City of Philadelphia Division of Social Services

1
City of PhiladelphiaDivision of Social Services

• Cross-Systems Financing
• Purchasing Plan
• Department of Behavioral Health/Mental
  Retardation Services and
• Department of Human Services

2
Target Population

• Youth in residential treatment for more than 1
  year and,
• Between the ages of 16 18 and,
• Are in the custody of DHS as dependent or
  delinquent or both
• Require a range of community-based supports,
  specialized treatment, and a host of vocational,
  educational and recreational services.

3
Assumptions Driving the Purchasing Plan

• Currently, all youth in RTF placement (Levels I,
  II and III) are funded through Medicaid (CBH).
• Medicaid can not support non-behavioral health
  services such as supported independent living,
  transitional living, vocational/educational,
  mentoring/peer support or other life skills
  supports many youth require.
• Youth with specialized needs such as co-occurring
  mental retardation, history of sex offending
  behavior, and co-occurring medical require a mix
  of behavioral health, mental retardation, child
  welfare supports that need to be funded by the
  multiple agencies.

4
Assumptions (continued)

• There is a lack of provider capacity to develop
  specialized programs as well as to treat many of
  the clinically complexities of these youth.
• There is a lack of sustainability for many of the
  youth who require life long supports,
  particularly youth with co-occurring mental
  retardation.
• Waiting lists for mental retardation services are
  extremely long (800 residential and 3900
  community-based) that the other systems (CBH and
  DHS) have to provide the care.

5
Assumptions (continued)

• Medical necessity shifts to life necessity
  reinforcing treatment but requiring the
  development and support of youth in all domains
  of their life.
• Assessment and planning for these youth have been
  completed separate from rather than in
  partnership with the different departments within
  the Division of Social Services causing
• Lack of information that could have guided
  treatment differently.
• Lack of bringing together resources early on that
  could have resulted in better placement
  decisions.
• Lack of understanding the family dynamics and the
  possibility of using them as a resource for
  discharge planning.

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Current Reality (Original Goals versus Actual
Performance)

• Goal To integrate services, supports, planning
  and resource development between DHS and DBH/MRS.

• Actual
• Change in leadership.
• Lack of shared information.
• Lack of mechanism to care manage those youth
  involved in both systems.

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Current Reality (continued)

• Goal To integrate funding streams to develop a
  pool of resources to fund specialized services
  for aging out youth.
• Actual
• Funding is limited to state regulations that do
  not allow blending currently.
• Restrictions to funding disallow creativity. The
  use of reinvestment is good on a case-by-case
  basis but not for sustainability and prevents the
  ability to develop overall capacity.

8
Current Purchasing Plan

• The following are expenditures for Residential
  Treatment for the 44 youth who represent the
  target group.
• DBH/MRS 3,774,100
• DHS 837,000
• Education Unknown
• MRS 9,000 (9 youth)
• Expenditures for RTF placement for calendar year
  2006 is 3,774,100 compared to 1,976,515 in
  2005.

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Proposed Purchasing Plan

• Plan (Part A)
• To coordinate funding so that all 44 youth
  targeted for this effort receive comprehensive
  assessments in the areas of
• Life Skills
• Level of Functioning
• Medical
• Behavioral Health (MH and DA)
• Education
• Family Support

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Proposed Purchasing Plan

• Plan (B) Identify for each youth based upon the
  holistic assessments the
• Type of supports
• Cost of supports
• Funding sources available/needed
• Providers that can support the plan
• Funding this would be part Medicaid, Education
  and DHS.

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Proposed Purchasing Plan

• Plan (Part C) To create the provider capacity to
  respond to the individual plans of these aging
  out youth (16-18)
• Case rate model/RFP process to recruit providers
  that can provide the continuum and array of
  services and supports identified in the plan.
• Providers must submit a plan that will respond to
  the needs of the youth.
• Performance-based contracting to ensure response
  to plan is appropriate.

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Funding Options

• Moving youth from institutional care to
  community-based programs will decrease City match
  and increase State reimbursement.
• Frees up City dollars to develop after-school,
  recreational, vocational supports etc.