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HomeMy WebLinkAboutResolutions - 2016.07.20 - 22436REPORT (MISC. #16169) July 20, 2016
BY: Human Resources Committee, Bob Hoffman, Chairperson
IN RE: DEPARTMENT OF HEALTH AND HUMAN SERVICES/HEALTH DIVISION — INTERLOCAL
AGREEMENT BETWEEN THE COUNTY OF OAKLAND AND THE OAKLAND COUNTY COMMUNITY
MENTAL HEALTH AUTHORITY FOR HEALTH EDUCATION PREVENTION SERVICES
To the Oakland County Board of Commissioners
Chairperson, Ladies and Gentlemen:
The Human Resources Committee, having reviewed the above referenced resolution on July 13, 2016,
reports with the recommendation that the resolution be adopted.
Chairperson, on behalf of the Human Resources Committee, I move the acceptance of the foregoing
report.
HUMAN RESOURCES COMMITTEE
HUMAN RESOURCES COMMITTEE VOTE:
Motion carried unanimously on a roll call vote.
MISCELLANEOUS RESOLUTION .#16169 July 20, 2016
BY: General Government Committee, Christine Long, Chairperson
IN RE: DEPARTMENT OF HEALTH AND HUMAN SERVICES/HEALTH DIVISION — INTERLOCAL
AGREEMENT BETWEEN THE COUNTY OF OAKLAND AND THE OAKLAND COUNTY COMMUNITY
MENTAL HEALTH AUTHORITY FOR HEALTH EDUCATION PREVENTION SERVICES
To the Oakland County Board of Commissioners
Chairperson, Ladies and Gentlemen:
WHEREAS an Interlocal Agreement between the County of Oakland and the Oakland County Community
Mental Health Authority (OCCMHA) was approved by the Oakland County Board of Commissioners in
2010 by Miscellaneous Resolution #10236 for Substance Use Disorder Services; and
WHEREAS on November 12, 2015 the Interlocal Agreement was amended through Miscellaneous
Resolution #15283 to cancel the Substance Use Disorder Access Management services provided by the
Oakland County Health Division (OCHD) Prior Authorization and Central Evaluation (PACE) services at
the request of OCCMHA; and
WHEREAS OCCMHA is requesting to replace the current Interlocal Agreement with a new Interlocal
Agreement; and
WHEREAS the new Agreement includes total FY 2016 funding in the amount of $461,595 which consists
of grant funding in the amount of $441,149 and a local match of $20,446; and
WHEREAS this Agreement provides an end date of January 31, 2016 and funding not to exceed
$236,685 for PACE services provided from October 1,2015 through January 31, 2016; and
WHEREAS this new Agreement continues OCHD Health Education Prevention Services with FY 2016
funding in the amount of $204,464 and a local match of $20,446 comprised primarily of general fund
salaries for supervision of the program; and
WHEREAS this funding will be used to continue two (2) Special Revenue Full-Time Eligible Public Health
Educator III positions (#1060233-00960 and #1060233-07497) within the CHPIS unit of the Health
Division; and
WHEREAS acceptance of these funds does not obligate the County to any future commitment; and
WHEREAS the Agreement is effective upon approval and will remain in effect until terminated by either of
the parties; and
WHEREAS the positions associated with OCHD PACE services shall be deleted with the approval of this
resolution; and
WHEREAS this Interlocal Agreement has completed the Grant Review Process according to the Board of
Commissioners Grant Procedures and is recommended for approval.
NOW THEREFORE BE IT RESOLVED that the Oakland County Board of Commissioners hereby
approves the Interlocal Agreement between the County of Oakland and the Oakland County Community
Mental Health Authority for total FY 2016 funding in the amount of $441,149 and a local match of $20,446
comprised primarily of general fund salaries for supervision of the program.
BE IT FURTHER RESOLVED that this resolution effectively ends PACE positions upon approval and
continues Health Education Prevention Services positions going forward.
BE IT FURTHER RESOLVED to delete the following Oakland County Special Revenue positions
associated with the former PACE Unit:
1060261-01919
1060261-06114
1060261-07151
1060261-07152
1060261-07154
1060261-07386
1060261-07387
1060261-07389
1060261-07498
1060261-07500
1060261-07566
1060261-08037
1060261-09026
1060233-09204
Substance Abuse Program Analyst
Substance Abuse Program Analyst
Treatment Services Supervisor
Substance Abuse Program Analyst
Office Assistant II
Substance Abuse Program Analyst
Auxiliary Health Worker
Office Assistant II
Account Clerk II
Substance Abuse Program Analyst
Office Assistant II
Substance Abuse Program Analyst
Substance Abuse Program Analyst
Public Health Educator III
GENERAL GOVERNMENT COMMITTEE
Motion carried unanimously on a roll call vote with Woodward and Quarles absent.
BE IT FURTHER RESOLVED to continue two (2) Special Revenue Full-Time Eligible Public Health
Educator III positions (#1060233-00960 and #1060233-07497) within the CHPIS unit of the Health
Division.
BE IT FURTHER RESOLVED that the current and future level of Health Education Prevention Services
will be contingent upon the level of funding for this program.
BE IT FURTHER RESOLVED that the Chairperson of the Board of Commissioners is authorized to
execute the agreement and to approve any extensions or changes, within fifteen percent (15%) of the
original award, which are consistent with the original agreement as approved.
Chairperson, on behalf of the General Government Committee, I move the adoption of the foregoing
resolution.
GENERAL GOVERNMENT COMMITTEE
GRANT REVIEW SIGN OFF — Health Division
GRANT NAME: 2016 Interlocal Agreement — Discontinuation of PACE Services and Continuation of
Substance Abuse Prevention Health Education Services
FUNDING AGENCY: Oakland County Community Mental Health Authority (OCCMHA)
DEPARTMENT CONTACT PERSON: Rachel Shymkiw / 452-2151
STATUS: Grant Acceptance
DATE: June 29, 2016
Pursuant to Misc. Resolution #13180, please be advised the captioned grant materials have completed
internal grant review. Below are the returned comments.
The captioned grant materials and grant acceptance package (which should include the Board of
Commissioners' Liaison Committee Resolution, the grant agreement/contract, Finance Committee Fiscal
Note, and this Sign Off email containing grant review comments) may be requested to be placed on the
appropriate Board of Commissioners' committee(s) for grant acceptance by Board resolution.
DEPARTMENT REVIEW
Department of Management and Budget:
Approved. — Laurie Van Pelt (6/22/2016)
Department of Human Resources:
HR Approved (Needs HR Committee) Deletes Positions — Lori Taylor (6/22/2016)
Risk Management and Safety:
Approved by Risk Management — Robert Erlenbeck (6/22/2016)
Corporation Counsel:
Approved. — Bradley G. Henn (6/29/2016)
From: Van Pelt. Laurie M
To: West. Catherine A; Taylor. Lori; Davis, Patricia G; Schultz, Dean )
Cc: Rivmkiw. Rach_el 14; McKay-Chlasson, Lisa; Plsacreta. Antonio S; Md.ernon. Kathleen M
Subject: RE: GRANT REVIEW: Health & Human Services/Health Division - 2016 Interlocal Agreement — Discontinuation of
PACE Services and Continuation of Substance Abuse Prevention Health Education Services - Grant Acceptance
Date: Wednesday, June 22, 2016 1:05:46 PM
Approved.
From West, Catherine A
Sent: Wednesday, June 22, 2016 10:35 AM
To: Van Pelt, Laurie M; Taylor, Lori; Davis, Patricia G; Schultz, Dean J
Cc: Shymkiw, Rachel M; McKay-Chiasson, Lisa; Pisacreta, Antonio S; McLernon, Kathleen M
Subject: GRANT REVIEW: Health & Human Services/Health Division - 2016 Interlocal Agreement —
Discontinuation of PACE Services and Continuation of Substance Abuse Prevention Health Education
Services - Grant Acceptance
GRANT REVIEW FORM
TO: REVIEW DEPARTMENTS — Laurie Van Pelt — Lori Taylor — Dean Schultz — Pat Davis
RE: GRANT CONTRACT REVIEW RESPONSE — Health gt Human Services/Health Division
2016 Interlocal Agreement — Discontinuation of PACE Services and Continuation of
Substance Abuse Prevention Health Education Services
Oakland County Community Mental Health Authority
Attached to this email please find the grant document(s) to be reviewed. Please provide your
review stating your APPROVAL, APPROVAL WITH MODIFICATION, or DISAPPROVAL, with
supporting comments, via reply (to all) of this email.
Time Frame for Returned Comments: June 29, 2016
GRANT INFORMATION
Date: June 22, 2016
Operating Department: Health St. Human Services/Health Division
Department Contact: Rachel Shymkiw
Contact Phone: 2-2151
Document Identification Number:
REVIEW STATUS: Acceptance — Resolution Required
Funding Period: 10/1/2015 through 9/30/2016
Original source of funding: Federal SAMHSA CFDA NO. 93.959
Will you issue a sub award (make payments to outside agencies) or contract (through
From:
To:
Cc:
Subject:
Date:
Taylor. Lori.
West. Catherine A; Van Pelt. Laurie Pt; Davis. Patricia G; SchuLl2 Dean J
ayjnithy.,BacheLE; F4day_Sliasspaj.L5a; Pisacreta. Antonio a; McLernon. Kathleen M; Russell, Roosevelt F;
Mason. Heather L
RE: GRANT REVIEW: Health & Human Services/Health Division - 2016 Interlocal Agreement — Discontinuation of
PACE Services and Continuation of Substance Abuse Prevention Health Education Services - Grant Acceptance
Wednesday, June 22, 2016 1:26:13 PM
HR Approved (Needs HR Committee) Deletes Positions
From: West, Catherine A
Sent: Wednesday, June 22, 2016 10:35 AM
To: Van Pelt, Laurie It Taylor, Lori; Davis, Patricia G; Schultz, Dean 3
Cc: Shymkiw, Rachel ft McKay-Chiasson, Lisa; Pisacreta, Antonio S; McLernon, Kathleen M
Subject: GRANT REVIEW: Health & Human Services/Health Division - 2016 Interlocal Agreement —
Discontinuation of PACE Services and Continuation of Substance Abuse Prevention Health Education
Services - Grant Acceptance
GRANT REVIEW FORM
TO: REVIEW DEPARTMENTS — Laurie Van Pelt — Lori Taylor — Dean Schultz — Pat Davis
RE: GRANT CONTRACT REVIEW RESPONSE — Health & Human Services/Health Division
2016 Interlocal Agreement— Discontinuation of PACE Services and Continuation of
Substance Abuse Prevention Health Education Services
Oakland County Community Mental Health Authority
Attached to this email please find the grant document(s) to be reviewed. Please provide your
review stating your APPROVAL, APPROVAL WITH MODIFICATION, or DISAPPROVAL, with
supporting comments, via reply (to all) of this email.
Time Frame for Returned Comments: June 29, 2016
GRANT INFORMATION
Date: June 22, 2016
Operating Department: Health & Human Services/Health Division
Department Contact: Rachel Shymkiw
Contact Phone: 2-2151
Document Identification Number:
REVIEW STATUS: Acceptance — Resolution Required
Funding Period: 10/1/2015 through 9/30/2016
Original source of funding: Federal SAMHSA CFDA NO. 93.959
From: Erlenbeck, gobert C
To: West. Catherine A; Van Pelt. Laurie M; Taylor. Lott Davis, Patricia G; Schultz Dean J
Cc: 5hyrnkiw, Rachel M; 11cKav-Chiasson, Lisa; Pisacreta, Antonio S; Lemon, Kathleen M
Subject: RE: GRANT REVIEW: Health & Human Services/Health Division - 2016 Interlocal Agreement — Discontinuation of
PACE Services and Continuation of Substance Abuse Prevention Health Education Services - Grant Acceptance
Date: Wednesday, June 22, 2016 5:26:54 PM
Approved by Risk Management, R.E, 6/22/16.
From: Easterling, Theresa
Sent: Wednesday, June 22, 2016 1:38 PM
To: West, Catherine A; Van Pelt, Laurie Ni; Taylor, Lori; Davis, Patricia G; Schultz, Dean J
Cc: Shymkiw, Rachel Ni; McKay-Chlasson, Lisa; Pisacreta, Antonio S; McLernon, Kathleen Ni
Subject: RE: GRANT REVIEW: Health & Human Services/Health Division - 2016 Interlocal Agreement —
Discontinuation of PACE Services and Continuation of Substance Abuse Prevention Health Education
Services - Grant Acceptance
Please be advised that your request for Risk Management's assistance has been assigned
to Bob Erlenbeck, (ext. 8-1694). if you have not done so already, please forward all related
information, documentation, and correspondence. Also, please include Risk Management's
assignment number, RM16-0338, regarding this matter.
Thank you.
From: West, Catherine A
Sent: Wednesday, June 22, 2016 10:35 AM
To: Van Pelt, Laurie Ni; Taylor, Lori; Davis, Patricia G; Schultz, Dean 3
Cc: Shymkiw, Rachel Ni; McKay-Chlasson, Lisa; Pisacreta, Antonio S; McLemon, Kathleen M
Subject: GRANT REVIEW: Health & Human Services/Health Division - 2016 Interlocal Agreement —
Discontinuation of PACE Services and Continuation of Substance Abuse Prevention Health Education
Services - Grant Acceptance
GRANT REVIEW FORM
TO: REVIEW DEPARTMENTS — Laurie Van Pelt — Lori Taylor — Dean Schultz — Pat Davis
RE: GRANT CONTRACT REVIEW RESPONSE — Health & Human Serv ices/Health Division
2016 interiocal Agreement Discontinuation of PACE Services and Continuation of
Substance Abuse Prevention Health Education Services
Oakland County Community Mental Health Authority
Attached to this email please find the grant document(s) to be reviewed. Please provide your
review stating your APPROVAL, APPROVAL WITH MODIFICATION, or DISAPPROVAL, with
supporting comments, via reply (to all) of this email.
Time Frame for Returned Comments: June 29, 2016
From: Oenn. Bradley G
To: West, CatherineA
Subject: RE: GRANT REVIEW: Health & Human Services/Health Division - 2016 Interlocal Agreement — Discontinuation of
PACE Services and Continuation of Substance Abuse Prevention Health Education Services - Grant Acceptance
Date: Wednesday, June 29, 2016 8:47:26 AM
Approved.
From: West, Catherine A
Sent: Wednesday, June 29, 2016 8:46 AM
To: Benn, Bradley G
Subject: FW: GRANT REVIEW: Health & Human Services/Health Division - 2016 Interlocal Agreement —
Discontinuation of PACE Services and Continuation of Substance Abuse Prevention Health Education
Services - Grant Acceptance
From West, Catherine A
Sent: Wednesday, June 22, 2016 10:35 AM
To: Grant Review
Cc: Shymkiw, Rachel M; McKay-Chiasson, Lisa; Pisacreta, Antonio S; McLernon, Kathleen M
Subject: GRANT REVIEW: Health & Human Services/Health Division - 2016 Interlocal Agreement —
Discontinuation of PACE Services and Continuation of Substance Abuse Prevention Health Education
Services - Grant Acceptance
GRANT REVIEW FORM
TO: REVIEW DEPARTMENTS — Laurie Van Pelt — Lori Taylor Dean Schultz Pat Davis
RE: GRANT CONTRACT REVIEW RESPONSE — Health & Human Services/Health Division
2016 Interlocal Agreement — Discontinuation of PACE Services and Continuation of
Substance Abuse Prevention Health Education Services
Oakland County Community Mental Health Authority
Attached to this email please find the grant document(s) to be reviewed. Please provide your
review stating your APPROVAL, APPROVAL WITH MODIFICATION, or DISAPPROVAL, with
supporting comments, via reply (to all) of this email.
Time Frame for Returned Comments: June 29, 2016
GRANT INFORMATION
Date: June 22, 2016
Operating Department: Health & Human Services/Health Division
Department Contact: Rachel Shymkiw
Contact Phone: 2-2151
OAKLAND COUNTY INTERLOCAL AGREEMENT
BETWEEN
OAKLAND COUNTY
AND
THE OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
This Agreement ("Agreement") is made and entered into between the County of Oakland,
("County") (DUNS # 136200362), a Michigan Constitutional and Municipal Corporation, a
political subdivision of the state of Michigan, and the designated Coordinating Agency per MCL
333.6201 et seq., whose address is 1200 North Telegraph, Pontiac, Michigan 48341 and the
OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY (hereafter "CMH
Authority"), a Michigan Statutory Public Governmental Entity (MCL 330.1100a(12), Federal
Employer 1.D. #38-3437521), created pursuant to the Michigan Mental Health Code (P.A. 1974,
No. 258, MCL 330.1100, et seq., hereafter "Mental Health Code"), whose address is 2011
Executive Hills Blvd., Auburn Hills, MI 48326. In this Agreement, either the CMH Authority or
the County may also be referred to individually as a "Party" or jointly as the "Parties."
PURPOSE OF AGREEMENT. The CM11 Authority is seeking to purchase services or provide
funds for programs to Oakland County. The Parties agrees, subject to the terms and conditions
set forth in this Agreement, to provide funds and/or services as described in Exhibits 1 and
Exhibit H.
The Parties are authorized to enter into this Agreement pursuant to P.A. 1967, No. 7 (MCL
124.501 et seq.).
In consideration of the mutual promises, obligations, representations, and assurances in this
Agreement, the Parties agree as follows:
1. DEFINITIONS. In addition to any other defined terms in this Agreement (e.g.,
"Agreement," "County," "Mental Health Code," "CMH Authority," "Party," or "Parties,"
etc.), the Parties agree that for all purposes, and as used throughout this Agreement, the
following words and expressions used throughout this Agreement, whether used in the
singular or plural, within or without quotation marks, or possessive or nonpossessive, shall
be defined, and interpreted as follows:
1.1. Agreement Documents mean the following documents, which this Contract includes
and incorporates:
1.1.1. Exhibit I: Financial Obligations
1.1.2. Exhibit II: Scope of Services
1.1.3. Exhibit III: Business Associate Agreement, Requirements for Contracts
Involving the Health Insurance Portability and Accountability Act, if
applicable
1.1.4. Exhibit IV: Attachments C, D, and E.
1.2. Claim(s) means any loss; complaint; demand for relief or damages; lawsuit; cause of
action; proceeding; judgment; penalty; costs or other liability of any kind which is
imposed on, incmed by, or asserted against the County or for which the County may
become legally or contractually obligated to pay or defend against, whether
commenced or threatened, including, but not limited to, reimbursement for reasonable
attorney fees, mediation, facilitation, arbitration fees, witness fees, court costs,
investigation expenses, litigation expenses, or amounts paid in settlement..
1.3. CMH Authority as defined on the first page of this Agreement, and shall be further
defined to include any and all "CMH Agents" as defined herein.
1.4. CMH Authority Agent shall be defined to include, any and all CMH Authority
Contractor(s)' employees, officers, directors, board members, concurrent board
members, managers, departments, divisions, trustees, volunteers, licensees,
concessionaires, subcontractors, vendors, subsidiaries, joint ventures or partners,
and/or any such CMH Authority Contractor(s)' successors or predecessors and any
such successors' or predecessors' employees (whether such persons act or acted in
their personal, representative or official capacities), and/or any and all persons acting
by, through, under, or in concert with any CMH Authority Contractor(s) "CMH
Authority Agency" shall also include any person who was a CMH Authority Agent
any time during the term of this Agreement but, for any reason, is no longer
employed, appointed, or serving as a CMH Authority Agent, without limitation, any
and all employees, officers, directors, members, managers, departments, and divisions
of the CMH Authority (whether such persons act or acted in their personal,
representative or official capacities but shall NOT include the County or "Concurrent
Board Member" as defined herein.
1.5. Concurrent Board Member shall be defined as any Oakland County Commissioner
who is also serving as a member of the Oakland County Community Mental Health
Authority Board.
1.6. County As this term may be used in this Agreement, "County" shall be further
defmed to include any and all "County Agents," as defined herein.
1.7. County Agent shall be defined as any and all elected officials, appointed officials,
directors, board members, council members, commissioners, authorities, other boards,
committees, commissions, employees, third-party contractors, departments, divisions,
volunteers, representatives, and/or any such persons' successors (weather such
persons act or acted in their personal representative or official capacities), and/or
"County Agents" shall also include any person who was a County Agent any time
during the term of this Agreement but, for any reason, is no longer employed,
appointed, or elected and serving as an County Agent, and shall include the any
"Concurrent Board Member."
2
1.8. M shall be defined as any calendar day, which shall always begin at 12:00:00 a.m.
and end at 11:59:59 p.m.
2. COUNTY SERVICES FOR THE CMH AUTHORITY. Subject to the terms and
conditions in this Agreement, and except as otherwise provided by law, the County shall
provide those services for the CMH Authority as described in Exhibit II and Exhibit IV
attached to this Agreement and hereby incorporated and made part of this Agreement. The
Parties intend, agree, and acknowledge that no services, other than those services described
in this Agreement, shall or are otherwise required to be provided by the County for or to the
CMH Authority. Additional services may be contracted by mutual agreement between the
Parties.
3, CMH AUTHORITY PAYMENT OBLIGATION FOR COUNTY SERVICES.
3.1. Subject to the terms and conditions of this Agreement the CIVILI Authority agrees to
pay to the County on a monthly basis the dollar amount described in Exhibit I. This
amount shall be paid to the County within the thirty days of the CMH Authority
receiving the expenditure report from the County, via a wire transfer to a bank
account designated by the County.
3.2. The Parties agree that the dollar Amount in Exhibit I is subject to change. The CMH
Authority will notify the County via a written notice at least 30 days in advance of
any such change, and the notice shall detail the change in the dollar amount.
Furthermore, if the dollar amount described in Exhibit I should change either by
increase or decrease the level of services provided by the County will change
accordingly to match that increase or decrease in funds. At no time will the County
be required to perform services for which it will not be paid or reimbursed.
3.3. Notwithstanding any references in the Exhibits to this Agreement, the Parties agree
that any and all references to "capitation," "Per Eligible Per Month (PEPM)
payments," "shared-risk," "risk" of any sort, or any maximum payment obligation
shall be completely void and without any effect in interpreting this Agreement.
