Appendix I Prvider f Last Resrt Prcurement Plan FY 2005
PROVIDER OF LAST RESORT PROCUREMENT PLAN FY 2005 Lubbck Reginal Mental Health Mental Retardatin Center I. Backgrund II. III. IV. CONTENTS Ntificatin: Lcal Authrity Designatin and Prvider Status Objectives/Gals Prcurement Prcess Current and Future Areas f Cncern V. Determinatin f Services t be Cntracted and Implementatin Timelines VI. Attachment A - Prvider Netwrk Analysis a. Mental Retardatin Services b. Mental Health Adult Services VII. Attachment B Request fr Infrmatin (RFI) Summary I. Backgrund. The 78 th Legislative Regular Sessin had prfund effects n the mental health, mental retardatin and chemical dependency service delivery system thrughut Texas. Specifically, the amendment f THSC 533.035(e) 1 required a lcal MHMR Authrity (LA) t assemble a netwrk f service prviders in which the LA may nly serve as a prvider f last resrt. The LA is cnsidered the prvider f last resrt if it can demnstrate that it has made every attempt t slicit an available and apprpriate prvider base and there is n willing prvider available in the lcal service area r cunty f need. Hwever, the new requirements f Sec. 533.035(e) must be fllwed in cnjunctin with the requirements cntained in Sec. 533.035(c). This means that the ptential prviders slicited by the Request fr Infrmatin (RFI) wuld ultimately be assembled int a netwrk by the LA thrugh cnsideratin f public input, ultimate cst-benefit, and client care issues t ensure cnsumer chice and the best use f public mney. T that end, in March 2004 an RFI prcess was develped and initiated as a means f determining interest in a cmprehensive treatment netwrk fr peple with mental illness and mental retardatin. Respndents were asked t prvide infrmatin n varius service packages and include any tpics r questins the respndent r any ther interested parties believes imprtant t address in any future Request Fr Prpsal (RFP). The RFI dcument included a gegraphic descriptin f the lcal service areas, thus giving the respndents the pprtunity t indicate the preference t serve the entire lcal service area r a prtin theref. The RFI dcument included the verbatim service descriptins frm LA s FY 04 Texas Department f Mental Health and Mental Retardatin (TDMHMR) Perfrmance Cntract, Attachment IX-Exhibits A, B, and C. Respndents were given an pprtunity t express interest in prviding the entire service package r individual services 1 a.k.a. HB2292, Sec. 2.74 (2003) Lubbck Reginal MHMR Center Page 2 f 7
within the package. See Attachment A fr Lubbck Reginal MHMR Center s current list f cntractrs/prviders and Attachment B fr Lubbck Reginal MHMR Center s RFI Summary. After reviewing the RFI respnses, cmments and questins, Lubbck Reginal MHMR Center, the designated lcal MH/MR Authrity fr the Lcal Service Area specified in its FY 2005 Perfrmance Cntract, nw submits its FY 2005 Prcurement Plan. II. Ntificatin: Lcal Authrity Designatin and Prvider Status. This Prvider f Last Resrt Prcurement Plan is submitted as required in Attachment VIII.; sectin VI.I f the FY 2005 Perfrmance Cntract between Lubbck Reginal MHMR Center and the Department f State Health Services (DSHS, legacy agency TDMHMR) and the Department f Aging and Disability Services (DADS, legacy agency TDMHMR). DSHS and DADS are hereinafter referred t cllectively in this Plan as the State, where apprpriate. Submissin f this Prvider f Last Resrt Prcurement Plan is cnditined upn the express understanding that nthing cntained in the Plan shall be cnstrued t limit Lubbck Reginal MHMR Center s ability t act as a prvider f the services described in Attachment A, nw r at any time in the future, nr shall it be cnstrued t limit Lubbck Reginal MHMR Center s ability t act as Lcal Mental Health Authrity and/r Lcal Mental Retardatin Authrity fr its Lcal Service Area, nw r at any time in the future. Acceptance f this Prvider f Last Resrt Prcurement Plan by the State will serve as implied cnsent t these terms. Lubbck Reginal MHMR Center requests immediate ntificatin frm the State if any cntents f this Prvider f Last Resrt Prcurement Plan shall be cnstrued as cntrary t this ntificatin paragraph