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HomeMy WebLinkAboutAgenda - 12-10-2002-5bORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: December 10, 2002 Action Age~ndab Item No. ..~ SUBJECT• Approval of OPC Area Program Local Business Plan DEPARTMENT: OPC Mental Health PUBLIC HEARING: (Y/N) No ATTACHMENT(S): Resolution Revised Chapter I, "Planning", In response to State Plan 2002: Blueprint for Change (Under Separate Cover) INFORMATION CONTACT: Gwen Harvey, 245-2300 Tom Maynard, 913-4000 TELEPHONE NUMBERS: Hillsborough 732-8181 Chapel Hill 968-4501 Durham 688-7331 Mebane 336-227-2031 PURPOSE: To consider approval of the final version on the OPC Local Business Plan addressing statewide mental health system reform which is due to the State on January 1, 2003, and adopt a resolution authorizing transmittal to the State. BACKGROUND: At its meeting on November 19, the BOCC received the last update from Orange-Person-Chatham (OPC) Mental Health staff along with a copy of the draft plan. The OPC Steering Committee met again on November 21 to review the draft plan and make any needed changes requested by the counties before referring the finished document back to each of the three governing boards -Orange, Chatham and Person -for formal approval before the end of the calendar year. Changes made on the basis of BOCC, Steering Committee and staff discussions are reflected in the revised Chapter I, "Planning", which is attached. No other sections of the draft plan were changed, although other appendices required by the State and referenced only in the earlier draft will be included in the formal submittal. A complete copy of the OPC Local Business Plan will be available in the Clerk's office by January 2, 2003. In the interim, please refer to the draft copy provided in the November 19 agenda materials for additional review. In general, the changes were made to emphasize the following points: The counties' ability to successfully implement the Local Business Plan required by the State is contingent upon the best interest of consumers and the availability of adequate funding. • The LME (Local Management Entity) will support the establishment at State expense of a Self Help & Peer Support Center as envisioned by the Consumer and Family Advisory Committee. • All plans and timetables for service divestiture are subject to immediate amendment if at any point it is determined to not be in the best interest of consumers or if the necessary supports are deemed inadequate. • Target Ratios for internal/external service delivery objectives are provided in the description of transition and divestiture issues. The OPC Steering Committee will meet next on January 22, 2003 to continue developing the legal and administrative framework for the transition from an area program to the LME structure under the strong governance model as previously authorized by the BOCC. FINANCIAL IMPACT: There is no immediate financial implication with the approval of the local plan. The three counties continue to assert, and it is embedded throughout the Local Business Plan, that the success of the LME system hinges completely upon adequate funding from the State. The Plan was drafted to allow as much flexibility as possible to the local elected officials and to allow the maximum time to carefully address issues of consumer interest and financing. RECOMMENDATION(S): The Manager recommends that the Board approve the OPC Area Program Local Business Plan and adopt the resolution authorizing its transmittal to the State by January 1, 2003. 3 RESOLUTION OF THE BOARD OF COMMISSIONERS OF ORANGE COUNTY, NORTH CAROLINA WHEREAS, N.C.G.S. ~122C-115 (a) requires each county in North Carolina to provide mental health, developmental disability and substance abuse services either through an area authority or a county program established pursuant to N.C.G.S. §122C-115.1; and WHEREAS, the Boards of Commissioners of Orange County, Person County and Chatham County intend to form a three county public entity to serve as the local management entity ("LME") for Orange, Person and Chatham counties; and WHEREAS, under the guidance and direction of a steering committee, comprised of commission, management, and consumer/family representatives, a local business plan has been developed and commended to the three counties which builds in as much flexibility as possible, allowing the elected leadership the maximum lead time on issues related to the best interests of the consumer and overall financial feasibility, NOW, THEREFORE, the Boards of Commissioners of Orange County by adopting this resolution approve and authorize transmittal by the OPC Area Program to the North Carolina Department of Health and Human Services a local business plan created as a joint effort for the provision of mental health, developmental disability and substance abuse services in Orange, Person and Chatham Counties. -3- 4 This resolution having been submitted to a vote, received the following vote and was duly adopted by Orange County this day of 2002. Ayes Noes MHR05Resolution -4- 5 I. Planning I.1 The Local Business