REVISED TEMPLATE FOR

PROVIDER NETWORK DEVELOPMENT PLAN

Complete and submit to performance.contracts@dshs.state.tx.us according to prescribed due date:

w Cohort I: July 27, 2010

w Cohort II: July 31, 2010

w Cohort III: August 31, 2010

Refer to Information Item I in the DSHS Performance Contract for a list of LMHAs in each cohort.

Responses should be concise, concrete, and specific.

Use bullet format whenever possible, and note that many sections have character limits.

Provide information for the past two years only (since submission of your first network development plan).

When completing a table, insert additional rows as needed.

Local Service Area

· Provide the following information about your local service area. Most of the data for this section can be accessed from the following reports in MBOW, using data from the following report: 2010 LMHA Area and Population Stats (in the General Warehouse folder)

Population	107,842
Square miles	2,140
Population density	50
Number of counties (total)	2
w Number of urban counties
w Number of rural counties	2
w Number of frontier counties

Major populations centers (add additional rows as needed):

Name of City	Name of County	City Population	County Population	County Population Density	County Population Percent of Total
Palestine	Anderson	17,598	57,852	54	53%
Jacksonville	Cherokee	13,868	49,990	47	46%
Rusk	Cherokee	5,085	49,990	47	46%

Using bullet format, briefly note other significant information about your local service area relevant to provider network development. Include population characteristics that are atypical and differentiate your local services area from most other LMHAs. Distinguishing characteristics might include a high proportion of racial, ethnic, or linguistic minorities, the presence of a large military base, or other factors that must be considered in service delivery.

w Primarily rural area with limited telecommunications technology infrastructure

w Median household incomes are well below State average & unemployment rates exceed State average

w No public transportation in either County

w Shortage of behavioral health providers in both counties, e.g. no psychiatrists in private practice in Cherokee County and only 2 in Anderson County with “at capacity” caseloads.

w Lack of community resources for indigent or substance abuse populations

Provider Availability

1) Provider Recruitment

Using bullet format, list steps the LMHA took to identify and recruit external providers over the past two years. This includes but is not limited to procurement associated with the 2008 planning cycle.

w 2008 procurement activities were advertised in all local newspapers and on local radio stations, on the Center’s website, and at multiple meetings and forums. Only one provider, The Wood Group, expressed initial interest in contracting with ACCESS and this provider, along with all other known providers in the two-county area, were notified by letter or email about contract procurement plans. Additionally, providers who expressed interest in contracting with community centers other than ACCESS on the DSHS website were invited to pursue contracting with the Center.

w Attempted to procure 25% capacity of Adult RDM SP3 through an RFP. No providers responded, including The Wood Group which had indicated their initial interest on the DSHS Provider Inquiry List.

w Attempted to procure the discrete services of Physician Pharmacological Management, either face to face or by Telemedicine, and CBT Counseling through an Open Enrollment (RFA). Again, no providers responded although ACCESS elected to extend the procurement period and advertised again in an attempt to secure providers for these services.

w During FY 2009, ACCESS began contracting for psychiatric medication management services provided via telemedicine to adolescents and children. In FY 2010, all psychiatric medication management services for children and adolescents are contracted to external telemedicine providers.

w ACCESS entered into discussions about providing MCOT services with AVAIL, a provider of crisis services in the region and the current provider of crisis hotline services for ACCESS. The provider ultimately determined that, at this time, it could not provide the service within the timeframes required to cover the 2 Counties and at the available rates.

w ACCESS, in collaboration with The Andrews Center and Community Healthcore, entered into a contract with The Wood Group in April of 2010 to provide crisis respite services.

2) Provider Availability

List each potential provider identified during the process described in Item 1 of this section. Include all current contractors, providers who registered on the DSHS website, and providers who submitted written inquiries over the past two years. Note the source used to identify the provider (e.g., current contract, DSHS website, LMHA website, e-mail, written inquiry). Summarize the content of the follow-up contact described in Appendix A. If the provider did not respond to your invitation within 45 days, document your actions and the provider’s response. In the final column, note the conclusion regarding the provider’s availability. For those deemed to be potential providers, include the type of services the provider can provide and the provider’s service capacity.

