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.

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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:

mahp minority report on section 298 FINAL

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:

Section 298 Initiative Model Proposal Template Final Draft

The Michigan Department of Health and Human Services (MDHHS) submitted the Final Section 298 Interim Report to the Michigan Legislature on Friday.

MDHHS also launched the next phase of the Section 298 Initiative. As part of the next phase of the initiative, interested stakeholders can submit potential models for consideration by the 298 Facilitation Workgroup.

MDHHS will accept model proposals submitted to [email protected] using a standardized template from January 13, 2017 to February 3, 2017 at 5:00 p.m. The model proposal template can also be viewed below.

Please feel free to contact us is you have questions about the materials or the work of the Section 298 Workgroup. Thank you to all of the families who shared their input throughout this process!

Final Interim Report of the 298 Facilitation Workgroup – Final Version

Section 298 Initiative Model Proposal Template Final Draft

Click here to read the January Newsletter of the Midwest Education Trust

The Education Trust-Midwest is a statewide education policy and advocacy organization focused first and foremost on doing what is right for Michigan children. Although many organizations speak up for the adults employed by schools and colleges, we speak up for students, especially those whose needs and potential are often overlooked.

Ed Trust-Midwest is affiliated with the national organization, The Education Trust, based in Washington, D.C. Opened in Michigan in 2010, Ed Trust-Midwest is the second state office of the Ed Trust.

https://midwest.edtrust.org/2017/01/10/mich-ed-roundup-jan-10/

More fabulous news!

Last night, the state Senate approved all 9 restraint/seclusion bills by votes of 36-1 or 37-0. The bills now go to the Governor for signature.

This is a tremendous victory for children with disabilities. For the first time, Michigan will have a statutory limit on the use of restraint or seclusion, bans on particularly dangerous practices such as prone restraint, mandatory notice and reporting, prevention planning, and training for school staff with state money attached. MPAS has been working on this issue for at least 13 years. We still have work to do in figuring out the enforcement and getting real support into classrooms to change the restraint/seclusion culture where it exists, but this is a good start.

Thank you to everyone who helped, from the attorneys that handled the three case examples we presented to the Senate Education Committee, to the I&R advocates who asked the survey questions that generated the data that addressed the concerns of at least one senator, to our board members who made themselves available to talk with legislators. It took everyone to make this happen.

A link to the draft report can be found in the statement released from MDHHS below. Please be sure to review the draft report and share your views on the series of policy recommendations within it which will be shared with the Michigan Legislature once it is approved. Your voice matters! 

Dear Stakeholders,

The Michigan Department of Health and Human Services (MDHHS) published the draft interim report for the Section 298 Initiative for public review. The Section 298 Initiative is a statewide effort to improve the coordination of physical health services and behavioral health services. The draft interim report contains a series of policy recommendations for the Michigan Legislature on this issue. The draft interim report can be accessed through the following link.

The interim report reflects the discussions and recommendations of the 298 Facilitation Workgroup. MDHHS convened the 298 Facilitation Workgroup to assist with the development of the recommendations. The workgroup also facilitated 44 Affinity Group meetings to gather input from more than 1,076 Michiganders, including 767 consumers and family members, 249 providers, 48 payers and 12 tribal health organizations. The input from the Affinity Group meetings was used to develop the recommendations for the interim report.

Public review of the draft interim report will last from December 14, 2016 to January 4, 2017. MDHHS has established several opportunities to gather comments on the draft interim report, including:

A short online survey to gather feedback on the draft interim report. The survey can be accessed by clicking here.

Written comments on the draft interim report are also being accepted. Comments can be sent via email to [email protected] or by mail to the Section 298 Initiative, with the Policy, Planning, and Legislative Services Administration, South Grand Building, 5th Floor, 333 South Grand Avenue, Lansing, Michigan 48933.

A public forum to gather comments will also be held on January 3, 2017 from 2 to 4 p.m. The forum will be held at the Lansing Community College West Campus, located at 5708 Cornerstone Drive in Lansing. Individuals can RSVP to attend the public forum by using this web link.

MDHHS and the 298 Facilitation Workgroup will use the comments from the public review process to refine and improve the policy recommendations in the interim report. MDHHS will submit the revised interim report to the legislature by January 15, 2017. MDHHS and the 298 Facilitation Workgroup will also create a final report for the Legislature, which will include the policy recommendations from the interim report and additional recommendations on integration models and benchmarks for implementation.

For more information about the draft interim report or the Section 298 Initiative, visit www.michigan.gov/stakeholder298 or send an email to [email protected].

Best regards,

The MDHHS 298 Team

The Association for Children’s Mental Health ACMH is pleased to announce that it was awarded a grant from the  Ethyl and James Flinn Foundation Grant, a private foundation that is committed to improving the scope, quality and delivery of mental health services in Michigan. The Flinn Foundation was founded in 1976 by Ethel “Peggy” Flinn and her brother James “Jim” Flinn Jr. Jim Flinn Jr. who was diagnosed with schizophrenia in his early 20’s, led a remarkable life until hid passing in 2007 at the age of 91. Since the foundation’s inception over 28 million dollars in grant funds have been awarded.

