Agreement Between And CMHSP For Managed …

1 MDHHS/ CMHSP Managed Mental Health Supports and Services Contract: FY18 1 Contract Manager and Location Building: John P. Duvendeck Lewis Cass Building, 320 S. Walnut Contract Number#_____ Agreement Between Michigan Department of Health & Human Services And CMHSP_____ For Managed Mental Health Supports and Services Period of Agreement : This contract shall commence on October 1, 2017 and continue through September 30, 2018. This Agreement is in full force and effect for the period specified. Program Budget and Agreement Amount: Total funding available for Managed mental health supports and services is identified in the annual Legislative Appropriation for community mental health services programs. Payment to the CMHSP will be paid based on the funding amount specified in Part II, Section of this contract.

2 The value of this contract is contingent upon and subject to enactment of legislative appropriations and availability of funds. The terms and conditions of this contract are those included in: (a) Part I: Contractual Services Terms and Conditions; (b) Part II: Statement of Work; and (c) all Attachments as specified in Parts I and II of the contract. Special Certification: The individuals signing this Agreement certify by their signatures that they are authorized to sign this Agreement on behalf of the organization specified. Signature Section: For the Michigan Department of Health & Human Services Christine H. Sanches, Director Date Bureau of Grants and Purchasing For the CONTRACTOR: Name (print) Title (print) Signature Date V2018-1 MDHHS/ CMHSP Managed Mental Health Supports and Services Contract: FY18 2 TABLE OF CONTENTS DEFINITIONS/EXPLANATION OF TERMS.

3 8 DEFINITION OF TERMS .. 8 PART I: CONTRACTUAL SERVICES TERMS AND CONDITIONS .. 12 PURPOSE .. 12 ISSUING OFFICE .. 12 CONTRACT ADMINISTRATOR .. 12 TERM OF CONTRACT .. 12 PAYMENT METHODOLOGY .. 12 LIABILITY .. 12 CMHSP RESPONSIBILITIES .. 13 ACKNOWLEDGMENT OF MDHHS FINANCIAL SUPPORT .. 14 DISCLOSURE .. 14 CONTRACT INVOICING AND PAYMENT .. 14 14 14 15 CONFIDENTIALITY .. 16 ASSURANCES .. 16 Compliance with Applicable Laws .. 16 Anti-Lobbying Act .. 16 Non-Discrimination .. 16 Debarment and Suspension .. 17 Federal Requirement: Pro-Children Act .. 17 Hatch Political Activity Act and Inter-governmental Personnel 18 Limited English Proficiency .. 18 Health Insurance Portability and Accountability Act .. 18 MODIFICATIONS, CONSENTS AND APPROVALS .. 18 ENTIRE 19 DISPUTE RESOLUTION .. 19 NO WAIVER OF DEFAULT .. 20 MDHHS/ CMHSP Managed Mental Health Supports and Services Contract: FY18 3 SEVERABILITY.

4 20 DISCLAIMER .. 20 RELATIONSHIP OF THE PARTIES (INDEPENDENT CONTRACTOR) .. 20 20 UNFAIR LABOR PRACTICES .. 20 SURVIVOR .. 21 GOVERNING 21 PART II: STATEMENT OF WORK .. 21 SPECIFICATIONS .. 21 Targeted Geographical Area for Implementation .. 21 Target Population .. 21 Responsibility for Payment of Authorized Services .. 22 SUPPORTS AND SERVICES .. 22 Availability of 22 ACCESS ASSURANCE .. 22 Access Standards .. 22 Medical Necessity .. 24 Other Access Requirements .. 25 Person-Centered Planning .. 25 Limited English Proficiency .. 25 Cultural Competence .. 25 SPECIAL COVERAGE PROVISIONS .. 26 Nursing Home Placements .. 26 Nursing Home Mental Health Services .. 26 Prevention Services .. 27 Categorical Funding .. 27 OBRA Pre-Admission Screening and Annual Resident Review .. 27 Long Term Care .. 28 SED Waiver .. 28 OBSERVANCE OF FEDERAL, STATE AND LOCAL LAWS.

5 31 Fiscal Soundness of the CMHSP .. 31 Suspended Providers .. 31 Public Health Reporting .. 32 CMHSP ORGANIZATIONAL STRUCTURE AND ADMINISTRATIVE SERVICES .. 32 Organizational Structure .. 32 Administrative Personnel .. 32 Customer Services .. 33 Customer Services: General .. 33 Recipient Rights and Grievance/Appeals .. 33 MDHHS/ CMHSP Managed Mental Health Supports and Services Contract: FY18 4 Marketing .. 34 Provider Network Services .. 35 Provider Contracts .. 35 Provider Credentialing .. 37 Collaboration with Community Agencies .. 37 Management Information Systems .. 37 Uniform Data and Information .. 38 Encounter Data 39 Financial Management System .. 40 General .. 40 Claims Management 41 Post-payment Review .. 41 Total Payment .. 42 Electronic Billing Capacity .. 42 Third Party Resource Requirements.

