Conference Participant List

Technical Conference Call - April 12, 2012 (pdf)

Final Transcript

STATE OF ILLINOIS: Tinley Park Request for Information

April 12, 2012/3:00 p.m. CDT

SPEAKERS

Dan Wasmer

Michael Pelletier

PRESENTATION

Moderator

Ladies and gentlemen, thank you for standing by, and welcome to the Tinley Park Request for Information conference. At this time, all participants are in a listen-only mode. Later there will be an opportunity for questions. As a reminder, this conference is being recorded.

I'd now like to turn the conference over to your host, Mr. Michael Pelletier. Please go ahead.

D. Wasmer

Thank you. Actually, this is Dan Wasmer speaking. I'm here with Michael Pelletier. Welcome everyone, this, as the moderator, Rochelle, said, this is the DHS technical assistance call for the Request for Information, the RFI, posted on April 4th for the Tinley Park Mental Health Center Community reinvestment.

Your host for the call will be Michael Pelletier, who is the special assistant to the director at the Division of Mental Health; and myself, Dan Wasmer, associate director of region services at the Division of Mental Health. We also have a few experts in the wings with us. We have Rick Nance, who's the administrator for the Bureau of Program Operations at the Division of Alcohol and Substance Abuse; Brian Brinker, the CFO, chief financial officer for the Division of Mental Health; and Brock Dunlap, who is with Community Services and is our fiscal policy specialist there at the Division of Mental Health.

Just some recommendations for the call. I would recommend if you have it handy to have a copy of the RFI in front of you, or to have it on the screen in front of you for reference. We would ask that when you're asking a question-this call will mostly be devoted to taking your questions-it would be helpful to us if the caller can reference the page and section or paragraph of the RFI for which they are seeking further clarification. That would help us track through the document as you ask your questions.

We're going to do a brief overview of some of the questions we've already received that came into our DMH email box after the RFI was posted on the 4th. Then we'll move on and we'll do our best to give you an answer to your questions on this call. But we're going to warn you that if we're not 100% sure of our answer, we will make sure to capture the question you are asking clearly, and discuss it offline and compose an answer to the question offline.

You should know that both the full transcript of this call, with all the questions and all the answers we give during the call, will be posted to our website. We're hoping it will be within two business days. Alongside that we're going to post a document with the answers we obtained after the call that we discussed offline. So about the same time we hope to be able to post the answers to all the questions brought up during this call.

We have a few things that we're going to touch on just briefly. One thing is to remind people that when we posted this, we posted the RFI as a pdf. Of course, a section of the RFI contains the attachment that the respondent will have to fill out to submit to DMH. Those can't be manipulated inside the pdf, so we also posted the actual documents themselves, which can be downloaded by you and then you can enter data into them and submit them electronically as part of your response. We just wanted to make people aware of that; we did get some questions early on about not being able to use the document.

We also want to alert people that the due date for responses was changed. We sent a follow up email to the original posting advising people that the due date has been moved back from the 16th of April to the 20th of April. Michael, I'm going to hand it over to Michael, and Michael will further clarify about how to make a proper submission on time, a timely submission to this RFI, and also a couple of other questions that were in the mailbox.

M. Pelletier

Thank you, Dan. Like Dan said, we've officially posted on our website and to the distribution list that you may be on that the due date for electronic submission of your proposal has been changed to Friday, April 20th close of business from the May 16th date. We are asking you to send those electronic submissions of your proposal to our dhs.mh@illinois.gov website by close of business on Friday, April 20th, and we're asking for an exact written submission of your proposal to arrive in our Springfield office as directed on the front page of the RFI by Monday, April 23rd, close of business. So we hope that, like Dan had said, we received some requests to modify our submission date. We modified both the date and the fact that the electronic submission will now become your formal admission that we'll be able to accept on close of business on Friday.

We have, again, received a number of questions. We've got one response to inquiry up that's posted for questions that had come in by close of business on April 6th. We have a subsequent document that's in the process of being posted to that same response of inquiries page for questions that we've received from April 9th, April 10th and April 11th. I'm sure there may be some people on the phone that will ask those questions again, and we'll give you the exact response either as posted already or will likely be posted before the end of the day.

Also, again, a number of the questions, particularly from hospitals about CHIPs contracts, we are expecting you to complete Attachment A for those contracts for the sections that are designated for hospitals. We are asking you to complete an Attachment B, which is a proposed budget proposal, which would be specific to your inpatient program loan, because the CHIPs program supports inpatient care. Attachment C and Attachment D are obvious, and those would also relate specifically if you're dealing with the CHIPs application proposal alone, would deal specifically with your inpatient services in response to those two attachments.

Also, just as a point of clarification, we are expecting an Attachment B, which is the budget sheet, for each different program that you are seeking funding from. So if you're seeking additional funds from us for a crisis residential program provided at your agency and/or a crisis intervention or crisis outreach program at your agency, we would expect you to provide us an Attachment B for each one of those programs separately and distinctly.

D. Wasmer

To add onto Mike's response on that, just so we can go over-because there were several questions about the attachments. Just to go over the four attachments once again, Attachment A is we expect provider information for the whole organization. I think that's pretty straightforward. As Mike said, Attachment B, if you are proposing, if you are interested in proposing to provide service, two types of services that we're seeking under this RFI, for example, if you reference the flow chart on page nine of the RFI, there are several programs listed along the bottom of the crisis system box such as crisis outreach, DMH crisis residential, DMH enhanced community services, DASA 3.5 or 3.7 residential or DASA enhanced services. If you're going to propose to provide two or more of those kinds of programs, we would ask you to submit an Attachment B for each of those so that we can evaluate them separately.

On Attachment C, again, is an all-agency Attachment, where you would spell out your funding across all of your agency, and you would add on all the new programs you're adding through this RFI; you propose to add. Attachment D, of course, is just a general count on your part about your success about doing linkages at your agency in those categories listed in the document. So that's the Attachments A-D. Michael, any other? I think that's all we wanted to do in terms of prepared comments, as opening comments. We're ready now, Rochelle, to go ahead to the Q&A.

Moderator

Certainly. (Instructions provided.) You have a question from the line of Ben Stortz. Please go ahead.

B. Stortz

Yes, this is Ben Stortz with Cornerstone Services. Just a question regarding the services. As I read through the RFI, it looks like we're making a delineation between the Phase I and the Phase II approach, and I'm wondering why we wouldn't want to fund some of the Phase II in the first go around, because many of those services would prevent people from going to the emergency room. I'm just wondering what the thought process is for that, and then if there is a Phase I/Phase II, what is the timeline for Phase II then? It would seem that a lot of the services would be beneficial in the forefront.

D. Wasmer

That's a good question. Thanks for asking that question. Phase I, what we wanted to do with this RFI was focus on all the new resources we're putting into the community first at the-if you will, we've talked about, several times, this whole project being sort of a sequential intercept exercise, trying to capture people before they come to Tinley Park Mental Health Center. What we've decided on for the purpose of this RFI is to fund in this first round the services that would intercept people at the 15 emergency departments in Region 1 South. Yes, it did come up during the meetings, the committee meetings we had leading up to the RFI that we could get more bang for the buck, if you will, if we were to design things that could intercept people before they got to the emergency room.

We're very interested in going there. The director has said that's the vision for this system in Region 1 South, but we have to start first and we have to prove to DHS and to the governor and to the legislature that we can intercept those 1,900 people who go into Tinley Park. We've all agreed that within DMH that we'll start on July 1 at those 15 EDs and that will be the beginning of Phase I as you will, but we will be talking and watching the progress of these Phase I programs. As we're able to consider Phase II, we'll move there. I think we'll anticipate moving to Phase II at different times and different places, depending on what we fund.

But if you will, again back to the flow chart on page nine of the RFI, the box that encompasses the Region 1 South crisis system of care, as you see, is positioned to take the people from the 15 community hospitals. This will be Phase I. How we're able to use these services in this box to intercept people on that line between the circle on the right hand-or the left hand side of the flow chart and the community hospitals at the top, how providers are able to intercept individuals along that path. We're going to be very open to designing that, but we'll have to, as that pops up, we'll have to find a way to document that those are the people that would have been served by Tinley Park because the goal is to divert them, 1,900 people, that are served by the state hospital right now.

B. Stortz

It would just make sense to me that to consider using those Phase II services earlier, because, as you said, we would get more bang for our buck. I would just be concerned that-I don't know how much money is being considered to be allocated for Phase I, but if too much is, what's going to be left for Phase II? That's where you can really make an impact. I think we should really consider that as people as submitting these requests.

D. Wasmer

Well, Ben, I think we'll know more about that in a couple of weeks when we see what the providers are proposing and how their narratives describe their current position, how the increased funding will change their position within the system, and of course I think anyone submitting an RFI should go ahead and speak about how that makes, sets the stage for intercepting people earlier in the path to the community hospitals. So we're completely open to that discussion right from the beginning.

B. Stortz

So in terms of that, should there be proposals submitted for the Phase II services at this time, or are you just going to look at the Phase I?

