HomeMy WebLinkAboutResolutions - 2003.11.20 - 27262MISCELLANEOUS RESOLUTION #03312 November 20, 2003
BY: General Government Committee, William R. Patterson, Chairperson
IN RE: DEPARTMENT OF HUMAN SERVICES/HEALTH DIVISION - 2003/2004 SUBSTANCE ABUSE
GRANT ACCEPTANCE
To the Oakland County Board of Commissioners
Chairperson, Ladies and Gentlemen:
WHEREAS the Health Division has been awarded by the Michigan Department
of Community Health (MDCH) $4,702,614 in Substance Abuse Grant Funds for the
period of October 1, 2003 through September 30, 2004; and
WHEREAS the 2003/2004 grant award includes $4,702,614 in grant revenue and
expenditures for this program, a decrease of $326,957 (6.5%) from the previous
year; and
WHEREAS these funds are used to subcontract with agencies to prevent and
reduce the incidence of drug and alcohol abuse and dependency; and
WHEREAS these contracts were awarded through the County's competitive
bidding process; and
WHEREAS acceptance of this grant does not obligate the County to any
future commitment; and
WHEREAS the grant agreement has been submitted through the County
Executive's Contract Review Process.
NOW THEREFORE BE IT RESOLVED that the Oakland County Board of
Commissioners accepts the 2003/2004 Substance Abuse Grant from the Michigan
Department of Community Health in the amount of $4,702,614.
BE IT FURTHER RESOLVED that the Chairperson of the Board of Commissioners
is authorized to execute the grant agreement and to approve minor changes and
grant extensions, not to exceed fifteen (15) percent variance from the original
award.
BE IT FURTHER RESOLVED that the future level of service, including
personnel, be contingent upon the level of funding for this program.
BE IT FURTHER RESOLVED that the Oakland County Board of Commissioners
authorizes its Chairperson to execute this Agreement subject to the following
additional condition: That the County's approval for entering into this Agreement
is specifically conditioned and premised upon the acceptance, approval and
execution of the Agreement containing Addendum A, by the Michigan Department of
Community Health, and that the failure of the Michigan Department of Community
Health to execute the Agreement as specified shall, without any further act of
the Oakland County Board of Commissioners, automatically negate and void the
County's approval and/or acceptance of this agreement as provided for in this
resolution.
Chairperson, on behalf of the General Government Committee, I move the
adoption of the foregoing resolution.
GENERAL GOVERNMENT COMMITTEE
it/v46-0674 1°141
General Government Committee Vote:
Motion carried unanimously on a roll call vote.
CONTRACT REVIEW - Health Division
GRANT NAME: FY 03-04 MDCH - Local Health Department Substance Abuse
Agreement
FUNDING AGENCY: Michigan Department of Community Health
DEPARTMENT CONTACT PERSON: Tom Fockler /22151
STATUS: Acceptance
DATE: October 6, 2003
Pursuant to Misc. Resolution #01320, please be advised the captioned
grant materials have completed internal contract review. Below are the
comments returned by review departments.
Department of Management and Budget:
Approved.- Laurie Van Pelt (10/3/2003)
Personnel Department:
Approved. - Ed Poisson (10/1/2003)
Risk Management and Safety:
Approval. - Gerald Mathews (9/26/2003)
Corporation Counsel:
I have reviewed the proposed Fiscal Year 2003-04 Substance Abuse Grant
Agreement documents which have been provided to this office, and approve
them for acceptance and signature. William Mann (10/3/2003)
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
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.
Greg Givens, Supervisor
Grants Administration Unit
Fiscal Services Division
Contract #:
Grant Agreement Between
Michigan Department of Community Health
hereinafter referred to as the "Department"
and
Oakland County Health Division
250 Elizabeth Lake Road, Suite 1550
Pontiac, Michigan 48341
Federal I.D.#:38-6004876
hereinafter referred to as the "Contractor"
for
Substance Abuse Services
Part I
1. Period of Agreement: This agreement shall commence on October 1, 2003
and continue through September 30, 2004. This agreement is in full force and
effect for the period specified.
2. Program Budget and Agreement Amount
A. Agreement Amount
The total amount of this agreement is $ . The
Department under the terms of this agreement will provide funding not
to exceed $4,702,614. The federal funding provided by the
Department is 66%; the Catalog of Federal Domestic Assistance
(CFDA) number is 93.959 and the CFDA Title is Block Grant for
Prevention and Treatment of Substance Abuse; the federal agency
name is Department of Health and Human Services; the federal grant
award number is 00 B1 MI SAPT 04 and federal program title is SAPT
Block Grant.
B. Equipment Purchases and Title
Any contractor equipment purchases supported in whole or in part
through this agreement must be detailed in the supporting detail
schedule. Equipment means tangible, non-expendable, personal
property having useful life of more than one (1) year and an acquisition
cost of $5,000 or more per unit. Title to items having a unit acquisition
DCH-0665FY2004 4103 (W) Page 1 of 16
cost of less than $5,000 shall vest with the Contractor upon acquisition.
The Department reserves the right to retain or transfer the title to all
items of equipment having a unit acquisition cost of $5,000 or more, to
the extent that the Department's proportionate interest in such
equipment supports such retention or transfer of title.
C. Deviation Allowance
A deviation allowance modifying an established budget category by
$10,000 or 15%, whichever is greater, is permissible without prior
written approval of the Department. Any modification or deviations in
excess of this provision, including any adjustment to the total amount
of this agreement, must be made in writing and executed by all parties
to this agreement before the modifications can be implemented. This
deviation allowance does not authorize new categories, subcontracts,
equipment items or positions not shown in the attached Program
Budget Summary and supporting detail schedules.
3. Purpose: The focus of the program is to provide for the administration and
coordination of substance abuse services within the designated coordinating
agency region, consisting of Oakland County.
4. Statement of Work: The Contractor agrees to undertake, perform and
complete the services described in Attachment A which is attached and hereby
made a part of this agreement through reference.
5. Financial Requirements: The reimbursement process shall be followed as
described in Part II of this agreement and Attachments B, D and E, which are
hereby made a part of this agreement through reference.
6. Performance/Progress Report Requirements: The progress reporting
methods, as applicable, shall be followed as described in Attachment C,
hereby made a part of this agreement through reference.
7. General Provisions: The Contractor agrees to comply with the General
Provisions outlined in Part II, hereby made part of this agreement through
reference.
8. Administration of the Agreement:
The person acting for the Department in administering this agreement
(hereinafter referred to as the Contract Manager) will be:
Mark Steinberg; Cass Bldg; Manager, S/A Abuse Contract Management; 517/335 -0180.
Name, Location/Building Title Telephone No.
DCH-0665FY2004 4/03 (W) Page 2 of 16
9.- Contractor's Financial Contact for the Agreement:
The person acting for the Contractor on the financial reporting for this
agreement will be:
Sandra Kosik, Coordinator, KosiksRco.oakland.mi.us 248/858-0001
Name Title E-Mail Address Telephone No.
10. Special Conditions:
A. This agreement is valid upon approval by the State Administrative
Board as appropriate and approval and execution by the Department.
B. This agreement is conditionally approved subject to and contingent
upon the availability of funds.
C. The Department will not assume any responsibility or liability for costs
incurred by the Contractor prior to the signing of this agreement.
11. Special Certification:
The individual or officer signing this agreement certifies by his or her signature
that he or she is authorized to sign this agreement on behalf of the responsible
governing board, official or Contractor.
12. Signature Section:
For the MICHIGAN DEPARTMENT OF COMMUNITY HEALTH
Michael Ezzo, Ed.D., Chief Deputy Director Date
For the CONTRACTOR
Name (print) Title (print)
Signature Date
DCH-0665FY2004 4/03 (W) Page 3 of 16
Part II
General Provisions
I. Responsibilities - Contractor
The Contractor in accordance with the general purposes and objectives of this
agreement will:
A. Publication Rights
1. Where activities supported by this agreement produce books, films,
or other such copyrightable materials issued by the Contractor, the
Contractor may copyright such but shall acknowledge that the
Department reserves a royalty-free, non-exclusive and irrevocable
license to reproduce, publish and use such materials and to
authorize others to reproduce and use such materials. This cannot
include service recipient information or personal identification data.
2. Any copyrighted materials or modifications bearing acknowledg-
ment of the Department's name must be approved by the
Department prior to reproduction and use of such materials.
3. The Contractor shall give recognition to the Department in any and
all publications papers and presentations arising from the program
and service contract herein; the Department will do likewise.
B. Fees
Make reasonable efforts to collect 1 st and 3rd party fees, where applicable,
and report these as outlined by the Department's fiscal procedures. Any
underrecoveries of otherwise available fees resulting from failure to bill for
eligible services will be excluded from reimbursable expenditures.
C. Program Operation
Provide the necessary administrative, professional, and technical staff for
operation of the program.
D. Reporting
Utilize all report forms and reporting formats required by the Department
at the effective date of this agreement, and provide the Department with
timely review and commentary on any new report forms and reporting
formats proposed for issuance thereafter.
E. Record Maintenance/Retention
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.
DCH-0665FY2004 4103 (W) Page 4 of 16
Assure that all terms of the agreement will be appropriately adhered to
and that records and detailed documentation for the project or program
identified in this agreement will be maintained for a period of not less than
three (3) years from the date of termination, the date of submission of the
final expenditure report or until litigation and audit findings have been
resolved.
F. Authorized Access
Permit upon reasonable notification and at reasonable times, access by
authorized representatives of the Department, Federal Grantor Agency,
Comptroller General of the United States and State Auditor General, or
any of their duly authorized representatives, to records, files and
documentation related to this agreement, to the extent authorized by
applicable state or federal law, rule or regulation.
G. Single Audit
The Contractor must comply with requirements of the Single Audit Act
Amendments of 1996, 31 USC 7501 et seq, and Section .320 of Office of
Management and Budget (OMB) Circular A-133, "Audits of States, Local
Governments, and Non-Profit Organizations" and by the current version of
the MDCH/BSAS Audit Guidelines and audit schedules and provide the
Department copies of any audits of the Contractor on any program
elements covered by this agreement. The reporting package must include
additional information as enumerated in the current version of the
MDCH/BSAS Audit Guidelines and audit schedules. The Contractor is
required to file with the Department the Single Audit reporting package
and management letter within nine months after the end of the contractor's
fiscal year, even if there are no findings reported in the audit pertaining to
Department programs. A contractor that expends less than $300,000 in
federal awards and received less than $300,000 in total Department
funding is reqUired to file the Audit Status Notification Letter (Attachment
E).
The Contractor must also assure that each of its subcontractors comply
with these audit requirements (i.e., subcontractors expending $300,000 or
more in federal awards during the subcontractor's fiscal year are required
to have audits performed in accordance with OMB Circular A-133, and
should provide these to the Contractor).
The Contractor must assure that the Schedule of Expenditures of Federal
Awards includes expenditures for all federally-funded grants. A copy of the
Single Audit reporting package should be forwarded to:
DCH-0665FY2004 4103 (W) Page 5 of 18
Michigan Department of Community Health
Office of Audit
Quality Assurance and Review Section
P.O. Box 30479 (Capital Commons Center, 400 S. Pine Street)*
Lansing, MI 48909-7979
Depending on the degree and extent of the level of risk involved, the
Department or Coordinating Agency may conduct or arrange for any or a
combination of the monitoring procedures outlined in the current version of
the MDCH/BSAS Audit Guidelines and audit schedules.
H. Notification of Modifications
Provide timely notification to the Department, in writing, of any action by its
governing board or any other funding source which would require or result
in significant modification in the provision of services, funding or
compliance with operational procedures.
I. Year 2000 Compatibility
The Contractor must ensure year 2000 compatibility for any software
purchases related to this agreement. This shall include, but is not limited
to: data structures (databases, data files, etc.) that provide 4-digit date
century; stored data that contain date century recognition, including but
not limited to: data stored in databases and hardware device internal
system dates; calculations and program logic (e.g., sort algorithms,
calendar generation, event recognition, and all processing actions that use
or produce date values) that accommodates same century and multi-
century formulas and date values; interfaces that supply data to and
receive data from other systems or organizations that prevent non-
compliant dates and data from entering any State system; user interfaces
(i.e., screens, reports, etc.) that accurately show 4-digit years; and
assurance that the year 2000 shall be correctly treated as a leap year
within all calculation and calendar logic.
J. Human Subjects
The Contractor agrees to submit all research involving human subjects,
which is conducted in programs sponsored by the Department, or in
programs which receive funding from or through the State of Michigan, to
the Department's Human Subjects Committee for approval prior to the
initiation of the research.
II. Responsibilities - Department
The Department in accordance with the general purposes and objectives of this
agreement will:
DCH-0665FY2004 4/03 (W) Page 6 of 16
A. Reimbursement
Provide reimbursement in accordance with the terms and conditions of
this agreement based upon appropriate reports, records, and
documentation maintained by the Contractor.
B. Report Forms
Provide any report forms and reporting formats required by the
Department at the effective date of this agreement, and provide to the
Contractor any new report forms and reporting formats proposed for
issuance thereafter at least ninety (90) days prior to their required usage
in order to afford the Contractor an opportunity to review and offer
comment.
HI. Assurances
The following assurances are hereby given to the Department:
A. Compliance with Applicable Laws
The Contractor will comply with applicable federal and state laws,
guidelines, rules and regulations in carrying out the terms of this
agreement. The Contractor will also comply with all applicable general
administrative requirements such as OMB Circulars covering cost
principles, grant/agreement principles, and audits in carrying out the terms
of this agreement.
B. Anti-Lobbying Act
The Contractor will comply with the Anti-Lobbying Act, 31 USC 1352 as
revised by the Lobbying Disclosure Act of 1995, 2 USC 1601 et seq, and
Section 503 of the Departments of Labor, Health and Human Services and
Education, and Related Agencies Appropriations Act (Public Law 104-
208). Further, the Contractor shall require that the language of this
assurance be included in the award documents of all subawards at all tiers
(including subcontracts, subgrants, and contracts under grants, loans and
cooperative agreements) and that all subrecipients shall certify and
disclose accordingly.
C. Non-Discrimination
1. In the performance of any contract or purchase order resulting
herefrom, the Contractor agrees not to discriminate against any
employee or applicant for employment or service delivery and
access, with respect to their hire, tenure, terms, conditions or
privileges of employment, programs and services provided or any
matter directly or indirectly related to employment, because of race,
color, religion, national origin, ancestry, age, sex, height, weight,
marital status, physical or mental disability unrelated to the
individual's ability to perform the duties of the particular job or
DCH-0665FY2004 4/03 (W) Page 7 of 16
position or to receive services. The Contractor further agrees that
every subcontract entered into for the performance of any contract
or purchase order resulting herefrom will contain a provision
requiring non-discrimination in employment, service delivery and
access, as herein specified binding upon each subcontractor. This
covenant is required pursuant to the Elliot-Larsen Civil Rights Act,
1976 PA 453, as amended, MCL 37.2201 et seq., and the Persons
with Disabilities Civil Rights Act, 1976 PA 220, as amended, MCL
37.1101 et seq., and any breach thereof may be regarded as a
material breach of the contract or purchase order.
2. Additionally, assurance is given to the Department that proactive
efforts will be made to identify and encourage the participation of
minority owned and women owned businesses, and businesses
owned by handicapped persons in contract solicitations. The
Contractor shall incorporate language in all contracts awarded: (1)
prohibiting discrimination against minority owned and women
owned businesses and businesses owned by handicapped persons
in subcontracting; and (2) making discrimination a material breach
of contract.
D. Debarment and Suspension
Assurance is hereby given to the Department that the Contractor will
comply with Federal Regulation, 45 CFR Part 76 and certifies to the best
of its knowledge and belief that it, including its employees and
subcontractors:
1. Are not presently debarred, suspended, proposed for debarment,
declared ineligible, or voluntarily excluded from covered
transactions by any federal department or contractor;
2. Have not within a three-year period preceding this agreement been
convicted of or had a civil judgment rendered against them for
commission of fraud or a criminal offense in connection with
obtaining, attempting to obtain, or performing a public (federal,
state, or local) transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of
embezzlement, theft, forgery, bribery, falsification or destruction of
records, making false statements, or receiving stolen property;
3. Are not presently indicted or otherwise criminally or civilly charged
by a government entity (federal, state or local) with commission of
any of the offenses enumerated in section 2, and;
DCH-0665FY2004 4/03 (W) Page 8 of 16
4. Have not within a three-year period preceding this agreement had
one or more public transactions (federal, state or local) terminated
for cause or default.
E. Federal Requirement: Pro-Children Act
1. Assurance is hereby given to the Department that the Contractor
will comply with Public Law 103-227, also known as the Pro-
Children Act of 1994, 20 USC 6081 et seq, which requires that
smoking not be permitted in any portion of any indoor facility owned
or leased or contracted by and used routinely or regularly for the
provision of health, day care, early childhood development
services, education or library services to children under the age of
18, if the services are funded by federal programs either directly or
through state or local governments, by federal grant, contract, loan
or loan guarantee. The law also applies to children's services that
are provided in indoor facilities that are constructed, operated, or
maintained with such federal funds. The law does not apply to
children's services provided in private residences; portions of
facilities used for inpatient drug or alcohol treatment; service
providers whose sole source of applicable federal funds is
Medicare or Medicaid; or facilities where Women, Infants, and
Children (WIC) coupons are redeemed. Failure to comply with the
provisions of the law may result in the imposition of a civil monetary
penalty of up to $1,000 for each violation and/or the imposition of
an administrative compliance order on the responsible entity. The
Contractor also assures that this language will be included in any
subawards which contain provisions for children's services.
2. The Contractor also assures, in addition to compliance with Public
Law 103-227, any service or activity funded in whole or in part
through this agreement will be delivered in a smoke-free facility or
environment. Smoking shall not be permitted anywhere in the
facility, or those parts of the facility under the control of the
Contractor. If activities or services are delivered in facilities or
areas that are not under the control of the Contractor (e.g., a mall,
restaurant or private work site), the activities or services shall be
smoke-free.
F. Hatch Political Activity Act and Intergovernmental Personnel Act
The Contractor will comply with the Hatch Political Activity Act, 5 USC 1501-
1508, and the Intergovernmental Personnel Act of 1970, as amended by
Title VI of the Civil Service Reform Act, Public Law 95-454, 42 USC 4728.
Federal funds cannot be used for partisan political purposes of any kind by
any person or organization involved in the administration of federally
assisted programs.
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G. Home Health Services
If the Contractor provides Home Health Services (as defined in Medicare
Part B), the following requirements apply:
1. The Contractor shall not use categorical grant funds provided under
this agreement to unfairly compete for home health services
available from private providers of the same type of services in the
Contractor's service area.
2. For purposes of this agreement, the, term "unfair competition" shall
be defined as offering of home health services at fees substantially
less than those generally charged by private providers of the same
type of services in the Contractor's area, except as allowed under
Medicare customary charge regulations involving sliding fee scale
discounts for low-income clients based upon their ability to pay.
3. If the Department finds that the Contractor is not in compliance with
its assurance not to use state local public health operations and
categorical grant funds to unfairly compete, the Department shall
follow the procedure required for failure by local health departments
to adequately provide required services set forth in Sections 2497
and 2498 of 1978, PA 368, as amended (Public Health Code), MCL
333.2497 and 2498, MSA 14.15 (2497) and (2498).
