Transcript Self-Direction of Mental Health Services in Kent County

Mental Health Services for
adults with Developmental
Disabilities
in Kent County:
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 Network180 is the Community Mental Health agency
in Kent County that manages Mental Health and
Substance Use services from the Medicaid Insurance
Plan.
 Network180 connects individuals eligible for
Medicaid and their families to services for mental
illness, substance use disorders, or developmental
disabilities.
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Medicaid
 You have to be eligible for Medicaid to receive services
as an adult with a Developmental Disability from
network180.
 Healthy Michigan does also cover adult DD mental
health services.
 If you are not eligible for Medicaid or Healthy
Michigan, you need to purchase private insurance and
review their insurance coverage plan and providers.
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How do you know if you are
eligible for Medicaid?
 Visit the Department of Community Health website
http://www.michigan.gov/mdch/0,4612,7-132-2943_4860---,00.html
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Supplemental Security Income (SSI)
 SSI is a cash benefit to low income adults who are
aged, disabled, or blind. The Social Security
Administration (SSA) determines SSI eligibility. SSI
beneficiaries are automatically eligible for Medicaid
and the comprehensive package of health care benefits
including, vision, dental, and mental health services.
Medicaid may continue even if SSI stops. Contact the
Social Security Administration to apply for this
program.
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Medicaid cont.
 Disabled Adult Children (DAC)
 A person who had a disability or blindness that began
before age 22 may be eligible to receive Medicaid
benefits in his adult years. He must also be receiving
DAC benefits from Social Security. Most beneficiaries
are enrolled in a Medicaid health plan and receive a
comprehensive package of health care benefits
including vision, dental, and mental health services.
Contact the local MDHS office in your county to apply
for this program.
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Insurance choices
People with disabilities who are
eligible for Medicaid have choices
they need to explore.
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Explore your eligibility for services
 Network180 manages the mental health and
substance use portion of Medicaid.
 The Department of Human Services also has
programs you may be eligible for.
 You can explore all of your options and then
choose what will best meet your needs.
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DHS programs
 The MI-Choice Wavier is available to seniors (age 65 and over) and persons
18 years of age and older with a disability who meet the medical and
financial criteria. Area Agency on Aging and HHS Health Options maintain
one wait-list for the MI Choice Waiver. You need choose which option will
work best for you. You cannot have both Mental Health and MI Choice
Waiver services(there is an exception for psychiatric services) .
 PACE – all inclusive care for elderly (over 55). This waiver integrates care
through both Medicaid/Medicare. Long-term care assessment criteria must
be met. Targets individuals who wish to live in the community. There is also
an asset-income criteria. CARE Resources is the provider of PACE. Care
Resources is a Health Plan which provides all medical care (24-hours a day),
a Day Health Center, home care services and transportation. You cannot
have both Mental Health and PACE.
 Home Help is for Personal Care needs for people with disabilities who live
in unlicensed settings. Some people are eligible for both Home Help and
Mental Health Services. Home Help can be used along with Mental Health
Services.
 Contact the Department of Human Services for more information
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Mental Health Services
 If you have Medicaid Insurance and think you are eligible
for mental health services as an adult with a
Developmental Disability and you want to explore that
option then you need to contact network180: 616-336-3909
 Your first step is to make an appointment at the Access
Center. The Access Center will determine if you are eligible
for our services. The Access Center clinician will follow the
Mental Health Code when making their determination.
 If you are eligible for services then you will be able to
choose a supports coordination agency to assist you with
your services.
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Contracts
 Network180 does not provide
direct services
 We contract with other
agencies to provide the services
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Supports Coordinator/Case Manager
 You get to choose which agency provides supports
coordination/case management. If you don’t know
which agency you want, Access Center staff will help
you decide.
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Supports Coordinators/Case Managers
 Supports Coordinators/Case Managers are your
guide for the choices you have about your mental
health services.
 They assess needs, request authorization for
services, link you to resources, coordinate and
monitor mental health services.
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Individual Plan of Service (IPOS)
 Federal regulations require states to
perform individualized assessments
and use person-centered planning
(PCP) in developing service plans for
Medicaid beneficiaries.
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Independent Facilitators
 You have the right to request an Independent
Facilitator for your IPOS meeting.
 Your Supports Coordinator/Case Manager will ask you
about this during your pre-planning meeting.
 The ARC of Kent County can assist adults with
Developmental Disabilities with this.
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Services
 Your supports coordinator will help you determine
what services you are eligible for. Our guide to services
describes the available services such as:
 Skill Building
 Supported Employment
 Respite
 Community Living Supports
 You can find our Guide to Services on our web site:
www.network180.org
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Skill Building
 Defined in Medicaid Manual: “to increase economic
self-sufficiency and/or to engage in meaningful
activities such as school, work, and/or volunteering.