To learn more about the Ethel and James Flinn Foundation and the wonderful work they do visit their website at www.flinnfoundation.org.

 

 

Download the 2016 Michigan Family Voices Fall Newsletter Today! family-voices-fall-2016-newsletter

MCCD Launches “Restoring Kids; Transforming Communities”

Today, MCCD is rolling out our “Restoring Kids, Transforming Communities” campaign to stop funneling thousands of youth through our juvenile justice system every year. In Michigan, children as young as five years old are suspended, arrested, restrained and detained for “breaking the law.” Far too often, these are behaviors that are not criminal for adults, like skipping school, running away, underage drinking, violating curfew or incorrigibility. In fact, over 90% of youth arrests in Michigan are for nonviolent offenses, with a disproportionate impact on youth of color, girls and students with disabilities.

Check out the MCCD November Youth Justice News by clicking here to learn more about this campaign and other important issues in Juvenile Justice in Michigan.

LANSING – Disagreement and grudges remain as Gov. Rick Snyder’s administration nears its deadline for a new proposal on who will manage the state’s more than $2 billion in annual Medicaid dollars for behavioral health.

In February, without any of the workgroups, pilots and forums that typically precede such a fundamental shift, Snyder said management of the behavioral health dollars should be taken away from public mental health groups and given to private health management organizations, who already manage physical care payments.

That plan was scrapped after an uproar from mental health groups and lawmakers of both parties.

Instead, the Legislature gave the state Department of Health & Human Services until Jan. 15 to propose a new funding scheme that will encourage better coordination of physical and behavioral care while maintaining community-based services and transparency. But DHHS hopes to have a draft proposal ready by Nov. 28, a deadline that’s already been pushed back once.

It’s a consequential decision. Whoever manages those funds makes “all the decisions on what to cover … using their networks of providers,” then-DHHS policy director Elizabeth Hertel, who recently took a job with Livonia-based hospital company Trinity Health, said last month.

Representatives of behavioral health groups and HMOs say the debate has calmed some since February. But the two sides are still trading barbs and hurling conflicting analyses and remain suspect of the other side’s motives as they work with DHHS toward a new plan.

Snyder’s original rollout “created a firestorm,” said Rick Murdock, the executive director of the Michigan Association of Health Plans. “I don’t think we’ve recovered from that yet.”

‘$2.4 billion can cause you to miss the point’

Several people from the behavioral health camp — made up mostly of public community mental health organizations and private, nonprofit advocacy groups — said they welcome better coordination with physical health care.

At least 39% of Medicaid and Medicare patients with physical health ailments also have a mental health condition, according to a 2014 federal study.

But they said coordination happens at the clinics, hospitals and homes where patients are treated, not in the boardrooms where payment and coverage decisions are made.

And they said giving the money to HMOs, a mix of nonprofit and for-profit companies, raises several concerns, chief of which is that the HMOs will make decisions based on profits instead of patients.

They point to a recent study, commissioned by the Michigan Association of Community Mental Health Boards, that found no “single financing model is consistently associated with cost savings” and care is most improved by changes where doctors interact with patients.

That study also pointed to other studies showing “a privately administered insurance is intrinsically more expensive” because they have administrative expenses such as sales and marketing.

But Murdock noted the HMOs fall under strict oversight from both the state and federal government, who require accessibility and standards of care. And he pointed to the accrediting firm the National Committee for Quality Assurance, which rated six of 10 Michigan Medicaid HMOs an overall 4 out 5 on their most recent review, which includes a measurement of patient satisfaction.

But Dohn Hoyle, director of public policy at the advocacy group the Arc Michigan, said there’s a reason behavioral health was carved out of Michigan’s move to HMOs under Gov. John Engler in 1990s. He said behavioral health care, especially for persons with developmental disabilities, often requires an intense level of treatment that goes beyond ailments to helping with quality of life issues such as cooking and cleaning. Persons with disabilities “have never fared well with the medical care system,” he said.

“I think $2.4 billion can cause you to miss the point,” Hoyle said. “(HMOs) don’t have an argument that holds water with me, at all.”

Murdock said HMOs would still be required to contract with the community mental health groups currently providing services and the Legislature has required that any funding shift address continuity of care for patients.

Finally, behavioral health groups said taking money from the public mental health organizations will reduce transparency in the management of billions of taxpayer dollars.

When the chief executive of the mental health group in Calhoun County was fired for giving Medicaid dollars to a mysterious Florida psychic, for example, the state’s Open Meetings Act allowed a Battle Creek Enquirer reporter to attend the organization’s board meetings and the state’s Freedom of Information Act allowed the newspaper to obtain illuminating records.

