2012 Provider Network Development Plan
Complete and submit in Word (.doc) format (not .pdf) to Performance.Contracts@dshs.state.tx.us no later than October 1, 2012.
Major populations include:
- All counties in catchment area are Medically Underserved Areas (MUAs) according to the Health Resources and Services Administration. There is a limited pool of medical professionals from which to recruit.
- No major universities are within the service area and limited community colleges to develop professionals.
- High proportion of persons whose primary language is Spanish, particularly in counties near the border with Mexico.
- Native American reservation (Kickapoo) in Maverick County.
- No public transportation systems exist in any of the counties served.
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 2010 planning cycle.
- Increased amount of contract physician time with Dr Bischoff for adult services.
- Developed contract with Brenda Compagnone in FY 12 in our Southwest counties to provide counseling services for Children's services.
- Developed contract with UTMB and Southwest Physicians Group (Clarity) for child/adolescent telemedicine in Maverick, Atascosa & Zavala Counties.
- Developed contract with JSA for telemedicine services for adults.
- Approximately 50% of the adult mental health psychiatric services in Eagle Pass are contracted.
- 100% of adults and children in Zavala Co. are receiving psychiatric services that are contracted.
- 100% of children in Maverick Co are receiving physician services by contracted psychiatrist.
- Unanswered RFA for physician and counselor services (adult and children's services) in Maverick, Dimmit and Zavala counties.
2) Provider Availability
Local Planning
3) Status of provider availability assessment for 2012 update
Complete this section only if you solicited community input before drafting your 2012 update.
Does the final assessment of provider availability documented above match the information about provider availability on hand at the time of community input?
NA
4) Community Engagement for the 2012 plan (if applicable)
NA
5) PNAC Involvement for the 2012 update (Required for all plan updates)
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.
- You are NOT required to solicit additional community input before drafting your 2012 plan update. You are required to solicit community input after your plan update is drafted through the public comment process.
- You may solicit additional community input if you believe it will be beneficial in drafting your update. If you do, conduct the provider assessment before engaging stakeholders so the input you receive is relevant to the options you have.
- Only include input that is specific to the network development plan.
3) Status of provider availability assessment for 2012 update
Complete this section only if you solicited community input before drafting your 2012 update.
Does the final assessment of provider availability documented above match the information about provider availability on hand at the time of community input?
NA
4) Community Engagement for the 2012 plan (if applicable)
NA
5) PNAC Involvement for the 2012 update (Required for all plan updates)
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.
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).
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.
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.
7) Current and Planned Network Development for FY 2013-2014
Complete the following table. Leave cells blank if the percent is 0.
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.
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 2011 and FY 2012 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 (tab 3: Service Target County by Component and LOCA). The link is: http://hhsapp08.mhmr.state.tx.us:8080/AnalyticalReporting/WebiView.do?cafWebSesInit=true&appKind=InfoView&service=/InfoViewApp/common/appService.do&loc=en&pvl=en_US&ctx=standalone&actId=224&objIds=7934&containerId=6569&pref=maxOpageU%3D100%3BmaxOpageUt%3D200%3BmaxOpageC%3D10%3Btz%3DAmerica%2FChicago%3BmUnit%3Dinch%3BshowFilters%3Dtrue%3BsmtpFrom%3Dtrue%3BpromptForUnsavedData%3Dtrue%3B
- Column B: State the percent of total capacity contracted to external providers in FY 2011. 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 2011; this is the actual capacity served by contractors.
- Column D: State the current percent of total capacity contracted to external providers for FY 2012. 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 2012 (September 2011 through February 2012); 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 2013 and in 2014. This is the cumulative percent you anticipate having under contract in that year, not the percent to be procured in that year.
- 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.
Use the following table to list any discrete routine services or crisis services with contracting activity (2011, 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 2011 and FY 2012 through the most recent closed quarter for services controlled by the DSHS contract. Capacity for discrete services is expressed as units of service delivered.
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.
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.
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.
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.
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.
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.
N/A
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.
N/A
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.
N/A
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.
N/A
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.
N/A
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.
N/A
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.
Procurement
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
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.
N/A
14) Enhanced Staff Qualifications
Do you require any individual practitioners to meet higher standards than those described in the DSHS performance contract?
Yes
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.
N/A
14) Enhanced Staff Qualifications
Do you require any individual practitioners to meet higher standards than those described in the DSHS performance contract?
Yes
Consumer Choice
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.
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.
16) 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.
17) Diversity
Capacity Development
18) 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 2010 network development plan.
Using bullet format, briefly describe plans for maximizing consumers' choice of providers and access to services, including relevant procedures, procurement specifications, and contract provisions.
- Consumer preferences for a provider are honored within the individual clinics whenever requested. As the Center begins to develop a network of external providers, the expectation is that access to quality care must be as good as, or better than what currently exists within Center operations.
- Telemedicine also offers a viable opportunity for consumers to have choice in physicians.