D. Wasmer

This will be Phase I, so what we're looking for in the proposal is for a provider to say I will do crisis outreach services for X number of people out of the emergency rooms in Region 1 South.

B. Stortz

Okay.

D. Wasmer

Or, I will establish a crisis residential that has capacity for X number of referral from in the Region 1 South crisis system of care. I think that's where we'll start, then, and we'll develop the system as we go. The experience-I will note that in talking with our counterparts at the C/A office, they have some very good reports that show how they're able to intercept people before the emergency room and avoid even the emergency room call. That is something that happened after they had established a system and started watching the data and moving the resources to the earlier intercept point. So I think we anticipate we'll be able to copy that experience that the C/A system has seen with the cares line and the past services.

Moderator

Okay, thank you. You have a question from the line of Dr. Joseph Troiani. Please go ahead. Doctor, your line is open.

D. Wasmer

Joe?

Moderator

If you have your mute on, you might want to take it off.

D. Wasmer

Could you move the next caller, Rochelle, and maybe come back to the Doctor. He might have stepped away.

Moderator

Certainly. The next question is from the line of Cherise Rosen. Please go ahead.

C. Rosen

Hi Dan and Michael, can you hear me?

D. Wasmer

Yes, we can.

M. Pelletier

Hi, Cherise.

C. Rosen

Hi. So thank you, you answered one of my major questions about filling out the application just specifically for the CHIP portion of the RFI. But I just have some specific questions, and if I could just go through them.

M. Pelletier

Go ahead.

C. Rosen

Just to clarify, with Attachment A for the staffing characteristics and the patient characteristics, we're focusing just on inpatient, correct?

M. Pelletier

Right.

C. Rosen

Okay. So that's the answer to question A, or Attachment A. This is inpatient and ER staff, like our ER psychiatric social work and those kinds of people, too, since our ER and our inpatient unit are connected?

M. Pelletier

The information for Attachment A and C would be for your inpatient unit only, and your budget would be for your inpatient only for Attachment B.

C. Rosen

Okay, great. Then with Attachment C, is there a program code for inpatient psychiatry? I see them listed under the CMH and it's already there; like 350, 510, 515. Is there a specific code that we put in?

M. Pelletier

No, there's not. You can just put CHIPs on the budget document and we'd understand that. Then just complete the row that is allocated on the Excel sheet for psychiatric inpatient.

C. Rosen

Just for the inpatient piece. Then Attachment D is pretty self-explanatory, so that one, and now I know where to focus it, so that's good. I just want to see if that answers all my questions so I can make sure I complete this correctly.

M. Pelletier

You had another question about language and ethnic categories?

C. Rosen

Oh, those two boxes, yes, at the end. Are those for the inpatient, or are those for community mental health providers?

M. Pelletier

We'd like to know your language and ethnic capabilities for obvious reasons. If you have staff that speak different languages or are of different ethnic backgrounds, certainly that's helpful for us in terms of determining how our diverse consumer community can be met by services at your hospital.

C. Rosen

Okay, so when you say cultural competency, do you not, are you speaking of like a training where people are demonstrating certain cultural competencies, or are you speaking to just cultural diversity within our staff?

M. Pelletier

I think we're more interested in the fact that your staff is trained to deal with different cultural groups.

C. Rosen

Okay.

M. Pelletier

Different ethnic cultural groups, as well as the language capabilities that you may have on the ….

C. Rosen

Got it. Okay, then that just answers all my questions.

M. Pelletier

Okay. Those should be posted later on today, officially, for you.

C. Rosen

Okay, thank you both. Thanks, guys.

M. Pelletier

Sure thing.

Moderator

Thank you. The next question is from the line of Dr. Joseph Troiani. Please go ahead.

Dr. Troiani

Okay, can you hear me now?

Moderator

Yes.

Dr. Troiani

Great. I must have had a bad line, or something. Just a couple of questions, regarding the CHIPs contract, I know that DMH was discussing CHIPs programs with individual hospitals. At this stage, what you're saying is if a hospital is interested in being a CHIPs provider, they are to submit as part of the RFI, correct?

M. Pelletier

That's correct.

Dr. Troiani

Okay. I know this question has been asked off and on, does the DMH, do you guys have currently any arrangements or agreements with hospitals for CHIPs, or are you just kind of using the RFIs as the starting line on that?

M. Pelletier

The RFI is the starting line for that.

Dr. Troiani

Okay. That answers my question. Thank you.

Moderator

Thank you. Question from the line of Jennifer Bosley. Please go ahead.

J. Bosley

Hi, I'm calling from Ingles Hospital. Just a couple of questions. First of all, what is the plan for the timeframe after the requests are submitted? What is the response time looking like?

