The Florida Senate

394.498  Child and Adolescent Interagency System of Care Demonstration Models.--

(1)  CREATION.--There is created the Child and Adolescent Interagency System of Care Demonstration Models to operate for 3 years for children and adolescents who have a serious emotional disturbance and for the families of such children and adolescents. It is the intent of the Legislature to encourage the Department of Children and Family Services, the Agency for Health Care Administration, the Department of Education, the Department of Health, the Department of Juvenile Justice, local governments, and any other interested public or private source to enter into a partnership agreement to provide a locally organized system of care for children and adolescents who have a serious emotional disturbance and for the families of such children and adolescents. A demonstration model must be provided within existing funds, center on the client and his or her family, promote the integration and coordination of services, provide for accountable outcomes, and emphasize the provision of services in the least restrictive setting that is clinically appropriate to the needs of the child or adolescent. Participation in the partnership agreement does not divest any public or private agency of its responsibility for a child or adolescent but allows these agencies to better meet the needs of the child or adolescent through shared resources.

(2)  GOALS.--The goal of the Child and Adolescent Interagency System of Care Demonstration Models is to provide a design for an effective interagency strategy for delivering services to children and adolescents who have a serious emotional disturbance and for the families of such children and adolescents. In addition to the guiding principles specified in s. 394.491, and the principles for service planning specified in s. 394.496(2), the goal of the strategy is to:

(a)  Enhance and expedite services to the seriously emotionally disturbed children and adolescents who choose to be served under the strategies of the demonstration model.

(b)  Refine the process of case management using the strengths approach in assessment and service planning and eliminating duplication of the case management function.

(c)  Employ natural supports in the family and the community to help meet the service needs of the child or adolescent who has a serious emotional disturbance.

(d)  Improve interagency planning efforts through greater collaboration between public and private community-based agencies.

(e)  Test creative and flexible strategies for financing the care of children and adolescents who have a serious emotional disturbance.

(f)  Share pertinent information about the child or adolescent among appropriate community agencies.

Except as otherwise specified, the demonstration models must comply with the requirements of ss. 394.490-394.497.

(3)  MODEL ENHANCEMENTS.--

(a)  The Legislature finds that strict reimbursement categories do not typically allow flexible funding for purchasing the formal and informal services that are needed by children and adolescents who have a serious emotional disturbance and who have particularly complex needs for services. Therefore, each demonstration model shall be governed by a multiagency consortium of state and county agencies and may use an integrated blend of state, federal, and local funds to purchase individualized treatment and support services for children and adolescents who have a serious emotional disturbance, based on client need rather than on traditional services limited to narrowly defined cost centers or appropriation categories.

(b)  The local consortium of purchasers is responsible for designing a well-defined care management system and network of experienced mental health providers in order to achieve delineated client outcomes.

(c)  The purpose of the demonstration models is to enhance the holistic concepts of mental health care by serving the total needs of the child or adolescent through an individualized services plan.

(d)  Notwithstanding chapter 216, the organized system of care implemented through the demonstration models may expend funds for services without any categorical restraints and shall provide for budget and program accountability and for fiscal management using generally accepted business practices pursuant to the direction of the multiagency oversight body. Funds shall be allocated so as to allow the local purchasing entity to provide the most appropriate care and treatment to the child or adolescent, including a range of traditional and nontraditional services in the least restrictive setting that is clinically appropriate to the needs of the child or adolescent. The consortium of purchasers shall assure that funds appropriated in the General Appropriations Act for services for the target population are not used for any other purpose than direct services to clients.

(e)  A local consortium of purchasers which chooses to participate in the demonstration model may reinvest cost savings in the community-based child and adolescent mental health treatment and support system. A purchaser that participates in the consortium is exempt from administrative procedures otherwise required with respect to budgeting and expending state and federal program funds.

(4)  ESSENTIAL ELEMENTS.--

(a)  In order to be approved as a Child and Adolescent Interagency System of Care Demonstration Model, the applicant must demonstrate its capacity to perform the following functions:

1.  Form a consortium of purchasers, which includes at least three of the following agencies:

a.  The Mental Health Program and Family Safety and Preservation Program of the Department of Children and Family Services.

b.  The Medicaid program of the Agency for Health Care Administration.

c.  The local school district.

d.  The Department of Juvenile Justice.

Each agency that participates in the consortium shall enter into a written interagency agreement that defines each agency's responsibilities.

2.  Establish an oversight body that is responsible for directing the demonstration model. The oversight body must include representatives from the state agencies that comprise the consortium of purchasers under subparagraph 1., as well as local governmental entities, a juvenile court judge, parents, and other community entities. The responsibilities of the oversight body must be specified in writing.

3.  Select a target population of children and adolescents, regardless of whether the child or adolescent is eligible or ineligible for Medicaid, based on the following parameters:

a.  The child or adolescent has a serious emotional disturbance or mental illness, as defined in s. 394.492(6), based on an assessment conducted by a licensed practitioner defined in s. 394.455(2), (4), (21), (23), or (24) or by a professional licensed under chapter 491;

b.  The total service costs per child or adolescent have exceeded $3,000 per month;

c.  The child or adolescent has had multiple out-of-home placements;

d.  The existing array of services does not effectively meet the needs of the child or adolescent;

e.  The case of the child or adolescent has been staffed by a district collaborative planning team and satisfactory results have not been achieved through existing case services plans; and

f.  The parent or legal guardian of the child or adolescent consents to participating in the demonstration model.

4.  Select a geographic site for the demonstration model. A demonstration model may be comprised of one or more counties and may include multiple service districts of the Department of Children and Family Services.

5.  Develop a mechanism for selecting the pool of children and adolescents who meet the criteria specified in this section for participating in the demonstration model.

6.  Establish a pooled funding plan that allocates proportionate costs to the purchasers. The plan must address all of the service needs of the child or adolescent, and funds may not be identified in the plan by legislative appropriation category or any other state or federal funding category.

a.  The funding plan shall be developed based on an analysis of expenditures made by each participating state agency during the previous 2 fiscal years in which services were provided for the target population or for individuals who have characteristics that are similar to the target population.

b.  Based on the results of this cost analysis, funds shall be collected from each of the participating state agencies and deposited into a central financial account.

c.  A financial body shall be designated to manage the pool of funds and shall have the capability to pay for individual services specified in a services plan.

7.  Identify a care management entity that reports to the oversight body. For purposes of the demonstration models, the term "care management entity" means the entity that assumes responsibility for the organization, planning, purchasing, and management of mental health treatment services to the target population in the demonstration model. The care management entity may not provide direct services to the target population. The care management entity shall:

a.  Manage the funds of the demonstration model within budget allocations. The administrative costs associated with the operation of the demonstration model must be itemized in the entity's operating budget.

b.  Purchase individual services in a timely manner.

c.  Review the completed client assessment information and complete additional assessments that are needed, including an assessment of the strengths of the child or adolescent and his or her family.

d.  Organize a child-family team to develop a single, unified services plan for the child or adolescent, in accordance with ss. 394.490-394.497. The team shall include the parents and other family members of the child or adolescent, friends and community-based supporters of the child or adolescent, and appropriate service providers who are familiar with the problems and needs of the child or adolescent and his or her family. The plan must include a statement concerning the strengths of the child or adolescent and his or her family, and must identify the natural supports in the family and the community that might be used in addressing the service needs of the child or adolescent. A copy of the completed service plan shall be provided to the parents of the child or adolescent.

e.  Identify a network of providers that meet the requirements of paragraph (b).

f.  Identify informal, unpaid supporters, such as persons from the child's or adolescent's neighborhood, civic organizations, clubs, and churches.

g.  Identify additional service providers who can work effectively with the child or adolescent and his or her family, including, but not limited to, a home health aide, mentor, respite care worker, and in-home behavioral health care worker.

h.  Implement a case management system that concentrates on the strengths of the child or adolescent and his or her family and uses these strengths in case planning and implementation activities. The case manager is primarily responsible for developing the services plan and shall report to the care management entity. The case manager shall monitor and oversee the services provided by the network of providers. The parents must be informed about contacting the care management entity or comparable entity to address concerns of the parents.

Each person or organization that performs any of the care management responsibilities specified in this subparagraph is responsible only to the care management entity. However, such care management responsibilities do not preclude the person or organization from performing other responsibilities for another agency or provider.

8.  Develop a mechanism for measuring compliance with the goals of the demonstration models specified in subsection (2), which mechanism includes qualitative and quantitative performance outcomes, report on compliance rates, and conduct quality improvement functions. At a minimum, the mechanism for measuring compliance must include the outcomes and measures established in the General Appropriations Act and the outcomes and measures that are unique to the demonstration models.

9.  Develop mechanisms to ensure that family representatives have a substantial role in planning the demonstration model and in designing the instrument for measuring the effectiveness of services provided.

10.  Develop and monitor grievance procedures.

11.  Develop policies to ensure that a child or adolescent is not rejected or ejected from the demonstration model because of a clinical condition or a specific service need.

12.  Develop policies to require that a participating state agency remains a part of the demonstration model for its entire duration.

13.  Obtain training for the staff involved in all aspects of the project.

(b)  In at least one demonstration model, rather than using a care management entity, the local consortium of purchasers may contract directly with a network of service providers that may use prospective payment mechanisms through which the providers would accept financial risk for producing outcomes for the target population. These demonstration models must provide an annual report to the purchasers who are participating in the demonstration model which specifies the types of services provided and the number of clients who receive each service.

(c)  In order for children, adolescents, and families of children and adolescents to receive timely and effective services, the basic provider network identified in each demonstration model must be well designed and managed. The provider network should be able to meet the needs of a significant proportion of the target population. The applicant must demonstrate the capability to manage the network of providers for the purchasers that participate in the demonstration model. The applicant must demonstrate its ability to perform the following network management functions:

1.  Identify providers within the designated area of the demonstration model which are currently funded by the state agencies included in the model, and identify additional providers that are needed to provide additional services for the target population. The network of providers may include:

a.  Licensed mental health professionals as defined in s. 394.455(2), (4), (21), (23), or (24);

b.  Professionals licensed under chapter 491;

c.  Teachers certified under s. 231.17;

d.  Facilities licensed under chapter 395, as a hospital; s. 394.875, as a crisis stabilization unit or short-term residential facility; or s. 409.175, as a residential child-caring agency; and

e.  Other community agencies.

2.  Define access points and service linkages of providers in the network.

3.  Define the ways in which providers and participating state agencies are expected to collaborate in providing services.

4.  Define methods to measure the collective performance outcomes of services provided by providers and state agencies, measure the performance of individual agencies, and implement a quality improvement process across the provider network.

5.  Develop brochures for family members which are written in understandable terminology, to help families identify appropriate service providers, choose the provider, and access care directly whenever possible.

6.  Ensure that families are given a substantial role in planning and monitoring the provider network.

7.  Train all providers with respect to the principles of care outlined in this section, including effective techniques of cooperation, the wraparound process and strengths-based assessment, the development of service plans, and techniques of case management.

(d)  Each demonstration model must comply with the requirements for maintaining the confidentiality of clinical records, as specified in s. 394.4615.

(e)  Each application for designation as a Child and Adolescent Interagency System of Care Demonstration Model must include:

1.  A plan for reinvesting the anticipated cost savings that result from implementing the demonstration model in the child and adolescent mental health treatment and support system. The plan must detail the methodology used to identify cost savings and must specify the programs and services that will be enhanced for the population that has complex service needs and for other children and adolescents who have emotional disturbances.

2.  A plan describing the methods by which community agencies will share pertinent client information.

3.  A statement that the appropriate business, accounting, and auditing procedures will be followed, as specified by law, in expending federal, state, and local funds.

(f)  Each consortium of purchasers shall submit an annual report on the progress of the demonstration model to the secretary or director of each state agency that participates in the model. At a minimum, the report must include the level of participation of each purchaser, the purchasing strategies used, the services provided to the target population, identified cost savings, and any other information that concerns the implementation of or problems associated with the demonstration model.

(g)  Each participating local agency and the administrative officers of each participating state agency must participate in interagency collaboration. The secretary or director of each participating state agency shall appoint a representative to select applications that meet the criteria for designation as a Child and Adolescent Interagency System of Care Demonstration Model, as specified in this section. The appointed representatives shall also provide technical assistance to the consortia in developing applications and in implementing demonstration models.

(5)  EVALUATION.--The Louis de la Parte Florida Mental Health Institute shall conduct an independent evaluation of each demonstration model to identify more effective ways in which to serve the most complex cases of children and adolescents who have a serious emotional disturbance or mental illness, determine better utilization of public resources, and assess ways that community agencies may share pertinent client information. The institute shall identify each distinct demonstration model to be evaluated. The evaluation must analyze all administrative costs associated with operating the demonstration models. The institute shall report to the Legislature by December 31, 2001, which report must include findings and conclusions for each distinct demonstration model and provide recommendations for statewide implementation. Based upon the findings and conclusions of the evaluation, the financial strategies and the best-practice models that are proven to be effective shall be implemented statewide.

(6)  RULES FOR IMPLEMENTATION.--Each participating state agency shall adopt rules for implementing the demonstration models. These rules shall be developed in cooperation with other appropriate state agencies for implementation within 90 days after obtaining any necessary federal waivers. The Medicaid program within the Agency for Health Care Administration may obtain any federal waivers that are necessary for implementing the demonstration models.

History.--s. 9, ch. 98-5.