Inside This Issue (Click to Go Directly to the Article)

Page 11 of 15

Inside This Issue (click to go directly to the article):

1.  The Latest on the DMH Budget Deficit and DMH Budget Mitigation Workgroup

2.  What Now? FFA and Group Home Performance-Based Contracting Scorecards Update

3.  Time to Flex Your Muscles! MHSA FSP Flex Funds Work Group Meets

4.  Back to the Future: ACHSA Probation Committee, Suitable Placement Provider Meeting Focus on Future Priorities

5.  DMH Convenes Countywide PEI Steering Committee for Update on Service Area Community Forums

6.  Children's Planning Council to Be Re-Invented But ACHSA Stays in the Mix

7.  MHSA Delegates Approve All Three PEI Early Funding Initiatives at Freight Train Speed

8.  Children’s Mental Health Committee Hosts DMH District Chief Paul McIver

9.  Minority Report: Roundtable on Asian Pacific Islander (API) Youth

10.  Mental Health Odds and Ends: Negotiation Package Update

11.  Upcoming ACHSA Meetings & Events

• The Latest on the DMH Budget Deficit and DMH Budget Mitigation Workgroup

Ø  As noted in the last ACHSA Update, DMH has established a Budget Mitigation Workgroup to attempt to develop a plan for the Board of Supervisors as to how to address a significant multi-million dollar budget deficit for both current FY 2008/09 and FY 2009/10. If this type of information sounds like old news, in some way it is, since we seem to have been dealing with DMH budget deficits for as long as can be remembered.

Ø  At the same time, over the past few years, DMH has done a better job of having addressed the huge structural deficit that it created a number of years ago by using one-time funding for ongoing programs. The most recent deficits have been primarily attributed to circumstances outside of the Department's control, including reduced Realignment and Sales Tax revenues and budgetary curtailments at the State level.

The Composition of the Current Fiscal Year Deficit

Ø  At this point in time, the DMH deficit for the current fiscal year is about $14.5 million, and is attributed to curtailments made by the Administration in the recently adopted State Budget. The $14.5 million is comprised of about $3 million in managed care curtailments, $5.2 million in state hospital bed cuts, and $6.3 million in IMD ancillary services cuts.

The Composition of Next Fiscal Year's Deficit

Ø  For next fiscal year, the currently projected DMH deficit is $32.7 million, and is comprised of the following elements: 1) the same curtailments that comprise the $14.5 million for this fiscal year (above); 2) additional managed care curtailments of about $1.5 million; 3) DMH directly allocated cost increases (e.g., COLAs and unavoidable County cost increases) of $6.5 million; 4) $7 million in prior VLF and Sales Tax revenue decreases covered this fiscal year with one-time funds; and 5) $3.2 million for increases for Fee-For-Service Inpatient Hospitals.

Agreements Obtained at October 31st Meeting

Ø  Our last article on the DMH budget deficit reported on the budget principles adopted by the Mitigation Work Group. Since the meeting where those principles were adopted, two additional meetings have been held. At the October 31st meeting, the following general agreements were made:

·  Preserve State Hospital beds to the extent possible.

·  Propose minimal reductions to IMD beds.

·  Exempt EPSDT funds that are currently being used from curtailment. [At the same time, DMH intends to identify agencies that have a history of under-utilizing their funding to identify potential CGF savings.]

Ø  It should also be noted, however, that at the October 31st meeting, ACHSA made it clear that community-based programs must be preserved as well. In fact, the State budget had made reductions in State Hospital and IMD beds, and not in community-based programs. Accordingly, ACHSA's recommended pitch to the Mitigation Workgroup was that DMH should argue to the Board of Supervisors that if the County wants to preserve those beds to the extent possible, the County must come up with the funding to be able to do so. In support of this position, ACHSA argued that these curtailments should be presented within the context of public safety, and given the same priority that the BOS has historically given to law enforcement and the fire department.

County v. Contractor Curtailment Percentage Allocations Debated

Ø  At the most recent meeting last Friday, the bulk of the time was focused on what the percentage curtailment allocation should be between DMH and the contract agencies for any of the curtailments that were generic in nature (e.g., the managed care curtailments) and not attributed to a particular program. This issue had been raised by ACHSA at one of the earlier Budget Mitigation Workgroup meetings, where DMH had distributed a document which reflected a proposed allocation of 70 percent of the curtailments going to the contract agencies with only 30 percent going to DMH, based on what DMH claimed was the percentage distribution of CGF funding.