3.4. Unless there is a termination as provided for herein, the CMH Authority's obligations
set forth in this Section, shall be absolute and unconditional and shall not be affected
by the occurrence of either Party's default of any term or condition of this
Agreement, nor shall any other occurrence or event relieve, limit, or impair the
obligation of the CMH Authority to pay any such amount due to the County.
3.5. In the event that any amount due and owing from the CMH Authority is not paid to
the County as otherwise required in this Agreement, the CMH Authority agrees that
the County may, at its sole option, recover any and all such amounts determined by
the County to be then due and owing by the CMH Authority by and through any
combination of reduced payments, set-off, and/or withholding of any CMH Authority
funds then in the possession of the County that would otherwise have been paid to the
CMH Authority by the County pursuant to the Mental Health Code and/or any prior
County funding commitment.
3.6. This Section shall not be interpreted as prohibiting, limiting or preventing the Parties
from mutually recognizing and agreeing that any amount invoiced by and/or received
3
or paid to the County in connection with this Agreement was in error and voluntarily
agreeing to correct same.
3.7. The Contract Amount per the Exhibit I for the applicable fiscal year represents a Not
To Exceed Amount (NTE) and is the maximum financial obligation of the CMH
Authority to the County for that fiscal year. If the Contractor projects their expenses
will exceed the NTE the County will submit to CMH Authority in writing a request
for additional funds as soon as projections indicate a potential overage but no later
than September 30th of the current fiscal year. Upon this notification the County and
ClVIE1 Authority will discuss potential adjustments to the NTE.
3.8. Cost Settlement 8z Audit: For each fiscal year (October 1 through September 30),
cost settlement will be based on a comparison of the Exhibit I categorical amounts, as
amended by CMH Authority, to the County's actual, allowable, net expenses incurred
and reported for the period.
4. ASSURANCES AND WARRANTIES.
4.1. The CMH Authority agrees to comply with the provisions of any and all laws relating
to nondiscrimination and conflict of interest with governmental employees and,
specifically, any County Agent. The CMH Authority warrants to avoid any conflict of
interest, whether real or perceived.
4.2. Any and all County services set forth in this Agreement are provided on an "as-in"
and "as-available" basis, without any warranty of any kind, to the maximum extent
permitted by applicable law. The County hereby expressly further disclaims any and
all warranties, of any kind, whether express or implied, including, without limitation,
any implied warranties of merchantability, fitness for a particular purpose, non-
infringement, and/or that any County services under this Agreement will meet any
CMH Authority's needs or requirements, will be uninterrupted, timely, secure, error
or risk free/or that any deficiencies in any County service. The entire risk arising out
of the use of any and all County services herein remains at all times, with the CMH
Authority to the maximum extent permitted by law.
5. NO INDEMNIFICATION.
5.1. Each Party shall be responsible for any Claims made against that Party and for the
acts of its Employees or Agents.
5.2. In any Claim that may arise from the performance of this Agreement, each Party shall
seek its own legal representation and bear the costs associated with such
representation including any attorney fees.
5.3. Except as otherwise provided in this Agreement, neither Party shall have any right
under any legal principle to be indemnified by the other Party or any of its employees
or Agents in connection with any Claim.
5.4, This Agreement does not, and is not intended to, impair, divest, delegate or
contravene any constitutional, statutory, and/or other legal right, privilege, power,
obligation, duty or immunity of the Parties. Nothing in this Agreement shall be
construed as a waiver of governmental immunity for either Party.
6. LIMITS AND EXCLUSIONS ON COUNTY SERVICES.
4
6.1. In no event and under no circumstances in connection with or as a result of this
Agreement shall the County be liable to the CMH Authority, or any other person, for
any consequential, incidental, direct, indirect, special punitive, or other similar
damages whatsoever (including, without limitation, damages for loss of business,
profits, business interruption, or any other pecuniary loss or business detriment)
arising out of this Agreement for any County services hereunder or any CIVIH
Authority use or inability to use any County services, even if the County has been
advised of the possibility of such damages.
7. NO IMPLIED WAIVER. Except as otherwise expressly provided for in this Agreement:
7.1. Absent a written waiver, no act, failure, or delay by a Party to pursue or enforce any
rights or remedies under this Agreement shall constitute a waiver of those rights with
regard to any existing or subsequent breach of this Agreement.
7.2. No waiver of any term, condition, or provision of this Agreement, whether by
conduct or otherwise, in one or more instances, shall be deemed or construed as a
continuing waiver of any term, condition, or provision of this Agreement.
7.3. No waiver by either Party shall subsequently affect its right to require strict
performance of this Agreement.
8. MONITORING.
8.1. The CMH Authority will perform regular monitoring and reporting on the County's
performance and the County agrees to cooperate with the monitoring.
8.2. The CMH Authority shall complete on-site reviews and/or audits of the County at
least annually and has the right to investigate alleged compliance violations by the
County.
8.3. The CMH Authority shall prepare a report summarizing the findings from the on-site
review and/or audit and shall forward a copy of the report to the County within 60
days of completion of the review and/or audit.
9. AUDITING. The County agrees that financial records will be available upon request for
review or audit by CMH Authority or other appropriate officials.
10. AGREEMENT INTERPRETATION. The Parties agree that performance under this
Agreement will be conducted in compliance with all federal, Michigan, and local laws and
regulations. This Agreement is made and entered into in the County of Oakland and in the
State of Michigan. The language of all parts of this Agreement is intended to and under all
circumstances to be construed as a whole according to its fair meaning and not construed
strictly for or against any Party.
11. EFFECTIVE DATE AM) DURATION OF THE AGREEMENT.
11.1. The Parties agree that this Agreement, and/or any subsequent amendments thereto,
shall not become effective prior to the approval by the Oakland County Board of
Commissioners and the CMH Authority. The approval and terms of this Agreement,
and/or any possible subsequent amendments thereto, shall be entered in the official
minutes and proceedings of the Oakland County Board of Commissioners and the
5
CMH Authority Board and shall also be filed with the office of the Clerk of the
County.
11.2. The Parties further agree that this Agreement, and/or any subsequent amendments
thereto, shall not become effective prior to the filing of this Agreement, and/or any
possible subsequent amendments with the Michigan Secretary of State (MCL
124.510).
11.3. This Agreement shall remain in effect until it is cancelled or terminated by either of
the Parties as provided herein.
12. INDEPENDENT CONTRACTOR. The Parties agree that at all times and for all purposes
under the terms of this Agreement, the County's and/or any and all County Agents' legal
status and relationship to the CMH Authority shall be that of an Independent Contractor.
Except as expressly provided herein, each Party will be solely responsible for the acts of its
own employees, agents, and servants during the term of this Agreement. No liability, right
or benefits arising out of an employer/employee relationship, either express or implied, shall
arise or accrue to either Party as a result of this Agreement.
13. TERMINATION OR CANCELLATION OF AGREEMENT. Either Party may
terminate and/or cancel this Agreement upon ninety (90) Days written notice to the other
Party. The effective date of termination and/or cancellation shall be clearly stated in the
written notice. Termination of this Agreement does not release any Party from any
obligations that Party has pursuant to any law.
13.1. The Parties agree and acknowledge that either Party's decision to terminate and/or
cancel this Agreement, or any one or more individual County Services identified
herein, shall not relieve the CMH Authority or any CMH Authority payment
obligation for any County Services rendered prior to the effective date of any
termination or cancellation of this Agreement. The provisions of this Subsection shall
survive the termination, cancellation, and/or expiration of this Agreement.
14. DISCRIMINATION. The Parties shall not discriminate against their employees, agents,
applicants for employment, or another person or entities with respect to hire, tenure, terms,
conditions, and privileges of employment, or any matter directly or indirectly related to
employment in violation of any federal, state or local law.
15. RECORD RETENTION. The Parties agrees to maintain records in accordance with state
law. All records relative to this Agreement shall be available at any reasonable time for
examination or audit by personnel authorized by CMH Authority or law.
16. CORPORATE COMPLIANCE. The County shall have a Corporate Compliance Plan
and/or Policy. The Plan shall advance the prevention of fraud, abuse and waste providing
health care and to detect misconduct or wrongdoing. The CMH Authority shall monitor the
implementation of the Plan. The County shall investigate any reported allegations of fraud
and abuse related to the purchase of services funded through this Agreement. The County
shall notify the CMH Authority within 48 hours of becoming aware of any such
allegation(s). The County shall also notify the CMH Authority of the outcome of the
investigation completed by the County.
6
17. DELEGATION/SUBCONTRACT/ASSIGNMENT. Neither Party shall delegate,
subcontract, and/or assign any obligations or rights under this Agreement without the prior
written consent of the other Party.
18. FORCE MAJEURE. Each Party shall be excused from any obligations under this
Agreement during the time and to the extent that a Party is prevented from performing due
to causes beyond the Party's control, including, but not limited to, an act of God, war, fire,
strike, labor disputes, civil disturbances, reduction of power source, or any other
circumstances beyond the reasonable control of the affected Party. Reasonable notice shall
be given to the other party of any such event.
19. SEVERABILITY. If a court of competent jurisdiction finds a term, or condition, of this
Agreement to be illegal or invalid, then the term, or condition, shall be deemed severed
from this Agreement. All other terms, conditions, and provisions of this Agreement shall
remain in full force.
20. CAPTIONS. The section and subsection numbers, captions, and any index to such sections
and subsections contained in this Agreement are intended for the convenience of the reader
and are not intended to have any substantive meaning. The numbers, captions, and indexes
shall not be interpreted or be considered as part of this Agreement. Any use of the singular
or plural number, any reference to the male, female, or neuter genders, and any possessive
or nonpossessive use in this Agreement shall be deemed the appropriate plurality, gender or
possession as the context requires.
21. NOTICES. Notices given under this Agreement shall be in writing and shall be personally
delivered, sent by express delivery service, certified mail, or first class U.S. mail postage
prepaid, and addressed to the person listed below. Notice will be deemed given on the date
when one of the following first occur: (1) the date of actual receipt; (2) the next business
day when notice is sent express delivery service or personal delivery; or (3) three days after
mailing first class or certified U.S. mail.
21.1. If Notice is sent to the County, it shall be addressed and sent to: 1200 North
Telegraph, Pontiac, Michigan 48341.
21.2. If Notice is sent to the CMH Authority, it shall be addressed and sent to: 2011
Executive Hills Blvd., Auburn Hills, MI 48326
21.3. Either Party may change the address and/or individual to which Notice is sent by
notifying the other Party in writing of the change.
22. GOVERNING LAW. This Agreement shall be governed, interpreted, and enforced by the
laws of the State of Michigan without giving effect to its conflict of law principles.
23. JURISDICTION AND VENUE. Except as otherwise required by law or court rule, any
action brought to enforce, interpret, or decide any Claim(s) arising under or related to this
Agreement shall be brought in the Sixth Judicial Circuit Court of the State of Michigan, the
50th District Court of the State of Michigan, or the United States District Court for the
Eastern District of Michigan, Southern Division, as dictated by the applicable jurisdiction of
the court. Except as otherwise required by law or court rule, venue is proper in the courts
set forth above. The choice of forum set forth above shall not be deemed to preclude the
enforcement of any judgment obtained in such forum or taking action under this Agreement
to enforce such judgment in any appropriate jurisdiction.
7
24. AGREEMENT MODIFICATIONS OR AMENDMENTS. Any modifications,
amendments, rescissions, waivers, or releases to this Agreement must be in writing and
executed by both Parties. The Parties agree that no such modification, rescission, waiver,
release or amendment of any provision of this Agreement shall become effective against the
County unless signed for by the Oakland County Board of Commissioners. The Parties
further agree that this Agreement shall not be changed, supplemented, or amended, in any
manner, except as provided for herein, and no other act, verbal representation, document,
usage or custom shall be deemed to amend or modify this Agreement in any manner.
25. ENTIRE AGREEMENT. This Agreement sets forth the entire agreement between the
Parties along with the Agreement Documents. In entering into this Agreement, CMH
Authority acknowledges that it has not relied upon any prior or contemporaneous
agreement, representation, warranty, or other statement by the County and/or any County
Agent that is not expressly set forth in this Agreement, and that any and all such possible,
perceived or prior agreements, representations, understandings, statements, negotiations,
understandings and undertakings, whether written or oral, in any way concerning or related
to the subject matter of this Agreement are fully and completely superseded by this
Agreement.
25.1. If there is a contradicting term or condition in any Exhibit to this Agreement, the
Agreement controls.
25.2. It is further agreed that the terms and conditions of this Agreement are contractual
and binding and are not mere recitals. The Parties acknowledge that this Agreement
contains certain limitations and disclaimers of liability.
OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY:
BY: DATE:
Deputy Executive Director
BY: DATE:
Chief Financial Officer
THE COUNTY OF OAKLAND
BY: DATE:
Chairperson, Oakland County Board of Commissioners
8
OAKLAND COUNTY INTERLOCAL AGREEMENT
BETWEEN
OAKLAND COUNTY
AND
THE OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
EXHIBIT I: Financial' and Reporting Obligations
PACE Services
October 1, 2015 — January 31, 2016
Description Budget
FY16 Salaries and Fringes 200,011
Supplies 667
Mileage and Conferences 1,000
Contractual 12,000
Other 3,000
Indirect Costs (14.99%) 20,007
Not To Exceed $236,685
The County shall submit an invoice to the CMH Authority on a monthly basis, which shall
itemize all amounts due and or owing by CMH Authority. The monthly invoice must reflect
total actual program expenditures by category. The invoices shall be submitted in a form and
format agreed upon by the Parties. If the transition of PACE services to OCCMHA does not
occur on or before January 31, 2016, the terms, conditions and funding levels shall remain in
effect until the transition is complete.
Health Education Services
October 1. 2015 — Sentember 30. 2016
Description Budget
FY16 Travel 3,856
Supplies & Materials 5,832
Contractual 193,472
Other 1,304
OCCMHA Funding 204,464
Local Match 20,446
Total Budget 224,910
1 Some or all of the funds provided by OCCMHA are federal funds. Department of Health and Human
Services/Substance Abuse and Mental Health Services Administration (SAMHSA), CFDA NO. 93.959, Block Grant
for Prevention and Treatment of Substance Abuse. Grant NO. 13 B1 Ml SAPT, award phase 2015. Title SAPT
Block Grant sub-recipient relationship, non-research and development project.
9
The County shall submit an invoice to the CMH Authority on a monthly basis, which shall
itemize all amounts due and or owing by CMH Authority. The monthly invoice must reflect
total actual program expenditures by category. The invoices shall be submitted in a form and
format agreed upon by the Parties.
10
OAKLAND COUNTY INTERLOCAL AGREEMENT
BETWEEN
OAKLAND COUNTY
AND
THE OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
EXHIBIT II: Scope of Services
I. SUPPORTS AND SERVICES:
A. The County shall assure for the provision of services for eligible individuals
pursuant to the Contract and this Scope of Services.
B. Federal Award Project Description: Support projects for the development and
implementation of prevention, treatment and rehabilitation activities directed to the
diseases of alcohol and drug abuse.
C. The County agrees to provide Prior Authorization and Central Evaluation (PACE)
services for adults and children with substance use disorders, and co-occurring
substance use disorders, and will comply with those terms and conditions in
Attachment E.
D. The County agrees to provide Health Education services and will comply with the
Management by Objective requirements in Attachment C and C-1 and the terms and
conditions in Attachment D.
II. ADMINISTRATIVE RESPONSIBILITIES
A. The County when practicable, and only when authorization has been obtained from
the Consumer, shall ensure that coordination of care occurs between the consumer's
Primary Care Physician and Medicaid Health Plan.
B. Required Staff Training(s): The County understands that various federal and state
rules and regulations impose specific training requirements on the Parties. The
County agrees that its entire staff will receive all required training(s) as applicable.
The County also agrees to document the completion of applicable training in the
personnel file of each staff.
C. Cultural Competency: The County must assure meaningful service for persons with
diverse cultural backgrounds (including, but not limited to religious, ethnical,
geographical, geriatric, socioeconomic, and/or disability). The County shall assess
11
the population(s) it serves, collaborating with other community agencies (e.g.,
Council on Aging) and training staff on any identified cultural issues.
D. Relationship with Other Providers (Contractors): The County when practicable shall
collaborate with agencies in the community to the benefit of the consumer. Such
agencies include but are not limited to hospitals, intermediate school district, local
schools, faith based organizations, courts, law enforcement, community corrections,
substance abuse, Indian Health Services and Tribal Health Centers, Early On and
other early intervention programs that are essential to positive outcomes to our
community.
E. Advance Directives. The County agrees to comply with federal and state law
regarding Advance Directives.
F. Customer Services:
1. Orientation: The County will provide orientation to newly enrolled
Consumers. Orientation will include information about benefits and
services provided by Oakland County's Office of Substance Abuse Services.
2. The County will acknowledge receipt of support and for Federal and State
funds from the Michigan Department of Health and Human Services
(MDHHS) and/or Oakland County Community Mental Health CMH
Authority in any articles or publications that are produced utilizing any such
funding.
3. Grievance: The County will have a policy, procedures and a process to
document the number and nature of grievances and complaints brought to
the County.
G. Due Process: The County shall take reasonable steps to inform new Consumers of
its Due Process procedures. The County will provide Adequate or Advance Notice
whenever there is a proposed or actual denial, termination, suspension or reduction
in services requested by or provided to a Consumer.
1. All such notices will be provided in accordance with State and Federal
regulations.
2. The County will use notice formats approved by both Parties, and will submit
required data elements according to the schedule adapted as set forth in this
Contract and/or any applicable State or Federal statute or rule.
H. Recipient Rights:
1. The County will, and will require its subcontractors to, at every service site,
make readily available to all employees and staff, and if applicable, will post
in a conspicuous place and/or make available, the following:
a. A summary of all recipient rights guaranteed by the Public Health Code;
12
b. Provide unrestricted access to Rights Complaint forms, Your Rights
booklets, and MDCH Request for Administrative Hearing form to
recipients and others;
c. Post the MDDHS/Office of Recipient Rights (ORR) Reporting
Requirements poster for staff;
d. Have available for review by any recipient or others, the Medicaid
Services Administration {MSA) Manual and Bulletins;
I. Service Cost Tables Reporting: The County agrees to cooperate with and
participate in CMH Authority's cost integrity process. The County agrees to develop
and submit to CMH Authority Service Cost Tables upon request by the CMH
Authority. The County agrees that the rates it establishes for all procedures listed in
the Service Cost Table are based on actual costs and are representative of current
costs incurred and paid by the County.
J. Quality Management:
I. Quality Improvement (QI) Plan and Status Reports Requirements: The County
will submit to the CMH Authority's Quality Management Team (QM) an
annual Provider QI Plan which describes the County's ongoing and planned
QI activities. The County will submit to the QM Team an annual Status
Report for the prior year's QI Plan. The status report will describe the
outcomes that were achieved by the County in regards to the QI plan.
2. Satisfaction Surveys: The County will also participate in the administration of
the satisfaction surveys as mandated by the Michigan Department of
Community Health.
3. Sentinel Events: The County will comply with state laws and regulations
regarding Sentinel Events and Other Reportable Critical Incidents which
specify actions that the County must take if an incident is identified as a
Sentinel Event. The County if required by state law will report events to the
CM11 Authority and it will adhere to reporting timeframes for Root Cause
Analysis and Action Plans.
4. Credentialing: The County will utilize a credentialing process to validate the
qualifications of its direct staff. The process will include evaluating and
verifying the appropriate education, licensing, malpractice history, insurance,
and service site as applicable. The County must complete primary source
verification of staff education and licensure. The County may utilize the
National Practitioners Data Bank for this purpose. The American Medical
Association or American Osteopathic Association (as applicable) may be
utilized to complete primary source verification for physicians. The County
will utilize a privileging process which includes a review of specific
13
education, training, and experience to determine the consumer populations
and/or service the practitioner will be approved to provide.
III. DATA MANAGEMENT:
A. As to the extent provided for by law the CMH Authority is the owner of all
data related to consumers pursuant to this agreement including all data
entered into the County's management information system(s), such as, all
eligibility and demographic data, utilization data, claims data, and any other
service, administrative or financial information that has passed through the
CMH Authority's or the County's operation that resides with the County.
Notwithstanding the foregoing, the County is not precluded from
maintaining and utilizing the data identified in this section in support of the
services provided to the consumer and internal County operations.
B. The County shall implement tools to prevent unauthorized access and virus
protection to its internal transaction and office system using planning,
management, and system monitoring tools.
C. The Parties agree that when transmitting information electronically the
national ANSI and HIPAA compliant standards shall be utilized
D. If the County is transferring data to the CMH Authority electronically, it
shall transmit data by the close of the next business month following the
month of service for direct care services and within 60 days of the close of
the month for subcontracted services. All data for the fiscal year must be
received by the 5th working day of December in the format reasonably
requested by the CMH Authority. In the event of termination of this
Contract and the data is being transferred electronically, the County shall
download for and provide to the CMH Authority, at no cost to the CMH
Authority, all such CMH Authority data in an electronically accessible
format within twenty (20) days following the termination of this Contract.
14
OAKLAND COUNTY INTERLOCAL AGREEMENT
BETWEEN
OAKLAND COUNTY
AND
THE OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
EXHIBIT III
BUSINESS ASSOCIATE AGREEMENT
(Health Insurance Portability and Accountability Act Requirements)
Exhibit II is a Business Associate Agreement between Contractor ("Business Associate") and the
County ("Covered Entity"). This Exhibit is incorporated into the Contract and shall be
hereinafter referred to as "Agreement." The purpose of this Agreement is to facilitate
compliance with the Privacy and Security Rules and to facilitate compliance with HIPAA and
the HITECH Amendment to HIPAA.
1. DEFINITIONS. The following terms have the meanings set forth below for purposes of
the Agreement, unless the context clearly indicates another meaning. Terms used but not
otherwise defined in this Agreement have the same meaning as those terms in the Privacy
Rule.
1.1 Business Associate. "Business Associate" means the Contractor.
1.2 CFR. "CFR" means the Code of Federal Regulations.
1.3 Contract. "Contract" means the document with the Purchasing Contract
Number:
1.4 Contractor. "Contractor" means the entity or individual defined in the Contract
and listed on the first page of this Contract.