Plan demonstrates congruence with the Mission and Principles of the State Plan. Orange Person Chatham Area Program is a proven leader in the development of state of the art services and best practices to support citizens with disabilities. Our primary mission is to work in partnership with individuals with disabilities so that they may live full and productive lives within the community. It is the intention of the current administration and the Commissioners of Orange, Person and Chatham Counties to continue this important work under the Local Management Entity ME) Model. The OPC Board of Directors has been a primary partner ' our wo to fulfill this mission and an important liaison to the elected officials of nge so and Chatham counties and the citizens they represent. We have bee fo na o inc d in our Board Membership, individuals who are national y r cog iz the fi lds of public policy and disability rights. In May 2000, the ea B and d ted a d th L E hereby adopts the following Mission Statement• Our Missi is to o k ~a to rs~h'ip it~i consumers and their families so the c ea atisfy' g 'ves d me integral, valued and o 'b 'ng m er the community. We will: • Suppor i i id a s t e meaningful choices and to achieve their • Respec the gnity and diversity of those we serve. • Ensure uman and civil rights. • Serve individuals most in need. • Make services readily available and as timely as possible. • Assist individuals to secure and keep a home and a job. • Recognize the importance and complex interaction of families. • Use natural supports such as family, friends, neighbors and community organizations. • Use appropriate resources wisely by using no more or no less than what is needed. The OPC Mission Statement is both congruent with and reflective of the North Carolina Department of Health and Human Services (DHHS) Mission, Vision and Guiding Principles. As an LME, we intend to be a responsible agent of the taxpayers by deploying public resources as efficiently as possible while supporting citizens with severe disabilities in their efforts to live as fully contributing members of the community. This Business Plan will describe an LME that will be both person centered and outcome focused. We will continue to work collaboratively with consumers, family members and community systems in order to maximize natural supports and minimize institutional 6 dependence for both our existing clients and any future clients transitioned from state-run institutions to the communities served by the LME. Our ability to successfully implement the changes described in this business plan is contingent upon two important factors. First, the best interest of our consumers will always be our primar~guiding_princi~le as we consider implementing_any system reforms. If at an~noint we feel mandated changes are ne~ativel~pacting the people we serve then our plan will be immediately modified to prevent any harm. Secondly success of the LME system hin e~ s completely upon adequate funding. All the goals and objectives set forth in this plan are subject to amendment if funding is deemed insufficient. As we move from an Area Program to a Local Management Entity Model, the way we serve the community will change significantly. Feedback from unity Stakeholders indicates that there are many people in target populations i eed o additional services. Since OPC already spends very little on non-priority 'e and ince OPC has been a leader in developing best practice model communi y su s o r opportunities to redeploy resources are not great. This ma she ro ess of p 'o itizing resources very important. Our LME proposal envisions a oca ly a ag d pu li process for evaluating needs and outcomes, where fe ack 's r pi ly tra sl into m dified action. Consumers, families, stakeh lder n to a f ci is ill all a cipate actively in this ongoing evaluation-~ A continuous pla in o e s i a n c ss to Y order to implement our vision and we moved quickly ea li t i y a to such a process. OPC created an active Steering Committ e t a m e s n thly basis. Steering Committee Members include a County Commis io fr O ange, Person and Chatham Counties, three County Managers, the OP Area irector, the OPC Board Chair and the chair of the Consumer and Family Advis ommittee. This group has provided important leadership in the planning process. hey have facilitated the review of stakeholder input and have worked to prepare the community and Area Program for the impending system transformations and improvements. Once the LME is initiated, three groups will assume the primary planning role. The OPC Local Management Entity Board, County Government and the Consumer and Family Advisory Committee will continuously monitor the system and recommend changes. These three groups will oversee OPC from the perspective of internal monitoring and self improvement, elected official oversight and consumer-family "customer feedback", all working together to ensure that the goals described in both our mission statement and business plan are constantly being evaluated by the citizens we serve. We view the State Plan and its system reforms as an important opportunity to improve how we provide services to the people most in need. Although we anticipate challenges along the way, we look forward to promoting a fully person-centered, efficient and responsive system that the community will be proud to support. 