Ø  Of course, ACHSA challenged that percentage allocation, and asked DMH to provide the back-up information upon which the allocation had been made. This information was supposed to have been presented on the 14th. Instead, DMH distributed another document which simply provided composite summary numbers for "Gross Program" and "Available County Funds." The dollar amounts and percentage allocations were as follows:

·  Gross Program

a) With EPSDT -- Contractors $810,585,353 (70.28%) and DMH $342,862,067 (29.72%)

b) Without EPSDT -- Contractors $437,302,753 (59.64%) and DMH $295,940,727 (40.36%)

·  Available County Funds

a) With EPSDT -- Contractors $111,366,360 (59.57%) and DMH $75,893,859 (40.53%)

b) Without EPSDT -- Contractors $85,945,815 (54.43%) and DMH $71,956,741 (45.57%)

Ø  As could be expected, a great deal of debate ensued regarding which of these allocations should be used. Also as you might expect, ACHSA argued strongly in support of the 54.43%/45.57% split. By the end of the meeting the consensus of the workgroup was to use one of the two Available County Funds allocation splits and it also appeared that the one advocated by ACHSA had been approved. But DMH backed down on final approval pending the receipt of information regarding the under-utilized EPSDT funds (referenced above).

Ø  The next Budget Mitigation Workgroup meeting is scheduled for Friday, November 21st.

For additional information, please contact Bruce or Wendy.

• What Now? FFA and Group Home Performance-Based Contracting Scorecards Update

Ø  In the July 1st ACHSA Update, ACHSA reported that DCFS was close to completing the second annual group home and FFA scorecards that reflect agencies’ 2007 performance. DCFS has since issued individual agency preliminary scorecards, asked providers to review and verify the information in the scorecards, and allowed for an appeals process where DCFS monitors should have made adjustments to the documents accordingly.

Ø  The Foster Care (FFA) and Residentially Based Services (Group Home) Performance Measures Task Groups (PMTGs) have continued to meet on a monthly basis throughout the year. At the November 7th meetings, ACHSA reiterated the need for the PMTGs to focus on refining current performance measures, standards, and operational definitions before developing any new components of future performance-based contracting scorecards.

Ø  The PMTGs discussed the need to develop a formalized method that would allow DCFS to effectively utilize feedback from providers to identify and correct systemic shortcomings in the child welfare system. The PMTGs specifically discussed variables inherent in performance measures, such as timely school enrollment and timely implementation of Corrective Action Plans (CAPs). Vernon Brown suggested that the FFA PMTG further evaluate the information contained in the “back-out codes” for FFA performance measures that are used by DCFS to adjust scorecards for FFAs based on factors outside the control of individual agencies. In addition, the PMTGs discussed issues regarding DCFS Medical Hubs and Youth Development Services (YDS). Preexisting inadequacies of such measures, codes, and issues prevent positive outcomes for youth and impact the performance of agencies.

Ø  The PMTGs have developed a Draft 2007 Report that summarizes the system-wide performance of group homes and FFAs on each of the performance measures. A select group of representatives from the PMTGs plan to present the report to the Board of Supervisors’ Children’s Deputies before the end of 2008.

Ø  The monthly Performance Measures Data Subcommittee meeting is scheduled to be held on November 17th and will discuss individual back-out codes for FFA performance measures, as well as the possibility of developing an addendum to the system-wide report to address the importance of these codes. In addition, the Subcommittee plans to further discuss operational definitions for FFAs and group homes.

Ø  Similar to last year, DCFS plans to host All-FFA and Group Home Forums to explain this year’s scorecard process and system-wide report with providers as well as answer any questions they may have. This year the forums will be held on Friday, December 5th. Although the exact times and location have not yet been confirmed, the FFAs are tentatively scheduled to meet in the morning and the group homes in the afternoon.

