Central Florida
Behavioral Health Network
“Achieving the dream
envisioned in
single management strategies.”
Why is the network initiative
important?

Networks will be the lead entities for:




2
Innovation
Collaboration and care integration
Contracting
Purchasing of mental health and substance abuse
services.
How it started…
CSAT Technical Assistance Report to Florida
January, 2000
Comprehensive continuation of accessible quality
services in the most appropriate environment
Regulatory oversight of treatment system that ensures
appropriate clinical care provided consistently and with
prevailing standards
Training for personnel
3
Treatment system includes clinical assessment,
individualized service planning, referral, progress
review and follow-up
Characteristics and Features
of a Well-Organized System of Care
(From CSAT Technical Assistance Report to Florida – January, 2000)
4
Services are organized into a simple network of care
Network services are available through multiple single
entry points
Formal linkages exist between mental health,
substance abuse and primary care
Local networks are responsible for coordination of
client services
Case managers are identified to coordinate care
Services are community-based
Prevention and intervention strategies are clearly
defined
Stakeholders have direct input
Characteristics and Features
of a Well-Organized System of Care
(From CSAT Technical Assistance Report to Florida – January, 2000)
Treatment available upon demand for special
populations (pregnant women, IV drug users,
individuals in family protection, dually-diagnosed,
SPMI, etc.)
Individualized, client-centered and flexible programs
Flexible funding strategies, including fee for service
and prospective payment mechanisms
Network-wide utilization management
5
Florida’s response…
Florida Legislature passed SB1258 to meet
the service delivery needs for:
 Accountability
 Control Costs
 Continuity of Care
 Admission/Discharge with State
 Early Diagnosis & TX
 Assess Local Needs
 Quality/Best Practices

 Cross – System Integration

 Creative Financing
6


Hospitals
Disseminate Data for Planning
Purposes
Special ALF Services
Reduction of Kids in Residential
Care
Services to Kids under Court
Orders
Service Delivery Goals 1258
 Coordination, Integration & Management
 DCF/MH/SA and AHCA/Medicaid
 Unit Cost Contracting & Fee-For-Service
 Risk-Sharing Arrangements
 Managing Entities – Public/Private
 Promote Flexibility & Responsiveness
 Expand Waivers, Maximize Federal $$$, New
Procedure Codes or Certified Match
7
Florida Legislature expanded the goals of
SB1258 with the passage of SB2404 in 2003
which:

8
Creates the Substance Abuse and Mental Health
Corporation

Responsible for oversight of publicly funded substance abuse
and mental health systems, including marking policy and
resource recommendations.

Requires DCF and AHCA to ensure Medicaid and Department
funded services are delivered in a coordinated manner, using
common service definitions, standards and accountability
mechanisms.

Requires corporation to conduct annual evaluation and report
the status of publicly funded mental health and substance
abuse systems to Legislature.
Amendment to
Chapter 394.9082
9

Provides direction for FMHI to continue the
evaluation of strategies in SB1258 and SB2404
pilot projects

Requires report by December 31, 2006 that
includes target dates for state-wide
implementation
Amendment to Chapter 409.912
(Relating to Mandatory Medicaid Managed Care Enrollment)
10

Directs AHCA to work with DCF to ensure children and families in child
protection system have access to mental health and substance abuse
services.

Directs AHCA to seek Federal approval to contract with single
management entities for all behavioral health services for Medicaid
recipients in an AHCA area.

Directs AHCA and DCF to collaborate to jointly develop all policy,
budgets, procurement procedures, contracts and monitoring plans for
behavioral health and targeted case management programs.

Requires AHCA and DCF to contract with managed care entities or
arrange to utilize capitated pre-paid arrangement for all inpatient and
outpatient behavioral health services to all Medicaid recipients by
07/01/06.
Amendment to Chapter 409.912
(Relating to Mandatory Medicaid Managed Care Enrollment)

Specifies that in AHCA areas with less than 150,000 Medicaid eligible
clients, AHCA must contract with a single managed care plan; in areas
over 150,000 Medicaid eligible clients, AHCA may contract with more than
one plan.
–
–

Requires AHCA to submit a plan by October 1, 2003 providing full
implementation of capitated behavioral health throughout the State.
–
–

11
Contracts must be competitively procured.
Both for-profit and not-for-profit entities are eligible to compete
Plan must include provisions ensuring service accessibility for children and
families in the child welfare and/or foster care system.
Plan must include participation of community-based care lead agencies,
community alliances, Sheriff’s Department and providers serving dependent
children.
Requires implementation to begin in 2003 in areas of the State that are
able to establish sufficient capitation rates.
Amendment to Chapter 409.912
(Relating to Mandatory Medicaid Managed Care Enrollment)
12

Allows AHCA to adjust capitation rates in any one area as necessary.

