Template 4

Managing Entity Annual Business Operations Plan

Contract Reference:Sections A-1.2 and C-1.1.6

Authority:Section 394.9082, F.S.

Frequency:Annually

Due Date:No later than July 31

Discussion:

This plan will provide:

•An outline of the system of care;

•An operational plan for the current state Fiscal Year; and

•An outline of the managing entity’s strategy for the current state Fiscal Year.

This plan will be approved by the Department, and will be subject to oversight throughout the life of the contract. It shall be completed simultaneously with the “COST ALLOCATION PLAN,” which will provide the basis for the Managing Entity’s strategy to report expenditures. The two plans are not intended to be mutually exclusive, and each will inform the construction of the other. This plan will demonstrate the methodology the Managing Entity will use to capture service level data, and the management strategy for the system of care.

This plan consists of six sections, each of which must be completed in their entirety. The plan shall be submitted electronically, and meet the following requirements:

•The narrative portions of the plan must be submitted as a Microsoft word document, formatted with single spacing, and no more than 11 point font.

•Quantitative data included in the narrative portion of the plan must also be submitted as a Microsoft Excel spreadsheet.

The Managing Entity has an obligation to ensure sufficient transparency to support ongoing verification of adherence to the plan.

Managing Entity Annual Business Operations Plan [Current State Fiscal Year]

SUBMITTED JULY 15, [Current Calendar Year]

Managing Entity Name

OPERATIONS PLAN

The annual Operations Plan shall contain the following minimum elements as discussed in detail below.

SECTION 1. GOVERNANCE AND ADMINISTRATION

SECTION 2. PROVIDER RELATIONS AND DEVELOPMENT

SECTION 3. SERVICE MANAGEMENT

SECTION 4. CUSTOMER SERVICE AND CONSUMER AFFAIRS

SECTION 5. PROJECTED COMMUNITY NEED, AND

SECTION 6.ANTICIPATED SERVICE TARGETS

SECTION 1. GOVERNANCE AND ADMINISTRATION –

This section shall address:

1.1 Mission

  • The managing entity shall include a statement regarding the development, implementation, administration, and oversight for the behavioral health safety net system of care.
  • This organizational overview shall include service objectives, and anticipated outcomes from the operation of the managing entity.

1.2 Operations

The managing entity shall include a description of:

  • The planning and development process for the system of care that assists provider infrastructure to be prepared for the shifting funding environment and maximizing limited block grant dollars for those individuals, services and activities not otherwise funded through other sources.
  • The implementation strategy for the business operations of the system of care to include:
  • Development, redesign and/or implementation of improved provider billing practices, including practice management and accounts receivable systems that address billings, collections, risk management and compliance;
  • Coordination of benefits among multiple funding sources, including insurance and MHBG/SABG funding; and Adoption of health information technology that meets meaningful use standards; and
  • Implementation of clinical strategies, including standards for the system of care that provides a coordinated cross-sector approach to services, including primary care, and address the needs of youth with substance use problems.
  • Scheduled monitoring activities for the year.
  • Implementation of statutory and regulatory requirements.
  • Implementation of methodology for adoption of health information technology that meets meaningful use standards for the tracking of outcomes, and reporting progress.
  • How outcomes will be realized.
  • Analysis of the strengths, weaknesses, opportunities, and constraints of the organization.

1.3Strategic Objectives

  • Specify the key objectives for the system of care. Include specifically in this system of care the following:
  • Promoting the most effective prevention, treatment, and recovery practices for behavioral health disorders;
  • Assuring behavioral health care is person-, family-, and community-centered;
  • Ensuring the availability of HIV and TB services for individuals receiving substance use disorder treatment services.
  • Encouraging effective coordination within the behavioral health care field and between behavioral health care providers and other health care, recovery, and social support services;
  • Trauma-informed system of care supporting behavioral health consumers and survivors of trauma;
  • Assisting communities to utilize best practices to enable healthy living;
  • Making behavioral health care safer by reducing harm caused in the delivery of care; and
  • Fostering affordable, high-quality behavioral health care for individuals, families, employers, and governments by developing and advancing new—and recovery-oriented—delivery models.
  • List and describe all the assumptions made, with the ability to address the key objectives, and the potential impact if not addressed.
  • List and describe the specific constraints that place limits or conditions on operations.
  • The managing entity shall identify at least three areas for improvement, stated in measureable terms, with target dates or timelines for completion. Indicate stakeholders involved in the development of areas for improvement.

SECTION 2. PROVIDER RELATIONS AND DEVELOPMENT

This section shall address:

2.1 Mission

  • The managing entity shall include a statement regarding what they want to accomplish for the system of care.
  • This organizational overview shall include service objectives, and anticipated outcomes from the provider relations and development perspective of the managing entity.

2.2 Operations

  • Describe the clinical standards for operations, paying particular attention to the minimization of duplicative requirements with other public funding sources, systems and procedures.
  • Describe a plan to monitor the Marketplace to ensure that individuals with behavioral health conditions are aware of their eligibility, able to get enrolled, and able to stay enrolled.
  • Describe how clinical standards for operations will address particularly vulnerable populations with evolving needs.
  • Describe the review strategy for Network Service Provider contracts, including performance measures developed.
  • Describe Network Service Provider engagement efforts, including how progress or change will be communicated, opportunities for partnering with other public funding sources to reduce duplication and overlapping of service, continuity of care, and integration activities.
  • Describe the provider dispute resolution process.
  • Describe how provider capacity will be built for third-party contract negotiations; e.g., negotiating contracts for participation in a qualified health plan, or Medicaid managed care plan.

2.3 Strategic Objectives

  • Specify the key objectives for the Network
  • The managing entity shall identify at least three areas for improvement, stated in measureable terms, with target dates or timelines for completion. Indicate stakeholders involved in the development of areas for improvement.
  • List and describe all the assumptions made, with the ability to address the key objectives, and the potential impact if not addressed.
  • List and describe the specific constraints that place limits or conditions on operations.

SECTION 3. SERVICE MANAGEMENT

This section shall address:

3.1 Operations

  • Describe network capacity, by program, service type, and an estimate of clients.
  • Describe plans for network modification, including justification and implementation timelines.

3.2 Strategic Objectives

The managing entity shall identify at least three areas for improvement, stated in measureable terms, with target dates or timelines for completion. Indicate stakeholders involved in the development of areas for improvement.

3.3 Network Service Provider Catalog Of Care

The Network Service Provider Catalog Of Care will serve as a catalog of behavioral health services offered in Florida for the current State Fiscal Year. The Network Service Provider Catalog Of Care shall be completed for each Provider contracted with a Managing Entity using the template provided at:

SECTION 4. CUSTOMER SERVICE AND CONSUMER AFFAIRS

This section shall address:

4.1 Operations

  • Describe how the managing entity will be responsive to consumers – of behavioral health services. Include a description of how dispute resolution, complaint management, and requests for information will be handled.
  • Include a description of how consumers will access behavioral health services. Include access to emergency services, continuity of care, and community-based, consumer-driven services in a manner that is consistent with statutory and regulatory requirements.

4.2 Strategic Objectives

Describe the methodology for adjustment for constraints. Include a description of communicating the adjustment to stakeholders.

SECTION 5. PROJECTED COMMUNITY NEED, AND ANTICIPATED SERVICE TARGETS

This section shall address:

5.1 Need

Describe how the managing entity will support the reduction of disparities in access, services provided, and behavioral health outcomes among its diverse subpopulations. Include a plan to collect and utilize data for identifying subpopulations and implementing strategies to decrease the disparities in access, service use, and outcomes both within those subpopulations and in comparison to the general population.

