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Michigan Department of Health & Human Services

Opioid Health Home Kickoff Meeting July 30, 2018 Great Wolf Lodge Jon G. Villasurda Jr., MPH State Assistant Administrator Behavioral Health and Developmental Disabilities Administration. Michigan Department of Health & Human Services.

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Michigan Department of Health & Human Services

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  1. Opioid Health Home Kickoff MeetingJuly 30, 2018 Great Wolf LodgeJon G. Villasurda Jr., MPHState Assistant AdministratorBehavioral Health and Developmental Disabilities Administration Michigan Department of Health & Human Services Putting people first, with the goal of helping all Michiganders lead healthier and more productive lives, no matter their stage in life.

  2. Agenda • Background • Opioid Health Home (OHH) • Overview • Michigan’s Model • Participating Providers • Progress to Date • Questions?

  3. Background

  4. Background

  5. Background • FACTS of Michigan’s PIHP Region 2: • Region 2 the highest per capita number of Medicaid beneficiaries with an Opioid Use Disorder diagnosis in the state • A ranking of opioid needs in Michigan’s 83 county shows nearly half (12) of the top 25 are located within Region 2: • Crawford 1 • Alpena 4 • Roscommon 8 • Iosco 13 • Kalkaska 14 • Otsego 15 • Wexford 17 • Grand Traverse 18 • Oscoda 20 • Cheboygan 22 • Benzie 23 • Emmet 24

  6. Background • FACTS of Michigan’s PIHP Region 2: • Region 2 the highest per capita number of Medicaid beneficiaries with an Opioid Use Disorder diagnosis in the state • A ranking of opioid needs in Michigan’s 83 county shows nearly half (12) of the top 25 are located within Region 2: • Crawford 1 • Alpena 4 • Roscommon 8 • Iosco 13 • Kalkaska 14 • Otsego 15 • Wexford 17 • Grand Traverse 18 • Oscoda 20 • Cheboygan 22 • Benzie 23 • Emmet 24

  7. Background • Local, State, and Federal Governments Taking Action • Increased funding • Legislative initiatives • Administrative initiatives • Leveraging Funds • Utilization of Medicaid/Healthy Michigan Plan • SAMHSA State Targeted Response Grant • SAMHSA Substance Abuse Block Grant • HRSA AIMS Funding • Section 2703 of the ACA (Health Home)

  8. Michigan’s OHH Concept • PIHP and practice level care management and coordination • Emphasis on person-centered care plan • Team-based with potential for multiple care pathways • Explicit and intense physical and behavioral health integration • Documentation and sharing of health information • Referral to and from OHH providers depending on recovery stage (e.g., stability index and treatment needs questionnaire) • Enhanced role of the Peer Recovery Coach and addressing the social determinants of health

  9. Michigan’s OHH Concept • Goal: to bolster access to Medication Assisted Treatment and integrative services for persons with Opioid Use Disorder • Crosses the “physical and behavioral health systems” by utilizing FQHCs and specialty BH providers • Utilize a “hub and spoke model” with Opioid Treatment Programs and Office Based Opioid Treatment providers • Comprehensive care management and coordination, including the sharing of data amongst participating providers • Robust provider staffing standards to ensure all facets of care are attended to • Target Population includes Medicaid beneficiaries with a diagnosis of: • Opioid use disorder, and • Having or being at risk of developing another chronic condition • Geography • All 21 counties in Michigan’s PIHP Region 2

  10. Michigan’s OHH Concept • Model Requirements: • Comply with the State Plan Amendment, Policy, and Handbook • Comply with necessary licensure/waivers to provide MAT • Utilize ASAM and other evidence-based practices for OUD services • Sign an agreement with MDHHS to adhere to OHH provisions • Enroll as a paneled provider with the PIHP • Submit valid encounters to the PIHP for payment for OHH services • Utilize current Medicaid reimbursement for other services (e.g., MAT) • Collect and store the signed MDHHS-5515 form ( beneficiary consent to share behavioral health/SUD information) • Meet specific staffing requirements

  11. Michigan’s OHH Concept • Enrollment Process • Two-pronged process utilizing MDHHS systems: • Autoenrollment • Provider recommended enrollment • Payment Process • MDHHS will pay the PIHP a case rate based on attributed lives • The PIHP will pay OHH providers based on approved encounters for enrolled beneficiaries • Payment will be in the form of a monthly case rate—one payment per month per beneficiary: • Recovery Action Plan Rate (enhanced first month rate to account for longer encounter) • Ongoing Care Management Rate • The PIHP will submit encounters to MDHHS • MDHHS will reconcile periodically based on submitted and approved encounters

  12. Michigan’s OHH Concept • Model Structure: • Prepaid Inpatient Health Plan (PIHP) • High-level care coordination • Enrollment • Payment • Opioid Treatment Program (OTP) • Provider of more intensive recovery services • Methadone, buprenorphine, and naltrexone administration • Robust counseling services and assurance of linkage to other needed services • Office-based Opioid Treatment (OBOT) • Provider of less intensive recovery services • Buprenorphine and naltrexone administration • Primary care and behavioral health services

  13. Michigan’s OHH Concept • Staffing Requirements: • Regional PIHP • Health Home Director (0.5 FTE) • Administrative Support Staff (5 FTE) • OTPs (per 400 patients; in addition to current staffing requirements required by licensure) • RN Care Manager (3 FTE) • Masters-level Clinical Case Manager (1 FTE) • Masters-level Addiction Counselor (2 FTE) • Certified Recovery Coach (3 FTE) • Primary Care Provider (.10 FTE) • Consulting Psychiatrist (.20 FTE) • OBOTs (per 400 patients) • RN Care Manager (3 FTE) • Masters-level Clinical Case Manager (3 FTE) • Certified Recovery Coach or Community Health Worker (3 FTE) • Supervising Primary Care Provider (.15 FTE) • Consulting Psychiatrist/Psychologist (.10 FTE)

  14. Providers Expressing Intent to Participate (as of 5/9/18) • PIHP • Northern Michigan Regional Entity (PIHP in Region 2) • OTP • NMSAS Recovery Center (OTP) • OBOT • Alcona Health Center (OBOT—FQHC) • Centra-Wellness Network (OBOT—CMHSP) • Thunder Bay Community Health Service, Inc. (OBOT—FQHC) • Traverse Health Clinic (OBOT—FQHC) • Geographic equity among the providers expressing intent thus far: • 1 OTP in Gaylord (central portion of region) • 2 OBOTs in the western portion of the region • 2 OBOT in the eastern portion of the region (anticipating another commitment in this portion)

  15. Progress to Date • State Plan Amendment (submitted June, 2018) • Medicaid Policy Promulgation • Public comment ended June, 2018 • Final policy will be released September 1, 2018 • Stakeholder Engagement • Business Integration Center Progress • Enrollment system enhancements (Waiver Support Application) • Payment system enhancements (CHAMPS)

  16. Next Steps • Receive SPA Approval from CMS • Promulgate final Medicaid policy • Incorporate more feedback into the OHH Handbook • Finalize systems accommodation work • Kickoff and Care Model Training • TARGET START DATE: 10/1/2018

  17. Questions? Jon G. Villasurda Jr., MPH villasurdaj@Michigan.gov

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