Michigan Association of COMMUNITY MENTAL HEALTH Boards

1. Michigan Association ofCOMMUNITY MENTAL HEALTHBoards What’s going on in Lansing – Legislative Update MACMHB ~ www.macmhb.org ~ 517-374-6848

2. Legislative Updates MACMHB ~ www.macmhb.org ~ 517-374-6848 • FY14 Supplemental Budget • Healthy Michigan Implementation • FY15 Budget Update • Excellence in Mental Health Act • Other Legislation of Interest

3. FY14 Supplemental Budget MACMHB ~ www.macmhb.org ~ 517-374-6848 • When the Healthy Michigan Plan (Medicaid Expansion) passed the Michigan Senate last fall the bill did not get immediate effect, which pushed the start date from January 1, 2014 to April 1, 2014. • Changing the implementation date made a spending authorization included in the bill "out of date”, which made it necessary for the legislature to pass a supplemental budget. • $152.9 million reduction from the CMH non-Medicaid line – state general fund savings from Medicaid expansion. • After several months of legislative debate, SB 608 finally passed the Legislature in March.

4. FY14 Supplemental Budget, cont. MACMHB ~ www.macmhb.org ~ 517-374-6848 SB 608 details • SB 608 added almost $76 million back into the CMH non-Medicaid line for FY14 - $50.9 million is for the implementation delay of Healthy Michigan and $25 million in additional GF support for CMH non-Medicaid services, but split it between two separate line items- $13 million (of the $25 million) will go directly into the base CMH non-Medicaid line and $12 million will go into a reserve fund.  • SB 608 had two key boilerplate sections :  Sec. 302. The department of community health shall report by April 1, 2014 to the senate and house appropriations committees and the state budget director on the estimated amount of funding necessary for community mental health services programs to continue  the identical level of service to non-Medicaid eligible individuals  that was provided prior to the expansion of the Medicaid program under 2013 PA 107. 4/1/14 report from DCH estimated $67.8M.

5. FY14 Supplemental Budget, cont. MACMHB ~ www.macmhb.org ~ 517-374-6848 SB 608 Details, cont. Sec. 304. Funds appropriated in part 1 for community mental health non-Medicaid services – contingent reserve shall only be expended upon approval by the state budget director of an expenditure plan prepared by the department of community health documenting that the funds are needed to maintain direct services to eligible clients. The state budget director shall provide notification to the senate and house appropriations subcommittees on community health and the senate and house fiscal agencies at  least 15 days prior to exercising the authority under this section. Administration agreed to allocate in last 3 months of fiscal yr. The Senate passed SB 608 30-5. Sen. Jack Brandenburg (R-Harrison Township), Sen. Patrick Colbeck (R-Canton Township), Sen. Joe Hune (R-Hamburg), Sen. Phil Pavlov (R-St. Clair) and Sen. John Proos (R-St. Joseph) voted no. The House passed the bill 106-2. Rep. Rose Mary Robinson (D-Detroit) and Rep. Tom McMillin (R-Rochester Hills) voted no.

6. Healthy Michigan Implementation MACMHB ~ www.macmhb.org ~ 517-374-6848 Open enrollment began on Tuesday, April 1, 2014 for the Healthy Michigan Plan. The Adult Benefit Waiver (ABW) beneficiaries were automatically enrolled into the program (50,000 individuals statewide). • As of Tuesday, April 22 the state has enrolled 89,774people in the Healthy Michigan Plan, which means they are now providing coverage to 139,774residents (this total includes ABW as well). Healthy Michigan (HMP) was intended to improve access to physical and behavioral health care services, but the deep General Fund (GF) reductions and over estimation of the number of persons qualifying for HMP will actually decrease behavioral health access in FY14 & FY15. On April 1, 2014 over $100 million of CMH general fund and ABW support and was removed and placed into state savings as a result of Healthy Michigan Plan implementation. The proposed reduction for the FY15 budget is over a $186 million, which is a 65% drop in state general fund support prior to Healthy Michigan going into effect. Taking all of the savings on day 1 did not allow for an adequate ramp up of Healthy Michigan.

7. Healthy Michigan Implementation, cont. MACMHB ~ www.macmhb.org ~ 517-374-6848 MDCH and State Budget Office estimated that 65% - 70% of the CMH GF costs would be covered under the HMP. However, CMH data shows only 50% of the current GF cost would be spent on individuals qualifying for HMP. MDCH and SBO overestimated the proposed CMH GF savings related to Healthy Michigan Plan. Below are several key services that do not appear to be included in the MDCH/SBO GF projections: • Jail Services • Spend-down for current Medicaid recipients • Children’s services • Medicare only persons • Injectable Drugs

8. FY15 Budget MACMHB ~ www.macmhb.org ~ 517-374-6848 ExecutiveHouseSenate CMH GF services $97,050,400 $97,050,400 $101,871,700 • CMH Non-Medicaid FY13 was $283,688,700 • 1.5% increase for the Medicaid Mental Health Services – Actuarially Soundness Rate Adjustment – $54 million (gross increase from FY14). The Senate added $100 to create an item of difference for conference committee. • All three budget include $900,000 to continue Behavioral Health Homes.