1.5 Covered Entity. "Covered Entity" means the County of Oakland as defined in
the Contract.
1.6 Designated Record Set. "Designated Record Set" is defined in 45 CFR 164.501.
1.7 Electronic Health Record. "Electronic Health Record" means an electronic
record of health-related information on an individual that is created, gathered,
managed, and consulted by authorized health care clinicians and staff.
1.8 HIPAA. "HIPAA" means the Health Insurance Portability and Accountability
Act of 1996.
1.9 HITECH Amendment "HITECH Amendment" means the changes to HIPAA
made by the Health Information Technology for Economic and Clinical Health
Act.
1.10 Individual. "Individual" is defined in 45 CFR 160.103 and includes a person who
qualifies as a personal representative in 45 CFR 164.502(g).
1.11 Privacy Rule. "Privacy Rule" means the privacy rule of HIPAA asset-forth in the
Standards for Privacy of Individually Identifiable Health Information at 45 CFR
part 160 and part 164, subparts A and E.
1.12 Protected Health Information. "Protected Health Information" or "PHI" is
defined in 45 CFR 160.103, limited to the information created or received by
Business Associate from or on behalf of Covered Entity.
1.13 Required By Law. "Required By Law" is defined in 45 CFR 164.103.
1.14 Secretary. "Secretary" means the Secretary of the Department of Health and
Human Services or his or her designee.
1.15 Security Incident. "Security Incident" is defined in 45 CFR 164.304.
1.16 Security Rule. "Security Rule" means the security standards and implementation
specifications at 45 CFR part 160 and part 164, subpart C.
2. OBLIGATIONS AND ACTIVITIES OF BUSINESS ASSOCIATE. Business
Associate agrees to perform the obligations and activities described in this Section.
2.1 Business Associate understands that pursuant to the HITECH Amendment, it is
subject to the HIPAA Privacy and Security Rules in a similar manner as the rules
apply to Covered Entity. As a result, Business Associate shall take all actions
necessary to comply with the HIPAA Privacy and Security Rules for business
associates as revised by the HITECH Amendment, including, but not limited to,
the following: (a) Business Associate shall appoint a HIPAA privacy officer and
a HIPAA security officer; (b) Business Associate shall establish policies and
procedures to ensure compliance with the Privacy and Security Rules; (c)
Business Associate shall train its workforce regarding the Privacy and Security
Rules; (d) Business Associate shall enter into a privacy/security agreement with
Covered Entity; (e) Business Associate shall enter into privacy/security
agreements with its subcontractors that perform functions relating to Covered
Entity involving PHI; and (f) Business Associate shall conduct a security risk
analysis.
2.2 Business Associate shall not to use or disclose PHI other than as permitted or
required by this Agreement or as required by law.
2.3 Business Associate shall use appropriate safeguards to prevent use or disclosure
of the PHI. Business Associate shall implement administrative, physical, and
technical safeguards (including written policies and procedures) that reasonably
and appropriately protect the confidentiality, integrity, and availability of PHI that
it creates, receives, maintains, or transmits on behalf of Covered Entity as
required by the Security Rule.
2.4 Business Associate shall mitigate, to the extent practicable, any harmful effect
that is known to Business Associate of a use or disclosure of PHI by Business
Associate in violation of law or this Agreement.
2.5 Business Associate shall report to Covered Entity any known Security Incident or
any known use or disclosure of PHI not permitted by this Agreement.
2.6 Effective September 23, 2009 or the date this Agreement is signed, if later,
Business Associate shall do the following in connection with the breach
notification requirements of the HITECH Amendment:
2.6.1 If Business Associate discovers a breach of unsecured PHI, as those terms
are defined by 45 CFR 164.402, Business Associate shall notify Covered
Entity without unreasonable delay but no later than ten (10) calendar days
after discovery. For this purpose, "discovery" means the first day on
which the breach is known to Business Associate or should have been
known by exercising reasonable diligence. Business Associate shall be
deemed to have knowledge of a breach if the breach is known or should
have been known by exercising reasonable diligence, to any person, other
than the person committing the breach, who is an employee, officer,
subcontractor, or other agent of Business Associate. The notification to
Covered Entity shall include the following: (a) identification of each
individual whose unsecured PHI has been breached or has reasonably
believed to have been breached and (b) any other available information in
Business Associate's possession that the Covered Entity is required to
include in the individual notice contemplated by 45 CFR 164.404.
2.6.2 Notwithstanding the immediate preceding subsection, Business Associate
shall assume the individual notice obligation specified in 45 CFR 164.404
on behalf of Covered Entity where a breach of unsecured PHI was
committed by Business Associate or its employee, officer, subcontractor,
or other agent of Business Associate or is within the unique knowledge of
Business Associate as opposed to Covered Entity. In such case, Business
Associate shall prepare the notice and shall provide it to Covered Entity
for review and approval at least five (5) calendar days before it is required
to be sent to the affected individual(s). Covered Entity shall promptly
review the notice and shall not unreasonably withhold its approval.
2.6.3 Where a breach of unsecured PHI involves more than five hundred (500)
individuals and was committed by the Business Associate or its employee,
officer, subcontractor, or other agent or is within the unique knowledge of
Business Associate as opposed to Covered Entity, Business Associate
shall provide notice to the media pursuant to 45 CFR 164.406. Business
Associate shall prepare the notice and shall provide it to Covered Entity
for review and approval at least five (5) calendar days before it is required
to be sent to the media. Covered Entity shall promptly review the notice
and shall not unreasonably withhold its approval.
2.6.4 Business Associate shall maintain a log of breaches of unsecured PHI with
respect to Covered Entity and shall submit the log to Covered Entity
within thirty (30) calendar days following the end of each calendar year,
so that the Covered Entity may report breaches to the Secretary in
accordance with 45 CFR 164.408. This requirement shall take effect with
respect to breaches occurring on or after September 23, 2009.
2.7 Business Associate shall ensure that any agent or subcontractor to whom it
provides PHI, received from Covered Entity or created or received by Business
Associate on behalf of Covered Entity, agrees in writing to the same restrictions
and conditions that apply to Business Associate with respect to such information.
Business Associate shall ensure that any such agent or subcontractor implements
reasonable and appropriate safeguards to protect Covered Entity's PHI.
2.8 Business Associate shall provide reasonable access, at the written request of
Covered Entity, to PHI in a Designated Record Set to Covered Entity or, as
directed in writing by Covered Entity, to an Individual in order to meet the
requirements under 45 CFR 164.524.
2.9 Business Associate shall make any amendment(s) to PHI in a Designated Record
Set that the Covered Entity directs in writing or agrees to pursuant to 45 CFR
164.526.
2.10 Following receipt of a written request by Covered Entity, Business Associate shall
make internal practices, books, and records reasonably available to the Secretary
in order to determine Covered Entity's compliance with the Privacy Rule. The
afore mentioned materials include policies and procedures and PHI relating to the
use and disclosure of PHI received from Covered Entity or created or received by
Business Associate on behalf of Covered Entity.
2.11 Business Associate shall document disclosures of PHI and information related to
such disclosures, to permit Covered Entity to respond to a request by an
Individual for: (a) an accounting of disclosures of PHI in accordance with 45
CFR 164.528 or (b) effective January 1, 2011 or such later effective date
prescribed by regulations issued by the U.S. Department of Health and Human
Services, an accounting of disclosures PHI from an Electronic Health Record in
accordance with the HITECH Amendment.
2.12 Following receipt of a written request by Covered Entity, Business Associate shall
provide to Covered Entity or an Individual information collected in accordance
with Section 2 to permit Covered Entity to respond to a request by an Individual
for: (a) an accounting of disclosures of PHI in accordance with 45 CFR 164.528
or (b) effective as of January 1, 2011 or such later effective date prescribed by
regulations issued by the U.S. Department of Health and Human Services, an
accounting of disclosures of Protected Health Information from an Electronic
Health Record in accordance with the HITECH Amendment.
3. PERMITTED USES AND DISCLOSURES BY BUSINESS ASSOCIATE. Business
Associate may use and disclose PHI as set forth in this Section.
3.1 Except as otherwise limited in this Agreement, Business Associate may use or
disclose PHI to perform functions, activities, or services for or on behalf of
Covered Entity as specified in the underlying service agreement between Covered
Entity and Business Associate, provided that such use or disclosure shall not
violate the Privacy Rule if done by Covered Entity or the minimum necessary
policies and procedures of the Covered Entity. If no underlying service
agreement exists between Covered Entity and Business Associate, Business
Associate may use or disclose PHI to perform functions, activities, or services for
or on behalf of Covered Entity for the purposes of payment, treatment, or health
care operations as those terms are defined in the Privacy Rule, provided that such
use or disclosure shall not violate the Privacy Rule if done by Covered Entity or
the minimum necessary policies and procedures of the Covered Entity.
3.2 Except as otherwise limited in this Agreement, Business Associate may use PHI
for the proper management and administration of the Business Associate or to
carry out the legal responsibilities of the Business Associate.
3.3 Except as otherwise limited in this Agreement, Business Associate may disclose
PHI for the proper management and administration of the Business Associate or
to carry out the legal responsibilities of the Business Associate, provided that
disclosures are Required by Law or Business Associate obtains reasonable
assurances in writing from the person to whom the information is disclosed that:
(a) the disclosed PHI will remain confidential and will be used or further
disclosed only as Required by Law or for the purpose for which it was disclosed
to the person and (b) the person notifies the Business Associate of any known
instances in which the confidentiality of the information has been breached.
3.4 Except as otherwise limited in this Agreement, Business Associate may use PHI
to provide data aggregation services to Covered Entity as permitted by 45 CFR
164.504(e)(2)(i)(B).
3.5 Business Associate may use PHI to report violations of law to appropriate federal
and state authorities, consistent with 45 CFR 164.502(j)(1).
4. OBLIGATIONS OF COVERED ENTITY.
4.1 Covered Entity shall notify Business Associate of any limitation(s) of Covered
Entity in its notice of privacy practices in accordance with 45 CFR 164.520, to the
extent that such limitation may affect Business Associate's use or disclosure of
PHI.
4.2 Covered Entity shall notify Business Associate of any changes in or revocation of
permission by an Individual to use or disclose PHI, to the extent that such changes
may affect Business Associate's use or disclosure of PHI.
4.3 Covered Entity shall use appropriate safeguards to maintain and ensure the
confidentiality, privacy and security of PHI transmitted to Business Associate
pursuant to this Agreement, the Contract, and the Privacy Rule, until such PHI is
received by Business Associate, pursuant to any specifications set forth in any
attachment to the Contract.
4.4 Covered Entity shall manage all users of the services including its qualified
access, password restrictions, inactivity thneouts, downloads, and its ability to
download and otherwise process PHI.
4.5 The Parties acknowledge that Covered Entity owns and controls its data.
4.6 Covered Entity shall provide Business Associate with a copy of its notice of
privacy practices produced in accordance with 45 CFR Section 164.520, as well
as any subsequent changes or limitation(s) to such notice, to the extent such
changes or limitations may effect Business Associate's use or disclosure of PHI.
Covered Entity shall provide Business Associate with any changes in or
revocation of permission to use or disclose PHI, to the extent the changes or
revocation may affect Business Associate's permitted or required uses or
disclosures. To the extent that the changes or revocations may affect Business
Associate's permitted use or disclosure of PHI, Covered Entity shall notify
Business Associate of any restriction on the use or disclosure of PHI that Covered
Entity has agreed to in accordance with 45 CFR Section 164.522. Covered Entity
may effectuate any and all such notices of non-private information via posting on
Covered Entity's web site.
5. EFFECT OF TERMINATION.
5.1 Except as provided in Section 5, upon termination of this Agreement or the
Contract, for any reason, Business Associate shall return or destroy (at Covered
Entity's request) all PHI received from Covered Entity or created or received by
Business Associate on behalf of Covered Entity. This provision shall apply to
PHI that is in the possession of subcontractors or agents of Business Associate.
Business Associate shall retain no copies of PHI.
5.2 If Business Associate determines that returning or destroying the PHI is
infeasible, Business Associate shall provide to Covered Entity written notification
of the conditions that make return or destruction infeasible. Upon receipt of
written notification that return or destruction of PHI is infeasible, Business
Associate shall extend the protections of this Agreement to such PHI and shall
limit further uses and disclosures of such PHI to those purposes that make the
return or destruction infeasible, for so long as Business Associate maintains such
PHI, which shall be for a period of at least six (6) years.
6 MISCELLANEOUS.
6.1 This Agreement is effective when the Contract is executed or when Business
Associate becomes a Business Associate of Covered Entity and both Parties sign
this Agreement, if later. However, certain provisions have special effective
dates, as set forth herein or as set forth in HIPAA or the HITECH Amendment.
6.2 Regulatory References. A reference in this Agreement to a section in the Privacy
Rule or Security Rule means the section as in effect or as amended.
6.3 Amendment. The Parties agree to take action to amend this Agreement as
necessary for Covered Entity to comply with the Privacy and Security
requirements of HIPAA. If the Business Associate refuses to sign such an
amendment, this Agreement shall automatically terminate.
6.4 Survival. The respective rights and obligations of Business Associate and
Covered Entity under this Agreement shall survive the termination of this
Agreement and/or the Contract.
OAKLAND COUNTY INTERLOCAL AGREEMENT
BETWEEN
OAKLAND COUNTY
AND
THE OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
EXHIBIT IV: Attachments
ATTACHMENT C
MBO — GENERAL SUBSTANCE ABUSE PREVENTION
OAKLAND COUNTY CONFAUNITY MENTAL HEALTH AUTHORITY
Management by Objective
FY 2015 -2018
Program Name: General Sub Abuse Prevention
Agency/Organization: OCHD1 Health Ed
Prepared By: Angle GuileKson/Trisha Ozumbo
Date Prepared: 2/3/2016
Program Goal: To delay onset/prevent the abuse of ATOD In the Oakland County commuriltf, especiaily among
youth
Specific Activity and Objective (s)
(Number consecutively and use separate page for each
Prevention Activity)
Estimated
Total
(12months)111
Number of Direct Service 1-burs (outputs)
= P Planned / A = Delivered let Qtr. Recipients
2nd Qtr, 3rd Qtr. 4th Qtr. TOTAL
A
10
PIIP
10
.111111M.1111
IIP
10
1111 A
*1-GENERAL SUBSTANCE ABUSE PREVENTIONt Act as a rwouite on
the general topic at substanc a abuse prevention by providing Infonnion
and researc h to OCCMHA arid OCHD staff arEithe community at large
including (a) IntpAtte educational presentations, materials and stafftraining
assistance (TA) to SA na a (b) provide technical ated groups and gencies
Including but not limited to coordinate planning & Implementing BASICS
Conference (c) provide a minimum of so prevention messages to OCFID for
use In social merle. Outcomes: List number and nature of seoic es
a 100
I.
b 150 IIIIIIIIINIMIIIIIIIIIIIIIIIM MM MI
c 2500 =
IIII ME= IIII
delivered, number of recipients ar4d estimated
•
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MI
. 111.
= MEM =
II Strategy: (list) C, E. N Sub TotaiP
Total
0 10 0 10 0 10 0
A = Alternative MIN MI
C = Community-Based
E = Education
N = Information dissemination
P = Problem ID & Referral
V = Ernironmental
A TTACHIVENTC
OAKLAND COUNT( COMMUNITY MENTAL HEALTH AU1HORSIY
Managenient by Objective
Y2015 -2016
Program Narre:
Agency/Crganizati on:
Prepared Eiyi
Program GoaL
Genera Sub Abuse Prevention
ocHot 1-leathld
Arnie GAksoniTritha Zizunto
To lid& onset/ oreverit the abu
youth
Date Prepared 2;3,2016
ATOD in the Oakland County COMTLiti mc.mq
Specific ActAty and Cbiective (s).
(Number consecutivety and use separate page for each
Preverton ActiOty)
Esli mated
Total
Reciponientssi th sti
ttUrriDEf of Direct Service Hours (outputs)
P 7-- Planned IA = Dekvered
r h TOTAL ou and A cinc mri A
42: LI E SKILL S rnfU MT): {a) c00 te r•ccria nt 0 ig k
student priplatioria Iva acruols and ether r:rhOrl actritty centers fr LST
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tir LEir tr Cu -0tatary &idiot atidtke strciai a9c cbkdrea in iti9h.dak scilarii
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a. to 20 11111M111111111110111 10 11 le, ''' IIIIIIIIIIIIIIIIIIIIIIIII MINI
. mmsimimnnim.mmioemii
11111111111111111111111111111.1111111111M11111111111 MIIIIIIIIIIIIIIMIIMIIIIIIIIIIIIIII=IIIIIIIIIII IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIMIIIIIIIIIIIIIII 11111111111111111111111111101111111111111 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 11111111101111111111111:51111211
mium moo
=
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Total
28 MI 28 111111 26 NM fl A :--- Alternative gal 1111111111111111111111.11111111111111
C Corrmirity-Based
E Education
N = Informaton disserrination
P Problem ID & Referral
V Environriertal
ATTACHMENT C
OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
Management by Objective
FY 2015 -2016
Program Name:
Agency/Organization:
Prepared By:
Program Goal:
General Sub Abuse Prevention Date Prepared: 2/3/2016
OCHD/ Health Ed
Angie Gullekson/Trisha Zzumbo
To delay onset/ prevent the abuse of ATOD in the Oakland County Community especiatiy among
youth
Specific Activity and Objective (s)
(Number consecutively and use separate page for each
Prevention Activity)
Estimated
Total
Recipients
(12 months)
Number of Direct Service Hours (outputs)
P = Planned / A = Delkered 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. TOTAL
P AP A P A P A P A
#3 UNDERAGE DRINKING (UD) 8. BINGE DRINKING (BD) BY YOUTH &
ADULTS: (a) act as a resource and provide technical assistance to OCHD
staff and the general community (b) collect and provide to OCCMHA,
relewint data on these priority problems by surNeying courts, law
enforcement and MI Liquor Control Commission(MLCC), MSP
information/data- to assess what is presently occurring in temis of retailer
alcohol enforcement checks, tracking community location, number and
results of checks accomplished by LE and and the MLCC and data on
Minors In Possession by community; (c) target non-coalition community
alcohol vendors and MLOC NAolators. Outcomes: (1) list details of
10 10 10 10 40
(a) 50
(b) na
(c) 150
services/TA delivered; (2) report summary of data research at 6 month and
year-end intervals; {3) complete a year to year comparison (FY12, FY13,
FY4) of violations occurring in non-coalition communities who receive
vendor education.
Strategy: (list) N, V, E Sub Total
Total
10 10 10 10 40
A = Alternatiw
C = Community-Based
E = Education
N = Information dissemination
P = Problem ID 8, Referral
V = Environmental
ATTACHMENT C
OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
Management by Objective
FY 2015 -2016
Program Name:
Agency/Organization:
Prepared By:
Program Goal:
General Sub Abuse Prevention Date Prepared: 2/3/2016
OCHD/ Health Ed
Angie Gullekson/Jennifer Kirby
To delay onset/ prevent the abuse of ATOD in the Oakland County Community especially
among youth
Specific Activity and Objective (s)
(Number consecutively and use separate page for each
Prevention Activity)
Estimated
Total
Recipients
(12months)P
Number of Direct Service Hours (outputs)
P = Planned / A = Deliwred
1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. TOTAL
A P A P A P A P A
#4 PRESCRIPTION AND OVER-THE COUNTER DRUG ABUSE: (a) Act
as a resource offering technical assistance to OCCMHA and OCHD staff,
the senior and general community on Rx and OTC misuse and other
emerging trends in OC especially opioids and stimulants like Milan (study
drugs); (b) provide support and technical assistance in the implementation
of any local and State-wide (OROSC dewloped) strategies to prevent the
misuse of Rx and OTC medicines; (c) support an awareness campaign on
the prevention of the nonmedical use of Rx drugs (d) Support and prokle
TA to prescription drug abuse focused community Partnerships/Task
Forces/Coalitions with including, but net limited to a focus an older adults
(e) Facilitate a minimum of one Photovoice Projects on the prevention of
the nonmedical use of Rx drugs Outcomes: (a) report on audiences,
(a) 100 14 14 14 14 56 0
(b) 500
, (c) 1000
(d) 1000
types of TA delhered, surveys It administered, emerging trends described;
(b) describle local or state-wide strategies Implemented, estimate reach;
(c) describe Implementation- press releases, etc., estimated reach; (d)
Strategy: (list) C, N, E, V Sub Total
Total
14 0 14 0 14 0 14 0 56
A = Alternative 251
C = Community-Based
E = Education
N = Information dissemination
P = Problem ID & Referral
V = Environmental
ATTACHMENT C-1
MBO - YOUTH TOBACCO USE PREVENTION
ATTACHMENT C-1
OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
Management by Objective
FY 2015-2016
Program Name: Youth Tobacco Use Prevention Date Prepared: 2/3/2016
Agency/Organization: OCHD/ Health Ed
Prepared By: Melanie Stone/Trisha Zizumbo
Program Goal: To delay/ prevent the onset of youth use of tobacco products in the region and coordinate efforts
to ensure Oakland County's compliance with the federal Synar Amendment
Specific Acthrity and Objective (s)
(Number consecutively and use separate page for each
Prevention Activity)
Estimated
Total
Recipients
(12 months)
Number of Direct Servte Hours (outputs)
P = Planned / A = Delivered
let Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. TOTAL
P A P A P A P A P A
TEEN TOBACCO USE PREVENTION: #1 Provide education and
technical assistance on youth tobacco use and secondhand smoke (a) act
as a resource to OCCMHA and OCHD staff and general community by
providing: information on tobacco use prevention and emerging trends like
anus, e-cigs, hookah, updates on cessation resources, and providing a
minimum of 30 tobacco prevention messages to OCHD for use on social
media sites (b) provide educational presentations requested on youth
tobacco uselpreventioR (c) Promote awareness of Kick Butts Day, World
No Tobacco Day, the ALA's Great American SmokeOut in the schools and
communities in OC; (d) act as staff to TFOC and provide technical
assistance to other local, regional and state planning groups (TFM, SF
Michigan Tobacco Coalition, to promote youth tobacco use prevention
efforts and support for smoke free environmentsfpolicies; Outcomes: (a)
and (b) report on populations served, general types of technical assistance
or data delivered and emerging trends; (c) describe participants,
implementation- tool kits distributed, press releases disseminated,
newsletter articles, media interviews, etc,, estimated reach: (d) describe
collaborative efforts, projects initiated or coordinated as a result of meeting
participation.
