FY 2011 Preliminary Operating Budget & Program Plan September 23, 2010 Public Hearing

1. SAGINAW COUNTY TREATMENT AND PREVENTION SERVICES FY 2011 Preliminary Operating Budget & Program Plan September 23, 2010 Public Hearing

2. Mission and Vision Statements • SCCMHA Mission Statement As the public manager of supports and services for citizens with mental illness, developmental disabilities and chemical dependency and their families, SCCMHA actively strives to develop a system of care and a community that values and embraces the potential and contributions of all individuals with disabilities. • SCCMHA Vision Statement A belief in potential A right to dream An opportunity to achieve

3. Populations Served • Saginaw County Residents: • Children with Serious Emotional Disturbance • Adults with Serious Mental Illness • Adults and Children with Intellectual and Developmental Disabilities • Adults and Children with Substance Use Disorders

4. Philip Grimaldi, Chairman Evelyn Wolfgram, Vice Chair Lisa Kleekamp, Secretary Raymond Albert Steve Fresorger Robin Humble Chuck Howley Andy Johnson, Jr. John Pugh Andrea Schrems Leola Wilson Robert M. Woods, Jr. Maggie Davis, Chair Ann Finta, Vice Chair Tania Neal, Secretary Lynn Bradfield Sarina Brown Mike Cierzniewski Susan Furlo Vicki Mikolajski Cheryl Nelson Merilee Perez Dalia Smith Eileen Vescio Joan Williams Citizens Advisory Committee Board of Directors Sandra M. Lindsey, CEO

5. 2010

6. 2010 Accomplishments Evidence-Based Practices (EBP) • Five (5) Years of EBP Development & Sustainability Plan • Trauma Policy, Gender Specific Groups & Train the Trainer Planning • System of Care Continuation/Expansion to Private Sector Agencies & SAMHSA submission and award for FY 11 • MiFAST Reviews (Community Support Services, Saginaw Psychological Services & Assertive Community Treatment and continuation of multi-stage Integrated Dual Disorder Treatment (IDDT-DDE) • MINT (Motivational Interviewing ) Training Plan

7. 2010 Accomplishments Evidence-Based Practices (EBP) • Peer Support Services Continuation – 14 full and part time positions throughout network and fidelity scale development • Mobile Urgent Treatment Team (MUTT) initiated for children/families for open CMH cases • Family Psycho Education (FPE) completion of one year required external supervision • Co-Location Planning with Health Delivery, Inc. • Parent Management Training-Oregon (PMTO) advancements

8. 2010 AccomplishmentsHousing Resource Center (HRC) • MDCH Shelter Plus Care Housing Grant transferred to SCCMHA by HUD for Sponsor Based Rental Assistance • MSHDA and HUD site visits in 2010 • Continuum of Care leadership and consultation with Corporation for Supportive Housing

9. 2010 Accomplishments Children’s Service • Mobile Urgent Treatment Team Initiated in pilot phase • SED Waiver Expansion continues to grow with addition of general fund SED Waiver • Saginaw Begins Implementation of Project LAUNCH including Mental Health Consultation Services to Pediatric Clinics and Childcare Expulsion Services • Additional case management services added to the network • Implemented services through a grant to treat mothers and children served through the Family Dependency Treatment Drug Court • Mental health consultant at DHS

10. 2010 AccomplishmentsA Life Like Everyone Else • Supporting 42 persons living self determined lives • Micro-enterprises continue to grow with 19 separate businesses • 129 individuals living in supported independence

11. 2010 Accomplishments Managed Care Administration (PIHP) • Developed residential rate methodology • Improved Provider Audit Scores (92% overall average) • Implemented auditing module in sentri • Completed over half of our 83 ARR goals in the first year • Improved processes for assistance with Medicaid entitlements • Implemented Level of Care Utilization System (LOCUS) • Implemented new MDCH Access Standards • Achieved substantial compliance in HSAG Surveys in Compliance, Performance Measure Validation and Process Improvement Project

