Major populations include:
Provider Network Development
6) Contract Expenditures
Complete the table below. Total DSHS funding is the amount described as Total Allocation from Section VIII Budget of the DSHS Performance Contract. The Federal Rehab is equal to the amounts received as 100% payment from Medicaid less the General Revenue that is State match. These amounts should be added to arrive at the total for Adult MH and Child/Adolescent MH Services. For FY 2012 data, provide information from the first six months of the year (September 2011 through February 2012).
* Total DSHS funding and Federal Rehab amounts includes funding for the Authority functions of the LMHA, as well as the state match for Case Management, which may not be performed by any entity other than the LMHA.** Include only contracts for physician and counselor services with no other associated services. These will generally be contacts with individual practitioners or groups of individual practitioners. List contracted service packages separately, even though they include physician and counseling services
FY 2012 Provider Contracts
List your FY 2012 Contracts in the table below. In the Provider Type column, specify whether the provider is an organization or an individual practitioner. If you have a lengthy list, you may submit it as an attachment using the same format.
8) Rationale for LMHA Service Delivery
a) Describe the rationale for your plan for network expansion, including the services to be procured and the volume of services to be procured. If only selected services are identified for procurement, explain why those services are being offered for contracting and others are not. Discuss services for adults and for children and adolescents separately.
Adult Services: The current consumer census does not provide the penetration to make viability possible for more than one provider across the service area or in various configurations of the counties served. Camino Real believes that adult services are built around the core of doctor services and lack of physician time is the source of waiting lists. Based on the input of stakeholders, we chose to pursue physician services which can be provided by teleconference and have increased the level of services by external providers. By doing this Camino Real has managed to serve consumers with waiting list time at a minimum.
Child and Adolescent Services: The same rationale applies to child and adolescent services that apply to adult services.
b) If the LMHA will continue to provide one or more services because the external network does not provide equivalent access (Condition 3), describe how this determination was made, including the source of data. NOTE: The LMHA must have supporting documentation that can be submitted to DSHS when requested.
c) If the LMHA will continue to provide one or more services because the external network does not provide sufficient capacity (Condition 4), complete the following table. Use this condition if the LMHA will use all of the available external provider capacity and directly provide only the balance of current capacity. External provider capacity is usually determined through the follow-up contacts that take place during the provider availability assessment.
d) If the LMHA will continue to provide the specified capacity of one or more services in order to preserve critical infrastructure to ensure continuous provision of services (Condition 5), identify the planned transition period and the year in which the LMHA anticipates procuring the full external provider capacity currently available. If the same transition period is planned for all services, only one entry is required. When different transition periods are planned, list each separately.
NOTE: The rule states that this condition can be used only when the LMHA identifies a timeframe for transitioning to an external provider network, during which the LMHA procures an increasing proportion of the service capacity of the external provider network in successive procurement cycles. This timeframe is the LMHA's best estimate based on the limited information currently available, and does not represent a firm commitment. The timeframe will be reassessed during each planning cycle based on the results of procurement, provider performance, and new information. The current estimate should assume that proposed procurement plans are successful and the contractors prove to be stable providers and meet established performance standards.
e) If the LMHA will continue to provide one or more services because existing agreements restrict procurement or existing circumstances would result in substantial revenue loss (Condition 6), briefly describe each of them, including the end date of any agreement. Describe any steps taken to amend the agreements or alter the conditions to allow contracting. NOTE: LMHA may be asked to submit copies of agreements or other supporting documentation.
9) Rationale for Volume of Services Provided by the LMHA to Preserve Financial Viability
If the percentage listed for any service is based on a determination that the service provision by the LMHA would not be financially viable at a lower level, explain the budget analysis used to arrive at the specified volume. Enter NA if you have no interested providers or if the volume of services to be provided by the LMHA is not higher than it would otherwise be to ensure financial viability. NOTE: Supporting documentation may be requested.
10) Strategies to Protect Critical Infrastructure
In bullet format, briefly describe the strategies will you implement to protect critical infrastructure and promote a stable, successful provider network. Enter NA if you have no interested providers.
11) Time to Re-establish Lost Service Capacity
Estimate the amount of time needed to re-establish the service volume lost if a contract is terminated. If time varies depending on the service type, list each separately. Enter NA if you have no interested providers.
12) Structure of Procurement(s)
In the table below, describe how the FY 2013-2014 procurement will be structured, making a separate entry for each service or combination of services that will be procured as a separate contracting unit
13) Fidelity and Continuity of Care.
Fidelity is accomplished over time through training, supervision, and continuous reassessment to maintain adherence to principles and practices with a specific model of care. In order to assure that consumers receives the necessary services from within the designated service package the providers shall be required to attend specified quarterly mandatory meetings, case reviews/staffings, and/or training programs. The provider will be notified by the LMHA of any staffing 30 days prior to the date of the staffing. All providers are subject to on-site audits, desk reviews, profiling, credentialing, utilization management reviews and compliance with all state and federal laws.
Continuity of Care: LMHA case managers will continue to provide routine and intensive case management services to make certain consumers are receiving services appropriate to address their identified needs.
14) Enhanced Staff Qualifications
Do you require any individual practitioners to meet higher standards than those described in the DSHS performance contract?
15) Single Provider
List all services to be provided by a single provider (regardless of provider availability) and the reason(s) for not offering consumers a choice of providers. Identify any economic factors involved in the decision. Enter NA if you have no interested providers.
List the comments you received after posting the draft procurement documents during the 2012 planning cycle, and how you responded to the comments, including any modifications made to the procurement document. If the comments are extensive, you may provide this information in an attachment.
24) Consumer Transition
Provide your consumer transition timeline in the following table. If more than one procurement is planned, provide a separate timeline for each (copy and paste additional rows to the table). Enter NA if you have no interested providers.