One of the most logical ways to quantify the unmet need for treatment is using waitlist data. For all treatment modalities, identify the number of individuals who were placed on a waitlist and the average number of days spent waiting. Also, identify specific actions that will be taken in order to reduce the number of individuals on the waitlist and the amount of time spent on a waitlist. Be sure to identify and describe the existing resources that will be redirected in order to reduce the number of individuals on the waitlist and the amount of time spent on the waitlist.

  • For substance use disorder treatment:
  • Submit to the department an assessment of the need in the region for authorized activities, both by locality and by the region in general. This shall which include the following:
  • Data which shows the incidence and prevalence in the region of drug abuse and dependency, substance misuse and alcohol abuse and dependency.
  • For primary prevention activities, the activities must be broken down by strategies used, and the specific activities conducted[1]. This shall include the following:
  • Specific risk factors being addressed by activity;
  • Age, race/ethnicity and gender of the population being targeted by the prevention activity; and
  • Community size and type where the activity is carried out.
  • For all treatment and prevention activities, including primary prevention, include the provider of the services, and describe the services provided. Services provided should be the most effective evidence-based prevention and treatment approaches, focusing on promotion, prevention and early intervention. This service delivery environment should have the most positive impact on the health and well-being of the persons and communities served.
  • Submit information on treatment utilization to describe the type of care and the utilization according to primary diagnosis of alcohol or drug abuse, or a dual diagnosis of drug and alcohol abuse.
  • Submit a detailed description on the extent to which the availability of prevention and treatment activities is insufficient to meet the need for the activities, the interim services made available and the manner in which such services are to be so available. Special attention should be provided to the following groups:
  • Pregnant women;
  • Women who are addicted and who have dependent children;
  • Injecting drug users; and
  • Substance abusers infected with HIV.
  • Submit documentation describing the results of the management information system pertaining to capacity and waiting lists. This shall include a summary of such information for admissions and, when available, discharges.
  • For mental health:
  • Submit to the department an assessment of the need in the region for authorized activities, both by locality and by the region in general. This shall which include the following:
  • Data which shows the incidence and prevalence in the region of mental health issues. This should include an estimate of serious mental illness among the adult population, and serious emotional disturbance among children.
  • An estimate of Medicaid, or other publically funded premium assistance program expenditures in the region. This should include the number of providers in the system of care that bill Medicaid, or other publically funded premium assistance programs.
  • Coordinated and targeted prevention programs should be offered in a range of settings coupled with research-supported environmental strategies. These activitiesmust be broken down by strategies used, and the specific activities conducted. Using the findings from public health research along with evidence-based prevention programs include the following:
  • Specific risk factors being addressed by activity;
  • Age, race/ethnicity and gender of the population being targeted by the prevention activity; and
  • Community size and type where the activity is carried out.
  • Submit information on treatment utilization to describe the type of care and the utilization according to primary Mental Health diagnosis, or a dual diagnosis of substance use.
  • Provide a narrative of the institutional transition strategy, to ensure that consumers are not kept at a level of care that is not clinically indicated to be necessary (This should include identification, referral, continuity of care, etc).
  • Submit a detailed description on the extent to which the availability of services may be insufficient to meet the need, the interim services made available and the manner in which such services are to be so available. This should include a detailed description of the methodology used to reach this conclusion.

Section 6. Anticipated Service Targets

Describe the methodology used to compute the service targets for the fiscal year. This shall include milestones to measure success, and an adjustment strategy for changes that may be required throughout the implementation of the business plan.

These targets shall be reported on the Monthly Progress Report, which is incorporated by reference in Attachment I.