a)1000 5 5 5 5 20
b)1000 2.5 2.5 2.5 2.5 10
0100
d)100 5 5 5 5 20
2200
Strategy: (list) E, N, V, C Sub Total
Total
13 13 13 13 50
A = Alternative
C = Community-Based
E = Education
N = Information dissemination
P = Problem ID & Referral
V = Environmental
ATTACHMENT C-1
OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
Management by Objective
FY 2016-2016
Program Name: Youth Tobacco Use Prevention
Agency/Organization: OCHD/ Health Ed
Prepared By: Melanie Stone/Trisha Zizurnbo
Date Prepared: 2/312016
Program Goal: To delay/ prevent the onset of youth use of tobacco products in the region and coordinate efforts
to ensure Oakland County's compliance with the federal Synar Amendment
Specific ActiVAy and Objective (s)
(Number consecutively and use separate page for each
Prevention Activity)
Estimated
Total
Recipients
(12 months)P
Number of Direct Service Hours (outputs)
P = Planned / A = Delivered
1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. TOTAL
A P A P AP A PA
#2 Synar-Related Activities: (a) train, monitor, collect and assess the
results of groups conducting Synar and law enforcement (LE) inspections:
(b) maintain a current list of Oakland County tobacco retailers for delivery
to OROSC as required; (c) provide an educational program for 2 Synar-
related target audiences as determined by needs assessment; (d)
coordinate the completion of (d)[1] State required number of Synar
inspections, (d)12] a minimum of 400 tobacco retailer education visits,
MP] the mailing of a educational letter to all Oakland County tobacco
retailers in cooperation with the County Sheriff (le) collect data on youth
tobacco use and provide the following to PIHP at the indicated times (e)[1]
on-going non-Synar Law Enforcement inspection results, (e)2) Synar
Inspection Report as required by OROSC, (0)[3] Ycuth Access to T bacco
Activity Report as required, (e)[41 the Annual Action Plan for Synar
implementation. Outcomes: Timely submission of deliverables as outlined.
a)50 15 15 15 15 60
b)850 2 2 2 2 8
0100 2 2
d1)60 15 15 15 15 60
d2)400
d3)850
e)100
2310
Strategy: (list) C, E, V Sub Total
Total
32 32 32 34 130
A = Alternative
C = Community-Based
E = Education
N = Information dissemination
P = Problem ID & Referral
V = Environmental
ATTACHMENT C-1
OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
Management by Objective
FY 2015-2016
Program Name: Youth Tobacco Usr Prevention
Agency/Organization: OCHD/ Health Ed
Prepared By: Melanie Stone/Trisha Zizumbo
Date Prepared: 2/3/2016
Program Goal: To delay/ prevent the onset of youth use of tobacco products and coordinate efforts to ensure
Oakland County's compliance with the federal Syrtar Amendment
Specific Activity and Objective (s)
(Number consecutively and use separate page for each
Prevention Activity)
Estimated
Total
Recipients
(l2 months)P
Number of Direct Service Hours (outputs)
= P Planned / A = Delivered 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. TOTAL
AP A P Ap A p A
ActMty #3 Facilltate Tobacco Free Oakland Coalition (TFOC) and the
achievement the following TPOC Goals by promoting policy change and
other appropriate environmental strategies.
a) Eliminating exposure to secondhand smoker public places & schools
0 Preventing youth initiation and access to tobacco products (school and
retailer policy changes)
c) Increasing and promoting accessible and affordable cessation services
especially targeting pregnant women and other disparate populations.
cl) Identifying disparities specific to race/ethnicity, socioeconomic status,
occupation, geography, gender and sexual orientation for targeted
services, Outcomes, Report on policy change attempts and success in
resourcing disparate populations.
a)200 3 3 3 3 12
b)200
C)1000
d)50
1450
Strategy: (list) E,N,V Sub Total
Total
4 0 4 0 4 0 4 0 16
A = Alternative
C = Community-Based
E = Education
N = Information dissemination
P = Problem ID & Referral
V = Environmental
ATTACHMENT C-1
OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
Management by Objective
FY 2016-2016
Program Name: Youth Tobacco Use Prevention
Agency/Organization: OCHD/ Health Ed
Prepared By: Melanie Stone/Trisha Zizumbo
Date Prepared: 2/17/2016
Program Goal: To delay/ prevent the onset of youth substance use through the implementation of activities that
reduce/prevent the occurrence of bullying in children and teens
and Objective Specific Activity ve (s)
(Number consecutively and use separate page for each
Prevention Activity)
Estimated
Total
Recipients
(12 months)
Number of Direct Service Hours (outputs)
= =
P Planned / A Delivered lst Qtr. 2nd Qtr. 3rd Qtr, 4th Qtr. TOTAL
p A P A P A P AP A
Activity #4 (a) Complete LifeSkills (LST) online training for
elementary level online. (b) Prepare to conduct at least one
session of LST with the optional Bullying Module(s) to a
Middle School 6-7 grades. (c) Act as a resource and
provide support and technical assistance for anti-bullying
efforts to groups such as taskforces, partnerships, and
coalitions as needed. Provide bullying presentations as
needed. (d) utilize media outlets to further anti-bully efforts.
a)35
b)100 17 17 7 41
c)100 5 5 5 5 20
d)1000
1145
Strategy: (list) E, N, C, V Sub Total
Total
5 22 22 12 61
A = Alternative 257
C Community-Based
E = Education
N = Information dissemination
P = Problem ID & Referral
V = Environmental
ATTACHMENT D
OAKLAND COUNTY
COMMUNITY MENTAL HEALTH AUTHORITY
SUBSTANCE USE DISORDER SERVICES
PURCHASE OF SERVICE POLICIES
For
PREVENTION PROVIDERS
FY 2015/2016
CONTENTS
I. Budgets
IL Billing and Payment
III. Amendments and Adjustment to Allocations
IV. Data and Reporting
V. Staff Credentials and Requirements
VI. Cultural Competency and Trauma-Informed Approach to Prevention
VII. Charitable Choice Policy and Procedure
VILE. Confidentiality
IX. Required Statement of Funding Sources and Recipient Rights
X. Programmatic and Financial Review
ATTACHMENTS
D-1 Request for Amendment Form
D-2 Mid and End-of-Year Prevention Program Report
D-3 Tobacco Activity Report
FY 2015/2016
OCCMHA Prevention Program Policies and Procedures
I. Budget
A. Prevention programs will submit an annual budget for OCCMHA-administered funds that
include revenue sources for total substance use disorder prevention programming using
the following forms: Prevention Budget/ Billing Summary and Budget/Billing Pages
(Attachment A).
B. Programs will provide a 10% local match for all OCCMHA funding and submit as part of
budget.
II. Billing and Payment
A. The Prevention Billing Summary Form along with the Prevention Budget Billing Pages
are the source document for billing the OCCMHA for actual expenditures related to
prevention services provided each month.
B. Payment for services will be based on actual expenses incurred for service delivery. The
Billing Summary page must include the total amount expended for each category
(Supplies & Materials, Travel, Contractual, etc.) for the month, as well as a breakout by
funding source (i.e., OCCMHA funds and/or Local Match) The Billing pages must
contain the monthly charges by line item in each category as identified in the original
budget.
C. Bills are due to OCCMHA no later than 10 days after the close of each service month;
those received after the 10th will not be processed for payment until the following month.
D. Reimbursements will be based on the understanding that a certain level of performance,
measured by outputs (face-to-face or direct service hours engaged with the service
population) must be met in order to receive full reimbursement of costs up to the
contracted amount at the end of the contract year.
E. For this agreement, the performance requirement is defined as 100% of the OCCMHA-
funded share of total direct service hours.
III. Amendments and Adjustments to Allocations
A. A program can request an amendment at any time up to the OCCMHA amendment
deadline of August 15, 2016.
B. A budget amendment with revised budget pages is required when there is a change in a
budget category over $2,000 or 15% of the category whichever constitutes the greater
amount. The deviation allowance does not authorize new categories or line items within
the category.
C. Request for Amendment Form (Attachment D-1) must be completed and approved by
OCCMHA before requested changes can be implemented.
1. In order to move 15% or $2,000 (whichever is greater) from one budget category
to another, it is necessary to complete the Request for Amendment Form,
including a detailed explanation of the changes, updated billing summary and
billing pages — (fax or email to Cyndi King at 248.975.9768, kingc@ocemha.org
or by mail to her attention at 2011 Executive Hills Blvd., Auburn Hills, MI 48326.
For questions call 248.758.1977.
2. You will receive a determination of approval, disapproval or pending status along
with comments -if further direction-is required within -10 bu-siness days.
IV. Data and Reporting
A. Prevention contractors must provide evidence-based prevention services (as defined in
the Research-based Prevention Protocol of their proposal.)
B. A Prevention Management by Objectives Form (Attachment C) describing specific
measurable objectives and number of outputs for each is submitted as part of the contract
and will be reviewed for compliance during the contract year.
C. All OCCMHA-funded program grantees are required to participate in the collection of
state-required prevention data elements by utilizing the Michigan Prevention Data
System (MPDS) (http://mpds.sudpds.corn), a web-based system- including but not
limited to:
• the number of direct hours (defined as face to face or output hours);
• the collection of strategies employed (Information Dissemination, Education,
Community-Based, Environmental, or Alternative);
• population code
• service population, type and domain
• service population demographics
• evidence-based practice
• funding source.
Outputs delivered during the invoiced month must be entered into the Michigan Data
Prevention System (MPDS) by the 10th of the month following the service month for on-
time reimbursement.
D. Reimbursements will be based on the understanding that a certain level of perfoimance,
measured by outputs (face-to-face or direct service hours engaged with the service
population) must be met in order to receive full reimbursement of costs up to the
contracted amount at the end of the contract year.
E. OCCMHA grantees must submit a Mid-Year and End-of-Year Prevention Program
Report (Attachment D-2) that includes a narrative and tables with data and outcome
evaluation results for all programs/services - no later than 10 days following the end of
the reporting period (e-mail to altmanla,oceinha.org .)
F. OCCMHA grantees must incorporate tobacco prevention activities into their
programming. A report of tobacco prevention activities is to be submitted biannually,
using the Tobacco Activity Report Form (Attachment D-3) no later than 10 days
following the end of Mid and End-of-Year reporting periods (e-mail
to altmanWoccrnha.org)
G. All forms and reports must be submitted in electronic form. Failure to submit required
reports in a timely manner to OCCMHA will result in withholding of payment for
services.
V. Staff Credentials and Requirements
A. During the period covered by this contract, the provider agency that directly employs or
contracts with the OCCMHA to provide prevention services is responsible for verifying
the ongoing certification status of the employee. This includes verification of the
credential(s), monitoring staff development plans, and compliance with continuing
education requirements.
B. As a condition of the contract, Prevention Professionals (commonly described as Program
or Prevention Coordinators, Prevention Specialist, or Consultants i.e., those responsible
for the planning, coordination and or oversight of program implementation) must be
certified by the Michigan Certification Board for Addiction Professional (MCBAP) as
one of the following:
• Certified Prevention Specialist M (CPS-M)
• Certified Prevention Specialist R (CPS-R)
• Certified Prevention Consultant M (CPC-M)
• Certified Prevention Consultant R (CPC-R)
• Certified Health Educator Specialist (CHES)
OR
• Must file a certification "Development Plan" with Michigan Certification Board
for Addiction Professionals (MCBAP) within 60 days of the contract start date.
Information on filing a Plan may be found at www.mcbap.com
• Failure to comply with credentialing requirement may result in termination of
contract.
C. All providers must conduct yearly criminal background checks on all employees (and
potential employees) employed in programs funded by the OCCMHA as a condition of
employment.
VI. Cultural Competency and a Trauma Informed Approach to Prevention
A. Providers must submit a cultural competency plan to the OCCMHA addressing the following
elements and be able to document same at their annual program review.
1. The program must identify and assess the cultural needs of potential and active
clients based on population served.
2. The program must identify how access to services is facilitated for persons with
diverse cultural backgrounds and Limited English Proficiency (LEP) and hearing
impairment.
3. The program must identify standards for the recruitment and hiring of culturally
competent staff members.
4. The program must document cultural competency training for provider staff upon
hire and hi-annually (every two years) thereafter for all staff.
S. The program must document staff training in a trauma-informed approach to
prevention. The training must include: an understanding of the critical nature of
trauma in the development of SUD, an understanding of the dimensions of
resiliency, building community capacity, and learning strategies to change
community conditions to support individuals, families and communities affected
by trauma/adverse experiences.
VII. Confidentiality
The provider will comply with all Federal requirements contained in 42 CFR, Part 2,
Confidentiality of Alcohol and Drug Abuse Patient Records, Final Rule, June 9, 1987, as well as
any information about alcohol and other drug use obtained by a "program" (42 CFR2.1
(42CFR2.12b). Information may be disclosed in summary, statistical, or other form which does
not directly identify particular individuals.
VIII. Charitable Choice Policy and Procedure
A. The Federal Register (45 CFR part 96) contains federal Charitable Choice SAPT block
grant regulations that apply to prevention and treatment providers/programs. The
regulations require: (1) that the designation of religious (faith-based) organizations as
such be based on the organization's self-identification as religious (or faith-based) and (2)
that a program beneficiary receiving services from such an organization who objects to
the religious character of a program has a right to notice, referral and alternative services
which meet standards of timeliness, capacity, accessibility and equivalency — and
ensuring contact to this alternative provider.
B. The program is required to comply with all applicable requirements of the Charitable
Choice regulations. If the program identifies itself as a religious or faith based
organization it must provide the federally mandated model notice to all clients. Providers
who are Faith-based must notify participants of their right by providing the following
model notice:
"No provider of substance abuse services receiving Federal funds from
the U.S. Substance Abuse and Mental Health Services Administration,
including this organization, may discriminate against you on the basis of
religion, a religious belief, a refusal to hold a religious belief, or a
refusal to actively participate in a religious practice.
If you object to the religious character of this organization, Federal law
gives you the right to a referral to another provider of substance abuse
services. The referral, and your receipt of alternative services, must
occur within a reasonable period of time after you request them. The
alternative provider must be accessible to you and have the capacity to
provide substance abuse services. The services provided to you by the
alternative provider must be of a value not less than the value of the
services you would have received from this organization"
IX. Required Statement of Funding Sources and Statement of Recipient Rights
Prevention programs that maintain records that include both the recipient's name and information
regarding his or her substance use or abuse, shall provide the recipient with a summary of
recipient rights protected by state or federal laws and promulgated rules. Any program
announcement, brochure, or other written communication that describes the program's substance
abuse prevention services shall state the following:
"Recipients of substance abuse prevention services have rights protected by state and federal
laws and promulgated rules". For information contact the OCCMHA Substance Use Disorder
Services, Recipient Rights Coordinator, Sherrie Kilpatrick, 2011 Executive Hills Blvd.,
Auburn Hills, MI 48326 or call 248.858.1210
Providers must assure that any program reports, articles and publications that result from
information gathered through the use of state, federal or county funds acknowledge receipt of
that support from the OCCMHA and/or the appropriate federal agencies by use of the
following statement:
"Federal, State, and/or County funding have been provided through the Oakland
County Community Mental Health Authority- Substance Use Disorder Services to
support the project costs".
X. Programmatic and Financial Review
OCCMHA grantees are subject to an annual site review as well as annual scheduled program
review by the OCCMHA Clinical Analyst. The site review affords OCCMHA an opportunity to
experience the staff and program in action, The program review looks at compliance with
contractual requirements: progress toward meeting output and outcome goals, process and
outcome evaluation, certification and background checks on employees, timeliness and accuracy
of billing and reporting, etc.
Grantees are also subject to a complete financial review on a bi-annual basis by the OCCMHA
Fiscal Analyst. The objectives of the financial review are:
9 To verify the reported expenditures have supporting documentation and were allowable
expenses;
• To determine whether agency's internal controls are adequate to provide reasonable
assurance that funds are managed in compliance with applicable laws and regulations
and/or provisions of the contract;
• Confirm the budget was consistent with the contract budget;
• Review the agency's financial audit to determine if there were any significant audit
findings.
..REQUEST FOR AMENDMENT
:
OAKLAND COUNTY COMMUNITy.:maNTAL HEALTH AUTHORITY
Substance Use Disorder Services- "
Agency:
Amending Budget: Date Requested: Requested by:
ATTACHMENT D-1
Purpose of Amendment:
Expenditures Current Budget
Proposed Budget
ncrease/Decrease
Travel
Supplies/Materials
Contractual
Other
TOTAL EXPENDITURES
• Source offuridi.
Local Match
OCCMHA Funding
TOTAL FUNDING
0 Approved 0 Not Approved
Fended:
Date
Comments:
Signature Date
ATTACHMENT D-2
Agency Name
OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
Substance Use Disorder Services
Prevention Program Report
(Mid-Year/End of Year)
0 Mid-Year — Due April 11, 2016
0 End of Year — Due October 10, 2016
Note: the mid-year report should reflect activity from October thru March. The end-of-year report
should contain a summation of activity for the entire year. Simply type your responses beneath
each question.
1) Describe your service population for the reporting period. Indicate how successful you were
in recruiting your target population. It is not necessary to provide exact numbers...however,
please describe what risk categories you intended to target and if different from your original
plan- describe the actual population served. What impact did this change have on
program/service delivery or outcomes?
2) Refer to your MBO (Management By Objective) form and comment on any services
that were not provided as planned (explain either why you were not able to complete
the activity and/or why you did something different from the original plan.)
3) Describe your program's overall process evaluation method(s) and the results of
your evaluation. (In a process evaluation items commonly include recruitment
procedures and retention rate; number of participants; participants' risk for
substance use; staff processing of program activity; participant comments or results
of satisfaction surveys.) Describe any ways in which your process evaluation results
will be used to improve the program in the future.
4) Outcome Evaluation: Complete the Attached Outcome Tables for each
service/activity listed on your MBO Form. State your measurable indicator(s) and
provide supporting data to show if the outcome was achieved. Use as many tables
as you need to present results in an organized and logical manner (please number if
using multiple tables.) For activities/services that are implemented as series at
multiple locations - you may choose to state outcomes by grade, school, city, etc.
but you must include a table with an overall result for a particular program.
For Alliance of Coalition for Healthy Communities (ACHC) ONLY: In replacement of
the Outcome Tables the ACHC is required to submit an MPDS summary of activities
report at Mid-Year. The Final Report however, must also include a narrative
submission in addition to the MPDS Report in the form of an Annual Report,
5) Provide supporting documentation.
• Actual data used to calculate outcome results and a description of how the
results were determined
• Program flyers or letters used to recruit participants
• Outline or brief description of the program or curriculum
• A copy of evaluation instruments
• Letters of support or news articles generated by the program
Call or email Kathleen Altman at altmankAoccmha.oro for
assistance in collecting, calculating, analyzing and reporting data.
OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY Substance Use Disorder Services Prevention Activities FY 2016/2016 Outcomes Table #Exam pie Program Name: Group Designation MBO Activity # Target Population Indicator Statement , Outcome Result's Sat/Unsat CMH Use Only (Example) (Example) (Example) # Econ Hispanic parents who participate in the Love Auburn Hill Elem Group #1 (a) 15% • Disadvantaged middle school students or Arab-Chaldean youth or Hispanic parents & Logic Program (3 hours per week for 8 weeks) will experience (a) 7% increase in positive parenting attitudes and interaction with their children and (b) a 10% increase in knowledge of positive parenting techniques as measured by the Love & Logic Pre Post (b) 12% A Test that accompanies this model program. 4....,K,, Comments: Please Note: for activities/services that are implemented in series at multiple locations — you may choose to state outcomes by grade, school location, city, etc., but please also include a table with an overall result. Use as many tables as you deem necessary to report results. Attach supporting data/spreadsheets to table or at end of report.
OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY Substance Use Disorder Services Prevention Activities FY 201512016 Outcomes Table #1 Program Name: Group Designation MBO Activity # Population Served Indicator Statement Outcome Results Sat/Unsat CMH Use Only Comments: Please Note: for activities/services that are implemented in series at multiple locations — you may choose to state outcomes by grade, school location, city, etc., but please also include a table with an overall result Use as many tables as you deem necessary to report results. Attach supporting data/spreadsheets to table or at end of report
OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY Substance Use Disorder Services Prevention Activities FY 201512016 Outcomes Table # 2 Program Name: Group Designation MBO Activity # Population Served Indicator Statement Outcome Results Sat/Unsat CMH Use Only Comments: Please Note: for activities/seivices that are implemented in series at multiple locations — you may choose to state outcomes by grade, school location, city, etc., but please also include a table with an overall result. Use as many tables as you deem necessary to report results. Attach supporting data/spreadsheets to table or at end of report
ATTACHMENT D-3
OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
Substance Use Disorder Services
PROGRAM
TOBACCO ACTIVITY REPORT FY 201512016
0 6 Month 9 Year End
Instructions: Please briefly describe any tobacco use prevention activities your group or organization has
undertaken in the past six-month reporting period in each of the following strategies-
Information Dissemination
Specific topic of information
Description of population distributed to
Estimated Outputs
Education
Type of format (class, series of classes, video, speaker, skills training, etc.)
Description of audience
Estimated outputs
Community-Based Activity (Describe activity: examples may include assessing community needs
regarding tobacco use; accessing services and funding for tobacco use prevention; providing trainings on
tobacco use prevention, etc.)
Estimated outputs
Environmental Strategies (Describe activity; examples include any activity undertaken to change
the physical, legal, economic, and social processes of a community that are associated with tobacco use,
i.e., establishing tobacco free policies, preventing underage sale of tobacco products to minors, vendor
education, changing codes, ordinances, or regulations regarding sale and use.)
