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June 04, 2002
June 4, 2002
The remaining two Community Mental Health Services Programs who have applied must demonstrate that specific requirements of the application have been met before a recommendation for contract can be approved. Michigan Department of Community Health Director, James K. Haveman, Jr., today announced conditional recommendations for 16 Community Mental Health Services Programs to provide Medicaid managed care for specialty mental health, substance abuse and developmental disability services.
?This will allow us to move forward in our efforts to improve service flexibility and choices for individuals in the public mental health system.? ?In these 18 applications I was very pleased to see the community mental health services programs commitment to ensuring access and quality care for persons with mental illness, developmental disabilities and substance abuse,? said Haveman.
A specialty Prepaid Health Plan is a managed care entity that provides Medicaid covered specialty services under a contract with the state on the basis of prepaid capitation fees. Under Michigan?s program, nearly all Medicaid specialty mental health, developmental disabilities and substance abuse services have been managed by specialty Prepaid Health Plans.
Qualified Community Mental Health Services Programs have been given initial consideration to operate as the specialty Prepaid Health Plan for a designated service area. Under the new plan, a single Prepaid Health Plan is selected to provide Medicaid specialty mental health, substance abuse and developmental disability services in specific geographic areas.
If they do not meet this criteria, they may combine with contiguous Community Mental Health Services Programs to make a consolidated application for Prepaid Health Plan designation. For a Community Mental Health Services Program to be considered for application they must have at least 20,000 Medicaid beneficiaries within their respective catchment area.
Community Mental Health Services Programs must Community Mental Health Services Program applicants must also meet an extensive set of qualification requirements before being selected as the Prepaid Health Plan, including administrative and service considerations. Community Mental Health Services Programs must ensure service eligibility and demonstrate a network of providers to meet consumer needs. assure that consumers continue to have access to the existing array of services and alternatives available to them and must assist consumers in community participation, integration and inclusion.
The Community Mental Health Service Providers must also allow the beneficiary to utilize out-of-network providers under special circumstances. To be selected as a Prepaid Health Plan, Community Mental Health Services Programs must facilitate consumer choices and offer external person-centered planning facilitators to assure the needs and desires of the consumer are fully identified. This process is for planning and supporting individuals and including them, their family members or others in the decision making process as they choose. In Michigan person-centered planning is vital for specialty services.
This panel, appointed by the Governor, is made up of state officials and consumer, family and advocacy representatives. The Community Health Specialty Services Panel conducted the selection process for specialty prepaid health plans.
efore a contract is signed:The following Community Mental Health Services Programs have been recommended for contracts and informed of any outstanding conditions the applicant must meet b
The Department will also continue to make determinations on arrangements for Medicaid services to be delivered to beneficiaries living in Manistee, Benzie and Monroe counties. The panel will reconvene in August to review these agencies progress in meeting requirements and make a recommendation to the Department. While the Detroit-Wayne Community Mental Health Agency and the Muskegon-Ottawa affiliation have not been recommended for contracts at this time, both agencies continue to work aggressively to meet the high standards of care expected from a specialty prepaid health plan.