SOLICITATION CONFERENCE AGENDA Invitation to Negotiate #10068 DIRECT SERVICE PROVIDERS FOR REDIRECTIONS

SOLICITATION CONFERENCE AGENDA Invitation to Negotiate #10068 DIRECT SERVICE PROVIDERS FOR REDIRECTIONS Tuesday, June 11, 2013 @ 2:00 p.m.. E.S.T. Florida Department of Juvenile Justice Knight Building Lobby (for directions) 2737 Centerview Drive Tallahassee, Florida 32399-3100 For conference attendance by telephone call #1-888-670-3525 and enter Participant Code #8665041679 when directed The Department of Juvenile Justice (Department), Office of Probation and Community Intervention, is issuing this Invitation to Negotiate (ITN), to interested parties for the purpose of obtaining one or more direct service Providers throughout the State to provide Redirections Services, in accordance with the minimum requirements of the ITN s Attachment A-1 (DJJ funded Redirections Services). In addition, the direct service providers shall ensure provision of Redirections Medicaid Services by a Medicaid Enrolled Type O5 provider with Redirections Certification, to DJJ youth eligible to receive Medicaid funded Redirections Services, in accordance with all applicable 1915(i) Medicaid State Plan Amendment requirements as further specified in Attachment A-2 of the ITN Respondents shall note that the Department desires to begin referring youth for Redirections services no later than November 1, 2013, so interested parties shall have or shall obtain Medicaid Enrolled Type O5 provider status (or have substantially completed the process) and then obtain Redirections certification from the Department s Contracted QIO by that date. The Department intends to select one or more providers to ensure provision of the most effective and appropriate Redirection Services for the target population and to ensure services are available in geographical areas sufficient to meet the needs of referred DJJ Youth. Priority will be given to those Respondents proposing larger geographical areas for service delivery and multiple delinquency intervention modalities. 1. Introductions Elaine Atwood, Procurement Manager 2. Review of Initial Questions Submitted Paul Hatcher, Probation Program Office 3. Opportunity for Additional Questions/Discussion from Prospective Providers All verbal questions discussed during the Solicitation Conference must be submitted in writing for an official Department response. Attendees who are present may write questions on 3x5 cards (provided) and hand them to Procurement Staff. Additional questions for submission after this conference is concluded must be submitted in writing to the Procurement Officer identified in the table below by 5:00 p.m., Thursday, June 13, 2013. Page 1 of 9

4. Review of Calendar Deadlines Thursday, June 13, CO B Solicitation Question Deadline Last date 2013 and time written questions will be accepted. Deadline for Submission of Intent to Respond Thursday, June 20, 2013 Tuesday, July 9, 2013 CO B 2:00 p.m. (Attachment N). Anticipated date that answers to written questions will be posted on the web site Responses due and opened Send to Elaine.Atwood@djj.state.fl.us MyFlorida.com web site http://www.myflorida.com/apps/vbs/vbs_www.main_me nu under the solicitation #. Attention: Elaine Atwood, Procurement Manager, CPPB, FCCN DJJ, Bureau of Contracts 2737 Centerview Drive, Suite 1100 Tallahassee, FL 32399-3100 5. Closing Statements Nothing discussed during the solicitation conference will augment or change the specifications of the ITN. Any Department changes to the specifications and the Department s formal answers to all questions will be posted in the form of an addendum to the RFP document on the MyFlorida.com website at http://fcn.state.fl.us/owa_vbs/owa/vbs_www.main_menu. Respondents should monitor the site for this ITN. NOTICE TO ALL ATTENDEES: The Department will accept oral questions during the solicitation conference and will make a reasonable effort to provide answers at that time. Impromptu questions will be permitted and spontaneous answers provided; however, the Department will issue a written answer ONLY to questions subsequently submitted in writing. Any information communicated through oral communication shall not be binding on the Department and shall not be relied upon by any prospective Provider. Respondents to this solicitation or persons acting on their behalf may not contact, between the release of this solicitation and the end of the 72-hour period following the agency posting the notice of intended award, excluding Saturdays, Sundays, and state holidays, any employee or officer of the executive or legislative branch concerning any aspect of this solicitation, except in writing to the Procurement Manager or as provided in the procurement documents. Violation of this provision may be grounds for rejecting a response. Any person with a qualified disability shall not be denied equal access and effective communication regarding any proposal/proposal documents or the attendance at any related meeting or proposal/proposal opening. If accommodations are needed because of a disability, please contact the Bureau at (850) 413-0708 at least two business days prior to the meeting. Page 2 of 9

