New Model to Replace Community Based Flexible Supports
REQUEST FOR INFORMATION
(RFI)
New Model to replace Community Based Flexible Supports
COMMBUYS # BD-17-1022-DMH08-8210B-16243
THE DEPARTMENT OF MENTAL HEALTH
Responses are due by:
June 2, 2017
Contact Information: Jerome Collins
Assistant Director of Contract Administration
THE COMMONWEALTH OF MASSACHUSETTS
DEPARTMENT OF MENTAL HEALTH
Request for Information
New Model to replace Community Based Flexible Supports
June 2, 2017
I. INTRODUCTION
DMH is developing a new Service Model (“New Model”) to replace its primary adult community-based service, Community Based Flexible Supports (CBFS). The New Model is a residential and community treatment service providing enhanced clinical and rehabilitative services focused on building and sustaining engagement to promote individual recovery, achievement of personal goals and successful completion of the service. Residential and community treatment occurs in all housing settings, including group living environments, other provider managed settings and independent situations. The New Model will align with MassHealth’s Behavioral Health Community Partner program (BH CP) and with all available employment services, including those provided by DMH Clubhouse providers and the Massachusetts Rehabilitation Commission (MRC), to leverage existing resources, improve coordination of care and avoid duplication of services.
MassHealth, as part of its 1115 demonstration, is advancing accountable care to emphasize value in care delivery and to better meet members’ needs through more integrated and coordinated care. The BH CP is a key element of this effort. The goal of the BH CP program is to support and coordinate services across the continuum of care for members with high behavioral health needs, including Serious Mental Illness (SMI) and/or Substance Use Disorders (SUD). BH CPs will partner with Accountable Care Organizations (ACOs) and Managed Care Organizations (MCOs) to facilitate integration of members’ care, including medical, behavioral health (BH), social, long term services and supports (LTSS), and other needs. BH CPs will also collaborate with members’ clinicians and other providers, such as DMH’s New Model, to promote collaborative, comprehensive and holistic care. MassHealth’s restructuring to accountable and outcome-based care has led to a service delivery model change across many of the Commonwealth’s health and human services programs and a decision to incorporate this focus into the New Model. DMH and MassHealth will establish clear roles and accountability between BH CPs and the New Model.
This past winter, DMH conducted a series of stakeholder engagement sessions with various stakeholders involved in CBFS to gather input for the purposes of informing the design of the New Model. This RFI seeks input from those who are interested in commenting on key components of the New Model. Questions of specific interest to DMH can be found in Section III of this RFI. Please answer any or all questions.
II. OVERVIEW OF NEW MODEL
The New Model will provide focused clinical and rehabilitative interventions and peer and family support to individuals residing in all housing settings, including supervised residential treatment settings as well as supported and independent settings. Specialty residential treatment services (e.g. medically intensive, clinically intensive) will be included in some of the anticipated contracts procured under the New Model. Services will be delivered by an integrated team, based on a standard staffing model, to promote engagement, provide continuity of relationships, and establish clinical accountability. In addition to the clinical and rehabilitative interventions, providers will be responsible for operating a range of housing options (supervised residential treatment settings, also known as group living environments, supported living arrangements, etc).
Care coordination functions will be delivered by BH CPs, One Care Health Homes and DMH Case Management to provide for the continuity of the care coordination relationship during and beyond the individual’s participation in the New Model. Providers of the New Model will collaborate with these care coordination entities to conduct assessments and treatment planning; promote community tenure; provide “critical time interventions” during and after hospitalizations, arrests and Emergency Department visits; and provide rehabilitative interventions that support health and wellness. Similarly, DMH will leverage a range of employment services, including DMH Clubhouse and MRC services, to provide job placement and support for individuals participating in the New Model. Providers of the New Model will deliver an essential piece of the employment experience in building interest to work through engagement strategies, incorporating employment goals into an individual’s treatment plan, coordinating with employment service providers and providing rehabilitation interventions that support individuals as they prepare for, seek and maintain employment.
