AGENDA. Agenda Item Discussion Motion/Action. 1. Call To Order & Roll Call. 2. Public Input (Maximum of 3 Minutes) 3.1) M - S - MA Receive the report

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1 AGENDA BAY ARENAC BEHAVIORAL HEALTH BOARD OF DIRECTORS PROGRAM COMMITTEE MEETING Thursday, December 13, 2018 at 5:00 pm Behavioral Health Center, Room 225, 201 Mullholland, Bay City, MI Committee Members: Present Excused Absent Committee Members: Present Excused Absent Others Present: Colleen Maillette, Ch Justin Peters BABH: Karen Amon, Joelin Hahn, and Sara John Andrus, V Ch Thomas Ryder McRae Ernie Krygier James Anderson, Ex Off Robert Luce Richard Byrne, Ex Off Legend: M-Motion; S-Support; MA- Motion Adopted; AB-Abstained Agenda Item Discussion Motion/Action 1. Call To Order & Roll Call 2. Public Input (Maximum of 3 Minutes) Clinical Program Review 3.1) Self Determination Services & Self- Directed Services, K. Amon Request for Clinical Privileges 4.1) None Unfinished Business 5.1) None New Business 6.1) Requested Letters of Support, K. Amon & J. Hahn a) Public Safety Enhancement Grant Program b) University of Michigan s HEALing Communities Across Michigan 3.1) M - S - MA Receive the report 6.1) M - S - MA Refer to full Board for information

2 AGENDA BAY ARENAC BEHAVIORAL HEALTH BOARD OF DIRECTORS PROGAM COMMITTEE MEETING Thursday, December 13, 2018 at 5:00 pm Behavioral Health Center, Room 225, 201 Mullholland, Bay City, MI Page 2 of 2 6.2) Update on Substance Use Disorder Services Expansion in Arenac County, J. Hahn 6.3) Proposed Changes to Substance Use Disorder Licensing, J. Hahn 6.2) M - S - MA Receive the report 6.3) M - S - MA Receive the report 7. Adjournment M - S - pm MA

3 Program Committee Self Determination-Self Directed Services 12/13/18 Self-Determination is a set of principles that enable a person to have autonomy over their life including the services and supports they receive from BABHA. The principles are: Freedom to plan a full life with the supports needed Authority to control the money for the support Support both formal and informally to stay connected to the community Responsibility to use the public dollars wisely and utilize the supports to build on choice and control. Confirmation to be a full participant in life and community Services and Supports are determined by the Person Centered Planning process and identified in the Plan of Service. The Self Determination Coordinator and the Peer Supports Broker assist the individuals to develop the budget, work with the Fiscal Intermediary and to implement the plans. Case Managers also assist the individual to implement the Plan of Service. BABHA History: In place for over 15 years for people with I/DD Self Directed Care for people with MI began with an MDHHS Grant beginning in August The first person to begin Self Directed Care began on 4/5/16 Utilization of Certified Peer Brokers to assist with implementation As of May 2017 there had been 11 people on Self Directed arrangements with reduction in hospitalizations costs by $38,000 and overall service costs by $76,000. October 2017 the MDHHS grant ended and BABHA hired the Certified Peer Broker on as a part time staff. Current Status of Self Determination and Self Directed Services: Overall: 80 individuals total 18 are involved with the Certified Peer Broker 10 are individuals under 18 years old Self Directed Update: The Certified Peer Support Broker has become full time FY16-FY17 total number of hospital days were 80 days and in FY17-18 total number of hospital days were 21. Only two people had an increase in hospital days. From FY16-17 compared to FY17-18 seven budgets decreased. Overall, increase in expenses by $2,000. Supports have been utilized to increase community integration, obtaining housing, completing and maintaining basic living skills, working toward advancing education and obtaining and maintaining employment. Participation in the Human Services Research Institute to evaluate Self Direction Efforts in 6 States. We are the only agency in Michigan. Page 3 of 7