H. Subcontracts
Assure for any subcontracted service, activity or product:
1. That a written subcontract is executed by all affected parties prior to
the initiation of any new subcontract activity. Exceptions to this
policy may be granted by the Department upon written request
within 30 days of execution of the agreement.
2. That any executed subcontract to this agreement shall require the
subcontractor to comply with all applicable terms and conditions of
this agreement. In the event of a conflict between this agreement
and the provisions of the subcontract, the provisions of this
agreement shall prevail.
A conflict between this agreement and a subcontract, however,
shall not be deemed to exist where the subcontract:
a. Contains additional non-conflicting provisions not set forth in
this agreement;
DCH-0665FY2004 4/03 (W) Page 10 of 16
b. Restates provisions of this agreement to afford the
Contractor the same or substantially the same rights and
privileges as the Department; or
c. Requires the subcontractor to perform duties and/or services
in less time than that afforded the Contractor in this
agreement.
3. That the subcontract does not affect the Contractor's accountability
to the Department for the subcontracted activity.
4. That any billing or request for reimbursement for Subcontract costs
is supported by a valid subcontract and adequate source
documentation on costs and services.
5. That the Contractor will submit a copy of the executed subcontract
if requested by the Department.
Procurement
Assure that all purchase transactions, whether negotiated or advertised,
shall be conducted openly and competitively in accordance with the
principles and requirements of OMB Circular A-102 (as revised),
implemented through applicable portions of the associated "Common
Rule" as promulgated by responsible federal contractor(s), or OMB
Circular A-110, as applicable, and that records sufficient to document the
significant history of all purchases are maintained for a minimum of three
years after the end of the agreement period.
J. Health Insurance Portability and Accountability Act
To the extent that this act is pertinent to the services that the Contractor
provides to the Department under this agreement, the Contractor assures
that it is in compliance with the Health Insurance Portability and
Accountability Act (HIPAA) requirements including the following:
1. The Contractor must not share any protected health data and
information provided by the Department that falls within HIPAA
requirements except to a subcontractor as appropriate under this
agreement.
2. The Contractor must require the subcontractor not to share any
protected health data and information from the Department that
falls under HIPAA requirements in the terms and conditions of the
subcontract.
3. The Contractor must only use the protected health data and
information for the purposes of this agreement.
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4. The Contractor must have written policies and procedures
addressing the use of protected health data and information that
falls under the HIPAA requirements. The policies and procedures
must meet all applicable federal and state requirements including
the HIPAA regulations. These policies and procedures must
include restricting access to the protected health data and
information by the Contractor's employees.
5. The Contractor must have a policy and procedure to report to the
Department unauthorized use or disclosure of protected health data
and information that falls under the H1PAA requirements of which
the Contractor becomes aware.
6. Failure to comply with any of these contractual requirements may
result in the termination of this agreement in accordance with Part
II, Section V. Termination.
7. In accordance with HIPAA requirements, the Contractor is liable for
any claim, loss or damage relating to unauthorized use or
disclosure of protected health data and information received by the
Contractor from the Department or any other source.
IV. Financial Requirements
A. Operating Advance
An operating advance may be requested by the Contractor to assist with
program operations. The request should be addressed to the Contract
Manager identified in Part I, Item ' 8. The operating advance will be
administered as follows:
1. The advance amount requested must be reasonable in relationship
to the program's requirements, billing cycle, etc.; and in no case
may exceed the amount required for 60 days operating expense.
Operating advances will be monitored and adjusted by the
Department according to total Department agreement amount.
2. The advance must be recorded as an account payable to the
Department in the Contractor's financial records. The operating
advance payable must remain in the Contractor's financial records
until fully recovered by the Department.
3. The monthly Financial Status Report (FSR) reimbursement for
actual expenditures by the Department should be used by the
Contractor to replenish the operating advance used for program
operations.
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4. The advance must be returned to the Department within 30 days of
the end date of this agreement unless the Contractor has a
recurring agreement with the Department, and may not be held
pending agreement audit. Subsequent Department agreements
may be withheld pending recovery of the outstanding advance from
a prior agreement. If the Contractor has a recurring agreement with
the Department, the operating advance outstanding must be
confirmed at the end of each fiscal year.
The Department may obtain the Michigan Department of Treasury's
assistance in collecting outstanding operating advances. The
Department will comply with the Michigan Department of Treasury's
Due Process procedures prior to forwarding claims to Treasury.
Specific Due Process procedures include the following:
a. Department offer of a hearing to dispute the debt, identifying
the time, place and date of such hearing.
b. A hearing by an impartial official.
c. An opportunity for the Contractor to examine department's
associated records.
d. An opportunity for the Contractor to present evidence in
person or in writing.
e. A hearing official with full authority to correct errors and
make a decision not to forward debt to Treasury.
f. Contractor representation by an attorney and presentation of
witnesses if necessary.
5. At the end of either the agreement period or Department's fiscal
year, whichever is first, the Contractor must respond to the
Department's request for confirmation of the operating advance.
Failure to respond to the confirmation request may result in the
Department recovering all or part of an outstanding operating
advance.
B. Reimbursement Method
The Contractor will be reimbursed in accordance with the staffing grant
reimbursement mechanism as follows:
Reimbursement from the Department based on the understanding that
Department funds will be paid up to the total Department allocation as
agreed to in the approved budget. Department funds are first source after
the application of fees and earmarked sources unless a specific local
match condition exists.
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C. Financial Status Report Submission
Financial Status Reports (FSRs) shall be prepared and submitted to the
Michigan Department of Community Health, Budget and
Finance/Administration, Accounting Division, Expenditure Operations
Section, P.O. Box 30720, Lansing, Michigan 48909, on a monthly basis,
no later than thirty (30) days after the close of each calendar month. The
monthly FSRs must reflect total actual program expenditures, regardless
of the source of funds. Attachment D contains the FSR form. The FSR
form and instructions for completing the FSR form are available through
your Contract Manager or the Department's web site:
• http://www.michigan.gov/documents/DCH-0384-
Financial_Status_Report_8214_7.pdf and
• http://www.michigan.gov/documents/DCH-0384-
Financial_Status_Reportinstructions_8216_7.pdf.
Failure to meet financial reporting responsibilities as identified in this
agreement may result in withholding future payments.
D. Reimbursement Mechanism
All contractors are encouraged to sign up through the on-line vendor
registration process to receive all State of Michigan payments as
Electronic Funds Transfers (EFT)/Direct Deposits.
E. Final Obligations and Financial Status Report Requirements
A report of estimated total agreement expenditures must be submitted
based on annual guidelines and deadlines issued by the Department.
Final FSRs are due sixty (60) days following the end of the fiscal year or
agreement period. The final FSR must be clearly marked "Final". Final
FSRs not received by the due date may result in a loss of funding
requested per the report of estimated total agreement expenditures and
may result in the potential reduction in the subsequent year's agreement
amount.
F. Unobligated Funds
Any unobligated balance of funds held by the Contractor at the end of the
agreement period will be returned to the Department or treated in
accordance with instructions provided by the Department.
V. Agreement Termination
The Department may cancel this agreement without further liability or penalty to
the Department for any of the following reasons:
A. This agreement may be terminated by either party by giving thirty (30)
days written notice to the other party stating the reasons for termination
and the effective date.
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B. This agreement may be terminated on thirty (30) days prior written notice
upon the failure of either party to carry out the terms and conditions of this
agreement, provided the alleged defaulting party is given notice of the
alleged breach and fails to cure the default within the thirty (30) day
period.
C. This agreement may be terminated immediately if the Contractor or an
official of the Contractor or an owner is convicted of any activity
referenced in Section III.D. of this agreement during the term of this
agreement or any extension thereof.
VI. Final Reporting Upon Termination
Should this agreement be terminated by either party, within thirty (30) days after
the termination, the Contractor shall provide the Department with all financial,
performance and other reports required as a condition of this agreement. The
Department will make payments to the Contractor for allowable reimbursable
costs not covered by previous payments or other state or federal programs. The
Contractor shall immediately refund to the Department any funds not authorized
for use and any payments or funds advanced to the Contractor in excess of
allowable reimbursable expenditures. Any dispute arising as a result of this
agreement shall be resolved in the State of Michigan.
VII. Severability
If any provision of this agreement or any provision of any document attached to
or incorporated by reference is waived or held to be invalid, such waiver or
invalidity shall not affect other provisions of this agreement.
VIII. Amendments
Any changes to this agreement will be valid only if made in writing and accepted
by all parties to this agreement.
IX. Liability
A. All liability to third parties, loss, or damage as a result of claims, demands,
costs, or judgments arising out of activities, such as direct service delivery,
to be carried out by the Contractor in the performance of this agreement
shall be the responsibility of the Contractor, and not the responsibility of
the Department, if the liability, loss, or damage is caused by, or arises out
of, the actions or failure to act on the part of the Contractor, any
subcontractor, anyone directly or indirectly employed by the Contractor,
provided that nothing herein shall be construed as a waiver of any
governmental immunity that has been provided to the Contractor or its
employees by statute or court decisions.
DCH-0665FY2004 4103 (W) Page 15 of 16
B. All liability to third parties, loss, or damage as a result of claims, demands,
costs, or judgments arising out of activities, such as the provision of policy
and procedural direction, to be carried out by the Department in the
performance of this agreement shall be the responsibility of the
Department, and not the responsibility of the Contractor, if the liability,
loss, or damage is caused by, or arises out of, the action or failure to act
on the part of any Department employee or agent, provided that nothing
herein shall be construed as a waiver of any governmental immunity by
the State, its agencies (the Department) or employees as provided by
statute or court decisions.
C. In the event that liability to third parties, loss, or damage -arises as a result
of activities conducted jointly by the Contractor and the Department in
fulfillment of their responsibilities under this agreement, such liability, loss,
or damage shall be borne by the Contractor and the Department in
relation to each party's responsibilities under these joint activities,
provided that nothing herein shall be construed as a waiver of any
governmental immunity by the Contractor, the State, its agencies (the
Department) or their employees, respectively, as provided by statute or
court decisions.
X. Conflict of Interest
The Contractor and the Department are subject to the provisions of 1968 PA 317,
as amended, MCL 15.321 et seq, MSA 4.1700(51) et seq, and 1973 PA 196, as
amended, MCL 15.341 et seq, MSA 4.1700 (71) et seq.
XL State of Michigan Agreement
This is a State of Michigan Agreement and is governed by the laws of Michigan.
Any dispute arising as a result of this agreement shall be resolved in the State of
Michigan.
XII. Confidentiality
• Both the Department and the Contractor shall assure that medical services to
and information contained in medical records of persons served under this
agreement, or other such recorded information required to be held confidential by
federal or state law, rule or regulation, in connection with the provision of
services or other activity under this agreement shall be privileged
communication, shall be held confidential, and shall not be divulged without the
written consent of either the patient or a person responsible for the patient,
except as may be otherwise required by applicable law or regulation. Such
information may be disclosed in summary, statistical, or other form which does
not directly or indirectly identify particular individuals.
XIII. Other Requirements—Attachment F
Attachment F contains additional requirements and is incorporated into this
agreement by reference.
DCH-0665FY2004 4/03 (W) Page 16 of 16
Version: Substance Abuse
Services
MICHIGAN DEPARTMENT OF COMMUNITY HEALTH
FY 03/04 AGREEMENT ADDENDUM A
1. This addendum adds the following section to Part I and Renumbers existing 11
Special Certification to 12 and existing 12 Signature Section to 13:
• Part I
11. Agreement Exceptions and Limitations
Notwithstanding any other term or condition in this Agreement including, but
not limited to, any provisions related to any services as described in the
Annual Action Plan, any Contractor (Oakland County) services provided
pursuant to this Agreement, or any limitations upon any Department funding
obligations herein, the Parties specifically intend and agree that the
Contractor may discontinue, without any penalty or liability whatsoever, any
Contractor services or performance obligations under this Agreement when
and if it becomes apparent that State or Department funds for any such
services will be no longer available. Notwithstanding any other term or
condition in this Agreement, the Parties specifically understand and agree
that no provision in this Agreement shall operate as a waiver, bar or limitation
of any kind, on any legal claim or right the Contractor may have at any time
under any Michigan constitutional provision or other legal basis (e.g., any
Headlee Amendment limitations) to challenge any State or Department
program funding obligations; and, the parties further agree that no term or
condition in this Agreement is intended and no such provision shall be
argued to state or imply that the Contractor voluntarily assumed or undertook
to provide any services as described in the Annual Action Plan, and thereby,
waived any rights the Contractor may have had under any legal theory, in
law or equity, without regard to whether or not the Contractor continued to
perform any services herein after any State or Department funding ends.
Page 1 of 3
Version: Substance Abuse
Services
2. This addendum modifies the following sections of Part II, General Provisions:
Part fl
1. Responsibilities-Contractor
1. Year 2000 Compatibility. This section will be deleted in its entirety
and replaced with the following language:
The Michigan Department of Community Health and the County of
Oakland will work together to determine and avoid potential Year
2000 computer systems problems.
Ill. Assurances
A. Compliance with Applicable Laws. This first sentence of this
paragraph will be stricken in its entirety and replace with the following
language:
The Contractor will comply with applicable Federal and State laws,
and lawfully enacted administrative rules or regulations, in carrying
out the terms of this agreement.
IX. Liability. Paragraph A. will be deleted in its entirety and replaced with the
following language.
A. Except as otherwise provided for in this Contract, all liability, loss, or
damage as a result of claims, demands, costs, or judgments arising
out of activities to be carried out pursuant to the obligations of the
Contractor under this Contract shall be the responsibility of the
Contractor and not the responsibility of the Department, if the liability,
loss, or damage is caused by, or arises out to the actions or failure to
act on the part of the Contractor, its employees, officers or agents.
Nothing therein shall be construed as a waiver of any governmental
immunity for the Contractor, its agencies, employees, or Oakland
County, as provided by statute or modified by court decisions.
Page 2 of 3
Date
Date
Version: Substance Abuse
Services
8. Special Certification:
The individual or officer signing this agreement certifies by his or her signature that
he or she is authorized to sign this agreement on behalf of the responsible
governing board, official or Contractor.
9. Signature Section:
For the MICHIGAN DEPARTMENT OF COMMUNITY HEALTH
Peter L. Trezise, Chief Operating Officer
For the CONTRACTOR
Name and Title
Signature
Page 3 of 3
ATTACHMENT A
STATEMENT OF WORK
Page 1 of 14 July 2003
ATTACHMENT A
STATEMENT OF WORK
1. General Statement of Work
The general responsibilities of the coordinating agency (CA) under this
Agreement, based on P.A. 368 of 1978, as amended, are to:
a. Develop comprehensive plans for substance abuse treatment and
rehabilitation services and prevention services consistent with guidelines
established by the Department.
b. Review and comment to the Department on applications for licenses
submitted by local treatment, rehabilitation, and prevention organizations.
c. Provide technical assistance for local substance abuse service
organizations
d. Collect and transfer data and financial information from local organizations
to the Department.
e. Submit an annual budget request to the Department for use of state
administered funds for its city, county, or region for substance abuse
treatments and rehabilitation services and prevention services in
accordance with guidelines established by the Department
f. Make contracts necessary and incidental to the performance of the
Agency functions. The contracts may be made with public or private
agencies, organizations, associations, and individuals to provide for
substance abuse treatment and rehabilitation services and prevention
services
Annually evaluate and assess substance abuse services in the city,-
county, or region in accordance with guidelines established by the
Department and federal goals.
2. Annual Action Plan Guidelines and Annual Action Plan
The CA will comply with requirements contained in the Department's Fiscal Year
(FY) 2004 Annual Action Plan Guidelines (AAPG). AAPG requirements are
incorporated into this Agreement by reference. The CA will also carry out its
responsibilities under this Agreement consistent with the CA's FY2004 Annual
Action Plan (AAP) submitted in response to the AAPG, as revised and approved
in writing by the Department. The CA's approved AAP is incorporated into this
Agreement by reference. The methodologies and program content to be used in
g.
Page 2 of 14 July 2003
achieving the CA's responsibilities under this Agreement must be consistent with
the MPG and the approved AAP.
3. Substance Abuse Prevention and Treatment (SAPT) Block Grant
Federal requirements deriving from Public Law 102-321, as amended by Public
Law 106-310, and federal regulations in 45 CFR Part 96 are pass-through
requirements. Most federal Substance Abuse Prevention and Treatment
(SAPT) block grant requirements applicable to states are passed on to CAs.
SAPT block grant requirements also apply to the Michigan Department of
Community Health (MDCH) administered state funds, unless a written exception
is obtained from MDCH. Sections from PL 102-321, as amended, that apply to
CAs and contractors include: 1921(b); 1922 (a)(1)(2); 1922(b)(1)(2); 1923;
1923(a)(1) and (2), and 1923(b); 1924(a)(1)(A) and (B); 1924(c)(2)(A) and (B);
1927(a)(1) and (2), and 1927(b)(1); 1927(b)(2); 1928(b) and (c); 1929;
1931(a)(1)(A), (B), (C), (D), (E) and (F); 1932(b)(1); 1942(a); 1943(b); 1947(a)(1)
and (2).
4. Match Rules
Pursuant to Section 6213 of Public Act No. 368 of 1978, as amended, Michigan
has promulgated match requirement rules for CA budgets. Rule 325.4153
appears in the 1981 Annual Administrative Code Supplement. In brief, the rule
defines allowable matching funds sources and states that the allowable match
must equal at least ten percent of each comprehensive CA budget.
5. Staff Qualifications and Professional Development
a. The CA shall assure that, for network providers, all direct service staff
providing Access, Assessment and Referral (AAR) services, and all
provider clinical staff, whether on a salaried or contractual basis, have
passed the Fundamentals of Substance Abuse Counseling (FSAC) or the
Fundamental of Alcohol and Other Drug Problems (FAODP) examination.
Individuals who possess any of the following are exempt from the above
requirement:
• Current licensure as a physician or psychologist
• Valid Certified Addictions Counselor (CAC) certification
• A Masters degree in counseling, social work, guidance and
counseling, or clinical psychology plus 2080 hours of supervised
professional experience in substance abuse treatment.
• Other specialty certification or membership credentials in
addictions, such as Addiction Certification for Counselors under the
National Board of Certified Counselors.
Page 3 of 14 July 2003
A one-time, six-month waiver may be requested from the Michigan
Certification Board for Addiction Professionals (MCBAP) to allow time to
schedule and prepare for the exam and/or certification, for each staff in
the process of applying. The waiver, if granted, will allow staff to perform
their duties under the supervision of a staff person who is already
appropriately credentialed while preparing for an exam and/or certification.
b. The CA shall require all treatment provider panel members to establish
and maintain a credentials file on all salaried or contractual staff who are
providing clinical services.