6.1. Adult Mental Health

Service / Current Year Utilization / Projected Target / Anticipated Challenges
Residential Care
Outpatient Care
Crisis Care
State Hospital Discharges

6.2. Children’s Mental Health

Service / Current Year Utilization / Projected Target / Anticipated Challenges
Residential Care
Outpatient Care
Crisis Care

6.3. Adult Substance Abuse

Service / Current Year Utilization / Projected Target / Anticipated Challenges
Residential Care
Outpatient Care
Detoxification

6.4. Children’s Substance Abuse

Service / Current Year Utilization / Projected Target / Anticipated Challenges
Residential Care
Outpatient Care
Detoxification
Prevention Services

1

FUTURE FISCAL YEAR PLAN

[Insert the following Fiscal Year] Behavioral Health Planning Tool

Managing Entity: ______

Direct Service Expenditures

Table 1 quantifies the directservice expenditures by program, for SAMPLE MANAGING ENTITY in [current Fiscal Year].

Table 1
Program / Direct Service Expenditures FY ______
Adult MH
Child MH
Adult SA
Child SA

Successes and Challenges

Table 2describes the successes and challenges that were encountered by SAMPLE ME, in [current Fiscal Year].

Table 2
Successes
Challenges

Strategy

Table 3 describes the overall strategy used to conduct the future fiscal year needs assessment for SAMPLE MANAGING ENTITY:

Table 3
Describe the methodology the Managing Entity used to assess the needs of the individuals served, providers, and the community, as required by Section 5 of this document. Please be sure to attach a summary of responses and copies of the stakeholder survey instruments used in the needs assessments.
Provide a description of the Managing Entity’s planning efforts and describe how the community was engaged this process.
Provide a description of the behavioral health service gaps, and how these priorities were chosen.
Describe the anticipated outcomes of action and inaction.

Table 4 quantifies the behavioral health expenditures by program and service type, for SAMPLE MANAGING ENTITY in [current Fiscal Year].

Table 4
Service Type / Expenditures FY ______
Adult MH / Child MH / Adult SA / Child SA
Behavioral Health Network (BNet) / N/A / N/A / N/A
Crisis / N/A / N/A
Detoxification / N/A / N/A
Florida Assertive Community Treatment (FACT) Team / N/A / N/A / N/A
Forensics / N/A / N/A / N/A
Indigent Drug Program (IDP) / N/A / N/A / N/A
Outpatient
Prevention
Projects
Residential
Temporary Assistance for Needy Families (TANF) / N/A

Table 5 quantifies the unduplicated number of people that were served by program and service type, for SAMPLE MANAGING ENTITY in [current Fiscal Year].

Table 5
Service Type / Unduplicated Number of People Served FY ______
Adult MH / Child MH / Adult SA / Child SA
Behavioral Health Network (BNet) / N/A / N/A / N/A
Crisis / N/A / N/A
Detoxification / N/A / N/A
Florida Assertive Community Treatment (FACT) Team / N/A / N/A / N/A
Forensics / N/A / N/A / N/A
Indigent Drug Program (IDP) / N/A / N/A / N/A
Outpatient
Prevention
Projects
Residential
Temporary Assistance for Needy Families (TANF) / N/A

Table 6identifies the priorities for investment by service type for Adult Mental Health, for SAMPLE MANAGING ENTITY.

Table 6
Description of Service Gap / Description of Need to Fill Service Gap / Projected Outcome

Table 7 identifies the priorities for investment by service type for Children’s Mental Health, for SAMPLE MANAGING ENTITY.

Table 7
Description of Service Gap / Description of Need to Fill Service Gap / Projected Outcome

Table 8 identifies the priorities for investment by service type for Adult Substance Abuse, for SAMPLE MANAGING ENTITY.

Table 8
Description of Service Gap / Description of Need to Fill Service Gap / Projected Outcome

Table 9 identifies the priorities for investment by service type for Children’s Substance Abuse, for SAMPLE MANAGING ENTITY.

Table 9
Description of Service Gap / Description of Need to Fill Service Gap / Projected Outcome

1

[1]As specified in 45 C.F.R. 96.125(b), states shall use a variety of evidence-based programs, policies, and practices that include information dissemination, education, alternatives, problem identification and referral, community-based processes, and environmental strategies.