12. 2010 AccomplishmentsProgram Service Administration (CMHSP) • Awarded a three year CARF Accreditation • Achieved our highest overall score in MDCH Audit in August 2010 (91.5%) • Published Meaningful Life Workbook entitled “A World of Choices” • Expanded data warehouse development • Selected as SED/DHS Waiver Pilot site • Participated as a Project LAUNCH partner • Awarded Mental Health Consultation contract for Head Start

13. 2010 AccomplishmentsProgram Service Administration (CMHSP) • Completed Engineering analysis of 500 Hancock mechanical systems • Implemented a centralized custodial supply system resulting in a 25% reduction in costs • Enhanced employee communication methods and benefit management systems • Revised all SCCMHA employee job descriptions to include and reflect the agency’s Mission, Vision, and Values • Recruited, hired, and provided orientation for 54 new SCCMHA employees

14. 2011

15. State FY 2011 Budget Crisis • 2011 State Budget Leaves CMH financing unknown • No balanced budget from State of Michigan yet • Medicaid funding for FY11 is unknown and federal Medicaid 1915 B&C Waivers lapse 12/31/10 • No appropriations for MDCH line item for General Fund (GF funding unknown) • Legislative proposals indicate reductions to CMH GF financing statewide. Proposed cuts could be as high as 20% or approximately $50 million (Saginaw = $1.6 or 20% reduction) • State Facility rates unknown for FY 11 Note: August 18, 2010 – Multi-year budget projections show a FY11 expenditure reduction is needed to balance FY11 GF budget deficit of $1.3 M (deficit includes projection for Saginaw’s share of GF reduction = $1.6M)

16. Values & Approaches to the 2011 Budget • Protect as many consumers as possible • Medicaid beneficiaries • Persons with the most serious disabilities who are uninsured • MDCH defined priority populations • Protect community safety • Ensure an adequate service array and choice • Preserve an adequate workforce to meet need • Continue to meet obligations to regulatory compliance • Maintain status as PIHP and avoid financial insolvency • Continue to meet MDCH contract and mental health code requirements

17. Other Significant Uncertainties for FY 2011 • As of this presentation, the amount of the funding cut to the 2011 SCCMHA General Fund authorization is unknown. Cut is likely to be between $250,000 - $1.6 million • Ability to manage increasing staff health care costs • Filling of HSW vacancies in 2011 is unknown, leaving $200,000 – 300,000 potential revenue at risk • Uncertain Adult Benefit Waiver enrollment • Managing increased service demand with need to reduce cost • Ability to successfully implement strategies to create financial stability and reserves to manage uncertainties

18. FY 2011 Preliminary Operating Budget August 18, 2010

19. FY 2010 Ten Months Comparison Report Actual to Budget

20. FY 2011 General Fund RealityAs a Result of Projected State Funding Reductions – August 18, 2010

21. Service Trends Persons Served

22. GF Supports Services to the Following Saginaw Citizens: • SCCMHA implemented new level of functioning eligibility requirements for uninsured persons with a CAFAS of 80 for children or a LOCUS of 23 for adults with mental illness. • Waiting List – the waiting list is monitored by the Crisis and Care Management departments with 178 uninsured persons presently waiting for service • Persons requiring specialty mental health services receiving Social Security Disability, insured by Medicare only • Persons requiring specialty mental health services with commercial insurance: • Insurance does not cover full cost of these services • Insurance does not cover CMH deep end services, at all • Insurance benefit for mental health services has been exhausted by either annual or lifetime benefits • Insurance has co-pays or deductibles that are beyond the consumers “Ability to Pay” • Persons with a Medicaid Spend down until Spend down is met