The credentials file must include, at minimum: academic history with proof
of completion; internship, practicum and clinical experience that is
supervised, with area of clinical practice, age group and/or special skills
learned; employment experience in the form of resume'; copies of
professional licenses, certification and registrations; current list of "in-
service" training completed, including other professional training
experiences pertinent to clinical practice. The credentials file will serve as
a support to clinical privileges practiced, which will be listed by date
granted in the credentials file. The CA is responsible for maintaining the
currency of its own credentials files. The CA is responsible for auditing
and monitoring the currency of its provider credentials files on an annual
basis. A sampling method may be used.
c. The CA must ensure that criminal background checks are conducted as a
condition of employment for its own potential employees and for network
provider potential employees. This requirement is not intended to imply
that a criminal record should necessarily bar employment.
d. The CA shall require professional development of counselors and all health
care workers relative to HIV/AIDS prevention and the prevention of other
serious communicable diseases.
6. Sliding Fee Scale
The CA shall implement a sliding fee scale. The scale shall be utilized in all
treatment programs, including the Access, Assessment and Referral (AAR)
agency
By April 1, 2004, the CA must adopt written policies and procedures for
determining when an individual has no ability to pay for services and for
determining when payment liability is to be waived.
Page 4 of 14 July 2003
Financial information needed to determine ability to pay (financial responsibility)
must be reviewed every six months or at a change in an individual's financial
status.
The CA sliding fee scale must be applied to all persons (except Medicaid
recipients) seeking substance abuse services in funded treatment providers.
The CA may apply the sliding fee scale to AAR services, or the CA may choose
to charge no fees for AAR services. If the CA chooses to charge for AAR
services, the same sliding fee scale as applied to treatment services must be
applied to MR services.
Services may not be denied because of inability to pay. If a person's income
falls within the CA's regional sliding fee scale, clinical need must be determined
through the standard assessment and patient placement process. If a financially
and clinically eligible person has third party insurance, that insurance must be
utilized to its full extent. Then, if benefits are exhausted, or if the person needs a
service not fully covered by that third party insurance, Community Grant funds
may be applied. Community Grant funds may not be denied solely on the basis
of a person having third party insurance.
With respect to MR services, all fees for in-person, teleconference and/or
telephone assessments within a region must be the same. A CA that charges for
an in-person assessment must also charge for telephone and teleconference
assessments.
With respect to Department-administered funds, the CA is a payer of last resort.
The CA must have written policies and procedures to be used by network
providers in determining an individual's ability to pay, and in identifying all other
liable third parties. The CA must also have policies and procedures for
monitoring providers and for sanctioning noncompliance.
7. 12-Month Availability of Services
The CA shall assure that, for any subcontracted treatment or prevention service,
each subcontractor maintains service availability throughout the fiscal year to
persons who do not have the ability to pay.
8. Licensure of Subcontractors
The CA shall enter into subcontracts for prevention and treatment services only
with providers licensed as required by Section 6321 of P.A. 368 of 1978, as
amended. The subcontractor must be licensed for the service category funded.
The CA must ensure that network providers residing and providing services in
bordering states meet all applicable licensing and certification requirements
within their states, that staff are credentialed per the requirements of this
Page 5 of 14 July 2003
agreement, and that providers are accredited per the requirements of this
agreement.
9. Accreditation of Subcontractors
The CA shall enter into subcontracts for treatment services only with providers
accredited by one of the following accrediting bodies: Joint Commission on
Accreditation of Health Care Organizations (JCAH0); Commission on
Accreditation of Rehabilitation Facilities (CARF); Council on Accreditation of
Services for Families and Children (COA); American Osteopathic Association
(AOA); or National Committee on Quality Assurance (NCQA). The CA must
determine compliance through review of original correspondence from
accreditation bodies to providers.
10. Satisfaction Surveys
The CA shall assure that satisfaction surveys of persons receiving treatment are
required of all subcontractors providing treatment and receiving state-
administered funds. Surveys may be conducted by individual providers or may
be conducted centrally by the CA. If individual providers conduct the satisfaction
surveys, the CA shall obtain evidence of provider compliance. At least once
each year, surveys must be conducted of clients of each provider. Clients may
be active clients or clients discharged up to 12 months earlier. Surveys may be
conducted by mail, telephone, or face-to-face. The CA must compile findings
and results of client satisfaction surveys for all providers, and must make findings
and results available to the public.
11. SAMHSA/DHHS License
The federal awarding agency, Substance Abuse and Mental Health Services
Administration/Department of Health and Human Services (SAMHSA/DHHS),
reserves a royalty-free, nonexclusive and irrevocable license to reproduce,
publish or otherwise use, and to authorize others to use, for federal government
purposes: (a) The copyright in any work developed under a grant, subgrant, or
contract under a grant or subgrant; and (b) Any rights of copyright to which a
grantee, subgrantee or a contractor purchases ownership with grant support.
12. Subcontracts with Hospitals
Funds made available through the Department shall not be made available to
public or private hospitals which refuse, solely on the basis of an individual's
substance abuse or substance dependence, admission or treatment for
emergency medical conditions.
Page 6 of 14 July 2003
18: Notice of Plan Submission
Where conditions of funding require the submission of a substance abuse
service plan, the applicant shall concurrently publicize, for at least one day,
notice that submission has occurred and that the substance abuse service plan
is available for review throughout the period of funding.
14. Residency in CA Region
The CA may not limit access to the programs and services funded by this
agreement only to the residents of the CA's region, because the funds provided
by the Department under this agreement come from federal and statewide
resources. However, the CA may give its residents priority in obtaining services
funded under this agreement when the actual demand for services by residents
eligible for services under this agreement exceeds the capacity of the programs
funded under this agreement.
15. Out-of- Network and Out-of-Region Services
The CA must have written policies and procedures for authorizing and
purchasing treatment services from out-of-network and out-of-region providers
for residents of the CA region who need care from such providers.
16. Cooperation with External Medicaid Evaluation
The CA is expected to cooperate with Department efforts in external evaluation
of Medicaid services. The CA is expected to ensure that CA-funded providers
will provide necessary data and facilitate access to individuals' files and other
records as required.
17. Reimbursement Rates for Community Grant and Medicaid Services
The CA must pay the same rate when purchasing the same service from the
same provider, regardless of whether the services are paid for by Community
Grant funds or by Medicaid funds.
18. Minimum Criteria for Reimbursing for Services to Persons with Co-
Occurring Disorders
Department funds made available to the CA through this Agreement may be
used to reimburse providers for mental health treatment services (in addition to
substance abuse treatment services) to persons with co-occurring substance
abuse and mental health disorders only when such persons have mild or
moderate mental health disorders and are not eligible for financial support for
such services through Community Mental Health Service Programs (CMHSPs).
Page 7 of 14 July 2003
The CA may reimburse a CMHSP for substance abuse treatment services for
such persons who are receiving mental health treatment services through the
CMHSP. The CA may also reimburse a provider, other than a CMHSP, for
substance abuse treatment provided to persons with co-occurring disorders. As
always when reimbursing for substance abuse treatment, the CA must have a
contract with the CMHSP (or other provider), and the CMHSP (or other provider)
must meet all minimum qualifications, including licensure, accreditation and data
reporting.
19. Persons Associated with the Corrections System
When the CA or its Access, Assessment and Referral agency receives referrals
from the Michigan Department of Corrections (MDOC), the CA shall handle such
referrals as per standard contract requirements. This would include determining
financial and clinical eligibility, authorizing care as appropriate, applying
admissions preferences, and other steps. MDOC referrals may come from
MDOC's substance abuse gatekeeper, from probation or parole agents, or from
Central Office staff.
When persons who are on parole or probation seek treatment on a voluntary
basis from the CA's MR or from a panel provider, these self-referrals must be
handled like any other self-referral to the MDCH-funded network. MR or
provider staff may seek to obtain consent agreement 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.
MDOC purchases treatment services from providers through its Substance
Abuse Services Program and through its Office of Community Corrections
(OCC). The CA may also purchase services from MDOC-funded providers,
including treatment services and/or room and board services. The CA may not
supplement MDOC Substance Abuse Service Program rates, except for room
and board using State Disability Assistance (SDA) funds under the standard
requirements for the use of SDA funds.
In no case may CA funds constitute duplication of payment. It is recommended
that when the CA contracts with providers that also receive MDOC funds
(including OCC funds), the CA contracts should contain explicit language
prohibiting duplication of payment.
20. State Disability Assistance (SDA)
MDCH will continue to allocate State Disability Assistance (SDA) funding and to
delegate management of this funding to the CA. The SDA funding will be
identified in the CA's allocation letter. The CA is responsible for allocating these
Page 8 of 14 July 2003
funds to qualified providers. Minimum provider qualifications are the Michigan
Department of Consumer and Industry Services (MDCIS) licensure as a
Residential treatment provider and accreditation by one of the five approved
accreditation bodies (identified elsewhere in this Agreement). A provider may be
located within the CA's region or outside of the region.
When a client is determined to be eligible by the Family Independence Agency
(FIA) for SDA funding, the CA where the provider is located must arrange for
assessment and authorization for SDA room and board funding and must
reimburse for SDA expenditures based on billings from contracted providers in
its region, consistent with CA/provider contracts. In addition, the CA may
authorize such services for its own residents at providers within or outside the
region.
The CA shall not refuse to authorize SDA funds for support of an individual's
treatment solely on the basis of the individual's current or past involvement with
the criminal justice system. Qualified providers may be reimbursed up to twenty-
three dollars ($23.00) per day for room and board costs for SDA-eligible persons
during their stays in Residential treatment.
To be eligible for SDA funding for room and board services in a substance abuse
treatment program, a person must be determined to be eligible for an incidental
allowance through the FIA; assessed by the regional AAR to be in need of
residential treatment services; authorized by the CA (or AAR) for residential
treatment when the CA expects to reimburse the provider for the treatment; and
in residence in a residential treatment program each day that SDA payments are
made.
The CA must have a contractual relationship with a provider in order to provide
SDA funds.
21. Case Management Reimbursement
The cost of case management services may be built into a licensed AAR,
Screening, Assessment, Referral and Follow-up (SARF), or treatment service
reimbursement rate, including those services provided at designated women's
services programs.
The CA may choose to pay for case management as a separate service during
FY 2004, on a one-year pilot basis. Case management services and provider
agencies must meet the criteria stated in the FY 2004 MPG, Attachment II,
Planning Policies, section on Case Management Services, unless the CA obtains
a written waiver from the Department's Division of Substance Abuse Quality and
Planning (DSAQP). The CA must also agree to provide reports describing case
Page 9 of 14 July 2003
management services to DSAQP by April 30 and October 31, 2004; report
content and format will be specified by DSAQP in writing by August 29, 2003.
22. Persons Involved With FIA
The CA must work with the Family Independence Agency office(s) in its region
on issues related to prevention, access, assessment and treatment of persons
involved with FIA, including families in the child welfare system and public
assistance recipients.
23. Primary Care Coordination
The CA must take all appropriate steps to assure that substance abuse
treatment services are coordinated with primary health care. In the case of CAs
that are under contract with Pre-paid Inpatient Health Plans (PIHPs)for the
Medicaid substance abuse program, CAs are reminded that coordination efforts
must be consistent with these contracts.
24. Media Campaigns
The CA shall not finance any media campaign using MDCH funding unless
authorized in writing by MDCH. Advertising about the availability of services
within the CA region is not considered a media campaign.
25. Notice of Funding Excess or Insufficiency
The CA must advise the Department in writing by May 1 if the amount of
Department funding may not be used in its entirety or appears to be insufficient.
26. Subcontractor Information to be Retained at CA
a. Budgeting Information for Each Service
This includes the Program Budget Summary form (DCH 0385).
b. Documentation of How Fixed Unit Rates Were Established
The CA shall maintain documentation regarding how each of the fixed unit
rates used in its contracts was established.
c. Indirect Cost Documentation
The CA shall review and approve or disapprove subcontractor indirect
cost documentation in accordance with OMB Circular A-87.
Page 10 of 14 July 2003
d. Equipment Inventories
For each subcontractor with a performance contract, the CA shall
maintain a list of equipment items that have a value of $5,000 or more.
The CA shall approve and retain a list containing the name of the agency
or provider requesting the equipment purchase and the dollar value of the
equipment.
e. Fidelity Bonding Documentation
The CA shall maintain fidelity bonding documentation.
27. General Reporting Requirements
Requirements concerning specific reports are contained elsewhere in the
Agreement, including in Attachment C. The following requirements pertain to
reports that are to be submitted to recipients within the Department's Mental
Health and Substance Abuse Services administration.
a. Each report must be submitted by the specified due date. Reports
postmarked on the due date or earlier will be considered timely, if sent
first class, expedited delivery by U.S. mail, or the equivalent by
commercial delivery service. Reports successfully e-mailed or faxed by
the due date are considered timely.
b. Reports must be sent to the addressee specified in this Agreement.
Reports that are not sent to the specified addressee are subject to being
determined not timely or not received.
Reports must be submitted on the form and in the format specified in this
Agreement (if form and format are specified).
28. Reimbursement for Primary Care with HIV Early Intervention Program (EIP)
Funds
HIV Early Intervention Program funds shall not be used to purchase primary care
unless such use is approved in writing by the Department.
29. Sentinel Events
Requirements for reporting data on Sentinel Events are contained in Attachment
F. Consistent with that material, the CA must ensure that a root cause analysis
or investigation takes place following the identification of each sentinel event.
Page 11 of 14 July 2003
The CA must then ensure that a plan of action be developed and implemented to
prevent further occurrence of the sentinel event. The plan must identify who is
responsible for implementing the plan, and how implementation will be
monitored. Alternatively, the CA may prepare a rationale for not pursuing a
preventive plan.
30. Clinical Eligibility: DSM IV-TR Diagnosis
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 IV-TR). These disorders are
listed below:
303.90
305.00
303.00
291.80
304.40
305.70
292.89
292.00
304.30
305.20
292.89
304.20
305.60
292.89
292.00
304.50
305.30
292.89
304.60
305.90
292.89
304.00
305.50
292.89
292.00
304.60
305.90
292.89
304.10
305.40
292.89
292.00
Alcohol Dependence
Alcohol Abuse
Alcohol Intoxication
Alcohol Withdrawal
Amphetamine Dependence
Amphetamine Abuse
Amphetamine Intoxication
Amphetamine Withdrawal
Cannabis Dependence
Cannabis Abuse
Cannabis Intoxication
Cocaine Dependence
Cocaine Abuse
Cocaine Intoxication
Cocaine Withdrawal
Hallucinogen Dependence
Hallucinogen Abuse
Hallucinogen Intoxication
Inhalant Dependence
Inhalant Abuse
Inhalant Intoxication
Opioid Dependence
Opioid Abuse
Opioid Intoxication
Opioid Withdrawal
Phencyclidine Dependence
Phencyclidine Abuse
Phencyclidine Intoxication
Sedative, Hypnotic, or Anxiolytic Dependence
Sedative, Hypnotic, or Anxiolytic Abuse
Sedative, Hypnotic, or Anxiolytic Intoxication
Sedative, Hypnotic, or Anxiolytic Withdrawal
Page 12 of 14 July 2003
304.90
305.90
292.89
292.00
Other (or Unknown) Substance Dependence
Other (or Unknown) Substance Abuse
Other (or Unknown) Substance Intoxication
Other (or Unknown) Substance Withdrawal
31. Claims Management System
The CA shall make timely payments to all providers for clean claims. This
includes payment at 90% or higher of clean claims from network providers within
60 days of receipt, and 99% or higher of all clean claims within 90 days of
receipt.
A clean claim is a valid claim completed in the format and time frames specified
by the CA and that can be processed without obtaining additional information
from the provider. It does not include a claim from a provider who is under
investigation for fraud or abuse, or a claim under review for medical necessity. A
valid claim is a claim for services that the CA is responsible for under this
Agreement. It includes services authorized by the CA.
The CA must have a provider appeal process to promptly and fairly resolve
provider-billing disputes.
32. Cultural Competence
CA must have a written cultural competency plan implemented in practice at their
agency and at all provider agencies. The plan must include:
a. The CA's identification and assessment of the cultural needs of potential
and active clients based on population served.
b. The CA's identification of how access to services is facilitated for persons
with diverse cultural backgrounds and LEP.
c. The CA's identification standards for the recruitment and hiring of
culturally competent staff members.
c. The CA's identification of how ongoing staff training needs in cultural
competency will be assessed and met and the evidence that staff
members receive training.
d. The CA's process for ensuring that contractual providers comply with all
applicable requirements concerning the provision of culturally competent
services.
e. The CA's process for annually assessing its compliance with the CA's
cultural competence plan.
Page 13 of 14 July 2003
33. Adult Benefits Waiver
In consideration for accepting the federal funding pushed to the Coordinating
Agency (CA) for the State Medical Program (SMP) eligibles under an approved
Health Insurance Flexibility and Accountability (HIFA) Adult Benefits Waiver (ABW),
the CA agrees to redirect existing state contracted general fund dollars to match the
federal Title XXI State Children's Health Insurance Program (SCHIP) FMAP dollars
and carry out the substance abuse program requirements issued under the Bulletin
for Project #328-SMP. The ABW program is contingent on federal approval of the
waiver application.
The total ABW funding applied to program expenditures (federal plus general
fund match) shall not exceed $3.80 per eligible member per month estimated at
62,000 eligibles statewide per month. MDCH shall push the federal portion of the
eligible amount to the CA at the beginning of each month (PEPM X $3.80 X
.6912) based on program enrollment. The amount of general fund dollars
applied by the CA to program costs shall equal .3088 percent of the total
program costs incurred during the FY 2004 contract year following the date of
program initiation. In the event that program costs do not exceed the federal and
state applicable match requirement amount, the CA shall retain the balance as
local dollars.
Reporting by the CA shall be specific to the ABW program category and
consistent with existing Medicaid reporting for encounter data, admissions,
discharges, and financial information. The CA is not at financial risk for the ABW
program, and is not required to pay for services for the enrolled population in
excess of the combined federal and applicable match funds. The CA may
choose to pay for additional services with other available funds consistent with
applicable contract provisions
Page 14 of 14 July 2003
ATTACHMENT B
BUDGETS
ATTACHMENT C
REQUIRED REPORTS—Fiscal Year 2004
The following table indicates the reports that the CA is required to submit to the
Department under this agreement. The table also indicates the time period covered by
each report, the report due date, where within the Department the report must be
submitted, and the location or source of instructions and specifications for completing
the report.
The contents of the table supersede any other communication of reporting
requirements, including requirements stated in the Annual Action Plan Guidelines
(AAPG)
Report forms and reporting instructions and specifications are as listed in the
Instructions and Specifications column on the following table.
Contractors are responsible for submitting all reports on time and per instructions.
Reports transmitted on or before the due date are considered timely. Transmission
date is determined by postmark, commercial carrier receipt, date of fax or date of
electronic transmission. Reports that do not conform to instructions may not be
determined as "received."
Page 1 of 5 (July 2003)
Attachment C
Required Reports—Fiscal Year 2004
Document Title Period Due Date Instructions &
Covered Specifications
_.
