Kristie R. Schmiege, MPH, President

Michigan Association of Substance

Abuse Coordinating Agencies

Substance Abuse Coordinating Agencies (CAs) were created in Article 6, Public Act 368 of 1978, the Public Health Code

Designation of CAs Currently - 16◦ Local Public Health - 3◦ Community Mental Health Board - 8◦ Public or Private Nonprofit Agency – 5

Bills passed last week in state legislative committee to change the designation to PIHPs, additional votes to come…

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3

Comprehensive Planning for SA Treatment, Rehabilitation (Recovery) & Prevention Services:◦ Needs Assessment◦ Resource Identification◦ Priority Setting◦ Service Gap Identification ◦ Action Planning◦ Evaluation Criteria Setting

4

Review and Comment on Applications for Licenses

Provide Technical Assistance Collect/Transfer Data & Financial Info Submit an Annual Budget Request Make (Sub)Contacts Necessary to the

Performance of the CA’s Functions ◦ Must not Provide Direct Services

Annually Evaluate and Assess Services◦ Contract Monitoring

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Local Advisory Council - Purpose:

◦ Consult – Responsive to Community’s Needs

◦ Comment on Licenses

◦ Comment on Annual Action Plan

◦ Comment on Services

◦ Forum to Discuss SA Services and Problems in the Region

Wide Array of Community Stakeholders

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Community Collaboratives (MPCBs)

Recovery Advocates, Persons in Recovery

Drug and Sobriety Courts

Community Corrections

Parole and Prison Re-entry

Law Enforcement

School Districts

Department of Human Services

Other Human Service Agencies

Etc., etc.

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$75,358,174 – Fed. Block Grant + State * $34,236,115 – Medicaid (goes to PIHPs,

separate pe/pm) $4,565,329 – Adult Benefit Waiver $44,057 – MIChild $18,492,219 – PA 2 (goes to Counties) $4,745,746 – Other $137,441,640 – TOTAL

* 20% Earmark for Prevention

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Administer Public Funds for SA Services to eligible individuals:◦ Medicaid/ABW/MiChild◦ Federal SA Treatment & Prevention Block

Grant – uninsured and “under” - insured◦ PA2/Convention Facilities (liquor tax)

Priority Populations–Pregnant Intravenous Drug Users, Pregnant, IVDU

Assure Publicly Funded Services are Available Throughout the Fiscal Year

Access Management System

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* Riverhaven - 800.448.5498 * Detroit Health Dept. - 800.467.2452

* Genesee Co. CMH - 877.346.3648 * Macomb – 877.484.8884

* Kalamazoo CMH & SA Services - 888.373.6200

◦ Venture/Calhoun – 877.252.0916

* Lakeshore – 800.981.2481 Muskegon

◦ Benton Harbor – 800.926.8389

* Midsouth – 888.230.7629 * Network 180 – 800.749.7720

* Northern Michigan – 800.686.0749 * Pathways – 800.305.6564

* Oakland Co. H. Div. – 888.350.0900 X 85200

* Saginaw Co. H. Dept. – 1.855.277.8277 * St. Clair Co. CMH – 888.225.4447

* Southeast Mich. Com. Al. – 800.686.6543

* Washtenaw Com. H. Org. – 800.440.7548

* Western UP – Medicaid clients – see Pathways – 800.305.6564

◦ Baraga, Houghton, Keweenaw -888.482.4097

◦ Dickinson & Iron – 888.779.0095

◦ Gogebic & Ontonagon – 888.482-4097

(See map of regions & CA names on slide #3)

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Strategic Prevention Framework – Prevention Prepared Communities – Tobacco Compliance

Full Continuum of Treatment Services

◦ Outpatient including Medication Assisted

◦ Residential Including Recovery Housing>Detox

◦ Women’s Specialty

◦ Focus – Co-occurring Competency (MH & SUD)

Recovery Oriented System of Care

Peer Coaches – Health Navigators

Integration with Physical Health Care

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Refer to Existing SUD Provider Networks Co-located Services -> Integrated Services Health Centers can apply for a license to

become a substance service provider◦ Must meet requirements including SUD

accreditation ◦ Submit Application to: ◦ Michigan Dept. of Licensing and

Regulatory Affairs (LARA) (517) 241-1970 http://www.michigan.gov/lara

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Please feel free to contact me:

Kristie Schmiege, MPHDirector of Prevention & Health PromotionGenesee County Community Mental Health

420 W. Fifth Ave.Flint, Michigan 48503

kschmiege@gencmh.org(810) 496-5541

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Michigan Association of

COMMUNITY MENTAL HEALTH

Boards

Overview:

Michigan’s Publicly Funded,

Community Based Behavioral Health

& Developmental Disabilities System

MPCA Webinar – 2/21/12

14MACMHB ~ www.macmhb.org ~ 517-374-6848

46 Community Mental Health Services Programs (CMHSP)

18 Prepaid Inpatient Health Plans (PIHPs)

All of the PIHPs are also CMHSPs

Need to have at least 20,000 Medicaid beneficiaries in a PIHP

8 PIHPs are stand alone CMHSP; 10 are affiliations, with 2 to

up to 5 CMHSPs

MACMHB ~ www.macmhb.org ~ 517-374-6848 15

Mental Health and Developmental

Disabilities System - Structure

16

Ontonagon

Gogebic

Houghton

Iron

Baraga

Keweenaw

Marquette

Dickinson

Alger

Delta

Schoolcraft

Luce

Chippewa

Mackinac

Emmet

Cheboygan Presque Isle

Charlevoix

Leelanau

Antrim Ostego Montmorency Alpena

Benzie Grand Traverse Kalkaska Crawford Oscoda Alcona

ManisteeWexford Missaukee Roscommon Ogemaw Iosco

Mason Lake Osceola Clare Gladwin

Arenac

Bay

Oceana

Newaygo

Mecosta Isabella Midland

Muskegon

Ottawa Kent

Montcalm

Ionia

Gratiot

Clinton

Saginaw

Shiawassee

Huron

Tuscola

Sanilac

Lapeer

Genesee

St. Clair

Macomb

OaklandLivingstonInghamEatonAllegan Barry

Van Buren Kalamazoo Calhoun Jackson

Berrien Cass St. Joseph Branch

HillsdaleLenawee

Washtenaw Wayne

Monroe

MenomineeNORTHCARE

NORTHERN AFFILIATION

NORTHWEST CMH AFFILIATION

AFFILIATION OF MID-MICHIGAN

SOUTHWEST MICHIGAN AFFILIATION

VENTURE BEHAVIORAL HEALTH

THUMB MENTAL HEALTH ALLIANCE

CMH PARTNERSHIP OF

SOUTHEAST MICHIGAN

ACCESS ALLIANCE OF MICHIGAN

UNAFFILIATED OVER 20,000

LAKESHORE BEHAVIORAL

HEALTH ALLIANCE

Washtenaw

Ber

rien

Cass

Van Buren

Kalam

azoo

St. Joseph

Summit

Pointe

BranchLenawee Monroe

Washtenaw

Detroit/

Wayne

Maco

mb

Oakland

St. Clair

LapeerG

enesee

Shiawassee

LivingstonC

lin

ton

-Eat

on-

Ingh

am

Ionia

Barry

SanilacTuscola

SaginawGratiot

Montcalm

Allegan

Ottawa

Kent

Muskegon

Newaygo

CMH for Central

Michigan

Bay-

Arenac Huron

Au Sable ValleyNorthern Lakes CMH

Northeast

Michigan

North Country

Manistee-

Benzie

Hiawatha

Pathways

Northpointe

Copper Country

Gogebic

West

Michigan

Michigan Association ofCommunity Mental Health Boards

Affiliation Map

Updated November 4, 2010

CMHSP AFFILIATIONS

Formed under Act 258 of the Public Acts of 1974 as amended (the Mental Health Code).

12 member boards appointed by County Commissions.

At least one-third of the CMH Board must be consumers or family members. One half must be primary consumers.

Subject to FOIA and Open Meetings Act.

Counties must contribute a financial match.

CMHSP may be organized as an agency, organization or authority.

MACMHB ~ www.macmhb.org ~ 517-374-6848 17

What is a CMHSP?

For persons without Medicaid coverage, the Mental Health Code establishes service priorities for CMHSPs as to who receives services:

1. Persons in emergent / crisis situations

2. Persons with more severe forms of serious mental illness (SMI), serious emotional disturbance (SED), and developmental disability (DD), and substance use disorders

3. Persons with less severe or mild/moderate conditions, and the general community including prevention.

MACMHB ~ www.macmhb.org ~ 517-374-6848 18

Who Receives Services

All CMHs have centralized access systems and a 24 hour emergency service.

• For non emergency referrals, a brief telephone screening will result a scheduled assessment for ongoing service. In emergent situations the person must be served within 3 hours.

• Persons with Medicaid are entitled to service. Persons without Medicaid are served based on the severity of their illness.

MACMHB ~ www.macmhb.org ~ 517-374-6848 19

How Do People Access Services?

State provides an annual General Fund appropriation

No General Fund increases in past 12 years

Periodic redirection to match Federal funds (Adult Benefit

Waiver)

Significant reductions over past 5 years - 20%

CMHs impacted disproportionally based on funding factors –

effort to reduce funding per capita disparities – per capita

range ($12.04 to $59.02)

MACMHB ~ www.macmhb.org ~ 517-374-6848 20

How Are Services Funded?