A. Integrated Team Model
The New Model is anchored by a standard team model designed to ensure early and sustained engagement. The integrated team will ensure that the full complement of services is available to all individuals and the team will continue to serve individuals as they move between settings (e.g. supervised residential treatment and independent settings). A Licensed Practioner of the Healing Arts (LPHA) is responsible for leading assessment and treatment planning activities and ensuring that interventions are delivered in accordance with the treatment plan. It is expected that the LPHA will be an active member of the team, delivering services to individuals in the community and providing clinical oversight through modeling and supervision. Additional roles on the team include substance abuse counselor, housing specialist, direct care staff and peer support. Peer support is inclusive of Certified Peer Specialists, Recovery Coaches, and Family Partners. Oversight for clinical accountability in the New Model is provided by a Program Director (team leader), Assistant Program Director and consultation through RNs and a Psychiatrist. To provide adequate support to staff and clinical accountability, providers of the New Model must ensure that supervision is available both within the team and as a discipline-specific activity as needed. In addition, all staff activities must be consistent with staff qualifications, credentials, job description and roles. The number of teams that a contract will have will be dependent of the size of the contract.
Residential and community treatment services in the New Model will include:
• Engagement
• Clinical and Rehabilitative Interventions, including Critical Time Interventions
• Peer Support and Recovery Coaching
• Family Engagement and Support
• Addiction Treatment
• Medication Administration
• Coordination and Communication Across Systems (Healthcare, Employment and Housing)
Several of these components are described in greater detail below.
B. Clinical and Rehabilitative Interventions
Clinical and rehabilitative interventions will continue to be the core services of the New Model. The New Model considers engagement strategies and critical time interventions during care transitions to be essential rehabilitative interventions. The provider must ensure that clinical and rehabilitative interventions are delivered flexibly to address individual recovery goals and are continuously changed to address barriers that are preventing an individual’s progress. Rehabilitative goals and interventions are developed with the goal of defining what is needed for individuals to achieve their recovery goals and successfully complete the service. The provider will be expected to provide the necessary support and training for individuals to self-administer and monitor their own medication whenever possible and to provide Medication Administration Program (MAP) services to individuals who require that level of intervention regardless of living arrangement.
C. Coordination Activities
A major goal of the shifting healthcare landscape in Massachusetts is to strengthen linkages between health care providers, including behavioral health (BH) providers, to support members with high behavioral health needs and to help these members navigate the system of behavioral health care in the Commonwealth. This has led to the creation of Behavioral Health Community Partners (BH CPs). The goal of the BH CPs is to support and coordinate services across the continuum of care of members with high behavioral health needs, including Serious Mental Illness and/or Substance Use Disorders. BH CPs will partner with Accountable Care Organizations (ACOs) and Managed Care Organizations (MCOs) to facilitate integration of members’ care, including medical, behavioral health (including the New Model and other DMH services), social, long term services and supports (LTSS), and other needs. DMH will ensure that each individual in the New Model will receive care coordination through BH CP, OneCare and/or DMH Case Management.
The care coordination entity is responsible for coordinating care between an individual’s service providers and for identifying and bridging gaps in the individual’s health care delivery experience.
New Model providers must collaborate with the care coordination entity in:
1. Assessing needs that the New Model will address;
2. Coordinating treatment interventions when both entities have a role in supporting the individual’s service need, and;
3. When the New Model identifies a need that requires an additional provider or resource.
The following table provides examples of activities that the New Model provider and BH CP may conduct. These examples are illustrative and are not intended to represent definitive actions that will be provided.
Example / New Model Activities / BH CP ActivitiesPerson is admitted into an inpatient psychiatric unit / · Perform critical time intervention and participate in discharge planning
· Participate in revision of crisis/ treatment plans
· Provide transportation home, if needed
· Receive mediation reconciliation information from BH CP
· Provide interventions to support person’s transition to home, such as filling prescriptions, sorting mail, purchasing food, reconnecting with social supports.