17) Diversity
- Camino Real service area houses a large Hispanic population with seven of nine counties having a percentage greater than 50%. This percentage is mirrored by the percentage of homes in which English is not the first language, the predominant language being Spanish.
- All new staff are currently required to receive training in cultural diversity.
- The LMHA ensures that minimum qualifications require documented bilingual (English/Spanish) skills in those services areas where the primary language spoken is Spanish.
- Any provider contracted to serve this area would be expected to base staff in the area they serve and meet these same training and bilingual language requirements.
Capacity Development
18) 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 2010 network development plan.
- By contracting UTMB, JSA Health, and Southwest Psychiatric Physicians for physician services the administrative cost of recruiting, hiring and benefits for an adult and child psychiatrist is a cost savings.
Identify any current efforts and plans to develop new opportunities for working jointly with other LMHAs.
19) Previous Network Development Efforts
In the table below, document your procurement activity over the past two years.
- video conferencing is being utilized for physician services in all rural service areas.
- Plan to train an external provider in CBT when the internal provider is certified to expand counseling services in Maverick, Dimmit and Zavala counties.
19) Previous Network Development Efforts
In the table below, document your procurement activity over the past two years.
- List each service separately, including the percent of capacity and the geographic area in which the service was procured.
- 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.
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.
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.
20) 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 FY 2013-2014 procurement.
- Due to minimal level of interest from external providers no new steps have been taken. Current internal authority resources are meeting current needs.
20) 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 FY 2013-2014 procurement.
21) Long Term Planning
22) 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.
Implementation
23) 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.
- It is the intent of Camino Real to continue to seek to contract with external providers as they become available in the rural areas served. The hope is that full transition can be met within the next decade but population growth will have to occur to make it feasible for external providers to expand into the Camino Real service area.
22) 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.
- The plan will be posted to the agency website.
- The plan will be advertised in the newspapers serving the nine county area.
- Potential providers will be notified of the posting of the plan when identified.
- Copies of the plan will be mailed to anyone requesting a copy.
Implementation
23) 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.
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.
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.
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:
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:
- Accepting the comment in full and making corresponding modifications to the plan;
- Accepting the comment in part and making corresponding modifications to the plan; or
- Rejecting the comment. Please explain the LMHA's rationale for rejecting the comment.
COMPLETE AND SUBMIT ENTIRE PLAN TO performance.contracts@dshs.state.tx.us by OCTOBER 1, 2012
Appendix A
LPND Potential Interested Provider Contact Steps
Provider Interest Inquiry form is submitted for posting on DSHS web site. DSHS Staff review information and post form. Provider and LMHA are notified via e-mail from DSHS staff that the form has been posted. LMHA contacts provider to schedule a teleconference or site visit. The LMHA may conclude that a provider is not interested in contracting with the LMHA if the provider does not participate in a teleconference or in-person meeting (whichever is requested by the LMHA) within 45 days of the initial LMHA contact.
Through the DSHS website, a provider can submit a Provider Inquiry Form to register interest in contracting with an LMHA. DSHS will notify both the provider and the LMHA when the Provider Inquiry Form is posted.
During its assessment of provider availability, it is the responsibility of the LMHA to review posted information and contact potential providers to schedule a time for further discussion. This discussion, which can take place in person or by phone, provides both the LMHA and the provider an opportunity to share information so that both parties can make a more informed decision about potential procurements.
If the LMHA does not contact the provider, the LMHA must assume the provider is interested in contracting with the LMHA.
The LMHA may request a teleconference or an in-person meeting, and must work with the provider to find a mutually convenient time. If the provider does not respond to the invitation or is not able to accommodate a teleconference or a site visit within 45 days of the LMHA's initial contact, the LMHA may conclude that the provider is not interested in contracting with the LMHA.
An LMHA is not obligated to go through procurement if no providers have demonstrated interested in contracting with the LMHA.
Appendix B
25 TAC §412.758 LMHA Provider Status.
1) The LMHA shall provide services only under one or more of the following conditions.
a) The LMHA determines that interested qualified providers are not available to provide services in the LMHA's service area or that no providers met procurement specifications.
b) The network of external providers does not provide the minimum level of consumer choice. A minimal level of consumer choice is present when consumers and their legally authorized representatives can choose from two or more qualified provider organizations in the LMHA's provider network for service packages and from two or more qualified individual practitioners in the LMHA's provider network for specific services within a service package.
c) The network of external providers does not provide consumers of the LMHA's service area with access to services that is equivalent to or better than the level of access as of a date to be determined by DSHS. Any LMHA relying on this condition shall submit to DSHS information necessary for DSHS to verify level of access. DSHS will use the latest healthcare access technology available to the agency to measure access.
d) The combined volume of services delivered by external providers is not sufficient to meet 100 percent of the LMHA's service capacity for each RDM service package as identified in the LMHA's local network development plan.