2 I.2 LBP planning process meets state plan requirements I.2.a There is a strength/weakness analysis including methodology for building on strengths and addressing and/or ameliorating weaknesses. To accurately evaluate the relative strengths and weaknesses of the existing Area Program, management initiated an extensive evaluation. The first step in this analysis was to ensure that all stakeholders were given the opportunity to provide input into what they liked about OPC Area Program and where the system could be improved. Consumers, their families, local advocacy groups, staff, private service providers, public officials, local citizens, public agencies such as Department(s) of Social Services, public school systems, and Department(s) of Juvenile Justice, and hospitals have all been included in this process and their input make up findings of this evaluation. An independent consultant created a written survey and i stratified active OPC clients by age and disability group. instruments specific to each age and disability grou p the survey instruments. The consultant also condu ted allow for a more in depth exploration of r ev nt i su s~~ consultant's full report are attached In addition to the work Staff conducted nu r of groups. Writte su stakeholders. Surv y i Committee has m r g valuable feedback n t] participating coun hearings on this pr pos lu~te~t i terviews. Staff cons ant prepared survey {' ely 960 clients received i 1 i terviews with clients to i s f the surveys and the ~diata from other sources. of the state plan to a variety ~nity organizations and other al Consumer and Family Advisory c Fe ry of 2002 and has provided extremely is weaknesses of the existing Area Program. Each forums and County Commissioners are holding public ss plan. Findings identify strengths that we plan to integrate into the new system as well as weaknesses that will require significant program modifications. For example, stakeholders generally identified case management as a program strength, but described problems related to service access, including crisis services. Our response is to create a system that will dramatically simplify program access, facilitate crisis response and build upon our strong case management services. This seamless system will not only help people to easily access services, it will also provide the crucial ongoing support required to prevent hospitalization. System details can be found in the Strategic Plan as well as Chapter IV (Service Management) and Chapter V (Access to Care). Stakeholders also identified several services they would like to see more of in the community. Respite Services, ACT Teams, and Supported Living programs were all identified as areas requiring resource development. Through the use of outcome driven utilization management and performance based contracting, we intend to create a provider network system that will encourage and reward the development of high quality services. Again, details can be found in the Strategic Plan as well as Chapters III (Qualified Provider Network Development) and Chapter IV (Service Management). 3 8 I.2.b There is a policy establishing the local Consumer/Family Advisory Committee (CFAC) and assuring opportunity for meaningful involvement of consumers and families by requiring: • Recognition of the contribution of consumers through their unique perspectives and abilities • Establishment of a non judgmental environment • Timely advance notification of actions proposed Establishment of Consumer and Family Advisory Committee Policy attached I.Z.c There is a statement attached attesting to consumer/stakeholder involvement consistent with the State Plan, which is representative of the broader population of the locality with the confirmation by the CFAC. A statement is attached /~ I.2.d There is a resolution of the governing body ac ti /a p oving the LBP as submitted. A resolution is attached I.2.e There is a separate repo ub 'tte b t e l ca A The CFAC Report is attache O I.3 The LBP in or or s a 3 ye r stra i plan for the initial implementatio t a • Ide ti ie a an year implementation strategy • Co tan gas, b~ fives and activities • Ide ti s m ames and responsible party (individual or entity) for eac goa and objective • Pr es evidence of ongoing planning effort • Attaches a policy requiring long-range planning methodology that meets State Plan requirements Tactical & Strategic Planning Policy is attached • Addresses steps necessary to transition individuals now in services who do not meet target population criteria to other community resources as necessary 4 9 STRATEGIC PLAN I. INTRODUCTION.