D. Wasmer

Good question, Jennifer. It came up at the … hearing, I think, on Tuesday. I will just quote what the Deputy Director said at that time, is we anticipate having the responses to the RFI reviewed and scored and have some initial idea about our funding plan by the 27th of April. So as we've said from the beginning, we are under a very tight timeframe here. I think it's been described as an express train rolling down the track, and we're going to plan on reviewing the responses and making some decisions by the 27th, which would put us in a position to begin notifying the agencies and beginning the contract negotiation phase the following Monday.

J. Bosley

Okay. Then I have a follow up question. What is the plan if there is insufficient response? So if only two hospitals step forward with proposals; if there are insufficient services to serve the number of patients that we're projecting?

M. Pelletier

We have two plans. One we … in the distribution that we emailed out in terms of changing the dates. We did ask for providers to send us a letter of intention by the 16th, so that will give us a clue in terms of the response that we would likely get. If the response is insufficient in any of the areas, we would look to the proposals that we've received to whether or not they can expand into different areas and/or give ourselves the opportunity to reach out to providers and see what the limitations or the barriers might have been and see what we could do to get a proposal in by the 23rd.

J. Bosley Okay

I guess if the timeframe is not working, is there a contingency plan? If the timeframe doesn't work, is there any scenario where Tinley would remain open for a certain amount of time in order to put together an appropriate community response and community services.

D. Wasmer

That's not really a question we can answer for you, Jennifer. The plan that we're operating on is that Tinley Park will close, and we will start our new crisis system on July 1. So far we've met our deadline so far, so we haven't missed any deadlines by any amount of time that tells us that we can't have something in place by the first of July. By the first of July we're going to have to have enough of a crisis system in place to respond to at least five, six referrals a day. We will just keep working to put that thing together.

We do have, as Deputy Director mentioned at the ... hearing, if we don't get sufficient response with the Region 1 South, this RFI was posted to the whole state of Illinois, we will start to work outwards from Region 1 South to Region 1 Central and Region 1 North, because the state hospital system that will be losing Tinley Park is a three hospital system, so we will look to our partners throughout the region to help us change capacities so that the 1,900 people that need services that would have been provided by Tinley Park are served somewhere within the DMH system.

But we're very hopeful that given the excitement we saw in the meetings at the hospital level and the community provider level, that we're actually concerned about having $9.8 million to spend and $15.5 million worth of proposals. So, it could go either way.

J. Bosley

Okay. Thank you.

Moderator

Thank you. You have a question from the line of Kenneth Stagliano. Please go ahead.

K. Stagliano

I'm just wondering, when is the letter of intent due, and where do we send that?

M. Pelletier

You send it to the dhs.mh@illinois.gov.

K. Stagliano

Okay, thank you.

D. Wasmer

That's for an email of intent. ….

Moderator

Thank you. The next question is from the line of Mike Mecozzi. Please go ahead.

M. Mecozzi

This is Mike at … Trinity Services. This is just a follow up about the letter of intent, as well. What specifically are you looking for in that email?

M. Pelletier

That email would just us a letter advising us what type of programs or services you intend to send us a proposal on.

M. Mecozzi

Great. Thank you.

D. Wasmer

Yes, whatever you're working on. That will help us get our review teams together so we can have enough people ready to review the responses and get our work done in the seven days we'll have to review them all.

M. Mecozzi

But you're not looking for any sort of proposed budget or anything in that.

D. Wasmer

No, just your intent to submit.

M. Mecozzi

Great. Thank you.

Moderator

Thank you. The next question from the line of Lisa Labiak. Please go ahead.

Tim

Hi, this is not Lisa, obviously, this is Tim … with Grand Prairie Services; Lisa is with me. I had a question concerning enhanced care, community care on page 14, paragraph 2. It mentions response to the RFI should include proposals to enhance the above service package to address the need of psychiatric appointments, brief supportive counseling or therapy, or other Rule 132 services that could help to continue the stabilization process.

What I'm trying to understand is this. Based on what I heard earlier, this would not be included in Phase I for follow up in the services after they initially get their crisis services, say, resolved. My concern is that then what would you do with an individual after that if they needed services if this isn't part of the first phase? That's the question.

D. Wasmer

That's a good question, Tim, and this is one of the services we want to fund in Phase I, it's one of the boxes listed along the bottom of the flow chart as part of the crisis system, DMH enhanced community services. During the community discussions, I think that we got a lot of advice and feedback on the existing non-Medicaid service package as not enough to stabilize the crisis. It isn't the right approach to stabilize the ¬crisis. It's too limiting for providers to use in the flexible way they need to to stabilize the crisis.