Provider	Source of Identification	Summary of Follow-up Meeting or Teleconference	Assessment of Provider Availability, Services, and Capacity
AVAIL	DSHS website	Via telephone call on May 6 with Janie Harwood, explored Provider’s interest in continuing to provide all crisis hotline services and whether other crisis services could also be contracted. Provider remains interested in providing crisis hotline services, and as service provision has met all contractual requirements, ACCESS will continue to contract with AVAIL for the service. Also discussed whether Provider would be interested in providing MCOT services but Provider indicated she was not interested in pursuing same at this time as the geographic area to be covered is so large that the probable rate structure would be insufficient to make the contract financially and operationally viable. She expressed no interest in providing other services.	Provider has the capacity and will continue to provide 100% of crisis hotline services but is unavailable to provide capacity for other crisis services for ACCESS at this time.
The Wood Group	DSHS website	Met with Jerry Parker of The Wood Group on March 31. Mr. Parker indicated his interest in providing SP 3 services to 65 to 75 consumers and was willing to also provide services to a lesser number of SP 1 consumers. However, Mr. Parker indicated he would have the same difficulty the LMHAs have in securing the services of a local psychiatrist to provide the medication management portion of the Service Packages and noted there would be other difficulties in establishing enough of a regional presence to be able to serve that many consumers at this time. As ACCESS only has 65 to 68 consumers served in SP 3 at any given time, ACCESS would have to continue providing some of the services to ensure the availability of more than one provider choice. Mr. Parker did not feel numbers less than 50 would be economically viable and also acknowledged that clients would need to choose Wood Group. Mr. Parker is not interested in providing services to children and adolescents.	The Wood Group does not have sufficient regional presence at this time to provide SP 3 services to consumers scattered across a large, primarily rural area in the amount needed to maintain consumer choice and still be financially viable for the provider. ACCESS and Mr. Parker also discussed their mutual expectation that The Wood Group will be able to expand its base of operations from the Crisis Respite program it has recently opened in Tyler and will be able to contract for services in the next 2-year planning cycle, if not sooner.

Trinity Counseling

Email

Telephone call and meetings with Provider in March and April to discuss his interest in providing counseling services and to provide information about RDM and DSHS training requirements. Provider decided he was unwilling to go forward with the procurement process, due to the requirement for completion of a state-approved CBT training process.

N/A – Provider not interested in pursuing contract.

Local Planning

Guidelines for Gathering Community Input

· Conduct the provider assessment before gathering input from the community.

· The scope and focus of community input will depend on the availability of external providers.

· Seek guidance on network development based on your knowledge of provider availability at the time.

· Information presented in this section of the plan should be specific to the network development plan. Ensure that stakeholders understand the statutory mandate to develop the provider network when qualified providers are available. Community input should be focused on how to use available external capacity based on local needs and priorities.

· If an LMHA has no interested providers, community input should be focused on other elements of the plan (e.g., reducing identified barriers to new providers, on potential strategies for attracting external providers, improving consumer access and choice)

· When gathering input, use the previous plan as the starting point for discussion, including the plans for procurement and the results.

· Before finalizing your plan, review the DSHS website to identify any additional potential providers.

3) Status of provider availability assessment

Does the final assessment of provider availability documented above match the information about provider availability on hand at the time of community input?

___X_ Yes _____ No

If no, briefly describe the difference.

4) Community Engagement

In the chart below, show the process used to provide information and solicit input about provider network development from stakeholders.

Include specific events as well as activities that take place over a period of time, such as surveys. Note that a variety of communication formats may be used, including telephonic, electronic, and paper. List surveys and similar activities first, including timeframes during which the activities took place, followed by events in date order. Insert additional rows as needed.

