DMH System Restructuring Initiative
Access and Eligibility Workgroup Meeting Minutes
September 15, 2006

Materials distributed: Minutes of the August 11, 2006 Access and Eligibility Workgroup Meeting, Minutes of the September 13, 2006 Standards of Care Sub-workgroup Meeting, Eligibility Workgroup Research Summary, Minutes of the August 2, 2006 Finance Workgroup Minutes, and Responses to questions from the Access and Eligibility Workgroup

Present: Sandy Lewis (Chair), Tim Sheehan, Mary Smith, Brittan Harris, Gustavo Espinosa, Dan Boehmer, Donna Buss, Londa Matlick, Dan Kill and Sarnia Cotton

Mary Smith convened the meeting at 12:20 P.M. Minutes from the August 11th meeting were reviewed and approved.

Review of Minutes from the Financial Workgroup Regarding Coordination of Benefits

The group reviewed the Financial Workgroup Minutes and discussed the contents at length. S. Lewis reported and answered questions on the Coordination of Benefits options. She and M. Smith have joined the Finance Workgroup meetings as a means of addressing the interface between access and coordination of benefits. Sandy explained that the Finance Workgroup had not identified a "target and eligible population" with regard to this issue, because they had determined that to be the function of the Access and Eligibility Workgroup. Following further discussion the group supported the Financial Subgroup's coordination recommendation of Option 2 or 4 as long as no outstanding policy or legal issues exist. It was further noted that there was agreement that consumers' with outstanding balances not be penalized with regard to access to service. It was reported that a previous recommendation from the Access and Eligibility workgroup regarding the use of a standardized fee scale by all providers has been shared with the Finance Workgroup.

Access and Eligibility Sub-Workgroup Reports:

Eligibility Sub-workgroup

Tim Sheehan, chair, reported on the work of the Eligibility Sub-workgroup. The objective is to finalize recommendations regarding eligibility and submit them for consideration to the SRI. If SRI accepts the recommendations they can then be forwarded to DMH for consideration of inclusion in the Request for Proposal for the ASO being formulated by Parker Dennison & Associates (PDA). The sub-group is focusing on two issues: 1) accessibility of services to individuals who are not receiving Medicaid and those who are Medicaid eligible; and 2) developing eligibility criteria. There was much discussion regarding development of recommendations to clarify eligibility criteria based on clinical need and financial eligibility. The Services Workgroup definition of eligibility criteria for the specialized services of ACT, PSR and Residential Services were discussed as an example of eligibility related to clinical need. It was suggested that eligibility criteria for the broader range of services be considered as a fairly small number of person's need the specialized services. S. Lewis suggested developing eligibility criteria based on clinical need and financial eligibility in relation to level of care. M. Smith asked the group to consider finalizing recommendations as soon as possible so that that can be forwarded to the SRI so that they might be considered by DMH as work on the ASO RFP progresses. Discussion regarding using the Parker-Dennison survey to further inform the discussion led to a suggestion by S. Lewis that the Eligibility Sub-workgroup use the discussion and the group's recommendations as a basis for further clarifying eligibility for services. It was agreed that T. Sheehan would draft eligibility criteria related to clinical need, financial need and level of care. This draft would then be shared with the sub-workgroup and that further recommendations would be received by Wednesday, September 20th. A follow-up teleconference for the Eligibility Sub-workgroup to review and finalize their recommendations was scheduled for Friday, September 22nd, 2:00 to 3:30 P.M.

Standards of Care Workgroup

Gustavo Espinosa, chair, reported on the work of the Sub-Committee. The draft Standards Matrix developed by the workgroup was sent to the Advocacy of Care group for review to obtain feedback regarding cultural competence standards. Recommendations based on this review were incorporated into the draft. Further work will focus on prioritizing the standards to be recommended, and on specification of access indicators. S. Lewis distributed Michigan's Mission Based Performance Indicator System standards for information. A teleconference has been scheduled to address these issues on September 26th, at 10:00 A.M. D. Boehmer noted rural and urban care settings should be considered with regard to assurance of access to care with regard to the standard stating that services should be available within 30 minutes, or services should be available within 30 miles of a consumers' residence.

Next Access and Eligibility Meetings

October 4, 2006, 10:00 A.M to 1:00 P.M. and October 20, 2006, 12:00 P.M. to 3:00 P.M.

Meeting was adjourned

Submitted by Sarnia Cotton