21

Ontonagon

Gogebic

Houghton

Iron

Baraga

Keweenaw

Marquette

Dickinson

Alger

Delta

Schoolcraft

Luce

Chippewa

Mackinac

Emmet

Cheboygan Presque Isle

Charlevoix

Leelanau

Antrim Ostego Montmorency Alpena

Benzie Grand Traverse Kalkaska Crawford Oscoda Alcona

ManisteeWexford Missaukee Roscommon Ogemaw Iosco

Mason Lake Osceola Clare Gladwin

Arenac

Bay

Oceana

Newaygo

Mecosta Isabella Midland

Muskegon

Ottawa Kent

Montcalm

Ionia

Gratiot

Clinton

Saginaw

Shiawassee

Huron

Tuscola

Sanilac

Lapeer

Genesee

St. Clair

Macomb

OaklandLivingstonInghamEatonAllegan Barry

Van Buren Kalamazoo Calhoun Jackson

Berrien Cass St. Joseph Branch

HillsdaleLenawee

Washtenaw Wayne

Monroe

MenomineeNORTHCARE

NORTHERN AFFILIATION

NORTHWEST CMH AFFILIATION

AFFILIATION OF MID-MICHIGAN

SOUTHWEST MICHIGAN AFFILIATION

VENTURE BEHAVIORAL HEALTH

THUMB MENTAL HEALTH ALLIANCE

CMH PARTNERSHIP OF

SOUTHEAST MICHIGAN

ACCESS ALLIANCE OF MICHIGAN

UNAFFILIATED OVER 20,000

LAKESHORE BEHAVIORAL

HEALTH ALLIANCE

Washtenaw

Ber

rien

Cass

Van Buren

Kalam

azoo

St. Joseph

Summit

Pointe

BranchLenawee Monroe

Washtenaw

Detroit/

Wayne

Maco

mb

Oakland

St. Clair

LapeerG

enesee

Shiawassee

LivingstonC

lin

ton

-Eato

n-

Ingh

am

Ionia

Barry

SanilacTuscola

SaginawGratiot

Montcalm

Allegan

Ottawa

Kent

Muskegon

Newaygo

CMH for Central

Michigan

Bay-

Arenac Huron

Au Sable ValleyNorthern Lakes CMH

Northeast

Michigan

North Country

Manistee-

Benzie

Hiawatha

Pathways

Northpointe

Copper Country

Gogebic

West

Michigan

Michigan Association ofCommunity Mental Health Boards

Affiliation Map

Updated November 4, 2010

CMHSP AFFILIATIONS

Medicaid Prepaid Inpatient Health Plans (PIHPs) –Eighteen (18) PIHPs manage the services and supports for persons enrolled in the Medicaid, MIChild and Adult Benefit Waiver programs.

These affiliations were created in order to realize administrative efficiencies in managing services and to provide a sufficiently large base of Medicaid enrollees to manage the risk-based, capitated funding system used to finance the system of care for Medicaid beneficiaries.

MACMHB ~ www.macmhb.org ~ 517-374-6848 22

How Does a PIHP Work?

PIHP (Prepaid Inpatient Health Plan) is a federal CMS designation.

Medicaid health plans are responsible for a 20 visit per year benefit for persons with moderate psychiatric disabilities.

PIHPs are responsible for management of all specialty BH/DD services to everyone enrolled in Medicaid. This is referred to as a “carve out” of specialty services.

MACMHB ~ www.macmhb.org ~ 517-374-6848 23

How Does a PIHP Work?

Like HMOs, PIHPs can contract with providers, perform gate keeping and authorization, monitor service outcomes and standards of care.

Like HMOs, PIHPs must manage with the capped pool of funds that are paid each month based on the number of Medicaid eligibles in the PIHP area.

When eligibles go up or down, funding corresponds. The # of people seeking service does not necessarily correspond & therefore managing the utilization of services is critical.

MACMHB ~ www.macmhb.org ~ 517-374-6848 24

How Does a PIHP Work?

For persons with Medicaid, access to mental health services is an entitlement. Based on a clinical assessment, people must be enrolled in appropriate services.

• People have a choice of provider.

• People denied service may have a second opinion.

• People may file appeals at the local & state level.

• People are not charged for services

MACMHB ~ www.macmhb.org ~ 517-374-6848 25

Who Receives Services

Michigan Association of Community Mental Health Boards

426 S. Walnut St, Lansing, MI 48933

(517) 374-6848

Michael Vizena Alan Bolter

Executive Director Associate Director

mvizena@macmhb.org abolter@macmhb.org

MACMHB ~ www.macmhb.org ~ 517-374-6848 26

Questions ?