Financial Status Report Monthly Last day of the following Contract
(MDCH-0384) month (BFA/Accounting) Attachment D _
Payables Report FY 2004 October 2004 (Accounting) Contract
Determined by DMB at Attachment D
year-end closing
FY 2003 Audit Report FY 2003 9 months after close of CA MDCH contract
fiscal year (Office of Audit)) boilerplate and
Attachment F
Prevention Expenditures Report FY 2003 01/31/04 (ODCP/PREV) FY 2002 AAPG,
Revision, dated
06/28/01
Substance Abuse Entity FY 2003 01/31/04 (SACM) December 2, 2002
Inventory/Legislative Report instructions
Final Financial Status Report FY 2003 12/15/03 (BFA/Accounting) Contract
Attachment D
Tobacco Narrative Report FY 2004 04/30/04 and 10/31/04 FY 2004 MPG
Semi-annual (ODCP/PREV)
Notice of Excess or Insufficient FY 2004 05/1/04 (SACM) Contract Attachment
Funds- A
Women & Families Progress FY 2004 04/30/04, 10/31/04 FY 2004 MPG
Narrative Report Semi-Annual (DSAQP/TX)
and Annual,
respectively
Communicable Diseases (TB, FY 2004 04/30/04, 10/31/04 FY 2004 MPG
STDs and HIV EIP), HIV Semi-Annual (ODCP/PREV)
Regional Center Narrative
Report
Page 2 of 5 (July 2003)
Attachment C
Required Reports—Fiscal Year 2004
Document Title Period Due Date Instructions &
Covered Specifications
,
Prevention Services Population FY 2004 04/30/04, 10131104 FY 2004 MPG
Report Semi-Annual (ODCP/PREV)
Injecting Drug Users 90% FY 2004 Last day of the following FY 2004 AAPG
Capacity Treatment Report and Monthly month reporting for, faxed
Federal Priority Populations to DSAQP/TX at 517/241-
Waiting List Certification Report 2611
SARF treatment admission and Submissions Last day of each month, Supplemental
treatment discharge records data are records for submitted via DEG to Instructions for 837
upload (Q1) each month MDCH/MIS-Operations Encounter & Quality
Improvement (QI)
Data Submission for
Substance Abuse
Coordinating
Agencies (10/02)
Health Insurance Portability & As services Last day of following Supplemental
Accountability Act (HIPAA) 837 are provided, month, submitted via DEG Instructions for 837
Encounters records are to MDCH/MIS-Operations Encounter & Quality
completed. Improvement (QI)
Submissions Data Submission for
are all monthly Substance Abuse
records for Coordinating
each quarter. Agencies (10/02)
Performance Indicators FY 2004 Last day of the month Electronic
Quarterly following the end of each Submission Forms:
quarter to R&E Performance
01/31/04, 04/30/04, Indicators for
07/31/04, 10/31/04 Substance Abuse
Services (Revised
12/02)
Page 3 of 5 (July 2003)
Attachment C
Required Reports—Fiscal Year 2004
Document Title Period Due Date Instructions &
Covered Specifications
Sentinel Events Data Summary Semi-Annual Last day of the month CA letter dated
(residential treatment only) CA Summary following the end of the 2' October 3, 2001
& 4 quarters to R&E
04130/04 & 10/31/04
Prevention Hours by Strategy FY 2004 Last day of the month FY 2004 MPG
Report Quarterly following the end of each
quarter to ODCP/PREV
01/31/04, 4/30/04,
07/31/04, 10/31/04
Adult Benefit Waiver Financial FY 2004 10/31/04 (SACM) Contract Attachment
Report A
Substance Abuse Contract Management Section (SACM) reports should be sent to:
Michigan Department of Community Health
Substance Abuse Contract Management Section
Lewis Cass Building
320 S. Walnut Street
Lansing, Michigan 48913
Research and Evaluation Section (R&E) reports should be sent to:
Michigan Department of Community Health
Quality Management and Customer Services Administration
Division of Quality Management and Planning
Research & Evaluation Section
Lewis Cass Building
320 South Walnut Street
Lansing, Michigan 48913
Page 4 of 5 (July 2003)
Attachment C
Required Reports—Fiscal Year 2004
Division of Substance Abuse Quality and Planning/Treatment (DSAQP/T)() reports should be sent
to:
Michigan Department of Community Health
Bureau of Mental Health, Substance Abuse and Long Term Care
DSAQP/TX
3423 North Martin Luther King, Jr. Blvd.
P.O. Box 30195
Lansing, Michigan 48909
Office of Drug Control Policy/Substance Abuse Prevention (ODCP/PREV) reports should be sent
to:
Michigan Department of Community Health
Office of Drug Control Policy/Prevention
Lewis Cass Building
320 South Walnut Street
Lansing, Michigan 48909
Bureau of Finance Administration/Accounting (BFA/ACCOUNTING) reports should be sent to:
Michigan Department of Community Health
Bureau of Finance Administration/Accounting Division
P.O. Box 30720
Lansing, Michigan 48909
Office of Audit reports should be sent to:
Michigan Department of Community Health
Office of Audit
Capitol Commons Center
400 S. Pine Street, 5th Floor
Lansing, Michigan 48933
Page 5 of 5 (July 2003)
ATTACHMENT D
FINANCIAL STATUS REPORT
FORM INSTRUCTIONS
(Form DCH-0384)
FINANCIAL STATUS REPORT (form DCH-0384)
Form Preparation Instructions
MICHIGAN DEPARTMENT OF COMMUNITY HEALTH
I. INTRODUCTION:
This form is available in MS Excel (that IS fill-in enabled with calculation formulas) and in MS Word (not fill-in
enabled).
The Financial Status Report (FSR) (DCH-0384) is used to provide a standardized format for reporting the
financial status of individual programs. All expenditures and revenues (including fees, local, state, federal,
and others) for the particular program are reported on the FSR. The FSR is typically prepared shortly after the
end of each month and must be submitted to the Michigan Department of Community Health, Bureau of
Finance, no later than thirty (30) days after the close of the calendar month or other prescribed reporting
period, unless otherwise specified in the program agreement. The FSR for the last month in the agreement
period (or other prescribed reporting period) is also due thirty (30) days after the end of the agreement. In
addition, a final report is required and due as specified in the program agreement. See attachment A of this
document for reporting instructions for the final report.
The•Financial Status Report is to be prepared reporting expenditures on a cash or accrued basis and revenue
on an accrued basis, with the exception of fees which should be reported on a cash basis as received. See
following definitions:
Cash Expenditures - Actual cash outlays for goods and services received.
Accrued Expenditures - Goods and services received, but not yet paid for.
Accrued Revenue - Total revenue earned, including amounts received and amounts earned
and not received. The amount of accrued revenue must be in compliance with available funding sources per
terms of the agreement.
II. DISTRIBUTION:
The original and one (1) copy of the Financial Status Report are prepared and distributed as follows:
Original - MICHIGAN DEPARTMENT OF COMMUNITY HEALTH
BUREAU OF FINANCE
ACCOUNTING DIVISION
P.O. BOX 30720
LANSING MI 48909-8220
One Copy - Retained by Local Agency
III. RETENTION:
This report should be retained for a period complying with the retention policies established in the agreement.
IV. FORM PREPARATION:
The Financial Status Report form (Attachment B), an example report (attachment C), and a blank FSR are
attached for reference.
A. B.P.O. Number - Enter the Department of Community Health B.P.0 number.
B. Local Agency Name - Enter the name of the local agency.
C. Street Address - Enter the street address of the local agency.
D. City, State, ZIP Code - Enter the City, State, and ZIP Code of the local agency.
DCH-0384-Instr (Rev. 4-01) (WP) Previous Editions Obsolete
E. Contract Number - Enter the Department of Community Health Contract Number.
F. Program - Enter the title of the program. (i.e. Governor's Discretionary Fund, Juvenile Intervention,
DARE, etc.)
G. Code - Enter a program code if applicable.
H. Report Period - Enter the inclusive dates covered by the report. (June 1 thru June 30)
Check box if FINAL REPORT.
I. Date Prepared - Enter the date on which the report is prepared.
J. Agreement Period - Enter the inclusive dates of the agreement.
K. F.E. ID Number - Enter Federal Employer Identification Number.
L. Expenditures Current Period Column - Enter the current period expenditures for the following items:
Expenditures must include only those authorized under the terms of the agreement.
(The current period must represent the report period.)
1. Salaries and Wages - This category includes the compensation paid to all permanent and part-
time employees on the payroll of the local agency and assigned directly to the program. This does
not include contractual services, professional fees or personnel hired on a private contract basis. It
is necessary to maintain sufficient documentation to support the allocation of staff working less than
100% of their time on one program.
2. Fringe Benefits - This category is to include the employer's contributions for insurance, retirement,
FICA and other similar benefits for all permanent and part-time employees assigned to the
program.
3. Travel - Use only for travel costs of permanent and part-time employees assigned to the program.
This includes cost for mileage, per diem, lodging, registration fees and approved seminars or
conferences, and other approved travel costs incurred by the employees for the conduct of the
program. Travel of consultants is included under Other Expenses - Consultant Services.
4. Supplies and Materials - Use for all consumable and short-term items and equipment items
costing less than five thousand dollars ($5,000). This includes office, printing, janitorial, postage,
and education supplies; medical supplies; contraceptives and vaccines; tape and gauze;
educational films, etc., according to the requirements of each applicable program.
5. Contractual (Sub-Contracts) — Use for written contracts or agreements with secondary recipient
organizations such as affiliates, cooperating institutions or delegate agencies. Payments to
individuals such as stipends, allowances for trainees and consulting fees are to be identified in the
Other Expenses category.
6. Equipment — This category includes stationary and movable equipment to be used in carrying out
the objectives of the program. The cost of a single unit or piece of equipment includes the
necessary accessories, and installation costs and any taxes. Equipment items costing less than
five thousand dollars ($5,000) each are to be included in the Supplies and Materials category. All
expenditures for equipment must relate to the budgeted equipment items. Equipment is defined to
be an article of non-expendable tangible personal property having a useful life of more than one (1)
year and an acquisition cost of $5,000 or more per unit.
7. Other Expenses — This category includes other allowable costs incurred for the benefit of the
program. Identify on the available lines the same items identified in the approved Program Budget.
Some of the more significant groups or sub-categories of costs follow:
a. Consultant Services — These are costs for consultation services related to the planning and
operations of the program or for some special aspect of the project. This does not include
consultant services for patient care, which is covered under item 7.b. Travel and other costs
DCH-0384-Instr (Rev. 4-01) (WP) Previous Editions Obsolete
of these consultants are also to be included in this category.
b. Patient Care — Services as required such as medical, social and educational services to
patients relating to prevention, diagnosis and treatment. This category also includes medical
fees, laboratory, pharmacy or other health inpatient care, home care services, treatments,
professional and consultation fees and related travel costs, transportation of patients including
accompanying parents or guardians (or other escort), and for sundry related support such as
meals and housing. This does not include personnel costs which are included under Salaries
and Wages.
c. Rentals and Leases — Costs of building space, rental of equipment, instruments, etc.,
necessary for the operation of the program.
d. Communication Costs — Cost of telephone, telegraph, data lines, etc., when related directly
to the operation of the program.
e. Other — All other items purchased exclusively for the operation of the program and not
previously included.
8. Total Direct — The total of the direct expenditures (lines 1-7).
9. Indirect Costs — Enter the indirect rate and the amount of the indirect costs for the current period.
Indirect costs can only be applied if an approved indirect cost rate has been established and is
accepted by the Michigan Department of Community Health.
10. Other Cost Distributions - Costs allocated from various contributing activities to this program area
based upon activity counts, time study support and data or other reasonable and equitable means.
An example of cost distribution may be Nursing Supervision.
11. Total Expenditures - Enter the total expenditures being reported for the program. This is the total
of lines 8, 9, and 10.
12.-15. Source of Funds - The various sources of funds utilized to provide program support.
16. Fees and Collections - Fees and collections received during the current report period. Fees and
collections represent funds, which the program earns through its operation and retains for
operational purposes. This would include fees for services, payments by third parties (insurance,
patient collections, Medicaid, etc.) and any other collections.
17. Total Funding - The total funding (lines 12-16) must be equal to the total expenditures (line 11).
M. Expenditures Agreement YTD Column - Add the "Current Period" amounts from this period's report
and the "Agreement YTD" amounts from the previously submitted period's report for each item (lines 1-
17) in the Agreement YTD Column.
Enter only amounts for the current agreement period in this column. The local agency should assure
that no items or unallowable category deviations are reported until approval is requested and
received from the Michigan Department of Community Health.
N. Agreement Budget Column - This column needs to reflect the program agreement budgeted amount.
Enter the "Agreement Budget" amounts for each item (lines 1-17). (Attachment B of Contract)
0. Agreement Balance Column - These balances are computed by subtracting the "Agreement YTD"
expenditure amount from the "Agreement Budget" amount for each item.
P. Authorized Signature and Date Signed - This section must be signed by an authorized official
certifying that documentation and records are available and easily accessible in support of all the data
contained on the report. The individual signing on behalf of the Local Agency certifies by his/her
signature that he/she is authorized to sign on behalf of the Local Agency. Any item found as a result of
audits to be improper or undocumented will be subject to an audit citation and generally will require a
payment adjustment
Q. Title — Enter the title of the person signing as authorized signature.
DCH-0384-Instr (Rev. 4-01) (WP) Previous Editions Obsolete
R. Contact Person - Enter the person's name to whom questions should be directed concerning this report.
S. Telephone Number - Enter telephone number of contact person.
T. FOR STATE USE ONLY - This section of the form is for State use only
DCH-0384-instr (Rev. 4-01) (WP) Previous Editions Obsolete
ATTACHMENT - A
MICHIGAN DEPARTMENT OF COMMUNITY HEALTH
FINANCIAL STATUS REPORT (DCH-0384)
FINAL REPORTING
The Financial Status Report for the last month of the agreement period (or other prescribed reporting period) is to be
prepared the same as previous monthly reports and is due no later then 30 days from the end of the agreement
period. This report is considered a preliminary final FSR.
A final Financial Status Report is due within sixty days of the end of the agreement period and must be marked
"FINAL". This requires the agency to liquidate all accounts payable and encumbrances within sixty days after the
end of the agreement period (see definitions below).
Exceptions may be granted for one-time obligations that cannot be liquidated within this time period. However,
should this be the case an additional fifteen days may be provided if a written request for an extension, with the
reason why additional time is needed, is submitted by the due date of the final FSR.
Failure to meet these final reporting deadlines may result in the State's inability to reimburse the full amount of the
state's share of the gross expenditures.
In addition to submitting FSRs, other financial information will be requested to assist DCH in properly closing the
State's fiscal year (September 30). This information will help ensure sufficient funds have been reserved by the
state to make reimbursement for the contract in the State's upcoming fiscal year. The additional financial
information required will include an estimate of open commitments and obligations incurred as of September 30, but
not yet paid. The DCH Accounting Division will provide detailed instructions for reporting additional financial
information each year around the first of September.
DEFINITIONS:
Accounts Payable - Obligations for goods or services received which have not been paid for as of the end of
the agreement period.
• Encumbrances - Commitments at the end of the agreement period related to unperformed (executory)
contracts for goods and services.
Note: If a contract does not end on September 30th it is still necessary to estimate accounts payable as of
September 30th.
All inquiries regarding financial reporting issues should be directed to the Expenditure Operations Section of the
Accounting Division.
References:
Michigan Department of Management and Budget
• Guide to State Government (1210.27).
• Year-End Closing Guide.
Federal OMB Circular A-102 (Revised & DHHS Common Rule).
DCH-0384-Instr (Rev. 4-01) (WP) Previous Editions Obsolete
MICHIGAN DEPARTMENT OF COMMUNITY HEALTH
FINANCIAL STATUS REPORT
ATTACHMENT
BPO Number Contract Number Page Of
.. A E
Local Agency Name Program Code
B F G
Street Address Report Period Date Prepared
C H Thru ii_ Final 1
City, State, ZIP Code Agreement Period FE ID Number
D J Thru K
xpendAtures - Agreement ,
. , I - •-• YA,,... .: ,,i... 44 Lei e ir .t, 1 , ptirreitPerid Al.EfelTiVil, ee , .r. ,
Salaries & Wages L M N - o
2 Fringe Benefits tfP05UW. Irith If Aitt V! 0421 lik. ill
ravel IN T A *(
3 T A 1 ICUt...,111 iNit
4 Supplies 8, Materials
5 Contractual (Sub-Contracts) CVAIILI 0 I
6 Equipment Kr,A,— --hilviii- IstE
7 Other Expenses
8 TOTAL DIRECT
9 Indirect Costs: Rate %
10 Other Cost Distributions
11 TOTAL EXPENDITURES
.! n
.
12 State Agreement
13 Local
14 Federal '
15 Other
16 Fees & Collections
17 TOTAL FUNDING
CERTIFICATION: I certify that I am authorized to sign on behalf of the local agency and that this is a true end correct statement of expenditures and collections for the report period. Appropriate documentation is
available and will be maintained for the required period to support casts and receipts reported.
Authorized Signature Date Title
P Q
Contact Person Name Telephone number
R S
FOR STATE USE ONLY
- mcrEx
Advance Outstanding
Advance Issued or Applied
Balance
Massage
Authority: PA 368 of 1978 The Department of Community Health is an equal opportunity, employer, services, and
DCH-0384 4101 (WP) Replaces FIN-130 Completion: Is a Condition of Reimbursement programs provider
MICHIGAN DEPARTMENT OF COMMUNITY HEALTH
FINANCIAL STATUS REPORT
ATTACHMENT -
BP° Number Contract Number Page
1310099999 20018883
Local Agency Warne Program Code
JONES CITY POLICE DEPART MENT TRUANCY INTERDICTION PROGRAM
Street Address Report Period Date Prepared
110 TEMPLE STREET 11/01/00 Thru 11/30/00 Final 12/20/00
City, State, ZIP Code " Agreement Period FE ID Number
JONES CITY, MI 42321 10101/00 Thru 09/31/01 38-99988868
,I Elp n d . turea ,...'' 7.7
, 4;eej enL
' b - •P'''' •
, '•,-,, 14,.,.;;; ,^,4F411.41:4 ,i.„iss •-si.4, 41..,•ss..silss,...ossn ,;0 s as s.,--41s, - , • Is':sisr,,N,RvCurient Pesnod , -
- okhkok — - - Ter!' rit - , ,., , , ,,Eit .... 4 en 6,0 i. . , ... :0.
Salaries & Wages
Fringe Benefits
Travel
Supplies & Materials 3,189.01 3,689.01 5,000.00 1,310.99
Contractual (Su)-Contracts) 17,966.30 19,966.30 38,000.00 18,033.70
Equipment
Other Expenses
--.
_ .
-,
TOTAL DIRECT 21,155.31 23,655.31 43,000.00 19,344.69
Indirect Costs: Rate % Noir A' A MOW VFW
10 Other Cost Distributions
AWAILM tit,
ler
IR raw JEW
11 TOTAL EXPENDITURES 21,155.31 23,655.31 43,000.00 19,344.69
-,
, , VII' "' ' ''; 11, c' _ .. .",144s;II.,... , , q,,,' q, . ,,,1 I.,
12 State Agreement 21,155.31 23,655.31 43,00E1.00 19,344.69
13 Local 0.00 0.00 0.00 0.00
14 Federal 0.00 0.00 0.00 0.00
15 Other 0.00 0.00 0.00 0.00
16 Fees 8. Collections 0.00 0.00 0.00 0.00
17 TOTAL FUNDING 21,155.31 23,655.31 43,000.00 . 19,344.69
CERTIFICATION; I certify that I am authorized to sign on behalf of the local agency and that this is a true and correct statement of expenditures and collections for the report period. Appropriate documentation is
available end will be maintained for the required period to support costs and receipts reported.
