Professional Documents
Culture Documents
STANDARDS TRAINING
[Date]
[Place]
Welcome
This training will model the characteristics and the
practices of a high quality customer services unit:
Friendly, welcoming, open attitude
Ready to help
G o v e r n a n c e : M ic h i g a n D e p t . C o m m u n i t y H e a l t h
M e n ta l H e a lt h & S u b s t a n c e A b u s e S e r v ic e s
M D C H / P I H P C o n t r a c t : S e c t io n 6 .3
E x t e r n a l Q u a lit y R e v ie w :
H e a lt h S e r v ic e s A d v is o ry G r o u p ( H S A G )
R e v ie w P r o t o c o ls : S t a n d a r d s V I , V I I & V I II
1 8 P r e - P a id I n p a t ie n t H e a lt h P la n s ( P I H P )
( M a n a g e M e d ic a id M e n t a l H e a lt h B e n e f it)
C u s t o m e r S e r v i c e s U n it
M a y b e d e l e g a t e d b y P I H P s t o C M H S P a f f i li a t e s ,
P r o v id e r N e tw o r k s ( e . g . , M C P N S ) o r,
S u b s t a n c e A b u s e C o o r d in a tin g A g e n c ie s (C A s )
C o m m u n it y : C u r r e n t M e d i c a i d B e n e f ic i a r i e s o f M H a n d S A S e r v i c e s
M e d i c a i d B e n e f i c i a r ie s w h o a r e p o t e n t i a l
M e n t a l H e a lt h a n d S u b s t a n c e A b u s e
R e c ip ie n ts
Background
The federal Balanced Budget Act (BBA) of 1997
was enacted after Congress heard critical
testimony from managed care recipients:
Lack of information about providers
No choice of providers
2006
Background, VI
Therefore, standards are not negotiable
Preamble
Front door: Welcome to Mental Health
Like a concierge service at a hotel
Structure
Funding
Services
Protections
General Service Structure
MDCH
Community Mental
Medicaid Prepaid
Health Services
Inpatient Heath Plans
Programs (46
(18 PIHPs)
CMHSPs)
Services
Each local CMHSP provides an array of Mental Health services through a network
of providers to adults with SPMI, children with SED, persons with DD and
persons with substance use disorders.
Funding
State taxes Federal Medicaid
State Appropriations
Federal Block
MDCH Grant funding
CMHSP - GF contract
CMHSP - PIHP Affiliate agreement Services
The Mental Health and Substance Abuse Treatment Delivery System in Michigan
Established under the state’s This is a ten (10) Medicaid Health Plans Specialty Mental Health and
Private mental health Substance Abuse Mental Health Code, the forty- session annual (16 in the state?) Substance Abuse Managed
and substance use Coordinating six (46) Community Mental benefit provided by Care Services made up of
Agencies (16) Health Services serving the any psychiatrist Provides Medicaid PIHPs (18),
disorder providers
arrange for state’s eighty-three (83) accepting new beneficiaries with up to CMHSP affiliates (46)
include: treatment through Medicaid FFS Twenty (20) outpatient and
counties provide a full array of
a network of of mental health services to patients. sessions per year under Substance Abuse Coordinating
Addiction counselors, licensed locally the basic mental health Agencies (16 in the state)
person with serious mental
Marriage counselors, There is also an benefit for persons with
based treatment health, serious emotional
Licensed social workers, expanded benefit mild to moderate mental The PIHP and its affiliate
providers disturbances, and
Licensed psychologists, from PIHPs and their health needs. (no providers are responsible for
developmental disabilities
Various types of therapists, affiliate CMHSPs substance use disorder providing those Medicaid
based upon their priority of
Physicians, when the person treatment) beneficiaries with moderate to
need.
Psychiatrists requires a “specialty severe needs with all B and B3
Private mental health clinics, level” of care Health Plan providers Specialty Services that are
Those applicants who are the
Private psychiatric hospitals intervention are to refer medically necessary. The array
most involved and find
themselves most urgently in beneficiaries to the of potential services is
need of services are a priority PIHP or CMHSP extensive and by design, very
for services. Those with lower affiliate if beneficiary’s flexible.
levels of needs may be either level of care cannot be
placed on an agency’s waiting adequately addressed There are also three limited
list or referred to private with outpatient services enrollment waivers:
providers in the community for 1. The (DD) Children’s waiver
service. which helps children remain
in their natural home who
Other Services include the otherwise would be admitted
Children's Waiver for children to an ICF/MR,
with emotional disturbances, 2. The (Adult) Habilitation
the MI Child (limited benefit) Waiver (HAB) for persons
program, and the Adult Benefit with developmental
Waiver (limited benefit) disabilities who otherwise
program would be admitted to an ICF/
MR, and
3. The SED waiver for children
with severe emotional
disturbances.
Mental Health Code Services
The public generally does not understand these financial and legal
limitations to service.
Medicaid Mental Health
Services