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In An Emergency Calling the Access Center Calling CARE MI Health Link Members

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A new section is being proposed for Boilerplate 298. We believe this language threatens Michigan's public mental health system.


Boilerplate 298 (e)

(e) That selected Medicaid health plans be allowed to contract directly with a service provider in an effort to achieve the contract requirements with this state for managing the physical and behavioral health of Medicaid eligible individuals within the pilot region.  The pilots described in this subsection shall not in any way mandate an exclusive arrangement between contracted Medicaid health plans and CMHSPs.  Any NCQA function presently maintained by a contracted Medicaid health plans shall remain the responsibility of the health plan for the purposes of this pilot regardless of their contractual arrangements with any CMHSP, and contracts between this state and the PIHPs shall be amended to allow for relief of CMHSPs from existing contractual requirements as necessary.

We are asking everyone to contact their House and Senate members opposing the Senate’s 298 2e language. Your support in sharing this information and contacting legislators is appreciated.   

Why we OPPOSE Senate Bill – Section 298 (2)(e):

 ·       We believe this approach would eventually destroy the local safety net by allowing private health plans to contract with vendors that do not have the same legal & moral responsibility of the CMHs in those communities.

o   Other vendors are not held accountable to the community like the local CMH – sheriff, schools, other community partners.

o   If the pilots do not go well other vendors can pack up and leave town, the CMH cannot.

·       Section 2(e) would allow Health Plans and other vendors to cherry pick the easiest least complicated cases, leaving the most expensive to serve with the CMH with drastically less resources.

o   Medicaid funding makes up over 90% of the CMH’s budget, if a significant portion of these funds are removed the CMH’s ability to fulfil its community obligations will be wiped out. 

·       This approach in Section 2(e) has been tried and failed in other states.

o   Iowa and Kansas contracted with for-profit insurers who made wide sweeping promises but, in the end, wiped out the state’s local safety net network by offering poor reimbursement rate and drastic cuts in services, which left families and consumers without competent provides. 

·       The language would also set the CMH payment system back to a fee for service model by requiring NCQA accreditation, adding additional cost and unnecessary processes through thousands of extra billings.
     o   This language will also give Medicaid health plans prior authorization rights regarding treatment for individuals.


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