• THE STRUCTURE AND FUNCTIONS OF THE LOCAL MANAGEMENT ENTITY We propose a strong LME model that will act as a local governmental unit, organized under the statutory authority granted the counties, and covering Orange, Person, and Chatham counties. We envision a public process that includes both the local government and citizens in the allocation of care and in the evaluation of its results. We intend to minimize the portion of public dollars that is spent on administration to ensure that maximum resources are available for consumer services. We will use these resources to target services to the consumers who are most in need and then build upon our track record in providing best practices to ensure the best possible result. The LME Service Delivery System will directly provide Tria s essment and Crisis Services, Case Management Services (for complex case y) an sychiatry (for the purpose of short term assessment and crisis interve 'ono 1 I has been suggested that LMEs could also act as a service provider for earl in enti n ervices. OPC is currently evaluating the feasibility and be efit of nc u~' g t is ervice as a core service component. All remaining providers. These systems Unit whose primary fup community agenciesand The LME Admini resources. It will Service Authoriza Human Resources to o r etwork of private olla o tion and Advocacy -kin lationshins with other to maximize the efficient use of hider Network Unit, Core Service Management, Information Systems, Quality Improvement and II. THE LME SERVICE DELIVERYSYSTEM The Triage, Assessment and Crisis Unit (TAC) All individuals, regardless of problem or disability group, will enter our service system the same way. Five Triage, Assessment and Crisis Units will be opened in convenient locations where citizens can receive assessment, referral and crisis related services. These same services can be accessed through a toll free 24 hour phone service. Additionally, people can access LME services through hospitals, key public agencies and qualified providers who will receive training and information regarding how to help people access LME services. In addition to providing access and referral services, the TAC Unit will also provide crisis related services. Immediate crisis intervention counseling and brief crisis intervention follow-up will be available as well as the mobilization of emergent resources as appropriate. These may include: Psychiatric assessment and medication evaluation; Community-based crisis stabilization, which may include brief residential placement or in-home supports to preserve community living; 10 • Determination of need for hospitalization when the level of need is more intensive than community alternatives can appropriately offer; and facilitation of such hospitalization; • Diversion from state hospitalization for persons with mental retardation; • Mobile crisis response, providing crisis assessment, intervention and supportive services in-home or elsewhere in the community; • respite care (in and out of home); If services are needed on a long term basis the TAC Unit will refer consumers to appropriate service providers. The Case Management Unit The essence of LME operations will be to expend resources by centered service plan and to evaluate the results of these expe management a critical part of local LME operations, as i rm; relationship between the individual with a disabili d t people least able to negotiate a complex syste w' ho ssist need of complex and/or long term service , th pri ci ~elat c individual and the system is best played by the LME. A decision tool management at receive LME C providers. The LME case i broker and servi through a direct plan. case ~ s of the person- r s. This makes case asis of the system for those When a person is in ip between the We believe this role is ~to determine who needs case med long term and complex will be referred an array of qualified 11 ~as an advocate, negotiator of the service plan, service . Outcomes and client satisfaction will to be monitored ~ with a consumer through the documented, written service The Collaboration and Advocacy Unit This unit will continually work to improve, develop and enhance relationships between the LME and community organizations. Additionally, this unit will work to maximize consumer and family participation in collaborative efforts and will participate in needs assessment and program evaluation studies. Finally, the LME is involved in a number of special projects that are described in detail below. The Collaboration and Advocacy Unit will be charged with administering and overseeing these efforts. III. THE LME ADMINSTRATIVE SYSTEM We are designing an administrative infrastructure that will be efficient in both its use of resources and how it manages the service system. Finance, Information Systems, Quality Improvement and Human Resources will continue to provide the support and training necessary to keep the service system running. Additionally, a Core Service Manager will be responsible for overseeing the Triage, Assessment and Crisis, Case Management and Collaboration Units. The Qualified Provider Network Unit will be charged with 6 11 managing the Private Provider system for the LME. Finally, a Service Authorization Unit will be designed to monitor service provider outcomes and to manage