Authorized Signature Date Title
Contact Person Name ' Telephone number
FOR STATE USE ONLY
f,'-'1'..-:,•' ,..., ',: t.-:' 111:-.1, Ge P t iso-,-,,,,V . ..n ,1'1n11n1111
Advance Outstanding
Advance Issued or Applied
Balance
Message
I Authority: P.A. 368 of 1978 - 1 The Department of Community Health is an equal opportunity, employer,
MICHIGAN DEPARTMENT OF C01n4MUNITY HEALTH
FINANCIAL STATUS REPORT
PO Number Contract Number Page Of
-
ocel Agency Name Program Code
-.
treat Address Report Period Date Prepared
Thru n Final -
3ty, State ZIP Code " Agreement Period FE ID Number
Thru _
en
T riod ' , .An-yr,r-cMvi J'ili sod .n
i Wallin & Wages
2 Fringe Benefits
3 Travel
4 Supplies & Materials
5 Contractual (Sub-Contracts) -
6 Equipment
7 Other Expernes
. —
II TOTAL DIRECT )
9 Indirect Costs: Rate %
10 Other Cost Distnbutions
-
11 TOTAL EXPENDITURES _
:i i
. i „ .'11 A ' 1: ..
12 State Agreement
-
13 Local
14 Federal - .-
IS Other
16 Fees & Collections
-
17 TOTAL FUNDING
CERTIFICATION: I certify that I am authorized to sign on behalf of the local agency and that this is a true and correct statement of expenditures and collections for the report period. Appropriate doctunentation h available and will be
maintained for the required period to support costs and receipts reported.
Authorized Signature Date Title
Contact Person Name Telephone number
FOR STATE USE ONLY
.
Advance Outstanding
Advance Bared or Applied
Balance
Message
1 The Department of Community Health is an equal opportunity, employer, services, and Authority: P.A. 368 of 1978
DCH-0384 4101 (VIP) Replaces F1N-130 Completion: is a Condition of Reimbursement - programs provider
MICHIGAN DEPARTMENT OF CQMMUNITY HEALTH
BP° Number Contract Number Page Of
Local Agency Name • ' Program Code
Street Address Report Period Date Prepared
Thru 11 Final
City, State, ZIP Coda_ Agreement Period FE ID Number
Thru
. .... i...
' EXpendittirls me t
Agi:eerImItY.TIR•;_,:',. lid i! ir10. V i .
Iter,it,',Porici:t1'':
"""T 4 .14` #10.,R.
1 Salaries 8 Wages
2 Fringe Benefits
3 Travel
4 Supplies & Materials
6 Contractual (Sub-Contracts) ,
6 Equipment
7 Other Expenses
,
8 TOTAL DIRECT
9 Indirect Costs: Rate %
I
10 Other Cost Distributions ,
1
11 TOTAL EXPENDITURES
:;.,. ',
II' - - D
.
12 State Agreement
13 Local
14 Federal -
15 Other
16 Fees & Collections
17 TOTAL FUNDING
CERTIFICATION: I certify that I am authorized to sign on behalf of the local agency and that this is a true and correct statement of expenditures and collections for the report period. Appropriate documentation is
available and will be maintained for the required period to support costs and receipts reported.
Authorized Signature Date Title
Contact Person Name Telephone number
FOR STATE USE ONLY
.'1. 14. • IA 1:
N, Aavalae PGA' , .....
Adelman Outstanding
Advance tome or Appead
Manner
Message
1 authority: PA. 368 of 1978 The Department of Community Health is an equal opportunity, employer, services, and programs provider
OCH-faliat lifill NVP1 Ranineas FIN-130 Completion: us Condition of Reimbursement
ATTACHMENT E
AUDIT STATUS NOTIFICATION LETTER
Audit Status Notification Letter
(Contractor exempt from the Single Audit or Financial Audit requirement)
Date:
To: Office of Audit
Quality Assurance and Review Section
Re: Period/ Fiscal Year:
The purpose of this letter is to comply with Michigan Department of Community
Health grant contract Audit requirements. I certify that the
(Name of Contractor)
expended less than $300,000 in federal awards, and received less than $300,000 in
total Department funding. Please be advised that our agency's audit did not address
any findings related to current or prior years, that negatively impact MDCH-funded
programs. Therefore, we are not required to submit either a Single Audit or Financial
Audit to the Department.
If you have questions, please contact at
(Contractor's Representative)
(Telephone number)
Sincerely,
(Contractor Representative/ Title)
ATTACHMENT F
OTHER REQUIREMENTS
1. Local Advisory Council Guidelines
2. Treatment Policy-02, Acupuncture, May 1, 1994 (Revised 2001)
3. HIV Early Intervention Project Guidelines
4. Enrollment Criteria for Methadone/LAAM Maintenance and Detoxification Programs
(Revised 2001)
5. Data Collection/Recording and Reporting Requirements—Effective 10/01/2003
(Revised August 2003)
6. Reporting Nonprescription Methadone
August 2003
ATTACHMENT F
OTHER REQUIREMENTS
1. Local Advisory Council Guidelines
August 2003
STATE OF MICHIGAN
JAMESJ.BLANCHARD,Govemmr
OFFICE OF SUBSTANCE ABUSE SERVICES
2150 Apollo Drive • P.O. Box 30206
LANSING, MICHIGAN 48909 •
JOAN WALKER, Administrator
MEMORANDUM
August 9, 1990
TO: All Substance Abuse Coordinating/Agencies
FROM: . Joan Walker, Administrator
SUBJECT:- Local Advisory Council Guidelines
Enclosed for your utilization are the Local Advisory Council
Guidelines which the Office as reissuing consistent'with
Public Act 368 of 1978. As you may recall; these guidelines were
originally issued during the initial development years of OSAS,
reprinted in March 1984 and included in subsequent Annual Action
Plan Guidelines.
If you have any questions, please contact your Contract
Specialist.
c: Executive Staff
Contract Specialists
JKB:A:LACGUIDE.MEM
LOCAL ADVISORY COUNCIL GUIDELINES
Established by the Administrator -of the
Office of Substance Abuse Services
I. Local Advisory Councils
A. Section 6226 (3) of Public Act 368 of 1978 states that
A "coordinating agency shall have a local advisory
council consisting of representatives of public and
private treatment and prevention programs and private
citizens in accordance with the guidelines established
by the Administrator."
1. Purpose of the councils - Each local advisory
council should:
a. consult with its coordinating agency to ensure
that their substance abuse services area is
responsive to their community's needs, that
services are available to all segments of the
community, and that the , services are
comprehensive;
b. provide an opportunity for individuals within
the community to comment on the issuance of
substance abuse services licenses; •
C. review and comment on the Annual Action Plan
developed by the coordinating agency;
'd. review and comment periodically on the progress
and effectiveness -of services delivered under.
the annual plan; and
a. provide their community a forum to discuss
substance abuse services and problems
. throughout the service area.
2. grazagtarg_321_ths_samajil - The Advisory Council
membership shall include equal representation from
the following sectors:
a. public and private agencies in the region,
including those which directly and indirectly
provide substance abuse services;
be client or patient groups or individuals who
are directly served- by substance- abuse
treatment/rehabilitation and prevention
programs; and
Local Advisory Council Guidelines Page 2 of 3.
c. the general public, including civic
organizations and the business community.
Within the above representation on the advisory
council, membership selection shall insure that
minority populations are adequately
represented. .
d. The information' regardingthe advisory council
to be submitted with the coordinating agency's
dez:Lgnation material to the office of Substance
Abuse Services each year, or as revised,
includes:
- exact title of the council;
- membership roster including expiration
dates of terms, place of residence,
professional position and/or other
pertinent information to reflect . the
groups represented;
- method of selecting membership;
council by-laws or charter;
- by-laws or charter . or agency policy
approved by the Governing Board shall
include an appeals process; and
if the structure of the Advisory Council
differs from the above criteria, approval
for any deviation must be obtained in
writing from the OSAS Administrator.
3. Coprdinatjnq' y and Advisory Council
Belationship - These entities have related but
different functions within the local substance abuse
network. It is important that they develop a
harmonious relationship which allows each to fulfill
its function. When differences of opinion occur,
these differences should be resolved in the best
interest of the community being served. A
description of the method by which the Advisory
Council has direct input/communication with the
governing, decision-making body, should be submitted
to the Office.
Local Advisory. Council Guidelines Page 3 of 3
oviernimg 5oarq memo CI AG V 1S0 Pa 4. -G
Upon request, the Office is available to serve as
a mediator between the two groups in resolving
differences.
- BOard
members may be reimbursed for
a. actual travel expenses for members of the
Governing Board and the Advisory Councils of
the coordinating agencies for meetings, but not
in excess of county travel standards and those
determined by the coordinating agency board;
and
b. actual expenses incur -red as the result of
attendance at meetings of the Governing Board
or Advisory Council of the coordinating agency.
State administered funds may not be used to
reimburse employees of governmental agencies
to the extent they receive reimbursement for
the same expenses from their employers.
A:JB:LACGUIDE
ATTACHMENT F
OTHER REQUIREMENTS
2. Treatment Policy-02
Acupuncture
May 1, 1994 (Revised 2001)
August 2003
MICHIGAN DEPARTMENT OF COMMUNITY HEALTH
MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES
TREATMENT POLICY -02
Subject: Acupuncture Effective Date: May 1, 1994
Revised: June 2001
Purpose: -
To establish the standard for the use of acupuncture when it is used as adjunct therapy ,
in substance abuse treatment.
Background:
In 1972, the use of auricular acupuncture for acute drug withdrawal was developed in
Hong Kong. Shortly thereafter, Michael Smith, M.D., a psychiatrist at Lincoln Hospital
in the South Bronx, New York City, started using it extensively. Dr. Smith developed a
five point auricular protocol, which has been adopted by the National Acupuncture
Detoxification Association. The following ear points are used in the protocol: liver,
kidney, lung, sympathetic nervous system, and the Shen men (spirit gate). Stimulation
of these ear points reduces stress and anxiety, which allows the patient to be more
receptive to couriseling. It also lessens depression and insomnia. It alleviates the
craving for substancesjhus aiding in recovery.
Auricular acupuncture offers a low cost way to enhance outcomes and lower the total
cost of substance abuse treatment. It has been shown to be effective in relieving the
symptoms of withdrawal from alcohol, heroin, and crack cocaine; making patients more
receptive to treatment; reducing or eliminating the need for methadone; and lessening
the chances of relapse. Auricular acupuncture has been used successfully in treating
pregnant substance abusing women and drug exposed infants who are going through
withdrawal. Over 800 auricular acupuncture programs, including over 700 in the United
States, are presently using this protocol.
Non-auricular acupuncture points can also be used as part of an individualized
acupuncture treatment plan when performed by a full body acupuncturist.
Acupuncture may be done as adjunct therapy to any treatment modality in any setting.
Counseling, 12-step programs, relapse prevention, referral for supportive services, and
life skills training are all components of a comprehensive program that can include
acupuncture. Auricular acupuncture for substance abuse treatment appears to work
best in a group setting. In keeping with the p hilosophy of Chinese Medicine, the patient
is encouraged to be actively involved in his/her own treatment and to see his/her
substance abuse as part of his/her total emotional, physical, and spiritual health and its
relationship to other people and the environment.
1
Procedure:
1. The Michigan Department of Community Health/Division of Substance Abuse
Quality and Planning (MDCH/DSAQP) will allow expenditure for acupuncture as
adjunct therapy in any substance abuse treatment supplement: residential;
intensive outpatient; individual or group outpatient. For contracting purposes, the
cost of acupuncture should be included in the cost of providing the supplement
of which it is a component. Acupuncture may be used either in drug-free or
pharmacologically supported treatment.
2. Acupuncture must be performed by any of the following individuals;
a) Medical Doctor;
b) Doctor of Osteopathy;
• c) Oriental Medical Doctor
d) Licensed Acupuncturist
e) or one who holds a Certificate of Training in Detoxification Acupuncture
issued by the National Acupuncture Detoxification Association.
In accordance with Michigan law, acupuncture must be performed under the
supen/ision of a person licensed to practice medicine in the state. The
supervising physician need not be trained in acupuncture.
3. Disposable sterile needles must be used for all acupuncture treatments.
4. Funded programs providing acupuncture may be requested to provide special
reports to MDCH/DSAQP.
References:
Brumbaugh, A. (1993). Acupuncture: New Perspectives in Chemical Dependency
Treatment. Journal of Substance Abuse Treatment. 10. 35-43.
Bullock, M., Culliton, P. & Olander, R. ( 1989). Controlled trial of acupuncture for severe
recidivist alcoholism. Lancet, 8652. 1435-1439.
Katims, J., Ng. L., & Lowinson, J. (1993). Acupuncture and transcutapeous electrical
nerve stimulation: afferent nerve-stimulation in the treatment of addiction. In J.
Lowsnson, P. Reiz, R. Millman, & J. Langrod (EDS.), Substance Abuse:
A Comprehensive Textbook (pp. 574-583). Baltimore: Williams & Wilkins.
Lone, P. (1991). Silencing Crack Addiction. American Journal of Maternal Child Nursing
16(4). 202-205:
Smith, M. and Khan, I. (1993). Acupuncture Helps Programs More than Patients.
Unpublished manuscript presented at the May 1993 National Acupuncture
Detoxification Association Conference.
2
ATTACHMENT F
OTHER REQUIREMENTS
3. HIV Early Intervention Project Guidelines
August 2003
Michigan Department of Community Health
Mental Health and Substance Abuse Services
Bureau of Substance Abuse Services
HIV EARLY INTERVENTION PROJECT GUIDELINES
HIV Early Intervention
"The set of medical, preventive and psychosocial services provided to
persons upon diagnosis of HIV infection. Involves monitoring
indicators of immune function as signals to provide interventions to
delay the onset of illness, psychosocial support, and measures to
prevent transmission."
Centers for Disease
Control and Prevention
May 1994
Released: January 11, 1995
Revised: April 1, 1998
Michigan Department of Community Health
Mental Health and Substance Abuse Services
Bureau of Substance Abuse Services
Lewis Cass Building, 5th Floor
320 S. Walnut
Lansing, Michigan 48913
(517) 241-2605
MICHIGAN DEPARTMENT OF COMMUNITY HEALTH
MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES
BUREAU OF SUBSTANCE ABUSE SERVICES
HIV EARLY INTERVENTION PROJECT GUIDELINES
Description: •
The Bureau of Substance Abuse Services (BSAS), HIV Early Intervention Project (EIP)
provides services to Michigan's substance abusing population, either at risk of or infected
with HIV. HIV Early Intervention focuses on the early stages of HIV infection because
recognition of HIV and medical intervention in the early stages of infection may be most
effective in delaying life-threatening symptoms. In addition, early intervention and
education often increase client involvement in treatment, improve access to services, and
slow the spread of the disease.
Target Population:
The target population for HIV E1P services is chronic substance abusers (either current or
recovering), especially those who inject or use heroin, crack, and/or cocaine, 'and/or their
sex or needle sharing partners. Within this target population, projects must also target
substance abusing communities of color in relationship to the proportion of the various
communities of color affected by and infected with HIV/AIDS in their communities.
Furthermore, at least 33 percent of the funds must be used for services provided to
women.
Affected persons may receive EIP case management services if the person living with
HIV/AIDS (PLWH/A) will directly benefit, if they are .a direct care giver, or if their health
directly relates to the PLWH/A However, affected persons served by the program should
be the exception, and HIWEIP funds should be viewed as the last source of funding for
services to this population.
HIV Early Intervention is defined as:
(1) appropriate pre- and post-test counseling for HIV;
(2) testing with respect to HIV, including tests to confirm the presence of the
disease, tests to diagnose the extent of the deficiency in the immune system,
and tests to provide information on therapeutic measures for preventing and
treating the deterioration of the immune system and for preventing and
treating conditions arising from the disease; and
(3) providing the therapeutic measures described in (2) for preventing and
treating the deterioration of the immune system and for preventing and
• treating conditions arising from the disease.
Note: This definition is given in the Federal Register (3/31/93) for the Substance Abuse Prevention and Treatment
Block Grants interim Final Rule. It is also the definition used in the Ryan White CARE Act
As the primary intent of these funds are to provide early intervention care services to
substance abusing persons living with HIV or AIDS, projects must assure that existing
community resources for care are adequate prior to inclusion of outreach and HIV
prevention test/counseling as services offered through these projects. Other than outreach
and HIV prevention/test counseling, all services must be given to individuals infected with
HIV who have an issue with substance abuse (whether currently abusing, in recovery, or
'through a sex partner). For all care services provided, verification of the individual's HIV
positive status must be documented. In addition, all case management services provided
through the ElPs must adhere to the Principles and Standards of Service for H1V/AIDS
Case Management in Michigan. Agencies that fund HIV prevention counseling and testing
must ensure that all prevention counseling and testing staff have successfully completed
the HIV/AIDS Prevention and Intervention Section (HAPIS) HIV counselcir training and that
the Centers for Disease Control and Prevention (CDC) specific counseling and testing
protocols are accurately utilized. It is recommended that EIP projects collaborate closely
with the HIV Regional Training Centers for provision of their HIV training needs and direct
the majority of their E1P funds to direct client service provision.
Examples of HIV Early Intervention Prevention Services:
• Outreach services to substance abusing individuals who may have HIV disease,
or may be at risk of the disease, and who may be unaware of the availability and
potential benefits of early treatment of HIV disease
• HIV prevention/test counseling
• Ongoing risk reduction education and counseling for substance abusing individuals
and partners of those PLWH/A
Examples of HIV Early Intervention Care Services for PLWH/A:
• Comprehensive case management that covers both social services and health care
a Ongoing risk reduction education and counseling
• Primary medical care
• Substance abuse treatment or mental health counseling
• Provision of appropriate immunizations
• Monitoring CD 4 lymphocyte counts and HIV viral loads
a Prevention of opportunistic infections and tuberculosis (including TB testing)
a Initiation of antiretroviral therapy
• Testing for and treatment of sexually transmitted diseases
• Eye, oral and dental care
• Gynecological care and pregnancy counseling
• Diagnostic testing of infants and children of HIV-infected mothers
2
SP Coordinating Agencies: These are the thirteen coordinating agencies (CM) directly
rebeiving BSAS HIV EIP funding, including:
• Detroit Health Department, Bureau of Substance Abuse;
111 Oakland County Health Division, Office of Substance Abuse;
• Southeast Michigan Community Alliance;
• Kent County Health Department, MINK Substance Abuse Coordinating Agency;
Washtenaw County Community Mental Health Center, Washtenaw-Livingston
Substance Abuse CA;
• Macomb County Community Mental Health Services, Office of Substance Abuse
Services;
• Kalamazoo County Human Services Department, Substance Abuse Services;
• Genesee County Health Department;
• Mid-South Substance Abuse Commission;
• Northern Michigan Substance Abuse Services;
a Eastern Upper Peninsula Substance Abuse Services;
• Bay Area Substance Abuse Services; and ▪ St. Clair County Health Department, Thumb Region Substance Abuse Services
Coordinating Agency
Projects implemented by two of the thirteen CAs cover multiple CA jurisdictions, resulting
in regional implementation of the HIV Prevention and ElPs. In the cases of regional
implementation, the lead CA receives the funding, which includes amounts earmarked for
each CA jurisdiction. The lead CA must work with the respective CM to coordinate service
delivery. The CM with regional implementation are:
• Kalamazoo County Human Services Department, Substance Abuse Services which
also covers the jurisdictions of the Lakeshore Coordinating Council.
a Eastern Upper Peninsula Substance Abuse Services which also covers the
jurisdiction of the Western Upper Peninsula Substance Abuse Services CA
Service Delivery Program: CM may contract with programs that directly provide HIV
early intervention services. These may be EIP health department-based CM, licensed
substance abuse service providers, local public health departments, community-based
organizations or local health providers.
