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FY14 Budget Details Issues related to CMH/SUD services

FY14 Budget Details Issues related to CMH/SUD services .

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FY14 Budget Details Issues related to CMH/SUD services

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  1. FY14 Budget Details Issues related to CMH/SUD services • Medicaid expansion is not included in the FY14 budget. Under the Executive's proposal Medicaid expansion savings within the Department of Community Health budget were projected to be $181.7 million GF/GP and additional federal Medicaid revenue of $1.5 billion, both covering three quarters of the fiscal year. • Items that are included in the final FY14 budget: • Maintains the CMH non-Medicaid services ($283,688,700) • FY14 GF was increased by $9.5 million, however it reflects adjustments to paid days in State facilities (a decrease), catch-up over the last few years of $9.0 million.  There was a corresponding $9.0 million reduction in the Purchase of State Services line. • The other change was a similar adjustment, the transfer of half a million in state-run leases from community residential services line to the CMH line as those leases expire and are picked up by the individual CMHs (16 leases in Oakland and two in Macomb). • 1.25% increase for the Medicaid Mental Health & Substance Abuse Services – Actuarially Soundness Rate Adjustments ($2,233,934,700) – $26.8 million (gross increase from FY13) • Mental Health Services for special populations ($8,842,800) • Eliminates the FY13 one-time appropriation of $3.0 million GF/GP and includes the funds in the ongoing appropriation line item. The $3 million in funding is allocated as follows: $250,000 for Hispanic/Latino Commission within the Department of Civil Rights; $700,000 for ACCESS; $700,000 for Arab/Chaldean; $650,000 for Chaldean Chamber Foundation; and $700,000 for Michigan Jewish Federation. • The remaining $5.8 million in funds go to the following organizations, although they are not equally distributed: ACCESS, Arab Chaldean Council, Chaldean Chamber Foundation, Chinese/Asian, Hispanic, Jewish Federation, Native American, & Vietnam Veterans. • $900,000 for Behavioral Health Homes demonstration project • Projects will be in PIHP Region 6 (Washtenaw, Livingston, Monroe, & Lenawee counties), Northern Michigan PIHP Region 2 and either Saginaw County or PIHP Region 10 (Genesee, St. Clair, Lapeer, and Sanilac counties)

  2. FY14 Budget Details Issues related to CMH/SUD services • Items that are included in the final FY14 budget, cont: • $1.6 million for Jail Diversion Program Initiative • Creates an Advisory Council to advise the Department of Community Health on the state's jail diversion plan; and enhance current jail diversion efforts for individuals with mental illness, emotional disturbance, or developmental disability within five communities. Sec. 500 is related boilerplate to the new program initiative. • $60,000 for Mental Health and Substance Abuse Services for Veterans • Adds $60,000 GF/GP to the Behavioral Health Program Administration line item to support programs designed to improve mental health and substance abuse service quality for veterans and their families. The funding would be allocated as follows: $20,000 for credentialing CMHSPs and Substance Abuse Disorder (SUD) providers in TriCare, an insurance system that pays for treatment for active duty/military families; $10,000 for co-location and/or co-credentialing of CMHSP and SUD providers by the Veterans Health Administration; $20,000 for a law enforcement training program in recognizing post-traumatic stress disorder related behavior; and $10,000 for military cultural competency for all CMHSPs and at least one SUD provider in each coordinating agency area. • $5 million one-time funding for Mental Health Innovation Grants • $2.5 million to finance and support home-based mental health services for children; $1.0 million for care management and treatment of high-risk youth; and $1.5 million for mental health training and awareness programs in identifying youth with mental health needs. Sec. 1901 is related boilerplate for the one-time appropriation. • $35,171,800 million gross ($12 million GF) for Medicaid/MiChild Autism Program • The Executive budget called for $38 million gross, but there was consensus among HFA, SFA, and the budget office to reduce the amount because expenditures have been below anticipated levels. Since the program is an entitlement, if expenditures come in above the estimate, there will be a supplemental budget or transfer, so the adjustment will not affect programming (this happens commonly with other Medicaid lines as well). • No change in the Health Insurance Claims Assessment (HICA) • There is no change to the base FY13 HICA authorization. The most recent estimate is that HICA revenues are short $137.0 million in FY13 and will be short $124.0 million in FY14. Senate Bill 335 which extends the sunset for the current 1% assessment to January 1, 2018 has passed both the House and Senate.

  3. FY14 Budget DetailsVarious local community partners within DCH • Add $2 million for essential local public health services • Adds $11.6 million gross ($3.9 million GF) for the expansion of the Healthy Kids Dental Program. • The expansion would include the counties of Ingham, Ottawa and Washtenaw, enrolling an additional 70,500 children. • Adds $2 million to Autism Center Grants • Maintains a $500,000 GF/GP grant to Eastern Michigan University Autism Collaborative Center, and provides an additional $500,000 GF/GP as onetime funding. Also provides $500,000 GF/GP each as one-time funding to 3 additional higher education institutions for autism education centers and programs. Sec. 1902 is related boilerplate for the one-time funding. • The newly created Department of Insurance and Financial Services (DIFS), which was a part of LARA reduced the $15 million private autism benefit incentive to $11 million. $2 million of which would go to Michigan universities with autism education center as mentioned above (Western Michigan, Central Michigan , Eastern Michigan, & Oakland)

  4. FY14 Budget Details Boilerplate Sections The following items were INCLUDED in the budget: • Section 264 – MDCH shall provide biannual reports summarizing the status of any new or ongoing discussions regarding the Duals proposal. Also allow for a 30 day public/legislative review of the plan prior to final implementation. • Section 490 – Requires DCH to establish a workgroup to develop a plan to maximize uniformity and consistency in the standards required of providers contracting through PIHPs, CMHSPs, and CAs. • Section 491 – Requires DCH to explore policy changes in HSW allocation methodology to redistribute available slots to counties with greater demonstrated need. • Section 492 – Permits the use of GF/GP dollars to fund those CMHSPs that provide mental health services to inmates of county jails. • Section 494 – Directs department to work with accrediting organizations, CMHSPs, and provider agencies to reduce the numbers of gaps in the CMH accreditation process. Submit recommendations to Approps Committee by July 1. • Section 496 – Permits CMHSPs and PIHPs to offset funding reductions by limiting administrative cost of contracts with providers and case management to 9%. • Section 497 – Directs the distribution of substance abuse block grant funds to be based on the most recent federal census.

  5. FY14 Budget Details Boilerplate Sections, cont. • Section 496 – Permits CMHSPs and PIHPs to offset funding reductions by limiting administrative cost of contracts with providers and case management to 9%. • Section 497 – Directs the distribution of substance abuse block grant funds to be based on the most recent federal census. • Section 498 – Requires MDCH to use standard program evaluation measures to assess the effectiveness of substance use disorders treatment programs. • Section 499 – Directs the department to explore ways to use mental health funding to create a statewide system to address the mental health needs of deaf and hard-of-hearing persons. • Section 500 – Requires DCH in allocating funds for the jail diversion programs initiative that priority is given to county sheriffs including  St. Joseph County Sheriff, and community court projects including the 36th District Court community court project. • Section 502 – Requires DCH to develop an outreach program on fetal alcohol syndrome services  and report on efforts to prevent, combat, and reduce the incidence of fetal alcohol syndrome. • Section 503 – Requires DCH to formally consult with CMHSPs from across the state when developing policies and procedures that will impact PIHPs or CMHSPs such changes in funding or state payment mechanics and changes or amendments being considered for the Medicaid as well non-Medicaid contracts. • Section 504 – Requires the DCH to create a Workgroup to make recommendations to achieve more uniformity in capitation payments made to the PIHPs. • Section 1865 – Directs the department to produce a written plan and organizational structure within MDCH of how they will monitor and oversee the integration of care with the Duals plan.

  6. FY14 Budget DetailsOther Items of Interest DHS Budget • $3 increase to private foster care agency administrative per diem payments – Section 546 • Provides a $3 foster care administrative rate increase for private child placing agencies under contract with DHS (from $37 to $40), provided that state law is amended to eliminate the county match rate for the $3 rate increaseand requires private providers to submit quarterly expenditure reports, if required by the federal government. • Includes language requiring a “lean process” of Medicaid Eligibility Determination – Section 620 • The department shall make a determination of Medicaid eligibility not later than 60 days after all information to make the determination is received from the applicant if disability is an eligibility factor. For all other Medicaid applicants, including patients of a nursing home, the department shall make determination of Medicaid eligibility within 45 days of application. • Includes Section 619, which exempts individuals convicted of a drug felony after August 22, 1996 from the federal prohibition on receiving Title IV-A and food assistance benefits; requires benefits be paid to a third party for these cases. Revision adds additional condition prohibiting repeat offenders from receiving Title IV-A and food assistance. • Adds $1.5 million for statewide Centers for Independent Living pilot

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