Weekly Update June 28, 2024
Shiawassee Health and Wellness CEO leaving & interim announced
Lindsey Hull, the CEO of Shiawassee Health and Wellness, has recently announced that she is stepping down from that role. Ryan Painter has been appointed as the interim CEO. We wish Lindsey the best in the next phase in her career.
DWIHN CEO announces resignation
Eric Doeh, the CEO of the Detroit Wayne Integrated Health Network (DWIHN) has recently announced that he is leaving DWIHN. We wish Eric the best in his next endeavor. The letter, from the Chair of the DWIHN Board of Directors, can be found here.
Work of Michigan’s public mental health system highlighted in latest stories in partnership with Issue Media Group
The latest news stories highlighting the innovation and successes of Michigan’s public mental health system, is made possible by the partnership of CMHA, a number of its members, and the Issue Media Group (IMG). This stories, found at the links below, highlight the innovative work being done in communities across the state:
Community mental health agency a resource for autism services
LifeWays takes a whole person-centered care approach to health care
Connecting to mental health services is as simple as picking up a phone
These stories, along with the growing list of solutions journalism stories centered around the work of Michigan’s public mental health system, can be found at: https://cmham.org/newsroom/
This partnership, with the Issue Media Group (IMG), is built around the concept of “solutions journalism” – providing news about innovative and concrete ways that communities, across Michigan, are addressing the needs of their residents along a number of dimensions – healthcare, economic development, education, the arts, to name a few. Solutions journalism investigates and explains, in a critical and clear-eyed way, how people try to solve widely shared problems. While news sources and many of us typically define news as “what’s gone wrong,” solutions journalism runs counter to that definition by covering the innovative responses to identified needs and problems.
This partnership ensures that the work of Michigan’s public mental health system is highlighted in IMG’s large suite of solutions journalism-focused publications.
If your organization would like to be a part of this effort, via the purchase of a partnership share and the active participation in the generation of stories for these local and statewide electronic newspapers, contact Bob Sheehan at rsheehan@cmham.org or Paul Schutt at paul@issuemediagroup.com
You can subscribe, at no cost, to these publications, on the websites of each of these publications. The list of partner publications and their websites are provided below:
Second Wave -Southwest Michigan
Look for more articles like this over the coming year.
Connections
Connections purpose is to be an avenue for the exchange of information that includes people’s dreams, stories, concerns and successes. Its intent is to connect us all – the individuals who sit around the board room table, our customers, our administrators, caregivers, and our partners in the communities in which we live.
Recipient Rights Booklets
The Mental Health Code states that Community Mental Health Service Providers are required to distribute “Your Rights When Receiving Mental Health Services in Michigan” booklet to each recipient receiving services. To place an order with CMHA please visit our websites bookstore page.
‘BoardWorks’ Videos Online
The CMHA BoardWorks program was developed to assist Board members in fulfilling their obligations as CMH leaders, directors of policy, and advocates for those they serve.
State & Federal Developments
Latest edition of Quarterly Behavioral Health Crisis System Newsletter issued
Weekly Update readers may remember that MDHHS publishes a monthly newsletter that provides a comprehensive picture of the developments within the state’s public mental health crisis system. The most recent edition of this newsletter can be found here.
Peer mentor 101 training announced
The Michigan Developmental Disability Council (MDDC) has recently announced its next series of Peer Mentor training sessions. Details on this series can be found here.
Sibshop facilitator training announced
The Family Center for Children and Youth with Special Health Care Needs is excited to announce that we will be offering a Sibshop Facilitator Training on August 15-16, 2024. This opportunity is open to parents, caregivers, educators, community partners, and local health department staff. During the two day event, participants will learn about sibs’ lifelong concerns, find out how to organize a local Sibshop, and experience what a Sibshop is all about as they join us and a group of young brothers and sisters for a Demonstration Sibshop.
Day one is open to anyone wanting to learn about sibling issues and Sibshops. Individuals interested in becoming a certified Sibshop facilitator should attend both days. Following the Sibshop training, the Family Center will be sharing information about how to apply for a grant to run a Sibshop in your community!
More information on the Sibshop Facilitator can be found here.
FY25 Budget Passed – Goes to the Governor for Signature
Early Thursday morning, the Michigan State Legislature voted on and approved a state budget for Fiscal Year 2025 (FY 25) which begins on October 1, 2024 – they also included a FY24 supplemental as part of SB 747. This budget was months in the making with negotiations culminating between the Governor’s office and Senate and House leadership over the past several weeks following the May 17th Consensus Revenue Estimating Conference’s assessment that revealed the state revenues were trending slights upwards for the General Fund and downwards for the School Aid Fund.