Ø  The PMTGs also plan to hold a retreat on January 9th to provide a retrospective and prospective overview of the overall performance-based contracting scorecard process for group homes and FFAs in Los Angeles County. Carol Schroeder, Executive Director of the California Alliance of Child and Family Services, is scheduled to facilitate the retreat, which is intended to serve as a joint public-private brainstorming session where the DCFS Out-of-Home Care Management Division, FFAs, group homes, and DCFS Monitors will discuss what can be done differently to improve the County’s child welfare system as a whole.

Ø  Due to the FFA and Group Home Forums in December and the retreat in January, the regular PMTG meetings will not start again until February of 2009.

For additional information, please contact Adam.

• Time to Flex Your Muscles! MHSA FSP Flex Funds Work Group Meets

Ø  As reported in the November 1st ACHSA Update, ACHSA and DMH finally met on October 8th to discuss previously identified MHSA program implementation issues. The majority of the issues were tabled for further consideration by three different work groups: MHSA Flex Funds, MHSA Policies and Procedures, and MHSA Full Service Partnership (FSP) Slot Allocation, Funding, and Expectations.

Ø  The MHSA Flex Funds Work Group, consisting of DMH staff and providers, met for the first time on October 28th. Led by DMH Children’s System of Care District Chief Bryan Mershon, the work group first defined the parameters of its role. The work group will not be compiling a comprehensive list of acceptable Flex Funds expenditures. Instead, the work group will craft more specific guidelines than those already included in Service Exhibit A in the MHSA contract.

Ø  Service Exhibit A describes five different service function codes related to MHSA Client Supportive Services. The work group plans to focus on service function code 72, the category used to track Flex Funds.

Ø  In discussing the purpose of Flex Funds, DMH staff believed that agency staff needs to explicitly show how requested Flex Fund expenditures relate to a client’s clinical needs. Moreover, DMH staff wanted to see agency staff document efforts to find the lowest “cost” for the requested expenditure.

Ø  As a model template, DMH distributed one ACHSA agency’s Flex Funds request for the purchase of a refrigerator. On the form, agency staff wrote that “I’ve looked at second hand stores and the price was from $250 and up. I also looked at Craig’s List, but due to transportation, [the new refrigerator] would cost around $500 and up.” DMH also highlighted another ACHSA agency’s internal Flex Funds policy.

Ø  DMH clarified that if agencies are utilizing Flex Funds for reimbursement of computers and laptops for FSP clients, they need approval from District Chiefs PRIOR to the purchase of these items (this is apparently required in an attachment to the MHSA contract). However, final decision on Flex Fund requests are made by the age group leads in consultation with the District Chiefs.

Ø  DMH staff also clarified that MHSA Flex Funds should not be the first funding stream that agencies’ use to cover a client’s needs. More specifically, DMH staff expects agency staff to consider alternative funding sources (i.e., DPSS, Social Security) available to a client before submitting a Flex Funds request.

Ø  In order to create a standardized process across all age groups, DMH plans to develop one uniform Flex Funds request form for all FSP clients. DMH circulated different age group forms to consider in creating the standard request form.

Ø  In addition to the Flex Funds request form, DMH will craft appropriate Flex Fund guidelines by consulting policies enacted by sister departments within L.A County, such as DPSS’ policy on the Homeless Assistance Program and DCFS’ policy on food certificates and gift cards. The policy would likely include a provision on emergency funds, additional safeguards against potential abuse, and further accountability from agencies.

Ø  One possible safeguard is the creation of an upper limit for individual Flex Funds requests. If a request exceeds the upper limit, the agency staff would need to fill out a more extensive expenditure request form.

Ø  In terms of agency accountability, DMH staff recommended random sampling of Flex Funds expenditures as part of the current technical assistance/monitoring site visits conducted by DMH for FSP providers. ACHSA stated emphatically that while accountability was important, the additional monitoring should not over burden agencies with additional administrative duties and increase staff anxiety.

Ø  The work group participants also agreed that the formation of a Review Committee to examine questionable Flex Fund requests would be prudent to ensure uniform application of guidelines countywide.

For more information, please contact Wendy.

• Back to the Future: Probation Suitable Placement Provider Meeting/ACHSA Probation Committee Focus on Ongoing Concerns/Future Priorities

Ø  The month of November began with a healthy dose of operational issues for providers and the Department to deal with. ACHSA’s Probation Committee met on November 4th and Suitable Placement held its soon-to-be quarterly Probation Provider Meeting on November 12th, looking to address these operational issues.