What we're looking for is based on your clinical experience in the field to describe what you think a good package would be to help a person stabilize in the community and to describe that. So, of course, we supplied a sample of what's in the attachment, actually in the appendix, of the current non-Medicaid package. For example, during some of the meetings, some providers said if we had some brief therapies, if we had the ability to schedule that in and do that, we can move them pretty quickly from a state of crisis to stabilizing back and returning back to the community. So those are the kinds of ideas we're looking to be expressed there. If you really see limits to the non-Medicaid service package, if that's a barrier, then describe how you would design that for the people you'll be serving, taking from the hospitals in the area and bringing back to the community, and cross that out for us.

Tim

Thank you; that helps clarify. I just have one more question. Concerning letter of intent, did I hear that it needed to be submitted prior to the RFI on April 20th? By the 16th?

M. Pelletier

We're just asking for a letter of intent.

Tim

From everyone?

M. Pelletier

From those persons who are intending to send us a proposal.

Tim

Okay. Thank you.

D. Wasmer

 It would be very helpful, we are going to review everything we receive on the 20th. But as I said before, it would help us plan and be ready to go with our teams of reviewers once you've submitted.

Moderator

Thank you. There are no further questions in queue. Someone just queued up. Would you like me to take that?

M. Pelletier

Sure.

Moderator

You have a question from the line of Kristi Convon. Please go ahead.

K. Convon

Hi, my name is Kristi Convon, and I'm with Morris Hospital. I sent you a list of questions which you may have answered already that will be posted, but I wanted to make sure that I found out what the answers are. We were not certain what a qualified responder was, and if we actually could request a build services for our ER, because we're one of the six hospitals that does not currently have any behavioral health. Do we qualify to submit for a build?

D. Wasmer

Michael has got your questions here, Kristi, and he's flipping to them so he can give you all the answers.

M. Pelletier

Yes, I apologize again, this is response to what you sent us and we're hopefully this was posted already or will be posted before the end of the day. You are a hospital that is targeted as one of the 15 hospitals that sends consumers to Tinley Park. You're correct; you're hospital that does not have a behavioral health unit. Hospital providers are qualified bidders for those three types of service; either CHIPs services, enhanced emergency assessment and linkage services, as well as bilt services. So those are opportunities that you have available to submit proposals to us for.

K. Convon

Even without inpatient behavioral health in place currently?

M. Pelletier

Correct.

K. Convon

Okay. Thank you.

M. Pelletier

Did you want me to go through your other questions that you submitted?

K. Convon

Well, a couple of them were about the deadline, so we don't have to do that. We already talked about the attachments. I did have a question about just maybe ACARES and talking a bit about that, which I don't have on this sheet.

M. Pelletier

Yes, that's one of your questions. First of all, ACARES is not a treatment or a service provider. That will be a systems contractor that DMH will secure to assist us in the eligibility and enrollment process.

K. Convon

Okay, so I understand it's going to work like SASS, and if we have someone that we think would qualify for service we would call the ACARES hotline like we do SASS, and a worker would be sent out?

M. Pelletier

Again, our intent is to identify a specific crisis outreach program for each of the 15 hospitals. Our responsibility in this first phase is to cover the services that are provided in existing, those 15 emergency rooms. So when we receive in proposals from your particular area, or your coverage area, we will be looking at how Morris Hospital, how other hospitals in your area are being covered for the crisis assessment and linkage portion of our RFI.

Either you can propose to do that internally and send us the proposal, or we would maybe, perhaps in your collaborations with other mental health centers in your area, default that or expect to have that done by another provider. But it's going to be our responsibility to make sure that all of the emergency rooms, all those 15 emergency rooms are covered either by an existing program at that hospital provided by that hospital staff, or by a mental health provider that would send someone to your emergency room to assist your emergency room staff in both the assessment and the linkage of appropriately enrolled persons.

D. Wasmer

Kristi, is that clear for you?

K. Convon

Yes.

D. Wasmer

Then in looking at, on Table 2 in the RFI on page six, we're showing that about 33 people flow from your emergency room to Tinley Park per year. So in my opinion, and this is just my opinion, that's a pretty low flow for something as comprehensive as a bilt program inside the ED, unless the bilt program was going to be a collaboration with some of the other EDs and actually serve an area; not just your own flow within your own ED. That's something to consider, but it depends on how much of the crisis system you want to staff and manage yourself.