Additional items played a role in the final FY 25 budget, most notably changes applied to Michigan’s Public School Employees’ Retirement System (MPSERS) and the Strategic Outreach and Attraction Reserve (SOAR). Regarding MPSERS, the legislature negotiated a one-year deal which reduces the amount school districts and teachers pay into the retiree health care and the state would instead provide funding with an increased cost of $176.4 million. In order to fund this change in practice, there was no increase to the per pupil foundation allowance. Regarding SOAR, while there were many conversations happening behind the scenes to reform the fund for future economic development projects in the state, the legislature will now wait until the fall to make additional changes. However, the budget did leave more than $600 million on the balance sheet, according to the House Democrats’ spokesperson, money that could be used later for the proposed Strategic Outreach and Attraction Reserve (SOAR) 2.0 proposal that House leadership and the Governor’s office pushed unsuccessfully this spring.
Following these negotiations, the final budget for the Fiscal Year 2025 sits at $82.5 billion. Below are some of the highlights included in the FY 2025 budget:
FY25 Conference Report (Final Bill/SB 747)
Specific Mental Health/Substance Abuse Services Line items
FY’24 (Final) FY’25(Exec Rec) FY’25 (Conference Bill)
-CMH Non-Medicaid services $125,578,200 $125,578,100 $125,578,200
-Medicaid Mental Health Services $3,160,958,400 $3,304,440,700 $3,387,066,600
-Medicaid Substance Abuse services $95,264,000 $97,941,400 $95,650,100
-State disability assistance program $2,018,800 $2,018,800 $2,018,800
-Community substance abuse $79,599,700 $79,626,200 $79,626,200
(Prevention, education, and treatment
programs)
-Health Homes $53,400,100 $53,418,500 $53,418,500
Program
-Autism services $279,257,100 $330,231,300 $329,620,000
-Healthy MI Plan (Behavioral health) $590,860,800 $535,228,600 $527,784,600
-CCBHC $386,381,700 $557,719,100 $525,913,900
-Total Local Dollars $10,190,500 $10,190,400 $10,190,500
Other Highlights of the FY25 Conference Report:
- Certified Community Behavioral Health Clinics (CCBHC) demonstration program – Conference includes $161.8 million Gross ($30.1 million GF/GP) and authorizes 12.0 FTE positions, and includes a study.
- Medicaid Autism rate increase – Conference includes $17.2 million Gross ($6.0 million GF/GP) to increase rates up to $66.00 per hour.
- Direct Care Wage Increase – Conference includes $28.7 million Gross ($10.0 million GF/GP) to provide a $0.20 per hour direct care wage increase.
- Opioid settlement funds (Opioid Healing and Recovery Fund) – Conference requires $4.0 million going be allocated for peer recovery support services and adds $25.0 million on a one-time basis for regional community mental health entities (PIHPs) ($10.0 million), Great Lakes Recovery women’s recovery center ($3.6 million one[1]time), Andy’s Place ($3.0 million one-time), Families Against Narcotics $2.5 million), ARC Michigan Sober Living ($2.0 million), tribal communities ($2.0 million), and recovery community organizations ($1.9 million one-time).
- PIHP Peer Supports Increase – Conference includes $4.0 million state restricted Opioid Healing and Recovery Fund to increase non-hospital peers supports provided through the PIHPs
- Addiction Workforce Medicine Curriculum – Conference includes $1.5 million GF/GP, on a one-time basis for addiction medicine training programming, including anti-stigma education, fellowship GME, and addiction specialists.
- Conference includes $19.6 million GF/GP for the following behavioral health related one-time funding:
- $3.5 million Team Wellness Community Clinic.
- $3.5 million GF/GP for KEYS.
- $3.0 million Kooth adolescent behavioral health tool.
- $2,4 million Hegira walk-in crisis center.
- $2.0 million ACCESS substance use treatment center.
- $1.7 million GF/GP for Common Ground.
- $1.5 million Paladin Community mental health and community outreach.
- $1.0 million Tecumseh FQHC.
- $500,000 Vital data platform.
- $250,000 GF/GP for Living and Learning Center.
- $250,000 GF/GP for Six Feet Over – Lemon-aid.
- Smoking Prevention and Cessation Increase – Conference includes $2.5 million GF/GP to expand tobacco cessation and prevention programming across the state.