The services provide knowledge and specialized skill
development and/or support.”
 “Out-of-home adaptive skills training: Assistance with
acquisition, retention, or improvement in self-help,
socialization, and adaptive skills.”
 Vocational focus
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Skill Building
 “Work preparatory services are aimed at preparing a
beneficiary for paid or unpaid employment, but are
not job task-oriented. They include teaching such
concepts as attendance, task completion, problem
solving, and safety.”
 “Activities included in these services are directed
primarily at reaching habilitative goals (e.g., improving
attention span and motor skills), not at teaching
specific job skills.”
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Skill Building providers
 Contract Providers
 MOKA: Community based SB
 Hope Network:
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Work Skills Solutions
Cedar Springs Center
Gordon Foods
Group Site (DECC)
 Self Directed Skill Building is also an option for 1:1 or
small group (up to 3).
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Supported Employment
 Defined in Medicaid Manual: “Provide job
development, initial and ongoing support services,
and activities as identified in the individual plan of
services that assist beneficiaries to obtain and
maintain paid employment that would otherwise be
unachievable without such supports.”
 “Supported/integrated employment must be provided
in integrated work settings where the beneficiary
works alongside people who do not have disabilities.”
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Supported Employment
 “Job development, job placement, job coaching, and long-
term follow-along services required to maintain
employment.”
 “Documentation must be maintained that the individual is
not currently eligible for services available through
Individuals with Disabilities Education Act (IDEA) or
Michigan Rehabilitation Services (MRS).”
 Microenterprise
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Supported Employment Providers
 Contract Providers
 Goodwill
 Real Life Living Services
 Self Directed Supported Employment is also an
option.
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Respite Care Services
Described in the Medicaid Provider Manual as:
Respite care services are intended to assist in maintaining a goal of living in a natural
community home and are provided on a short-term, intermittent basis to relieve the
beneficiary’s family or other primary caregiver(s) from daily stress and care
demands during times when they are providing unpaid care.
Respite is not intended to be provided on a continuous, long-term basis where it is a
part of daily services that would enable an unpaid caregiver to work elsewhere full
time. In those cases, community living supports, or other services of paid support or
training staff, should be used.
Decisions about the methods and amounts of respite should be decided during person
centered planning.
PIHPs may not require active clinical treatment as a prerequisite for receiving respite
care. These services do not supplant or substitute for community living support or
other services of paid support/training staff.
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Respite
"Short-term" means the respite service is provided during a limited period of time
(e.g., a few hours, a few days, weekends, or for vacations).
"Intermittent" means the respite service does not occur regularly or continuously. The
service stops and starts repeatedly or with a time period in between.
"Primary" caregivers are typically the same people who provide at least some unpaid
supports daily.
"Unpaid" means that respite may only be provided during those portions of the day
when no one is being paid to provide the care, i.e., not a time when the beneficiary
is receiving a paid State Plan (e.g., home help) or waiver service (e.g., community
living supports)or service through other programs (e.g., school).
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Respite
Since adult beneficiaries living at home typically receive home help services and hire
their family members, respite is not available when the family member is being paid
to provide the home help service, but may be available at other times throughout
the day when the caregiver is not paid.
Respite care may be provided in the following settings:
 Beneficiary’s home or place of residence
 Licensed family foster care home
 Facility approved by the State that is not a private residence, (e.g., group home or
licensed respite care facility)
 Home of a friend or relative chosen by the beneficiary and members of the planning
team
 Licensed camp
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Community Living Supports
• Described in the Medicaid Manual as:
• “CLS are used to increase or maintain personal self-
sufficiency, facilitating an individual’s achievement of his
goals of community inclusion and participation,
independence or productivity. The supports may be
provided in the participant’s residence or in community
settings.”
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Community Living Supports
Training in the following areas:
 meal preparation
 laundry
 routine, seasonal, and heavy household care and maintenance
 activities of daily living (e.g., bathing, eating, dressing, personal
hygiene)
 shopping for food and other necessities of daily living
 Money management
 Non-medical care (not requiring RN or MD intervention)
 Socialization and relationship building
 Transportation
 Participation in regular comm. activities and recreation
 Attendance at medical appointments
 Reminding, observing and monitoring medication admin.
 Assistance with preserving health and safety
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How can CLS be provided?
 CLS in a licensed residential facility
 Individual CLS
 Life Skills CLS
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CLS for individuals with Developmental Disabilities
 1,982 Developmentally Disabled (DD) individuals have been served
in 2014 (as of August 31).
