|1) The membership, appointment process, and meeting schedule for the alternative Advisory Structure shall be clearly articulated to assure that the fee-for-service issue, including SASS, can transition effectively into the on-going structures. The composition of the Advisory Structure should be at least 50% consumers or families, and should include local beneficiaries of the public mental health system, such as representatives from law enforcement, schools, judicial systems, and/or local mental health funding boards.
- Regional planning and input bodies shall be used periodically to review and analyze service and need data, and to gather input regarding community needs. That information should be brought to the state-wide DMH Advisory Structure for overall public mental health planning and priorities.
- The SRI shall cease to exist as a separate group once the restructured DMH Advisory Structure is in place and the work has been fully transitioned to the new Advisory Structure, its subcommittees or working groups.
On-going-During meetings in late August and early September, membership of the existing fee-for-service advisory structure, SRI, was reluctant to significantly modify its membership as envisioned by DMH except to add new members, including the four workgroup chairs. Current SRI members expressed concern that new members would not have benefit of the history of the fee for service transition process and therefore, may not be prepared to represent the issues as effectively as current members. During the process of reviewing its purpose and membership, SRI agreed that its scope was implementing fee for services in a manner that is best for all parts of the system, and that strategies needed to be developed to enhance participation of consumers and their families.
The SRI/fee-for-service conversion workgroups have been restructured to be more inclusive of other providers, consumers and other stakeholders.
|2) DMH shall continue to work with DPA and other affected departments to develop a Medicaid state plan amendment that includes current recommendations from the services workgroup related to recovery-focused service taxonomy with corresponding changes to Rule 132 and rates for these services. To the extent possible given the required federal approvals, the state plan amendment, changes to Rule132 and rates shall be effective no later than July 1, 2006, to correspond to the full implementation of fee-for-service. If all the recommended changes cannot be accomplished by this date the priority recommendations should be done first.
- A workgroup process is preferred as a method to develop recommendations for revised service definitions for DPA and DMH consideration. The existing services workgroup can be adjusted to incorporate greater clinical representation for this function.
|On-going-A process for amending the Medicaid state plan and a prioritized list of services to be included in the amendment and changes to Rule 132 has been approved by the Inter-departmental Medicaid Group (HFS, DHS, DCFS, DOC). The planned process and prioritized services have been communicated to the Services workgroup and its Residential subgroup. Work on specific types of services (residential, ACT and PSR) is being initiated through the formation of subgroups for each service. The Services workgroup and its subgroups are inclusive of DMH and DCFS providers and staff, consumers, trade groups, and staff from HFS. All subgroups have met in September and will be meeting 1-2 times per month until completion of task. The groups continue to work toward the original timelines of July 1, 2006, however, the feasibility of that goal will be clearer by the end of the next quarter.
|3) The provider communication structure and methods that have been developed during the field test process shall be expanded beyond the 30 field test agencies to include all 158 providers impacted by the transition to fee-for-service. Logistics and resources required for monthly, state-wide meetings cause it to be likely that alternative communication strategies will be necessary, such as relying on website postings, email, and less frequent regional or "semi-regional' meetings. As a part of increased reliance on regional structures for communication, DMH shall make best efforts to ensure the consistency of regional information and resources. Progress reports on these alternate communication strategies and resource requirements will be part of the quarterly reports.
||On-going-The first state-wide meeting for all providers was held in late September and a second statewide meeting is planned for mid-December. Representatives from all providers are being included in the restructured workgroups as a further means of improving communication and representation throughout the DMH provider network. The effectiveness of regional network communication structures is included as one component of the state readiness assessment scheduled to be completed in early November.
|4) FY 06 provider contracts shall include the following:
- FY 06 contracts shall permit a limited portion of Medicaid and Non-Medicaid funding to be reallocated from those providers with very low billing levels to those with the highest levels of billing. The financial work group will continue to work with DHS/DMH on implementation of this process.
- Providers shall continue to receive monthly advances of contract amounts, although the specific amounts of the advances shall be sufficiently flexible to allow the adjustments referenced above that begin to align billing and contract amounts, and to address cash flow problems associated with the 718 Mental Health Trust Fund.
- Reconciliations shall continue to compare advance payment amounts with billing levels for all providers, with a monthly summary that details the number of providers above/below 100%, 90%, and 80% of prorata Medicaid and Non-Medicaid billing levels by date of service.
- Capacity grants shall be maintained at current levels for FY 06, which is consistent with the recommendation from the finance workgroup and SRI. Further analysis of the amount of capacity grants and services supported by capacity grants shall be completed during FY 06 to facilitate changes that are aligned with service taxonomy and rate changes that are implemented with fee-for-service and as a part of the state plan amendment and Rule 132 changes.
- The existing financial workgroup, including representatives from across the entire provider network and consumers/families, shall continue to provide input to DMH regarding FY 06 contracts and financially related transition issues. The membership in the existing financial workgroup shall be adjusted to include broader representation from the provider network while maintaining a reasonable size.
- Reconciliation of provider contracts shall continue as outlined in the FY 05 Community -Based Mental Health Services Memorandum of Understanding, as amended.
- On-going-Contract language included the midyear reallocation, and proposed models have been developed by a subgroup of the Finance workgroup and presented to all providers and the Finance workgroup in late September.
- On-going-Providers are continuing to receive monthly advances of FY06 contract amounts. A 718 Fund/Cash Flow subgroup has been formed to continue work on these issues.
- On-going-Reconciliations of advances to billing levels are available to all providers from SIS Online. A report of providers at varying levels of billing against targets for FY05 was distributed as part of the proposed FY06 midyear reallocation calculations, and a report for FY06 is under development.
- On-going-DMH has completed a preliminary analysis of the components of current capacity grant funding and proposed principles and allocation methods that have been presented to the Finance workgroup. The same information will be presented to the SRI at an upcoming meeting. A Capacity Grant subgroup has also been formed to provide input on further analysis, funding and allocation methods.
- Complete-The Finance workgroup has been restructured to include representatives beyond the 30 field test agencies and consumers; it held its first meeting in late September.
- Complete-Reconciliations of advances to billing levels is available to all providers through SIS Online.
|5) A plan for provider technical assistance and training shall be developed and implemented for FY 06 that includes large group training and tailored technical assistance. The technical assistance shall be for a limited number of providers identified through criteria as needing additional assistance to be given best-effort opportunity to successfully complete the transition to fee-for-service. The technical assistance and training shall be provided through a combination of DMH, consulting and, potentially, provider trade association resources.
||On-going-A provider training and technical assistance plan has been developed and presented to SRI. Consulting resources in this area have been identified through a procurement process, however, the contract is not yet in place.
|6) A process shall be developed and articulated to identify geographic or service areas where service disruptions may occur, along with development of a contingency plan to address consumer needs in the event of changes in service capacity/availability during the transition to fee-for-service.
||On-going-This activity will be assigned to the Access workgroup. Membership for the Access workgroup has been restructured to include consumers and representatives from all DMH providers. The provider chair has been selected and has set the first meeting of the group for October 13th.
|7) DMH shall complete a readiness review of the state systems, using consultants with appropriate experience. The readiness process shall identify and address critical implementation issues that must be addressed prior to the full implementation of fee-for-service.
||On-going-Planning for assessing the state's readiness to function in a fee for service environment is well underway with the bulk of the onsite activities scheduled for late October. A report is expected during December. One component of the readiness assessment, DMH advisory structures, was completed in July and a summary report was made available to DMH and all participants in the process.
|8) Mechanisms shall be identified and developed to address two cash flow issues that have been identified as a part of the field test process-the 718 Mental Health Trust Fund shortfall, and the time from claim submission to payment on Medicaid claims. Discussions on alternate financing of the mental health system shall occur with the current SRI finance group during June and July and reported to the House Fee-For-Service Initiatives Committee. If no agreement is reached, discussions will continue.
||On-going-- A 718 Fund/Cash Flow subgroup has been formed to continue work on 718 cash flow issues, and overall cash flow issues associated with the time from claim submission to payment. Discussions of alternate financing of the mental health system have not yet occurred but will be on the agenda for the Finance workgroup next quarter.
|9) DMH shall lead a process to develop baseline access to care standards that are measured regularly at local, regional and state-wide levels. The process shall include input from the stakeholder workgroup.
||On-going-This task has been assigned to the Access workgroup. In addition, access to care standards will be included in the state's readiness assessment process.
|10) DMH in collaboration with the SRI/Advisory Structure shall prepare quarterly progress reports describing progress on the fee-for-service transition. Those reports shall be delivered the House Special Committee on Fee-For- Service, the Senate Health and Human Services Committee, and the Governor and published on the website no later than 30 days following the close of the quarter.
||On-going-Reports have been prepared with the SRI Task Group and submitted for the following dates: September 30, 2005