DIRECT SERVICE PROVIDERS FOR REDIRECTIONS Initial Questions Received This document is provided for discussion purposes at the Solicitation Conference. (Questions are presented in exact manner received.) QUESTIONS FROM YOUTH VILLAGES INC. Question # 1: Who are the department s current contracted providers for Redirections Services and in which DJJ Circuit do they provide services? Answer #1: Question # 2: Answer # 2: Question # 3: What are the current Redirections services rates? Does the department envision using similar services and rates to the current contracted Redirections programs? Related to the Department s implementation of the 1915i, can the Department label in more detail the complexity of the contractor s relationship with the QIO? Answer # 3 Question # 4: Answer # 4: Question # 5: What statute identifies staffing credential requirements for staff delivering services? Would the department be open to a grant-style funding arrangement where DJJ pays the provider x amount per year for a certain number of youth served for that year? Answer # 5: QUESTIONS FROM HENRY AND RILLA WHITE FOUNDATION, INC. Question # 6: Answer # 6: Question # 7: Answer # 7: Question # 8: Answer # 8: Question # 9: Answer # 9: Question # 10: Answer # 10: Question # 11: Answer # 11: How long do you anticipate the process will be to receive certification from the Department's QIO? Are the Medicaid rates for Redirections fully established by AHCA, and if so, what are they? Must the rates for youth who are not Medicaid eligible be the same? While it's clear that respondents are encouraged to offer multiple services, can our response include different fixed rates for different services? On the Table that illustrates the estimated number of Redirection referrals by Circuit/Counties, do those numbers reflect new/expanded cases and capacity only or do they include capacity currently served by already existing Redirections programs? Will already existing Redirection programs continue to operate or must they also compete for this ITN? Under "Youth to be Served", the ITN indicates "11 to 19 years of age at the time of referral for services." However, under "Youth Eligibility" for Medicaid it indicates "Under 18 years of age". Are those differences intentional? Page 3 of 9

Question # 12: Answer # 12: Question # 13: Answer # 13: Question # 14: Answer # 14: The ITN indicates that " The DJJ must authorize all individualized treatment plans." Who specifically will have that responsibility and how long will be the turnaround for approval? Our understanding is that Medicaid will reimburse based on an all-inclusive weekly rate. Must the reimbursement for non-medicaid services also be based on a weekly rate? Under "Method of Payment" in the proposed contract attached to the ITN, it indicates that the Department will pay the provider a filled and unfilled bed rate. Should this read slots instead of beds or will there be some other payment method? QUESTIONS FROM CAMELOT COMMUNITY CARE Question # 15: Is there any data on current redirections clients regarding the percentage of Medicaid eligible clients? Answer # 15: Question # 16: Answer # 16: Question # 17: Answer # 17: Question # 18: Answer # 18: Question # 19: Answer # 19: Question # 20: Answer # 20: Is there a Medicaid case rate/reimbursement rate established? If yes, what is that rate? Will there be any start-up funds provided? Is it expected that the provider provide Substance Abuse/Psychiatric services for this contract or can they refer out for this service? Since DJJ is giving preference to agencies offering more than 1 model, would this also include giving preference for offering more than 1 model for each circuit that a provider applies? Can you please clarify if a provider can respond to specific circuits throughout each of the 3 DJJ designated regions or are they to apply to a region inclusive of all the circuits in that region? This is referenced on the Notice of Intent to Submit a Response intent to submit a response for ITN # 10068 for the provision of services as a Provider for a Redirections Services program in each of the Department s three (3) designated geographical regions. QUESTIONS FROM COMMUNITY SOLUTIONS Question # 21: Page 14 c 3 The department has final decision regarding disputed referral Does this mean the case is opened regardless of clinical decision or in consult with model? Answer # 21: Question # 22: Answer # 22: Question # 23: Answer # 23: Question # 24: Answer # 24: Page 16 c 1 g Diagnosis ; treatment recommended Neither MST or FFT requires diagnosis such as this (DSMIVR; Axis 1-V) Is this now a requirement? Will the diagnosis now be in the referral packet? Page 17 4 g 4 Administrative discharges Will this be limited to within 7 days as is the current situation? Page 17: Drug Screening ; Are we going to be the only screeners or are the clients screened by JPO and we just screen for suspected use? Page 4 of 9