23. State Rules for General Fund • Medicaid funds cannot be used for anything except services to Medicaid beneficiaries • We must serve the most disabled first, all others may wait • Eligibility is determined locally and based on available funding • Based on the Michigan Mental Health Code the following must be provided: • 24 / 7 crisis screening / eligibility determination • Payment for all state inpatient hospital care regardless of any other insurance, including Medicaid • Payment for inpatient psychiatric care at local hospitals for uninsured / under-insured persons for whom we’ve authorized admission

24. Steps Taken in 2010 to Reduce Expenditures / Increase Revenue • Imposed layoff / furlough days • Delayed capitol improvements • Expanded patient assistance program for pharmacy needs • Implemented training/conferences attendance restrictions • Created operational efficiencies • Delayed technology upgrades • Aggressively pursued entitlements in partnership with DHS • Maximized grant opportunities • Instituted provider rate reductions • Removed 28 vacant staff positions from the budget • Closed 177 active cases as of August 1 and transferred cases to healthcare partners

25. Strategies to Reduce Expenditures / Increase Revenues in 2011 • Continue 2010 strategies • Intensify utilization review in all service areas: • Review admission risks and recidivism for inpatient care • Create weighted Community Living Supports scales • Ask SIP providers to implement intensity levels in their programs. • Reduce length of authorizations for person receiving services supported by General Fund • Continue to work with DHS on behalf of consumers with Medicaid spend down • Strengthen entitlement eligibility monitoring • Continue to seek additional new funding sources such as grants and partnerships • Continue to examine service delivery design to ensure efficiencies.

26. Fiscal Year 2011 Priorities • Intensify state facility and forensic center utilization management • Implementation of co-location block grant project with Health Delivering Inc • Continued sustainability of EBP • Implementation of SAMHSA multi-year System of Care grant • Improve inpatient utilization management & reduce local hospital costs • Redesign partnership with Saginaw County Jail

27. Saginaw County Substance Abuse Treatment and Prevention Services

28. TAPS Mission & Vision • To support and advise substance abuse treatment and prevention program through leadership, expertise, and funding in a integrated collaborative equitable effort • To educate community stakeholders including families, schools, service providers, community leaders, faith-based organizations, law enforcement and consumers

29. Saginaw County Substance Abuse Treatment and Prevention Services • Public manager for Substance Abuse Treatment and Prevention Services (TAPS) for Saginaw County • TAPS is under the auspices of Bureau of Substance Abuse, Michigan Department of Community Health • TAPS is a program of the Saginaw County Department of Public Health • Medicaid contract with SCCMHA

30. Cheryl Hadsall, Chairperson Doug Carter Eddie Foxx Russell Howell Dennis Morrison Arthur O’Neal Georgia Reyes James Threws TAPS Advisory Board / Leadership

31. TAPS Leadership and Staff • Bryant J. Wilke, Interim Director • Amy Murawski, Treatment Coordinator • Jean Wackerle, Prevention Coordinator • Colleen Kelly, Access Management • Catherine Filary, Access Management • Roberta Colpean, Administrative Support

32. TAPS Budget FY 2009/10 Medicaid $1,476,913.20 Block Grant(including Prevention, SDA & SPF/SIG) $1,944,636.00 ABW $ 107,886.69 Total Budget $3,529,435.89 • Saginaw County contracts with MDCH for block grant funds • TAPS contracts with SCCMHA for Medicaid Substance Abuse Services • Effective in FY10 - TAPS contracts with SCCMHA for ABW Substance Abuse Services

33. 2009/10 TAPS Targets & Accomplishments • Co-Occurring Disorders (COD) collaboration with SCCMHA • Community collaboration & Evidence-Based Practices • State Prevention Framework (SPF) / State Incentive Grant (SIG) • Methadone Clinic Victory Clinical 1-1/2 years • Family Dependency Treatment Court • Implementation of Recovery Oriented System of Care

34. Admissions

35. Admissions by Funding Source

36. Primary Drug at Admission

37. Age at Admission

38. Indication of Mental Health Issues at Admission

39. Invitation for Public Comment SAGINAW COUNTY TREATMENT AND PREVENTION SERVICES