the utilization review process. IV THE ROLE OF CONSUMER & FAMILYADVISORY COMMITTEE (CFAC) As an Area Program, we have atwenty -year plus history of consumer involvement in an advisory and decision making capacity that goes far beyond state mandated requirements. Consumers have consistently played an active role in a variety of areas including membership on the Client Rights Committee and the Area Board. In keeping with this long standing practice, we look forward to a productive working relationship with our Consumer Family Advisory Committee. As directed by state statute and rule, the Committee's duties and responsibilities shall be consistent with the principles of the State Plan. These include, but are not limited to: • advising and commenting on the LME's local business plan a pl nning effort • reviewing and submitting a separate report to the Divisi on the ME's local business plan and planning effort • providing recommendations on areas of service ligi ' ity a d ervice array, including identifying gaps in services • assisting in the identification of der- rve po ulatio s • providing advice and cons tion ga d' g he de opme t additional services and new models of servi • monitoring se e dev o m~ a d el ery • reviewing and o nt n on s e d l0 1 e budgets • observing and ep rti g t im ntat' n of state and local business plans • participating in all qu li 'm r ve activities, including tracking and reporting on outcome meas e d e fo ace indicators • ensuring cons a an fa ' y participation in all quality improvement projects at both the provider an L levels In addition, CFAC will have representation on various LME committees. This will allow for the participation in policy development, consumer survey development and outcome system design and analysis. The CFAC will also have access to LME management and governing board for the purpose of advising the LME about needed service improvements. The CFAC has already identified several urgent needs including housing, transportation, and the DD waiting_list. CFAC will also help father and provide on~oin~ needs assessment service evaluation data and will have access to all LME service, outcome, and cost data that is not restricted by confidentiality. CFAC will also help gather and provide ongoing needs assessment service evaluation data. They will be responsible for assisting in the identification of training needs and for providing relevant training to LME staff. The CFAC has proposed the establishment of a Self-Help & Peer Support Center. The LME will support the establishment of such a project and will work to mobilize resources sufficient to operate a formal staff organization. Since the State of North Carolina has expressed strong support and endorsement of independent consumer empowerment outside LME control, we fully expect direct State funding of this effort. Once 7 12 oyerational, the LME will work with the center to make system consumers aware of the center, and to assist in the promulgation of information about the center. The full text of the CFAC proposals made to the LME during the planning_process is attached. V. PILOT PROGRAMS The Area Program has a long history of involvement in pilot projects that demonstrate the principles of best practice. These include projects in supported housing, supported employment, ACT Teams, the Transitional Employment Demonstration Project, Mental Illness/Substance Abuse Pilot Project, Self Determination Pilot Project, OPC Sexually Aggressive Youth Program, Child and Youth Demonstration Project, and our Supported Living Project. We feel this history prepares us to take a leadership position as we enter this new era of service provision. We are requesting permission plot four changes to the State's plan for the LME system. First, we propose a system that allows the LME to capitated funds. This authority will give t E unique needs of our community. We are illi g tc decision making capabilities b use a eel a trc citizens. ' I Second, we propo e that th M'~ a~ the region. The L E i l ~nt 'n c will authorize all p n it o ul range of services a~ a le o th c e practically mount o t n xc L process for the sel ction f a vendor. e tl manage at-risk s exibility to meet the ;h ri k associated with these is be t suited to serve its b~ty for utilization management for provider contracts are managed and The LME will develop a competitive of the client. When services cannot be contract, the LME assures a fair, competitive Thirdly, we propose that the Division of Mental Health Services supports our efforts to recruit a Multisystemic Therapy (MST) program for our area. This pilot requires the creation of a service definition for the intensive, in-home service for youth in the CMSED categories. Reimbursement for this intensive service would be a monthly or daily rate and be supported by Medicaid, IPRS and CTSP. A community group including DSS, DJJ, school staff and family members have determined that this type of service is a priority for youth in Orange, Person and Chatham counties who have serious emotional disturbances. Finally, our intention is to implement a system of performance based contracting that will tie financial rewards to favorable outcomes. This will be accomplished initially through the selection of critical indicators and the specification of financial incentives for the attainment of critical outcomes. This activity will not replace the use of any DMH developed outcome instruments nor the ongoing development of our local system of Utilization Management. This system will gather extensive data related to client outcome measures and resource costs. Profiles of individual and team providers will be developed in order to compare providers to their peers on a local, regional and (when available) 13 national level. This proactive, broad-based approach will allow the LME to create a learning environment within the network which will shape more effective service strategies. The LME will devote its time and energy toward examining trends with the larger client population while clinicians and providers are empowered to work with people on an individual level. A more comprehensive system of performance contracting using more sophisticated outcomes instruments and standards will be developed over time and will replace the initial few indicators used in performance contracting. VI. SPECIAL PROJECTS The Area Program is involved in a variety of special projects that we intend to continue as a Local Management Entity. It is our feeling that these ventures represent important collaborative efforts that will ultimately promote positive outcomes and best practices. These programs will be administered through the Collaboration and Advocacy Unit of the LME. Examples of some of these projects are described below Clinical Trials Network The Area Program has been a participant s' c the Fa 10 200 i the North Carolina node of the National Institute on Drug Ab se I A 1' ica T ials Network. The Network was established by th ati al n tit to n g A us to test and disseminate innovative approaches to tre in b to e bu e 'n he com a ity. The Regional Research and Train' Ce to f r e e w i t e uke Clinical Research Institute. OPC is one of fo Area Pr ra s rti ipating. The LME is com itt d ti u'ng is articipation, enabling clinical trials to be implemented with i s e i e s s e nd provider network, thereby enhancing the quality of its subst n e b s tr atment practices and furthering the development of treatment nationw de. Proiect Odvssev The Developmental Disabilities Department of OPC Area Program is in the third year of participation in the NC Self-Determination Demonstration Project. OPC was selected to receive one of the four grants in North Carolina to implement the principles and practices of Self-Determination for persons with developmental disabilities. These principles require that individuals with developmental disabilities be given control over how public funds for DD services and supports are spent. The pilot projects have worked to change the service system to put people with disabilities and their families in charge of their own lives. Our goal has been to provide the person with a disability the responsibility of deciding what services are needed and direct their own service purchases using public monies. The project has made funds available to hire "support brokers" who are accountable to the participant with developmental disabilities. The support broker assists in planning and coordinating the needed services as identified in the person-centered plan and individual budget. 9 14 System of Care Grant In 1999, OPC received a federal System of Care Grant to develop community-based services for children with serious emotional disturbance and their families. Child and Family Teams and interagency collaboration are core components of the system of care approach. The existing Orange and Chatham Community Collaborative and a Person Community Collaborative serve as the local management structure for the System of Care project. Involved with OPC in this Collaborative are parents of children with serious emotional disturbance, Family Advocates, Department of Social Service staff, Juvenile Justice, local schools, Guardian ad Litem, community agencies (including Chatham Together and the Mental Health Association) and interested community members. The Collaborative has many responsibilities including budget oversight for the grant, identifying and coordinating services and resources across child serving agencies, identifying training needs and exploring resource development rtunities. In 2001, the System of Care project for OPC initiated a resource projec volvi community partners, families and private foundations to explore p ling f public funds and acquisition of private funds in order to expand the onti f ervices for children with serious emotional disturbance. ~ Deaf Services In FY 2000 the OPC Area MH/DD/SAS, Adu en coordination and Central Region. year hired two cc Services. the St~teJDivision of ~ct or~,~vit r uest to consider taking on the to he deaf d and of hearing for part of the North r e o h' equest and at the end of that fiscal ul Services and one for Child and Youth These positions se e the P~ catchment area with direct therapy and case management services. They al o vide consultative services and limited direct service to Durham, Alamance, Caswel ,Vance, Granville, Franklin, Warren, Rockingham and Randolph counties. In addition to individual client services, the Coordinators work collaboratively with the area programs and other service and community providers to access resource/service needs and develop therapeutic, vocational, recreational, and social services for the deaf and hard of hearing throughout the area. They also serve as advocates and educators in obtaining and enhancing access to services and improving the quality of a range of services. They do outreach case finding, coordinate specialized services, including interpreter services and provide linkage to the State Coordinator for Deaf Services. A consequence of the establishment of these coordinator positions has been a dramatic increase in the accessing of these specialized services, as consumers needing them have been identified. From an initial 5, the caseload has grown to nearly 50. Continuation of these functions will be assured by the Regional Coordinator positions, as employees of the LME. Due to the special access needs of deaf and hard of hearing consumers, the Regional Coordinators will work closely with the Triage, Assessment and 10 15 Crisis unit and Case Management unit of the LME. The coordinators will provide access, crisis, case management and special therapy functions where possible and will assist the unit staff when they are providing service directly to consumers. The LME will also establish contracts with other LME's in the region. This will ensure Medicaid reimbursement for services provided by the Regional Coordinators to consumers who reside in other catchment areas. VII. DIVESTITURE AND TRANSITION ISSUES A transition plan and checklist will be developed to help LME staff to identify current consumers who do not meet the target population eligibility requirements. Appropriate community resources will be identified and LME staff will provide individuals with the necessary information and referrals. LME staff will work to ensure individuals are transitioned in a thoughtful and appropriate manner. Community resource information will be compiled i a st tha will be available to all staff and will also be made available on the LME ebsi 's 'st will be updated on a regular basis and will include contact info a ion or acc ssi ealth services, financial support, self-help and advocacy services, aith bas d e ices, h Bless support services, Alcoholics Anonymous suppo ,nnd 11 o h r a p pr' res ur es. As the transition to na~re^~c sefl hri 't' s oc a s. some resources will be freed uv that identified in our iressin~ unmet r and The LME intends o~w6rk toward divesting from its current role as service provider gradually over the course of the next three to five years. Programs that spin off from the OPC system will be supported as much as possible during this transition. We are currently examining specific ways of helping those agencies create the necessary infrastructure they will need to succeed, while ensuring the integrity of free access to a diverse qualified provider network. All plans and time tables for service divestiture are subject to immediate amendment if at anypoint it is determined that these Chan eg s are not in the best interest of our consumers. We will be exploring divesting options that may include contracting out current services, transferring current functions to existing agencies or assisting in the creation of new entities. This is a complicated process and all divestiture decisions will require careful consideration to ensure consumers are not ne at~~pacted during this transition period. Like all components of this business plan successful divesture is contingent upon sufficient funding. Our divestiture plan is subject to modification if the necessary supports are deemed inadequate. A detailed divestiture plan is being written and will be completed during the first quarter of fiscal year 2004. 11 16 THREE YEAR IMPLEMENTATION PLAN Goal One -The Service Delivery System: The LME will work to maximize client choice and accessibility while maintaining service integrity during the building and implementation of the Core Service System and the Qualified Provider Network. nb~CCt1VeS f~Ct1v1t1eS Projected Responsible Completion Parties Date Core Services: Analysis of the • Finalize core service structure First Quarter Management current service structure is and content FY 2004 Team complete and the design and • Continue to analyze service initial implementation of the delivery data new core service units is • Finalize Target Population underway. Eligibility system • Develop implem ation a with process an date Core Services: • E su C C e anagem t First Quarter Management The implementation of the f t a d of a or ti a d Advoc c FY 2005 Team phase of core services ' D nit ar lly cti nal complete and all esse ial • eg n to gathe ele ant baseline functions are in place. at • dif news stem as needed Qualified Provider or • Fi review of