Program Reouirements:
EIP CM and service delivery programs must establish linkages with the comprehensive
community HIV resource network to assure an accessible, comprehensive and non-
duplicative approach to service delivery. Linkages must be established with the Regional
HIV Care Consortium and the Regional HIV Prevention Planning Groups, and individuals
from the EIP CA must participate on an ongoing basis in these groups (for example, as a
group member or advisor). In addition to these linkages, projects must collaborate with
3
local methadone treatment providers and other treatment providers serving chronic,
substance abusers; the HIV Regional Training Centers; local health department(s); and
other community-based organizations. Projects focusing on adolescents must develop
partnerships with the local teen health centers, as available in their communities. Projects
focusing on women must collaborate with the women's designated substance abuse
treatment programs and health care providers and programs for women (e.g., prenatal
-care, family planning, etc.).
Early intervention services will be undertaken voluntarily by, and with the informed consent
.of, the individual, and undergoing such services will not be a condition of receiving
treatment services for substance abuse or any other services. Early intervention services
Will reflect cultural competency by understanding and accommodating the language,
values, beliefs, and behaviors of the individuals and groups they serve. In addition, the
services will be provided in settings accessible and acceptable to the individuals and
communities intended to be served.
Each E1P CA must establish a plan to carry out HIV early intervention services. This plan
must be developed with the cooperation and support of each Regional HIV Care
Consortium and Regional HIV Prevention Planning Group within the CA jurisdiction. A
directory of current HIV care consortia and HIV community prevention planning co-chairs
is attached. The HIV EIP plan must also be consistent with the Statewide Coordinated
Statement of Need (see attached). Proposed services must also be consistent with Special
population HIV early intervention needs. These needs may be identified through an
analysis of community HIV/AIDS and substance abuse data, the Regional HIV Care
Consortium and Regional HIV Prevention Planning Group needs assessments and/or
other community needs assessment focusing on HIV/AIDS and substance abuse.
Proposed service delivery programs may be selected through consensus of the E1P CA,
the Regional HIV Care Consortium and the Regional HIV Prevention Planning Group.
The HIWEIP Plan will be submitted on a yearly basis as part of the CA Annual Action Plan.
The plan will include:
(1) An overall program/project summary.
(2) A description of the services to be provided.
(3) An estimated number of individuals to be served.
(4) Demographic data on the population to be served.
(5) Rationale for selecting the service, including explanation of gaps in services and
unmet need in the community (as the primary intent of these funds are to provide
early intervention care services to persons who are substance abusers and living
with HIV or AIDS, projects must assure that existing community resources for care
are adequate prior to inclusion of outreach and HIV prevention test(counseling as
proposed services in their plans; a written assurance must be included in this
section of the plan).
(6) Average cost of providing each service and the extent to which such cost is paid by
(7)-
(8)
(9)
third party payors, and whether service is being provided in-kind.
Description of evaluation and data collection methods, including goals, measurable
objectives, and a project timeline.
Letters of support documenting ongoing collaborative support of the plan by each
Regional HIV Care Consortium and the Regional HIV Prevention Planning Group
within the CA jurisdiction.
Proposed budget on the BSAS budget forms and a budget breakdown by services
funded equal to the total allocation (Amounts allocated to prevention services and
care services must be budgeted separately).
Releasing a request for proposal is encouraged. If the plan includes the development and
dissemination of a request for proposal and determination of services have not yet been
made, not all of the above requirements would apply. In this case, the plan would include
the parameters and requirements of the request for proposal, a list of eligible applicants,
a timeline; the proposal evaluation mechanism, a list of the proposed objective proposal
review panel members, description of evaluation and data collection methods, a proposed
budget, and documentation of Support of the plan by the Regional HIV Care Consortium
and the Regional HIV Prevention Planning Group. Each service delivery program that
receives early intervention funds must have been in operation for at least one year prior
-to the current fiscal year.
The E1P CA must develop effective evaluation strategies, based upon project goals and
objectives. These strategies must include collection of aggregate number, demographic
and -substance abuse information of clients receiving services, by type of service, and
report on the progress towards meeting project goals and objectives. The collection of
data will be consistent with the HIV/AIDS Prevention and Intervention Section (HAP1S),
data collection methods. These methods include the Uniform Reporting System client-
level data, which uses an encrypted unique record number for client identification, the HIV
Counseling and Testing data collection system, and the Summary Activity Tables for other
prevention services.
Additional evaluation strategies may include:
1) types and units of service provided
2) aggregate information on changes in knowledge, attitude, behavior, skills, and/or
health status
3) documentation of client satisfaction
4) others, as identified by the project
Reports on the progress of these projects will be submitted by the EIP CA. A semiannual
narrative report is due to BSAS by April 30 and a cumulative year end report is due on
October 30 of each fiscal year. Quarterly data submission to HAPIS is also required, on
January 15, April 15, July 15, and October 15 for Uniform Reporting System data and the
Summary Activity Tables (see attached chart).
5
• Funds will not be utilized to make payments for any service to the extent that payment has
been made or can reasonably be expected to be made, e.g., through third-party payers.
All HIV E1P services funding should be considered funding of last resort and should not
be used to fund services already available free or at a low cost to clients.
Information regarding the HIV and substance abuse status of the clients and the HIV early
_intervention services they receive must be maintained confidentially pursuant to state and
federal confidentiality regulations.
. Coordinators of the projects will meet with state staff, at a minimum, twice per year.
Program Recommendations (Optional):
It is recommended that EIP CAs publicize and conduct an open meeting prior to
development of their plan. All organizations eligible to receive HIV early intervention
funding should be invited. The agenda of this open meeting should include: (1)
explanation of-the intent of the funding and the process for distribution of funding; (2)
discussion between and/or testimony from participants regarding the services that are
available; and (3) identification of the gaps in services and unmet needs within the
community.
Service delivery programs may include outreach to low-income HIV-positive individuals
who are chronic substance abusers and/or their sex or needle sharing partners to inform
these individuals of these services.
6
ATTACHMENT F
OTHER REQUIREMENTS
4. Enrollment Criteria for
Methadone/LAAM Maintenance
And Detoxification Programs
(Revised 2001)
August 2003
ENROLLMENT CRITERIA FOR METHADONE/LAAM
MAINTENANCE AND DETOXIFICATION PROGRAMS
The Michigan Department of Community Health/Division of Substance Abuse Quality and
Planning (MDCH/DSAQP) has established enrollment criteria for prospective patients of
methadone and LAAM maintenance and detoxification programs under contract with
substance abuse coordinating agencies (CAs). These criteria are to be utilized by CAs and
Access Assessment and Referral agencies (AARs) (or approved alternative authorizing
agency) contracted by the CAs to perform assessment, diagnostic, and placement
services. This enrollment criteria was established in response to a need to standardize
the assessment process used to determine the appropriate level of care for narcotic
dependent patients.
The enrollment criteria include:
a) Preliminary patient assessment criteria, and
b) The determination of eligibility for methadone/LAAM treatment which includes:
criteria for the medical assessment; patient placement criteria for Methadone/LAAM
maintenance; patient placement criteria for methadone/LAAM detoxification.
The enrollment criteria were developed in concurrence with the following current and
interim federal and state rules and regulations governing the use of methadone and LAAM
for the treatment of narcotics addiction or dependence:
- 21 CFR Part 291- Sec. 501, 505 - Drugs Used for Treatment of Narcotics Addicts;
- 21 CFR Part 291- Sec. 501, 505- Drugs Used for Treatment of Narcotics [Interim
Rule]; and -Administrative Rules For Substance Abuse Service Programs in
Michigan, Sec.R325.14409(1-5), Sec.R 325. 14410(1), Sec.R 325. 14418(1-2)
The following technical assistance and resource publications were also utilized in the
development of the enrollment criteria:
- Center for Substance Abuse Treatment- Treatment Improvement Protocol (TIP) Meeting
Patient Needs in Opioid Substitution Therapy: Matching Patients to Treatment Services,
Draft 1994;
- Center for Substance Abuse Treatment- Matching Treatment to Patient Needs In Opioid
Substitution Therapy, Treatment Improvement Protocol (TIP) Series, number 20;
- Center for Substance Abuse Treatment - Approval and Monitoring of Narcotic
Treatment Programs, A Guide on the Roles of Federal and State Agencies, Technical
Assistance Publication (TAP) Series, number 12;
- Center for Substance Abuse Treatment - State Methadone Treatment Guidelines,
Treatment Improvement Protocol (TIP) Series, number 1;
- Center for Substance Abuse Treatment - LAAM in the Treatment of Opiate Addiction,
Treatment Improvement Protocol (TIP) Series, number 22;
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2
BSAS Reference Manual, Volume III A, C (1)(d) Continuum of Care, Methadone/LAAM;
BSAS Reference Manual Volume Ill, C (2)(a) Program Requirements, Central Diagnostic
and Referral (CDR) Services, Direct Client Functions;
American Society of Addiction Medicine (A SAM) Patient Placement Criteria, Second
Edition;
National Institutes of Health Consensus Development Statement: "Effective Medical
Treatment Of Heroin Addiction" (1997)
ENROLLMENT CRITERIA AND PROCESS
A. Preliminary Patient Assessment
B. Determination of Eligibility For Methadone/LAAM Treatment
A. Preliminary Patient Assessment
The appropriate application of clinical judgment in the matching of patients to the most
appropriate treatment begins with preliminary assessment. Preliminary patient assessment
must be conducted in person with prospective patients at an Access Assessment and
Referral (AAR) agency (or approved alternative). The preliminary patient assessment must
include a review by a duly licensed physician or clinical staff in the following areas:
1. The Need for Emergency Care
The examining clinical staff or physician where indicated must determine if:
There is an acute or severe medical problem. If so, an immediate referral to a
primary care physician or acute care medical facility must be made.
The patient exhibits psychotic or suicidal symptoms. If so, an immediate referral to
an acute care mental health provider, facility or Community Mental Health (CMH)
screening unit must be made.
The patient exhibits other symptoms that jeopardize his or her safety or that of
others. If so, an immediate referral to a mental health or law enforcement authority
must be made.
2. Presence of Opiate Dependence (Addiction)
The clinical staff must:
- Determine the level of psychoactive substance dependence and presence of opiate
addiction.
- Complete a biopsychosocial assessment which collects sufficient information to
-
6/01
3
address the six dimensions of the American Society for Addiction Medicine (ASAM)
Patient Placement Criteria. The ASI, with additional questions as needed, may be
used. The Level of Care Index (LOCI) checklists or other crosswalks may be used
to assist in the determination.
7 Apply the (ASAM) Patient Placement Criteria to determine appropriate placement.
- Use the Diagnostic and Statistical Manual for Mental Disorders (DSM-1V) to
determine diagnosis.
3. Extent of Alcohol and other Drug Use
The examining physician, physician's assistant, registered nurse, or otherclinical staff
must evaluate:
- The results of the urine toxicological screening test.
- Whether the client is physically dependent if patient tested positive for alcohol and/or
other drugs.
- The need for immediate (acute) detoxification from other drugs, including alcohol. If
so, an immediate referral to an (acute) detoxification program must be made.
- The need for residential (sub acute) detoxification treatment. If so, an immediate
referral to a residential treatment program must be made.
4. Co-occurring Medical and Psychiatric Conditions
The examining physician or clinical staff must evaluate:
- Whether, based on the results of assessment, there appears to be a co-occurring
medical and/or psychiatric condition(s). If so, an immediate referral to a primary
care physician or Community Mental Health Services Program must be made.
5. Evaluation of Living Environment, Family, Social, and Legal Problems
Clinical staff must determine whether:
- The prospective patient is homeless.
- The prospective patient is residing with other addicts.
- The prospective patient is residing in a building or neighborhood with a high intensity
of drug use and drug traffic.
- There is family conflict or support.
- The prospective patient is a parent.
- There is a child in the household of the prospective patient.
6. Review of Treatment Options
The clinical staff must determine, with concurrence of the patient, whether the patient
is best suited for:
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4
- Drug-free therapy
- Opioid substitution therapy (methadone or LAAM treatment) in an outpatient
setting, or
Residential detoxification using methadone or LAAM.
B. Determination of Eligibility For Methadone/LAAM Treatment
Medical Assessment:
•
The medical assessment must be performed by a duly licensed physician employed at the
licensed methadone/LAAM program to which the patient is referred.
The purpose of the medical assessment is to confirm preliminary findings secured during
the preliminary assessment process and to determine eligibility for opioid substitution
therapy (methadone/LAAM). The medical assessment is based on the following criteria:
[As specified in the Administrative Rules for Substance Abuse Service Programs in
Michigan, Sec. R325.14409 (1-5)]
1. A physician must determine whether a prospective patient is physiologically dependent
upon narcotics and has been continuously dependent for at least one year before
admission or enrollment. A narcotic dependent is defined as an individual who is
physiologically addicted to heroin or a morphine-like drug and is dependent upon the
narcotic(s) to prevent the onset of signs of withdrawal.
2. In determining current physiologic dependence, the physician must consider signs and
symptoms of intoxication, a positive urine specimen for a narcotic drug, and old or fresh
needle marks. Other evidence of current physiologic dependence can be obtained by
noting early signs of withdrawal, such as lacrimation, rhinorrhea, pupillary dilation,
piloerection, increased body temperature, high blood pressure, pulse rate, and
_ respiratory rate during the initial period of abstinence.
3. A prospective patient who has been previously treated and subsequently detoxified
from methadone maintenance treatment may be enrolled in methadone maintenance
treatment without evidence to support current physiological dependence up to six
months after discharge provided that prior methadone maintenance treatment of six
months or more is documented from the program attended, and that the physician
conducting the medical assessment finds the re-enrollment to maintenance treatment
medically justified.
4. The examining physician must have documented evidence of prior treatment and
evidence of all other findings (biomedical, psychiatric and emotional/behavioral
information) and criteria (listing of diagnostic and assessment instruments) used to
determine such findings.
5. If the prospective patient is between 16 and 18 years of age, the patient must have two
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5
documented attempts at detoxification and at least a one-year history of addiction prior
to the medical assessment. A one-year history of dependence is defined as
physiological dependence to a narcotic for at least one year before application for
enrollment. A person under 16 years of age is not eligible for methadone maintenance
.treatment without the prior approval of the State Methadone Authority and the Food and
Drug Administration (FDA). A person under the age of 16 may be eligible for
methadone detoxification if there is current physiological dependence to a narcotic and
if the methadone detoxification is deemed medically appropriate by a physician
conducting the medical assessment.
Patient Placement Criteria for Outpatient Methadone/LAAM Maintenance:
Patient placement criteria are based on assessment dimensions used to define
biopsychosocial severity. The criteria specified under each dimension will assist in the
determination of the appropriate level of treatment for the prospective patient. Patient
placement criteria must be based on the Patient Placement Criteria for the Treatment of
Psychoactive Substance Use Disorders, Second Edition developed by ASAM and on the
Administrative Rules for Substance Abuse Programs in Michigan. The patient placement
criteria must be applied by a duly licensed physician and/or clinical staff employed at the
licensed methadone treatment program to which the patient is referred:
1. Acute intoxication and/or withdrawal:
The examining physician must determine that the patient diagnosis meets all of the
following criteria:
a) The prospective patient is physiologically dependent upon a narcotic and became
physiologically dependent at least one year before application of enrollment.
b) The current physiological dependence and history of addiction includes an
examination of physical signs of withdrawal, positive urine specimen, fresh needle
marks, vital signs, and treatment history.
C) The prospective patient is at minimal risk of severe withdrawal.
2. Biomedical Conditions and Complications:
The examining physician, in cooperation with the clinical staff, must determine that the
patient diagnosis meets at least one of the following criteria:
a) There are no current illnesses, other than withdrawal, requiring medical treatment
that could not be managed with outpatient medical monitoring.
b) Concurrent and non-chronic illnesses or pregnancy can be stabilized and will not
complicate treatment.
c) Concurrent illnesses, including those that are chronic, can be stabilized and
maintained on an outpatient basis with minimal daily monitoring.
d) There is the presence of current non-acute illnesses that can be managed on an
outpatient basis that do not require residential treatment, such as liver disease,
6/01
6
pancreatitis, gastrointestinal problems, cardiovascular disorders, HIV, AIDS, and
other sexually transmitted diseases, tuberculosis, and other communicable
diseases and psychiatric illness requiring psychotropic medications.
3. .Emotional/Behavioral Conditions and Complications:
The clinical staff, in cooperation with the examining physician, must determine that the
patient diagnosis meets at least one of the following criteria:
a) There are no current psychiatric illnesses or psychological, behavioral, or emotional
problems that need to be addressed or which complicate treatment.
b) Prospective patient may suffer chronic conditions, such as stable but chronic
schizophrenia, affective disorder, or personality disorder that may affect treatment,
however, such disorders are manageable in a structured outpatient setting.
c) Prospective patient has emotional/behavioral problems that are to be expected as
part of addiction illness or has some emotional/behavioral problems that seem
independent.
d) There is a mild risk that the prospective patient may exhibit behaviors endangering
self or others with or without .a history of severe depression, suicidal, and/or
homicidal behavior, however, these behaviors can be managed safely in a
structured outpatient environment.
e) There is a presence of emotional/behavioral stability, but the prospective patient
still needs pharmacotherapy to prevent relapse to narcotic use.
4. Treatment Acceptance/Resistance:
The clinical staff, in cooperation with the examining physician must determine that the
patient diagnosis meets the criteria outlined in "a" and at least one of the criteria
outlined in "b" -
•a) The prospective patient requires structured therapy and pharrnacotherapy, such as
methadone, to promote treatment progress and recovery.
b) The prospective patient exhibits resistance high enough to require structured
outpatient therapy to promote treatment progress, but resistance will not render
outpatient treatment ineffective.
c) The prospective patient feels that he/she is ready for outpatient methadone/LAAM
treatment but needs motivating and monitoring activity.
d) The prospective patient is willing to accept treatment and does not disagree with
others' perception that he/she has an addiction problem.
e) The prospective patient does not complain to avoid negative consequences, and
seems self-motivated to seek treatment and recovery from the addiction.