e) The LMHA documents that it is necessary for the LMHA to provide certain services specified by the LMHA during the two-year period covered by the LMHA's local network development plan in order to preserve critical infrastructure to ensure continuous provision of services. Under this condition, the LMHA will identify 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. The LMHA shall give up its role as a service provider at the end of the transition period when the network has multiple external providers if the LMHA determines that external providers are willing and able to provide sufficient added service volume within the timeframe specified by the LMHA in its approved local network development plan, as provided in §412.756(g)(8)(F) of this title (relating to Local Network Development Plan), to compensate for service volume lost should any one of the external provider contracts be terminated.
f) Existing agreements impose restrictions on the LMHA's ability to contract with external providers for specific services during the two-year period covered by the LMHA's local network development plan, or existing circumstances would result in the loss of a substantial source of revenue that supports service delivery during the two-year period covered by the plan. If the LMHA invokes this condition, DSHS may require the LMHA to provide DSHS with a copy of the relevant agreement(s). Examples of such agreements and circumstances include:
1. grants or other sources of funding that require direct service provision by the LMHA and that cannot be amended;
2. buildings or other physical infrastructure that are not reasonably expected to be sold, leased, or otherwise disposed of;
3. tax-exempt government bonds or other long-term financing that place restrictions on the LMHA's ability to meet its financial obligations, either in whole or in part; and
4. leases or contracts that cannot be terminated.
Appendix A
LPND Potential Interested Provider Contact Steps
Provider Interest Inquiry form is submitted for posting on DSHS web site. DSHS Staff review information and post form. Provider and LMHA are notified via e-mail from DSHS staff that the form has been posted. LMHA contacts provider to schedule a teleconference or site visit. The LMHA may conclude that a provider is not interested in contracting with the LMHA if the provider does not participate in a teleconference or in-person meeting (whichever is requested by the LMHA) within 45 days of the initial LMHA contact.
Through the DSHS website, a provider can submit a Provider Inquiry Form to register interest in contracting with an LMHA. DSHS will notify both the provider and the LMHA when the Provider Inquiry Form is posted.
During its assessment of provider availability, it is the responsibility of the LMHA to review posted information and contact potential providers to schedule a time for further discussion. This discussion, which can take place in person or by phone, provides both the LMHA and the provider an opportunity to share information so that both parties can make a more informed decision about potential procurements.
If the LMHA does not contact the provider, the LMHA must assume the provider is interested in contracting with the LMHA.
The LMHA may request a teleconference or an in-person meeting, and must work with the provider to find a mutually convenient time. If the provider does not respond to the invitation or is not able to accommodate a teleconference or a site visit within 45 days of the LMHA's initial contact, the LMHA may conclude that the provider is not interested in contracting with the LMHA.
An LMHA is not obligated to go through procurement if no providers have demonstrated interested in contracting with the LMHA.
Appendix B
25 TAC §412.758 LMHA Provider Status.
1) The LMHA shall provide services only under one or more of the following conditions.
a) The LMHA determines that interested qualified providers are not available to provide services in the LMHA's service area or that no providers met procurement specifications.
b) The network of external providers does not provide the minimum level of consumer choice. A minimal level of consumer choice is present when consumers and their legally authorized representatives can choose from two or more qualified provider organizations in the LMHA's provider network for service packages and from two or more qualified individual practitioners in the LMHA's provider network for specific services within a service package.
c) The network of external providers does not provide consumers of the LMHA's service area with access to services that is equivalent to or better than the level of access as of a date to be determined by DSHS. Any LMHA relying on this condition shall submit to DSHS information necessary for DSHS to verify level of access. DSHS will use the latest healthcare access technology available to the agency to measure access.
d) The combined volume of services delivered by external providers is not sufficient to meet 100 percent of the LMHA's service capacity for each RDM service package as identified in the LMHA's local network development plan.
e) The LMHA documents that it is necessary for the LMHA to provide certain services specified by the LMHA during the two-year period covered by the LMHA's local network development plan in order to preserve critical infrastructure to ensure continuous provision of services. Under this condition, the LMHA will identify 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. The LMHA shall give up its role as a service provider at the end of the transition period when the network has multiple external providers if the LMHA determines that external providers are willing and able to provide sufficient added service volume within the timeframe specified by the LMHA in its approved local network development plan, as provided in §412.756(g)(8)(F) of this title (relating to Local Network Development Plan), to compensate for service volume lost should any one of the external provider contracts be terminated.
f) Existing agreements impose restrictions on the LMHA's ability to contract with external providers for specific services during the two-year period covered by the LMHA's local network development plan, or existing circumstances would result in the loss of a substantial source of revenue that supports service delivery during the two-year period covered by the plan. If the LMHA invokes this condition, DSHS may require the LMHA to provide DSHS with a copy of the relevant agreement(s). Examples of such agreements and circumstances include:
1. grants or other sources of funding that require direct service provision by the LMHA and that cannot be amended;
2. buildings or other physical infrastructure that are not reasonably expected to be sold, leased, or otherwise disposed of;
3. tax-exempt government bonds or other long-term financing that place restrictions on the LMHA's ability to meet its financial obligations, either in whole or in part; and
4. leases or contracts that cannot be terminated.