Question # 25: Answer # 25: Question # 26: Answer # 26: Question # 27: Answer # 27: Question # 28: Answer # 28: Question # 29: Answer # 29: Question # 30: Answer # 30: Page 17: Slot Flexibility ; Will slots be added to circuits on top of existing slots i.e. changing the bottom line OR will slots be added to a circuit and removed from another circuit not changing the bottom line of slots being serviced? Page 25 10 a-c Will we be trained on and have access to JJIS? Pages 26-27: Minimum standards ; Do we come up with our own minimums or did you forget to add them? Page 33: Reimbursement Rates ; Which fee do we fall under? Page 38: Mandatory Reqs ; Are we considered a current Provider since we are currently servicing DJJ clients OR is EBA considered the current Provider since they hold the current contract and we are contracted with EBA? General question: Is the Provider awarded allowed to earn revenue? This is a per diem rate with Medicaid funding. QUESTIONS FROM VISION QUEST Question # 31: Are there priority points for agencies currently providing Redirections services in the state of Florida? Answer #31: Question # 32: Answer #32: Question # 33: Answer #33: Question # 34: Answer #34: Question # 35: Answer #35: Question # 36: Answer #36: Question # 37: Answer # 37: What is the federal Medicaid service definition that DJJ plans to have providers bill under? Is it expected that the Redirections Services as listed on ITN page 7 will be along the lines of mental health and substance abuse and will be evidence-based models (like FFT, etc.) or promising practices/family-centered therapies, while the Medicaid Redirections Services as separated on page 7 and elsewhere will be different services and will include individual, family, and group therapy? a. If an agency proposes to provide one type of service in a county or circuit, must that service be available for all anticipated referrals annually? (i.e. in Escambia County, Circuit 1, there are 164 anticipated slots: should one proposed service cover all 164 slots?) b. Could an agency propose to provide one service throughout the state, but only take a select number of slots per circuit/county and leave the rest available for other providers/services? (i.e. provide one service statewide but not use every youth slot?) c. Can an agency propose to provide multiple services in one circuit or county and divide the slots up accordingly? In designating geography, is DJJ interested in providers specifying by county or circuit? Are multi-agency collaborations/consortiums allowed? If a provider is part of a collaboration or consortium and are not the lead entity, may they submit a separate proposal to provide services as the lead entity? Page 5 of 9

Question # 38: Answer # 38: May an agency submit several proposals with different consortiums/collaborative arrangements as the lead entity? QUESTIONS FROM THE STARTING PLACE Question # 39: Attachment A, Section X (pp. 9-10) Target Population Data, Estimated Number of Redirection Referrals Annually (by County). a. Does this data reflect youth who are also Medicaid eligible? b. What is the estimated Medicaid Redirections Referrals Annually (by County)? Answer # 39: Question # 40: Attachment A, Section XII (pp. 10-11) Additional Resources. a. Does the Evidenced-Based Practice for this service need to be one of those listed in the Florida DJJ guidelines? b. Does the Evidenced-Based Practice for this service need to have a primary family-focus model? Answer # 40: QUESTIONS FROM PSYCHOLOGICAL ASSESSMENT & TREATMENT SERVICES Question # 41: What is the department s stance on offering funds prior to program start-up for the specialized training required of evidenced based services? Answer # 41: Question # 42: Answer # 42: Question # 43: Answer # 43: Question # 44: Will the department allow for a partnership of agencies who each have different expertise appropriate to providing the service to engage in a MOU/MOA etc? For instance one agency performing the direct service delivery, while the other providing fiduciary, financial, etc? The department stated in the bid states, Department desires to begin referring youth for Redirections services no later than November 1, 2013 so interested parties shall have or shall obtain Medicaid Enrolled Type O5 provider status (or have substantially completed the process) and then obtain Redirections certification from the Department s Contracted QIO by that date. Has the Department anticipated any complications from Medicaid to billing for services such as in the case of MST: the Medicaid code for provider reimbursement is described as H2033 Multisystemic Therapy for juveniles, per 15 minutes. This code is not found or available in the current Florida Medicaid fee schedule description. Will the department seek inclusion of this code in the Florida fee schedule? And if so, when is this change anticipated to occur? On a related matter to question #3, how does the department intend to address the following issue as it pertains to the delivery of MST services, if MST is used? According to MST policy statement on Medicaid : Position Statement Memo Author(s): Keller Strother and Melanie Duncan Date: 06/19/09 Topic: Issue: Programs Medicaid Funding for MST Programs Strengths and Weaknesses of Using Medicaid Funding for MST The purpose of this position statement is to summarize the state of the learning Page 6 of 9