9. FY15 Budget MACMHB ~ www.macmhb.org ~ 517-374-6848 ExecutiveHouseSenate HM funding $205,350,300 $260,200,000 $260,200,000 • Includes a mental health and SUD benefit. The House and Senate appropriation equals a $52 per member/per month payment. • The House and the Senate budgets included $110 million in GF to fill the HICA shortfall. • The Executive and House budget recommendations included $15.6 million in funding to implement several recommendations of the mental health and wellness commission. Initiatives included: coordination between schools and healthcare providers, increasing permanent housing, law enforcement training, information sharing and reducing stigma. The Senate budget removed the $15.6 million in funding and replaced it with a $100 placeholder.

10. FY15 Budget, cont. The Senate and House reduced the community substance use disorder prevention, education, and treatment program by $6.2 million. (These services will be provided and supported by the Healthy Michigan Plan) The Executive and House budget recommendations included $3.3 million in funding to implement several recommendations of the Jail Diversion Council. Initiatives include: Assisted outpatient treatment, probation mental health resources, crisis intervention teams, jail behavioral health treatment, local re-entry behavioral health treatment, and data collection. • The Senate budget removed the $3.3 million in funding and replaced it with a $100 placeholder.

11. FY15 Budget - Boilerplate Senate Budget Section 428 – Local match, Each PIHP shall provide, from internal resources, local funds to be used as a bona fide part of the state match required under the Medicaid program in order to increase capitation rates for PIHPs. (INCLUDED) Sec. 490 – Requires DCH to establish a workgroup to develop a plan to maximize uniformity and consistency in the standards required of providers contracting through PIHPs, CMHSPs, and CAs. (INCLUDED) Section 491 – Requires DCH to explore policy changes in HSW allocation methodology to redistribute available slots to counties with greater demonstrated need. (INCLUDED) House Budget Section 428 – Local match, Each PIHP shall provide, from internal resources, local funds to be used as a bona fide part of the state match required under the Medicaid program in order to increase capitation rates for PIHPs. (INCLUDED) Sec. 490 – Requires DCH to establish a workgroup to develop a plan to maximize uniformity and consistency in the standards required of providers contracting through PIHPs, CMHSPs, and CAs. (NOT INCLUDED) Section 491 – Requires DCH to explore policy changes in HSW allocation methodology to redistribute available slots to counties with greater demonstrated need. (NOT INCLUDED) MACMHB ~ www.macmhb.org ~ 517-374-6848

12. FY15 Budget - Boilerplate Senate Budget • Section 492 – Permits the use of GF/GP dollars to fund those CMHSPs that provide mental health services to inmates of county jails. (INCLUDED) • Section 494 – Directs department to work with accrediting organizations, CMHSPs, and provider agencies to reduce the numbers of gaps in the CMH accreditation process. Submit recommendations to Approps Committee by June 1. (INCLUDED) • Section 496 – Permits CMHSPs and PIHPs to offset funding reductions by limiting administrative cost of contracts with providers and case management to 9%. (NOT INCLUDED) House Budget • Section 492 – Permits the use of GF/GP dollars to fund those CMHSPs that provide mental health services to inmates of county jails. (NOT INCLUDED) • Section 494 – Directs department to work with accrediting organizations, CMHSPs, and provider agencies to reduce the numbers of gaps in the CMH accreditation process. Submit recommendations to Approps Committee by June 1. (INCLUDED) • Section 495 – Directs use of $3.35 million for the mental health diversion council recommendations. (INCLUDED) • Section 496 – Permits CMHSPs and PIHPs to offset funding reductions by limiting administrative cost of contracts with providers and case management to 9%. (INCLUDED) MACMHB ~ www.macmhb.org ~ 517-374-6848