in any way. III. Gals f Prcurement Prcess. Prvide the basis fr negtiatin f timelines between Lubbck Reginal MHMR Center and the State in accrdance with the December 9, 2003 mem frm Karen Hale. Crdinate the Prcurement Plan with the 2005 Perfrmance Cntract required Lcal Plan which is due June 1, 2005. Cmply with Guidelines fr Lcal Service Area Planning. Optimize the availability f prviders in Lubbck Reginal MHMR Center s Lcal Service Area. Ensure cmpliance and synchrnizatin f the relevant statutry, regulatry, and cntractual requirements enumerated in the Texas Health and Safety Cde Chapters 533 and 534, 25 TAC 412 Chapter B, Medicaid rules, and Perfrmance Cntract requirements. Ensure participatin f Lubbck Reginal MHMR Center s Bard f Trustees, Advisry Cmmittee members and ther stakehlders. IV. Current and Future Areas f Cncern Ambiguity/Uncertainty f Texas lcal service delivery system. Center received a lw respnse (nly 11 respndents) t the previusly published RFI. Lubbck Reginal MHMR Center Page 3 f 7
Uncertainty f the rle f LA s in the future. Funding instability and uncertainty including cnsideratin that rates f service have nt been adequately determined fr all services which have the ptential fr prcurement. Medicaid cncerns including applicability f under-arrangement agreements and service crdinatin/case management mandates. Ptential Department f Labr cncerns caused by the degree f cntrl required t be exercised by the LA ver the ptential cntract prviders. Incnsistent requirements f present and future relevant statutry, regulatry, and cntractual requirements enumerated in Texas Health and Safety Cde Chapters 533 and 534, 25 TAC 412 Chapter B, Medicaid rules, and Perfrmance Cntract requirements. V. Determinatin f Services t be Prcured The determinatin f which services will be prcured fr FY 2006 and the implementatin timeline will be cntingent upn a variety f factrs including: Analysis f current prvider netwrk; Finalizatin f lcal planning prcess; Obtaining clarificatin and guidance fr the cncerns enumerated in Sectin IV. Lubbck Reginal MHMR Center will submit its Lcal Plan inclusive f the Prvider Netwrk Analysis and the Prcurement Plan. Lubbck Reginal MHMR Center Page 4 f 7
VI. Attachment A A. Prvider Netwrk Analysis Lubbck Reginal MHMR Center Cntracted Services Mental Retardatin Service Prvider Prcurement Infrmatin Cmmunity Supprt Respite Bair Fundatin Emplyment Assistance and Supprted Emplyment Marin Mss Enterprises Vcatinal Training Day Habilitatin Alternative Business Services Lubbck Adult Day Center Nursing Physician Netwrk Assciatin Behaviral Supprt Kaylene Brwn, L.P.C. Diane Sucey, L.P.C. Specialized Therapy Dietician Karen Simnacher, R.L.D. Specialized Therapy OT, PT, ST, AT Audi Acustics Lubbck State Schl Owens White Rehab Center Theracare Specialized Therapy Hipptherapy Turf Therapy Lubbck Reginal MHMR Center Page 5 f 7
Lubbck Reginal MHMR Center Cntracted Services Mental Health Service Prvider Prcurement Infrmatin Crisis Cunseling Psychiatric Cnsultatin Crisis Respite C&A Inpatient Hspitalizatin Adult Inpatient Hspitalizatin *Texas Tech University Bair Fundatin Desert Springs Hspital Sunrise Canyn Hspital *Subcntract Arrangement Pharmaclgical Management Services Rutine Case Management Medicaid prhibits subcntracting f service. Rehabilitative Services Supprted Emplyment Rehabilitative Cunseling and Therapy Skills Training Child and Parent Family Psycheducatin Family Partner Intensive Case Management Medicaid prhibits subcntracting f service. Medicatin Management Psychiatric Evaluatin Treatment Fster Care Bair Fundatin Pharmacy Best Discunt Pharmacy Natinal Extended Care (NEC) University Medical Center Ambulance Transprtatin Lubbck Aid Ambulance Lubbck Reginal MHMR Center Page 6 f 7