- Nursing Loan Repayment Program (One-Time) – Conference includes $9.2 million GF/GP , on a one-time basis, to provide student loan repayment for eligible nurses employed by public and private health facilities in the state.
- Medicaid Behavioral Health Provider Rate Increase (for Medicaid Health Plans mild/moderate) – Conference includes $22.7 million Gross ($6.4 million GF/GP) to increase Medicaid behavioral health reimbursement rates by approximately 33% for both health plans and fee-for-service (FFS).
- Hospital Peer Support Substance Use Disorder Services – Executive includes $8.3 million Gross ($2.5 million GF/GP) to provide Medicaid reimbursements for services provided by hospital-based, peer-support recovery services for individuals with substance use disorders – Conference concurs with the Executive
- Medicaid Coverage for Incarcerated Individuals – Conference does not include – Executive includes $30.5 million Gross ($5.6 million GF/GP) and authorizes 3.0 FTE positions to provide Medicaid-funded health care supports for incarcerated individuals in preparation for reentry into society. Services would be provided in the final 90 days of incarceration. A federal waiver approval is required for this Medicaid change.
- School Per-Pupil Mental Health & School Safety Grant (Sec. 31aa) – Executive provides $300.0 million SAF ($150.0 million ongoing; $150.0 million one-time) for per-pupil payments to districts, ISDs, and the Michigan Schools for the Deaf and Blind for activities to improve mental health and improve school safety.
- Conference provides $25.0 million ongoing SAF and $1.5 million one[1]time GF/GP. Concurs with Executive to strike requirement on 50% of funds being used for mental health. Requires recipients to opt-in to receive per-pupil funding. Concurs with House to retain nonpublic schools as eligible recipients. Expands allowable uses and allows for no uses not explicitly listed.
FY 24 Supplemental Budget Items
- Certified Community Behavioral Health Clinic Demonstration Includes $39.3 million Gross ($19.4 million GF/GP) to account for costs related to FY 2022- 23 settlements, increases to the prospective payment rate, and a higher than anticipated caseload from clinic’s daily visits.
- CMHSP Supplemental Retroactive Payment Includes $5.4 million Gross (net increase of $3.8 million GF/GP) to provide retroactive payments to Medicaid methadone service providers that were not reimbursed at the bundled rate of not less than $19.00.
Key Boilerplate Sections
Section 231 – Direct Care Workers (reporting requirements) – (2) Not later than March 1 of the current fiscal year, the department shall submit a report to the standard report recipients that includes the following information by program and provider type for the previous fiscal year:
(a) Hours of service that qualified for the direct care worker wage increase.
(b) The aggregate increase in wages attributable to the funding appropriated in part 1.
(c) A comparison of the projected increase included in the capitation rates and the reported amount expended on the wage increase.
Sec. 907. Community Substance Use Disorder Prevention, Education, and Treatment – REVISED Requires that appropriations for community substance use disorder prevention, education, and treatment be expended to coordinate care and services provided to individuals with severe and persistent mental illness and substance use disorder diagnoses; requires DHHS to approve the managing entity fee schedules for providing substance use disorder services and charge participants in accordance with their ability to pay; requires the managing entity to continue current efforts to collaborate on the delivery of services to those clients with mental illness and substance use disorder diagnoses with the goal of providing services in an administratively efficient manner. Executive, House, Senate, and Conference revise by deleting requirement that DHHS approve managing entity fee schedules.
Sec. 912. Salvation Army Harbor Light Program – RETAINED Requires DHHS to contract with the Salvation Army Harbor Light Program for providing non-Medicaid substance use disorder services, if program meets standard of care. Executive deletes. House, Senate, and Conference retain.
Sec. 917. Michigan Opioid Healing and Recovery Fund and Report – REVISED Allocates $23.2 million from the Michigan Opioid Healing and Recovery Fund, MCL 12.253, to supplement other opioidrelated programs and services and requires a semiannual report. Executive revises by requiring DHHS to provide a portion of the funds to create incentive pool to local recipients for goals and recommendations of the Opioid Advisory Commission. House revises by increasing the amount and by listing out specific grant programs and recipients. Senate revises dollar amount. Conference revises to require $4.0 million be allocated for peer recovery supports.
Sec. 924. Autism Services Fee Schedule – REVISED Requires DHHS to maintain a fee schedule for autism services by not allowing expenditures used for actuarially sound rate certification to exceed the identified fee schedule, also sets behavioral technician fee schedule at not less than $53.20 per hour and not more than $58.20 per hour. Executive deletes. House revises by increase the behavioral technician rate to not less than $62.00 per hour. Senate revises to $70.00 per hour. Conference revises to $66.00 per hour.