regarding the strengths and challenges of using Medicaid funding to support MST implementation. Medicaid funding has emerged as an important part of the MST landscape and is playing a critical role in the financial sustainability of many MST programs across the United States. However, we caution stakeholders against viewing Medicaid funding as a silver bullet solution to their funding troubles, due to the potential limitations and challenges of using Medicaid funds to support the model-adherent implementation of MST as outlined below. Strengths: Many youth and families who can benefit from standard MST are Medicaid eligible. Medicaid funding allows states to receive partial federal support for their evidence-based MST programs. Once a funding standard for MST is added to the state plan, funding is readily available. Medicaid waivers, 1915(b) Managed Care waivers and 1915(c) Home and Community-based Services waivers, and the 1915(i) Home and Community-Based Services state plan option, can be used to give states the flexibility to structure the funding for MST in the form of a per diem, weekly or monthly, billing rate. Weaknesses: Medicaid funding alone is often insufficient to support an MST program. Under the Rehabilitative Services Option of the Medicaid code (a.k.a.the Rehab option), Medicaid funding will never fully sustain an MST program. (See below for more on this topic.) Not all families in need of MST meet the eligibility criteria for Medicaid. The current MST HCPCS (Healthcare Common Procedure Coding System) code available for use by states is based on a 15-minute billing increment. The nature of this increment, being a relatively short increment of time, is leading systems to establish reimbursement structures based on client contacts and is encouraging greater administrative/management focus on the billable nature of clinical work in practice settings. (See below for elaboration on each topic.) Under the Rehabilitative Services Option, the Centers for Medicare and Medicaid Services (CMS) is not able to create per diem, weekly or monthly billing rates for MST due to the number of non-allowable activities that are required as part of implementing MST. (See below for more.) Many Medicaid systems only reimburse for face-to-face contacts and, at times, only contacts with family members when the youth is present. This type of funding structure can easily lead to non-model adherent practices that over emphasize face-to-face contacts in clinical implementation. In MST implementation, a therapist who gets the same high-quality outcome with less face-to-face contact is doing a better job. A common revenue management practice in fee-for-service Medicaid systems is the use of productivity metrics to focus staff on certain activities that are viewed as most appropriate. Many organizations, however, define productivity solely on revenue generation (billable activity) rather than clinical outcomes. In the most extreme examples of this, administrators post lists of productivity rates (a.k.a. revenue generation rates) publicly within the agency to shame staff into engaging in more billable activity. When properly used, productivity metrics can be used to ensure that therapist activities, as monitored through activity logging, are clinically appropriate, model-adherent and are focused on producing better outcomes for clients. No states currently have Medicaid funding available for the MST- Psychiatric adaptation of MST. This can lead to inappropriate referrals to standard MST programs of youth with significant psychiatric service Page 7 of 9

needs and for whom these psychiatric service needs are viewed as the primary driver for the youth s inappropriate behaviors. CMS feedback regarding funding under the Rehab Options: Our understanding of the feedback from staff at the federal offices of the CMS is that the following types of services and expenses included in the delivery of MST are not allowable and can neither be reimbursed directly nor built into rates for MST under the Rehabilitative Services Option. It is our estimate that these kinds of activities constitute at least 10%, to over 30%, of an MST program s annual budget, depending on the program size, structure, and case-specific service requirements. Five-day MST orientation training Quarterly MST Booster training Ongoing training, work sample review, etc. with supervisor and/or teammates Staff time spent reading relevant clinical material for training purposes or reviewing reference materials General supervision activities, including on-site supervision and case review (The exception to this would be the rare situation when the MST client is present.) Administrative functions executed by the Supervisor Face-to-face delivery of marital therapies to adult caregivers without youth present (only allowable if issues are directly related to the youth s behavior or needs) Time spent trying to contact and engage families when no shows occur and/or when overall commitment to participation in treatment is low Staff meetings and non-clinical discussions Flex funds Court appearances Start-up expenses prior to client referrals Services delivered prior to authorization for billing Two additional areas worthy of comment are phone contacts and collateral contacts. While CMS does allow these types of activities, they MAY or MAY NOT be allowable in individual states, depending on the standards established by each state. Phone contacts with caregivers Collateral contacts with significant others that affect the youth including, but not limited to, the neighborhood, social, educational, and vocational environments, as well as those from the criminal justice, child welfare, health and mental health systems. Phone contacts with collateral contacts Conclusions: While Medicaid funding can be a meaningful part of an MST funding strategy, it is seldom a sufficient source of funding on its own. MST program administrators, operating programs under the Rehabilitative Services Option, consistently report that Medicaid reimbursements can reliably cover about 40% to 60% of a modeladherent MST team s operating budget. States operating under waivers that grant the flexibility to structure funding for MST in the form of a per diem, weekly or monthly billing rate are often more successful in using Medicaid to fund a greater proportion, or even all, of an MST program s budget. Absent such a waiver, we recommend that MST programs create a multi-faceted funding stream that braids multiple sources of funding at a budgetary level and incorporates the available Medicaid reimbursements with these other sources of funding (e.g., state services funds from juvenile justice, mental health, etc.) in such a way that model adherence and client outcomes are always the primary focus for every MST clinician and program administrator. Page 8 of 9

Answer # 44: Page 9 of 9