Description, Location/Format, and Date or Timeframe	Participating Organizations (List)	Summary of Input Briefly summarize input relating to the network development plan. If the LMHA has identified interested providers, include recommendations for how the LMHA should implement the mandate to develop the provider network.	Number of Individuals
			Consumers	Family	Other
Stakeholder Survey (Internet & Consumer Focus Groups) June 15, 2010 – July 9, 2010	ACCESS consumers, family members, NAMI, local government officials, interested citizens, members of law enforcement, medical and mental health service providers,	Responses reflected the communities’ desire (66.7%) to see increased services for children, including counseling and skills training, and expanded access to medication services for children and adults (40%). Factors considered most important for ACCESS to consider when expanding the external provider network included experience in providing mental health services (43%), availability of transportation (68%), cost of services (68%), and proximity of service locations (68%). Responses indicated a high degree of satisfaction (95%) with services currently delivered by ACCESS. Although there were no interested providers, there was a general consensus that ACCESS should consider procuring additional counselors to provide CBT services and also to attempt to add more psychiatrists to its network. Other feedback addressed the need for public transportation, low-cost housing, and employment opportunities as this area has been hit particularly hard by the recent economic downturn.	21	3	22
Meeting of Jacksonville Kiwanis February 10, 2010	Community Stakeholders: business people, civic officials, ACCESS staff	Reviewed the programs currently offered by ACCESS and local planning and network expansion requirements. Feedback elicited from group involved concerns about costs of services and lack of sufficient local behavioral health providers.			22
Meeting of Palestine Leadership February 10, 2010	Community Stakeholders: business people, civic officials, ACCESS staff	Reviewed the programs currently offered by ACCESS and local planning and network expansion requirements. There were no specific recommendations regarding network expansion.			10
Partners in Health Advisory Board February 24, 2010	Stakeholders from Public Health Department; community non-profits; colleges; medical providers; ACCESS staff	Reviewed the programs currently offered by ACCESS and local planning and network expansion requirements. Discussed need for more providers of low-cost medical services for large indigent population and concerns about reductions in Prescription Assistance Programs. Also discussed there is no “back door” out of services ACCESS offers due to lack of providers and pay sources. Recommended ACCESS and other stakeholders continue attempts to bring a Federally Qualified Healthcare Center (FQHC) to the local area.			11

ACCESS Board of Trustees Meeting Jacksonville, TX April 27, 2010	ACCESS Board members; ACCESS staff; family member	Provided overview of local planning activities and requirements. Advised Board that no willing providers had been identified but that ACCESS should possibly consider attempting to increase the pool of counselors and psychiatric medication management providers.		4	11
ACCESS Staff Training Day Jacksonville, TX April 30, 2010	ACCESS staff	Provided update to ACCESS staff on local planning and probable efforts to recruit additional providers of counseling and psychiatric medication management services as directed by consumers and community stakeholders.			72
Public Planning Forum in Palestine, TX May 25, 2010	ACCESS staff	Although heavily advertised (local newspapers, invitations mailed to 164 local stakeholders, notices posted in ACCESS Clinic and local assisted living facility), there were no attendees.
Public Planning Forum in Jacksonville, TX May 26, 2010	ACCESS staff	Although heavily advertised (local newspapers, invitations mailed to 164 local stakeholders, notices posted in ACCESS Clinic and local assisted living facility), there were no attendees.
Meeting with Cherokee County Juvenile Probation Jacksonville, TX May 26, 2010	Cherokee JPD staff and ACCESS staff	Acknowledged there were no willing providers identified during this procurement cycle but agreed that ACCESS should attempt to procure additional counseling and psychiatric medication management services to expand the pool of local providers.			7
Meeting of Palestine Rotary Palestine, TX June 9, 2010	Community Stakeholders: business people, civic officials, ACCESS staff	Reviewed the programs currently offered by ACCESS and local planning and network expansion requirements. Feedback elicited from group involved concerns about access to needed community services and lack of services for indigent individuals. No specific recommendations regarding network expansion were elicited as there are no interested providers.		3	72
Local Festival (Tomato Fest) Jacksonville, TX June 12, 2010	Community stakeholders, ACCESS staff and consumers	Handed out information about ACCESS services and discussed network expansion requirements to festival attendees who expressed an interest. No recommendations specific to network expansion were elicited.			53
Meeting of NAMI & Cherokee County Peer Support Group Jacksonville, TX June 15, 2010	Consumers, family members, ACCESS staff	Reviewed draft plan with group and advised them that no willing and qualified providers had expressed interest in contracting at this time. Discussed barriers to recruiting providers to the area and NAMI members expressed their concerns about lack of public transportation and the possibility that services might not be offered in the same location or close proximity to where they live. Although no providers indicated their interest, the group still recommended that ACCESS should attempt to procure the discrete services of counseling and psychiatric medication management in an attempt to increase choice through the availability of additional providers.	12	2	1
Crisis/Jail Diversion Meeting Rusk, TX 7/9/2010	ACCESS staff, local law enforcement, hospital providers, local judicial representatives	Discussed existing crisis services and shortage of qualified behavioral health providers, as well as extreme difficulties experienced in accessing state hospital beds. Stakeholders reported satisfaction with crisis hotline services provided by AVAIL and responsiveness of ACCESS crisis staff.			13

5) PNAC Involvement

Show the involvement of the Planning and Network Advisory Committee (PNAC) in the table below. PNAC activities should include input into the development of the plan and review of the draft plan. Briefly document the activity and the committee’s recommendations.

