Community Mental Health for Central Michigan s3

Community Mental Health for Central Michigan Provider Meeting 05/11/04

State and agency budget issues - George Rouman

1. The FY 2004 state budget continues to have problems. There is a projected shortfall in the Medicaid budget of between $80– 120 million, due in large part to a growing demand for services. Some resolution to this budget problem must be reached by year-end and, unless additional revenues are found, there probably will be an Executive Order issued by Governor Granholm.

2. The FIA Adult Home Help issue has been only temporarily resolved. We understand that a new directive will be issued by July 1 that will restore some of the benefits, but will still result in significant funding cuts. You may remember that the original directive would have resulted in a loss of almost a million dollars for our agency. We will await with great interest the issuance of the new directive.

3. The state legislature continues its work on the FY2005 budget. It will take a combination of program reductions and revenue enhancements to achieve a balanced budget next year. No action has been taken yet on the revenue enhancements proposed by the Governor and it is conjectured that these decisions will be delayed until the last minute, both to allow for the emergence of some better revenue news and to allow the pressure for adjournment in preparation for the fall election to persuade our legislators make some of the tough decisions that will have to be made.

4. We are very pleased that we are able to give the direct care staff on our provider network a rate increase this year and that we will be able to continue it into next year. This is a result of our good experience in controlling unnecessary administrative and other costs. We do not know what next year will bring in terms of budget challenges, but at least we will have made this modest gesture toward rewarding some of our most dedicated and underpaid staff.

5. Our agency remains financially solvent, but we believe there will be continuing budget challenges next year. We will continue to take advantage of every opportunity to reduce costs while maintaining the quality of our services. As members of our provider network, you represent more than 67% of our services. Only by working together will we be able to continue to enjoy financial good health and to be able to continue to provide needed services to our consumers.

Residential Services - Rate Setting for Group Home Contracts - Mike Hilley/Bryan Krogman

1 Bryan Krogman provided guidelines to clarify how rates are determined under various situations for Type B group home providers.

1. If a vacancy exists and there is a short-term placement (short term is defined as 2 weeks or less), the provider will bill for the new person at the existing per diem rate for the home.

2. If a vacancy exists and there is an ongoing placement, the staffing schedule and budget is reviewed. An adjustment to the rate may or may not occur depending on the analysis. If no adjustment is needed the provider bills for the new person at the existing per diem rate.

3. If there are no vacancies but existing capacity exists and there is a short term placement, the following approach will be taken:

a. First determine if additional staffing is required. b. If additional staffing is required the contract rate for the new person will be based on the cost of the additional staffing plus $22.00 per day for other operational costs c. If additional staffing is not required, the contract rate for the short-term placement will be $22.00 per day.

4. If there are no vacancies but existing capacity exists and there is an ongoing placement, the staffing schedule and budget are refigured and the per diem rate for everyone in the home is modified, based on the new budget. If the placement does not result in any change in staffing or other budget items, the per diem rates are still refigured spreading the costs out over more individuals.

Residential Services - Group Home Consolidation - Mike Hilley/Bryan Krogman

Vacancies and/or underutilized capacity continues to exist in the licensed group homes. As a result, we are considering consolidation of some Type B homes. Program Directors have looked at this situation and will be using the Person-centered planning approach to address possible client moves. Meanwhile, Providers are urged to begin brainstorming about possible moves. CMHCM will be meeting with Providers to discuss these ideas.

Behavior Management, Human Rights Committee Update - Karen Langeland

The pre-screen committee on behavior management issues has met three times and there are three trends emerging that may simplify and streamline the procedures for Behavior management program review.

1. Individuals who have a secondary diagnosis may take psychotropic medications without a behavior program.

2 2. Individuals who have been on essentially the same program for a long time (3 or more years) and seldom (once or twice a year) require physical intervention will no longer require a behavior program but would require that it be a routine that staff understand.

3. Hands down and hands prompt will now be taught as part of confrontation avoidance and not treated as physical intervention requiring an Incident Report unless there is significant force.

Community Innovation Grants - Karen Langeland

Karen reminded Providers that there are still funds available for the Community Innovation Grants. A recent grant was given to the Probate Court for At Risk Children for Day Camp.

Claims/Electronic Billing Update - Bryan Krogman

1. Bryan reported that there are currently 36 providers set up to submit bills through electronic billing.

2. Peg Schafer and Sandy Schafer will be contacting Providers through e-mail to let them know of any keying corrections.

3. Peg and Sandy will also be e-mailing Providers to let them know of any problems or changes that may occur. For instance, some Providers may receive 2 checks this month, depending on when bills arrive and which check run they are in. For this reason, Providers should be sure to keep their e-mail addresses up to date with CMHCM.

4. If something does not look right while using the new billing process, please call Peg or Sandy.

5. Providers indicated that there is a problem with printing and that some screens have to be hand written.

6. Providers also indicated that there is no notification from the system that CMHCM received the claim. CMHCM is looking into the possibility of sending e-mails or making phone calls to let Providers know we received their claims.

