Bluebonnet Trails Community Services [PROVIDER NETWORK DEVELOPMENT PLAN] Provider Availability and Procurement of Providers for FY 13

Transcription

1 2012 Bluebonnet Trails Community Services [PROVIDER NETWORK DEVELOPMENT PLAN] Provider Availability and Procurement of Providers for FY 13

2 Table of Contents A. Provider Network Development Plan 1. Local Service Area Provider Availability Local Planning 7 4. Provider Network Development Procurement Consumer Choice Capacity Development Implementation Stakeholder comments on Draft Plan and LMHA Response.. 26 Appendix A.. 28 Appendix B.. 29 Attachment 1 30 Attachment 2 39 October 1,

3 PROVIDER NETWORK DEVELOPMENT PLAN Revised October 1, 2012 Complete and submit in Word format (do not PDF) to no later than October 1, Responses should be concise, concrete, and specific. Use bullet format whenever possible, and note that many sections have character limits. Provide information for the past two years only (since submission of your 2012 network development plan). When completing a table, insert additional rows as needed. Local Service Area Provide the following information about your local service area. Most of the data for this section can be accessed from the following reports in MBOW, using data from the following report: 2010 LMHA Area and Population Stats (in the General Warehouse folder) Population 796,074 Square miles 6,977 Population density 114 Number of counties (total) 8 Number of urban counties 0 Number of rural counties 8 Number of frontier counties 0 Major populations centers (add additional rows as needed): Name of City Name of County City Population County Population County Population Density Round Rock Williamson 104, , % Seguin Guadalupe 26, , % Bastrop Bastrop 8,378 81, % County Population Percent of Total October 1,

4 Using bullet format, briefly note other significant information about your local service area relevant to provider network development. Include population characteristics that are atypical and differentiate your local services area from most other LMHAs. Distinguishing characteristics might include a high proportion of racial, ethnic, or linguistic minorities, the presence of a large military base, or other factors that must be considered in service delivery. Williamson County (north of Austin Texas) is experiencing a huge population growth and is therefore placing stress and demand on existing public services. Round Rock has no public transportation and in addition the county continues to have a rural disposition with Hutto, Taylor, Jarrell and Georgetown also within the county city limits. Provider Availability 1) Provider Recruitment Using bullet format, list steps the LMHA took to identify and recruit external providers over the past two years. This includes but is not limited to procurement associated with the 2010 planning cycle. September 2012 posted RFA for Crisis On-Call Workers for the Guadalupe-Gonzales- Caldwell area and the Bastrop-Fayette-Lee Area. June 2012 posted RFA for Cognitive Behavioral Therapists. Remains Open. March 11, 2011 issued RFP to recruit external providers for Adult SP1,2,3,4 and Children / Adolescent SP-4 services. No bids received. 2) Provider Availability List each potential provider identified during the process described in Item 1 of this section. Include all current contractors, providers who registered on the DSHS website, and providers who submitted written inquiries over the past two years. Note the source used to identify the provider (e.g., current contract, DSHS website, LMHA website, , written inquiry). Summarize the content of the follow-up contact described in Appendix A. If the provider did not respond to your invitation within 45 days, document your actions and the provider s response. In the final column, note the conclusion regarding the provider s availability. For those deemed to be potential providers, include the type of services the provider can provide and the provider s service capacity. Provider Source of Identification Summary of Follow-up Meeting or Teleconference Assessment of Provider Availability, Services, and Capacity The Wood Group (update) Current Provider Inquiry 2012 Spoke with Jerry Parker on numerous occasions in the last couple of months and on September 19, 2012, to review his availability to provide any of the MH service package services. He currently provides our Crisis Respite Residential Care. He prefers to provide We are considering partnering with Wood Group to increase our provider network in specific locations. Mr. Parker indicated by October 1,