Date	PNAC Activity and Recommendations
3/11/2010	Approved Draft Implementation Timeline
5/11/2010	Identified local service priorities, including strengths of the current system, gaps in service delivery, and potential barriers to external provider recruitment.
7/7/2010	Approved draft LPND procurement plan for FY 2011-2012 procurement cycle, with no recommendations for changes.

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 2010 data, provide information from the first six months of the year (September 2009 through February 2010).

* 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.

7) FY 2010 Provider Contracts

List your FY 2010 Contracts in the table below. In the Provider Type column, specify whether the provider is an organization or an individual practitioner.

Provider	Service(s)	Provider Type	Dollars Allocated
Clinical Pathology Labs, Inc.	w Lab Services	Organization	$ 23,136
East Texas Behavioral HealthCare Network	w Pharmacy Services	Organization	$250,000
Bahadur Sakari, MD	w Telemedicine Psychiatric Services	Individual	$ 88,000
Brad Brazeal, MD	w Psychiatric Medication Services	Individual	$ 8,250
UTMB	w Telemedicine Psychiatric Services	Organization	(N/A –Grant funded)
Vernon Johnson, MD	w Psychiatric Medication Services	Individual	$ 18,000
Anderson County	w Mental Health Deputy	Organization	$ 43,000
Cherokee County	w Mental Health Deputy	Organization	$ 49,000
Avail Solutions	w Crisis Hotline	Organization	$ 18,000
Behavioral Hospital of Longview	w Inpatient Psychiatric Care	Organization	$ 20,000
East Texas Medical Center	w Inpatient Psychiatric Care	Organization	$ 75,000
Palestine Regional Medical Center	w Inpatient Psychiatric Care	Organization	$250,000
Wood Group	w Crisis Respite	Organization	$ 30,000

8) Current and Planned Network Development

Complete the following table. Leave cells blank if the percent is 0.

· Column A: Document current capacity for all service packages, regardless of past or planned contracting. Current service capacity is the average monthly capacity based on service data from FY 2009 and FY 2010 through the most recent closed quarter for services controlled by the DSHS contract. Capacity for service packages is expressed as the number of clients served; use the following DSHS data warehouse report to determine current service capacity: PM Service Target LPND (Enterprise: CA Utilization Mgt: UM Service Delivery: PM Service Target LPND). If projected capacity is significantly different than current capacity, insert a footnote noting the projected capacity.

· Column B: State the percent of total capacity contracted to external providers in FY 2009. This is the maximum capacity to be served by external provides according to the terms of the contract.

· Column C: Document the percent of capacity served by contractors in FY 2009; this is the actual capacity served by contractors.

· Column D: State the current percent of total capacity contracted to external providers for FY 2010. This is the maximum capacity to be served by external provides according to the terms of the contract. .

· Column E: Document the percent of capacity served by contractors in the first six months of FY 2010 (September 2009 through February 2010); this is the actual amount paid to external providers during this period. When calculating percentages, use six month figures in both the numerator and denominator.

· Columns F and G: If you will be procuring complete service packages in the next biennium, state the percent of current capacity planned for contract in 2011 and in 2012.

· Column H: Note the number of available providers based on your provider assessment documented in the previous section.

· Column I: Use the following list to identify the number of the applicable condition that justifies the level of service the LMHA will continue to provide internally. Include all conditions that apply. Refer to the Appendix B for complete language as specified in 25 TAC §412.758.

1. Willing and qualified providers are not available.

2. The external network does not provide minimum levels of consumer choice. Use this condition if only one external provider is interested in contracting with the LMHA, and the LMHA will therefore provide up to 50% of the service. This condition does not justify the LMHA providing more than 50% of services.

3. The external network does not provide equivalent access to services. Use this condition if access is the only reason the LMHA will not use all of the available external capacity. Applicability of this condition will probably be made after procurement.

4. The external network does not provide sufficient capacity. Use this condition if the LMHA will use all of the available external provider capacity and directly provide only the balance of current capacity.

5. Critical infrastructure must be preserved during a period of transition. Use this condition if the LMHA will not use all of the available external provider capacity. Instead, the LMHA plans a phased transition to full utilization of external provider capacity, increasing the volume of contracted services over two or more planning cycles.