Directs AHCA to develop policies and procedures to allow for certification
of local and state funds.

Excludes children residing in inpatient and DCF residential programs
(BHOS) from enrollment into pre-paid plans.

Requires existing child welfare providers under contract with DCF be
offered the opportunity to participate in any provider network for pre-paid
behavioral health services.

Requires AHCA and DCF to develop a plan for new procedure codes for
emergency and crisis care, supportive residential services and other
services designed to maximize use of Medicaid funds for recipients
needs.
Network Administration

What is a Network?
–

What is the purpose of a Network?
–
–
–
–
13
Two or more agencies with a formal agreement to
manage or deliver behavioral health services.
Improve access to care
Improve quality
Improve efficiency and effectiveness
Assist providers/members
Unique Features of
Community-Based Networks

Strengths

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14
Community governance and oversight
Shared risk with providers
Comprehensive service delivery and ability to
provide integrated services
Consumer involvement
Community re-investment
Coordination with collateral systems
Opportunity for gradual transition
Unique Features of
Community-Based Networks

Vulnerabilities

Historical preservationists
-
-

15
May be slow to change practice standards
May be difficult to move from program-focused planning to
person-focused planning
Lack of capacity for utilization management, $$
required for IS development and capitation risk
pools, RFP grant response/marketing, provider
accreditation, administrative capabilities
Not-for-Profit Provider-Sponsored Networks
16

Services are based on needs of persons served and
stakeholders

Demonstrated opportunity for consumer choice

Timely services

Services are culturally sensitive

Mission is communicated and embraced by all
members
Not-for-Profit Provider-Sponsored Networks

A common set of indicators is applied
–
–

17
Access
Effectiveness
- Efficiency
- Consumer satisfaction
Indicators are used for quality improvement,
performance assessment and corrective
actions
Not-for-Profit Provider-Sponsored Networks
18

Individual provider and aggregate performance
outcomes

Review of service patterns

Utilization of data to improve efficiency,
effectiveness and customer satisfaction
Not-for-Profit Provider-Sponsored Networks
Coordination of a system of care for a person
receiving services from more than one provider or
levels/types of care includes:
19

Planning of individual services

Delivery of services

Evaluation of services

Service review and revision as needed

Formal information sharing process
Not-for-Profit Provider-Sponsored Networks
A prerequisite for membership in the Network is a
demonstrated commitment to and the history of client
advocacy and collaborative practice.
20

Non-profit providers

Contracts with the State SAMH Program Office

Medicaid provider
Not-for-Profit Provider-Sponsored Networks

Accreditation, licensing, certification

Fiscal stability and responsibility

Commitment to community-based care principles
–
–
21
Commitment to consumer choice
Rehabilitative principles of care

Ability to provide access to treatment

Ability to deliver service
_____
_____
Network Benefits
_____
Examples of benefits the Network strives to offer include:



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



22
Enhancement of core competencies
Ability to share administrative functions and associated costs
Improved continuity of care
Improved linkages with non-ADM services
Development of best practices
Maximization of revenues
Joint marketing efforts
Stronger advocacy efforts
Ability to shift contract funds between providers
Shared knowledge
Core Administrative Functions







23
Provider network management
Strategic planning
Customer services
Quality management
Utilization management
Financial management
Information management
Core Administrative Functions
Provider Network Management

Planning and identifying network components
–
–

Selection of providers/networks
–
–

–
- Selection criteria
- Approval process
Documentation of licensure
Professional credentialing
- Accreditation
Management of provider network
–
–
–
24
Open or competitive bidding
Evaluation
Credentialing
–