5 Avail Solutions Inc. (update) Telecare Corporation (update) Providence Corporation Current Provider Inquiry 2012 Current Provider Inquiry 2012 Current Provider Inquiry 2012 services for just Rehabilitative Services (discrete services) instead of the entire array of services available in each of the service packages. He has agreements with other MHAs to provide the entire array of services and even SP-1 services but it is difficult to provide this for less than the Medicaid rate. If he took over a MH Clinic that included SP-1, 2, and 3, he would have to have at least 75 clients in SP-3 or about 60% of the consumers enrolled in that particular service package. Wood Group is not able to provide ACT Services at this time. Spoke with Janie Harwood via Telephone conference on September 20, 2012 to review her current business model and whether she had expanded her current responsibilities. Avail Solutions Inc. has the majority of their business involved in Hotline / Crisis Services but continue to provide MCOT related care in Nueces County (Corpus Christi, Texas). Because Avail Solutions Inc. is located in Corpus Christi they are able to provide MCOT services for Nueces County MHMR Center. Send an to Telecare on September 20, 2012 regarding availability of intensive services providers in our area. David Pan had previously been interested in 2010 but the percentage of caseload allowable for intensive services was too low for him to consider back in correspondence with Norman Mealey, Texas State Director for Providence. He is expressing interest in reviewing our needs for providers in our service areas. on September 20, 2012 that Wood Group wishes to continue discussions with Bluebonnet Centers pertaining to these services. We currently are under contract with Avail Solutions Inc. for our 24/7 crisis hotline responsibilities. Avail is not interested in providing other types of MH services at this time. David Pan responded on September 21, 2012 indicating that Telecare was not a provider of mental health services in Texas at this time. Mr. Mealey is willing to review our needs and consider providing services in our area. Avail Solutions DSHS Met with Janie Harwood in Round Rock Texas for a face to face Avail will consider MCOT services Inc. conversation with the LPND team on June 9, Avail is currently but only if the service providers providing Hotline Services for BBT, they wanted to ensure these could be assigned to other after services were continued in the future. They also provide MOT hours services in our area. She is services for Andrews Center and Coastal Plains. She has a crisis not able to have just dedicated hotline service in those areas and uses staff associated with the hotline MCOT service providers for a to also provide face to face emergency screening under contract. She specific area. It would not be cost is not able to just have dedicated staff waiting for a crisis call, they effective without having probably a have to be associated with another after hour service to make this Hotline System in addition to the work for her. She would like to consider a hotline service in this area MCOT services. She would have to which would enable her to provide face to face emergency screenings come into our area(s) and hire staff October 1,

6 Excell Rise Above the Rest Methodist Health Care Systems of San Antonio Providence Service Corporation of Texas DSHS Website DSHS Website for BBT. Telephone call on June 29 th and June 30 th, Left messages. Telephone Discussion with Liza Jensen on June 30, Interested in contracting for inpatient beds since SASH / ASH beds are regularly on diversion. DSHS Telephone conversation with Richard Wallace on April 13, Providence provides in home counseling for mostly children (60% kids and 40% adults) but also adults. Medicaid rate is very low at $58 per session but they are able to pay providers $38,000 to $40,000 salaries.with low overhead. It has a lot to do with the rate, case rate is interesting. Volume is another issue; it would have to be a good business model for them to be interested. If referrals are not guaranteed it would be tough to put time and effort into an RFP. Has a family preservation services contract with Juvenile Probation in Travis County family therapy and individual services and can use LPC-I to provide the services. (not contract staff). Avail currently provides our Crisis Hotline services and would like to continue to provide this service. No return calls. Methodist Hospital would like a contract to provide inpatient psychiatric services for persons from our service areas (Guadalupe and Gonzales Counties). They sometimes have clients from our service area and would like to have a funding source for these beds. Providence provides licensed counseling services (in home services). Richard indicated he has no MHMR contracts and was interested in Intensive services if the rate was acceptable. He indicated he would like to bill for services directly than have to take a cut for our billing services especially if they are CARD services (Counseling is CARD services). Interest in discrete Rehabilitative services for Adults and Children, but would like to review the rate and determine if it would be feasible to provide care in our service areas. Discussed the DSHS training requirements and his concern that this is not reimbursed. No indication of how many clients he could consider for this initiative. Retrospective DSHS Telephone conversation with Victoria Jones on June 14, She is Provides counseling services to interested in counseling services. Would like to consider a contract children in the Austin Area and is October 1,

7 Solutions Website for services. interesting in contracting for CBT services for both Adult and Children. Referred her to contracts (Kathy Kuehner at BBT) since we are already contracting most of our counseling services. Telecare Corporation The Wood Group DSHS Website DSHS Website Telephone conversation with David Pan on June 30, He has an extensive history providing intensive MH services in the San Antonio Area. They have current contracts with Molina (HMO) and the Center for Health Care Services along with Harris County. Intensive CM services are their expertise. Prefers caseloads of 1:8 but at times it may be 1:10. He follows the ACT model and is certified by CARF Rehabilitative Services. Telephone conversation with Jerry Parker on April 8, He reviewed his interest in providing Rehabilitative services and his current contracts with multiple MHMR agencies. He has mostly residential services under contract with numerous agencies but does provide rehabilitative services in the valley. He manages a small clinic for Camino Real MHMR but does not provide the doctor services. Not interested in Children or DD services. Starting a new contract / services with Tarrant County which includes the full service package for both GR client and Medicaid clients. David Pan is interested in contracting for intensive services which may include the medication services as well (bundle all services for SP-3 and SP-4 clients). He would need a service area with at least 100 persons enrolled in Intensive services. He would need two or three months to establish his agency in our area. Jerry is interested in Rehabilitative Services.is not interested in the doctor services but rather discrete SP-3 services. He would need at least 50 cases to ensure he is able to be cost effective. Currently Wood Group provides our Crisis Respite Residential Services and would like to continue providing this service for BBT. Local Planning You are NOT required to solicit additional community input before drafting your 2012 plan update. You are required to solicit community input after your plan update is drafted through the public comment process. You may solicit additional community input if you believe it will be beneficial in drafting your update. If you do, conduct the provider assessment before engaging stakeholders so the input you receive is relevant to the options you have. Only include input that is specific to the network development plan. October 1,