 341 DD individuals living in group homes with CLS
 358 DD individuals use a contracted provider for individual CLS
 362 DD individuals were authorized for a Life Skills CLS program
 249 DD individuals living in Adult Foster Care (AFC) homes with
CLS
 87 DD individuals used Agency with Choice [AWC] for CLS
 70 DD individuals used Direct Employment [DE] for CLS
 *Based on data from August 2014
 In 2013, over $50 million was spent on DD Services – $39 million was
for CLS (78%)
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CLS for individuals with Mental Illness
 3 individuals are Direct Employers
 6 individuals are using an Agency with Choice
provider
 Compared to:
 6 individuals use Hope Network for Individual CLS
 9 individuals use Real Life Living Services for
Individual CLS
 97 individuals receive CLS in an AFC home
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Do CLS and Home Help cover the same things?
 Home Help covers: Unskilled, hands-on personal care or cueing along
with supervision to ensure the individual performs the tasks properly
for activities of daily living (ADL) and instrumental activities of daily
living (IADL):
 Eating
 Toileting
 Bathing
 Grooming
 Dressing
 Transferring
 Mobility
 Taking Medication
 Meal preparation and cleanup
 Shopping and errands
 Laundry
 Housework
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So what’s the Difference Between
Home Help and CLS?
 Home Help/Expanded Home Help is always the first
source of funding for personal care services in an
unlicensed setting. This state plan must be exhausted
(including appeals) before an individual can have CLS.
 A person cannot decide to skip applying for Home
help and ask for CLS instead
 CLS can “complement” Home Help/Expanded Home
Help for some things once the consumer’s needs for
assistance have been officially determined to exceed
the DHS parameters
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How do you know if you are eligible for SelfDetermination/self-direction?
 No one is eligible or ineligible for self-determination or
self-direction.
 First you need to go to the Access Center at network180 to
find out if you are eligible for Mental Health Services. If
you are, then the access center will do a warm transfer to
an SC agency
 Next, your SC/CM determines whether you are eligible for
one or more Medicaid covered mental health services.
 If you are eligible for Medicaid covered mental health
services, then you can choose to have those services
delivered through a contracted provider or a self-direction
arrangement.
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
Annette Tuitel
Self-Determination
Contract Manager
DD Division
Network180
790 Fuller NE
Grand Rapids, MI 49503
616.855-5247
[email protected]
Network180


Sandy Willison
Kim Kooistra
BHTD-Gusco Money
Management
356 E. Main St
PO Box 60
Saranac, MI 48881
616.642.9467
[email protected]
[email protected]
Fiscal Intermediary
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Self-Determination – It’s an
Umbrella Concept
 Family
 Friends
 Faith
 Education
 Community
 Physical health
 Mental health
 Employment
 Recreation/hobbies
 Volunteering
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The Myths and the Reality
 SD means you get as much of
you want of whatever service
you want.
 There are “SD dollars.”
 Services delivered through SD are
based on an individual plan of service
with goals and a determination of
“medical necessity.”
 There isn’t any “extra” money for SD.
We have a capitated budget and must
serve all eligible people from that pot of
money.
 SD is a program. If you’re in it
all your services have to be
SD.
 SD isn’t a program – it’s a voluntary
agreement to receive public mental
health services in a different way. You
can choose to have some or all of your
services through a SD arrangement.
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The Myths and the Reality continued…
 SD gives you freedom from the
rules.
 You can use SD in a licensed
group home or segregated
setting.
 If you have a guardian, you can’t
use SD.
 You have to figure SD out all on
your own.
 People using SD still have to follow
Medicaid rules/regulations, labor
laws, recipient rights, etc.
 SD is intended to be an alternative
to segregated and licensed settings.
 Lots of people with guardians in
Kent County use SD arrangements.
But, it must still be the choice of
the consumer.
 Supports coordinator/case
managers, clinical supervisors, the
network180 SD contract manager
and the FI will help you!
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Self-determination goals
 There are no self-determination goals.
 The SC/CM writes goals just as they always have.
 They don’t focus on deficits but rather dreams/desires.
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Managing Risk, Balancing Personal
Autonomy, and Protecting from Harm
 One challenge is coming up with a way to give
individuals greater personal freedom and control while
at the same time ensuring that they are able to live
safely in the community.
 Under a self-directed arrangement, authority and
control is shifted to the individual but it does not
change the state’s obligation to ensure the health and
safety of the individual.
 A common challenge we face is the fact that
“supervision” is not a mental health service.
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Community Living Supports
 People talk about Community Living Supports (CLS)
like it is Self-Determination
 But CLS is not Self-Determination
 CLS is a service
 However, if you are eligible for CLS then you can
choose to have an arrangement that supports selfdetermination to get the CLS you are eligible for.