Estimated outputs
ATTACHMENT E
OAKLAND COUNTY
COMMUNITY MENTAL HEALTH AUTHORITY
PACE SERVICE POLICIES
For
Access Management System
FY 2015/2016
OAKLAND COUNTY
COMMUNITY MENTAL HEALTH AUTHORITY
PACE SERVICE POLICIES
Table of Contents
Attachments
I. Policy statement
IL Eligibility Program
III. Requirements Program
IV. Service Eligibility: Block Grant
V. Service Eligibility: Medicaid and Healthy Michigan Plan
VI. Clinical Eligibility: Block Grant, Medicaid and Healthy Michigan Plan
VII. Priorities for Admission into Treatment
VIII. Waitlist
IX. Interim Services
X. Access to Care: Medicaid
XI. Covered Services: Block Grant, Medicaid, Healthy Michigan Plan and MIChild
XII. Authorization: Block Grant, Medicaid and Healthy Michigan Plan
XIII. Levels of Care
XIV. Utilization Management
XV. Client Documentation and Record
XVI. Financial Requirements
XVII. Program Reviews
XVIII. Complaint/Grievance/Appeals Process
XIX. Persons Associated with the Corrections System
XX. Sanctions
ATTACHMENTS
E-1 DSM-V Diagnosis Codes
E-2 Medical Necessity Criteria
E-3 CareNet Initial Authorization Request
E-4 CareNet Reauthorization Request
E-5 Billing Codes/Modifiers
E-6 Rights and Confidentiality
E-7 Plan of Action Reauthorization Request
E-8 Interagency Consent 8z Authorization to Release Protected Health Information
E-9 Client Responsibility Notice
E-10 Client Sliding Fee Schedule
E-11 Communicable Disease and Interim Services
E-I2 CareNet SARF Form
E-13 Client Complaint/Grievance Procedure
E-I4 Medicaid Fair Hearing Requirements
E-15 Trauma Informed System of Care Overview
E-16 Recovery Housing Guidelines
Substance Use Disorder Treatment Services
I. POLICY STATEMENT
All Substance Use Disorder Treatment Services provided on behalf of the Oakland County
Community Mental Health Authority (OCCMHA) and funded by appropriations from the
Michigan Department of Health and Human Services (MDHHS), the Michigan Department of
Health and Human Services/Medical Services Administration (Medicaid) shall be administered
through Purchase of Service contracts with eligible local programs.
Oakland County, through it§ Pnor Authorization Central Evaluation (PACE) Unit, is the provider
of Substance Use Disorder (SUD) services for the purpose of this policy.
H. ELIGIBILITY: PROGRAM
A. The Substance Use Disorder Provider shall be a legal entity with the ability to contract
and shall follow all State and Federal laws and regulations.
B. Services shall be available Monday-Friday 8:30 a.m. — 5 p.m. An after-hours message
shall direct callers to Common Ground Crisis Center or a medical emergency center if
immediate service is needed when the agency is closed. The Crisis Center shall contact
the on-call PACE Treatment Service Supervisor, based on the 24/7 Substance Use Access
Plan. The PACE shall make available a toll free telephone number and shall accept
collect calls for the purpose of this contract.
C. Screenings
PACE shall perform specific services for clients eligible for OCCMHA funding. These
services shall include:
1. Determining funding eligibility based on finances, residency and insurance
coverage
2. Identifying additional type(s) of funding individuals qualify for and Informing
clients of any co-pays associated with treatment services
3. Performing clinical screening to determine service needs, level of treatment
needed based on American Society of Addiction Medicine (ASAM) Patient
Placement Criteria and medical necessity for services
4. Providing linkage and referrals to the appropriate provider
5. Conducting care management to ensure successful engagement with referrals and
follow up services
6. Authorizing services as in accordance to OCCMHA policies
HI. REQUIREMENTS: PROGRAM
A. Cultural Competency Plan
PACE shall have a written Cultural Competency Plan implemented in practice which
includes the following:
1. PACE shall identify and assess the cultural needs of potential and active clients
based on population served.
2. PACE shall identify how access to services is facilitated for persons with diverse
cultural backgrounds and Limited English Proficiency (LEP).
3. PACE shall identify standards for the recruitment and hiring of culturally
competent staff members.
4. PACE shall identify how ongoing staff training needs in cultural competency
shall be assessed and met and the evidence that staff members receive training.
B. Charitable Choice Policy and Procedure
I. PACE is responsible for processing request for alternative services.
2. The Federal Register (45 CFR part 96) contains Federal Charitable Choice SAPT
block grant regulations that apply to prevention and treatment
providers/programs. The regulations require: (1) that the designatioh_of religious
(faith-based) organizations as such be based on the organization's self-
identification as religious (or faith-based) and (2) that a program beneficiary
receiving services from such an organization who objects to the religious
character of a program has a right to notice, referral and alternative services
which meet standards of timeliness, capacity, accessibility and equivalency — and
ensuring contact to this alternative provider.
3. The Program identified by PACE is required to comply with all applicable
requirements of the Charitable Choice regulations. If the Program identifies itself
as a religious or faith based organization it shall provide the federally mandated
model notice to all clients.
4. The model notice is:
"No provider of substance abuse services receiving Federal funds from
the U.S. Substance Abuse and Mental Health Services Administration,
including this organization, may discriminate against you on the basis of
religion, a religious belief, a refusal to hold a religious belief, or a refusal
to actively participate in a religious practice.
If you object to the religious character of this organization, Federal law
gives you the right to a referral to another provider for substance abuse
services. The referral, and your receipt of alternative services, shall occur
within a reasonable period of time after you request them. The alternative
provider shall be accessible to you and have the capacity to provide
substance abuse services. The services provided to you by the alternative
provider shall be of a value not less than the value of the services you
would have received from this organization."
C. Limited English Proficiency Policy and Procedure
PACE shall have a written Limited English Proficiency (LEP) policy and procedure that
is in compliance with related Federal and State requirements. The policies and procedures
shall contain the following:
1. PACE shall have a procedure for identifying and assessing the language needs of
the clients served.
2. PACE shall have a range of oral language assistance options.
3. PACE shall provide notice to LEP persons in their primary language of the right
to free language assistance.
4. PACE shall provide appropriate staff training and program monitoring related to
LEP policies and procedures.
5. PACE shall have provisions for written materials in language other than English,
where a significant number of percentages of the affected population need
services or information in a language other than English to communicate
effectively.
6. PACE shall have provisions for language interpreters who are trained and
competent.
7. PACE shall provide documentation of timely assistance and explanation of "no
charge" to the LEP recipient for these services.
8. Provisions regarding the use of family members and/or friends as a language
interpreter shall not be required. Should the client choose to use family or friends
as an interpreter, both the offering of other resources and the client's choice shall
be documented in writing. Availability of client's family and friends as
translator/interpreter shall not waive other LEP requirements herein described.
D. Communicable Diseases
OCCMHA is not involved with and does not financially support any needle exchange
programs in Oakland County.
1. PACE shall screen all substance use clients entering treatment for HIV/AIDS,
Sexually Transmitted Disease (STD), TB, Hepatitis (Attachment E-11).
2. PACE shall refer all persons receiving substance use disorder services who are
infected with TB for medical evaluation using the OCCMHA developed resource
list.
3. The Public Health Nurse shall facilitate services with PACE staff.
4. PACE shall provide information about resources, health education, risk reduction
activities and referrals for testing and treatment (with follow-up) to clients with
high-risk behaviors.
E. Welcoming/Engagement
1. PACE shall have a written policy that describes how the agency shall address
client engagement, no-shows, cancellations and Against Medical Advice (AMA).
2. PACE shall have a written policy regarding welcoming.
3. The Treatment Program shall notify the PACE Care Manager immediately of
clients who do not show for admission.
F. Recipient Rights
1. PACE agrees to strictly comply with all recipient rights provisions of the
Michigan Department of Public Health Center for Substance Abuse Service
Programs in Michigan Part 3, Recipient Rights (Rules 301-307).
2. PACE agrees to take all necessary steps to ensure that clients shall be protected
from rights violations while they are receiving services under this contract and
shall fully cooperate with any Prepaid Inpatient Health Plan (PHIP), State or
Federal agency's investigation into any alleged violation or suspected violation
of any client's Recipient Rights.
3. PACE shall make readily available to all employees and clients, the following
information:
a. Recipient Rights shall be displayed in a public area of all licensed
programs that also indicates the names and phone numbers of the PIHP
Recipient Rights Consultant and the State Recipient Rights Coordinator.
b. Instructions on how to contact and/or access the OCCMHA Recipient
Rights Consultant.
c. Provide for unrestricted access to rights complaint forms and rights
booklets.
d. Provide a written or oral description of recipient rights for clients
receiving substance use services in a language that is understood by the
recipient.
e. Have readily available, all applicable State Policies including those set
forth in the Michigan Department of Public Health/Center for Substance
Abuse Services Administrative Rules for Substance Abuse Service
Programs in Michigan; Part 3, Recipient Rights (Rules 301-307).
f. Direct complaints to OCCMHA SUD Service Network Team
4. PACE shall notify the Department of Health and Human Services Protective
Services Division, as required by law, regarding any alleged or suspected abuse
or neglect of any client receiving services.
IV. SERVICE ELIGIBILITY: BLOCK GRANT
A. An individual with a substance use disorder as defined in P.A. 368, Public Acts of 1978,
and Section 6107(3) as amended.
B. Immediate family members of a person with a substance use disorder.
C. Significant others, which include those involved in a continuing primary relationship with
a person who has a substance use disorder, whether or not they are legally related to that
individual.
D. Individuals who meet the criteria established in A, B, or C above shall also meet the
income criteria established in the OCCMHA Reimbursement/Sliding Fee Schedule
(Attachment E-10).
E. Preference shall be given to individuals who live in Oakland County. Should service
requests exceed the monthly prorated treatment slots, two wait lists should be maintained
to ensure provision of services to Oakland County residents prior to offering services to
residents from other jurisdictions.
V. SERVICE ELIGIBILITY: MEDICAID AND HEALTHY MICHIGAN PLAN
A. Medicaid, Healthy Michigan Plan and MIChild recipients who are eligible for OCCMHA
Medicaid Prepaid Substance Use Services Plan are those Medicaid recipients who reside
within Oakland County.
B. Current Medicaid, Medicaid spend down and Healthy Michigan Plan eligibility and
residency shall be confirmed using the 270/271 System on CareNet.
C. The following process shall be followed for clients with Medicaid spend-down:
Outpatient Referrals (Methadone, Suboxone, TOP, OP)
1. Clients are responsible for meeting their deductible each month.
2. Remind the client to submit their receipts to MDHEIS so their Medicaid shall
activate once the deductible is met. All medical bills including prescriptions can
be counted towards the monthly deductible.
3, In the event the client is unable to meet their deductible and cannot cover
substance use treatment services, submit a Request for Income Category Fee
Waiver form to OCCMHA requesting block grant assistance for the client. The
client is responsible for all payments for services rendered. The provider cannot
bill block grant without the approval of the waiver form.
4. Authorizations shall be submitted for the client in the event the deductible is met,
and Medicaid is billed for part of the month, or in the event a waiver is approved
and block grant dollars are used to assist the client.
5. PACE shall explain this expectation to Methadone-referred and Suboxone-
referred clients before authorizing services.
Residential, Detox, and DIOP Referrals:
1. All Residential, Detox and DIOP referrals are issued through the PACE office. If
PACE refers a spend-down client, block grant funding, when needed shall be
authorized during the referral process.
2. PACE shall attempt to verify the client's spend-down amount and place it in the
"Payor" screen under the notes section.
If PACE is unable to obtain the spend-down before placing the client in
treatment, the provider is responsible to obtain the amount before billing for
services. Without the spend-down amount OCCMHA cannot determine how
many days to approve under block grant funding. Lack of a documented spend
down amount shall result in the billing being denied.
4. The client's first few days (until the deductible is met) should be billed under
block grant. Once the deductible is met and MDHHS activates the Medicaid, the
remaining services for the month should be billed under Medicaid,
5. Providers shall submit a receipt to MDHHS showing the client met their
deductible. Make sure this process is done each month if the client is in treatment
more than one month.
6. Billing for the client's Medicaid cannot be completed until the Medicaid is
activated by 1VIDHHS. Check the 270/271 System for updates to the client's
status.
7. Providers may contact the PACE supervisor, if they are unable to obtain the
client's spend-down activated by MDHHS, or if the spend down amount cannot
be verified.
VI. CLINICAL ELIGIBILITY: BLOCK GRANT, MEDICAID AND HEALTHY MICHIGAN
PLAN
A. Clients shall meet use or dependency criteria for one of the substance-related disorders
found in the DSM V Table (Attachment E-1).
B. All decisions concerning client care are based on clinical eligibility, medical necessity
criteria and person-centered planning.
C. Decisions concerning client care include admission, level of care, continuation, discharge
and other decisions regarding scope, intensity, and duration of care. These decisions are
based on Medical Necessity Criteria (Attachment E-2). Medical necessity is defined as a
determination that a specific service is medically (clinically) appropriate, necessary to
meet a person's symptornology and functional impairments, is the most cost-effective
option in the least restrictive environment and is consistent with clinical standards of
care.
VII. PRIORITIES FOR ADMISSION INTO TREATMENT
A. PACE shall give preference for admission into treatment services to clients, regardless of
level of care, in the following order:
1. Pregnant Injecting Drug Users (IOU)
2. Pregnant substance users
3. IDUs
4. A parent or caregiver whose child has been removed from the home under the
Child Protection Laws of this state or is in danger of being removed from the
home under the Child Protection laws of this state because of the parent's
substance use
5. All others
B. OCCMHA requires that a screening tool be used to gather sufficient information to
determine if a person is a potential substance use disorder client, to establish the client's
eligibility for public dollars, to verify insurance status and to determine admission
priority status, such as IDU and pregnancy status.
C. Admission Timelines for Pregnant Women
1. Pregnant women shall be admitted to the treatment program within 24 hours. If
the Program has a wait list the client shall be referred to PACE. PACE shall
attempt to locate a treatment program that can enroll the client immediately.
2. If a pregnant woman cannot be admitted within 24 hours into a program, the
client shall be placed on the pregnant women wait list and PACE shall provide
Interim Services within 48 hours.
3. No pregnant woman should be put on a wait list at the program level.
D. Admission Timelines for Injecting Drug Users (IDU)
1. Programs serving IDUs shall maintain a wait list of each [DU seeking treatment.
2. Programs shall establish a mechanism for notifying clients on the wait list that a
treatment slot is available.
3. If a client cannot be located for admission to treatment after three (3) attempts or
if a person refuses treatment, he/she may be taken off the wait list (The wait list
should indicate the number of attempts and method for trying to reach the client).
VIII. WAIT LIST
PACE shall provide for Wait List Management of clients waiting for funded Substance Use
Disorder Treatment Services. PACE shall facilitate admissions to treatment services based on
federally mandated preferences for treatment admission.
IX. INTERIM SERVICES
A. Programs and/or PACE shall provide federally mandated Interim Services within 48
hours to:
I. IDUs who cannot be admitted into treatment within 14 days
2. Pregnant women who cannot be admitted into treatment immediately
B. Interim Services minimally consist of the following:
1. 1DUs
a. Counseling and education about HIV and hepatitis
b. Completion of TB screening history
c. Risks of needle-sharing
d. Risks of transmission of HIV and other STDs to sexual partners and
infants
e. Steps that can be taken to ensure that HIV transmission does not occur
f. Referral for HIV and TB services if necessary
2. Pregnant Women
a. Services listed above
b. Counseling on effects of alcohol, tobacco and other drug use on the fetus
c. Referral for prenatal care
C. PACE shall provide Interim Services for all eligible clients who are assessed. The
Program shall refer all pregnant women and IDU clients who present at the program and - cannot be admitted per above guidelines to the PACE for interim services.
D. OCCMHA provides funding for Women Specialty Services. PACE shall refer clients that
meet Women Specialty Services criteria to providers identified in the OCCMHA
network.
X. ACCESS TO CARE: MEDICAID
A. Urgent: PREGNANT WOMEN (individual is determined to be at risk of experiencing an
emergent situation in the near future if care is not received).
1. Shall be assessed within 24-hours of referral 95% of the time
2. Admission to treatment shall be within 24-hours of assessment 95% of the time
3. Report on number of clients who make intake appointment and do not show
4. Program shall report its performance against these standards quarterly to the
OCCMHA
B. Non urgent
I. Shall be assessed within five calendar days 95% of the time
2. Admission into treatment shall be within seven calendar days 95% of the time
3. Report on number of clients who make intake appointment and do not show
4. Program shall report its performance against these standards quarterly to
OCCMHA
XL COVERED SERVICES: BLOCK GRANT, MEDICAID, HEALTHY MICHIGAN PLAN
AND MICHILD
A. Covered Services:
I. Initial/Intake Assessment
2. Outpatient (including individual, family and group)
3. Intensive Outpatient PRISM
4. Intensive Outpatient with Domiciliary (NO MIChild)
5. Domicile Outpatient (NO MIChild)
6. Opiate Replacement Therapy including laboratory for Medicaid/Healthy
Michigan Nan (NO MIChild)
7. Sub-acute detoxification
8. Residential services
9. Pharmacy, laboratory and inpatient (MIChild ONLY)
B. Excluded Services:
I. Emergency medical care
2. Emergency transportation
3. Routine transportation
4. Substance use prevention and treatment which occurs routinely in the context of
providing primary health care
5. Room and board
6. Pharmacy
7. Laboratory
8. Acute detoxification
XII. AUTHORIZATION: 13 OCK GRANT, -MEDICAID AND HEALTHY MICHIGAN PLAN
A. Prior Authorization for Intensive Services
Services shall be reimbursed according to CPT Codes (Attachment E5). Clients shall
need prior authorization from PACE prior to admission to a residential (detoxification,
short or long term), domiciliary intensive outpatient program (D1OP), Recovery Housing
and Opiate Specific programming. Programs shall refer clients to PACE for screening.
Authorizations are valid for 30 days.
1. OCCMHA requires clients to be provided with individualized treatment that
includes timely movement into varying levels of care. While OCCMHA
encourages the development of diversified treatment packages, it shall be
emphasized that predetermined documented client need, shall determine the
client's movement through various treatment modalities.
2. Decisions related to authorization for initial and continuing care are based on
medical necessity (such as the service is clinically appropriate) necessary to meet
a person's symptomology and functional impairments, is the most cost-effective
option in the least restrictive environment, and is consistent with clinical
standards of care.
3. Providers are required to fax a copy of the two-way release to PACE once the
client admits to treatment. PACE shall not release information to the provider
until the two-way release is received.
4. Information from the Bin-psycho-social Assessment shall be entered into
CareNet by the provider. An initial authorization shall be submitted by the
provider and supported with clinical justification. Authorizations should be
requested based on the client's treatment plans.
5. Reauthorizations shall be reviewed for clinical necessity. Approval for
reauthorizations shall be reviewed within seven business days.
6. Program Admission
a. When the client is admitted, proof of Oakland County residency shall be
presented to the provider. The client's identification and other documents
shall be in the record. The following documents are acceptable:
• Picture ID
• Medicaid card/Department of Health and Human Services
• Utility bill
• Voter registration card
• Pay stub
• Letter from a family or friend confirming residency
b. The provider shall contact PACE if services are unable to be provided
upon admission. The PACE Care Manager shall coordinate a transition
plan with the provider.
c. The provider may also contact the PACE Care Manager to assist with
continued care planning for clients who successfully complete the
program.
B. Authorization for Outpatient Services
1. PACE shall complete a SARF form (Attachment E-12) on each client and submit
to OCCMHA via CareNet. The ASAM Patient Placement Criteria shall be used
in decisions regarding admission, continued stay and discharge/transfer.
2. An individual session is fifty (50) minutes or more in length and one-half (1/2)
individual session is thirty (30) minutes in length. Frequency of individual
sessions shall be determined by documented clinical need. A full session will, at
a minimum, be fifty (50) minutes of direct client contact. The additional ten (10)
minutes shall be allocated for paperwork and/or transition between client
appointments for scheduled clients.
3. Programs shall fax a copy of their H1PAA/42 CFR compliant two-way Consent
for the Release of Confidential Alcohol and Drug Treatment Information Form
for the program, OCC1VfHA and PACE to communicate before initial
authorization shall be released. Release should remain valid for thirty (30) days
post discharge from program.
4. The program has ten (10) days following the date of admission to enter the
authorization request in CareNet and submit the two-way release to PACE. If the
release of information is received within ten (10) days the initial authorization
shall be approved. If the release of information is received on day eleven ( 11) or
after, the initial authorization shall be approved starting on the date that the faxed
release is received, not on the date of admission. The program shall not be able to
bill for services provided prior to the date the faxed release of information was
received at the OCCMHA.
5. All units of service (Medicaid, Healthy Michigan Plan, MIChild and Block
Grant) shall require authorization. Each level of care shall have its own
authorization number. Clients shall be discharged from one level of care before
being admitted to another.
6. The program shall submit an INDIVIDUALIZED initial authorization request
on the CareNet Initial Authorization Request (Attachment E-3) using the
appropriate CPT Code (Attachment E-5).
7. PACE shall review and authorize initial outpatient sessions based on clinical
necessity once the Consent for the Release of Confidential Alcohol and Drug
Treatment Information form is received. The initial approval for outpatient
services is for ninety (90) days. Any requests for additional sessions shall include
clinical justification and a specific plan for treatment intervention. Initial
authorizations shall be reviewed within seven (7) business days.
8. Outpatient programs may exchange one (1) authorized CPT unit for another.
Sessions shall be entered under "individual" and it is expected that the clinician
shall exchange them as needed based on the client's treatment plan.
9. Outpatient psychiatric evaluations and medication review units are not
exchangeable.
C. REAUTHORIZATION REQUIREMENTS
1. When requesting a reauthorization, therapists shall use the CareNet
Reauthorization Request Form (Attachment E-4) that clearly documents the
reasons continued treatment is necessary (ASAM Patient Placement Criteria),
specific goals and objectives on which the continued treatment shall focus,
specific time frames for achievement of the goals, and the criteria to be met for
treatment termination.
2. The treatment plan on the Reauthorization Request Form shall match the Master
Treatment Plan and/or Treatment Plan Reviews from the client's record.