8 3) Status of provider availability assessment for 2012 Update Complete this section only if you solicited community input before drafting your 2012 update. Does the final assessment of provider availability documented above match the information about provider availability on hand at the time of community input? Yes _X No If no, briefly describe the difference: Bluebonnet Trails Community Services has the privilege to be involved in the new Medicaid Transformation Waiver Initiative this year and in the coming years. Below is information regarding the 1115 Wavier Initiative. Delivery System Reform Incentive Payment (DSRIP) Projects from four (4) different Regional Healthcare Partnerships (RHP), in which BBT is directly associated with, were required to provide a community needs assessment that had the following elements for each region. 1. Demographic information. 2. Insurance coverage. 3. Description of the region s current health care infrastructure and environment. 4. Description of any initiatives in the above areas expected to occur during the waiver period of federal fiscal years Key health challenges specific to the region (i.e., access issues and high emergency department utilization, etc.) The Community Needs Assessment was not administered by Bluebonnet Trails Community Center but is included in our Local Plan since all DSRIP projects had to address a community need. 4) Community Engagement for the 2012 Plan (If applicable) If you chose to solicit community input before drafting your 2012 update, provide the following information. Include specific events as well as activities that take place over a period of time, such as surveys. Note that a variety of communication formats may be used, including telephonic, electronic, and paper. If input is received from individuals, identify how many consumers, family members, and other individuals participated. Bluebonnet Trails Community Center participated in the comprehensive Community Needs Assessments with our 4 Anchors through the Medicaid 1115 Transformation Waiver program ---- soliciting information from our local partners and residents of our communities. We continue to have monthly meetings with our community partners who participate in the Monthly mental health Task Force meetings. The Medicaid Transformation Waiver has been a major part of these discussions. We have been involved in 4 Regional Partnerships in the development of related projects. If the projects are approved, these projects will enable us to further expand our Local Provider Network. In addition, this summer we participated in the Public Consulting Group (PCG) stakeholder meetings providing insight into needs expressed by family members and advocacy groups. PCG is conducting a comprehensive analysis of the public behavioral health system in Texas, as required October 1,

9 Consumer s Family Other by the 82 nd Legislature under DSHS Rider 71. The needs expressed by the families and advocates are incorporated into the Community Needs Assessments of our 4 Anchor---and within our Medicaid Transformation Waiver project plans. See Community Needs Assessments located at: RHP-4 (Gonzales County) Located at under Helpful Links. RHP-6 University Health System (Guadalupe County) Located at under Updated RHP Community Needs Assessment. RHP-7- Central Health (Bastrop, Caldwell, Fayette and Lee Counties)- Locate report at (click on New Community Needs Assessment Sept RHP-8 Texas A&M Health Center (Burnet and Williamson County) Locate report at see county assessment data. FYI: DSRIP Plans and program description can be viewed in Attachment 2 for Bluebonnet Trails Community Services. Description, Location/Format, and Date or Timeframe Participating Organizations (List) Summary of Input Briefly summarize input relating to the network development plan. If the LMHA has identified interested providers, include recommendations for how the LMHA should implement the mandate to develop the provider network. Number of Individuals N/A See Community Needs Assessment for RHP-4, RHP-6, RHP-7 and RHP-8. 5) PNAC Involvement Show the involvement of the Planning and Network Advisory Committee (PNAC) in the table below. PNAC activities should include input into the development of the plan and review of the draft plan. Briefly document the activity and the committee s recommendations. Date PNAC Activity and Recommendations 09/24/12 Reviewed LPND plan for submission with Regional PNAC (ETBHN). The only provider interested according to our Provider Inquiries was Wood Group of Wichita Falls, Texas. They are currently providing Crisis Respite Services for BBT but are also providing discrete Rehabilitative Services with a number of Community Centers around the State. They also run a small rural outpatient Clinic for Camino Real in South Texas providing all service packages. Jerry Parker would like to be considered for discrete Rehabilitative Services but would also consider providing the full array of package services, if he had a higher percentage of intensive consumers (SP-3) overall. He would need about 60% of the services to be provided to intensive consumers. We will review and consider the options. 4/10/2012 Reviewed the LPND plan submitted in 2010 and the lack of responses. Consider the DSRIP Project and how the collaborations October 1,

