Crains Michigan Morning January 26, 2017 7:30 p.m.
Mental health organizations hit back on HMO plan for reform
By JAY GREENE –
Direct link to Crain’s Article:http://www.crainsdetroit.com/article/20170126/NEWS/170129868/mental-health-organizations-hit-back-on-hmo-plan-for-reform
Six behavioral health advocacy organizations issued a strong statement ( Advocate Coalition Response to MAHP’s Minority Report) late Thursday afternoon that blasted a Section 298 Workgroup “minority report” (mahp minority report on section 298 FINAL) released earlier this week by Michigan’s 11 Medicaid health plans on their vision of how the state should improve integration of dual behavioral health and physical health systems.
The Michigan Association of Health Plans, which represents the HMOs, said in its report Tuesday that the state Legislature should consider pilot models that would allow HMOs to manage the $2.4 billion Medicaid mental health system.
“The only thing bothering the MAHP is that no one other than them wants public behavioral health dollars turned over to the (managed health plans),” Dohn Hoyle, director of public policy with the Arc Michigan, said in a statement.
“For almost a year now, the MHPs have been shut down at every stage of the Section 298 process, including the lieutenant governor’s initial 120-person workgroup and the subsequent DHHS 298 workgroup (approximately 25 members) that currently exists.”
Doyle said that in 31 smaller workgroup sessions last fall, a majority of the 800 participants expressed “overwhelming opposition to the MHPs controlling behavioral health dollars and services to a greater extent than now.”
The dispute between the public mental health system and the Medicaid HMOs began early last year. Gov. Rick Snyder’s proposed 2017 state budget included a provision that could have allowed the state’s managed care organizations to manage the $2.4 billion Medicaid behavioral health funding. Currently, 10 prepaid inpatient health plans, which are operated by the public mental health system, manage the funding and contract with providers. The HMOs manage about $6 billion in covered Medicaid physical health care services.
Mental health advocates strenuously objected to HMOs taking over the entire system and the issue has been contentious all last year between the two sides and the state. After meeting for nine months with facilitating consultants and the state Department of Health and Human Services, a 91-page interim report was completed two weeks ago and submitted to the Legislature. A final report is due March 15.
But Dominick Pallone, MAHP’s executive director, told Crain’s on Wednesday that the HMO community felt the report did not adequately explain the position of the managed care organizations. The minority report document was intended to present additional information for legislators to mull over.
“My membership did ask us to assist in documenting our industry’s opposition to some of the (MDHHS interim) report’s points, and while they appreciate all the hard work that has gone into this process thus far, they are disappointed that the concept of fully integrating (at the financial and service system levels) the Medicaid program has not been more widely accepted,” Pallone said.
Lt. Gov. Brian Calley, who has become closely involved in the mental health reform efforts, issued the following statement Thursday evening about the dispute:
“Achieving the successful integration of physical and behavioral health care will require hard work and perseverance. Still, it is necessary and the effort is important. The 298 workgroup includes a diverse set of stakeholders, who will differ on these complex issues at times and I appreciate the involvement and perspectives of all who are involved in this process.
“Although the interim report was released, the work is far from complete. I remain committed to the inclusive process we have established and encourage everyone to continue to work together and not lose sight of the main goal, which is to improve the coordination, effectiveness and outcomes of health care services for Michiganders.”
But Mark Reinstein, CEO of the Mental Health Association in Michigan, has a different view about the ultimate goals of MAHP.
“The Medicaid HMOs have failed dramatically in all 298 deliberations that have occurred since last February. So now they want to complain that things haven’t been done satisfactorily,” Reinstein said in a statement. “That is their right, but it is our obligation to point out that they are simply trying to do an end-run on the tremendous amount of work that has taken place on this — work that they participated in and often times supported.”
Reinstein said Snyder’s original proposal to “move all community mental health Medicaid money and clients to the MHPs has been thoroughly discussed and assessed three times in the last year” and “that proposal has gone down every time.”
Pallone told Crain’s that the main reason MAHP issued its minority report was that the MDHSS report process did not allow for dissent opinions to be adequately documented in it.
“The makeup of the workgroup is dominated by behavioral health advocates, prepaid inpatient health plan representatives and community mental health representatives — leaving our opinions in the vast minority,” Pallone said. “This was our way to document those opinions, so that it could not be said that since we participated in the workgroup that we agreed with all of its recommendations.”
Pallone also softly criticized MDHHS for not fully completing its report by Jan. 15, as the state Legislature originally required.
“While the interim report notes that there is additional work to be done by compiling financing model pilot suggestions and establishing annual benchmarks to measure progress in implementing new financing models, our minority report simply notes that we wanted this concluded by the statutory due date,” Pallone said.
“The delay … effectively means that (Snyder’s) fiscal year 2018 executive budget recommendations will not be able to explicitly recommend specific alternative financing model pilots,” Pallone said.
It is expected that the MDHHS will submit a full report to the state Legislature by March 15. It will include additional language that suggests a variety of pilot models by which integration of behavioral health and physical health care be accomplished.
However, the six behavioral health organizations contend that the interim report prohibits HMOs from submitting pilot studies or models in which they manage the dual streams of funding.
“Pilot proposals for health care integration/coordination (should) be … considered, as long as the lead entities for those proposals are public entities, which the state’s Medicaid health plans, or HMOs, are not,” said the statement by the behavioral health groups.
Pallone said the health plan interpretation is that any organization could be selected by MDHHS to manage a pilot demonstration.
“Alternative financing pilot programs are the way to test one set of reforms,” Pallone said in an email Thursday evening. “MAHP thinks they should go forward; this group doesn’t.”
Pallone also said there is wide agreement — simply by reading the interim state report — that the current system is broken and needs fixing.
“At the end of the day, without major reform, the very patients that we all believe need to get more and better treatment will end up with either the same failed system, or worse, less treatment as costs escalate faster than state-allocated resources,” Pallone said.
The six behavioral health organizations also include the Association for Children’s Mental Health, Michigan Disability Rights Coalition, Michigan Protection & Advocacy Service and National Alliance on Mental Illness-Michigan.
For more information you can:
Read the Advocate Coalition’s Response here: Advocate Coalition Response to MAHP’s Minority Report
Read the Minority Report released by the Michigan Association of Health that the Advocate opposes:
To read more about the release of the Interim Final Report click here.
To download MDHHS’s pilot initiative proposal template click the link below: