Mental Health Services for adults with Developmental Disabilities in Kent County:

1. Mental Health Services for adults with Developmental Disabilities in Kent County:

2. Network180 is the Community Mental Health agency in Kent County that manages Mental Health and Substance Use services from the Medicaid Insurance Plan. • Network180 connects individuals eligible for Medicaid and their families to services for mental illness, substance use disorders, or developmental disabilities.

3. Medicaid • You have to be eligible for Medicaid to receive services as an adult with a Developmental Disability from network180. • Healthy Michigan does also cover adult DD mental health services. • If you are not eligible for Medicaid or Healthy Michigan, you need to purchase private insurance and review their insurance coverage plan and providers.

4. How do you know if you are eligible for Medicaid? • Visit the Department of Community Health website http://www.michigan.gov/mdch/0,4612,7-132-2943_4860---,00.html

5. Supplemental Security Income (SSI) • SSI is a cash benefit to low income adults who are aged, disabled, or blind. The Social Security Administration (SSA) determines SSI eligibility. SSI beneficiaries are automatically eligible for Medicaid and the comprehensive package of health care benefits including, vision, dental, and mental health services. Medicaid may continue even if SSI stops. Contact the Social Security Administration to apply for this program. 

6. Medicaid cont. • Disabled Adult Children (DAC) • A person who had a disability or blindness that began before age 22 may be eligible to receive Medicaid benefits in his adult years. He must also be receiving DAC benefits from Social Security.  Most beneficiaries are enrolled in a Medicaid health plan and receive a comprehensive package of health care benefits including vision, dental, and mental health services. Contact the local MDHS office in your county to apply for this program.

7. Insurance choices • People with disabilities who are eligible for Medicaid have choices they need to explore.

8. Explore your eligibility for services • Network180 manages the mental health and substance use portion of Medicaid. • The Department of Human Services also has programs you may be eligible for. • You can explore all of your options and then choose what will best meet your needs.

9. DHS programs • The MI-Choice Wavier is available to seniors (age 65 and over) and persons 18 years of age and older with a disability who meet the medical and financial criteria. Area Agency on Aging and HHS Health Options maintain one wait-list for the MI Choice Waiver. You need choose which option will work best for you. You cannot have both Mental Health and MI Choice Waiver services(there is an exception for psychiatric services) . • PACE – all inclusive care for elderly (over 55). This waiver integrates care through both Medicaid/Medicare. Long-term care assessment criteria must be met. Targets individuals who wish to live in the community. There is also an asset-income criteria. CARE Resources is the provider of PACE. Care Resources is a Health Plan which provides all medical care (24-hours a day), a Day Health Center, home care services and transportation. You cannot have both Mental Health and PACE. • Home Help is for Personal Care needs for people with disabilities who live in unlicensed settings. Some people are eligible for both Home Help and Mental Health Services. Home Help can be used along with Mental Health Services. • Contact the Department of Human Services for more information

10. Mental Health Services • If you have Medicaid Insurance and think you are eligible for mental health services as an adult with a Developmental Disability and you want to explore that option then you need to contact network180: 616-336-3909 • Your first step is to make an appointment at the Access Center. The Access Center will determine if you are eligible for our services. The Access Center clinician will follow the Mental Health Code when making their determination. • If you are eligible for services then you will be able to choose a supports coordination agency to assist you with your services.

11. Contracts • Network180 does not provide direct services • We contract with other agencies to provide the services

12. Supports Coordinator/Case Manager • You get to choose which agency provides supports coordination/case management. If you don’t know which agency you want, Access Center staff will help you decide.

13. Supports Coordinators/Case Managers • Supports Coordinators/Case Managers are your guide for the choices you have about your mental health services. • They assess needs, request authorization for services, link you to resources, coordinate and monitor mental health services.

14. Individual Plan of Service (IPOS) • Federal regulations require states to perform individualized assessments and use person-centered planning (PCP) in developing service plans for Medicaid beneficiaries.

15. Independent Facilitators • You have the right to request an Independent Facilitator for your IPOS meeting. • Your Supports Coordinator/Case Manager will ask you about this during your pre-planning meeting. • The ARC of Kent County can assist adults with Developmental Disabilities with this.

16. Services • Your supports coordinator will help you determine what services you are eligible for. Our guide to services describes the available services such as: • Skill Building • Supported Employment • Respite • Community Living Supports • You can find our Guide to Services on our web site: www.network180.org

17. Skill Building • Defined in Medicaid Manual: “to increase economic self-sufficiency and/or to engage in meaningful activities such as school, work, and/or volunteering. The services provide knowledge and specialized skill development and/or support.” • “Out-of-home adaptive skills training: Assistance with acquisition, retention, or improvement in self-help, socialization, and adaptive skills.” • Vocational focus

18. Skill Building • “Work preparatory services are aimed at preparing a beneficiary for paid or unpaid employment, but are not job task-oriented. They include teaching such concepts as attendance, task completion, problem solving, and safety.” • “Activities included in these services are directed primarily at reaching habilitative goals (e.g., improving attention span and motor skills), not at teaching specific job skills.”

19. Skill Building providers • Contract Providers • MOKA: Community based SB • Hope Network: • Work Skills Solutions • Cedar Springs Center • Gordon Foods • Group Site (DECC) • Self Directed Skill Building is also an option for 1:1 or small group (up to 3).

20. Supported Employment • Defined in Medicaid Manual: “Provide job development, initial and ongoing support services, and activities as identified in the individual plan of services that assist beneficiaries to obtain and maintain paid employment that would otherwise be unachievable without such supports.” • “Supported/integrated employment must be provided in integrated work settings where the beneficiary works alongside people who do not have disabilities.”

21. Supported Employment • “Job development, job placement, job coaching, and long-term follow-along services required to maintain employment.” • “Documentation must be maintained that the individual is not currently eligible for services available through Individuals with Disabilities Education Act (IDEA) or Michigan Rehabilitation Services (MRS).” • Microenterprise

22. Supported Employment Providers • Contract Providers • Goodwill • Real Life Living Services • Self Directed Supported Employment is also an option.

23. Respite Care Services Described in the Medicaid Provider Manual as: Respite care services are intended to assist in maintaining a goal of living in a natural community home and are provided on a short-term, intermittent basis to relieve the beneficiary’s family or other primary caregiver(s) from daily stress and care demands during times when they are providing unpaid care. Respite is not intended to be provided on a continuous, long-term basis where it is a part of daily services that would enable an unpaid caregiver to work elsewhere full time. In those cases, community living supports, or other services of paid support or training staff, should be used. Decisions about the methods and amounts of respite should be decided during person centered planning. PIHPs may not require active clinical treatment as a prerequisite for receiving respite care. These services do not supplant or substitute for community living support or other services of paid support/training staff.

24. Respite "Short-term" means the respite service is provided during a limited period of time (e.g., a few hours, a few days, weekends, or for vacations). "Intermittent" means the respite service does not occur regularly or continuously. The service stops and starts repeatedly or with a time period in between. "Primary" caregivers are typically the same people who provide at least some unpaid supports daily. "Unpaid" means that respite may only be provided during those portions of the day when no one is being paid to provide the care, i.e., not a time when the beneficiary is receiving a paid State Plan (e.g., home help) or waiver service (e.g., community living supports)or service through other programs (e.g., school).

25. Respite Since adult beneficiaries living at home typically receive home help services and hire their family members, respite is not available when the family member is being paid to provide the home help service, but may be available at other times throughout the day when the caregiver is not paid. Respite care may be provided in the following settings: • Beneficiary’s home or place of residence • Licensed family foster care home • Facility approved by the State that is not a private residence, (e.g., group home or licensed respite care facility) • Home of a friend or relative chosen by the beneficiary and members of the planning team • Licensed camp

26. Community Living Supports • Described in the Medicaid Manual as: • “CLS are used to increase or maintain personal self-sufficiency, facilitating an individual’s achievement of his goals of community inclusion and participation, independence or productivity. The supports may be provided in the participant’s residence or in community settings.”

27. Community Living Supports Training in the following areas: • meal preparation • laundry • routine, seasonal, and heavy household care and maintenance • activities of daily living (e.g., bathing, eating, dressing, personal hygiene) • shopping for food and other necessities of daily living • Money management • Non-medical care (not requiring RN or MD intervention) • Socialization and relationship building • Transportation • Participation in regular comm. activities and recreation • Attendance at medical appointments • Reminding, observing and monitoring medication admin. • Assistance with preserving health and safety

28. How can CLS be provided? • CLS in a licensed residential facility • Individual CLS • Life Skills CLS

29. CLS for individuals with Developmental Disabilities • 1,982 Developmentally Disabled (DD) individuals have been served in 2014 (as of August 31). • 341 DD individuals living in group homes with CLS • 358 DD individuals use a contracted provider for individual CLS • 362 DD individuals were authorized for a Life Skills CLS program • 249 DD individuals living in Adult Foster Care (AFC) homes with CLS • 87 DD individuals used Agency with Choice [AWC] for CLS • 70 DD individuals used Direct Employment [DE] for CLS • *Based on data from August 2014 • In 2013, over $50 million was spent on DD Services – $39 million was for CLS (78%)

30. CLS for individuals with Mental Illness • 3 individuals are Direct Employers • 6 individuals are using an Agency with Choice provider • Compared to: • 6 individuals use Hope Network for Individual CLS • 9 individuals use Real Life Living Services for Individual CLS • 97 individuals receive CLS in an AFC home

31. Do CLS and Home Help cover the same things? • Home Help covers: Unskilled, hands-on personal care or cueing along with supervision to ensure the individual performs the tasks properly for activities of daily living (ADL) and instrumental activities of daily living (IADL): • Eating • Toileting • Bathing • Grooming • Dressing • Transferring • Mobility • Taking Medication • Meal preparation and cleanup • Shopping and errands • Laundry • Housework

32. So what’s the Difference Between Home Help and CLS? • Home Help/Expanded Home Help is always the first source of funding for personal care services in an unlicensed setting. This state plan must be exhausted (including appeals) before an individual can have CLS. • A person cannot decide to skip applying for Home help and ask for CLS instead • CLS can “complement” Home Help/Expanded Home Help for some things once the consumer’s needs for assistance have been officially determined to exceed the DHS parameters

33. How do you know if you are eligible for Self-Determination/self-direction? • No one is eligible or ineligible for self-determination or self-direction. • First you need to go to the Access Center at network180 to find out if you are eligible for Mental Health Services. If you are, then the access center will do a warm transfer to an SC agency • Next, your SC/CM determines whether you are eligible for one or more Medicaid covered mental health services. • If you are eligible for Medicaid covered mental health services, then you can choose to have those services delivered through a contracted provider or a self-direction arrangement.

34. Names to know • Annette Tuitel Self-Determination Contract Manager DD Division Network180 790 Fuller NE Grand Rapids, MI 49503 616.855-5247 Annette.Tuitel@network180.org • Sandy Willison • Kim Kooistra BHTD-Gusco Money Management 356 E. Main St PO Box 60 Saranac, MI 48881 616.642.9467 sandyw@bhtdpc.com kimkooistra@bhtdpc.com Network180 Fiscal Intermediary

35. Self-Determination – It’s an Umbrella Concept • Family • Friends • Faith • Education • Community • Physical health • Mental health • Employment • Recreation/hobbies • Volunteering

36. The Myths and the Reality • SD means you get as much of you want of whatever service you want. • There are “SD dollars.” • SD is a program. If you’re in it all your services have to be SD. • Services delivered through SD are based on an individual plan of service with goals and a determination of “medical necessity.” • There isn’t any “extra” money for SD. We have a capitated budget and must serve all eligible people from that pot of money. • SD isn’t a program – it’s a voluntary agreement to receive public mental health services in a different way. You can choose to have some or all of your services through a SD arrangement.

37. The Myths and the Reality continued… • SD gives you freedom from the rules. • You can use SD in a licensed group home or segregated setting. • If you have a guardian, you can’t use SD. • You have to figure SD out all on your own. • People using SD still have to follow Medicaid rules/regulations, labor laws, recipient rights, etc. • SD is intended to be an alternative to segregated and licensed settings. • Lots of people with guardians in Kent County use SD arrangements. But, it must still be the choice of the consumer. • Supports coordinator/case managers, clinical supervisors, the network180 SD contract manager and the FI will help you!

