Reports, Waitlist Reports, Retention Reports and tracking of access concerns for trend analysis. Consumer records are reviewed during CQI and Investigative activities to further evaluate and monitor compliance with access. In FY 12 13, SFBHN implemented new contract language requiring providers to make warm hand offs when providing linkage and referrals. Beginning in fiscal year FY through this current fiscal year subcontractors are required by contract to implement and maintain policies and procedures that address the referral and linkage process of individuals served to local community providers for services not offered by the network provider. The network provider is responsible for tracking and ensuring that the proper linkages are made. As incorporated into contract language: Linkage and Referral Process: The network provider may only refer a consumer to a provider that offers the service for which the network provider created the referral. 15 P age

16 If the network provider is a receiving provider then the network provider must inform the referring provider that the consumer was admitted/not admitted within seven (7) calendar days, unless otherwise required by applicable state, federal rules and/or statues. If the network provider is the receiving provider, the network provider will have seventy two (72) hours to respond to a new referral, unless otherwise required by applicable state, federal rules and/or statues. If the network provider is the receiving provider, and if upon assessing a referred consumer on intake, determines that the consumer requires a service that is different from the service for which the consumer has been referred, the network provider will admit the consumer for the service that the consumer needs if the network provider offers the service and has availability to offer the service. In the event the network provider does not offer the service nor has availability to offer the service, the network provider will create a referral for the consumer to receive the service at a different provider. In addition to the contract language, the referral process will be further refined through the Otsuka Digital Health (ODH) system. Through ODH, referrals will be managed and tracked electronically. The functionality of this referral system has been in operation since November 2014 for the Adult System of Care. SFBHN is still in process of fully transitioning the Children s System of Care (CSOC) into ODH. Providers are additionally required to track the following performance measures which are expected to be part of the semi annual CQI plan submission: 1) Average number of calendar days between a request for service and the date of the initially scheduled face to face appointment, tracked by assessment, counseling/psychotherapy and psychiatric appointments. 2) Percent of individuals served who do not appear for their initial appointment tracked by assessments, counseling/psychotherapy and psychiatric appointments. 3) Percent of appointments cancelled by the client tracked for all initial appointments for assessments, counseling/psychotherapy and psychiatric services. 4) Percent of appointments cancelled by the staff for all initial appointments for assessments, counseling/psychotherapy and psychiatric services. 5) Medication error percentage, as documented during the reporting period including: wrong medication, wrong dose or wrong time of administration as reported in inpatient/csu and residential settings. It is the intent to use the providers QA/QI initial plans and semi annual CQI updates as source for monitoring the providers Monitoring of Access: SFBHN utilizes several methods to monitor provider access. Specific activities that monitor access include, but are not limited to: Secret Shopper Calls, Consumer Satisfaction Surveys, Contract Accountability Monitoring, tracking of complaints and the Report Card. 16 P age

17 III. Utilization Management Systems A) Utilization Management Overview: Utilization Management (UM) is a system for the evaluation of the appropriateness, clinical need and efficiency of behavioral health services, procedures and facilities according to established criteria and/or guidelines. SFBHN s specific goals of utilization management include elimination/management of wait lists, the maximum utilization of treatment resources, and the delivery of clinically appropriate services in the least restrictive setting and most cost effective manner. SFBHN s UM systems include preauthorization for multiple services as well as retrospective reviews and focused reviews of individuals receiving services and subcontractors whose utilization of services is outside of expected parameters. Utilization management includes methods used to manage the system of care to ensure access to the appropriate level of care, at the right frequency and for the appropriate duration. It also includes financial screening to ensure maximization of fiscal resources including other third party payors such as, but not limited to KidCare, Medicaid, Medicare, and other HMOs. These methods may include programs of intervention and/or diversion. Utilization management includes not only managerial and supervisory strategies, methods and tools to ensure timely access to care, but also includes processes to promote continuous improvement to manage resources. As the Managing Entity for the Southern Region, South Florida Behavioral Health Network (SFBHN) has developed an automated utilization management system to include additional treatment authorization and management reports for the system of care. SFBHN conducts oversight, reporting and management of the behavioral health services for individuals served. In the event that waiting lists do develop, the managing entity implements procedures for managing the substance abuse and mental health waiting list for all applicable levels of care including provision of interim services through utilization management strategies. SFBHN conducts initial and continued stay authorizations for applicable levels of care as described in the Utilization Management Manual. In order to ensure timely access to behavioral health services and minimize the wait lists. The authorization processes include: 1) Timeliness standards for authorization review. All authorization reviews must adhere to timeline standards for the services provided and departmental, statutory, and judicial regulations or requirements. 2) Processes for communicating UM decision making criteria to practitioners including any standardized tools and assessments for use in determining placement and/or level of care. 3) Provisions for providing timely reconsiderations, or second opinions, when a request for authorization for a particular service is denied. (A reconsideration differs from a grievance in that grievances are used when a recipient or member of the covered population believes that he or she has been treated improperly, whereas a reconsideration is a request to review authorization or reauthorization for a particular service.) The second opinion shall be obtained according to the timeliness standards for the service in question as outlines in the Reconsiderations section of the Utilization Management Manual. The Care Coordination Plan and the Utilization Management Manual protocols include managing the systems most costly services such as Residential, Detoxification, Crisis Stabilization, and Short Term Residential. These procedures meet the Department s requirements and define the processes to be utilized to minimize over and underutilization of services. 17 P age