B. Baseline Level f Netwrk Develpment Activities 1. Legal and Cntractual Requirements fr Netwrk Develpment TEXAS HEALTH & SAFETY CODE 533.035(c) requires that Lubbck Reginal MHMR Center cnsider public input, ultimate cst-benefit, and client care issues t ensure cnsumer chice and the best use f public mney in: Assembling a netwrk f service prviders; and Making recmmendatins relating t the mst apprpriate and available treatment alternatives fr individuals in need f mental health r mental retardatin services. In additin, the Perfrmance Cntract has required that each LA have a prcess fr bjectively evaluating services. This represents part f an n-ging effrt t gather infrmatin t assure Lubbck Reginal MHMR Center s Management Team and the Bard f Trustees make infrmed decisins relative t assembling a netwrk f prviders. 2. Ensuring Public Input, Cst Benefit, and Client Care in Netwrk Develpment Lubbck Reginal MHMR Center utilizes an advisry cmmittee prcess in planning fr, assembling, and managing the perfrmance f a netwrk f prviders which ffers the greatest value in the prvisin f services and supprts fr peple with mental illness r mental retardatin in a manner which reflects the highest integrity and stewardship ver public resurces. Lubbck Reginal MHMR Center must analyze its prvider netwrk t ensure that it has the capacity t prvide its cnsumers with access t a full array f services. This capacity can best be understd by using varius Netwrk Develpment Analysis Tls, described belw, t examine the strengths and weaknesses f the current prvider system. The bjective is t identify gaps in services and t slicit input frm cnsumers, family members, and ther stakehlders, in cmpliance with the statutry and cntractual requirements stated abve. This apprach has prvided the infrmatin necessary t analyze Lubbck Reginal MHMR Center s prvider netwrk while building a prvider base that supprts the gals f Lubbck Reginal MHMR Center in many ways. 3. Netwrk Develpment Analysis Tls Examples f Netwrk Develpment Analysis Tls that Lubbck Reginal MHMR Center utilizes t ensure cnsideratin f public input, cst benefit and client care include: The Planning & Netwrk Advisry Cmmittee (PNAC) The PNAC s Evaluatin f Services Prcess Perceptin Analysis Surveys Adult Mental Health Satisfactin Surveys Yuth Services Surveys fr Families Satisfactin Questinnaire fr Cnsumers/Parents/Guardians/Care Prviders Staff Surveys Other Surveys ad hc as requested by ther agencies r as related t specific issues Services Assessment Surveys Lubbck Reginal MHMR Center Page 7 f 7
Fcus Grups Cmmunity Needs Assessment Data Cllectin and Analysis 4. FY 2005 Prvider Netwrk Develpment Assessment and Implementatin Timeline The tls and prcesses described abve have assisted Lubbck Reginal MHMR Center in determining whether t prvide a particular service r t cntract that service ut. Mre imprtantly nw, hwever, in light f the changes brught by the Prvider f Last Resrt amendment f THSC 533.035(e), these tls will cntinue t assist Lubbck Reginal MHMR Center by ensuring the nging requirement f cnsidering public input, ultimate cst benefit, and client care issues in assembling its netwrk f prviders. Lubbck Reginal MHMR Center will incrprate these prcesses int its Lcal Plan, which will be cmpleted by June 1, 2005, as per FY 2005 Perfrmance Cntract, Attachment XVIII, Page XVIII-3. After June 1, 2005, the determinatin f which services will be prcured fr FY 2006, if any, and the timelines fr implementatin f prcurement, will be cntingent upn a variety f factrs. These factrs include: Cnsideratin f the infrmatin received thrugh Lubbck Reginal MHMR Center s public input prcess; Analysis f prvider interest, as may be evidenced by examining respnses t the RFI prcess; and Examinatin f prvider capacity, as may be evidenced by RFI Respndents existing services and activities in Lubbck Reginal MHMR Center s Lcal Service Area. By recgnizing these factrs, Lubbck Reginal MHMR Center will ensure that the gal f the Lcal Planning prcess t aggregate the requirements f all custmers, internal, external and ultimate, int a set f initiatives which guide Lubbck Reginal MHMR Center s resurce allcatin and pririties, taking int accunt fiduciary respnsibility as well as excellence f care is met while ensuring cmpliance with all relevant statutry and regulatry requirements as well. VII. Attachment B A. Request fr Infrmatin (RFI) Summary Attached is the RFI Summary Lubbck Reginal MHMR Center submitted t DSHS, that lists all respndents t the RFI Dcument. Lubbck Reginal MHMR Center Page 8 f 7