Community Mental Health for Central Michigan
Provider Meeting
Date: / 11/8/05Time: / 10:05 am
Place: / Lake Michigan Conference Room
Meeting called by: / Bryan Krogman
Type of meeting: / Regular
Note taker: / Sylvia Harvey
cc:
Welcome/Sign-in / Brief introductions to associate names to agencies.
Agenda Topic: / Announcements – All
Presenter: / Bryan Krogman, Provider Network Manager
Discussion &
Conclusions: / · Providers were reminded that the provider survey is located on the website at www.cmhcm.org. Click on the Provides menu button, and then select Provider Survey. Providers are encouraged to complete this survey to provide input to the agency.
· Extended an invitation to the providers regarding George Rouman’s retirement party on November 18, 2005 from 1-4pm at the Administrative building located at 301 S. Crapo, Mt. Pleasant, Michigan.
· The Central Michigan Mental Health Facilities Board is pleased to announce a change at the Administrative Building located at 301 South Crapo Street, Mt. Pleasant, Michigan.
On November 5, 2005, the Board voted unanimously to name the building “The George Rouman Center.” The Board wanted to thank George Rouman for his lifetime contributions and felt this was a small way to recognize and honor him for all he has done.
New lettering will be placed on the building within the next couple of weeks. This will not affect the name of the agency; Community Mental Health for Central Michigan will now be located in The George Rouman Center.
Agenda Topic: / State and Agency Update
Presenter: / George Rouman, Executive Director
Discussion &
Conclusions: / 1. The budget that was approved for the Department of Community Health for FY 2006 ended up much better than we had feared. Medicaid funding was increased to account for caseload growth; Medicaid adult dental services were restored; Medicaid coverage for nineteen and twenty year olds as well as for parents and caretaker relatives were also restored. In all, $109 million was added to the original House recommendation for a total MDCH budget of $2.9 Billion.
2. The Medicaid rates that are the basis for capitation payments to PIHPs were re-based this year. We suffered a loss of $1,114,140 as a result of this process, but because of a smoothing effort on the part of those PIHPs/CMHSPs that had windfalls, our loss was reduced to $630,492. We will need to use our savings to cover this shortfall.
3. Our agency operating budget for FY2006 is $66,134,977. Our revenues, unfortunately, are projected to be $64,641,266, or $1,493,711 short. We will be utilizing our Medicaid Internal Service Fund to make up any shortage we experience at the end of the year. This is a tight budget but, unless unforeseen events occur, we should be able to provide the same level of service as we did last year.
Agenda Topic: / Medicaid Services Overview
Presenter: / Bryan Krogman, Provider Network Manager
Discussion &
Conclusions: / A presentation was given in order to provide information about Medicaid services.
§ Our expected revenue for fiscal year 2005-06 is $64.6 million dollars. 94% or $60 million comes from the State of Michigan. 82% of this funding is in the form of Medicaid dollars, while just 18% is from other state funding. The Medicaid program provides an entitlement to a set of mental health services. With limited general fund dollars we find ourselves challenged to meet “non-priority” needs.
§ In 1998 the State of Michigan adopted a managed care approach to the purchase of Medicaid supports and services
1915(b) State plan services are those services that a participating state must cover and include:
nAssertive Community Treatment (ACT)
nAssessments
nBehavior Management Review
nChild Therapy
nClubhouse Psychosocial Rehab Programs
nCrisis Intervention
nCrisis Residential Services
nFamily Therapy
nHealth Services
nIndividual/Group Therapy
nICF/MR services
nIntensive Crisis Stabilization
nMedication Administration
nMedication Review
nNursing facility mental health monitoring
nOT, PT, Speech
nPersonal Care in licensed specialized residential setting
nSubstance abuse
nTargeted case management
nTransportation
nTreatment planning
1915(b)(3) The intent of the “b3” services is to promote community inclusion and participation, independence, and/or productivity and include:
nAssistive Technology
nCommunity Living Supports
nEnhanced Pharmacy
nEnvironmental Modifications
nExtended Observation Beds
nFamily Support and Training
nHousing Assistance
nPeer-Delivered or Operated Support Services
nPrevention-Direct Service Models
nRespite Care Services
nSkill Building Assistance
nSupported/Integrated Employment Services
nWraparound services for children and adolescents
nSub-Acute Detoxification
nResidential Treatment
1915(c) Available for people with a developmental disability residing in a community setting who, without the support provided through a waiver service, would require institutional care (ICF/MR) and include:
nChore service
nCommunity living supports
nEnhanced Medical Equipment and Supplies
nEnhanced Pharmacy
nEnvironmental modifications
nFamily training
nOut of home Non-Vocational Habilitation
nPersonal emergency response system
nPre-vocational habilitation
nPrivate duty nursing
nRespite care
nSupports coordination
nSupported employment
Children’s Home and Community Based Waiver services are available for children up to age 18 with a developmental disability at risk of being placed into an ICF/MR facility
§ All services must be provided in sufficient amount, scope and duration to reasonably achieve their purpose. Each person must be made aware of the amount, scope and duration of service to which he/she is entitled.
§ Amount: The number of units of service identified in the individual plan of service to be provided ( e.g., 25 15-minute units of targeted case management).
§ Scope: The parameters within which the service will be provided, including; who, how and where.
§ Duration: The length of time it is expected that a service identified in the individual plan of service will be provided (e.g., three weeks, six months).