18 B) Housing Initiative: SFBHN continues to work towards developing nontraditional partnerships with community housing providers, organizations, and agencies to facilitate access to supportive housing resources for individuals who are dealing with a mental illness and/or co occurring disorders. During the FY 14 15, SFBHN has added some new participants to the quarterly Housing Initiative meetings and has invited various presenters to provide information on community resources. SFBHN will continue to seek out new community partners to attend and participate in the Housing Initiative meetings to discuss new and available resources. During the FY 14 15, the following presentations were made during the quarterly Housing Initiative meetings: Manuel Sarria (Homeless Trust) provided an overview of the Vulnerability Index & Service Prioritization Decision Assistance Tool (VI SPDAT) (June 20, 2014). Dr. Levi Minzi (Veteran s Administration) presented on the Veterans Outreach Program and their involvement in diverting criminally justice involved veterans into treatment/rehabilitation services. (January 29, 2015). Eleanor Lanser, Director of Community Services (Douglas Gardens), also provided information on their Housing First Program. (January 29, 2015). Diana Valderrama, Data Analyst (SFBHN) provided information on the Community Needs Assessment Meetings that were being held countywide to obtain community feedback from providers, individuals served, family members, etc. about community services and needs. Amy McClellan (Key Clubhouse) presented on Housing First and the FL Senate First Bill (April 16, 2015). Olga Golik (Citrus) discussed the LINK initiative advising that that Citrus is a referral agency and has several MOUs with housing developers. (April 16, 2015). Jonathan Dummitt (SFBHN) presented on the mental health performance outcome measures. (April 16, 2015). On January 12, 2015, SFBHN staff attended the Shenandoah Neighborhood Association Meeting to address housing concerns. Additionally, SFBHN was involved in a conference call with DCF Tallahassee regarding the LINK Program and Rental Assistance for SAMH Individuals served on April 13, For FY , we have secured 2 new presenters: John Lehman, President of FARR (Florida Association of Recovery Residences) Emily Eisenhauer, Ph.D, Program Coordinator, Office of Civic and Community Engagement from the University of Miami. As part of this initiative, SFBHN will continue to track and use subcontractors housing performance measures to gear efforts toward ameliorating the community s housing issues. Providers that are not meeting the performance measures are required to attend these meetings. In December 2014, the Housing Directory was finalized and made available to providers, individuals served, and community stakeholders on the SFBHN website. This directory will be updated as resources change and/or at least once annually. 18 P age