38. Self-determination goals • There are no self-determination goals. • The SC/CM writes goals just as they always have. • They don’t focus on deficits but rather dreams/desires.

39. Managing Risk, Balancing Personal Autonomy, and Protecting from Harm • One challenge is coming up with a way to give individuals greater personal freedom and control while at the same time ensuring that they are able to live safely in the community. • Under a self-directed arrangement, authority and control is shifted to the individual but it does not change the state’s obligation to ensure the health and safety of the individual. • A common challenge we face is the fact that “supervision” is not a mental health service.

40. Community Living Supports • People talk about Community Living Supports (CLS) like it is Self-Determination • But CLS is not Self-Determination • CLS is a service • However, if you are eligible for CLS then you can choose to have an arrangement that supports self-determination to get the CLS you are eligible for. • Self-Determination is a way to get services delivered

41. So what Mental Health services can be self-directed? • You can have an arrangement that supports self-determination for any of the mental health services you are eligible for. • Services that have been self-directed in Kent County: • Community Living Supports is the most common. • Several people also use SD arrangements for Skill Building, Supports Coordination, Supported Employment, Respite, Occupational Therapy and Enhanced Pharmacy. • We also have individuals exploring an SD Arrangement for therapy and behavior specialist

42. Choice of providers for mental health service • You can decide if and how you want the services you are eligible for to be delivered. • Have services from a provider who contracts with network180 OR • Have services through an Arrangement that supports Self-Determination

43. This is where self-direction really begins…

44. Using a provider network180 contracts with • Even when you decide not to self-direct services and use a contracted provider you have choices • Your Supports Coordinator should offer choices of service providers minimally each year at the Individual Plan of Services (IPOS). • They will offer you a Guide to Services Handbook every year which lists the agencies we contract with for each service.

45. Contracted Providers • Network180 has a provider panel of agencies to provide services. • Hope Network West Michigan • MOKA • Spectrum Community Services • Thresholds • Real Life Living Services • Goodwill • Pine Rest • Genesis Housing • These agencies contract with network180 to provide certain services at the rate we pay. • The panel provider agency is the employer but you still have choices about who works with you and when. • MI and Children’s divisions also have contracted providers

46. Agency with Choice Agreement • You choose an agency that is not on the network180 provider panel to provide the service. • This option cannot be used to purchase traditional or segregated services from a non-panel agency. • Contract is between you and the agency using network180 form. • Agency is employer of record while you or your guardian is the managing employer (hiring and scheduling your staff). • You/guardian sign the SD agreement choosing to have services delivered through SD arrangement. • This arrangement uses a Fiscal Intermediary. FI is a Medicaid covered service paid for by network180.

47. AWC: • You control who helps you, how they help you and when they help you. • You chooses where you live • …and you don’t have to move if you decide to change your support provider. • The AWC provider shares employer duties with you. • You live in your own home with supports from an agency. • You are not living in a home run by an agency.

48. Direct Employment • This is the SD arrangement that gives you the most control and responsibility over public mental health services. • You are the employer and recruit, interview, hire, manage, schedule, fire staff in accordance with law. • You ensure employees have required training, back ground checks, have signed required forms (Medicaid, pay roll, taxes, etc.) and returned them to SC/CM and FI. • This arrangement uses a Fiscal Intermediary. The FI acts as “employer agent” and helps with payroll, using budget, determining number of hours of service available, etc.

49. Individual Service Budget • The supports coordinator/case manager is responsible for developing an individual service budget based on the rate (which is based on eligibility). The ISB shows the dollars that have been allocated to the individual for a certain public mental health service. • The supports coordinator/case manager is required to deduct certain funds from the budget, the most common being a Home Help funds.

50. Fiscal Intermediary • Fiscal Inermediary services provide financial accountability and Medicaid integrity for the individual budgets authorized for individuals using SD arrangements.