 Self-Determination is a way to get services delivered
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So what Mental Health services can be self-directed?
 You can have an arrangement that supports self-
determination for any of the mental health services
you are eligible for.
 Services that have been self-directed in Kent County:
◦ Community Living Supports is the most common.
◦ Several people also use SD arrangements for Skill
Building, Supports Coordination, Supported
Employment, Respite, Occupational Therapy and
Enhanced Pharmacy.
◦ We also have individuals exploring an SD
Arrangement for therapy and behavior specialist
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Choice of providers for
mental health service
 You can decide if and how you want the services you
are eligible for to be delivered.
 Have services from a provider who contracts with
network180
OR
 Have services through an Arrangement that supports
Self-Determination
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This is where self-direction really
begins…
Eligibility for Services is
Determined by the
Supports Coordinator
Self-Determination
(Self-Direction of
mental health
services)
Agency with Choice
Employer of
Record
Contract Agency
Choice of agencies
that contract with
Network180
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Using a provider network180 contracts with



Even when you decide not to self-direct
services and use a contracted provider you
have choices
Your Supports Coordinator should offer
choices of service providers minimally each
year at the Individual Plan of Services (IPOS).
They will offer you a Guide to Services
Handbook every year which lists the agencies
we contract with for each service.
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Contracted Providers
 Network180 has a provider panel of agencies to provide services.
 Hope Network West Michigan
 MOKA
 Spectrum Community Services
 Thresholds
 Real Life Living Services
 Goodwill
 Pine Rest
 Genesis Housing
 These agencies contract with network180 to provide certain services at
the rate we pay.
 The panel provider agency is the employer but you still have choices
about who works with you and when.
 MI and Children’s divisions also have contracted providers
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Agency with Choice Agreement
 You choose an agency that is not on the network180

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provider panel to provide the service.
This option cannot be used to purchase traditional or
segregated services from a non-panel agency.
Contract is between you and the agency using network180
form.
Agency is employer of record while you or your guardian is
the managing employer (hiring and scheduling your staff ).
You/guardian sign the SD agreement choosing to have
services delivered through SD arrangement.
This arrangement uses a Fiscal Intermediary. FI is a
Medicaid covered service paid for by network180.
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AWC:
 You control who helps you, how they help you and
when they help you.
 You chooses where you live
 …and you don’t have to move if you decide to
change your support provider.
 The AWC provider shares employer duties with
you.
 You live in your own home with supports from an
agency.
 You are not living in a home run by an agency.
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Direct Employment
 This is the SD arrangement that gives you the most control and
responsibility over public mental health services.
 You are the employer and recruit, interview, hire, manage, schedule,
fire staff in accordance with law.
 You ensure employees have required training, back ground checks,
have signed required forms (Medicaid, pay roll, taxes, etc.) and
returned them to SC/CM and FI.
 This arrangement uses a Fiscal Intermediary. The FI acts as
“employer agent” and helps with payroll, using budget, determining
number of hours of service available, etc.
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Individual Service Budget
 The supports coordinator/case manager is
responsible for developing an individual
service budget based on the rate (which is
based on eligibility). The ISB shows the dollars
that have been allocated to the individual for a
certain public mental health service.
 The supports coordinator/case manager is
required to deduct certain funds from the
budget, the most common being a Home Help
funds.
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Fiscal Intermediary
 Fiscal Inermediary services provide financial
accountability and Medicaid integrity for the
individual budgets authorized for individuals using SD
arrangements.
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Fiscal Intermediary
 The FI does not develop the ISB or direct how services
and supports are used
 The FI ensures that the payments it makes correspond
with the individual budget.
 Home Help is paid directly to the person or agency
who provides the care
 Home Help cannot be paid to the Fiscal Intermediary
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For More Information on Self-Direction in
Kent County
 Talk to your supports coordinator/case manager supervisor.
 www.network180.org – Click on self-determination.
 Forms can be found by your supports coordinator in the
network180 service specifications on the extranet.
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For More Information on SelfDetermination
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Beach Center on Disability
Center for Self-Determination
NAMI
State of Michigan
TASH
The Arc Kent County
The Arc Michigan
The Arc US
United Cerebral Palsy
MDCH
www.beachcenter.org
www.self-determination.com
www.nami.org
www.michigan.gov
www.tash.org
www.arckent.org
www.arcmi.org
www.thearc.org
www.ucp.org
 http://www.michigan.gov/mdch/0,4612,7-132-2941_4868_4900-264686--,00.html
 Michigan Partners for Freedom
http://mifreedom.org/
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