Sec. 960. Autism Services Provision and Cost Containment – REVISED Requires DHHS to continue to cover all autism services that were covered on January 1, 2019; to restrain costs required DHHS to develop written guidance for standardization; and requires 3-year reevaluations, unless a clinician recommended an earlier reevaluation, and require maintenance of statewide provider trainings, limits practitioners who can perform a diagnostic evaluation and requires evaluations performed by a master’s level practitioner to be reviewed by a second practitioner, provide fidelity reviews and secondary approvals, and prohibit specific providers from providing both evaluation and treatment; requires a report. Executive deletes. House revises by removing specific listing of qualified licensed practitioners and for master’s level evaluations to be reviewed by another practitioner. Senate retains. Conference concurs with the House with technical revisions.
Sec. 965. Methadone Medication Assisted Treatment – RETAINED Requires DHHS to reimburse methadone administration, bundled rate H0020, to at least $19.00. Executive and House delete. Senate and Conference retain.
Section 1001 – CMHSP Eligibility by Category – Sec. 1001. Not later than May 15 of the current fiscal year, each CMHSP shall submit a report to the department that identifies populations being served by the CMHSP broken down by program eligibility category. The report must also include the percentage of the operational budget that is related to program eligibility enrollment. Not later than February 15 of the current fiscal year, the department shall submit the reports described in this section to the standard report recipients.
Sec. 1002. Certified Community Behavioral Health Clinic (CCBHC) Demonstration Criteria – NEW Executive establishes criteria organizations need to meet to be part of the CCBHC expansion including: be a CMHSP or other eligible organization as outlined in federal law, be able to achieve CCBHC certification by September 1, 2024, and have implemented evidence-based practices by July 1, 2024 including Air Traffic Control Crisis Model with MICAL, assertive community treatment, cognitive behavioral therapy, trauma-focused cognitive behavioral therapy, medication assisted treatment, and motivational interviewing. House does not include listing of specific evidence-based practices, adds requirement that funds are prioritized for organizations in counties without a CCBHC, and includes a legislative report. Senate concurs with the Executive with technical edits. Conference does not include listing of specific evidencebased practices and requires administrative funds be used for outreach to encourage CCBHC expansion into new counties.
Section 1006 – CCBHC Report – Sec. 1006. (1) From the funds appropriated in part 1 for certified community behavioral health clinics on a semiannual basis, the department shall submit a report to the standard report recipients on the following:
(a) The total number of clients served by CCBHC.
(b) The total number of daily visits per CCBHC.
(c) The amount of prospective payment system rates for each center over the entire demonstration period allocated across the 9 service types.
(d) The total expenditures by CCBHC in the previous fiscal year.
(e) The total cost factors and implications in interpreting how CCBHCs deliver care over the course of the demonstration change.
(f) The comparison of costs for a random sample of enrollees between care provided by a CCBHC provider and non-CCBHC Medicaid provider.
The sample must include participants known to have received services at CCBHC providers and non-CCBHC Medicaid providers.
Sec. 1059. State Psychiatric Hospital and Center for Forensic Psychiatry Performance Report – REVISED Establishes outcomes and performance measures for the Center for Forensic Psychiatry and state psychiatric hospitals, and requires a report. House, Senate, and Conference revise to include outcome measures by adults and children, total number of admission requests, and number and reasons for individuals removed from the waiting lists.
Section 1929 – CCBHC Study – Sec. 1929. (1) From the funds appropriated in part 1 for certified community behavioral health clinics study, the department shall allocate $250,000.00 to complete a comprehensive quantitative spatial analysis to evaluate cannibalization effects on existing enrolled locations of community behavioral health clinics. The purpose of this evaluation is to provide actionable insights into the extent of cannibalization and inform strategic decision-making processes related to site selection, network optimization, and future certified community behavioral health clinic expansion. The comprehensive quantitative spatial analysis shall include, but not be limited to, the following:
(a) Inclusion of geographic information system (GIS) methodologies and statistical analysis techniques to define catchment area and participant volume for existing clinics for the periods before and after expansions and forecasted amounts for newly added clinics.
(b) The analysis will involve geocoding existing clinic locations, spatially joining demographic and participant data, performing buffer and overlap analysis, regression modeling, and validating results against historical data for the period before and after clinic expansion.
(2) As used in this section, “cannibalization effects” means the change in participant volume due to marginal expansion of additional clinic sites within the same relative geographic area.
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Resources from Great Lakes MHTTC
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