· Inform BH CP of any changes that need to be communicated to other providers / · Participate in discharge planning
· Revise crisis/treatment plans
· Perform medication reconciliation with outpatient providers and New Model and communicate discharge plan
· Ensure person engages in follow-up appointments and communicate relevant information to all providers
· Provide face-to-face encounter within three days of discharge
Person is newly diagnosed with diabetes / · Participate in revision of treatment plan
· Provide interventions to support purchasing and preparing foods consistent with dietary recommendation
· Inform BH CP of person’s response to interventions, such as decision to not follow recommended diet / · Revise treatment plan
· Communicate treatment recommendations to all providers
· Ensure person engages in follow-up appointments
· Connect individuals to additional services, such as diabetes education group, specialists
E. Utilization Review Process
DMH anticipates that the New Model design, including the emphasis on engagement strategies, rehabilitative interventions and clinical accountability, will help individuals achieve treatment goals and prepare for successful completion of the New Model. The care coordination entity will ensure that there is continuity of care and sufficient transition when a person achieves treatment goals and no longer needs the service.
DMH will develop a comprehensive utilization review strategy to ensure New Model service providers are sufficiently engaging individuals in the service, that services align with individuals’ needs, and to identify individuals who can transition to other services. Enrollment in the New Model and in group living environments will be the responsibility of DMH. DMH also intends to focus utilization review activity on group living environments to monitor the individual’s continued need of these service and efficient use of this limited resource.
In addition, DMH and MassHealth will develop operational guidelines addressing collaboration between New Model service providers and care coordination entities, including assessment and treatment planning, critical time interventions and data exchange.
F. Additional Resources
For additional information pertaining to proposed model changes, the stakeholder engagement process, and stakeholder meeting materials, please reference the site below:
http://www.mass.gov/eohhs/gov/departments/dmh/cbfs-stakeholder-engagement.html
III. QUESTIONS
DMH is seeking feedback on the following areas of the proposed New Model. Respondents are not required to respond to all questions. Brevity should be considered when contemplating a response; please do not provide a response that exceeds 5 pages. Bulleted lists and short paragraphs are both appropriate response formats.
Integrated Team Model:
Given that the integrated team will ensure that the full complement of services are available to all individuals and that the team will continue to serve individuals as they move between settings:
1. What is the best structure for the integrated team to deliver interventions, provide clinical accountability and maintain continuity throughout duration of service?
2. How should this team model be adjusted to support clients living on their own in the community?
3. What impact does size of contract and level of resources (i.e. number of supervised residential treatment settings) have on how integrated team(s) is structured? What should DMH consider in developing a standard team model?
4. What standards does DMH need to consider to safeguard and support peer roles on the Integrated Team, including job functions and supervision?
Assessment and Treatment Planning:
If a client is engaged with a BH CP prior to enrolling in the New Model, the BH-CP will have conducted an assessment for the client.
1. Should the service providers of the New Model do an independent assessment for the client, or could there be coordination between the providers and BH CPs during this process?
2. Are there any components of the BH CP’s assessment that could contribute to the Provider of the New Model’s assessment and creation of the treatment plan? If so, is there a timeline after which components of the BH CP’s assessment should no longer be considered?
3. What else should DMH consider in regard to integrating the New Model and BH CP assessment and treatment planning processes? What value can be achieved from an efficiency perspective and from the perspective of the person served?
Model Standards:
1. What standards should DMH consider for the New Model providers to encourage family engagement and the use of other natural supports in a client’s care when desired by the client?
2. What specific considerations should be included when the individual is a parent? What are examples of standards related to the assessment and treatment planning which DMH should contemplate to assess service needs?
3. What standards and supports pertaining to engagement and service delivery should be considered for:
· young adults (18-25)?
· older adults (60+)?
4. What standard should be considered for individuals with high risk needs (e.g. homelessness, criminal justice involvement, substance use, history of aggression, separation from service)?
Interrelationships within Healthcare System:
1. What guidance would you provide to help DMH ensure that the relationships between the New Model providers and BH CPs are as seamless as possible? Please consider the following scenarios: