Clinton Eaton Ingham Community Mental Health Authority Coordinating Agency

1. Clinton Eaton Ingham Community Mental Health Authority Coordinating Agency Substance Use Disorder Advisory Council Orientation General Overview Sources of Legal Mandates Financial Overview Services Overview Board Resources

2. “Drug addiction is a brain disease that can be treated” Quote from Nora D. Volkow, M.D., Director of NIDA

3. What is drug addiction? Addiction is defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. It is considered a brain disease because drugs change the brain—they change its structure and how it works. These brain changes can be long lasting, and can lead to the harmful behaviors seen in people who abuse drugs.

4. Functions of a Coordinating Agency Under Section 6228 a) Develop a comprehensive plan for substance abuse treatment, rehabilitation services, and prevention services. b) Review and comment to the Michigan Department of Community Health (MCDH) on applications for licenses submitted by local treatment, rehabilitation, and prevention organizations. c) Provide technical assistance for local substance abuse service organizations. d) Collect and transfer data and financial information from local organizations to MDCH. e) Submit an annual budget request for use of funds for substance abuse treatment, rehab services, and prevention services. f)Make contracts necessary and incidental to the performance of the agency’s functions. g) Annually evaluate and assess services.

5. Sources of Legal Mandates Federal ● Medicaid Specialty ServicesWaiver ● Health & Human Services – Federal Block Grant ● HIPAA (Health Insurance Portability and Accountability Act) ● Adult Benefit Waiver and MiChild ● Balanced Budget Act of 1997 (BBA) ● Deficit Reduction Act of 2006 (DRA) State ● Public Act 368 of 1978, as amended ● Administrative Rules for Substance Abuse Programs in Michigan ● Annual Legislative Appropriations Bill ● Public Act 2 of 1986 – Liquor License Fee ● Public Act 72 of 2007 ● Public Act 72 of 1977 – Medicaid False Claims Act ● Public Act 469 of 1980 – Whistleblower’s Protection Act

6. Clinton Eaton and Ingham Community Mental Health Authority Coordinating Agency Currently Serving: Clinton, Eaton, Gratiot, Hillsdale, Ingham, Ionia, Jackson, and Newaygo Counties. Previous Coordinating Agency functions were held by Mid-South Substance Abuse Commission Mid-South was established: December 18, 1996 Integrated CA functions w/ CEI-CMHA: October 1, 2012

7. CA Region

8. Duties of the SUD Advisory Council • Review substance abuse service array, identified needs of service population, and system capacity for change • Develop new or revise current program services and content • Make recommendations involving local service needs and funding

9. Role of the SUD Advisory Council Global by Nature - Approve Policies - Approval of Budgets Containing Local Funds for Treatment or Prevention of Substance Use Disorders - Advise & Make Recommendations Regarding other Non-Local Funding Sources - Advise and Make Recommendations Regarding SUD Specific Contracts

10. Role of Administration Operational by Nature - Develop Services - Develop Contracts - Evaluate Services - Develop Spending Plan - Assure Compliance of Requirements

11. Nature of Funding Medicaid – approximately 58% federal and 42% state funding for those persons determined eligible by the state Department of Human Services. MiChild and Adult Benefit Waiver (ABW) – approximately 71% federal and 29% state funding. MiChild is for children 18 and under determined eligible by the state Department of Human Services. There is a $5/month payment required to participate. ABW is for the previously qualified State Medical Eligible (SME) individuals. Community Grant – approximately 80% federal and 20% state funding for services provided to those not able to pay based on a mandated state sliding fee scale based on income and number of family members. Public Act 2 - Also known as Cobo Hall or Liquor Tax. Counties have a choice to return all dollars to taxpayers or distribute one-half for substance abuse services to the Coordinating Agency for use in the county from which it was received, and one-half to their county general fund. Funds forwarded to the Coordinating Agency are not county dollars and by law are governed by the Coordinating Agency. Investments – earnings on cash deposited from all funding sources and aggressively but securely managed.

12. Funding Sources for Expenditures Notes: In 2006, Venture removed Medicaid funding for Calhoun County approx. $380,000. In 2006, Community Grant dollars increased one-time by DCH approx. $400,000 In 2007, Community Grant funding increased by $153,530 for SPF/SIG Grant In 2008 removed Calhoun County allocation approximately $800,000 and included a one time DCH increase of $250,000, and $194,333 for SPF-SIG Grant. In 2009, Community Grant funding for SPF-SIG was decreased 267,310 for phase out of grant. Medicaid increased by $632,564, ABW by 135,608, use of PA2 funds and other local increased by 375,741.

13. Recovery Oriented Systems of Care The movement from an acute care model of service delivery to a chronic care model

14. Recovery Oriented Systems of Care • “Michigan’s recovery oriented system of care supports an individual’s journey toward recovery and wellness by creating and sustaining networks of formal and informal services and supports. The opportunities established through collaboration, partnership, and a broad array of services promote life enhancing recovery and wellness for individuals, families, and communities.” • Michigan’s SUD treatment and prevention delivery systems are recognizing that to treat addiction we need to move from an acute care mindset to that of a chronic model

15. Recovery Oriented Systems of Care • Services within a ROSC Framework • Community Based Case Management • Peer Supports • Recovery Coaches • Recovery Centers • Recovery Check-ups • Transitional Housing

16. Recovery Oriented Systems of Care Importance of Community in Recovery • A wonderful analogy from Don Coyhis of White Bison describes the importance of community in recovery. “Temporarily transplanting sick trees, nurturing them back to health, and then replanting them in the original diseased soil from which they were removed makes little sense. We must treat the wounded individuals and the disease soil of community life by treating the community as well as its members – by creating a healing forest. It is in this way that the community becomes simultaneously a recipient of treatment and an instrument of recovery initiation and maintenance.” (Coyhis, 1999)

17. Contracted Substance Use Disorder (SUD) Services • Prevention Services • Community Coalitions • Strategic Planning • Community Based Services (i.e. Environmental Policy Change, Social Marketing Campaigns, Prevention Programming, etc. • Youth Alcohol & Tobacco Access and Availability Activities • Early Intervention/Problem Identification & Referral Services Treatment Services • Outpatient Treatment • Residential-Stabilization • Residential-Long-term • Sub-Acute Detox Services • Methadone Services • Community-based Case Management Services • Co-occurring Treatment (Mental Health/Substance Abuse) • Women’s Specialty Services • Early Intervention • Peer Recovery Support Services

18. What Are We Trying to Accomplish in Prevention? ● Fund Outcome Based prevention programs, policies, and practices. ● Carry out the 2010-2015 Strategic Substance Abuse Prevention Plan through corresponding annual Implementation Plans. ● Utilize the Strategic Planning Process to create regional and local systems change. This planning process increases capacity (skills & abilities) and organizes infrastructure (agencies, staff, & other resources) in local communities to create positive and lasting population level change. ● Engage local communities in data driven decision making to reach prevention outcomes. Communities utilize local, regional, state, and national data to identify needs, develop plans, and allocate resources. ● Work in conjunction with structured multi-sectoral substance use disorder coalitions. CEI/CA participates, trains, and provides technical assistance to all eight county coalitions and their provider networks operating within the CA region.

19. What is a Strategic Planning Process? Why is it Important? It is a capacity building process for demonstrating and documenting outcomes. It involves five steps or paths that include: 1. Needs & Resource Assessment (Data Collection) 2. Capacity Building (Enhanced Skills and Abilities in the Region) 3. Strategic Planning (5 Year Strategic Plan) 4. Implementation (Annual Implementation Plans) 5. Outcome Evaluation (Evaluate, Modify, and Improve Strategies) Substance use disorder coalitions that successfully adopt and institutionalize the strategic planning process will have the ability to bring additional dollars into their county to address identified substance use disorder and behavioral health needs.

20. Access and Utilization Management Function – Care Coordination Center ● Assure a comprehensive array of services to Medicaid and low income uninsured or underinsured individuals residing in the nine-county region. ● Screen to determine eligibility and appropriateness for substance use disorder services. ● Refer to substance use disorder treatment provider or appropriate support (Community Mental Health, County Health Department, etc). ● Contact provider through “warm transfer” to assure appointment for assessment. ● Not an emergency service, but available 24/7 to answer all calls. ● Review authorization requests for appropriate individual needs. ● Provide care management by coordinating individual needs and referring to appropriate services for efficient and effective resource utilization. ● Track and manage service availability; maintaining waiting list information. ● Assure appropriate use of best practices.

21. SUD Advisory Council Resources ●SUD Advisory Council Binder ● CEI-CMHA-CA Staff (ask us questions you want answers to) ● Other Council Members ● CEI-CMHA-CA Web Site – www.ceicmhca.org ● MDCH Web Site – www.mdch.gov/mdch