ACHSA FY 03/04 Annual Report

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ACHSA FY 06/07 Annual Report

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COUNTY DEPARTMENT RELATED SIGNIFICANT ACCOMPLISHMENTS

*DMHCounty General Fund Flexibility -- In a major victory, the Board of Supervisors unanimously approved a motion by Supervisor Knabe to provide DMH contract agencies with continued contract flexibility and instruct DMH to report back with a long term solution to the shift of funds issue. This lead to an ACHSA meeting with the Health Deputies and DMH which resulted in final agreed upon shift of funds contract language, approved by the Board of Supervisors. With the new contract language in effect, the first "re-basing" effort of agencies' allocation of County General Funds between uninsured and insured clients took place.

*County's Title IV-E Waiver -- The County's Title IV-E Waiver Plan approved by the Board of Supervisors addressed all of the major issues ACHSA had identified in the draft Plans, in part based on ACHSA meetings with DCFS, Probation, and several Children's Deputies. Major changes included: 1) the County's modification of its waiver goal of "reducing the number of children and length of stay in congregate care" to reference individualized case planning and appropriate community alternatives to be in place first; 2) the addition of aftercare as a priority activity; 3) the addition of MAT assessments as a priority activity; 4) the elimination of mandated usage of resource families; and 5) the inclusion of language on flexible funding to provide incentives to back-end providers to redirect resources to front end services.

*Probation's LongstandingCritical Issues -- After a two year struggle, ACHSA made major progress on its most significant Probation issues. ACHSA met with BOS Juvenile Justice Deputies and testified at the BOS's Budget Hearings, at which Chief Probation Officer Bob Taylor was asked to address ACHSA concerns. Progress made included: 1) Chief Taylor's recommendation for an additional 50 Suitable Placement Deputy Probation Officers; 2) Probation's dramatically increased efforts to fill numerous longstanding DPO vacancies; and 3) major improvement in the timeline for providers' receipt of the Medi-Cal card/letter authorization for Suitable Placement youth.

*DMHFY 2007/08 Boilerplate Contract -- Discussions over many months with DMH, County Counsel, and the Auditor-Controller's office on a review of the entire DMH boilerplate led to a contract approved by the ACHSA negotiating team and Board of Directors, which incorporated a number of major victories with regard to the language. Among the major issues successfully addressed were: 1) DMH's agreement to add language putting a time frame on the payment to Contractor of approved claims; 2) agreement to add language requiring DMH to seek BOS approval for payments to Contractor for audit amounts owed within 30 days of post-audit and final settlement; 3) maintenance of language DMH attempted to delete allowing Contractor to retain unanticipated revenue for one year; 4) the addition of language allowing an overage in services/activities from the Maximum Monthly payment in one month to be applied to offset any underage in another month; 5) ACHSA's fending off of County Counsel efforts to eliminate agency protections in language allowing DMH to redirect funds from underutilizing providers; 6) ACHSA's fending off of County Counsel efforts to add language preventing Contractor from pursuing claims against the County for disputes regarding entitlement to payment; and 7) the addition of numerous new Contractor due process protections.

*FFA Contract Amendments -- ACHSA advocacy caused DCFS to eliminate a number of significant proposed changes to the Terms and Conditions, including one giving the County the right to approve all contractor staff, and another allowing the County to require unfunded staff background checks. With regard to the Statement of Work, ACHSA, among other things: 1) eliminated a mandate that FFAs complete adoption home studies for all newly recruited homes; 2) successfully eliminated problematic performance measures, consistent with the work of the Foster Care Performance Measures Task Group; and 3) got DCFS to make a number of other major changes, including a return to a seven day notice discharge policy (replacing DCFS' proposed 30 day notice requirement).

*DMH's Long-Term Budget Deficit -- In addressing DMH's almost $50 million long-term budget deficit, contract agency curtailments, originally limited to a potential of only $5 million as a result of ACHSA's strenuous advocacy efforts, were successful eliminated, as DMH was unable to prove, per an agreement negotiated with ACHSA, that pure CGF curtailments could not occur without actual client service reductions. Alternatively, DMH ultimately utilized additional State funding for EPSDT to shift CGF toward the deficit, which resulted in no agency service curtailments. DMH also committed to restore the agency CGF should the additional State funding contribution for EPSDT be eliminated at a later date.

*Group Home Work and FFAPerformance-Based Contracting Scorecards -- As a significant measure of agency performance, the scorecards were the result of the work of the two Performance Measures Task Groups, in which ACHSA has had considerable influence. In preparation for the scorecards, ACHSA developed a position statement, the most significant issue of which related to ACHSA's objection to the inclusion of permanency performance measures for individual agencies. A major victory was obtained on this issue, when DCFS agreed, at ACHSA's request, to only report system-wide results, rather than individual agency results, for the four permanency performance measures beyond the control of individual agencies. ACHSA also influenced the development of the language for the other measures, was actively involved in the setting of appropriate benchmarks for the measures, and successfully advocated for necessary changes to the scorecard format. Finally, ACHSA was successful in getting DCFS to issue draft scorecards for agencies to review and verify before the Department issued the final scorecards.

*DMHProposed 5% EPSDT Withhold -- ACHSA successfully fought off DMH efforts to withhold 5% of agencies' EPSDT payments mid-way through the fiscal year, in response to the State's 5% withhold from the counties. ACHSA successfully argued that this would cause undue hardship in the form of unexpected cash flow problems. Thereafter, ACHSA was also successful in amending future DMH EPSDT withhold contract language to provide for protection in the form of 60 days prior written notice, allowing time for advocacy efforts to maintain County funding levels.

*DCFS Audit Redundancy -- Following ACHSA's successful effort last fiscal year to obtain a Board of Supervisors' motion directing the County to consider a monitoring plan for out-of-home foster care placements that avoids duplicative activities, ACHSA obtained a commitment from DCFS to recommend to the Board offices a once a year single DCFS/Auditor-Controller program audit of FFAs and group homes.

*DMHCost of Living Adjustment (COLA) -- To attempt to address mental health agency concerns about salary disparities with County employees and the lack of a funded cost of living increase for a number of years, ACHSA engaged the services of PricewaterhouseCoopers to conduct a salary comparison study. This study, which once again confirmed significant salary disparities, is being used as the basis for ACHSA's advocacy efforts on this issue. ACHSA also drafted a Board motion, at the request of Supervisor Antonovich's Health Deputy, which would require DMH to investigate a potential funding source for the COLA.

*Negotiation of New Group Home and FFA Contracts -- While major discussions with DCFS on the new GH and FFA contracts have been deferred into next fiscal year, ACHSA did obtain a very major concession on the contract Terms and Conditions (Ts and Cs) -- i.e., that only BOS mandated changes would ultimately be reflected in the Ts and Cs, with the exception of possible section name changes. In addition, DCFS has committed to ACHSA that it will take the time necessary to try to reach consensus with ACHSA on the new language in the Statements of Work before the contracts are finalized.

*Preparation for DMH Integrated Behavioral Health Information System (IBHIS) Transition -- To address the largest challenge in the next couple of years facing ACHSA's mental health agencies, ACHSA developed an IBHIS Plan of Action, with two primary goals: 1) assisting agencies to transition existing IT systems to meet the compatibility requirements of the new IBHIS; and 2) working with DMH to ensure that provider identified desired outcomes for the system and IBHIS technical issues are addressed. ACHSA then hired consultant Keely McGeehan to provide consultation services in the following three areas: 1) information sharing (primarily through a monthly blog); 2) the delivery of a series of seminars covering agency planning, budgeting, product selection, and internal preparation; and 3) workgroup facilitation (based on agency readiness).

*Uniform Needs and Services Plan/Quarterly Report for DCFS/Probation -- ACHSA worked collaboratively with DCFS, Probation, the Auditor-Controller's office, and Community Care Licensing to develop a standardized client Needs and Services Plan/Quarterly Report for group homes and FFAs. ACHSA was successful in getting the County to make necessary changes in the template and to pilot the new template prior to implementation. ACHSA also made sure that the County conducted joint provider training, and provided for a waiver option to allow agencies with justification to continue use of their own current forms.

*DMH Contract Negotiation Package -- ACHSA successfully negotiated to have DMH agree to waive the requirement that agencies report negotiated rate reimbursements in excess of actual costs, with DMH alternatively agreeing to the establishment of a work group with ACHSA to discuss the development of a mutually agreeable future operating mechanism.