3. OCCMHA/PACE may request additional documentation, clarifications, or may
require a PACE assessment if there are clinical concerns. Requests that are
outside the guidelines without an explanation shall not be approved.
4. Clients that demonstrate noncompliance with programming via ongoing positive
drug screens and/or nonpartieipation in the treatment process; OR are not
demonstrating reasonable progress may not be authorized for further OCCMHA
funding.
5. Re-authorization requests shall not be approved without an updated toxicology
report that includes the primary drug of choice.
6. Re-authorizations shall be entered ten (10) days prior to the expiration of the
authorizations.
XIII. LEVELS OF CARE
Social Detoxification
Services are provided in a supervised setting for 23 hours. Trained personnel, including
Peer Specialists, shall monitor withdrawal symptoms and provide linkage to treatment
services and/or community supports.
A. Sub-Acute Detoxification (prior authorization by PACE is required)
Detoxification services are defined as medically supervised care provided in a
sub-acute residential setting for the purpose of managing the effects of
withdrawal from alcohol and/or other drugs. A detoxification program shall be
staffed 24-hours per day, seven days per week, by a licensed physician or by the
designated representative of a licensed physician. Detox services typically last
three to five days. When detoxification cannot be completed within that time, the
Medical Director shall determine if acute detox is needed in a hospital setting.
Medicaid and Healthy Michigan Plan recipients shall be admitted within seven
(7) days of PACE referral.
B. Residential - Short Term (prior authorization by PACE is required)
Short-term residential care is defined as planned individual and/or group
therapeutic and rehabilitative counseling and didactics provided as an intense,
organized, daily treatment regimen in a residential setting which includes an
overnight stay. These progyams have a trained treatment staff supervised by a
professional who is responsible for the quality of clinical care. The provider
room and board facility shall maintain a daily census log to document use of the
facility by eligible clients. Medicaid and Healthy Michigan Plan recipients shall
be admitted within seven (7) days of PACE referral.
C. Residential Long Term (prior authorization by PACE is required)
Long-term residential care is defined as a professionally supervised program that
includes planned individual and/or group therapeutic and rehabilitative
counseling, didactics, peer therapy, and rehabilitative care. These services are
provided in a residential setting and include an overnight stay. The provider room
and board facility shall maintain a daily census log to document use of the
facility by eligible clients.
D. Intensive Outpatient (prior authorization by PACE is required)
Services are provided over a specified time period as determined by program
design, clients' needs and individualized treatment plan. Didactic, group, and
individual therapy in combination with the individualized treatment needs of the
client are provided. Aftercare planning and referral services are provided. A
minimum of one (1) individual session per week shall be provided during the
intensive outpatient program.
E. Intensive Outpatient with Domiciliary (DIOP) (prior authorization by PACE is required)
The initial authorization and subsequent reauthorizations shaft be based on
medical and clinical necessity. DIOP programming should be a minimum of
three (3) clinical contact hours per day, up to seven (7) days per week and should
include at least one (1) individual contact weekly as part of the programming.
F. Recovery Housing (prior authorization by the AMS Provider is required)
The initial authorizations and subsequent authorizations will be based on the
client's level of engagement in the recovery process. This process in includes no
use of alcohol and illicit substances, involvement in recovery activities and or
treatment services. Progress related to recovery goals and individualized need for
continued support.
Refer to Attachment E-16 for guidelines
G. Domiciliary Outpatient (DOP) (prior authorization by the AMS Provider is required)
I. The provider shall comply with all applicable Michigan and local laws and
ordinances.
2. The provider shall be associated with a licensed OP substance use disorder
treatment program.
3. The provider shall maintain a daily census log to document use of the facility by
eligible clients.
4. The room and board facility shall be located in a different building than the DOP
substance use disorder treatment program.
5. The provider shall document that the client's public assistance or foster care
payments do not cover room and board before billing for room and board
expenses.
The initial authorization and subsequent reauthorizations shall be based on medical and
clinical necessity. Clinical services are based on person-centered planning and
individual need.
H. Outpatient (including Opioid Treatment Programs)
Outpatient programming should range from very frequent to infrequent based on medical
and clinical necessity, client need, and client motivation and should be individualized
based on where the client is at during the course of treatment.
1. More than one group session may be offered in a week, but no more than one
session per day unless there has been prior authorization. Group therapy may
be up to ninety (90) minutes in length.
2. An individual session is fifty (50) minutes or more in length and one-half
individual session is thirty (30) minutes in length. Frequency of individual
sessions shall be determined by documented clinical need. A full session will, at
a minimum, be fifty (50) minutes of direct client contact. The additional ten (10)
minutes shall be allocated for paperwork and/or transition between client
appointments for scheduled clients.
3. The program can provide and bill for up to two different service codes in one
day. Any additional services shall need prior approval from OCCMHA/PACE.
1. Methadone (prior authorization by PACE is required)
New admissions shall require an appointment at PACE.
1. A client under the age of 18 is required to have had at least two documented
unsuccessful attempts (to be determined by PACE) at drug-free treatment within
a twelve (12) month period to be eligible for maintenance treatment.
2. Clients shall provide current copies of all prescription labels and/or receipts and
they shall be included in the client record.
3. The initial authorization for Methadone dosing shall be up to three (3) months.
4. Re-authorizations for Methadone dosing may be up to three (3) months based on
medical necessity, unless the client is on a Plan of Action.
5. Re-authorization requests for Methadone dosing shall be determined using the
following criteria:
a. The client has a clinical diagnosis of Opiate Dependency.
b. The client is demonstrating progress on the Goals and Objectives
established in the Master Treatment Plan (MTP).
c. The client is actively participating in the treatment programming as
demonstrated by attendance, therapist report and active involvement in
treatment planning.
d. The client is submitting clean drug screens for alcohol and all illicit
substances.
e, The clinic physician is in support of the clients continued treatment with
Methadone.
6. Clients not meeting criterion shall be placed on a formal Plan of Action by the
provider. (Attachment E-7)
7. The following process for the initial Plan of Action shall be utilized:
a. The therapist and or physician are responsible for initiating a plan of
action.
b. The PACE Care Manager may initiate a plan of action.
c. The therapist and client shall have a written plan which shall be included
in the reauthorization request.
d. The plan shall remain in the client's record at the program.
e. The Plan of Action shall provide clear and concise objectives related to
the identified problem areas and identify the interventions the client and
therapist shall use to address them.
f. A signed Release of Information (ROI) Form to all physicians
prescribing medications should be included with the Plan of Action if the
client agrees.
g. The Plan of Action shall be valid for a maximum of thirty (30) days.
8. The Plan of Action shall be reviewed for compliance every thirty (30) days, for a
minimum of sixty (60) days, to ensure compliance with the plan. A client shall
demonstrate complete compliance with the plan in order to resume normal re-
authorization procedures.
9. If the client fails to submit a Plan of Action or fails to comply with his/her Plan
of Action, finding for treatment shall be discontinued. The OCCMHA shall send
the client a forty-five (45) day Notice of Discontinuation of Funding letter that
shall formally notify the agency and client of our intent to discontinue funding
due to non-compliance. This shall allow for a safe detoxification or alternate
treatment services.
10. Authorization for Methadone dosing beyond two years shall be based on medical
necessity and client compliance with and completion of Clinical Treatment Plan
goals and objectives.
J. Medical Maintenance Only Criteria
The following criteria shall be used for clients who may have reached the maximum
therapeutic benefit from treatment services.
1. Client who has remained in continuous treatment for at least two (2) years.
2. Client has demonstrated abstinence from illicit substances and from use of
prescription drugs for a period of at least six (6) months.
3. No reported or demonstrated use of alcohol (ETOH).
4. Ability to maintain stability in their current living arrangement.
5. Stable and legal source of income.
6. Involvement in productive activities as defined in the client's individual
treatment plan.
7. No criminal Or legal involvement in the past year.
8. Adequate social support system.
9. Absence of significant or unstable co-occurring disorders.
Authorization Guidelines:
1. Ninety (90) days dosing.
2. One fifteen (15) minute physician contact every sixty (60) days.
3. One sixty (60) minute individual session every sixty (60) days.
4. Treatment Plan Review shall be conducted every sixty (60) days.
5. If additional sessions are needed a reauthorization request supporting clinical
necessity shall be submitted.
XIV. UTILIZATION MANAGEMENT
Utilization Management (UM) is a set of administrative functions that pertain to the assurance of
appropriate clinical service delivery. Through the application of written policies and procedures,
UM is designed to ensure the following services.
1. Only eligible beneficiaries receive plan benefits
2. All eligible beneficiaries receive all medically necessary plan benefits required to
meet their needs
3. Beneficiaries are linked to other services when necessary
UM consists of the following components:
A. Access and Eligibility Determination - This functional component includes both
screening for clinical eligibility and financial eligibility determination. Activities include:
1. Development of access and eligibility policy and procedures
2. Initial contact with potential consumers (when not reported as an encounter)
3. Initial screening (when not reported as an encounter)
4. Collection of consumer-specific information
5. Verification of funding sources including determination of public funding status
and first and third part liability
6. Service referral, setting up first appointment if determined eligible.
13. UM Protocols - This component is the development and monitoring of clinical and
authorization protocols to be used for determining level of care (LOC) and service
selection process. This includes protocols for the following.
I. Determination ofMedical Necessity
2. LOC assessments
3. Service intensity or selection criteria
4. Continuing Stay review
5. Services requiring specialist review, best practice guidelines
C. Utilization Review (UR) - It should be noted that there may be overlap between UM and
UR. This component provides review/monitoring of individual consumer records,
specific provider practices and system trends. Review of activities of the provider
network is included. It may include the following activities.
1. Review and monitoring to determine appropriate application of guidelines and
criteria (LOC, service selection, authorization, best practice)
2. Consumer outcomes
3. Over-utilization or under—utilization
4. Review of outliers
5. Development of procedures for system-level data review
6. Policy and procedures regarding use of review documents
7. Documentation and monitoring of UM/UR activities.
D. Core Provider and OSAS Residential Provider Referrals
1. AMS staff shall notify the CPA agency of screening appointment if a Release of
Information Form is obtained by the client in advance.
2. CPA shall attend appointment if applicable.
3. AMS shall obtain a ROI Form during the screening and fax to the CPA.
4. CPA shall provide AMS staff with a case summary to assist in the decision
making process.
5. AMS staff shall contact the CPA with the disposition on the screening.
Residential provider information, including date of admission for treatment
service. If residential services are not authorized, rationale shall be provided to
the CPA.
6. Information noted in #4 shall be communicated to the CPA within 24 hours of
the disposition.
7. If the client decides to leave against medical advice, rule violation, etc. the CPA
may contact Pace to assist with making decisions regarding other treatment
options.
XV. CLIENT DOCUMENTATION AND RECORD
A. A Consent and Authorization to Release of Information Form shall be signed by the
client (Attachment E-8) with an expiration of no less than thirty (30) days after discharge.
B. Verification of current address shall be obtained at admission (such as Driver's license,
state ID, utility bill and so forth).
C. PACE may require the client to sign Client Responsibility Notice (Attachment E9).
1. If a client has a medical condition that may impact their substance use disorder
treatment and/or treatment plan, there should be evidence of coordination of care
with the physician.
2. The Medicaid assigned physician should be identified on the form. The client
may indicate communication is not authorized.
3. If a client does not have a primary care physician PACE shall refer to a Federally
Qualified Health Clinic.
D. There shall be evidence that PACE checked Medicaid/Healthy Michigan Plan eligibility
via the 270/271 System on CareNet.
E. Medicaid and Healthy Michigan Plan clients have access to the Fair Hearing Process.
(Attachment E-14) Information regarding the Fair Hearing Process shall be presented at
time of admission, with signed documentation in the client record.
XVI. FINANCIAL REQUIREMENTS
A. Sliding Fee Scale
1. PACE shall at minimum, utilize the sliding fee scale implemented by OCCMHA.
(Attachment E-10)
2. The sliding fee scale shall be applied to all persons receiving Block Grant funds.
3. If a person's income falls within the sliding fee scale, clinical need shall be
determined through the standard assessment and ASAM criteria.
4. If a financially and clinically eligible person has third-party insurance that
insurance shall be utilized to its full extent.
5. If those benefits are exhausted or the person needs services not covered by the
third party insurance or if the co-pay or deductible amount is greater than the
person's ability to pay, Block Grant funds may be utilized.
B. Co-Pays
PACE shall assess and determine the co-pays for detoxification, short-term residential,
DIOP and long-term residential. PACE Care Managers shall communicate the
determined co-pay at the time of the referral. Co-pays should be distributed throughout
the duration of their initial authorization. If the client leaves treatment early, the client
shall forfeit their entire co-pay to the Provider.
XVII. PROGRAM REVIEWS
A. PACE shall be reviewed at least annually to ensure compliance with contact
requirements.
XVIIL COMPLAINT/GRIEVANCE/APPEALS PROCESS
A. Clients wishing to express an opinion about care or service provided or to present an
issue with a request for remedy may contact the OCCMHA with either an oral or
written complaint/grievance. The procedure is documented in (Attachment E-13).
B. Medicaid, MIChild, and Healthy Michigan Plan clients have access to the Fair Hearing
Process. Information regarding the Fair Hearing Process shall be presented at time of the
screening, with signed documentation in the client record. The procedure is documented
in (Attachment E-14).
XIX. PERSONS ASSOCIATED WITH THE CORRECTIONS SYSTEM
A. When the OCCMHA or its PACE receives referrals from the Michigan Department of
Corrections (MDOC), PACE shall handle such referrals as per all applicable
requirements in this agreement. This woultL include determining financial and clinical
eligibility, authorizing care as appropriate, applying admissions preferences, and other
steps. MDOC referrals may come from probation or parole agents, or from MDOC
Central Office staff.
B. In situations where persons have been referred from MDOC and are under their
supervision, state-administered funds should be used as the payment of last resort.
C. When persons who are on parole or probation seek treatment on a voluntary basis from
the OCCMHA, PACE or from a panel provider, these self-referrals shall be handled like
any other self-referral to the MIN-MS-funded network. PACE or provider staff may seek
to obtain releases to communicate with a person's probation or parole agent but in no
instance may this be demanded as a condition for admission or continued stay.
D. The OCCMHA may collaborate with MDOC, and with the Office of Community
Alternatives (OCA) within MDOC, on the purchase of substance use disorders services
and supports. This may include collaborative purchasing from the same providers, and for
the same clients. In such situations, OCCMHA shall assure that:
1. All collaborative purchasing is supported by written agreements among the
participants.
2. Rates paid to providers, whether by a single purchaser or two or more purchasers,
do not exceed provider costs.
3. Rates paid to providers are documented and are developed consistent with
applicable OMB Circular
4. No duplication of payment occurs.
XX. SANCTIONS
Non-compliance with contract requirements may result in the following sanctions:
A. Additional reviews from OCCMHA.
B. Probation/Corrective Action Plan.
ATTACHMENT E-1
OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
SUBSTANCE USE DISORDER SERVICES
DSM V Diagnosis Codes
In order to be eligible for services, an individual must be found to meet the criteria for one or more
selected substance use disorders found in the Diagnostic and Statistical Manual of Mental Disorders
(DSM 5). These disorders are listed below:
Cannabis Related Disorders:
305.20 Cannabis Use Disorder -Mild
304.30 Cannabis Use Disorder - Moderate/Severe
292.89 Cannabis Intoxication
292.0 Cannabis Withdrawal
292.9 Unspecified Cannabis-Related Disorder
Hallucinogen Related Disorders:
305.90 Phencyclidine Use Disorder-Mild
304.60 Phencyclidine Use Disorder - Moderate/Severe
305.30 Other Hallucinogen Use Disorder Mild
304.50 Other Hallucinogen Use Disorder - Moderate/Severe
292.89 Phencyclidine Intoxication
292.89 Other Hallucinogen Intoxication
292,89 Hallucinogen Persisting Perception Disorder
292.9 Unspecified Phencyclidine Related Disorder
292.9 Unspecified Hallucinogen Related Disorder
Inhalant Related Disorders:
305.90 Inhalant Use Disorder - Mild
304.60 Inhalant Use Disorder - Moderate/Severe
292.89 Inhalant Intoxication
292.9 Unspecified Inhalant Related Disorder
Opioid Related Disorder:
305.50 Opioid Use Disorder - Mild
304.00 Opioid Use Disorder - Moderate/Severe
292.89 Opioid Intoxication
292.0 Opioid Withdrawal
292.9 Unspecified Opioid Related Disorder
Sedative, Hypnotic, or Anxiolytic (SHA) Related Disorders
305.40 SHA Mild
304.10 SHA Moderate/Severe
292.89 SHA Intoxication
292.0 SHA Withdrawal
292.9 Unspecified SHA Related Disorder
Stimulant Related Disorders:
Stimulant Use Disorder -
305.70 Amphetamine Type - Mild
305.60
305.70
304,40
304.20
Stimulant Intoxication
292.89
292.89
292,89
Cocaine - Mild
Other or Unspecified Stimulant - Mild
Amphetamine Type - Moderate/Severe
Cocaine - Moderate/Severe
Amphetamine or other stimulant, without perceptual disturbances
Cocaine, without perceptual disturbances
Amphetamine or other stimulant, with perceptual disturbances
292.89 Cocaine, with perceptual disturbances
292.0 Stimulant Withdrawal
292.9 Unspecified Stimulant Related Disorder
Alcohol Use Disorders
305.00
303.90
303.00
291.80
291.9
Alcohol Use Disorder—Mild
Alcohol Use Disorder — Moderate/Severe
Alcohol Intoxication
Alcohol Withdrawal
Unspeci lied Alcohol-Related Disorder
Other (unknown) Substance Related Disorders:
305.90 Other (unknown) Substance Use Disorder — Mild
304.90 Other (unknown) Substance Use Disorder— Moderate/Severe
292.89 Other (unknown) Substance Intoxication
292.0 Other (unknown) Substance Withdrawal
292.9 Unspecified Other (unknown) Substance Related Disorder
ATTACHMENT E-2
OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
SUBSTANCE USE DISORDER SERVICES
Medical Necessity Criteria for
Mental Health and Substance Use Disorder Services
A. Mental health, developmental disabilities, and substance use disorder services are
supports, services, and treatment:
• Necessary for screening and assessing the presence of a mental illness,
developmental disability or substance use disorder; and/or
• Required to identify and evaluate a mental illness, developmental disability or
substance use disorder; and/or
• Intended to treat, ameliorate, diminish or stabilize the symptoms of mental illness,
developmental disability or substance use disorder; and/or
• Expected to arrest or delay the progression of a mental illness, developmental
disability, or substance use disorder; and/or
• Designed to assist the beneficiary to attain or maintain a sufficient level of
functioning in order to achieve his goals of community inclusion and
participation, independence, recovery, or productivity.
B. The determination of a medically necessary support, service or treatment must be:
• Based on information provided by the beneficiary, beneficiary's family, and/or
other individuals (e.g., friends, personal assistants/aides) who know the
beneficiary; and
• Based on clinical information from the beneficiary's primary care physician or
health care professionals with relevant qualifications who have evaluated the
beneficiary; and
• For beneficiaries with mental illness or developmental disabilities, based on
person-centered planning, and for beneficiaries with substance use disorders,
individualized treatment planning; and
• Made by appropriately trained mental health, developmental disabilities, or
substance abuse professionals with sufficient clinical experience; and
• Made within federal and state standards for timeliness; and
• Sufficient in amount, scope and duration of the service(s) to reasonably achieve
its/their purpose.
C. Supports, services, and treatment authorized by OCCMHA must be:
• Delivered in accordance with federal and state standards for timeliness in a
location that is accessible to the beneficiary; and
• Responsive to particular needs of multi-cultural populations and furnished in a
culturally relevant manner; and
• Responsive to the particular needs of beneficiaries with sensory or mobility
impairments and provided with the necessary accommodations; and
• Provided in the least restrictive, most integrated setting. Inpatient, licensed
residential or other segregated settings shall be used only when less restrictive
levels of treatment, service or support have been, for that beneficiary,
unsuccessful or cannot be safely provided; and
• Delivered consistent with, where they exist, available research findings, health
care practice guidelines, best practices and standards of practice issued by
professionally recognized organizations or government agencies.
D. Using criteria for medical necessity, OCCMEIA may:
• Deny services that are:
• deemed ineffective for a given condition based upon professionally and
scientifically recognized and accepted standards of care;
• experimental or investigational in nature; or
• for which there exists another appropriate, efficacious, less-restrictive and
cost-effective service, setting or support that otherwise satisfies the
standards for medically-necessary services; and/or
• Employ various methods to determine amount, scope and duration of services,
including prior authorization for certain services, concurrent utilization reviews,
centralized assessment and referral, gate-keeping arrangements, protocols, and
guidelines.
Comments:
AXIS II
OMT I I 115 111..1 14) iro
4.1.11M) Intoxication
andiat Withdrawn!
Poloyfildi
1CareNat - Initial Authorization
Initial Authorization -
CIIont totQrnratiail
CLIENT NAME CLIENT ID DATE OF BIRTH COUNTY OF RESIDENCE
ATTACHMENT E-3
DILUNG TYPE
REQUEST DATE
PROvinER NAME
CONTACT PERSON
PROVIDER LICENSE 11 PROVIDER CONFIDENTIAL Pax !,t
HOURS AVAILABLE
Atiro.igslor Diagnosis
AXIS I
AXIS I MN
Flit eary:
Secondwy:
Primary:
Socrsniimy
Primary:
Secondary',
AXIS III
Axis IV
AXIS V
[ I PROBLEMS VVITI-I PrZlIk4ARY
S[J1,1-,C)Ii1 ()ROI IF
[ [ OCCLIPATIONAL. PROSLEMS
[ ERCRLEMS 'MTH ACCESS TO
HEALII I CARE,
GAB Snre..