Defining continuum of care
- Community planning
Determination of type, number and provider qualifications
Communication
Assessment of continuum of care
Training and technical assistance
- Community input
Core Administrative Functions
Strategic Planning

Annual review of:
–
–
–
–




25
Services
Utilization data
Access standard
Outcomes
Gap analysis
Needs assessment
Member satisfaction
Provider input
Core Administrative Functions
Customer Services

Customer relations
–
–
–
–

–
Benefits and services
Rights and responsibilities
- Member advocacy
- Grievances and appeals
Coordination with other systems
–
–
–
26
- Providers
- Funding sources
- Community stakeholders
Members
–

Board members
Consumers
Advocacy groups
State/local agencies
Child welfare
Juvenile justice
Health c are
- Education
- Corrections
Core Administrative Functions
Quality Assurance, Continuous Quality Improvement, Performance Improvement

Leadership commitment
–
–

Accreditation
Board structure and management
Quality management goals
–
Focus on persons served

–
27
–
Enhance access and quality of behavioral health services
Improve coordination of care within geographic areas
Promote effective, efficient and economical use of resources
Core Administrative Functions

Quality Improvement Committee
–

Performance improvement reviews
–
–
–
–
–

Case file review
Medical record review
Customer survey
Data/outcomes review
Service validation review
Performance measures
–
–
–
–
28
Comprised of QI personnel from all providers
State mandated outcomes
High risk
High volume
Problem prone
Core Administrative Functions



29
Quality assurance
– Continuous quality improvement
– Performance improvement
– Utilization review
– Risk management
Data driven
– What, how, when to measure
– How to use what is measured
– Is system in management tool for improving quality
Treatment
– Screening/assessment
– Placement criteria
– Continuing care criteria
– Services individualized to client’s need/client driven
– Continuums of care
– Alignment of resources and utilization
Core Administrative Functions

Prior authorization
–
–
–

Concurrent review
–
–
–

–
30
Continued medical necessity
Level of care appropriate
Continued stay criteria
Retrospective review
–

Define covered services requiring prior authorization
Medical necessity
Lead restrictive level of care
Emergency admissions
Sample of cases to establish provider profile
Reviews decrease with provider readiness
Core Administrative Functions
Financial Management

Regulatory compliance
–
–
–

Accounting
–
–
–
–

Safeguard assets
Monthly, quarterly and annual financial statements
Surplus/deficit and provider utilization reports
Annual budgets and forecasts
Integration of clinical and financial data
–
–
–
31
Legal
Contract
Grants management
Cost analysis
Clinical analysis
Rate setting
Core Administrative Functions
Information Management

Members tracking
-

Utilization management
-
Aggregate reporting
Utilization
-

Claims
-
Billing, processing, reconciliation

Quality
-
Provider performance
Reporting
Outcomes analyses
Utilization analyses
-
32
Enrollment/eligibility
Admission/authorization
Continued stay
“Seamless” care across levels of
care and providers
Integration of assessments
and treatment planning
-
Core Administrative Functions
Revenue Maximization



Develop and define services to be covered
Reimbursement consistent with level of service and cost to
provide service
Payment methodologies
–

Use of multiple revenue streams to support treatment
–
–
–
–
–
33
FFS, capitation, rates, unit cost, case rates, etc.
TANF
Medicaid
Private insurance
Corrections
General revenue
Transition Planning for Networks
Planning Process
34

Significant changes to the management and financing
of systems of care require careful planning