§ Medical Necessity: The determination that a specific service is medically (clinically) appropriate, necessary to meet needs, consistent with the person’s diagnosis, symptomatology and functional impairments, is the most cost-effective option in the least restrictive environment, and is consistent with clinical standards of care.
§ Resources: Medicaid Provider Manual (www.michigan.gov/mdch), The Kaiser Foundation (www.kff.org), and Substance Abuse and Mental Health Services Administration (www.samhsa.gov).
Agenda Topic: / Priority Populations
Presenter: / Karen Langeland, Deputy Director – Administration
Discussion &
Conclusions: / History of Outpatient Services at CMHCM
§ We aggressively pursued 3rd party payers so we could serve all of our community members
§ Provided services to all individuals who were Medicaid eligible if there was a mental health need
§ Introduced 65% productivity to allow us to compete for 3rd party payers
§ In January of 2005 a change in Medicaid indicated that we were only funded to provide mental health services to the ‘carve out population’
§ The 3rd party payers are no longer meeting our costs
§ We completed a study to determine the level of service to priority vs. non-priority population
§ We determined the ‘right size’ of our outpatient staffing in each county based on the needs of the priority population
Transition Phase
§ We have more clearly defined our priority population through a guideline utilized by all access workers
§ Priority population does include people who are in crisis. Three visits will be allowed for individuals who present in crisis.
§ We met with the Qualified Health Plans to determine if they would meet our costs. Only one is willing to do that. McLaren-Isabella County
§ The Department of Community Health is clear that we are only to serve priority population
§ We have created and are continuing to develop a resource list for people who will no longer be receiving services from us
§ We posted in our offices in July an announcement of 3rd party payers we are no longer accepting
§ We will continue to serve some BC/BS insured who are priority and Medicare priority and we are currently serving all individuals insured in McLaren Qualified Health Plan in Isabella County as McLaren is meeting our current rates
§ For all non-Medicaid priority individuals beginning November1 we are expecting payment at time of services. This payment will be based on their insurance and /or their ability to pay. We have a sliding fee scale and that will be applied.
Outcomes
§ Frustration in that we are no longer able to serve all of our community members
§ All of our outpatient offices are now ‘right sized’ through attrition and transfer
§ Community members have expressed disappointment with our inability to provide services
§ No one is being ‘kicked out’ of service without a transition plan. If the need for service is short term (less than six sessions) we will continue to see until termination is appropriate.
Agenda Topic: / Evidence Based Practices
Presenter: / Linda Kaufmann, Deputy Director – Operations
Discussion &
Conclusions: / CMHCM formed the Improving Practices Leadership Team in May of this year with the charge of assuring the availability of evidence-base practices in the agency. This was not the first time a team was formed to address this issue, but this time the membership is more inclusive and it is formed with connections to the committees at the state level.
An evidence-based practice is simply one that is a well-implemented, well-evaluated program that produces a consistent positive pattern of results. In other words- it works. This assures that people with a mental illness or developmental disability will have a choice of interventions and supports that have the best evidence of success and usefulness in helping them achieve their goals.
The state selected three evidence-based practices to focus on. They are: Co-Occurring Disorders: Integrated Dual Disorder Treatment; Family Psychoeducation; and Parent Management Training. CMHCM received grant money for the last two years for Co-Occurring training. We have received notice that we have received grant monies for Family Psychoeducation and Parent Management Training for this fiscal year.
Co-Occurring practice is the use of treatment aimed at working with someone who has both a mental illness and issues with substance abuse towards their recovery. Family Psychoeducation is a specific method of working in partnership with consumers and families in a long-term treatment model to help them develop increasingly sophisticated coping skills for handling problems posed by mental illness. Again the goal is to work together to support recovery. Parent Management Training- Oregon Model focus is to improve child and family well being based on social interaction learning theory. It is a family intervention designed to empower parents and build on family strengths. It consists of skill encouragement, limit setting, monitoring, family problem solving and positive involvement.
We also use other evidence-based practices in the agency and have renewed interest in pursuing additional ones. Other examples are the use of Assertive Community Teams (ACT) and Dialectical Behavioral Therapy (DBT.)
We are very excited about the increasing body of knowledge available to staff and consumers about these practices. We have a commitment to use this knowledge as a guide to system improvement.
Agenda Topic: / Service Authorizations
Presenter: / Bryan Krogman, Provider Network Manager
Discussion &
Conclusions: / Some providers have been converted to a prior authorization system for their billing process. The intent is to movie all providers to this process during this fiscal year. Contract Management and Finance are working with providers as they are being selected for conversion. Dialogue took place regarding feedback from providers who are currently on the authorization system. Providers indicate that timeliness is an issue because if the authorized service is not entered in the cmh system by the time the provider bills, the claim will be rejected.
Agenda Topic: / Provider Topics
Presenter: / All
Discussion &
Conclusions: / The Medicare Prescription Plan was discussed. Providers wanted to insure that the consumers were enrolled in the right plan or their medication may not be covered. Anyone who is dual enrolled will be automatically enrolled into this prescription plan. Enrollment begins November 15th through December 31, 2005. The Community Mental Health for Central Michigan Supports Coordinators/Case Managers are working with clients in the enrollment process. For additional links regarding the enrollment process, go to www.arcmi.org.
A question was raised about availability of dentists accepting Medicaid. There are approximately two dentists in Isabella County that will take Medicaid. If there are any additional dentist in the area that will take Medicaid please provide this information to Contract Management staff.
Meeting adjourned at: / 11:25 am
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CMHCM-768 02/17/04