6. Existing agreements restrict procurement or existing circumstances would result in substantial revenue loss. Use this condition if an external restraint is the controlling factor limiting full use of external provider capacity.

PAST and CURRENT						PLANNED
	A	B	C	D	E	F	G	H	I
Service	Current service capacity	Percent of total capacity contracted in FY 2009	Percent total capacity served by contract providers in FY 2009	Percent of total capacity contracted in FY 2010	Percent total capacity served by contract providers in FY 2010 (6 mo)	Percent of total capacity planned for contract in FY 2011	Percent of total capacity planned for contract in FY 2012	Number of available providers	Applicable condition
Adult Service Packages
Adult RDM SP 1	705								1
Adult RDM SP 2	33								1
Adult RDM SP 3	68								1
Adult RDM SP 4	10								1
Adult RDM SP 0	47								1
Adult RDM SP 5	5								1
TOTAL Adult Services	868
Child Service Packages
Children’s RDM SP 1.1	113								1
Children’s RDM SP 1.2	16								1
Children’s RDM SP 2.1									1
Children’s RDM SP 2.2	3								1
Children’s RDM SP 2.3	1								1
Children’s RDM SP 2.4									1
Children’s RDM SP 4	103								1
Children’s RDM SP 0	5								1
Children’s RDM SP 5	1								1
TOTAL Children’s Services	242

Use the following table to list any discrete routine services or crisis services with contracting activity (2009, current, or planned) OR interested providers.

· Leave cells blank if the percent is 0.

· Current service capacity is the average monthly capacity based on service data from FY 2009 and FY 2010 through the most recent closed quarter for services controlled by the DSHS contract. Capacity for discrete services is expressed as units of service delivered.

PAST and CURRENT						PLANNED
	A	B	C	D	E	F	G	H	I
DISCRETE ROUTINE SERVICES And CRISIS SERVICES	Units of service delivered in 2009	Percent of total capacity contracted in FY 2009	Percent total capacity served by contract providers in FY 2009	Percent of total capacity contracted in FY 2010	Percent total capacity served by contract providers in FY 2010	Percent of total capacity planned for contract in FY 2011	Percent of total capacity planned for contract in FY 2012	Number of available providers	Applicable Condition
Telemedicine/ Psychiatric Medication Management for children/adolescents	498	100%	100%	100%	100%	100%	100%	5	N/A
CBT Counseling						50%	50%	Unknown	N/A
Crisis Respite	N/A	New Service	N/A	100%	100%	100%	100%	1	N/A
Crisis Hotline	1350	100%	100%	100%	100%	100%	100%	1	N/A
Inpatient Psychiatric Care	667	100%	100%	100%	100%	100%	100%	2	N/A
Lab Services	$23,316*	100%	100%	100%	100%	100%	100%	1	N/A

* Cost of services – unable to translate into specific units of service

9) 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.

Only 2 providers expressed initial interest in contracting with ACCESS. After discussions with each, it was determined that they were not interested or do not currently have the capacity to provide the services they indicated initial interest in providing.

Although there are no providers who have currently expressed interest in providing discrete services, ACCESS intends, through an RFA, to seek additional providers in the areas of CBT counseling and Psychiatric Medication Management Services. There is an ongoing shortage of behavioral health providers in the area, both psychiatrists and counselors, and the addition of providers of these services will not only offer consumers more choices but will assure that sufficient providers are available to continue services should one or more of the current providers opt out of the system.

There were no providers interested in providing services to children and adolescents.

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.

N/A

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.

Service	Capacity Needed	External Provider Capacity	Information and Method Used to Determine External Network Capacity
N/A

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.

Service	Transition Period	Year of Full Procurement
N/A

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.

w N/A

10) 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.

N/A

11) 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.

w N/A

12) 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.