[ ) EROBLEM:i [ED TO SOCIAL
DIVIROOME NIT
) NOISING PROM EMS
[ 1 PROBLEMs RELAIEE TO THE LEGAL
BISTEM
[ I EDUCATIONAL
PROBLEMS
[ ECONOMIC
PROBLEMS
I IMPER
AsA10 PLACEMENT nimeistoirs.
cV)eck :AverIty tor aach rtlmenGiDe anti 041y Edo,' mtivn stIr oil I o recith:st to ol.m.111miiiiitimi)
As evidericod by;
III.2-D 7.1) ,
) ( )
Blomodlca) ConflitIons
loci Complications
i.nirelate4.1 to
WI ItrIrruwoll
( ) ( ) I ) ) ( )
PROCEDURE CODE UNITS REQUESTED
flqe 2 012
As esidonced
EintflunalfRehavion(
Conditions and
Cool pketiuns
weldeorcd by:
Traabnent I ) Act.eptanciaillesistaate
As avidermod by!
) I ) I ) ) I I 1_ I
Relapse/Month-KIM Use
rotenlial
eeldencod by:
Pocovevy E'nvironment
A. evidenced by
Admission InfonnatSon
Acirnissibn Date
1(It )1( )I (U I tIJ
Sorvice Category
Authorization Datuu
Ractussted: -
Con-Inv:Ms
This clinical authorization does not guarantee payment.
Oorarict wi _220 f 55O Nub-4:1;40T Olimbr:4 cs,
AXIS I
Aoionl$sion DlagnosIS
Primary:
Secondary:
PrInvvy
Secondary:
( (PROBLEMS WITH PRIMARY
SUPPORT GROUP
(OCCUPATIONAL PROBLEMS
PROBLEMS WITH ACCESS TO
HEALTH CARE
PROBLEMS NELATEE TO SOCIAL
ENVIRONMENT
[ HOUSING PROBLEMS
I PROBLEMS RH AIM TO IF-IC LEGAL
SYSTEM
I EnUcivricriAL
PROBLEMS
(ECONOMIC
PROS LEMS
(OTHER
A= V I GAP Score:
ATTACHMENT E-4
REMuthcirization
Reauthorization -
Client Information
CLIENT NAME CLIENT ID DATE OF BIRTH COUNTY OF RESIDENCE
—1
BILUNG TYPE PROVIDER NAME PROVIDER LICENSE # PROVIDER CONFIDENTIAL Fax 0
REQUEST DATE CONTACT PERSON HOURS AVAILABLE
A.'3AM PLACE-VIEW-DIMENSIONS (Ploasn ntirook noverity fe.r ere;ht urey Indczte oh]ectiee ink-mealier' related to
request For te ,nethorlzatioe)
Levetn oF'Frnatment:
.5 . er,atio,)
I = OutpatIon1
0141 Methadone
II , 10P
III Resirlentiat
IV Hosintal
.5 °MI 81 iv
Withdrawal 1 Detexitiaatioli Peientiai
Client IE tin a bie a allstaln (-rem illicit drug use or alcohol abuse at
( N/A ( )24 Hoare )48 HOW8 72 Hours
Gkirrent wIlhdra.vel 0.7es
eareNet ReautlioriZation
Page 2 of 3
I I Little or no problem in this area
I ) inlansification of 1;coblonts al !Ins area Mal should [al affille.9sed i,1 a higher level of care
I 1 In on Melnadnno/LAAM
( ) ( I ( I ( ) ( ) ( )
rogriter with
take home schedule
COrTittIVIlks:
Bfomedical Conditions rind Coin pliOn tionS (unrelated to withdrawal
( 1 Currant I chtoniO physioellowtlIcal ilk-losses PM letdifering with treatment
I Jo experiencing inlonsifionlloe ef problems Mat sheaf he addressed In a tfillerent least Di G4Fs
[ i Client reskIng progress but NOT suflicioni In allow far {I -nosier to a Ims. linertsise level of cold
( I Clive; prowess is sufliciert la oilOw transfer to a lower levet dune
[ ) civil iS experiencing Nile or no problems; or progress is soften] fie disc:lump
( / IL ) ( ) ) ( ) ( )
Comments:
Emotional / Behavioral Contliliona and CompIicit lions
I
I
I
I I
I
Curierri chronic druolional 1 benuaioral condifordsl arc interfering with houtuattil
Ctlent is correnlly being preSOribed rnediCatIOn tor en emotional/Ochre/Wel canilihrei
Os experietvan9 intensificailon of problems that should 00 addressorilin a Vinton( Inset of 001
r-.11,,t Inallrriog Ougrm trill NOT 11101001 10 allow for gansirei 100 lower ;spat of esie
Cliont's progress is s 1.1i[tiCIII to allow fel transfer to a lower level 010000
Met is ospnrionding hide er prt problems; or progratt is sufficient tor diSohargo
( ) ( ) ( ) I ) ( 1 )
COMMent:
TreatmOnt Acceptance i Resistance
i Client continues le el4ect to ilealiugni or attends Only to avoid eogolirro coneogtioncos
I Client Is non compliant with attendenno, assignments
j Client continues to disofay poor !impulse control
] is experiencing intensidentIon of problems shut should he 8(W -rooted in a different Level of cam.
) Client molding progress 001 NOT sufficient to allow for lianslor bulb lower level of coin
I Client's p00111e55 K 1011101001 to-Mew for transfer le a lower losel of card
/ Client Is experiencing little OF no problems: nr progress is sulk:Log for discharge
( ) ( } ( ) ( ) ( )
Comments:
Relapse / Continued Use Potential
1Client na5 been unable In achieve oneoistent abstinence
) if ahatinsnl, tient at MO nsl; for iisirly I raiiipse
1 10 experiencing intenaillcalino DI probldius lloll should he analossea in a different 10001 o; care
I Chirentnlaking progress hut NOT sufficigni to allow l'or transfer toss lower Noel Cl ears
I C doilies tuogress Is sufficient le alow for a gensfot to 0 lower level of csou
)Cidird Is experiencing No also protinins; or proriless lo sufficient for discharge
Comments:
Recover; Environment
1 1 Crodeff Nem r social I vocational I hearicial environment lineopres dna, irddeeeni
f 1 Client idands selfritotp, souped group attendance or is sogerficlady invelded in recovery community
l ) le expoileilidng irgensifieutian 01 problems Inal should be addressed In a diffe,isiit ievai of cste
[ i Client tusking progiose but IsICIT sufficionl ha allow for transfer to a Ichver level Cl care
I 1 Client's progress it noffioiera to (Mow for a transfer to a Iconor lol el care
I 1 0110111 It oxpurioncing hale or or; pinCrInoln, or progress is sufficient for &suborns
( ) ( ) ( ) I ) ( )
Comments!
CURRENT TRE AT fvIENI PLAN
Problem ;
Admission Date Service Category
(7=Net - Reauthorization Page 3 of 3
Goal :
Progress;
Est. Date of Comp.:
Problem :
Goal
Progress:
Est. Date of Comp,:
Problem
Goal :
Progress:
Est. Date of Comp.:
ls client (.11 current medic:100u? I I I I Nrs
Please list:
P4ycliotropl I )Merfir,;11
Arfifdrision Mformatier)
Authorization Dales
Requested: -
COMments
This clinical authorization does not guarantee payment.
Carcret vA,226 ,0 2COU NetGentri ishsrejie I:.
Block
Grant
X
X
HMP Medicaid
X X
X X
X X
X
X
X
X
ATTACHMENT E-5
OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
SUBSTANCE USE DISORDER SERVICES
FY 14/ 15
Billing Codes / Modifiers
CPT Code
90791
90791-HD
90791-HH
90792
90792-HD
90792-HH
90846-H0-HF
90846-HF
90846-HF-HH
90846-HF-HH-HD
90847
90847-HD-HF
90847-HF
90847-HH
90847-HH-HD-HF
90847-HH-HF
90849-HD
90849-HD-HF
90849-HF
90849-HH-HD-HF
90849-HH-HF
97810
99202
Description
psychiatric diagnostic evaluation (no medical services)
psychiatric diagnostic evaluation (no medical services)
psychiatric diagnostic evaluation (no medical services)
psychiatric diagnostic evaluation with medical services (or
E&M new patient codes)
psychiatric diagnostic evaluation with medical services (or
E&M new patient codes)
psychiatric diagnostic evaluation with medical services (or
E&M new patient codes)
Family Therapy (Collateral) 60 Minutes
Family Therapy (Collateral) 60 Minutes
Family Therapy (Collateral) 60 Minutes
Family Therapy (Collateral) 60 Minutes
Family Psychotherapy (Conjoint) 60 Minutes
Family Psychotherapy (Conjoint) 60 Minutes
Family Psychotherapy (Conjoint) 60 Minutes
Family Psychotherapy (Conjoint) 60 Minutes
Family Psychotherapy (Conjoint) 60 Minutes
Family Psychotherapy (Conjoint) 60 Minutes
Multiple Family Group Psychotherapy
Multiple Family Group Psychotherapy
Multiple Family Group Psychotherapy
Multiple Family Group Psychotherapy
Multiple Family Group Psychotherapy
Acupuncture, 1 or more needles; without electrical
stimulation, initial 15 minutes of personal one-on-one
contact with the patient
Medication Review - Outpatient - New 20 min
X
99202-HD
99202-HH
Medication Review - Outpatient - New 20 min
Medication Review - Outpatient - New 20 min
99213
99213-HD
99213-1-IH
99241
99241-H H
H0001
H0004 Behavioral health counseling and therapy, per 15
minutes.
Medication Review - Outpatient - Established 15 min
Medication Review - Outpatient - Established 15 min
Medication Review - Outpatient - Established 15 min
15 min 60 day Physician contact
15 min 60 day Physician contact
Assessment
X
X X
H0004-HD
H0004-HH
Behavioral health counseling and therapy, per 15
minutes. X
Behavioral health counseling and therapy, per 15
minutes. X
60 min Alcohol and/or drug services; group counseling by
a clinician. Family or group therapy X X
90 min Alcohol and/or drug services; group counseling by
a clinician. Family or group therapy X X
Step Forward 90 min Alcohol and/or drug services; group
counseling by a clinician. Family or group therapy
60 min Alcohol and/or drug services; group counseling by
a clinician. Family or group therapy X
H0005
H0005
HG005
H0005-HD
X
90 min Alcohol and/or drug services; group counseling by
a clinician. Family or group therapy X X
60 min Alcohol and/or drug services; group counseling by
a clinician. Family or group therapy X X
90 min Alcohol and/or drug services; group counseling by
a clinician. Family or group therapy X
H0005-HD
H0005-HH
H0005-HH
X
X
X
H0006
H0006
H0006
H0006
H0010
H0010-HD
H0010-HH
H0015
H0015-HD
H0015-H H
H0018-HF
H0018-HD-H F
Alcohol and/or drug services; case management (15 Min)
Alcohol and/or drug services; case management (30 Min)
Alcohol and/or drug services; case management (60 Min)
Alcohol and/or drug services; case management (90 Min)
Acute Detoxification
Acute Detoxification
Acute Detoxification
Intensive Outpatient
Intensive Outpatient
Intensive Outpatient
Residential
Residential
H0018-HH-HF Residential
H0018-HH-HD-HF Residential
H0019 Halfway House
H0019-HD Halfway House
H0019-HH
Halfway House
H0020 Medication (Methadone)
H0033 Pharmacologic support (Suboxone)
H0025
Family Education (90 Minutes)
H0025-1-ID
Family Education (90 Minutes)
X
H0025-HH
Family Education (90 Minutes)
X
H2027 Didactics - 15 minute units
Case Management Group Didactics - 15 minute units
Didactics - 15 minute units
Didactics - 15 minute units
Didactics - 15 minute units
Didactics - 15 minute units
Didactics - 15 minute units
Didactics - 15 minute units
An hour of outpatient alcohol/other drug treatment
services.
An hour of outpatient alcohol/other drug treatment
services.
An hour of outpatient alcohol/other drug treatment
services.
H2027-CM
H2027-HD
H2027-HD-FIF
H2027-HF
H2027-1-IH
H2027-HH-HD-HF
H2027-HH-HF
H2035
H2035-HD
H2035-HH
X
X
H2036
H 2036-H D
H 2036-H H
T1016-HF
T1016-HF
Alcohol and/or drug treatment program, per diem
Alcohol and/or drug treatment program, per diem
Alcohol and/or drug treatment program, per diem
Case Management Face to Face (15 Min)
Case Management Face to Face (30 Min)
T1016-HF Case Management Face to Face (60 Min)
X X
**When billing for a Medicare/Medicaid, Blue Cross/Medicaid or any third party insurance, bill
OCCMHA the difference between the third party payment and the OCCMHA rate.
ATTACHMENT E-6
OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
SUBSTANCE USE DISORDER SERVICES
Receipt of Recipient Rights PolicylProcedures
and
Notice of Confidentiality of Alcohol and Drug Abuse Patient Records
I hereby certify that I have been provided with my copy of "Know Your Rights" and have been
apprised of my rights as a recipient of services through the Oakland County Health Division —
PACE Unit.
understand that if I feel my rights as a recipient of services has been violated I will educate
myself to the complaint procedure and will pursue my complaint as outlined.
I also certify that I have received a copy of "Confidentiality of Alcohol and Drug Abuse
Patient Records" regarding notice of Federal rules and regulations on confidentiality of my
records, specifically 42 C.F.R. Part 2.
In addition, I have also been provided a copy of the Privacy Notice related to the Health
Insurance Portability and Accountability Act of 1996 (HIPAA), describing the County's use
or disclosure of my Protected Health Information for the purpose of diagnosing or providing
treatment and care for me, payment or reimbursement for any health care bills for which I am
responsible, and to conduct its health care operations.
if I am receiving Medicaid funding I acknowledge that I have received a copy of my rights on
the Complaint/Grievance Process and Medicaid Fair Hearing.
By signing, I acknowledge I have received the above notices and have had the information
contained in the notices read / explained to me, and that I understand the content of these notices.
Client Signature Date
Witness Signature Date
Prepared in accordance with Rule 302(4) of the Michigan Department of Community Health Recipient
Rights Administrative Rules and Federal Confidentiality Law 42 C.F.R. Part 2.
ATTACHMENT E-7
Plan of Action
Re-Authorization Request
Date:
A request for funding re-authorization has been made to the Oakland County Health
Division/Office of Substance Abuse Services (OSAS). These indicate that you are in non-
compliance with your treatment plan.
• You will be given an opportunity to work with your therapist to develop a "plan of action"
that addresses the above issues.
• You have one week to develop and submit this plan to PACE for review. Once the plan of
action is approved, you will be re-authorized for treatment and your progress will continue to
be monitored.
• If you fail to develop and submit your plan of action within two weeks or you do not comply
with the plan of action, your funding will be discontinued.
• At that time you will receive a "Discontinuation of Funding" notice which will be final.
It is our hope that you will take immediate action to avoid any interruptions of funding related to
your treatment. We wish you success in your recovery journey.
Sincerely,
ATTACHMENT E-8
lirOAKIANM COUNTY MICHIGAN
Oakland County Government
Interagency Consent and Authorization
To Release Protected Health Information
I_ grant perm ission_to_(cheek one or more).
O Circuit Court-Family Division 0 DERIS/ChilcIren's Village 0 Medical Examiner
O Community Corrections III DHHS/Health Division 0 Employment & Training
O Community Mental Health 0 Mich. Dept. o ['Human Services-Oakland
CI Sheriff's Department [lather (specify)
To release information on:
Name of Person: DOB or SS#
2. This information may be released to the following (check one or more):
O Circuit Court-Family Division 0 DHHS/Children's Village 0 Medical Examiner
O Community Corrections 0 DI-ll IS/Health Division 0 Employment & Training
CI Community Mental Health 0 Mich. Dept of Human Services-Oakland
El Sheriff's Office ['Dither (specify)
3.* What information may be released:
4. For what purpose is the information to be released:
0 To assist in the coordination and/or provision ofservices.
0 Other (specify)
5. I understand that I have a right to receive a copy of this document.
6. I understand that I may withdraw this consent by written notification received by the agency head at any time before
information is released. I also understand that disclosure of the above protected health information may be subject to
redisclosure by the recipient and, therefore, may no longer be protected. I thither understand that redisclosure of
substance abuse-related information by the recipient is prohibited unless authorized by 42 CFR, Part 2.
7. Unless withdrawn in writing, this consent expires as follows:
A. Date:
B. Event:
C. Condition.
*NOTE: AIDS-related information (i.e., HIV, ARC, AIDS) and/or psychotherapy notes shall not be released unless
specifically listed under Item #3 above.
Client/Parent/Guardian Signature (Relationship) Date
Witness Signature Date
This authorization is consistent with standards established under 42 CPR, Part 2:45 CFR, Parts 16.0 and 164; and Michigan Law. No Oakland County
agency may release protected health information without a current valid written authorization in its possession or as otherwise provided by law.
DlIFIS 10/24/12 (Revised)
Contract 14 - 15 / Attachment E-8 Anthorifation to Release Information 2-Wayfim
ATTACHMENT E-9
OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
SUBSTANCE USE DISORDER SERVICES
Client Responsibility Notice
The Oakland County Community Mental Health Authority (OCCMHA) is pleased to inform you
that OCCMHA is providing funding assistance for your treatment at:
It is important that you understand your responsibilities as they relate to your treatment. You will
develop a treatment plan with your therapist and be expected to work towards the goals
established in the plan.
in order to maintain OCCMHA funding, you are expected to:
• participate in your treatment planning
• attend scheduled appointments
• demonstrate some level of progress in meeting treatment plan goals
Failure to comply with these expectations will require a re-evaluation of services and may result
in a referral to an alternate level of care.
My signature below acknowledges my understanding and agreement.
Client Signature Date
Witness Signature Date
ATTACHMENT E-10
OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
SUBSTANCE USE DISORDER SERVICES
Reimbursement Rate / Sliding Fee Schedule
For
Clients Must Bring In Proof Of Income
This could include:
)> Medicaid card, general assistance papers, check stub, unemployment papers, letter for
Social Security, bank statement, W-2 forms, note from homeless shelter, etc.
Clients married/co-habituating or are dependent in a household, must provide proof of
household income.
Adults who have no income, but live with others (roommates, parents, siblings, relatives) will be
assessed at: Income Category I.
Adults who have an income and live alone: fee based on personal income.
Adults who have an income and live with others (roommates, parents, siblings, relatives):
Increase personal income fee category by one level.
Level 1 2 3 4 5 6 7
Income 0 $19,495 $26,229 $32,959 $39,691 $46,423 $53,155
$19,494 $26,226 $32,958 $39,690 $46,422 $53,154 $59,086 .
Clients married or co-habituating or dependent children regardless of age, who live with parent,
are supported by parent and claimed for income tax purposes by parent, will have fees
assessed upon household income.
1 2 3 4 5 6 7
Income 0 $19,495 $26,229 $32,959 $39,691 $46,423 $53,155
$19,494 $26,226 $32,958 $39,690 _ $46,422 $53,154 $59,086
Family
Size 100% 90% 80% 70% 60% 50% 45%
1 *0/68 7/61 14/54 20/48 27/41 34/34 37/31
2 0/68 0/68 7/61 14/54 20/48 27/41 34/34
3 0/68 0/68 0168 7/61 14/54 20/48 27/41
4 or more 0/68 0/68 0/68 0/68 7/61 14/54 20/48
(* Client pays numerator and OCCMHA pays denominator)
ATTACHMENT E-11
OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
SUBSTANCE USE DISORDER SERVICES
Communicable Disease and Interim Services
Client Name
Possible High Risk
Pregnant
IDU
TB or risk for
Other hepatitis
STD or risk for
HIV/AIDS or risk for
Hepatitis C or risk for
Other
All clients are to be screened for TB, HIV, STD and hepatitis. Clients with high-risk behaviors
will be given information about resources available and referral to testing and treatment.
IDU clients must receive interim services on:
1. Counseling and education about HIV and hepatitis
2. Completion of TB screening history
3. Risks of needle-sharing
4. Risks of transmission or HIV and other STDs to sexual partners and infants
5. Steps that can be taken to ensure that HIV transmission does not occur
6. Referral for HIV and TB services if indicated
Pregnant Women must receive all the above and...
1. Counseling on the effects of alcohol, tobacco and other drug use on the fetus
2. Referral to prenatal care
This client was
Given counseling and fact sheets on hepatitis/HIV/STDs
Was referred to OCHD for TB, HIV, or STD testing and treatment
Was referred to Oakland Primary Health Services, Inc.
Was referred to Department of Human Services
Was referred to personal physician or HMO
Was given counseling and brochures on effects of ATOD on fetus
Other
Care Manager Signature
ATTACHMENT E-12
CareNet - SARF Form
Adiair-ision Information
Client Name Client SSN/ID Date of Dirth
Admission Date fienvdcifri.g.6 Age at Admission Is this client Medicaid
eligible at the Urns of
admission?
) No - 2 ( Yes-
Medicaid/ASW Recipient ID Agency Client IOU
Service Category Referral to lead of care Referral Source CiA or
Non -SA)
Demographic Inferniation
County of Residence
Race
Sex
{ Felirale -2 ( ) Male - 1
I Pregnant at Admission
( ) No- 2 ( ) 'Yes -
Arrest History
Corrections Related Status
Substance Abuse History
Drug Code
Primary Drug
Has this Omit injected drugs in the last 20 days?
Diagnosis
Diagnostic Impression
Additional information
Time Waiting for Assessment (days since request made)
temisir ris13-0 bek7W Of Me Ceernenk mettoof
Route of Admin.
( ) No - 2 ( ) Yes -
Indication of Mental Health Issues?
Drug Court Client?
Katrina Eva cuoe?
Is this a Transitional Housing Client?
Contact Dates
initial Contact Dale
First Appointment Offered
fimelir ess
( )Merliceiri client, Urgent Status
( No -2 ( ) Yes 1
( ) No - 2 )Yes 1
( )No-2( )Yes
( ) No 2 ( )Yes
Days from Initial Contact to Admission Dale
Days from the ipitial Contact in First Appointment Offered
Was client offered an assessment within 24 hours after initial
contact?
(I Yes, and client :accepted
(areNt.1 - SART Form OF 2
( j Yes, but client declined kite initial appt. ofterad
( ) No
( )Merlicaid client, F,oullrie Status (Non-
urgent)
Was client offered an assessment within 5 days after initial contact?
( ) Yes, and cllool accepted
( ) Yes, but client declined lois initial appt. offered
( ) No
( jhlo, this is note Medicaid client
YesL Did cormimecrequest an appointment outside the-14 calendar day poried?-- ------
If YP.,S Plosi-V.,7, Provide Fx.plan:4tion
Comments
.......