Changes should be implemented in stages over time

Transition planning team is focal point for identifying
issues and developing detailed implementation
strategies
Transition Planning for Networks
Contract Financing
Current System
Interim System
Ideal System
Performance Based/Unit Cost/Cost Center-based ADM
Contracts
Contracts based on OCA categories for identified number
of persons to be served (similar to District 1 Prepaid
Aggregate Fixed Sum Contract)
Risk or shared risk-based or other types of contracts
based on valid actuarial data and models.
TANF system with cumbersome and expensive
administrative requirements.
Payment on 1st day of month, actual advance funding.
Permit subcontracts to be on risk or shared-risk basis,
case rate or other strategies to be developed.
CFBHN subcontracts with providers on same basis.
Reconciliation based simply on number of persons served.
If indicated, utilize profit and loss risk corridors.
Complicated and expensive billing and data systems.
Utilize PIDS Manual and DCF Guide to SB1258
Contracting for ADM Services
Delays in receipt of funds.
Management, Monitoring and Oversight
Current System
Interim System
Ideal System
Program Monitoring by ADM and CFBHN
Use accreditation in lieu of monitoring as described in
SB1258 (Ch394)
Accreditation for all providers and networks
Administrative and contract monitoring by CPU, ADM
and CFBHN
CFBHN performs interim monitoring as described in
SB1258 (Ch394)
Licensure monitoring by ADM and AHCA
ADM and CPU review CFBHN’s monitoring reports
Medicaid compliance by AHCA
CPA Audits
Utilize CPA audits to replace certain items in the
monitoring instruments
Accreditation for most providers
Develop process to redefine/reduce items to be monitored
Move from system that focuses on monitoring to one
that focuses on leadership & management development,
development of organizational competencies, refinement
of quality and performance improvement strategies and
practices, best practices, improvements to system
integration, and staff training and development
Development of legislative budget requests jointly by
CFBHN and ADM/DCF based upon identified needs of
Suncoast Region.
Data Collection and Reporting
Current System
Interim System
Ideal System
IDS, HomeSafeNet, etc.
Suncoast and CFBHN become additional demonstration
project for PIDS, currently be developed and implemented
in District 1
The ideal integrated database (s) has yet to be defined,
but at a minimum it should eliminate all double or triple
entries. It (they) should be efficient to use and effective
for the state, CFBHN and subcontractors
Data validity problems, some of which are based on
matching services to enrollments
Lack of timely mechanisms to correct inefficiencies
and problems
35
Limited utility of database by providers
Would include participation in Unity One system and
ability to access other state data systems
Transition Planning Team Consists
of Three Separate Teams
Regional Transition
Planning Team
MIS & Data
Team
36
Contract
Development
Team
System of
Care Team
Transition Planning Team
At a minimum, team consists of representatives of the following
parties and other appointed by team.








37
DCF SAMH Program Office
DCF Contract Manager
ASO
Provider Network representative/Board member
Representative from AHCA and any prepaid plan, if
established
Representative from community-based care agency
Consumer representative
Ad hoc representation from identified stakeholders as
required
Transition Planning Team
MIS & Data Team



38
Responsible for analyzing all data and
management information issues
Provides data need by Contract Development
Team for preparation of the contract
Includes representatives from State MIS, ASO,
providers, Regional SAMH Program Office,
system consultant
Transition Planning Team
Contract Development Team



Addresses the changes to the contract between the
Department and the Network’s ASO
Development of prepaid, fixed sum or risk-based
contract
Development of provider contract requirements
–
–
–
39
Incorporates provider application process
Incorporates provider credentialing process
Incorporates recommendations from MIS and System of Care
Teams
Transition Planning Team
System of Care Team
40

Addresses the array of services to be provided

Addresses access to care requirements

Addresses clinical protocols, clinical pathways,
etc.
Central Florida
Behavioral Health Network
CFBHN is a not-for-profit network of community
providers incorporated to ensure and enhance an
array of behavioral health and other human
service needs for the citizens of our community.
41
Current
Organizational Capacity
42

The mission, values and principles ensure highly-effective, family-focused services
are provided in a fiscally sound manner

A provider-sponsored network that has demonstrated commitment to and
treatment of client advocacy and collaborative practice

Encourages network membership and provider development in a manner that is
representative of both geographic and specific service needs of clients and their
families

Currently provides the following services for five major funders:

–
Administrative services
–
Systems and network development
–
Quality oversight
–
Training, education and clinical development
Serves over 6000 clients annually, has 19 member agencies and 28 service
providers under contract
Network Goals
Provide identified regions in the state with a well-managed and
integrated behavioral health delivery system to:
Increase access to care
Improve continuity of care to vulnerable populations
Prevent duplication of effort
Reward efficiencies
Encourage exemplary practices
43
Organizational Structure
44

In May, 2002 Bylaws revised to reflect
significant changes in the organizational
leadership and Board structure

Changes implemented to meet the Network’s
need for the Board to be more representative
of the expanded geographic area
Organizational Structure