K. Convon

I don't know if anyone else from Morris Hospital is online that wants to join in with me. I don't have the staff in front of me. But we really felt like we maybe sent you 33 patients that we had so many more patients that maybe came in that couldn't get a bed at Tinley, so they ended up in our inpatient unit until they were stable enough to be discharged home. So we don't really feel like that 33 is reflective of what happens at our hospital at our ED, as far as our psych. I'm sorry I'm actually out of town and I don't have the information in front of me. Liz or Linda, if you were able to join us, maybe you could help me out with this.

D. Wasmer

We're on a moderated call; they would go into a queue; they wouldn't be able to just-

K. Convon

Oh, that's okay. That's fine.

D. Wasmer

Unless Rochelle can somehow identify any other people from Morris that might be on. But we could just let-

K. Convon

Okay, and we'll put that in our proposal, what we feel like it looks like to us.

D. Wasmer

Yes; that's a great plan.

K. Convon

Okay. Thank you. And as far as CHIPs spreads, I have a few questions regarding that, as well. One of the things that we had considered, and that we had actually done in the past when CHIPs beds were available, was have an agreement with a hospital that already has inpatient psych to be a part of their CHIPs program, or call them for a CHIPs bed. It sounds like you're proposing that hospitals that have inpatient also provide for that. Is that a memorandum of understanding kind of thing with another hospital that we would do, or how would that work? Is that a possibility?

M. Pelletier

Again, I'll refer you to page 72 and it basically says there that we're wishing to contract with hospitals with existing behavioral health units for utilization numbers from the table on that page 62, both for referrals from their ER as well as to support portions of capacity from other area hospital EDs where no inpatient behavioral health capacity exists. So when we receive proposals in for CHIPs contracts, we will appreciate the historical number of admissions that were coming from those hospitals that did not have CHIPs, and it will be our attempt to contract with those CHIPs hospitals to assume some or part of the obligation from other hospitals. That will be part of our discussions both with you and those hospitals.

And Morris is not on that table. You were correct; whoever submitted the questions via the table on Appendix 7, it does not have Morris on there. Again, we're working off of the projection of serving 1,900 people, 1,500+ that came from Region 1 South emergency department. Our projection for inpatient utilization is off of the clinical focus studies that we've done, thinking that possibly up to about 60% of the current persons that were sent to Tinley Park from emergency rooms would likely continue to need inpatient care, so we projected out the CHIPs volumes for each of these hospitals related to that formula.

So in your case, you had 33 referrals to us, 60% of that we would expect might need inpatient hospitalization for 20 admissions. We've extrapolated out on a six day average length of stay, which is our historical utilization for CHIPs so that we would be looking to buy, if you will, 120 bed days for those 20 admissions, and that would equal out to about a 1/3 of a patient a day in an inpatient unit.

So that's how that table in represented. You had questions about it, and I think some other folks had some questions about how that table was represented, and how were those cells developed.

K. Convon

For clarification, if we don't have to have an RFI that we're hoping we're going to specifically ask a certain hospital that has them to also provide us that. That's not part of what we have to do at this point?

M. Pelletier

That part is something you would do. We would obviously at some point in time always figure out who's going to cover your assessment and linkage for your emergency department, and we would have to try to find inpatient capacity to support your ….

D. Wasmer

To flush out how that would work for the flow chart, your emergency room would call the ACARES service to get the proper assessments done, and that inpatient, if the person is eligible for a CHIPs admission, the ACARES line would find the closest bed that's open, and then we'd be able to authorize the admission there and the transportation there.

K. Convon

Okay.

M. Pelletier

I think that completes all of the formal questions that you had on your document. Oh, you had a question about transportation, as well.

K. Convon

I think somebody in our ER needed DASA or needed to go residential, and they were voluntary, is that something that you're going to also cover?

M. Pelletier

Again, DMH is looking at a number of options. We do know that transportation is a specific and critical service component. We are looking at, again, options to provide and we will be providing if none of the proposals come in with that component attached to it. We will be the default provider for transportation services for getting them from your evaluating site to the authorized treatment site. So yes, there is a transportation component that would take voluntary patients from Morris Hospital to a subsequent treatment provider.

We have, I think, indicated in our RFI that if there are residential treatment providers, either DASA or DMH that have the ability to provide existing transportation from an emergency room to their treatment site, they can include that cost and those volumes into their proposals for their residential component.

K. Convon

Okay. I have one more question about this submission. If Morris Hospital is, say we want to provide some of these services and then Grundy County Health Department is also going to be involved in providing some services, and then there's a private practice, psychiatry group in town that also wants to be involved, we all three need to submit an RFI for our piece of it, but do we write our letter of intent telling you that these three organizations plan to try to work together on providing all of the services that you're offering, or all the ones that you're applying for?