5. Relapse/Continued Use Potential:
The clinical staff, in cooperation with the examining physician, must determine that
the patient diagnosis meets all of the following criteria:
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7
a) The prospective patient requires psychotherapy and pharmacotherapy
(methadone/LAAM) because the patient may be in immediate danger of continued
severe distress and narcotic using behavior and attributes the distress to the
physiological need for narcotics.
b) Without the administration of structured psychotherapy and pharmacotherapy, the
prospective patient does not appear to have any recognition and understanding of,
and skills for how to cope with, his/her addiction to prevent relapse and continued
use.
c) Severe distress and narcotic using behavior reappear if the prospective patient is
not engaged in structured outpatient methadone treatment.
6. Recovery Environment:
The clinical staff, in cooperation with the examining physician, must determine that the
patient diagnosis meets at least one of the following criteria:
a) There appears to be a sufficient and supportive environment, including significant
others, family, employers, and support services, present . to render
methadone/LAAM outpatient treatment feasible.
b) The patient, without the supportive environment to assist with immediate recovery
efforts, exhibits motivation to secure a supportive mechanism to create an
environment conducive for outpatient methadone/LAAM treatment.
c) There is the presence of legal, vocational, social service agency or criminal justice
requirements that may enhance motivation for seeking treatment and recovery.
Patient Placement Criteria for Residential Methadone/LAAM Detoxification:
The diagnostic and assessment functions for patient placement in methadone
detoxification treatment must be performed by a duly licensed physician and clinical staff
employed at the licensed methadone treatment program to which the patient is referred.
For detoxification from narcotic drugs, methadone must be administered daily by the
program under close observation in reducing doses over a period of not more than 21
days, and LAAM must be administered no more frequently than every other day over the
same period. (See Administrative Rules for Substance Abuse Programs in Michigan, Sec.
R 325.14410 and FDA 21 CFR Part 291.505 Drugs Used for Treatment of Narcotics
Addicts [Interim Rule], (k)(1) Dosage and Responsibility for Administration.)
In the state of Michigan, methadone/LAAM detoxification programs must be licensed as
residential (subacute) treatment programs.
'Patient Placement Criteria for methadone/LAAM detoxification must be based on ASAM's
Patient Placement Criteria for the Treatment of Psychoactive Substance Use Disorders
and the Administrative Rules for Substance Abuse Service Programs in Michigan [Sec.R
325. 14410(1-3)).
6/01
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Please note the following patient placement criteria for methadone/LAAM detoxification:
1. Acute Intoxication and/or Withdrawal Potential:
The program physician must determine that the patient diagnosis meets all of the
following criteria:
a) The prospective patient exhibits moderate to severe withdrawal or potential for
moderate to severe withdrawal.
b) The withdrawal is manageable in a clinically managed residential setting.
c) The patient is physiologically dependent on narcotics (opiates) and requires
methadone/LAAM maintenance therapy to prevent withdrawal.
2. Biomedical Conditions and Complications:
The program physician, in cooperation with the clinical staff, must determine that the
patient diagnosis meets at least one of the following criteria:
a) The prospective patient possesses current and/or chronic illnesses that will
complicate treatment.
b) The current and/or chronic illnesses are manageable and the conditions are
stabilized.
c) There are current and/or chronic conditions sufficient to distract from outpatient
treatment.
d) The prospective patient needs medical monitoring in a residential setting.
3. Emotional/Behavioral Conditions and Complications:
The program physician, in cooperation with the clinical staff, must determine that the
patient diagnosis meets at least one of the following criteria:
•
a) There are psychiatric illnesses and psychological, behavioral, and emotional
problems that need to be addressed.
b) The psychiatric illnesses and psychological, behavioral, and emotional problems
pose a distraction to recovery.
c) The psychiatric illnesses and psychological, behavioral, and emotional problems
are manageable in a clinically managed residential treatment setting.
4. Treatment AcceptanCe/Resistance:
The clinical staff, in cooperation with the program physician, must determine that the
patient diagnosis meets at least one of the following criteria:
a) The prospective patient's resistance is high enough to require a structured
program, but too high to render outpatient treatment effective.
6/01
9
b) The prospective patient is open to recovery, but needs a structured and clinically
managed residential environment to maintain therapeutic gains.
c) The prospective patient has considerable difficulty with or opposition to treatment
with serious consequences if not engaged in treatment.
5. Relapse/Continual Use Potential:
The clinical staff, in cooperation with the program physician, must determine whether
the patient diagnosis meets at least one of the following criteria:
a) The prospective patient is at high risk for relapse or continual use without
structured and clinically managed residential treatment
b) The prospective patient understands relapse but needs to maintain therapeutic
gains in a structured and clinically managed residential setting.
c) The prospective patient exhibits some awareness of relapse, but needs
interventions provided by clinically managed residential setting.
d) The prospective patient exhibits no recognition of skills needed to prevent
continued use with possible dangerous consequences.
6. Recovery Environment:
The clinical staff, in cooperation with the program physician, must determine whether
the patient diagnosis meets at least one the following criteria:
a) The family, significant others, and the social support system increase the risk for
personal conflict about drug use.
b) The environment is dangerous for prospective patient, but recovery is achievable
in a clinically managed residential setting.
c) The environment is dangerous for the prospective patient and the patient lacks the
skill to cope outside of a clinically managed residential setting.
Exceptions to Enrollment Criteria:
1. A person who has resided in a penal or chronic care institution for one month or longer
may be admitted to methadone maintenance treatment within 14 days before release
or discharge, or within six months after release from such an institution without
documented evidence to support findings of physiological dependence, provided the
person would have been eligible for admission before he/she was incarcerated or
institutionalized and, in the reasonable clinical judgement of a program physician,
treatment is medically justified. (As specified in FDA 21 CFR Part 291.505 Drugs
Used for Treatment of Narcotic Addicts, Sec. (d)(1) Minimum Standards for Admission,
Exceptions to Minimum Admission Criteria.)
2. Pregnant patients, regardless of age, who have had a documented narcotic
dependency in the past and who may return to narcotic dependency, with all its
attendant dangers during pregnancy, may be placed on a methadone maintenance
6/01
10
regimen. For such patients, evidence of current physiological dependence on narcotic
drugs is not needed if a program physician certifies the pregnancy and, in his/her
reasonable clinical judgement, finds treatment to be medically justified. (As specified
in FDA 21 CFR Part 291.505 Drugs Used for Treatment of Narcotic Addicts, Sec.
(d)(1) Minimum Standards for Admission, Exceptions to Minimum Admission Criteria.)
3. Patients who are, or become, pregnant must not be started or continued on LAAM
except by the written order of a physician who determines LAAM to be the best choice
of therapy for that patient. An initial pregnancy test must be performed for each
prospective female of childbearing age before admission to LAAM maintenance
treatment and monthly pregnancy tests performed thereafter on such female patients
in LAAM maintenance treatment. Analysis of the pregnancy tests must be performed
by a laboratory approved by the Clinical Laboratory Improvement Act, as amended,
or in a laboratory certified by a state or private accrediting body approved by the
Health Care Financing Administration. (As specified in FDA 21 CFR Part 291, Drugs
Used for Treatment of Narcotics Addicts (Interim Rule), Sec. 291.505 (v) Approved
narcotic drugs for use in treatment programs, (iii) (B) Pregnant Patients.)
4. A person under 18 years of age must not be admitted to LAAM maintenance treatment.
(As specified in FDA 21 CFR Part 291, Drugs Used for Treatment of Narcotics Addicts
[Interim Rule], Sec. 291.505 (C) (iv) Special Limitation; Treatment of Patients Under 18
years of age.)
Continued Stay Criteria:
The need for continued stay must be determined by a duly licensed physician and clinical
staff employed at the licensed methadone/LAAM treatment program in which the patient
is enrolled. The determination of need for continued stay must be based on the six (6)
dimensions of the ASAM patient placement criteria and the extent and severity of opioid
(narcotic) addiction disorder. If a patient's treatment is being funded by a CA, authorization
for continuation of funding must be obtained from the CA.
Patients must be given careful consideration for discontinuation of methadone/LAAM use.
Pharmacotherapy (methadone/LAAM) and social rehabilitation must have been maintained
for a reasonable period of time as specified in the patient's initial treatment plan developed
and countersigned by the clinical staff and the program physician. [See Administrative
Rules for Substance Abuse Programs in Michigan, Sec. R 325. 14418 (1)]
Treatment plans, including dosage levels, must be reviewed, reevaluated, updated and
countersigned by the clinical staff and/or program physician at least once every 60 days.
The dispensing nurse must make note of medical progress of the patient on a monthly
basis. The program physician must evaluate a patient's mental and physical status every
60 days. This examination includes a determination of appropriate dosage levels.
Treatment plans, including dosage levels, may be altered any time based on the
physician's review of the patient's mental and physical status. [See Administrative Rules
6/01
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for Substance Abuse Programs in Michigan, Sec. R 325.14404 (2), 14419 (2)]
At least once a year the program physician must date, review, and countersign the
patient's treatment plan and must ensure each patient's progress or lack of progress in
achieving treatment goals. [See Administrative Rules for Substance Abuse Programs in
Michigan, Sec. R 325.14404 (2), 14419 (2)] If the program physician in his/her reasonable
clinical judgement determines that the patient is ready for discharge, the program physician
must follow the "Discharge Criteria" as presented in this document.
Maintenance treatment must be discontinued within two years after such treatment has
begun unless a request for the continuation of treatment submitted by the program on
behalf the patient has been approved by the CA or authorizing authority. The request from
the program for continuation of treatment must include, based on the recorded clinical
judgement of a duly licensed physician, a medical and clinical justification for the
continuation of maintenance treatment beyond the two-year limitation. The request for
continuation of treatment must be submitted by the program on behalf of the patient to the
CA or authorizing authority forty-five (45) days prior to the treatment termination date. The
treatment termination date is defined as the date upon which the patient completes
administrative detoxification. If the request for the continuation of treatment is approved,
additional requests for continuation of treatment must also be submitted by the program
and reviewed and approved by the CA or authorizing authority.
If the request for continuation of maintenance treatment is denied, the CA or authorizing
authority must notify the patient of the determination. The notification of denial must
include a notification of the patient's right to file a recipient rights complaint in accordance
with the grievance process specified in the Administrative Rules for Substance Abuse
Programs In Michigan, Part 3. Recipient Rights, Section R 325. 14303. The notice of
denial must also include a notification of a Medicaid enrolled patient's right to request an
administrative hearing.
To determine whether a patient should continue in treatment, the program physician in
cooperation with the clinical staff, and the CA or authorizing authority must use the
following ASAM Patient Placement Criteria:
1. Acute narcotics dependence and/or potential relapse:
The patient diagnosis meets at least one of the following criteria:
a) Continued methadone/LAAM maintenance is required to prevent relapse to illicit
narcotics use.
b) The patient needs ongoing medical monitoring and access to medical
management.
c) Patient continues to have adequate support systems to ensure commitment to
continuing methadone maintenance treatment.
6/01
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2. 'Biomedical Conditions and Complications:
The patient diagnosis meets at least one of the following criteria:
_ a) There is a current or chronic illness and opiate addiction problem that requires
medical monitoring and management.
b) There is a presence of or potential for:
- Episodic use of drugs other than narcotics;
- Positive HIV status or AIDS;
- Chronic health conditions that could be medically compromised with
discontinuation of methadone/LAAM maintenance treatment; including but not
limited to:
• Liver disease or problems with the hepatic decompensation;
• Pancreatitis;
• Gastrointestinal, cardiovascular, and other systems disorders;
• Sexually transmitted diseases;
• Concurrent psychiatric illness requiring psychotropic medications;
• Tuberculosis, hepatitis
c) Patient is pregnant and narcotic dependent.
3. Emotional/Behavioral Conditions and Complications:
The patient diagnosis meets at least one of the following criteria outlined in "a" -
a) The patient's emotional/behavioral functioning may be jeopardized by
discontinuation of methadone/LAAM maintenance treatment.
b) The patient demonstrates the ability to benefit from methadone treatment but may
not have achieved significant life changes.
c) The patient is making progress toward resolution of an emotional/behavioral
problem, but has not sufficiently resolved problems to benefit from a transfer from
methadone/LAAM maintenance to a less intensive level of care.
d) The patient's emotional/behavioral disorder continues to distract the patient from
focusing on treatment goals, however, the patient is responding to treatment, and
it is anticipated that with additional intervention the patient will meet treatment
objectives.
e) The patient continues to exhibit risk behaviors endangering self or others, but the
situation is improving.
f) The patient is being detained pending transfer to a more intensive treatment
service.
g) The patient has a diagnosed but stable emotional/behavioral or neurological
disorder which requires monitoring, management, and/or psychotropic medication
due to the patient's history of being distracted from recovery and/or treatment.
4. Treatment Acceptance/Resistance:
The patient diagnosis meets the following criteria in "d" and at least one of the criteria
6/01
13
-outlined in "a" - "c":
a) The patient recognizes the severity of the drug problem, however, the patient
exhibits little understanding of the detrimental effects of drug use, including alcohol,
. yet the patient is progressing in treatment.
b) The patient recognizes the severity of the addiction and exhibits an understanding
of his/her relationship with narcotics, however, the patient does not demonstrate
behaviors that indicate the patient has assumed responsibility necessary to cope
with the situation.
c) The patient is becoming aware of responsibility for addressing the narcotic
addiction, but still requires current level of treatment and psychotherapy to sustain
personal responsibility in treatment.
d) The patient has accepted responsibility for addiction and has determined that
ongoing methadone/LAAM treatment is the best strategy for preventing relapse to
narcotics dependence.
5. Relapse Potential:
The patient diagnosis meets the following criteria in "d" and at least one of the criteria
outlined in "a" - "c":
a) Due to continued relapse attributable to physiological cravings, the patient requires
structured outpatient psychotherapy with methadone to promote continued
progress and recovery.
b) The patient recognizes relapse cues, but has not developed or exhibited
coping skills to interrupt, postpone or neutralize gratification, or to change impulse
control behavior.
c) Narcotic addiction symptoms are stabilized, but have not been reduced to support
successful functioning without structured outpatient treatment.
d) The pharmacotherapy (methadone/LAAM) has been effective as an adjunct to
psychotherapy and as a strategy used to prevent relapse, however, withdrawal
from methadone/LAAM is likely to lead to recurrence of addiction symptoms and,
possibly, relapse.
6. Recovery Environment:
The patient diagnosis meets at least one of the following criteria:
a) The patient has not integrated and exhibited coping skills sufficient to survive
stressful situations in the work environment, or has not developed vocational
alternatives.
b) The patient has not developed coping skills sufficient to successfully deal with a
non-supportive family and social support environment or has not developed
alternative living support systems.
C) The patient has not integrated and exhibited the socialization skills essential to
establishing a supportive family and social support environment
6/01
14
d) The patient has responded to treatment of psychosocial problems affecting
patient's social and interpersonal life, however, the patient's ability to cope with
psychosocial problems would be limited if the patient is transferred to a less
intensive level of treatment.
e) The patient's social and interpersonal life has not changed or deteriorated,
however, the patient needs additional treatment to cope with his/her social and
interpersonal life or to take steps to secure an alternative environment.
f) Emotional and behavioral complications of addiction are present, however, the
behavioral complications are manageable in a structured outpatient program. The
behaviors include: 1) criminal activity involving illicit drugs; 2) victim of abuse or
domestic violence; 3) inability to maintain a stable househbld, including the
provision of food, shelter, supervision of children and health care; and 4) inability
to secure or retain employment.
Patient Discharge Criteria:
The decision to discharge must be made by a duly licensed physician and clinical staff
employed at the licensed methadone/LAAM treatment program in which the patient is
enrolled. The determination of the appropriateness of discharge must be based on the six
(6) dimensions of the ASAM patient placement criteria and the extent and severity of opioid
addiction disorder. If a patient's treatment is being funded by a CA, the decision for
discharge must be agreed upon by the CA.
A patient is considered eligible for discharge when the patient diagnosis indicates that:
- the patient exhibits remission of opiate addiction without the need for methadone or
LAAM; or
the patient continues to exhibit opiate addiction requiring another level of care.
(See ASAM Patient Placement Criteria and other assessment tools under Patient
Placement and Continued Stay Criteria listed above)
Upon appropriate diagnosis of the patient's level of opiate addiction, the following criteria
is to be used for discharging patients:
1. Acute Drug Dependence/Potential Relapse
The patient diagnosis does not meet any of the continuing stay criteria.
2. Biomedical Conditions and Complications:
The patient diagnosis meets at least one of the following criteria outlined in "a" or
a) The patient's biomedical condition (current and/or chronic illnesses) and opiate
6/01
15
addiction problem has been stabilized without continued use of methadone/LAAM,
and the patient does not meet any of the continued stay criteria.
b) The program physician has determined that continued methadone/LAAM treatment
presents a serious medical risk and continued treatment is required at another level
. in a more intensive and medically monitored treatment setting.
3. Emotional/Behavioral Conditions and Complications:
The patient diagnosis meets at least one of the following criteria outlined in "a" or
a) The patient's emotional or behavioral problems have stabilized to the extent that
the problems can be managed or treated through outpatient counseling or self-help
organizations, and the patient does not meet any of the continued stay criteria for
additional methadone/LAAM treatment.
b) The program physician has determined that a psychiatric condition exists that is
prohibiting or interfering with methadone/LAAM maintenance treatment for opiate
addiction, and that condition presents a severe psychiatric risk if the patient
continues in maintenance treatment on an outpatient basis. The patient requires
treatment at a more intensive level.
4. Treatment Acceptance/Resistance:
The patient diagnosis meets at least one of the following criteria outlined in "a" or b":
a) The patient has exhibited sufficient acceptance of an addiction problem and has
a commitment to addiction recovery to the extent that maintenance of recovery
without methadone/LAAM in an outpatient counseling and/or a self-help
organization is expected.
b) The patient has consistently failed to achieve treatment objectives despite revisions
in the treatment plan to the extent that the patient should be placed in a more
intensive level of treatment.
5. Relapse Potential:
The patient diagnosis meets at least one of the following criteria outlined in "a" or
a) The patient recognizes relapse cues and has developed coping skills to negate or
interrupt gratification and impulse controls without methadone/LAAM, but the
patient may need outpatient psychotherapy to maintain recovery.
b) The patient consistently exhibits drug seeking behavior or craving, is not
responsive to methadone/LAAM treatment in an outpatient setting, and, therefore,
is in need of more intensive treatment at another level of care.
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6. Recovery Environment:
The diagnosis meets at least one of the following criteria outlined in "a," "b," or
a). The patient's family, significant other(s) and social support systems are sufficient to
support recovery without the patient being exposed to significant risk for relapse, and
the patient does not meet any of the continued stay criteria.
b) The patient appears to be functioning adequately and does not Meet any of the
continued stay criteria that indicate a need for additional methadone/LAAM treatment. .
c) The patient family, significant other(s) and social support systems are not sufficient to
support recovery without the patient being exposed to substantial risk for relapse. The
current recovery environment outside the treatment program will make it very difficult for
the patient to achieve treatment goals.