Those laws do not apply to the private HMOs.

Murdock, however, said there still will be a public grievance process for patients who feel they’ve been wronged, and the HMOs have to report voluminous amounts of data to the state and federal government.

“I recognize there are some state programs that don’t have strong oversight,” Murdock said. “This one does.”

‘Very clumsy’

All of those disagreements are deep-seated and decades-old, and people on both sides of the issue said Snyder’s February budget bomb may have made it more difficult to reach an amicable agreement.

Murdock said “integration is going to happen,” one way or another. “A perfect storm” of budgetary pressures are building around Medicaid, the so-called “Pac-Man of budgets” because it takes up such a huge piece of a spending pie chart, he said.

The federal government is rolling back its investment in expanded Medicaid and is tightening rules about the kinds of taxes states can dedicate toward Medicaid costs. At the same time, new spending on roads and other issues is eating up more the state’s general fund, which has always subsidized Medicaid.

Against this backdrop, the administration saw dual benefits in giving behavioral health dollars to HMOs: It could improve coordination, the administration said, and produce administrative efficiencies by removing a group of overseers.

But, when Snyder’s budget proposal in February said DHHS “shall” shift the money to HMOs by Oct. 1, “it was a very clumsy way of moving forward,” Murdock said.

Lt. Gov. Brian Calley, whose daughter has autism and who is himself an advocate for persons with disability, created a “298 workgroup” — taking its name from the section of the DHHS budget dealing with the issue — after the original budget proposal. In July, that group issued a report on “core values” that should inform the debate going forward, including that whatever model is developed should be “person-centered” and “family-driven.”

Around the same time, DHHS began its own 298 workgroup, as required by the language the Legislature approved in place of Snyder’s original request. But several people from the behavioral health side felt hoodwinked — in August, several walked out of a meeting — because they felt DHHS was ignoring the principles developed by the Calley group.

Murdock said the Calley group was lopsided with voices from the behavioral health side.

Those walkouts have since returned to the discussions because “we’ve gotten assurance from the state that those (Calley group principles) are going to be honored,” said Mark McWilliams, director of public policy at Michigan Protection & Advocacy Service. “I don’t think anybody’s walked out in the last few meetings.”

Nonetheless, McWilliams said the behavioral health camp is working on its own proposal, even as DHHS begins gathering input from various groups — patients, providers, funders — as it works toward that late-November draft. The department hopes to gather input on that draft before crafting its final proposal by the January deadline.

With bad blood still bubbling, no one is sure what that January proposal will be.

The final Section 298 language calls on the department to “consider the use of one or more pilot programs” and develop benchmarks to measure progress over a three-year period.

Contact Justin A. Hinkley at (517) 377-1195 or [email protected]. Follow him on Twitter @JustinHinkley. Sign up for his email newsletter, SoM Weekly, at on.lsj.com/somsignup.

Click here to read the entire story and comments on the State Journal Website.

LANSING, Mich. – The Michigan Department of Health and Human Services (MDHHS) recently announced the first meeting dates for the Section 298 Initiative Affinity Groups – the next step in developing recommendations for improving the coordination of physical health and behavioral health services as directed by the state legislature.

MDHHS is also accepting written comments from those wishing to provide feedback but unable to participate in an Affinity Group meeting. Questionnaires are available on the 298 Workgroup webpage www.michigan.gov/stakeholder298 under the “Affinity Group Questions” section.

You can also download a copy of the questions here: affinity-group-questions-for-eligible-populations-and-families. You can also access background information about the process by downloading the following document: To view background about the Affinity Group Meeting process download the following document: background-information-for-affinity-group.

Completed questionnaires should be sent via email to [email protected] or by mail to the Section 298 Initiative, with the Policy, Planning, and Legislative Services Administration, South Grand Building, 5th Floor, 333 South Grand Avenue, Lansing, Michigan 48933.

The first Affinity Group meetings were held on October 4 & 5 and were be focused on gathering information from eligible populations and their families.  MDHHS will announce additional Affinity Group meetings over the next few weeks. During these meetings, MDHHS will collect ideas, input, and feedback from stakeholders to help inform the development of the recommendations by consulting with individuals who receive services, families, providers, service agencies, associations, and other stakeholders.

The Section 298 Initiative is a statewide effort to improve the coordination of physical health services and behavioral health services. The 2017 executive budget proposal began a statewide discussion to develop the best approach for coordinating physical and behavioral health services. The original 298 Workgroup met from March 2016 to June 2016 and produced a report, a set of core values, and design elements for future discussions. The new 298 Facilitation Workgroup and the Affinity Groups will provide additional feedback on the recommendations which must be submitted to the legislature by Jan. 15, 2017.

For more information about the 298 Facilitation Workgroup or the Affinity Groups, visit www.michigan.gov/stakeholder298. To set up an Affinity Group meeting for your organization, email [email protected].