10 within the four (4) different regions would affect services for individual with a mental illness, depending on which plan is accepted. Reviewed some of the initiatives being considered such as Crisis Respite / 48 hour hold program, Transitional housing with Peers, Integration of Physical and Behavioral Healthcare, Patient Navigator, and Substance Abuse Treatment Initiatives. Plan for more RFPs to attract network providers in our area. Consider providing Services in all of our 8 county service area by Packages. 1/ 10/2012 Reviewed ATCIC plan to seek external providers for Rehabilitative Services. Considered our Plan for the coming year. Provider Network Development 6) Contract Expenditures Complete the table below. Total DSHS funding is the amount described as Total Allocation from Section VIII Budget of the DSHS Performance Contract. The Federal Rehab is equal to the amounts received as 100% payment from Medicaid less the General Revenue that is State match. These amounts should be added to arrive at the total for Adult MH and Child/Adolescent MH Services. For FY 2012 data, provide information from the first six months of the year (September 2011 through February 2012). SERVICE CATEGORY Total DSHS funding and Federal Rehab 2009* External provider contract expenditures 2009 Total DSHS funding and Federal Rehab 2010* External provider contract expenditures 2010 Total DSHS funding and Federal Rehab 2011* External provider contract expenditures 2011 Projected DSHS funding and Federal Rehab 2012* (6 months x 2) Projected external provider contract expenditures 2012 (6 months x 2) Adult MH Services Child/Adol MH Services TOTAL MH Services Dollars % Dollars % Dollars % Dollars % $8,793,470 $2,528,123 29% $11,751,576 $2,274,663 19% $11,178,023 $1,838,514 16% $10,583,619 $1,554,792 15% $1,085,941 $538,493 50% $1,360,519 $339,799 25% $1,183,729 $244,131 21% $1,106,535 $219,182 20% $9,879,411 $3,066,616 31% $13,112,095 $2,614,462 20% $12,361,752 $2,082,645 17% $11,690,154 $1,773,974 15% October 1,

11 Breakout of CONTRACTED SERVICES: Medication and Labs $1,558,460 51% $1,219,745 47% $851,876 41% $526,840 30% Physician Services** $592,913 19% $574,707 22% $420,537 20% $419,865 24% Counselor Services** $83,928 3% $98,180 4% $81,370 4% $46,620 3% Crisis Services $371,933 12% $383,211 15% $381,458 18% $427,958 24% Residential Services Inpatient Services $175,641 6% $316,860 12% $330,454 16% $324,264 18% 0% 0% 0% 0% Other (list): 0% 0% 0% 0% Respite Services $259,941 8% 0% 0% 0% Nursing Services $23,800 $21,759 $16,950 $23,440 Family Partner 0% 0% 0% $4,987 0% TOTAL $3,066,616 99% $2,614,462 99% $2,082, % $1,773, % * Total DSHS funding and Federal Rehab amounts includes funding for the Authority functions of the LMHA, as well as the state match for Case Management, which may not be performed by any entity other than the LMHA. ** Include only contracts for physician and counselor services with no other associated services. These will generally be contacts with individual practitioners or groups of individual practitioners. List contracted service packages separately, even though they include physician and counseling services. 7) FY 2010 Provider Contracts October 1,

12 List your FY 2012 Contracts in the table below. In the Provider Type column, specify whether the provider is an organization or an individual practitioner. If you have a lengthy list, you may submit it as an attachment using the same format. ( See Attachment 2 for a comprehensive list of External Providers) 8) Current and Planned Network Development for FY Complete the following table. Leave cells blank if the percent is 0. Column A: Document current capacity for all service packages, regardless of past or planned contracting. Current service capacity is the average monthly capacity based on service data from FY 2011 and FY 2012 through the most recent closed quarter for services controlled by the DSHS contract. Capacity for service packages is expressed as the number of clients served; use the following DSHS data warehouse report to determine current service capacity: PM Service Target LPND (tab 3: Service Target County by Component and LOCA). The link is: mon/appservice.do&loc=en&pvl=en_us&ctx=standalone&actid=224&objids=7934&containerid=6569&pref=maxopageu%3d100%3bmax OpageUt%3D200%3BmaxOpageC%3D10%3Btz%3DAmerica%2FChicago%3BmUnit%3Dinch%3BshowFilters%3Dtrue%3BsmtpFrom%3Dtru e%3bpromptforunsaveddata%3dtrue%3b Column B: State the percent of total capacity contracted to external providers in FY This is the maximum capacity to be served by external provides according to the terms of the contract. Column C: Document the percent of capacity served by contractors in FY 2011; this is the actual capacity served by contractors. Column D: State the current percent of total capacity contracted to external providers for FY This is the maximum capacity to be served by external provides according to the terms of the contract.. Column E: Document the percent of capacity served by contractors in the first six months of FY 2012 (September 2011 through February 2012); this is the actual amount paid to external providers during this period. When calculating percentages, use six month figures in both the numerator and denominator. Columns F and G: If you will be procuring complete service packages in the next biennium, state the percent of current capacity planned for contract in 2013 and in This is the cumulative percent you anticipate having under contract in that year, not the percent to be procured in that year. Column H: Note the number of available providers based on your provider assessment documented in the previous section. Column I: Use the following list to identify the number of the applicable condition that justifies the level of service the LMHA will continue to provide internally. Include all conditions that apply. Refer to the Appendix B for complete language as specified in 25 TAC Willing and qualified providers are not available. 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, and the LMHA will therefore provide up to 50% of the service. This condition does not justify the LMHA providing more than 50% of services. 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. October 1,

13 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 only the balance of current capacity. 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. Instead, the LMHA plans a phased transition to full utilization of external provider capacity, increasing the volume of contracted services over two or more planning cycles. 6. Existing agreements restrict procurement or existing circumstances would result in substantial revenue loss. Use this condition if an external restraint is the controlling factor limiting full use of external provider capacity. PAST and CURRENT PLANNED Service Adult Service Packages A B C D E F G H I Current service capacity Percent of total capacity contracted in FY 2011 Percent total capacity served by contract providers in FY 2011 Percent of total capacity contracted in FY 2012 Percent total capacity served by contract providers in FY 2012 (6 mo) Percent of total capacity planned for contract in FY 2013 Percent of total capacity planned for contract in FY 2014 Number of available providers Adult RDM SP 1 1, % 50% 0 1, 4 Adult RDM SP % 50% 0 1, 4 Adult RDM SP % 50% 2 3,4 Adult RDM SP Adult RDM SP Adult RDM SP TOTAL Adult Services 2684 Child Service Packages Children s RDM SP % 50% 0 3,4 Children s RDM SP Children s RDM SP Children s RDM SP Children s RDM SP Children s RDM SP Children s RDM SP % 50% 0 3,4 Children s RDM SP Applicable condition October 1,

14 Children s RDM SP TOTAL Children s Services Use the following table to list any discrete routine services or crisis services with contracting activity (2009, current, or planned) OR interested providers. Leave cells blank if the percent is 0. Current service capacity is the average monthly capacity based on service data from FY 2011 and FY 2012 through the most recent closed quarter for services controlled by the DSHS contract. Capacity for discrete services is expressed as units of service delivered. DISCRETE ROUTINE SERVICES And CRISIS SERVICES PAST and CURRENT PLANNED A B C D E F G H I Units of service delivered in 2011 Percent of total capacity contracted in FY 2011 Percent total capacity served by contract providers in FY 2011 Percent of total capacity contracted in FY 2012 Percent total capacity served by contract providers in FY 2012 (6 mo) Percent of total capacity planned for contract in FY 2013 Percent of total capacity planned for contract in FY 2014 Number of available providers Crisis Hotline (Avail Solutions) 8, % 100% 100% 100% 100% 100% 1 N/A Crisis Respite Residential Bed Days Psychiatric/Diagnostic Evaluations 2, % 100% 100% 100% 100% 100% 1 N/A 2,527 30% 30% 35% 33% 30 % 30% 17 N/A Pharmacological Mgmt 25,400 18% 18% 24% 23% 25% 25% 17 N/A Venipuncture % 87% 93% 90% 90% 90% 1 N/A CBT Counseling 2,365 88% 88% 98% 99% 100% 100% 8 N/A Crisis Intervention Svc 6,480 44% 44% 57% 56% 50% 60% 17 N/A Applicable Condition 9) Rationale for LMHA Service Delivery a) Describe the rationale for your plan for network expansion, including the services to be procured and the volume of services to be procured. If only selected services are identified for procurement, explain why those services are being offered for contracting and others are not. Discuss services for adults and for children and adolescents separately. October 1,

15 Assuming achievement of the stipulations of: (1) availability of qualified external providers interested in contracting with the center and (2) willingness of external providers able to provide sufficient service volume in a timely manner, the Center intends to achieve full utilization of available external provider capacity by gradually increasing the percentage of service capacity procured over the next three years. If these stipulations hold true, the potential for procurement of 100% of service capacity by external providers may be accomplished by January 1, As the Center gains experience with our providers, the Center will assess, discuss and consider increasing the percentage of the service capacity to be contracted out based on: (1) demonstrated stable service delivery and (2) willingness and ability of the external provider to accept additional capacity. Adult Services As enrolled adults in need of mental health services make up 80% of the total capacity of mental health services provided through our eight (8) counties served by BBT, the primary goal of the previous planning cycle had been establishing a procurement target for adult services. Although BBT did not achieve the target procurement numbers during the previous planning cycle, the Center will maintain the target for AMH plus include SP 3 services for the FY 2013 planning cycle. During the FY 2013 planning cycle, we will broaden our base seeking external providers for AMH SP-1, SP-2, and SP-3. We will continue to recruit external providers for all (except SP 4) adult service packages who are able to demonstrate an ability to effectively provide the services in each of our eight (8) counties. The Center has chosen not to prioritize crisis services for this planning period as the Center currently has 57% of the services provided by external providers. As the Center received no notice of interest from external providers for Adult Services during the previous planning cycle and, therefore as the Center has no experience with contracting during the LPND planning cycle the Center will continue to ensure the internal provider system in each of the eight (8) counties remains operational as a safety net while the external network is developed during this planning cycle. Child and Adolescent Services The Center will recruit external providers for CMH AP -1.1 and SP-4 services. The largest numbers of clients enrolled in Children Services (77%) are in these two service packages..therefore we will begin our procurement efforts in these two service packages. The Center will seek external providers demonstrating capacity to serve persons in SP-1.1 and SP-4 in each of our eight (8) counties. If the Center is successful in recruiting external providers for SP-1.1 and SP -4, the next step will be to offer a larger percentage of the caseload. Bluebonnet Trails Community Services will continue as a provider only if we are not successful in recruiting at least two other providers who have capacity to accept the numbers that are enrolled in services. Currently, the Center has external providers responsible for 100% of the discrete counseling services associated with SP1.2 and SP2.3. Therefore BBT is not seeking external providers (for the entire service package) at this time. The numbers in these service packages do not justify trying to procure services at this time. The Center will continue to ensure the internal provider system in each county remains operational as a safety net while the external provider network is developed. October 1,

16 b) If the LMHA will continue to provide one or more services because the external network does not provide equivalent access (Condition 3), describe how this determination was made, including the source of data. NOTE: The LMHA must have supporting documentation that can be submitted to DSHS when requested. BBT will continue to provide MH Services since we have not been successful in procuring external providers in our service areas. BBT will only provide services as a result of not having at least two external providers or if service capacity does not exist. c) If the LMHA will continue to provide one or more services because the external network does not provide sufficient capacity (Condition 4), complete the following table. Use this condition if the LMHA will use all of the available external provider capacity and directly provide only the balance of current capacity. External provider capacity is usually determined through the follow-up contacts that take place during the provider availability assessment. In previous attempts to expand our external provider system BBT has not received any contracts from provider systems in the community. We will continue to dialogue with existing and willing partners to determine external provider capacity in the coming years. More information will be collected within the next 6 months or after the RFP is published. Service Capacity Needed External Provider Capacity Information and Method Used to Determine External Network Capacity See note above. d) If the LMHA will continue to provide the specified capacity of one or more services in order to preserve critical infrastructure to ensure continuous provision of services (Condition 5), identify the planned transition period and the year in which the LMHA anticipates procuring the full external provider capacity currently available. If the same transition period is planned for all services, only one entry is required. When different transition periods are planned, list each separately. NOTE: The rule states that this condition can be used only when the LMHA identifies a timeframe for transitioning to an external provider network, during which the LMHA procures an increasing proportion of the service capacity of the external provider network in successive procurement cycles. This timeframe is the LMHA s best estimate based on the limited information currently available, and does not represent a firm commitment. The timeframe will be reassessed during each planning cycle based on the results of procurement, provider performance, and new information. The current estimate should assume that proposed procurement plans are successful and the contractors prove to be stable providers and meet established performance standards. N/A Service Transition Period Year of Full Procurement N/A October 1,

17 e) If the LMHA will continue to provide one or more services because existing agreements restrict procurement or existing circumstances would result in substantial revenue loss (Condition 6), briefly describe each of them, including the end date of any agreement. Describe any steps taken to amend the agreements or alter the conditions to allow contracting. NOTE: LMHA may be asked to submit copies of agreements or other supporting documentation. N/A 10) Rationale for Volume of Services Provided by the LMHA to Preserve Financial Viability If the percentage listed for any service is based on a determination that the service provision by the LMHA would not be financially viable at a lower level, explain the budget analysis used to arrive at the specified volume. Enter NA if you have no interested providers or if the volume of services to be provided by the LMHA is not higher than it would otherwise be to ensure financial viability. NOTE: Supporting documentation may be requested. N/A 11) Strategies to Protect Critical Infrastructure In bullet format, briefly describe the strategies will you implement to protect critical infrastructure and promote a stable, successful provider network. Enter NA if you have no interested providers. Our efforts to expand our External Provider System in the past two years did not lead to a deterioration of our infrastructure. We will continue to monitor this issue and advise DSHS accordingly. 12) Time to Re-establish Lost Service Capacity Estimate the amount of time needed to re-establish the service volume lost if a contract is terminated. If time varies depending on the service type, list each separately. Enter NA if you have no interested providers. Service(s) Pharmacological Mgmt and Psychiatric Evaluations Skills Training MCOT Services CBT Counseling Time Needed to Re-establish Service Volume 120 days 90 days 90 days 90 days October 1,