M. Pelletier

If you've already done that collaboration, certainly that could be indicated in a singular letter of intent. We would ask that if the entity that's wishing to provide a specific service wants to be specifically and directly funded that we would need to have the attachments and their specific response to the RFI and all of the appropriate attachments for their specific services. If that is a service that, in your case let's say just as an example that Grundy County might wish to subcontract out psychiatric services to a practice group, that would be something that we would like to see in the Grundy County proposal, just using your thought line as an example. But if the provider wishes to be funded independently and solely, we would need to have a specific proposal from them.

K. Convon

Okay. Did you say if more questions come up after we hang up that we can either send them in or there's someone we can contact to further clarify?

M. Pelletier

You can continue to send in questions to dhs.mh@illinois.gov and we'll try to respond to those by posting those responses as quickly as we can.

K. Convon

Okay, very good. Thank you very much.

Moderator

Thank you. The next question is from the line of Addie Anderson. Please go ahead.

J. Foster

Hi, this is Jeff Foster out of Loretto Hospital. Our understanding is this IMD rule may apply to the CHIPs patients. Is this correct, or does it not apply?

M. Pelletier

I'm sorry; that was a question you posted. Like I said, it's a response that should be up on our website later on this afternoon, but I will answer that. Any admission to any hospital for CHIPs is under our standing just part of the routine business that happens in your hospital. Consistent with the scope of service that you've seen on CHIPs and your prior experiences as a CHIPs provider, you do know that we do expect a Medicaid application to be filed on those consumers.

We do expect a significant percentage of CHIPs submissions to convert to Medicaid. How that Medicaid conversion will affect your individual Medicaid utilization rate specific to the IMD rule is really something that you have to evaluate independently on your own. Again, we are expecting a significant percentage of CHIPs admissions to convert to Medicaid.

J. Foster

Thank you.

W

We were also wondering how much consideration are you going to give requests that you get from hospitals outside of the Region 1 South area?

M. Pelletier

We are giving considerable attention to the hospitals in the 1 Central area as part of preparation and dealing with the entire Region 1 South rebalancing. We do anticipate a continued need for state operated services, either because the clientele of the consumer has a need that's more specifically and readily clinically addressed through a state hospital admission, or more times when there isn't a capacity in the system in different areas of Region 1 South. So we were building into our proposals the ability for us to increase our capacity availability at Madden by being sure that we have hospitals and other treatment services that could be provided to people that would be coming to Madden perhaps because of capacity issues, and that we could utilize those other resources in 1 Central to divert or deflect that admission.

W

Okay, thank you.

Moderator

Thank you. One moment. The next question is from the line of Edwin Claudio. Please go ahead.

E. Claudio

I'm Edwin Claudio with Healthcare Alternatives Systems. I'm confused. Are non-hospitals respond to this-respond to information? Or is this exclusively for hospitals?

M. Pelletier

There are three levels of services that are outlined in the RFI, and if you go to page nine, I believe, is the-

E. Claudio

Right. I've read the RFI about three times.

M. Pelletier

The flow sheet identifies the fact that we are interested in receiving hospital-specific proposals for the three services that we believe hospitals are solely and distinctly qualified to bid to us. We are seeking bids from community mental health rule 132 certified providers for mental health services that are within the array of 132 services, and we are, as you know, are soliciting as well DASA services from Medicaid certified DASA providers, particularly for 3.5 and 3.7, but also for contingent services, again, related to post-discharge care. Eliciting proposals from DASA, Medicaid DASA certified providers.

E. Claudio

Okay, thank you very much.

Moderator

Thank you. The next question is from the line of Kenneth Stagliano. Please go ahead.

K. Stagliano

Can you hear me?

M. Pelletier

Yes. Can you repeat your name again? I'm sorry; you're a little light on your volume.

K. Stagliano

My name is Ken Stagliano. I just had a question. Supposed you wanted to apply for more than one of the boxes on page nine. Do you have to submit a separate narrative for each of those?

M. Pelletier

Who are you with?

K. Stagliano

Hay Market Center.

M. Pelletier

Hay Market. Thank you very much. If you are proposing multiple services from a provider you can certainly include all of that in a brief narrative, but we would require a separate budget for the separate services. I think we've outlined in one of the attachments all of the DASA program codes, and again, we are asking you to break out on, I believe, Attachment C the capacity that you're requesting for each one of those DASA program codes.

So if you're, let's say proposing services under 3.5 or 3.7, we would ask you to give us a brief proposal in terms of what that service is and who you are and how that's done. Break down the budget, specifically, on Attachment B, and then break out your existing contract, your existing volume, and your proposed new volume and your proposed new funding request for that service. If you are a proposing other DASA program level services, that, again, you outline those specifically both in Attachment B and on Attachment C.