Service(s)	Time Needed to Re-establish Service Volume
N/A	N/A

Procurement

13) Structure of Procurement(s)

In the table below, describe how the 2012 procurement will be structured, making a separate entry for each service or combination of services that will be procured as a separate contracting unit. Enter NA if you have no interested providers.

w Note the method of procurement: competitive procurement (RFP) or open enrollment (RFA).

w Identify the geographic area(s) in which the service will be procured, and the percent of your clients living in the designated geographic area. Specify whether an external provider will be required to cover the entire area. If an external provider will be permitted to contract for services in only a portion of the identified area, note how the area may be partitioned.

w Describe the rationale for how the procurement will be structured. In the rationale the following issues must be addressed:

o Method of procurement (competitive vs. open enrollment)

o procurement of discrete services rather than service packages (provide a separate rationale for each discrete service)

o bundling of services or service packages

o service area (whether the entire local service area is included or only selected counties, and choice of individual counties)

Date(s)	Method (RFA or RFP)	Service or Combination of Services to be Procured	Geographic Area(s) in Which Service(s) will be Procured	Percent of Clients	Rationale
2/1/11	RFA	Psychiatric medication management	Anderson and/or Cherokee Counties	25%	Although there are no providers who have currently expressed interest in providing this discrete service, there is an ongoing shortage of psychiatrists in the area. The addition of providers of these services through open enrollment will not only offer consumers more choices but will assure that sufficient providers are available to continue services should one or more of the current providers opt out of the system.
2/1/11	RFA	CBT Counseling	Anderson and/or Cherokee Counties	50%	Although there are no providers who have currently expressed interest in providing this discrete service, there is an ongoing shortage of CBT counselors in the area who have completed the state-mandated training. The addition of providers of these services through an open enrollment period will not only offer consumers more choices but will assure that sufficient providers are available to continue services should one or more of the current providers opt out of the system.

14) Fidelity and Continuity of Care (complete only if discrete services will be procured).

If you plan to procure discrete services (rather than full service packages), describe how you will maintain fidelity and continuity of care in the provider network. The content of this section describes what changes or additions will be made to your standard process to address the additional fragmentation that can occur when services for a single consumer are provided by multiple contractors, often in multiple locations. Enter NA if you have no interested providers or plan to procure service packages only.

Fidelity will be assured through training, supervision, and continuous reassessment of contracted external providers’ performance. Provider Relation processes will be established that include: the provision of mandatory initial and ongoing training of external providers to ensure fidelity to Resiliency & Disease Management (RDM) service arrays; regularly scheduled meetings; on-site and desk reviews of documentation and compliance with federal and state laws by ACCESS Quality Management staff; and reviews of utilization patterns and clinical outcomes to assess adherence to RDM and other best practice models.

To further continuity of care and seamless service delivery, providers will be required to enter their data into ACCESS’ clinical database and to participate in treatment team staffings for consumers they serve. Access to and appropriateness of care and services delivered, as well as outcomes for individuals, will be monitored through evaluation of waiting lists, missed appointments, service utilization, consumer/provider satisfaction; consumer/provider complaints; continuity of care planning, efficacy of discharge and transfer planning, and results of consumer, provider, and family satisfaction surveys. Results of profiling activities will be disseminated to providers and other stakeholders to ensure continuous and sustained improvement in the care provided to consumers.

15) Enhanced Staff Qualifications

Do you require any individual practitioners to meet higher standards than those described in the DSHS performance contract?

_____Yes __X_ No

If yes, identify the practitioner(s) and the specific qualifications. Enter NA if you have no interested providers.

w N/A

Consumer Choice

16) 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.

Service to be Provided by a Single Provider	Reason(s) for Limiting Client Choice
N/A	N/A

17) Choice and Access

Using bullet format, briefly describe plans for maximizing consumers’ choice of providers and access to services, including relevant procedures, procurement specifications, and contract provisions.

w All provider service sites must meet ADA accessibility requirements and be centrally located.

w Services and written materials must be available in the primary language of the consumer and respect issues of diversity.

w At first service contact, consumers and families will be provided with a list of all available qualified providers from which to choose and at least annually thereafter to ensure they remain satisfied with their provider choice. The list will contain information about each provider including the following: contact information, service location, hours/days of service, language(s) spoken, and any “value-added” services provided.

w Providers will work with ACCESS and the consumer to obtain any financial benefits to which the consumer may be entitled.

w ACCESS Quality Management staff will monitor wait times, provider cancellation rates, no-show rates, provider change requests, and provider and consumer complaints to ensure unimpeded consumer access to the service delivery system.

w Provider Fairs will be scheduled so that consumers of services can meet providers and receive information about the services they offer.

w Providers in the network will be listed on the Center’s website and printed material in the client’s primary language will be made available to support choice. Choice of Provider will also be provided after completion of an assessment and every treatment plan review.

w Clients will be able to receive their services at one location and not need to travel to multiple locations for their services.

w Services will also be provided in the same communities as currently provided so clients do not need to travel to a location further away.

18) Diversity

Using bullet format, briefly describe how the LMHA will ensure its provider network meets the diverse cultural and linguistic needs in the local community. Include relevant standards, procedures, procurement specifications, and contract provisions.

w Providers must complete ACCESS’ initial and annual cultural diversity/competency training which includes information on protecting and respecting the rights of all individuals as to race, ethnicity, gender, sexual orientation, and age.

w Providers will complete the “Cultural and Linguistic Competency Assessment” prior to contracting and annually thereafter to ensure their written policies, staffing patterns, use of interpreters, written translation materials and grievance procedures are respectful of cultural and linguistic differences.

w Providers must be able to demonstrate capacity for providing translation services to hearing-impaired consumers and Spanish-speaking individuals, the 2 groups for which communication needs have been identified in the local service area.

w Complaints and rights violation allegations are compiled and trended by the ACCESS Rights Protection Officer to identify recurring issues and need for additional training among providers.

Capacity Development

19) Cost Efficiency

Using bullet format, list steps taken in the past two years to minimize overhead and administrative costs and achieve purchasing and other administrative efficiencies. Do not report efforts included in the 2008 network development plan.

w Entered into an agreement with UTMB to provide telemedicine psychiatric medication management services to children and adolescents one day a week, providing a significant reduction in the dollars ACCESS expends for those service while also providing services from a Board-certified Child and Adolescent Psychiatrist. Discussions are underway to add another day each week of these services.

w Televideo equipment has been placed in the jails in each County to facilitate faster screenings of the inmate populations and to reduce ACCESS and jail staff travel time.

w Televideo equipment has also been placed in the Courthouses in each County to facilitate faster warrant and commitment hearing processes, also saving ACCESS staff travel time.

w The organizational structure has been flattened by removing a layer of administration, freeing up additional dollars for services and improving directness of communication between administration and staff.

w ACCESS entered into a collaborative arrangement with the Andrews Center and Community Healthcore to contract with The Wood Group to open a crisis respite program. It is anticipated that use of these beds will result in decreased utilization of expensive inpatient psychiatric beds.

w Psychiatrists and Counselors are now using a transcription service to reduce the time they spend entering documentation into the electronic clinical record, freeing up time for them to see additional consumers and with the added benefit of increasing the readability of their documentation.

w Began implementing an electronic medical record to meet EHIT requirements and increase consistency of documentation practices.

w Initiated changes to the screening and intake processes to reduce duplication and facilitate more rapid access to services.

w Continued participation in ETBHN cost savings initiatives such as bulk utility purchasing, use of the closed-door pharmacy, and implementation of a Wide Area Network (WAN) that facilitates meetings and trainings by televideo to substantially reduce travel time and costs.

List partnerships with other LMHAs related to planning, administration, purchasing and procurement or other authority functions, or service delivery. Include current, ongoing partnerships (regardless of date established) and time-limited activities that occurred over the past two years.

Start Date	Partner(s)	Functions
July 1997	ETBHN Centers	UM Authorizations, Utilization Management Committee, Medication Purchasing/Pharmacy, Pharmacy and Therapeutics Committee, Regional Planning Network Advisory Committee, Veterans Grant Procurement, Regional Medical Director, Board of Trustees Training, Regional HIPAA training, Wide Area Network (WAN), Autism Summit, Housing Summit, Business Opportunities Committee, Information Services Workgroup, Regional Oversight Committee
2009	Andrews Center & ACCESS	Created relationship to promote peer relationships, collective brainstorming and information sharing, shared cost in staff development, and jointly collaborated and share cost in Crisis Respite services.

Identify any current efforts and plans to develop new opportunities for working jointly with other LMHAs.

w ACCESS, along with Andrews Center and Community Healthcore, has recently (April 2010) opened a crisis respite program in Tyler to be utilized jointly by the three Centers. The 3 Centers entered into a management contract with The Wood Group to run that program.

w Other planning activities are in progress through the ETBHN collaboration, including exploring website development and data management systems for use by all of the Centers; expanding regional training opportunities; email encryption partnering; Veteran’s Summit in Round Rock this Fall; joint ETBHN retreat to explore additional opportunities.

w Participation in service code matching workgroup with 5 other LMHAs.

20) Previous Network Development Efforts

In the table below, document your procurement activity over the past two years.

w List each service separately, including the percent of capacity and the geographic area in which the service was procured.

w State the results, including the number of providers obtained and the percent of service capacity under contract. If no providers were obtained as a result of procurement efforts, please note under results.

Procurement (Service, Capacity, Geographic Area)	Results (Providers and Capacity)
Adult SP 3 – 25% of capacity in Anderson and Cherokee Counties	No providers responded
Physician/Pharmacological Management – 25% of capacity in either Anderson and/or Cherokee County	No providers responded
Telemedicine Pharmacological Management – 10% of capacity in either Anderson and/or Cherokee County	No providers responded
Counseling Services – 50% of capacity in either Anderson and/or Cherokee County	No providers responded

List the comments you received after posting the draft procurement documents during the 2008 planning cycle, and how you responded to the comments, including any modifications made to the procurement document.

Comment or Suggestion	LMHA Response
No comments/suggestions were received	N/A

In bullet format, list specific steps taken over the past two years to develop the LMHA’s internal capacity to develop and manage the external provider network. The scope of activity should be appropriate to the level of interest from external providers.

w Expanded telecommunication technology through development of a Wide Area Network; purchase of televideo equipment to enhance opportunities for use of telemedicine; and development of electronic medical record components.

w Evaluated and streamlined screening and financial intake processes to facilitate more rapid provider referral processes.

w Developed procurement documents/processes, Provider Relations processes, and contract monitoring procedures.

21) Barriers

Identify the barriers you encountered when trying to recruit external providers, including any local circumstances that make recruitment difficult. Describe how you plan to address each barrier or reduce its impact during the 2012 procurement.

Barriers	Plans
Shortage of Local Providers	Promote use of telemedicine; encourage providers to hire Center staff when services are being transitioned from the internal provider to an external provider; pursue collaborative relationships with other Centers to expand pool of available external providers.
Local Counseling Providers not interested in obtaining State-mandated CBT training	Advocate for regional training opportunities provided by the State and/or removal of mandated CBT training if provider can prove competency otherwise through different training, experience, and performance.
Rates and DSHS contract requirements not attractive to external providers	Continue supporting legislation and lobbying efforts to improve funding and streamline requirements.

22) Long Term Planning

Note: Long term plans are based on the limited information currently available, and will be reassessed during the next planning cycle; they do not represent a firm commitment.

If the LMHA is continuing to provide services in order to protect critical infrastructure, briefly describe your plan for transitioning to full utilization of the service capacity being offered by external providers. Assume that proposed procurement plans are successful and the contractors prove to be stable providers and meet established performance standards. The plan must include a target date for the transition and measurable objectives for each procurement period.

If your proposed procurement is successful, what are your current plans for expanding the external provider network during the 2012 cycle? Identify the services and general volume capacity you are considering for procurement in the next planning period. If this information is documented in your critical infrastructure transition plan, simply reference it. Enter NA if you have no interested providers.

w N/A

23) Public Comment

Using bullet format, list the steps you will take to publicize and get public comment on the draft network development plan. Include outreach and activities directed to consumers, local advocacy groups, and potential providers.

w Post on ACCESS website

w Email notices that the plan has been posted to the 163 local planning survey recipients and to the providers who indicated initial interest

w Post notices in clinic locations

w Meet with local NAMI and consumer groups

w Present draft plan to RPNAC

Implementation

24) Procurement Timeline

Provide your procurement timelines in the following table. Allow at least 14 days for public comment to the draft procurement instrument. 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.

Date	Key Activities and Milestones
10/1/10	Draft procurement document (RFA/RFP) posted for public comment (at least 14 days)
11/1/10	Publication of final procurement
12/1/10	Due date for procurement responses
2/1/11	Award date
4/1/11	Contract start date

25) 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.

Date or Timeframe	Key Activities and Milestones
2/1/11	Date provider list will be posted to website and distributed to consumer and advocacy groups
2/1/11-4/1/11	Timeframe for hosting provider forums to allow providers to share information with consumers
4/1/11	Date to begin offering consumers choice of providers in the new network
4/1/11-6/1/11	Period of time given to consumers to select provider
6/1/11 – 8/31/11	Timeframe for transitioning current clients to new providers

Stakeholder Comments on Draft Plan and LMHA Response

Allow 14 days (minimum) for public comment on draft plan.

In the following table, summarize the public comments received on the draft plan. Use a separate line for each major point identified during the public comment period, and identify the stakeholder group(s) offering the comment. Describe the LMHA’s response, which might include:

w Accepting the comment in full and making corresponding modifications to the plan;