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6 Sara McRae Subject: FW: SUD Rules UPDATE From: Alan Bolter Sent: Wednesday, December 12, :23 PM To: Alan Bolter Cc: Robert Sheehan Monique Francis Subject: SUD Rules UPDATE Quick update I will provide a full legislative rundown on Friday, but things are moving fast and furious these days. On Tuesday, the JCAR (Joint Committee on Administrative Rules) committee voted 10 0 to waive the 15 day legislative requirement for the Substance Use Disorder Service Program rules. The committee came prepared to vote but Senator Hertel did ask a single question on the staffing requirements for social detox programs to the Department. The Department stated that the rules require that in a social detox program a minimum of a nurse practitioner be on site 24/7. The Department also stated again that this is the first draft and that they plan to start drafting a second round of rules in February to address this concern from Senator Hertel and additional concerns they have received such as levels of detoxification to match the national standards. Chairman Senator Stamas told Larry Horvath from the Department that they would be monitoring the drafting of phase 2 of the rules to make sure they are drafted in a timely manner. Senator Hertel added that he plans to draft proposed legislation to create some differences between the way social detox and medication detox are regulated. Prior to Tuesday s committee meeting, I had multiple conversations with LARA officials and Sen. Stamas office, I told them both we have concerns with the detox rules (significant concerns), they set higher standards than recommended by the ASAM in many areas, etc We were told by LARA that they will go through a phase 2 with these rules and will take another look at the detox part, however because of timing they cannot do that right now (pull back rules and make changes before the legislature adjourns). MY REQUEST of both LARA and Sen. Stamas was while LARA is working on phase 2 language that they do not enforce the newly adopted detox rules while they are working on crafting phase 2 rules to address the concerns. Both seemed OK with that approach. Other concerns outside of detox services were mostly addressed during the redrafting process Below are the troublesome sections of the detox rules we sent to LARA and Sen Stamas: 1. Recognize the different levels of detoxification (withdrawal management) as defined by the American Society of Addiction Medicine (ASAM). ASAM criteria are the industry guidelines for substance use disorder treatment. The Michigan Department of Health and Human Services (DHHS) adopted the ASAM Criteria for all SUD treatment programs, and the ASAM Criteria is mandated under the Michigan Medicaid Provider Manual. The staffing and service requirements for residential detoxification in the Proposed Rules do not distinguish between severities of symptoms. Instead, they mandate the same requirements across the board for all patients admitted for detoxification services. Proposed Rule 1387 requires high intensity services and staffing for all residential detoxification units, regardless of level of care (acute, subacute, ambulatory). If the different levels of withdrawal management are not utilized, many detoxification programs in Michigan will no longer be able to provide services, which will result in a reduction of access to services. 2. Eliminate the requirement to have an equivalent of one full time licensed counselor, LMSW or licensed psychologist for detoxification. The goal is to stabilize an individual in sub acute detoxification, then process a transfer Page 6 of 7

7 to a lower level of care where psychotherapy will be provided. While there are some professional counseling services in sub acute detoxification units, the emphasis is on the use of recovery support services (Peer Recovery and Case Management) in this level of care. The proposed requirement for a full time licensed counselor is not medically justified for this level of care and will increase the cost of services. 3. Do not add a new requirement to detoxification programs requiring a physical examination upon admission by a physician, PA or NP and prior to starting medication protocols. Requiring physical examinations upon admission exceeds the level of medical care necessary for this level of treatment. As stated in ASAM Criteria, a physician (or physician extender) should be available to assess the patient within 24 hours of admission. ASAM Criteria states, a registered nurse or other licensed and credentialed nurse is available to conduct a nursing assessment on admission. This proposed new requirement will force providers to limit admissions to those hours a doctor or mid level is on premises. Currently, we admit clients after hours and on weekends. All clients undergo a nursing assessment upon admission and are treated under doctor s orders and pursuant to protocols. All clients undergo a physical examination within 24 hours. This new requirement will reduce access to services and drive up the cost of services. 4. Do not add a new requirement to detoxification (or residential) programs requiring a licensed health professional sign for all medications being dispensed. Many detoxification programs supervise and monitor the selfadministration of medications. These programs have appropriately licensed, credentialed and/or trained staff and policies and procedures in accordance with state and federal laws and national accreditation standards. Trained staff ensures clients are taking medications according to physician prescription and legal requirements. To now require that process only be done by a licensed health professional unnecessarily drives up costs. Feel free to reach out with questions. Alan Bolter Associate Director Community Mental Health Association of Michigan Michigan Association of Community Mental Health Boards is now Community Mental Health Association of Michigan. 426 South Walnut Street, Lansing MI Phone: (517) Fax: (517) cmham.org Page 7 of 7