K. Stagliano

Thank you.

D. Wasmer

Ken, let me go over that and make sure you've got what you need to do the work. So if you were going to propose services in two of the boxes, say DASA 3.5 and DASA enhanced community services, then you would do one attachment, one narrative that embraces all of what you plan to do as part of the Region 1 South crisis response system. Two Attachment Bs; one for the DASA 3.5 and one for the DASA enhanced community services. One Attachment C where you would show your whole agency existing programs, and then show those two new pieces; how they get added to the whole array of services that all Hay Market provide, and then one Attachment D.

K. Stagliano

Okay. Thank you.

D. Wasmer

That would be perfect.

Moderator

Thank you. The next question comes from the line of Dr. Joseph Troiani. Please go ahead.

Dr. Troiani

Okay, just a couple of comments, again confirming. In planning we need to take a look at the actual number of admissions, the breakout of admissions to those who would be hospitalized versus those who would not be hospitalized. With those to be hospitalized we would look at the average length of stay and that would give us an idea of how many patient bed days we would need in our area, correct?

M. Pelletier

Again, that's outlined already for you on Attachment 7, and that was placed there for your planning purposes. If that doesn't mix or match, but that's how we projected out inpatient utilization based on the historical volumes coming from emergency rooms.

D. Wasmer

If you will, this is Dan, back to the flow chart on page nine, if you look at the people presenting with psychiatric crisis, the … to the 15 hospitals, we tried to give you the data of the people moving from those 15 community hospitals … and now we're getting rid of that line and they're flowing down through the crisis system. So in the narrative and in the proposals, we want people to identify how they would intercept them at the community and move them through whatever pieces they're proposing to operate in the crisis system. That includes, a lot of providers already are part of the crisis system there, explaining their present capacities and flows and the new capacity and flow that's going to account for those lives, those 1900 lives that are going to be flowing through that system.

Dr. Troiani

And that's important, because this is the driver of that system that would need to be designed. Good. My other question along those lines is that you're also looking at, when you evaluate proposals, you're looking at economy of scale, correct?

M. Pelletier

Yes, we will be looking at the most comprehensive bids for the coverage.

Dr. Troiani Which then the next question is if there's a collaboration that could be submitted as one proposal with multiple collaboratives, correct?

M. Pelletier

Yes.

Dr. Troiani

So, say for example, part of the Will/Grundy County land, if we wanted to submit a Will/Grundy county land proposal with multiple partners taking part so that could be incorporated as a one system design or one system of care for a geographical region.

M. Pelletier

Yes.

Dr. Troiani

Okay, good. In terms of 132 services, would any of that be capacity capability, or do you envision that being strictly fee for service, not Medicaid?

M. Pelletier

The first year, for FY '12 contracts that we're projecting to give out contracts that will allow you to staff up and train your staff for implementation July 1. There will be some contracts that we will want to implement for actual service delivery prior to July 1 to make sure that we have as much capacity available for when Tinley Park does close. The FY '13 budgets and the proposals, we are looking at-currently we are looking at contracting at capacity grants reconciled against future services.

Dr. Troiani

This is an evolutionary process in terms of doing what needs to be done in order to stand up the program, and then transition to more of a traditional fee for service model.

M. Pelletier

Correct.

Dr. Troiani

Okay. Good. Thank you.

Moderator

Thank you. There are no further questions in queue.

M. Pelletier

Okay, I just want to announce that the second request response to inquiries that I was speaking about or questions that I received in for the 9th and the 10th and the 11th, that is now posted to the DHS website at the response to inquiries page. Again, several of the programs asked specifically their questions, and hopefully we responded to them, but that official document is now posted.

D. Wasmer

It's perfectly okay if what we post still doesn't make it crystal clear; to shoot back another email and challenge us to make it crystal clear to you. We want to do that. We have as much invested in a successful RFI process as you do, and we're excited about it. Once again, for anybody who joined the call late, the transcript of this call, the entire transcript of the call will be typed up and posted to our website. We'll make an announcement when that posting happens. Also, we're not taking any questions away for further clarification, but keep checking the site for any other questions that come to us and get posted subsequent to that, right up until the due date of the 20th.

Michael, anything else?

M. Pelletier

I don't think we have anything else, Rochelle, unless there are other questions that have come in?

Moderator

No, there are no further questions.

M. Pelletier

Okay, thank you for your time, folks.

Moderator

Thank you. That concludes our conference for today. Thank you for your participation and using AT&T Executive Teleconference Service.