13. FY15 Budget - Boilerplate Senate Budget • Section 497 – Directs the distribution of substance abuse block grant funds to be based on the most recent federal census. (INCLUDED) • Section 498 – Requires MDCH to use standard program evaluation measures to assess the effectiveness of substance use disorders treatment programs. (INCLUDED) • Section 499 – Directs the department to explore ways to use mental health funding to create a statewide system to address the mental health needs of deaf and hard-of-hearing persons . (INCLUDED) House Budget • Section 497 – Directs the distribution of substance abuse block grant funds to be based on the most recent federal census. (NOT INCLUDED) • Section 498 – Requires MDCH to use standard program evaluation measures to assess the effectiveness of substance use disorders treatment programs. (NOT INCLUDED) • Section 499 – Directs the department to explore ways to use mental health funding to create a statewide system to address the mental health needs of deaf and hard-of-hearing persons . (NOT INCLUDED) MACMHB ~ www.macmhb.org ~ 517-374-6848

14. FY15 Budget - Boilerplate Senate Budget • Section 502 – Directs the department to develop an outreach program on fetal alcohol syndrome . (INCLUDED) • Section 503 – Directs the department to formally consult with CMHSPs from across the state when developing policies and procedures that will impact PIHPs or CMHSPs. (INCLUDED) • Section 504 – The department shall work to seek more statewide uniformity in capitation payments made to PIHPS. (INCLUDED) House Budget • Section 502 – Directs the department to develop an outreach program on fetal alcohol syndrome . (INCLUDED) • Section 503 – Directs the department to formally consult with CMHSPs from across the state when developing policies and procedures that will impact PIHPs or CMHSPs. (INCLUDED) • Section 504 – The department shall work to seek more statewide uniformity in capitation payments made to PIHPS. (NOT INCLUDED) MACMHB ~ www.macmhb.org ~ 517-374-6848

15. Excellence in Mental Health Act MACMHB ~ www.macmhb.org ~ 517-374-6848 On March 31, 2014, Congress passed the Protecting Access to Medicare Act (H.R. 4302). This legislation includes provisions of the Excellence in Mental Health Act, which will increase access to community mental health and substance use treatment services while improving Medicaid reimbursement for these services. A summary of these provisions: • Creates criteria for “Certified Community Behavioral Health Clinics” as entities designed to serve individuals with serious mental illnesses and substance use disorders that provide intensive, person-centered, multidisciplinary, evidence-based screening, assessment, diagnostics, treatment, prevention, and wellness services. The Secretary of the Department of Health and Human Services is directed to establish a process for selecting states to participate in a 2-year pilot program. • Provides $25,000,000 that will be available to states as planning grants to develop applications to participate in the 2- year pilot. Only states that have received a planning grant will be eligible to apply to participate in the pilot.

16. Excellence in Mental Health Act MACMHB ~ www.macmhb.org ~ 517-374-6848 • Stipulates that eight (8) states will be selected to participate in the 2-year pilot program. Participating states will receive 90% FMAP for all of the required services provided by the Certified Community Behavioral Health Clinics. • Requires participating states to develop a Prospective PaymentSystem for reimbursing Certified Behavioral Health Clinics for required services provided by these entities.

17. Excellence in Mental Health Act MACMHB ~ www.macmhb.org ~ 517-374-6848 The details: • Criteria For Certified Community Behavioral Health Clinics To Participate In Demonstration Program. Not later than September 1, 2015, the Secretary shall publish criteria for a clinic to be certified by a State as a certified community behavioral health clinic for purposes of participating in the demonstration program • Guidance On Development Of Prospective Payment System For Testing Under Demonstration Programs.Not later than September 1, 2015, the Secretary, through the Administrator of the Centers for Medicare & Medicaid Services, shall issue guidance for the establishment of a prospective payment system that shall only apply to medical assistance for mental health services furnished by a certified community behavioral health clinic participating in the demonstration program.

18. Excellence in Mental Health Act MACMHB ~ www.macmhb.org ~ 517-374-6848 The details: • Planning Grants. Not later than January 1, 2016, the Secretary shall award planning grants to States for the purpose of developing proposals to participate in time-limited demonstration programs. • Demonstration Programs.Not later than September 1, 2017, the Secretary shall select States to participate in demonstration programs that are developed through planning grants awarded, meet the requirements of this subsection, and represent a diverse selection of geographic areas, including rural and underserved areas. No discussions with DCH to date – State interest in pursuing?

19. Other Legislation of Interest MACMHB ~ www.macmhb.org ~ 517-374-6848 HBs 5345-5352 & SBs 805-811 (“R” word Legislation) – The first recommendation to see legislative movement from the Mental Health and Wellness Commission was a fifteen-bill bipartisan, bicameral legislative package that removed the words “mentally retarded” and “mental retardation” from all Michigan laws and replaces them with person-first language that is more respectful and inclusive. • On March 28, Lt. Governor Calley signed into law House Bills 5345 – 5352 and Senate Bills 805 – 811, which puts Michigan in line with all but six other states that have removed the word from their law books. HB 4891 (Dedicated SUD Funding Stream) – MACMHB is working closely with MASACA on legislation that would provide a dedicated funding stream for substance use disorder treatment and prevention services. Dedicates for each state fiscal year 9.5% of the prior year’s net income from alcoholic beverage sales and fees, as reported by the Michigan Liquor Control Commission.