18 Procurement 13) Structure of Procurement(s) In the table below, describe how the 2012 procurement will be structured, making a separate entry for each service or combination of services that will be procured as a separate contracting unit. Enter NA if you have no interested providers. Note the method of procurement: competitive procurement (RFP) or open enrollment (RFA). Identify the geographic area(s) in which the service will be procured, and the percent of your clients living in the designated geographic area. Specify whether an external provider will be required to cover the entire area. If an external provider will be permitted to contract for services in only a portion of the identified area, note how the area may be partitioned. Describe the rationale for how the procurement will be structured. In the rationale the following issues must be addressed: o Method of procurement (competitive vs. open enrollment) o procurement of discrete services rather than service packages (provide a separate rationale for each discrete service) o bundling of services or service packages o service area (whether the entire local service area is included or only selected counties, and choice of individual counties) Date(s) Meth od (RF A or RFP) Service or Combination of Services to be Procured Geographic Area(s) in Which Service(s) will be Procured Percent of Clients Rationale December 31, 2012 RFP SP-1, 2, and 3 (bundled services include doctor, counseling, and skills training services.) Entire Service Area: Bastrop, Burnet, Caldwell, Fayette, Gonzales, Guadalupe, Lee, and Williamson Counties 25% to 50% of the service package listed. We are hopeful that this coming year we will be successful in recruiting an external service provider system. We will start with the percentage listed to assess capacity and dedication to service areas. BBT will therefore support an RFP which will cover the entire service area in an effort to develop more choice options for persons enrolled in BBT services. December 31, 2012 RFP SP 1.1 and SP- 4. (Entire array of services available in Service Packages) Entire Service Area: Bastrop, Burnet, Caldwell, Fayette, Gonzales, Guadalupe, Lee, and Williamson Counties 25% to 50% for now but will transition to a larger percentage as appropriate. We will procure services for the entire service package and transition to a larger percentage as appropriate. We would like to transition services for the other service packages as well, but since the largest numbers of clients are in SP -1.1 and SP-4, we will begin with these two service packages. October 1,

19 14) Fidelity and Continuity of Care (complete only if discrete services will be procured). If you plan to procure discrete services (rather than full service packages), describe how you will maintain fidelity and continuity of care in the provider network. The content of this section describes what changes or additions will be made to your standard process to address the additional fragmentation that can occur when services for a single consumer are provided by multiple contractors, often in multiple locations. Enter NA if you have no interested providers or plan to procure service packages only. Note: BBT has discrete services on contract for psychiatric (doctor) services, counseling and crisis services. We will continue to support these initiatives and COC strategies to ensure continued client care and communication of any concerns. 15) Enhanced Staff Qualifications Do you require any individual practitioners to meet higher standards than those described in the DSHS performance contract? Yes x No If yes, identify the practitioner(s) and the specific qualifications. Enter NA if you have no interested providers. Consumer Choice 16) Single Provider List all services to be provided by a single provider (regardless of provider availability) and the reason(s) for not offering consumers a choice of providers. Identify any economic factors involved in the decision. Enter NA if you have no interested providers. Service to be Provided by a Single Provider Intake (Screening, Pre-admission Assessment) Case Management Services Reason(s) for Limiting Client Choice The Center believes that this is an essential LMHA role to retain these services in order to establish eligibility for services. The Center is also responsible for ensuring that authorized services do not exceed general revenue allocation. CM services will continue to be an essential role for the LMHA to assess the right level of service and monitor recovery of the person receiving services. 17) Choice and Access Using bullet format, briefly describe plans for maximizing consumers choice of providers and access to services, including relevant procedures, procurement specifications, and contract provisions. October 1,

20 Consumer access and choice are critical aspects of expanding the provider network. Consumers expressed their desire for improvements in terms of relationship, access and service quality. Minimally, it is expected that individuals who receive services can expect high quality of services and improved access. Through the survey process, public input, meetings, and other opportunities to gather consumer concerns, individuals have expressed a desire to have services closer to home or able to access transportation services (Carts). Consumers desire pleasant wait areas with timely appointments and shorter wait for services. If appointments are cancelled for any variety of reasons, consumers want to be assured that they will be rescheduled promptly. They would appreciate timely return of telephone calls and assistance in negotiating conflicts with providers and an opportunity to choose a provider, particularly doctors and counselors. Consumers expressed the desire to be engaged with providers who are professional, friendly, sensitive and who clearly communicate expectations of care. Consumers want someone who believes in their recovery. 18) Diversity Using bullet format, briefly describe how the LMHA will ensure its provider network meets the diverse cultural and linguistic needs in the local community. Include relevant standards, procedures, procurement specifications, and contract provisions. The Center is committed to ensuring that all individuals who receive services have the opportunity to effectively communicate with their service providers. It encourages and works to facilitate the involvement of families and consumers regardless of the language which the consumers speak or their cultural background. The Center recognizes that culture impacts how people label and communicate distress, explain the causes of mental health problems, perceive mental health providers, and utilize and respond t mental health treatment. While there is an ongoing goal of bringing quality services to consumers and to continuously improving those services through the use treatment approaches such as evidence-based practices, it is recognized that cultural adaptation must also be utilized to keep the services consistent with the consumer s culture. The Center will maintain its position that cultural competency takes place in the mental health service delivery system when cultural issues are acknowledged and addressed at all organizational levels (administration, service delivery and clinician). Requirements that all individuals receiving services will have the opportunity to effectively communicate with their service providers will be included in provider contacts. Bi-lingual staff are recruited and hired for those positions needing that skill whenever possible. October 1,