*Improved Probation Juvenile Hall Release Process -- ACHSA advocacy resulted in a major improvement in the Probation Juvenile Hall release process, based on the development of a written policy which significantly shortened the time that providers have to wait for youth to be released from the halls.

*DMH IS Rendering Provider Backlog -- Significant pressure from ACHSA upon DMH to fix this very problematic agency IS bottleneck resulted in Dr. Southard's commitment to do "whatever it takes to address the problem," which led to the hiring of additional staff and the payment of a significant amount of overtime to resolve the problem in a very prompt fashion.

*Mental Health Services Act -- To address member agencies concerns regarding MHSA program implementation, DMH, at ACHSA's request, hosted an Open Forum to obtain provider feedback on implementation issues and suggested recommendations for improvement. Also at ACHSA's request, DMH developed a contact list of key point persons responsible for addressing specific problems related to MHSA implementation.

OTHER ADVOCACY RELATED SIGNIFICANT ACCOMPLISHMENTS

*Multi-Disciplinary Assessment Team (MAT) Project -- ACHSA, the driving force in getting the MAT Project (a privatized model of assessing children going into out-of-home foster care) off the ground with DCFS and DMH, was able to further institutionalize the project through its advocacy efforts. Now certain to be expanded countywide, ACHSA was also instrumental in getting DCFS to commit to provide over $1 million in County funds for non-EPSDT reimbursable MAT services.

*Auditor-Controller Assistance in Evaluating ASFA Services -- ACHSA's growing influence in its relationship with the Auditor-Controller's office was reflected in a request by the A-C to evaluate the cost effectiveness of contracting out relative home assessments under the Adoption and Safe Families Act (ASFA). ACHSA put together a work group which developed a proposal that was discussed at a meeting with the A-C, DCFS, and two Board offices. The ultimate outcome is yet to be determined.

*Assistance with Timely School Enrollment of Foster Youth -- ACHSA, together with the Children's LawCenter and the Education Coordinating Council, drafted a letter which was signed by local school superintendents for use by placement agencies, foster parents, and relative caregivers to ensure timely school enrollment of foster children. The letters were designed to help school personnel understand their legal obligation to immediately enroll foster children, even when necessary documents such as school records are not yet in place.

*ACHSA Letter to Editor on Title IV-E Waiver Article -- The Daily News published ACHSA's letter to the editor in response to a negative article on child welfare agencies relative to the Title IV-E Waiver. ACHSA highlighted the fact that entry into foster care is controlled by the county and the courts, that rates are set by the state, and that the county's average costs increased because of a changing, more difficult client mix and not higher pay for providers.

*Foster Care Awareness Campaign -- ACHSAhelped to increase public awareness of foster care issues and promote positive images of foster parents and agencies though active participation on the Planning Committee for the 2007 L.A. County Foster Care Awareness Campaign.

ORGANIZATION RELATED SIGNIFICANT ACCOMPLISHMENTS

*Political Connections -- ACHSAcontinued regular Board and Membership meetings with the Directors of the Departments of Children and Family Services, Mental Health, and Probation, and maintained significant linkages with the County Board of Supervisors' Children's, Mental Health, and Juvenile Justice Deputies.

*Meetings with Board Deputies -- ACHSAarranged meetings with the Mental Health and Child Welfare/Juvenile Justice Deputies for all five Supervisors in order to update them on key issues and provide agencies with the opportunity to interact with the offices of their respective Supervisors.

*ACHSA Update Newsletter -- ACHSAcontinued publication of its very highly acclaimed bi-weekly electronic newsletter, ACHSA Update, providing valuable and timely information and analysis of critical issues for Member agencies.

*Annual Luncheon -- ACHSAhad a very successful Annual Luncheon, which honored California State Assembly Member Karen Bass and ACHSA's consumer Inspiration Award Winner.

*Employee Salary Survey -- ACHSAconducted and published its bi-annual Membership Employee Salary Survey, which provided Member agencies with important comparative salaryinformation.

*DMH Stakeholder Process -- ACHSAcontinued its participation as a representative organization to the DMH Stakeholder process, which is the primary planning body for Mental Health Services Act implementation.

*Council Representation -- ACHSAcontinued its participation as a member of both the Children's Planning Council and the Education Coordinating Council, to maintain visibility as one of the critical stakeholders at the table with the County Departments serving children and representatives of the Board of Supervisors.