7. Anyone still interested in having their computer set up for electronic billing should contact Bryan Krogman or Ruth Moeggenberg.

FIA Adult Home Help Policy Reversal - Bryan Krogman

1. Bryan reported that the FIA Adult Home Help Policy has been reversed. Letters went out to Providers indicating 2 Options for handling this:

3 Option 1: Providers would bill for regular and complimentary hours at the rate before March 1st. Providers would then look at FIA for retro adjustments. Option 2: Providers would bill for reduced number of hours and an adjustment would be made on future billings. The Provider would then provide a refund to CMHCM.

2. It was noted that Providers are receiving letters from the FIA about reductions, but they are not receiving a copy of the detailed assessment.

3. Providers and CMHCM are both waiting to hear from the FIA regarding refunds.

Provider Recognition - Bryan Krogman

1. There have been 4 or more Providers that have received recognition through this program. Attached is the Provider Recognition Form that may be used.

Provider Topics

1. A Provider asked if Direct Deposit was possible.

At this time, the computer program that is being used, CMHC, does not have the capability for direct deposit. CMHCM is on a waiting list to receive the enhancement to the CMHC software.

2. A Provider questioned if there was a procedure to follow to address maintenance issues in leased homes.

Maintenance of major structural problems are the owners responsibility, as described in the Lease Agreement with the home owner and CMHCM. Major structural problems should be brought to the attention of Bryan Krogman, who will then contact the home owner to ensure that corrections are made in a timely manner. CMHCM may use an inspector to be sure the home owner has corrected the situation the right way.

3. Providers questioned whether they need self-closing doors in group homes where the consumer is unable to open a door. This is a JCAHO requirement, but not an AFC licensing requirement.

Granting of waivers from JCAHO have been given to Providers in the past, when use of a self-closing door would result in seclusion. This process will be looked at by the Leadership Team.

4. A Provider asked how they could be notified about changes as soon as possible.

4 E-mails is a good way to keep Providers informed of changes. Providers should be sure to keep CMHCM updated on their e-mail addresses.

5. The Direct Care Worker Conference is scheduled for June 23, 2004. Contact Karen Bressette in the Training Department for more details.

6. A Provider questioned if there was a process of obtaining a consumer’s personal money for funeral expenses when he/she dies. As it is now, the money sits in the account and then goes through Probate Court. CMHCM will contact the Arc to see if they can look into this problem.

7. Mark Buss handed out information regarding burials. It was noted that some Funeral Homes are willing to work with the family or providers to handle funding.

8. A Provider experienced some conflict with regard to compliance with both Recipient Rights and AFC licensing standards. Licensing and Recipient Rights are trying to communicate with each other during their investigations.

9. Mike Hilley reported that there have been some revisions to the Adult Home Help issue. Revisions are out for public comment. Comments need to be back to FIA by the end of May.

5 COMMUNITY MENTAL HEALTH FOR CENTRAL MICHIGAN

PROVIDER RECOGNITION

Community Mental Health for Central Michigan believes that it is important to provide recognition of its service providers, and in so doing, support staff, agency and community learning that enhances the lives of mental health consumers.

INSTRUCTIONS FOR COMPLETING THE FORM

1. Review the values stated below and then provide a written description identifying which of the values the provider has met and the reasons why. Be sure to identify the provider and include your name and telephone number in case more information is needed.

2. Mail, fax, or hand-deliver the form to CMH for Central Michigan, Attention Customer Services. The mailing address is 301 South Crapo, Mt. Pleasant, MI 48858; the fax # is (989) 773-1968.

VALUES

1. Consumer Focus/Customer Driven Services Consumer satisfaction, Meet person-centered-plan goals (helping dreams come alive), Listening to what the person wants, Consumer on boards, advisory committees, conduct town hall meetings, Consumer employment, volunteers within organization, Consumer controls own funds, selects their own staff, select their own living situation, Consumer education, Consumer defines quality, Mission, vision, policies support self-determination, Cultural responsiveness

2. Consumer Impact and Quality Improvement Involvement in the arts, Volunteer opportunities, Employment, Assisting in the development of natural supports, Community inclusion, Relationship development/building, Gives options to chose from, Quality improvement program that is responsive, Meets or exceeds established outcomes or benchmarks, Addresses safety issues, Access to services, Affordable, accessible housing, Grievance and appeals process/policy, Creative and innovative service provision

3. Consumer/Provider/Community Partnering Systems change initiatives through community collaboration (HSCB participation, local and state initiatives), Advocacy group participation (Arc, RICC), Direct involvement with consumers (assistance with newsletters, micro enterprises, mentoring/teaching)

4. Promoting Education/Advocacy on Mental Health Issues Newsletters, mental health columns, booths at health fairs, newspaper articles, Community Involvement (civic groups, service organizations, advocacy groups), Political advocacy, Sponsoring conferences and trainings, Community organization around issues

______has contributed to the values in the following way(s):

6 (Name of provider) ______

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(Continue on back)

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7 Form completed by:______Phone #______

CMHCM-326 (02/18/04)