45
Board President represents substance abuse
agencies
President Elect represents mental health
agencies
The two offices rotate annually between
substance abuse and mental health systems to
ensure both areas are adequately represented
Executive Committee
46

Executive Committee is comprised of the President,
President Elect and one representative selected by each
of the four designated Network regional councils

The four regional councils include:
– Hillsborough County
– Pinellas/Pasco Counties
– South Region (Manatee, Sarasota and DeSoto
Counties)
– District 14 (Highlands, Hardee and Polk Counties)
PINE
Regional Council
Responsibilities
Nominate Executive Committee regional representative
Design and coordinate a localized system of care for each business
activity identified for that region
Establish and maintain local planning forums of members, vendors,
stakeholders and partners to formulate and articulate services delivery
strategies and plans for inclusion in the Corporate Business Plan
Develop and implement regional business plans
Facilitate the implementation of behavioral health services that are
responsive to the needs and institutions of their respective communities
47
Develop vendor recommendations
Inclusiveness & Provider Relations
48

Communities, funders, persons served and providers
are integral partners in the design, evaluation and
support of the Network’s services and service delivery
structure

CFBHN is a provider-sponsored network striving to
meet the needs of its members by providing
outstanding services and value-added benefits that
clearly demonstrate the advantages of membership
Network Membership










49
ACTS
Boley Center for Behavioral
Health Care
Centre for Women
Coastal Recovery Center
Directions for Mental Health
DACCO
First Step of Sarasota
Gulf Coast Community Care
The Harbor Behavioral
Healthcare Institute
Human Services Associates









Manatee Glens
Mental Health Care
Northside Mental Health
Center
Operation PAR
Peace River Center
PEMHS
Suncoast Center for
Community Mental Health
Tri-County Human Services
Winter Haven Hospital
TANF

50
Provide management and oversight for all ADM TANF-funded services
throughout the Region and District 14
 Co-location of outreach at One-Stop centers in some child welfare
community-based care lead agencies
 Partner with Family Safety/diversion clients
 Partner to provide Dependency Court services
 Service provider for Welfare-to-Work/Hillsborough County Workforce
Board
 Contract with Workforce Development Lead Agencies to provide support
and outreach
 Enhance supportive employment opportunities throughout Network area
 Collaborate with the Spring for domestic violence outreach
 Manage funds throughout the Suncoast Region and District 14
 17 agencies provide services
 Allow full utilization of benefits for TANF-eligible persons
Co-Occurring
2001
Project to develop capacity of mental health and substance abuse
agencies to treat persons with co-occurring disorders
Federal SAMHSA Grant – Center for Mental Health Services
(CMHS) Community Action Grant on co-occurring disorders
2002
51
New GP Wood funding to Network to implement community action
plan for integration of services for persons with co-occurring
disorders
 Agency action plans
 Goals for additional resources
 Systems integration and development
 Research capability and agreement to share information
with Florida Health Partners
Co-Occurring
2003
-
52
Systems Coordinator works with providers to “move”
action plans
Funding to agencies to enhance co-occurring services
Co-occurring capability for all Family Intervention
services
Expansion of model throughout Network
Family Safety
53

Mental health dollars targeted to community-based care needs

Additional resources for intervention with caretakers and reunification with
clinical support to co-locate staff

Additional resources for adoption stabilization needs, clinical support and
co-location of staff

Specialty services for abused children

Family Intervention services co-located throughout Suncoast Region and
District 14

Dependency Court services in District 14
Family Safety


54
Assist in level of care decisions
Specialty network developed for HKI for:
– Psychological evaluations
– Domestic violence evaluations
– Parenting classes

8 agencies participating with HKI

6 agencies participating with the Partnership for Safe Children

Pilot diversionary program developed for Sarasota Family YMCA
Bibliography
Network Development, Thomas E. Lucking, Ed.S.,Lucking Consulting,
tom@luckingconsulting.com
Brave New World of Managed Care, National Council for Community
Behavioral Health Care, Troy Baily, Neal Cash, Colette Croze, Jeff Jorde
Administration & Policy in Mental Health, Volume 29, Number 1, September,
2001
CSAT Technical Assistance Report, January, 2000
OPPAGA Report, 2001
55