stakeholder and First Quarter Management The analysis of cunen pr vi er WOT data FY 2004 Team network is complete. • Evaluate needs assessment data and make recommendations regarding any service gaps • Finalize decisions regarding which services to spin off and add to PN Qualified Provider Network: • Ongoing meetings with potential Third Quarter QPN Unit The initial Qualified Provider QPN members are underway FY 2004 Network is in place. • Publish RFPs for unmet service needs • Continue to build comprehensive service network Qualified Provider Network: • Outcome and other performance Third Quarter QPN Unit, QI QPN related data is being based contracting data is being FY 2004 Unit, UM Unit gathered, analyzed and shared gathered with providers in a meaningful • Client's Rights, incident review way and other QI information is integrated into the new QPN system • Feedback loops between the LME and the QPN are developed and modified as needed 12 17 Goal Two -The Administrative System: Develop an accountable, flexible and efficient organization designed to provide all the necessary supports required by the service system. ObjectlveS Activities Projectcti Responsible Parties Completion Datc The LME. Governing • Compile necessary First Quarter County Board the LME qualifications and FY 2004 Commissioners, Advisory Board is in conduct member search Management Team place. if necessary Implementation of by- Research various First Quart r Management Team, laws and permanent options FY 2 committee structure of • Create by-laws CFAC Chair CFAC is established. • Finalize committee LME Staff Liaison structure Continue to identify • Consolida on pti ns first u rter Management Team contract options for are consi ered nd Y 2 0 cost sharing. nego 'ate ns rti s ar d e d Merger or o ple e any First Quarter Management Team Consolidations nec s tia i ns FY 2005 decisions are final ze ak na decisions Information In to rofiler system First Quarter Management Team, technology Implement decision FY 2005 Information infrastructure has een support tools Systems Unit developed and • Continue report im lemented development process An LME Financial • Continue to monitor First Quarter Finance Unit, Management Plan is in and evaluate internal FY 2004 Management Team place. controls and audit trails • Ensure compliance with all state and federal re uirements 13 18 Goal Three -Pilot and Special Projects: Use the LME model to build upon the Area Program's long history as a proven leader in the development and implementation of pilot programs that demonstrate principles of best practice. Objectives Activities Projected Responsible Completion Parties Date Pilot a Service • Gain authorization Third Quarter Utilization Authorization System from the Division to FY 2004 Management Unit that will measure implement pilot client outcomes and program reward providers who • Gather and finalize demonstrate positive baseline data results. • Determine outcome indicators to be measured • Work wit N U it, MIS, QI d ntr ct o 'ders to en ur syste n mot ly ea a d di o s s cess The Implementati n Ga a hori do First Quarter Management Team, performance base om t e ivis~ to FY 2005 Utilization contracting pilot ill i ple e pilot Management Unit, begin Pr m QPN Unit Negotiate and finalize performance criteria with QPN • Negotiate and finalize reward criteria and feedback loops with QPN • See service authorization activities above At-risk capitation • Gain authorization First Quarter Management Team management pilot from the Division to FY 2005 program is fully implement pilot implemented. program • Design reports or any additional requirements the Division deems necessaryto accurately monitor ilot ro ram 14 19 Goal Four -Transition and Divestiture Issues: Ensure that all clients are supported in a thoughtful manner during this time of significant change and that important programs are transitioned in a manner that maximizes their chance for success in the private sector. Objectives Activities Projected Responsible Completion Parties Date A detailed Divestiture Develop criteria that First Quarter Management Team Plan is completed. will determine which FY 2004 programs to divest • Determine specific timetable for divestiture • Create support system to maximize opportunity for divested program success A detailed transition Develop first a rter Management Team plan is complete. reh s've Y 2 0 transi io c c fist m let 1 s o pr prat o nit res urc s rai s of m a pro 'a e id n ' cation and transition of individuals who do not meet target population criteria • Ensure a thoughtful transition process that will match all non- target clients with community programs of their choice Internal to external • Continue First Quarter Management Team service provision target Implementation of FY 2005 ratio will be 40%: Divestiture Plan 60%. Internal to external • Continue First Quarter Management Team service provision target implementation of FY 2006 ratio will be 20%: Divestiture Plan 80%. Target for 100% Complete First Quarter Management Team divestiture of services. implementation of FY 2007 Divestiture Plan 15