21 Capacity Development 19) Cost Efficiency Using bullet format, list steps taken in the past two years to minimize overhead and administrative costs and achieve purchasing and other administrative efficiencies. Do not report efforts included in the 2010 network development plan. Continued partnership with ETBHN Network continues as in our 2010 Network Development Plan which has realized cost savings in Pharmacy Services, Authority Functions and UM functions; Continue partnership with FQHC in Gonzales, Caldwell and Guadalupe Counties. Mental Health Clinic in Gonzales County is co-located with the FQHC program. List partnerships with other LMHAs related to planning, administration, purchasing and procurement or other authority functions, or service delivery. Include current, ongoing partnerships (regardless of date established) and time-limited activities that occurred over the past two years. Start Partner(s) Date 9/01/2010 We share office space with Austin Travis County Integral Care 9/01/2010 We share office space with Heart of Texas MHMR in Waco, Texas Functions OSAR Services OSAR Services Identify any current efforts and plans to develop new opportunities for working jointly with other LMHAs. 20) Previous Network Development Efforts In the table below, document your procurement activity over the past two years. List each service separately, including the percent of capacity and the geographic area in which the service was procured. State the results, including the number of providers obtained and the percent of service capacity under contract. If no providers were obtained as a result of procurement efforts, please note under results. Procurement (Service, Capacity, Geographic Area) Results (Providers and Capacity) October 1,

22 Adult Service Package 1,2, and 4 (20% to 100% of package services), in all 8 counties served by BBT Children and Youth Services Package 4 (100%), in all 8 counties served by BBT Posted March 14, 2011 but no external providers responded to RFP Posted March 14, 2011 but no external providers responded to RFP List the comments you received after posting the draft procurement documents during the 2010 planning cycle, and how you responded to the comments, including any modifications made to the procurement document. Comment or Suggestion None LMHA Response N/A In bullet format, list specific steps taken over the past two years to develop the LMHA s internal capacity to develop and manage the external provider network. The scope of activity should be appropriate to the level of interest from external providers. BBT attempts to develop our Provider Network in 2010, and 2011 did not attract any external providers. Although we were unsuccessful in the recruitment process we will continue to promote our efforts to ensure we have a choice of provider within our service areas. Discrete services such as crisis, counseling and psychiatric (doctor) services are ongoing recruitment efforts that will continue through-out the planning period and between fiscal years. UM processes have been established to better manage both the internal and external provider network. As our provider network grows we will ensure that our UM Department is able to handle the increase responsibility. 21) Barriers Identify the barriers you encountered when trying to recruit external providers, including any local circumstances that make recruitment difficult. Describe how you plan to address each barrier or reduce its impact during the 2012 procurement. Barriers Shortage of external providers willing to provide the full array of services in our entire service area (8 counties). October 1, Plans Maximize the efficiency of the external network by focusing on procuring providers willing to provide the full array of mental health-related services Rates not attractive to external providers We will offer 100% of the Medicaid Rate for the FY 13 procurement plans

23 22) Long Term Planning Note: Long term plans are based on the limited information currently available, and will be reassessed during the next planning cycle; they do not represent a firm commitment. If the LMHA is continuing to provide services in order to protect critical infrastructure, briefly describe your plan for transitioning to full utilization of the service capacity being offered by external providers. Assume that proposed procurement plans are successful and the contractors prove to be stable providers and meet established performance standards. The plan must include a target date for the transition and measurable objectives for each procurement period. If your proposed procurement is successful, what are your current plans for expanding the external provider network during the 2012 cycle? Identify the services and general volume capacity you are considering for procurement in the next planning period. If this information is documented in your critical infrastructure transition plan, simply reference it. Enter NA if you have no interested providers. If BBT is successful in recruiting external providers to our network, we intend on expanding capacity as necessary to ensure Choice of Providers for all counties in our service areas. Success to BBT is defined as first recruiting external providers but also achieving and promoting recovery based thinking, to reduce the symptoms of MI but also to increase wellness and recovery for the persons enrolled in MH services. Compliance with contract requirements, customer satisfaction, and access to services will also promote success for this initiative. BBT welcomes this relationship and will nurture these providers to ensure our network is competitive and successful in the provision of mental health care. BBT believes that the primary focus of behavioral health care planning and organization should lie in the community. The staff of the Center working with the stakeholders, advisory committee members, consumers and families and its board of trustees, has established business practices based on the planning considerations we have identified to prepare for this service model shift. This has allowed the Center to be able to prepare the community, consumers and their families as well as Center staff to the realities of this new environment. The Center must continue to refine our service delivery outcomes and prepare standard measures for service delivery that are consistent, timely and provide quality outcomes for people that meet our community s expectations so that this Center can position itself as having a network of Behavioral Health Care Providers that enhances services and quality of life for consumers within our service areas. Long term strategic planning has historically proven to be of value to this Center. Some of the principles we are keeping in the forefront of our future planning include: October 1,