Referral
Referring to Provider
....._......
Miscellaneeos
This SARF Appointment Type
Program Name
MEDICAID GRIEVANCE PROCEDURE (For Medicaid Clients only)
I ] A$ a Medicaid recipient, the client has bean notified of the right Co file a request fur tin administrative hearing ifiwlicit a
benefit is denied, terminated, suspended, or reduced,
As a Medicaid recipient, the client has been given the 'Notice of Privacy" for substance abuse services provided within the
Nor ItiCare Pre-Fuld Heallii P1211 (PHI') Network, Clioni has signed ackecwicigement of receipt and understanding of this
notification,
Carenclv4.22tle 2C011 Nosouot Tochoutgo,3*, o4,
ATTACHMENT E-13
OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
SUBSTANCE ABUSE DISORDER SERVICES
Client Complaint/Grievance Procedure
I. Introduction
A complaint is a communication by a client or a client's representative expressing an
opinion about care or service provided by the plan, or presenting an issue with a
request for remedy that can be resolved informally. Complaints may be oral or written
and will be received by the person designated as the OCCMHA's recipient rights
coordinator.
A grievance is a written request for remedy or reconsideration of an OCCMHA
decision submitted by or on behalf of a client regarding:
A. availability, delivery or quality of services, including a complaint regarding an
adverse determination made pursuant to utilization review; and
B. claims payment, handling or reimbursement for services.
Grievances will be handled by the regional recipient rights coordinator.
The recipient rights coordinator will receive, investigate and resolve complaints and
grievances. This person will also assist clients in filing written grievances, as needed.
Grievances may be submitted by a client or their selected representative.
IV. Internal complaint and grievance resolution process
A. Complaint is referred to the recipient rights coordinator. If the recipient rights
coordinator is the person who made the initial decision that is the subject of the
complaint, an alternate qualified reviewer will be selected.
Complaint data form is completed, containing minimally client's name,
date of the complaint, and a short summary of each question or
problem. A release of information is initiated, if necessary, to enable
contacts necessary to conduct an investigation of the complaint. A file
is initiated to contain the investigative record and any associated
documentation.
2. Sources of information relevant to investigation of the complaint are
contacted.
3. Within 15 business days of receiving the complaint, a written response
will be provided to the person or agency initiating the complaint.
B.
Grievance is referred to the recipient rights coordinator. If the recipient rights
coordinator is the person who made the initial decision that is the subject of the
grievance, an alternate qualified reviewer will be selected.
1. Grievance data form is completed. A file is initiated to contain a copy
of the original grievance, the investigative record and associated
documentation.
2. Within two business days of receipt, recipient rights coordinator
contacts the person/agency submitting the grievance for
clarification/additional information regarding the circumstances
initiating the grievance. A release of information is initiated to enable
appropriate contacts necessary to conduct an investigation of the
grievance.
3. Sources of information relevant to investigation of the grievance are
contacted.
4. Within 15 business days of receiving the grievance, a written response
will be communicated to the person or agency initiating the grievance.
a. An appropriate clinical peer will conduct reviews of
grievances concerning adverse determinations in the
same or similar specialty as would typically manage the
case being reviewed.
b. Response will contain information regarding subsequent
avenues available to the client if he/she is not satisfied
with the result.
5. In situations where the standard 15-day time frame would seriously
jeopardize the life or health of a client or would jeopardize the client's
ability to regain maximum function, an expedited review of a grievance
will be provided.
a, lin such cases, all necessary information, including the
OCCMHA's decision, will be transmitted between the
OCCM_HA and appropriate party(s) by telephone,
facsimile, or the most expeditious method available.
Decisions will be rendered within 24 hours.
6. At time of client/agency notification of the OCCMHA's decision
regarding the grievance, information regarding subsequent avenues
available to the client/agency will be provided if they are not satisfied
with the result.
C. The client will have the opportunity to present his/her grievance in person or
through a representative to a committee designated by the governing body to
handle grievances.
ATTACHMENT E-14
OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
SUBSTANCE USE DISORDER SERVICES
Medicaid Administrative Hearings Requirements
Federal law (42 CFR 31.200-250, 431.250-Fair Hearings) provides rights for fair hearings for
Medicaid recipients. Medicaid recipients may file a request for an administrative hearing when a
benefit is denied, terminated, suspended, or reduced as a result of a utilization review decision
made by the OCCMHA or its authorized designee. The Michigan Department of Community
Health/Community Health Manual, General Administration Chapter, Legal Section provides the
policy and procedures on Administrative Hearings. The Administrative Hearings Policy and
Procedure is part of this attachment.
Medicaid recipients must be informed of and have simultaneous access to: 1) the recipient rights
procedure and 2) the MDCH Administrative Procedure established by federal law and
departmental policy.
I. Medicaid Administrative Hearing Requirements.
A. The OCCMHA must adhere to the Administrative Hearings Policy and
Procedures issued by the Department which were effective September 1, 1999.
B. All Medicaid recipients must be told and informed in writing of their right to an
administrative hearing, if a recipient does not agree with the type or amount of
authorized services. When providing the Advance Notice of Action or the Notice
of Denial of Service, the Notice of Hearing Rights and the Hearing Request forms
must also be provided. Federal law requires that this information be given to or
mailed to recipients.
Note: Advance Notice of Action, Notice of Denial of Service, Notice of Hearing Rights,
and Hearing Request forms are enclosed. Hearing Request forms and pre-
addressed envelopes are available from the Administrative Tribunal of MDCH.
C. The OCCMHA must identify who from OCCMHA will represent OCCMHA in
Administrative Hearings.
IVIDCH Responsibilities for the Administrative Hearing Procedure
The MDCH will maintain an Administrative Hearing process to assure that Medicaid
recipients involved in an OCCMHA managed care plan or their legal representatives have
the opportunity to appeal decisions of OCCMHA to deny, terminate, suspend, or reduce,
Medicaid-covered services. This process will be administered by the Administrative
Tribunal, P.O. Box 30195, Lansing, M1 48906.
ADVANCE NOTICE OF ACTION
Suspension, Reduction or Termination
Date
Name
Address
City, State, Zip
Re: Member's Name
Member's ID Number
Dear
Following a review o I' the substance abuse treatment service(s) that you are currently receiving it has been
determined that the following service(s) shall be <terminated, suspended, or reduced> effective <date>. The reason
for this action is <reason>. The legal basis for this decision is 42CFR440.230/(d)
Service(s) Effective Date
if you do not agree with this action, you may request a Michigan Department of Community Health Authority/SOD
Service Network administrative hearing within 90 days of the date of notice. Hearing requests must be made in
writing and signed by you or an authorized person.
To request an administrative hearing, complete the "Hearing Request" form, and mail it in the enclosed envelope to:
ADMINISTRATIVE TRIBUNAL
MICHIGAN DEPARTMENT OF COMMUNITY lEALTH
PO Box 30195
LANSING, MI 48909-7695
You will continue to receive the affected substance abuse treatment service(s) in most circumstances until a hearing
decision is rendered if your request for an administrative hearing is received within 10 days of receipt of this notice.
If you want to know more about how an administrative hearing works, call (517) 335-9384. You may also request a
review through the Oakland County Community Mental Health Authority.
OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
2011 EXECUTIVE HILLS BOULEVARD
AUBURN Hal.s, MI 48326
248-858-1210
248-858-1633 FAX
You may request both an administrative hearing and a local grievance review. The hearing and grievance review
processes may occur at the same time.
You may contact the Administrative Tribunal or the OCCMHA if you have thither questions.
Enclosures: Hearing Request Form & Return Envelope
NOTICE OF DENIAL of SERVICES
Date
Name
Address
City, State, Zip
Re: Member's Name
Member's ID Number
Dear
Following a review of the substance abuse treatment service(s) for which you have applied, it has been
determined that the following service(s) shall not be authorized. The reason for this denial is <reason>.
The legal basis for this decision is 42CFR440.230/(d)
Service(s) Effective Date
If you do not agree with this action, you may request a Michigan Department of Community Health
Authority administrative hearing within 90 days of the date of notice. Hearing requests must be made in
writing and signed by you or an authorized person.
To request an administrative hearing, complete the "Hearing Request" form, and mail it in the enclosed
envelope to:
ADMINISTRATIVE TRIBUNAL
MICHIGAN DEPARTMENT OF COMMUNITY HEALTH
PO Box 30195
LANSING, MI 48909 7695
If you want to know more about how an administrative hearing works, call (517) 335-9384. You may also
request a review through the OCCMHA.
OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
2011 EXECUTIVE HILLS BOULEVARD
AUBURN HILLS, MI 48326
248-858-1210
248-858-1633 FAX
You may request both an administrative hearing and a local grievance review. The hearing and grievance
review processes may occur at the same time.
You may contact the Administrative Tribunal or the OCCMHA if you have further questions.
Enclosures: Hearing Request Form & Return Envelope
NOTICE OF HEARING RIGHTS
Substance Use Disorder Authorization
Date
Name
Address
City, State, Zip
Re: Member's Name
Member's ID Number
Dear
You have been authorized to receive substance abuse treatment services. The Oakland County
Community Mental Health Authority is responsible for the authorization of these services. The
legal basis for any utilization review decisions is 42CFR440.230 (d).
If you do not agree with the scope, duration, or intensity of the services included in this
authorization for substance abuse treatment services, you may request a Michigan Department of
Community Health Authority administrate hearing before an administrative law judge. The
request must be in writing signed by you and your authorized hearing representative, and
received by the OCCMHA within 90 days of the date of this authorization.
To request an administrative hearing, complete the "Hearing Request" form, and mail it in the
enclosed envelope to:
ADMINISTRATIVE TRIBUNAL
MICHIGAN DEPARTMENT OF COMMUNITY HEAL]] 1
PO Box 30195
LANSING, MI 48909 7695
If you want to know more about how an administrative hearing works, call (517) 335-9384.
Enclosures: Hearing Request Form
Return Envelope
ATTACHMENT E-15
OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
SUBSTANCE USE DISORDER SERVICES
Trauma Informed System of Care Overview
• Safe, calm and secure environment, with supportive care to ensure the physical and
emotional safety of children, youth, and adults
• System wide understanding of trauma prevalence, impact and trauma informed care
• Cultural Competence
• Recovery, consumer-driven and trauma specific services
• Engagement in organizational self-assessment of trauma informed care
• Screening for trauma exposure and related symptoms for each population
• Referral and treatment recommendations will align with Trauma Policy TIP 57
ATTACHMENT E46
RECOVERY HOUSING LEVEL H MONITORED SERVICES
Recovery Housing provides a location where individuals in early recovery from a behavioral
health disorder are given the time needed to rebuild their lives, while developing the necessary
skills to embark on a life of recovery. This temporary arrangement will provide the individual
with a safe and secure environment to begin process of reintegration into society, and to build the
necessary recovery capital to provide varying degrees of support and structure. Participation is
based on individual need and the ability to follow the requirements of the program.
Staff Qualifications
A. High school diploma or equivalent
B. Must possess interpersonal skills
• Empathy
• Verbal and written communication skills
• Listening skills
C. Must have a good working knowledge of recovery resources and activities.
Training Requirements
• Personal Safety
• Ethics
• Confidentiality
• Cultural Competence
• Recipient Rights
• Communicable Disease/HIV level I
• CPR/First Aid/Universal Precautions (recommended)
II. Program Services
A. Staff will maintain an alcohol-and illicit-drug-free environment.
B. Maintain a safe, structured, and supportive environment.
C. Set clear rules, policies, and procedures for the house and participating residents
D. Establish a screening process for residents.
E. Services/structure will be consistent with NARR Level TI Monitored Services
Ill. Eligibility Requirements
A. Individual meet the criteria for OSAS funding (income, residency, and substance use
disorder diagnosis).
B. Individual is in need of a highly structured and monitored living environment where
recovery support is available.
C. Individual has a history of unsuccessful recovery attempts
D. Individual has significant negative factors in the areas of family, social, work, or
environment that places him/her at-risk for relapse.
IV. Admission Requirements
A. Individual has completed or does not need medical or sub-acute detoxification.
B. Individual does not present with a severe medical or psychiatric condition that would
interfere in his/her ability to function in a supervised supportive living environment.
C. Individual will engage in treatment services and/or recovery groups/activities.
D. Individual demonstrates active motivation for recovery and a desire to work towards self-
sufficiency.
V. Recovery Housing Placement
A. ACCESS Management System Staff will refer and coordinate admission to the home.
B. In cases where the Treatment Provider request placement. The provider will contact the
AMS Staff. The Provider will enter a note in CareNet with the following information:
• Summary of progress and level of engagement
• Rationale for placement
• Plan for community integration and self-sufficiency, i.e. employment/independent
housing etc.
C. AMS Staff will review the information and make a recommendation for placement based
on the admission requirements/availability.
D. AMS staff will assist in arranging admission.
E. The Provider will complete an Initial Authorization Form for approval from the A MS.
F. Recovery Home Placement is based on first come first serve availability. Waiting list will
not be established for this service level. DIOP or DOP maybe an option. The AMS staff
will make the determination.
G. Recovery Home Staff will keep the AMS Staff apprised of openings.
VI. Recovery House Admission Procedure
A. Recovery Home Provider will complete the standard information required for admission.
In addition to the OSAS required documents.
B. Recovery Home Provider will assist the client in developing an individualized recovery
plan including Peer and Case Management Services if applicable.
VII. Authorizations/Re-Authorization Request
A. Clients will be authorized for sixty (60) days. Thirty (30) day extensions will be
considered on an individual basis. Extensions will be based on the following criteria:
• No behavioral challenges with staff or other residents
• Seeking employment or employed
• Compliance with house rules and regulations
• Engagement in treatment services and /or recovery groups/activities
• Progress toward recovery goals as evidenced by measurable improvement in
meeting recovery plan goals/recovery process
• Other pertinent information
B. If services are needed after sixty (60) days an extension maybe requested. The Recovery
Home Provider may request a reauthorization for continued stay through AMS ten (10)
days prior to the expiration date of the initial authorization. Information noted above for
extension request must be included in the reauthorization request.
VIII. Records
The Recovery Home Provider will maintain adequate program, and fiscal records and
files, including source documentation, to support program activities and all expenditures
made under the terms of this agreement, as required.
A. A daily log for each billable date of service will be kept for each client served.
B. OSAS CareNet Forms (i.e. Admission/Discharge, Etc.) will be completed within
timeframes noted in Attachment E. Timelines are consistent with outpatient
guidelines.
C. OSAS required documents including the Provider Consent for services.
D. All client specific information will be kept in a secure location and the Recovery
Home Provider will adhere to confidentiality requirements.
E. Release of Information Forms must be obtained before sharing client information
with outside entities.
IX. Code/Rate
The Code is H2036
The Rate $22.00 per day
Standards Criteria Recovery Residence Levels of Support 1i1NARR National Attrance for Recover), ResIdences Level I Peer-Run Level II Monitored Level 11111 Supervised Level IV Service Provider Administration • Democratically run • Manual or policy and procedures • House manager or senior resident • Policy and procedures • Organized hierarchy • Administrative oversight for service providers • Policy and procedures • Licensing varies from state to state • Overseen organizational hierarchy • Clinical and administrative supervision • Policy and procedures • Licensing varies from 1 state to state Services • Drug screening • House meetings • Self-help meetings encouraged • House rules provide structure • Peer-run groups • Drug screening • House meetings • Involvement in self- help and/or treatment services • Life skill development emphasis • Clinical services utilized in outside community • Service hours provided in-house • Clinical services and programming are provided in-house • Life skill development Residence • Generally single family residences • Primarily single family residences • Possibly apartments or other dwelling types • Varies — all types of residential settings • All types — often a step-down phase within care continuum of a treatment center • May be a more institutional in environment Staff • No paid positions within the residence • Perhaps an overseeing officer • At least 1 compensated position • Facility manager • Certified staff or case managers • Credentialed staff
FISCAL NOTE (MISC. #16169) July 20, 2016
BY: Finance Committee, Tom Middleton, Chairperson
IN RE: DEPARTMENT OF HEALTH AND HUMAN SERVICES/HEALTH DIVISION — INTERLOCAL
AGREEMENT BETWEEN THE COUNTY OF OAKLAND AND THE OAKLAND COUNTY COMMUNITY
MENTAL HEALTH AUTHORITY FOR HEALTH EDUCATION PREVENTION SERVICES
To the Oakland County Board of Commissioners
Chairperson, Ladies and Gentlemen:
Pursuant to Rule XII-C of this Board, the Finance Committee has reviewed the above-referenced
resolution and finds:
1. Public Act 500 of 2012 amended Public Act 258 of 1974, MCL 330.1287(5) changing the
designated substance abuse coordinating agency from the Oakland County Health & Human
Services Department (DHHS)/Health Division to the Oakland County Mental Health Authority
(OCCMHA).
2. An Interlocal Agreement was approved through Miscellaneous Resolution #15283 on November
12, 2015 to cancel the Substance Use Disorder Access Management services provided by the
Oakland County Health Division (OCHD) Prior Authorization and Central Evaluation (PACE)
services at the request of OCCMHA.
3. The current resolution recognizes entering into a new Interlocal Agreement between the Oakland
County Department of Health and Human Services/Health Division and the OCCMHA which
provides an end date of January 31, 2016 and funding not to exceed $236,685 for PACE services
provided from October 1, 2015 through January 31, 2016 as well as continues OCHD Health
Education Prevention Services with FY 2016 funding in the amount of $204,464 and a local
match of $20,446 comprised primarily of general fund salaries for supervision of the program for
total FY 2016 funding in the amount of $461,595.
4. With the discontinuation of PACE services one (1) Special Revenue (SR) Treatment Services
Supervisor position (#1060261 —07151); one (1) SR Auxiliary Health Worker position (#1060261
—07387); one (1) SR Public Health Educator 111 position (#1060261 -09204); one (1) SR Account
Clerk II position (#1060261 — 07498); three (3) SR Office Assistant II positions (#1060261
07154, 07389, 07566); seven (7) SR Substance Abuse Program Analyst positions (#1060233 —
07152, 07386 and #1060261 — 01919, 06114, 07500, 08037, 09026) will be deleted effective
immediately.
5. With the continuation of OCHD Health Education Prevention Services two (2) SR Public Health
Educator II! positions (#1060261 — 00960 and 07497) will remain through September 30, 2016.
6. The future level of service, including personnel, will be contingent upon the level of funding
available through future contract awards. A budget amendment for services after September 30,
2016 will be made upon future contract acceptance.
7. The FY 2016 - FY 2019 budgets are amended as follows to reflect services through September
30,2016:
HEALTH MDPH OSAS FUND (#28249)
GR0000000203 / Budget Reference 2016
activity: GLB analysis: GLB
Revenues
1060261-134795-610313 Federal Operating Grants
1060261-134800-610313 Federal Operating Grants
Total Revenues
Expenditures
1060261-134795-702010 Salaries
FY2016 FY2017 — FY2019
($ 5,155) ($ 209,619)
( 622,3421 ( 859,027)
S 627,497)
( 103,412)
FINANCE COMMITTEE VOTE:
Motion carried unanimously on a roll call vote with Woodward and Quarles absent.
1060261-134795-722740 Fringe Benefits 0 ( 73,886)
1060261-134795-730926 Indirect Costs 0 ( 15,666)
1060261-134795-731213 Membership Dues 0 450)
1060261-134795-731346 Personal Mileage 0 ( 3,673)
1060261-134795-731388 Printing 3,904) ( 5,000)
1060261-134795-732018 Travel and Conference 0 ( 1,327)
1060261-134795-750245 Incentives
1060261-134795-750294 Material and Supplies
1060261-134795-750392 _Metered Postage
1060261-134795-750399 Office Supplies
1060261-134795-750567 Training Educational Supplies
1060261-134795-770631 Building Space
1060261-134800-702010 Salaries
1060261-134800-722740 Fringe Benefits
1060261-134800-730926 Indirect Costs
1060261-134800-731346 Personal Mileage
1060261-134800-731388 Printing
1060261-134800-730373 Contracted Services
1060261-134800-731997 Transportation of Clients
1060261-134800-732018 Travel and Conference
1060261-134800-750294 Material and Supplies
1060261-134800-750392 Metered Postage
1060261-134800-750399 Office Supplies
1060261-134800-750567 Training-Educational Supplies
1060261-134800-774637 Info Tech Managed Print Svcs
1060261-134800-774677 Insurance Fund
1060261-134800-778675 Telephone Communications
Total Expenditures
100) 300)
200) 400)
500) 1,500)
450) 600)
2,500)
0 904)
346,561) 473,305)
224,457) 297,725)
52,707) 71,706)
0 467)
800 700)
3,308 0
0 100)
1,217) 1,750)
442 225)
0 2,100)
792 700)
0 1,200)
1,220 300)
0 2,000)
3,963) ( 6,750)
627,497) ( 1068646)
Resolution #16169 July 20, 2016
Moved by Hoffman supported by Zack the resolutions (with fiscal notes attached) on the Consent Agenda
be adopted (with accompanying reports being accepted).
AYES: Dwyer, Fleming, Gershenson, Gosselin, Hoffman, Kochenderfer, KowaII, Long,
Middleton, Quarles, Scott, Taub, Weipert, Woodward, Zack, Bowman, Crawford. (17)
NAYS: None. (0)
A sufficient majority having voted in favor, the resolutions (with fiscal notes attached) on the Consent
Agenda were adopted (with accompanying reports being accepted).
MOW APPROVE THIS RESOLUTION
CHIEF DEPUTY COUNTY EXECUTIVE
ACTING PURSUANT TO MCL 45,559A (7)
STATE OF MICHIGAN)
COUNTY OF OAKLAND)
I, Lisa Brown, Clerk of the County of Oakland, do hereby certify that the foregoing resolution is a true and
accurate copy of a resolution adopted by the Oakland County Board of Commissioners on July 20, 2016,
with the original record thereof now remaining in my office.
In Testimony Whereof, I have hereunto set my hand and affixed the seal of the County of Oakland at
Pontiac, Michigan this 20th day of July, 2016.
Lisa Brown, Oakland County