19 In April 2015, as a means to address the limited housing resources available to individuals served, SFBHN partnered with the Miami Dade County Homeless Trust (MDCHT) through a MOU to create a Homeless Set Aside Pilot Project for the provision of housing and support services for homeless households who are high utilizers of both systems of care. SFBHN will identify homeless, frequent users of high costs systems (crisis stabilization units, jails, residential treatment) and MDCHT will confirm that the frequent user meets the HUD definition for Chronic Homelessness. SFBHN and MDCHT will collaborate in developing a case plan for the household identified that will include: Length of time resources are approved for; Identification of behavioral health services authorized by SFBHN; Allocation of SFBHN service dollars being authorized for selected household; Identification of housing expenses approved by MDCHT; Allocation of MDCHT housing assistance dollars being authorized for the selected household; and Selection of a service and housing provider. Specific collaboration meetings on housing during this Fiscal Year include: 10/9/2014: Housing Initiative Quarterly Meeting (SFBHN, DCF SAMH, Providers, Community Individuals served/families, Stakeholders) 1/29/2015: Housing Initiative Quarterly Meeting (SFBHN, DCF SAMH, Providers, Community Individuals served/families, Stakeholders) 4/9/2015: Telephone conference between SFBHN and MDCHT to discuss Homeless Set Aside Pilot Project 4/16/2015: Housing Initiative Quarterly Meeting (SFBHN, DCF SAMH, Providers, Community Individuals served/families, Stakeholders) 5/8/2015: Telephone conference between SFBHN and MDCHT to discuss Homeless Set Aside Pilot Project 5/12/2015: Telephone conference between SFBHN and MDCHT to discuss Homeless Set Aside Pilot Project 6/16/2015: Telephone conference between SFBHN and MDCHT to discuss Homeless Set Aside Pilot Project SFBHN housing partners include: Department of Children and Families, Miami Dade County Homeless Trust, Better Way of Miami, Key Clubhouse of South Florida, Jessie Trice Community Health Center, St. Luke s Center at Catholic Charities, New Direction (Miami Dade County Community Action Human Services Department), Juvenile Services Department of Miami Dade County, Bruce W. Carter VA Medical Center, Fresh Start of Miami Dade Drop In Center, Jackson Behavioral Health Hospital, Advocate Program, Miami Dade Department of Corrections Rehabilitation Services, The Village South, Douglas Gardens Community Mental Health Center, Citrus Health Network, Fellowship House, Camillus House, Division of Vocational Rehabilitation, Community Health of South Florida (CHI), Banyan Health Center, New Hope Drop In Center, and Transition, Inc., Consumer Network, Jail Diversion Program, Passageways, Jackson Community Mental Health Center, Julian s House, and Legacy House. C) UM System Enhancements: SFBHN has targeted several ways of enhancing the Utilization Management (UM) System. One such system enhancement was to move the entire SA system into the utilization of the Global Appraisal of Individual Needs (GAIN). The GAIN is a recognized evidenced based assessment instrument that is web based. After several years of use, the Mental Health network providers indicated that they 19 P age

20 wanted a tool that was able to capture the mental health diagnostic impressions in a more accurate and complete manner. The GAIN is a strong Substance Abuse Assessment tool but lacks some of the refinement needed to accurate assess the mental health needs of our individuals served. As a Network, providers came together and formed a clinical workgroup composed of clinicians, psychologists and psychiatrists. The purpose of the workgroup was to create a clinical assessment that meets the needs for assessing individuals served in both Substance Abuse and Mental Health. The tool was developed and is in the process of being incorporated and implemented through the Otsuka Digital Health system. Another significant development to the UM system is the implementation of the Otsuka Digital Health (ODH) system. The new system will include logic processes that will screen and ensure Medicaid eligibility prior to authorization or billing for applicable services thus ensuring that DCF is the payor of last resort. The system also allows for a more accurate management of available resources by the System of Care staff to ensure that individuals served are better able to access needed services. The ODH system is fully implemented in the Adult System. SFBHN is developing a Children s Assessment Instrument and hopes to fully implement ODH into the Children s System during FY D) Continuous Integrated System of Care and System Efficiencies: As mentioned in the SOC Section and fully described in the CQI Section, SFBHN is continually evaluating the SOC to ensure services are responsive to individuals served and families individualized needs ensuring the best value for the community, the State, and the individuals served. SFBHN submits quarterly CQI Reports to the Department documenting and highlighting trends within our System of Care. These reports include utilization, retention, average length of stay, waitlist, high utilizers, and census reports which assist SFBHN make timely decisions concerning Utilization Management. Additionally SFBHN has the capacity through its Data System to track all unduplicated individuals served served. For FY 13 14, SFBHN served a total of 37,898 unduplicated individuals served. Through April 30, 2015, SFBHN has served a total of 31,175 unduplicated individuals served. The final fiscal year numbers will be available during the first quarter of fiscal year It should be noted that the State began tracking individuals served in different categories during FY 14 15; however, SFBHN is able to still validate unduplicated individuals served served. SFBHN will continue to manage the system to assist individuals served accessing services while maximizing resources. A) Employment Initiative: SFBHN continues to host the Employment Initiative meeting that strives to bring together community stakeholders and network providers to identify strategies to support recovery, resiliency and self sufficiency in the individuals we serve and increase their employment opportunities within our community. During the FY 14 15, SFBHN has invited new community stakeholders to the quarterly meetings to provide information on available community resources as employment is a major unmet need for the individuals served we serve. During the FY , the following presentations were made during the quarterly Employment Initiative meetings: P. Ford (SFBHN) presented a Power Point on the Florida Institute on Homelessness and Supportive Housing Conference (October 9, 2014) 20 P age