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August 27, 2002
August 27, 2002
Contracts were recommended today for 18 Community Mental Health Services Programs (CMHSPs) to provide Medicaid managed care for specialty mental health, substance abuse and developmental disability services, the Michigan Department of Community Health (MDCH) reported today. The recommendations by the Community Health Specialty Services Panel came after follow-up on outstanding conditions that resulted from its June review of applications for the specialty prepaid health plans. The panel, appointed by the Governor, is made up of state officials and consumer, family and advocacy representatives. The panel's recommendations will be forwarded to MDCH Director James K. Haveman, Jr. for final approval.
Sixteen of the CMHSPs were recommended in June, pending results of the follow-up. The remaining two, Detroit-Wayne and the Muskegon-Ottawa affiliation, were required to demonstrate that specific conditions of the application were met before a recommendation for contracts could be approved. The Clinton-Eaton-Ingham affiliation was recommended pending MDCH verification of application details by September 1.
"Each of these 18 applicants has made a commitment to ensuring access and quality care for persons with mental illness, developmental disabilities and substance abuse," said MDCH Director James K. Haveman, Jr. "I look forward to receiving the panel's recommendations. I will review them quickly and expect to have a final decision by Friday of this week."
Under Michigan's program, nearly all Medicaid specialty mental health, developmental disabilities and substance abuse services have been managed by specialty prepaid health plans. These are managed care entities that provide Medicaid covered specialty services under a contract with the state on the basis of prepaid capitation fees.
Under the new plan, a single prepaid health plan is selected to provide services in specific geographic areas. Qualified CMHSPs have been given initial consideration to operate as the specialty prepaid health plan for a designated service area.
Application requirements included:
· At least 20,000 Medicaid beneficiaries within their respective catchment area. If they do not meet this criteria, they may combine with contiguous CMHSPs to make a consolidated application for prepaid health plan designation.
· An extensive set of qualification requirements, including administrative and service considerations.
· Assurance 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. CMHSPs must ensure service eligibility and demonstrate a network of providers to meet consumer needs.
· Person-centered planning, requiring that CMHSPs facilitate consumer choices and offer external person-centered planning facilitators to assure the needs and desires of the consumer are fully identified. CMHSPs were required to provide opportunities for consumers, their families and advocates to actively participate in the application development. CMHSPs must also allow the beneficiary to use out-of-network providers under special circumstances.
The CMHSPs recommended for contracts:
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