Michigan Department of Community Health • Responsible for delivery of all publicly funded mental health, developmental disability and substance abuse services. • Services organized around county-sponsored community mental health services programs (CMHSPs). 48 CMHSPs in state's 83 counties. Mental Health Code • Michigan mental health code outlines the responsibilities of the state and CMHSPs. Code Requirement effective 1997 • 330.1712 Individualized written plan of services. • Sec. 712. (1) The responsible mental health agency for each recipient shall ensure that a person-centered planning process is used to develop a written individual plan of services in partnership with the recipient. Person-Centered Planning Practice Policy Guideline • Provide direction to community Mental Health Service Programs who must implement Mental Health Code Requirement. • Attachment to the contract between the Department of Community Health and Michigan 48 community mental health services programs. Policy Practice Guideline Essential Elements • 1. Person-centered planning is a process in which the individual is provided with opportunities to reconvene any or all of the planning processes whenever he/she wants or needs. • 2. The process encourages strengthening and developing natural supports by inviting family, friends and allies to participate in the planning meeting(s) to assist the individual with his/her dreams, goals and desires. • 3. The development of natural supports shall be viewed as an equal responsibility of the CMHSP and the individual. The CMHSP in partnership with the person, is expected to develop, initiate, strengthen, and maintain community connections and friendships through the person-centered process. • 4. The individual is provided with options of who facilitates his/her meeting(s). Essential Elements • 5. Before a person-centered planning meeting is initiated, a preplanning meeting occurs. In preplanning the individual chooses: • a. dreams, goals, desires and any topics about which he/she would like to talk Essential Elements • b. topics he/she does not want discussed at the meeting • c. who to invite • d. where and when the meeting will be held • e. who will facilitate • f. who will record • 6. Potential support and/or treatment options to meet the expressed needs and desires of the individual are identified and discussed with the individual. • Health and safety needs are identified in partnership with the person. The plan coordinates and integrates services with primary health care. Essential Elements • 7. The individual has ongoing opportunities to express his/her needs and desires, preferences, and to make choices. This includes: • a. Accommodations for communication, with choices and options clearly explained, shall be made. • b. To the extent possible, the individual shall be given the opportunity for experiencing the options available prior to making a choice/decision. This is particularly critical for those persons who have limited life experiences in the community with respect to housing, work and other domains. • c. Individuals who have court-appointed legal guardians shall participate in person-centered planning and make decisions that are not delegated to the guardian in the Guardianship Letters of Authority. • d. Service delivery shall concentrate on the child as a member of a family with the wants and needs of the child and family integral to the plan developed. Parents and family members of minors shall participate in the person-centered planning process unless: • (1) The minor is fourteen years of age or older and has requested services without the knowledge or consent of parents, guardian or person in loco parentis within the restrictions stated in the Mental Health Code; Essential Elements • (2) The minor is emancipated; or • (3) The inclusion of the parent(s) or significant family members would constitute a substantial risk of physical or emotional harm to the recipient or substantial disruption of the planning process as stated in the Mental Health Code. Justification of the exclusion of parents shall be documented in the clinical record. 8. Individuals are provided with ongoing opportunities to provide feedback on how they feel about the service, support and/or treatment they are receiving and their progress toward attaining valued outcomes. Information is collected and changes are made in response to the individual's feedback. • 9. Each individual is provided with a copy of his/her person-centered plan within 15 business days after their meeting. • Person-centered planning processes begin when the individual makes a request to the Community Mental Health Services Program (CMHSP). The first step is to find out from the individual the reason for his/her request for assistance. During this process, individual needs and valued outcomes are identified rather than requests for a specific type of service. Since person-centered planning is an individualized process, how the CMHSP proceeds will depend upon what the individual requests. Medicaid 1915(b)(c) Waiver Beginning October 1, 1998 • Capitated pre-paid specialty service system. • For persons with developmental disabilities, the CMHSP specialty services plan is operated in conjunction with the state's Home and Community Based Habilitation Supports Waiver. • Traditional health care services including physician, hospital etc., are provided by the Medicaid health care provider. Purpose of the Waiver Plan • Increased flexibility in order to permit more individualized supports and services as desired by consumers and delivered at the appropriate intensity and duration for the individual. • Incentives for provider agencies to develop and utilize more cost-effective options. Contain growth of Medicaid costs. • Support the values of self-determination and of the provision of quality services and supports that consumers want and need to lead productive lives in their communities. Waiver Services • CMHSPs manage mandatory and optional Medicaid specialty services and supports for any Medicaid recipient in the service area requires specialty services. Recipients may either self-refer to or be directed to the CMHSP by their primary health care providers (qualified health plans). • The CMHP is responsible to provide medically necessary covered specialty mental health and substance abuse services, or under authority of Section 1915 (a) (1) (A), they may elect to provide alternative services that meet the primary objectives, essential functions and intended outcomes of a covered service to any Medicaid eligible person in the service area who requires such alternative services. Services • The 1915(b) and (c) waiver permitted Michigan to offer covered state plan services and home and community-based services, and from any savings resulting from moving to managed care, "alternative services." Individuals may select during person-centered planning a mix of covered and alternative services, or covered or alternative services only, depending on what services best meet their needs and will assist them in achieving their goals. Alternative Services for People with Mental Illness • 1. Family Skills-MI • 2.Respite Care • 3. Community Living-Training and Supports • 4. Housing Assistance • 5. Skill Building Assistance • 6. Extended Observation Beds • 7. Wraparound • 8. Direct Prevention Services • 9. Peer Directed and Operated Services Alternative Services for People with Developmental Disabilities • 1. Crisis Stabilization • 2. Supports Coordination • 3. Family Support-Family Skills • 4. Respite Care • 5. Community Living- Staff • 6. Community Living-Equipment • 7. Community Living - Environmental Mods Alternative Services for People with Developmental Disabilities • 8. Housing Assistance • 9. Skill-building - all other • 10. Enhanced Health Care Staff • 11. Assistance for Challenging Behavior • 12. Prevention - Direct Alternative Substance Abuse Services • 1. Residential Detoxification • 2. Residential treatment Waiver Renewal Requirement Procurement Process • Competitive Procurement for contracts beginning October 1, 2002. • Application for Participation • Applicants to become prepaid health plans must provide a plan for consumers to have the option to request independent facilitation of the person-centered planning process.