1998
Revised-6/2001
10/8/98 larry\entocri3.drt
ATTACHMENT F
OTHER REQUIREMENTS
5. Data Collection/Recording and
Reporting Requirements—Effective 10/0112003
(Revised August 2003)
August 2003
DATA COLLECTION/RECORDING AND REPORTING
REQUIREMENTS - Effective 10/1/2003
Overview of Reporting Requirements
The reporting of substance abuse services data by the CA as described in this material
meets several purposes at MDCH including:
-Federal data reporting for the SAPT Block Grant application and progress report, as
well as for the treatment episode data set (TEDS) reported to the federal Office of
Applied Studies, SAMHSA.
-Managed Care Contract Management
-System Performance Improvement
-Statewide Planning
-CMS Reporting
-Actuarial activities
Special reports or development of additional reporting requirements beyond the initial
data and reports required by the Department may be requested within the established
parameters of the contract. The CA will likely maintain, for management and local
decision-making, additional information to that specified in the reporting requirements.
Standards for collecting and reporting data continue to evolve. Where standards and
data definitions exist, it is expected that each CA will meet those standards and use the
definitions in order to assure uniform reporting across the state. Likewise, it is
imperative that the CA employs quality control measures to check the integrity of the
data before it is submitted to MDCH. Error reports generated by MDCH will be
available to the submitting CA the day following a DEG submission. MDCH's
expectation is that the records that receive error Ids will be corrected and resubmitted
as soon as possible. The records in the error file are cumulative and will remain errors
until they have been corrected.
Individual services recipient data received at MDCH are kept confidential and is always
reported out in aggregate. Only a limited number of MDCH staff can access the data
that contains any possible individual client identifiers. (Social Security number, date of
birth, diagnosis, etc.) All persons with such data access have signed assurances with
MDCH indicating that they are knowledgeable about substance abuse services
confidentiality regulations and agree to adhere to these and other departmental
safeguards and protections for data.
Page 1 of 8 August 2003
DATA COLLECTION/RECORDING AND REPORTING REQUIREMENTS (Continued)
Technical specifications-- including file formats, error descriptions, edit/error criteria,
and explanatory materials on record submission with associated record tagging
requirements at the CA level to assure data synchronization with MDCH data records,
are in the Supplemental Instructions for 837 Encounter and Quality Improvement (QI)
Data Submission for Substance Abuse Coordinating Agencies. This document is on
the MDCH Website at:
http://www.michigan.gov/documents/SA_SupplementallnstructionsforEncounters_0218
03_58382_7.pdf
Reporting covered by these specifications includes the following:
-Treatment Admission Records (due monthly)
-Treatment Discharge Records (due monthly)
-Screening, Assessment, Referral and Follow up (SARF) Records (due
monthly)
-HIPAA Compliant 837 4010 Encounter Records (due monthly)
-Performance Indicators Reports (due quarterly)
-Sentinel Events (due semi-annually)
A. Basis of Data Reporting
The basis for data reporting policies for Michigan substance abuse services
includes:
1. Federal funding awarded to Michigan through the Substance Abuse Prevention
and Treatment (SAPT) federal block grant to share in support of substance
abuse treatment and prevention requires submission of proposed budgets and
plans. Resources and plans must be reviewed and considered by the State in
light of statewide needs for substance abuse services.
2. Public Act 368 of 1978, as amended, requires that the department develop:
A comprehensive State plan through the use of federal, State, local, and
private resources of adequate services and facilities for the prevention and
control of substance abuse and diagnosis, treatment, and rehabilitation of
individuals who are substance abusers.
Page 2 of 8 August 2003
DATA COLLECTION/RECORDING AND REPORTING REQUIREMENTS (Continued)
In addition, the department shall:
Establish a statewide information system for the collection of statistics,
management data, and other information required.
Collect, analyze and disseminate data concerning substance abuse
treatment and rehabilitation services and prevention services.
Conduct and provide grant-in-aid funds to conduct research on the
incidence, prevalence, causes, and treatment of substance abuse and
disseminate this information to the public and to substance abuse services
professionals.
3. Comprehensive planning requires statewide needs assessments to include
identification of the extent and characteristics of both risks for development and
current substance abuse problems for the citizens of Michigan.
B. Policies and Requirements Regarding Data
Treatment Data reporting will encompass Substance Abuse (SA) services provided to
clients supported in whole or in part with state administered funds through
MDCH/DCS/SA contracted funds and funds for SA services to Medicaid recipients
included in CMHSP contracts. Prevention services data requirements are addressed in
Minimum Data Set (MDS) instructions.
Definitions:
State administered funds: Any state or federal funding provided by the MDCH/DCS/SA
contract. Funds provided include federal SAPT Block Grant, state general funds,
MIChild, and other categorical or special funds. Since funds provided under the
contract include local match (fees and collections, local, and P.A. 2 as examples) data
reporting requirements include those funds which are considered as "in-part" funding.
Medicaid funds are covered under the MDCH/CMHSP contract as required reporting by
CAs as part of their data reporting responsibilities.
Data: Client admission and discharge records (for treatment services), client
assessment records (for Screening, Assessment, Referral and Follow-up), and any
services activity records (Monthly Client Activity Summary data) and backup required to
produce this information (e.g. billings from providers, services logs, etc.). Prevention
services data are not addressed herein.
Services: Substance abuse treatment (residential, residential detox, intensive
outpatient, outpatient, including pharmacological supports as part of above), substance
Page 3 of 8 August 2003
DATA COLLECTION1RECORDING AND REPORTING REQUIREMENTS (Continued)
abuse assessment (screening, assessment, referral and follow-up) provided by
appropriately state licensed programs. Prevention services data are not addressed
herein.
Supported in whole or in part: Those services for which the CA pays, inclusive of co-
pays with other:sources of funds (e.g. first party, third party insurance, other funding
sources).
Policy:
Reporting is required for all clients whose services are paid in whole or in part with state
administered funds regardless of the type of co-pay or shared funding arrangement
made for the services. This includes both co-pay arrangements where public funds are
applied from the starting date of admission to a service, as well as those where public
funds are applied subsequent to the application of other funding or payments.
For purposes of MDCH reporting, an admission is defined as the formal acceptance of
a client into substance abuse treatment. An admission has occurred if and only if the
client begins treatment. Therefore, events such as initial screening, assessment, and
referral are considered to take place before an admission and should be reported under
the SARF record.
A client is defined as a person who has been admitted for treatment of his/her own drug
problem.. A co-dependent (a person with no alcohol or drug abuse problem who is
seeking services because of problems arising from his or her relationship with an
alcohol or drug user) who has been formally admitted to a treatment unit and who has
his/her own client record also should be reported with the record indicating his/her co-
dependency.
For purposes of identifying the circumstances under which data should be submitted,
MDCH assumes a simplified process model of treatment services delivery related to
substance abuse. Basic to this model is the treatment episode, which is defined the
period of service between the beginning of a treatment service for a drug or alcohol
problem and the termination of services for the prescribed treatment plan. The first
event in this episode is an admission and the last event is a discharge.
Any change in service and/or provider during a treatment episode should be reported
as a discharge, with transfer given as the reason for discharge. For reporting purposes,
"completion of treatment" is defined as the completion of ALL planned treatment for the
current episode. Completion of treatment at one level of care or with one provider is
Page 4 of 8 August 2003
DATA COLLECTION/RECORDING AND REPORTING REQUIREMENTS (Continued)
not "completion of treatment" if there is additional treatment planned or expected as
part of the current episode. The reason for discharge given in all instances where the
treatment has not been terminated should be 06 (Transfer-Continuing in Treatment).
The code of 06 will identify the fact that the client's treatment episode did not terminate
on the date reported.
1. Data definitions, coding and instructions issued by MDCH apply as written.
Where a conflict or difference exists between MDCH definitions and information
developed by the CA or locally contracted data system consultants, the MDCH
definitions are to be used.
2. All data collected and recorded on assessment, admission and discharge forms
shall be reported using the proper Michigan Department of Consumer and
Industry Services (MDCIS) substance abuse services site license number.
MDCIS license numbers are the only basis for recording and reporting data to
MDCH at the program level.
Combined reporting of client data in data uploads from more than one license
site number is not acceptable or allowable, regardless of how a CA funds a
provider organization.
3. Failure to assure initial set up and maintenance of the proper site license
number and CA code will result in data that will be treated as errors by MDCH.
Any data submitted to MDCH with improper license numbers will be rejected in
full. The necessary corrections and data resubmissions will be the sole
responsibility of the CA in cooperation with the involved service providers.
4. Each admitted or served client shall have both his/her Social Security Number
(SSN) and a unique CA Client ID as required individual client numbers.
Along with the SSN, there must be a unique CA client identifier assigned and
reported. It can be up to 11 characters in length, all numeric. This same
number is to be used to report data for all admissions and encounters for the
individual within the CA. It is recommended that a method be established by
the CA and funded programs to ensure that each individual is assigned the
same identification number regardless of how many times he/she enters
services in any program in the region, and that the client number be assigned to
only one individual.
5. Clients admitted to treatment services, by definition, have a current substance
abuse problem of their own, or are a significant other/family member of
someone with a substance abuse problem.
MDCH expects client assessment and treatment admission forms to reflect
accurate descriptions of clients seeking and entering treatment. This includes
Page 5 of 8 August 2003
DATA COLLECTION/RECORDING AND REPORTING REQUIREMENTS (Continued)
accurate reporting of days of substance use in the 30 days before entry to the
program. If an individual has a personal substance abuse problem, it is unlikely
that there has been no recent (within the last 30 days before coming into a
program) use of some kind of substance unless the individual was incarcerated
or otherwise could not physically obtain any illicit drugs or alcohol. This would
not necessarily be the case for significant others/family members who may not
use any substances themselves.
Coding for significant other/family members who are admitted to treatment
should be done using a code of "00" for primary drug abuse problem (within the
Substance Use History data item layout), and the appropriate code describing
their relationship to a substance abuser in the Codependent data item (Yes-No)
or the "Other Factors" data item on the treatment admission records (either
code 2=adult child, or 3=significant other).
If a client has not used in the last 30 days and is not a current substance
abuser, a service other than treatment may be warranted. Treatment services
are intended for those with current substance abuse problems of their own, or of
their family or significant other. Those with personal substance abuse problems
will have one or more DSM-IV diagnosis codes assigned and also reported.
Those persons entering treatment directly out of a controlled environment (jail or
prison, or from a residential or inpatient service) may not have used a drug
within the last 30 days. These situations should be carefully documented in
client case files and include rationale as to why the client is being treated in the
absence of current (past 30 days prior to admission date) substance abuse.
If a client is "in denial" and states that he/she has not used within the last 30
days, this should be explored carefully during the initial admission visit. If there
is no use, then a service other than admission to treatment may be appropriate.
6. Any changes or corrections made at the CA on forms or records submitted by
the program must be made on the corresponding forms and appropriate records
maintained by the program. Failure to maintain corresponding data at the CA
and program levels will result in data audit exceptions on discovery of
discrepancies during an MDCH on-site data audit/review. Each CA and its
programs shall establish a process for making necessary edits and corrections
to ensure identical records. The CA is responsible for making sure records at
the state level are also corrected via submission of change records in data
uploads.
7. Providers of residential and/or detoxification services must maintain a daily
client census log that contains a listing of each individual client in treatment. This
listing can be made in client name or using the client identification number.
Census must be taken at approximately the same time each day, such as when
Page 6 of 8 August 2003
DATA COLLECTIONIRECORDING AND REPORTING REQUIREMENTS (Continued)
residents are expected to be in bed. MDCH or the CA will review the daily client
census logs in data auditing site visits.
Providers of pharmacologic support services (either methadone or LAAM) must
maintain a log that contains a listing of each client in treatment, and their daily
dosages of these medications provided by the program. MDCH or the CA will
review these logs in data auditing site visits
8. Diagnosis coding on client data forms shall be consistent with the client's
substance abuse treatment plan. If there is more than one substance abuse
diagnosis determined, then the secondary diagnosis code should be reported
accordingly. Diagnosis codes on the data records must be consistent with those
listed on other client documentation (such as billing forms, etc.). Codes should
be entered using only the proper DSM-IV definitions for substance abuse and
other related problems that are being treated.
The primary diagnosis should correspond to the primary substance of abuse
reported at admission. The secondary diagnosis may or may not be consistent
with the secondary substance of abuse if another diagnosis better reflects a
more serious secondary problem than the secondary substance.
9. CAs are to provide training, manuals, and records/ forms to their funded
services providers.
10. All data forms/records should be submitted by service provider organizations to
the respective CA on a weekly or other regular schedule. This allows data to be
relatively current and avoid data entry bottlenecks. Data records should be
completely filled out and legible for editing and data entry by provider or by the
CA. CAs have the right to return incomplete or erroneous forms to the program.
It is the service program's responsibility to correct and resubmit data records in
a timely fashion.
CAs are to edit and correct as necessary all data records, and ensure that
complete data entry occurs routinely as data flows into their offices and data
systems. Data shall be as current as possible. All data from a particular month
shall be entered into the CA's database by the end of the following month in
preparation for uploading to MDCH.
11. The CA is responsible for generating each month's data upload to MDCH
consistent with established protocols and procedures. Monthly and quarterly
data uploads must be received by MDCH via the DEC no later than the last day
of the following month.
Page 7 of 8 August 2003
DATA COLLECTION/RECORDING AND REPORTING REQUIREMENTS (Continued)
12. The CA should not request MDCH to provide reimbursements for any program
that does not submit complete and accurate data to the CA within the
established reporting time lines. Late or incomplete data reporting by the
provider and/or CA may result in the withholding and potential loss of funding
from MDCH.
13. Treatment clients may not be admitted to more than one program or one service
category at the same time. The only allowable exceptions are: (1) for case
management services from a CDR for clients who are also open at a treatment
program; and (2) for clients receiving methadone in one program while receiving
other specialized treatment in another.
14. The CA must communicate data collection, recording and reporting
requirements to local providers as part of the contractual documentation. CAs
may not add to or modify any of the above to conflict with or substantively affect
State policy and expectations as contained herein.
15. This document contains several references to data entry, editing, and correction
by the CA. These references are not meant to preclude the program from data
entry, editing, and correction. MDCH encourages data entry at the program
level as long as all the criteria for reporting content and editing are met.
16. Statements of MDCH policy, clarifications, modifications, or additional
requirements may be necessary and warranted. Documentation shall be
forwarded accordingly.
17. Treatment clients who have not had any treatment activity in a 30-day period
shall be considered inactive and their case discharged. A treatment discharge
record should be completed and submitted; the effective date of discharge
would be the last date of actual contact with the program. The record should be
completed and submitted based on the clients status as of the last contact;
records with all data items marked as unknown or left blank are not acceptable.
Page 8 of 8 August 2003
ATTACHMENT F
OTHER REQUIREMENTS
6. Reporting Nonprescription Methadone
August 2003
STATE OF MICHIGAN
ttir`t/ig
JOHN ENGLER, Governor
DEPARTMENT OF PUBLIC HEALTH
3423 N. MARTIN L. KING JR. BLVD.
P.C. BOX 30195, LANSING, MICHIGAN 48909
James K. Haveman,Jr.,Acting Director
DATE: March 21, 1996
TO:
FROM: Karen Schrock; -Chief
Center for Substance Abuse Services
SUBJECT: Reporting of Non-Prescription Methadone
As you are aware, the Michigan Department of Public Health/Center for Substance Abuse
Services (MDPH/CSAS) has conducted a review of client records in which non-prescription
methadone (drug code 21) was reported as a primary, secondary, or tertiary substance of abuse
at admission. Prior to this effort, 613 records indicated methadone abuse during the past two
fiscal years. Subsequently, only 191 cases of non-prescription methadone abuse were verified
as accurate by the CM. All of the necessary error corrections have not occurred yet; certain CAs
-will receive further communication about this.
The most common reason given for this volume of data reporting errors was misinterpretation
of the definition of non-prescription methadone abuse. Many treatment programs were using drug
code 21 to report clients . who were being transferred from a methadone program as well as those
who had received prior methadone treatment. In either case, methadone had been prescribed and
legally administered in conjunction with treatment This constitutes appropriate use, not abuse,
of methadone.
To clarify, when completing the "Substance Use History" (item 27 of the treatment admission
form), drug code 21 should be used only to report abuse of illegally obtained methadone, as in
cases of methadone diversion from treatment programs. Methadone is a prescribed treatment for
dependence on heroin (drug code 20) or other opiates (drug code 22). These drugs should be
reported as the substances of abuse.
Methadone should not be reported as a substance of abuse solely on the basis of a client's
previous methadone treatment. Drug code 21 should be used for these clients only if there is
current abuse of illegally obtained methadone.
Methadone diversion is a serious issue that is being monitored by' the federal Drug Enforcement
Agency. Accurate reporting of the data is crucial. Please ensure that this clarification is
forwarded to all providers.
If you have any further questions, please feel free to call Richard Callcins at (517) 335-8858.
Thank you for your cooperation in this process.
-25 12/95
All Regional Substance Abuse Coordinating Agencies
($ 20,041)
(306,916)
($ 326,957)
0
FISCAL NOTE MISC. 03312 November 6, 2003
BY: FINANCE COMMITTEE, CHUCK MOSS, CHAIRPERSON
IN RE: DEPARTMENT OF HUMAN SERVICES/HEALTH DIVISION - 2003/2004 SUBSTANCE ABUSE
GRANT ACCEPTANCE
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. The Michigan Department of Community Health (MDCH) has awarded the
Oakland County Health Division $4,702,614 in Substance Abuse Grant
funds.
2. Funds will be used to subcontract with agencies to prevent and
reduce the incidence of drug and alcohol abuse and dependency.
3. The County is expected to incur $182,538 in support costs, which
have been included in the FY 2004 budget. This grant does not allow
for the recovery of these costs.
4. Grant acceptance represents a decrease from the prior year grant
amount of ($326,957) a (6.50 96) decrease from the previous year.
5. The grant period extends from October 1, 2003 through
September 30, 2004.
6. A budget amendment is recommended to the Fiscal Year 2004 Special
Revenue Budget to match the Fiscal Year 2004 award as delineated
below.
FY 2004
FUND 275 Amendment
Revenue
1-275-275497-72500-0171 State ($ 326,957)
Expenditures
2-275-354997-72500-2572 Cont Svs.
2-275-754997-72500-2572 Cont Svs.
Total Expenditures
FINANCE COMMITTEE
FINANCE COMMITTEE
Motion carried unanimously on a roll call vote with Crawford
absent.
Resolution #03312 November 20, 2003
Moved by Wilson supported by Hatchett the resolutions on the Consent Agenda be adopted (with
accompanying reports being accepted).
AYES: Coleman, Coulter, Crawford, Gregory, Hatchett, Jamian, Knollenberg, KowaII, Law, Long,
McMillin, Middleton, Moffitt, Moss, Palmer, Patterson, Potter, Rogers, Scott, Suarez, Webster, Wilson,
Zack, Bullard. (24)
NAYS: None. (0)
A sufficient majority having voted therefore, the resolutions on the Consent Agenda were adopted (with
accompanying reports being accepted).
ls-
/
I OEN APPROVE TIE DIEGOICESAUTION
STATE OF MICHIGAN)
COUNTY OF OAKLAND)
I, G. William Caddell, 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
November 20, 2003 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 November, 2003.
G. William Caddell, County Clerk
_ Vi ?IONIA 18111