6 42 Vouchers .. 42 Payment of State-Delivered Services .. 43 State Lease Expiration .. 43 Quality Assessment and Performance Improvement Program Standards .. 43 General .. 43 Annual Effectiveness Review .. 43 Service and Utilization Management .. 44 State Managed Services .. 44 Individual Service Records .. 45 Other Service Requirements .. 45 Coordination .. 45 Jail Diversion .. 46 School-to Community Transition .. 46 Children s Waiver .. 46 CONTRACT FINANCING .. 47 Local Obligation .. 47 Revenue Sources for Local Obligation .. 48 County 48 Other Appropriations and Service Revenues .. 48 Gifts and Contributions .. 48 Special Fund Account .. 48 Investment Interest .. 49 Other Revenues for Mental Health Services .. 49 Local Obligations - Requirement Exceptions .. 49 MDHHS Funding .. 49 State Mental Health General Fund Formula Funding.

7 50 Special and/or Designated Funds: Exclusions .. 50 Fee-for-Service .. 51 Implementation of Current Year Appropriation Act .. 51 Operating Practices .. 51 Audits .. 51 MDHHS/ CMHSP Managed Mental Health Supports and Services Contract: FY18 5 Financial Planning .. 52 Savings Carry Forward .. 53 General Fund Carry Forward .. 53 Expenditures to Retire Unfunded Pension Liabilities .. 53 Finance Planning, Reporting and Settlement .. 53 CONTRACT REMEDIES AND SANCTIONS .. 54 RESPONSIBILITIES OF THE DEPARTMENT OF HEALTH & HUMAN SERVICES 55 General Provisions .. 55 Contract Financing .. 55 State Facilities .. 56 Reviews and Audits .. 56 MDHHS Audits .. 57 RESPONSIBILITIES OF THE DEPARTMENT OF ATTORNEY GENERAL .. 58 MDHHS/ CMHSP Managed Mental Health Supports and Services Contract: FY18 6 TABLE OF ATTACHMENTS.

8 C County of Financial Responsibility COFR Access System Standards C Person-Centered Planning C Recovery Policy & Practice Advisory C Self-Determination Practice & Fiscal Intermediary Guideline Special Populations Metrics and Reporting Template C PASARR Agreement C SEDW Agreement C Technical Requirement for SED Children C Mental Health Court Pilot Projects C CMHSP Local Dispute Resolution Process C FSS Guidelines for Determining Eligibility of Applicants C CEU Requirements for RR Staff C RR Training Standards for CMH and Provider Staff TR C Recipient Rights Appeal Process C CMHSP Reporting Requirements C QI Programs for CMHSPs TR for Behavior Treatment Plan Review Committees C IST & NGRI Protocol C State Facility Contract C Housing Practice Guideline C Inclusion Practice Guideline C Consumerism Practice Guideline C Jail Diversion Practice Guideline C School to Community Transition Guideline C Family-Driven and Youth-Guided Policy & Practice Guideline MDHHS/ CMHSP Managed Mental Health Supports and Services Contract: FY18 7 C Employment Works!

9 Policy C CMHSP Trauma Policy C MDHHS Funding C Performance Objectives C CMH Compliance Examination Guidelines C Appeal Process for Compliance Examination Management Decisions C MDHHS Audit Report and Appeal Process MDHHS/ CMHSP Managed Mental Health Supports and Services Contract: FY18 8 DEFINITIONS/EXPLANATION OF TERMS DEFINITION OF TERMS The terms used in this contract shall be construed and interpreted as defined below unless the contract otherwise expressly requires a different construction and interpretation. Any reference to Medicaid, CMS or medical necessity is limited in application to the Children s Waiver and SED Waiver programs administered by the CMHSP as part of this contract. Appropriations Act: The annual Appropriations Act adopted by the State Legislature that governs Michigan Department of Health & Human Services (MDHHS) funding.

10 Categorical Funding: Funding or funds as applicable that are (1) designated by the state legislature in the Appropriations Act for a specific purpose, project, and/or target population or so designated by the MDHHS; and (2) identified as Categorical Funds in the contract. Clean Claim: A clean claim is one that can be processed without obtaining additional information from the provider of the service or a third party. 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. Community Mental Health Services Program ( CMHSP ): A program operated under Chapter 2 of the Michigan Mental Health Code - Act 258 of 1974 as amended. Cultural Competency: An acceptance and respect for difference, a continuing self-assessment regarding culture, a regard for and attention to the dynamics of difference, engagement in ongoing development of cultural knowledge, and resources and flexibility within service models to work towards better meeting the needs of minority populations.