20. Other Legislation of Interest MACMHB ~ www.macmhb.org ~ 517-374-6848 HB 4363 (Open Meetings) – The bill amends the Open Meeting Act to not allow a member of a public body to cast a vote who is not physically present. Under the Open Meetings Act, all decisions of a public body must be made at a meeting that is open to the public. The bill states that "a meeting is not open to the public if a member of the public body casts his or her vote on a decision without being physically present at the meeting.“ • The bill passed the House in May and has been referred to the Senate Government Operations Committee. HB 4486 (SUD Involuntary Commitment) – The bill would allow a family member (or professional) to petition the court to have someone clinically detained for up to five days.  The bill would align SUD with the involuntary provisions of the MH code for mental illness.

21. Other Items of Interest MACMHB ~ www.macmhb.org ~ 517-374-6848 • Mental Health and Wellness Commission Report • Medicare/Medicaid Dual Eligibles Planning • 2014 Election

22. Mental Health & Wellness Commission MACMHB ~ www.macmhb.org ~ 517-374-6848 On February, 20, 2013 Governor Snyder issued Executive Order 2013-6, which created the six-member Mental Health and Wellness Commission within the Michigan Department of Community Health. • The 6-member commission is chaired by Lt. Gov. Brian Calley, DCH Director James Haveman serves as vice chair. Other members include; Senator Bruce Caswell (R – Hillsdale), Senator Rebekah Warren (D – Ann Arbor), Representative Matt Lori (R – Constantine), and Representative Phil Cavanagh (D – Redford). • The goal of the commission is to outline gaps and barriers in the current system and also look at how individuals with mental illness, developmental/Intellectual disabilities, and SUD interact with other state departments.

23. Mental Health & Wellness Commission MACMHB ~ www.macmhb.org ~ 517-374-6848 On Tuesday, January 21, 2014 the Mental Health and Wellness Commission released nearly 60 recommendations they believe are necessary to improve both the lives of and the outcomes for individuals and families living with mental illnesses, developmental disabilities and substance use disorders in our state. The call for change focuses around ideas of removing barriers, eliminating stigma, streamlining procedures to assist healthcare providers and governments and helping our most vulnerable residents. Executive Order 2014-7, extends Commission through December 31, 2015 and adds tasks to Commission: Solutions to overcoming transportation challenges, expansion of the scope of diversion council to include juvenile justice, transition planning for parents and children, and evaluating policies, programs, and services outlined in the Commission report.

24. Dual Eligibles MACMHB ~ www.macmhb.org ~ 517-374-6848 MOU agreement was signed by CMS and MDCH on April 3, 2014. Phased Enrollment Process Phase 1 – Regions 1 (UP) and 4 (SW MI) • Opt-in Enrollment • Enrollment period starts no earlier than December 1, 2014 • Services start no earlier than January 1, 2015 • Passive Enrollment of eligible individuals if they do not opt-out • Includes 60-day and 30-day notification letters • Services start no earlier than April 1, 2015 for people passively enrolled Phase 2 – Regions 7 (Macomb) and 9 (Detroit Wayne) • Opt-in Enrollment • Enrollment period starts no earlier than March 1, 2015 • Services start no earlier than May 1, 2015 • Passive Enrollment of eligible individuals if they do not opt-out • Includes 60-day and 30-day notification letters • Services start no earlier than July 1, 2015 for people passively enrolled Quarterly Regional Forums - The next Forum will be in Macomb County - June 8th at the Macomb County Intermediate School District

25. 2014 Election MACMHB ~ www.macmhb.org ~ 517-374-6848 Who’s on the ballot this year? • Governor (Lt. Governor) • Secretary of State • Attorney General • State Supreme Court Justices • University Board of Regents • All state legislative offices (110 House & 38 Senate seats) • All legislative leadership positions will be open as well – Senate Majority and minority leaders, Speaker of the House, Appropriations Chairs in House and Senate, and majority floor leaders in the House and Senate. • Republicans current hold a 59-51 majority in the House and a 26-12 majority in the Senate. Majority retirements at the federal level will loom large across the state. • Senator Carl Levin • Congressman Dave Camp (R – Midland) • Congressman John Dingell (D – Dearborn) • Congressman Mike Rogers (R – Brighton)

26. Questions/Contact Information MACMHB ~ www.macmhb.org ~ 517-374-6848 Michael Vizena Executive Director mvizena@macmhb.org Alan Bolter Associate Director abolter@macmhb.org (517) 374-6848