Chapter 9. Service Array for Mental Health Medicaid Specialty Supports and Services Descriptions

Note: If you are a Medicaid beneficiary and have a serious mental illness, serious emotional disturbance, developmental disability, or substance use disorder, you may be eligible for some of the Mental Health Medicaid Specialty Supports and Services listed below.

Before services can be started, you will take part in an assessment to find out if you are eligible for services. It will also identify the services that can best meet your needs. You need to know that not all people who come to us are eligible, and not all services are available to everyone we serve. If a service cannot help you, your Community Mental Health will not pay for it. Medicaid will not pay for services that are otherwise available to you from other resources in the community. 

During the person-centered planning process, you will be helped to figure out the medically necessary services that you will need and the sufficient amount, scope, and duration required to achieve the purpose of those services. You will also be able to choose who provides your supports and services. You will receive an individual plan of serve that provides all of this information.

 

Mental Health Services

In addition to meeting medically necessary criteria, services listed below marked with an asterisk (*) require a doctor's prescription.

Note: The Michigan Medicaid Provider Manual contains complete definitions of the following services as well as eligibility criteria and provider qualifications. Customer Service can help you access the manual and/or information from it.

  • Assertive Community Treatment (ACT)
  • Assessment
  • *Assistive Technology
  • Behavior Treatment Review
  • Clubhouse Programs
  • Community Inpatient Services
  • Community Living Supports
  • Crisis Interventions
  • Crisis Residential Services
  • *Enhanced Pharmacy
  • *Environmental Modifications
  • Family Support & Training
  • Fiscal Intermediary Services
  • Health Services
  • Home-Based Services for Children and Families
  • Housing Assistance
  • Intensive Crisis Stabilization
  • Medication Administration
  • Medication Review
  • Mental Health Therapy & Counseling for Adults, Children, and Families
  • Nursing Home Mental Health Assessment and Monitoring
  • *Occupational Therapy
  • Partial Hospital Services
  • Peer-Delivered and Peer Specialist Services
  • Personal Care in Specialized Residential Settings
  • *Physical Therapy
  • Prevention Service Models
  • Respite Care Services
  • Skill-Building Assistance
  • *Speech and Language Therapy
  • Substance Use Disorder Treatment Services
  • Supports Coordination or Targeted Case Management
  • Supported/Integrated Employment Services
  • Transportation
  • Treatment Planning
  • Wraparound Services for Children and Adolescents

  

Services for Habilitation Supports Waiver and Children's Waiver Participants Only

Some Medicaid beneficiaries are eligible for special services that help them avoid having to go to an institution for people with developmental disabilities or a nursing home. These special services are called the Habilitation Supports Waiver (HSW) and the Children's Waiver. In order to receive these services, people with a developmental disability need to be enrolled in either of these "waivers." The availability of these waivers is very limited. People enrolled in the waivers have access to the services listed above as well as those listed here:

  • Goods and Services
  • Non-Family Training
  • Out-of-home Non-Vocational Supports and Services
  • Personal Emergency Response Devices
  • Prevocational Services
  • Private Duty Nursing
  • Specialty Services

  

Services for Persons With Substance Use Disorders

The Substance Use Disorder (SUD) Treatment services listed below are covered by Medicaid. These services are available through the Thumb Alliance PIHP, which has been designated by the State of Michigan as the SUD Services Coordinating Agency for Lapeer, Sanilac, and St. Clair counties.

  • Access, Assessment, and Referral
  • Intensive/Enhanced Outpatient
  • Methadone and Levo-Alpha-Acetyl-Methadol Treatment (LAAM)
  • Outpatient Treatment
  • Residential Treatment
  • Sub-Acute Detoxification

If you receive Medicaid, you may be entitled to other medical services not listed above. Services necessary to maintain your physical health are provided or ordered by your primary care physician. If you receive Community Mental Health services, your local Community Mental Health Services Program will work with your primary care doctor to coordinate your physical and mental health services. If you do not have a primary care doctor, your local Community Mental Health Services Program will help you find one.

Note: The Home Help Program is another service available to Medicaid beneficiaries who require in-home assistance with activities of daily living and household chores. In order to learn more about this service, you may call the local Michigan Department of Human Services (MDHS) number below or contact Customer Service for assistance.

Lapeer County MDHS
1505 Suncrest
Lapeer, Michigan
Phone: (810) 667-0800

Sanilac County MDHS
515 S. Sandusky
Sandusky, Michigan
Phone: (810) 648-4420

St. Clair County MDHS
220 Fort Street
Port Huron, Michigan
Phone: (810) 966-2200

 

Mental Health and Substance Use Disorder Services for Adult Benefits Waiver Enrollees

Individuals enrolled in the Adult Benefits Waiver (ABW) may be eligible for mental health and substance use disorder services such as those listed below. An assessment will determine the medical necessity for these services. The ABW enrollee may be required to pay a co-pay for these services.

Note: The Michigan Medicaid Provider Manual contains complete definitions of the following services as well as eligibility criteria and provider qualifications. Customer Service can help you access the manual and/or information from it.

Mental Health Services

  • Crisis interventions for mental health related emergency situations and/or conditions
  • Identification, assessment, and diagnostic evaluation to determine the beneficiary's mental health status, condition, and specific needs.
  • Inpatient hospital psychiatric care for mentally ill beneficiaries who require care in a 24-hour medically-structured and supervised licensed facility.
  • Other medically necessary mental health services.
  • Psychotherapy or counseling (individual, family, group) when indicated.
  • Interpretation or explanation of results of psychiatric examination, other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist the beneficiary.
  • Pharmacological management, including prescription, administration, and review of medication use and effects.
  • Specialized community mental health clinical and rehabilitation services, including case management, psychosocial interventions and other community supports, as medically necessary, and when utilized as an approved alternative to more restrictive care or placement.

Substance Use Disorder Services

Initial assessment, diagnostic evaluation, referral, and patient placement:

  • Outpatient Treatment
  • Federal Food and Drug Administration approved pharmacological supports for Levo-Alpha-Acetyl-Methadol (LAAM) and Methadone only
  • Other substance use disorder services may be provided, at the discretion of the PIHP, to enhance outcomes.

 

Medicaid Health Plan Services

If you are enrolled in a Medicaid Health Plan, the following kinds of health care services are available to you when your medical condition requires them:

  • Ambulance
  • Chiropractic
  • Doctor Visits
  • Family Planning
  • Health Check-ups
  • Hearing Aids
  • Hearing & Speech Therapy
  • Home Health Care
  • Immunizations
  • Lab and X-Ray
  • Medical Supplies
  • Medicine
  • Mental Health (limit of 20 outpatient visits)
  • Nursing Home Care
  • Physical & Occupational Therapy
  • Prenatal Care & Delivery
  • Surgery
  • Transportation to Medical Appointments
  • Vision

The Medicaid Health Plans serving the three counties are listed in the CMH brochure, which is in the pocket of the Customer Handbook. If you already are enrolled in one of the health plans, you can contact the health plan directly for more information about the services listed above. If you are not enrolled in a health plan or do not know the name of your health plan, you can contact Customer Service at (888) 225-4447.

 

Payment for Services

If you are enrolled in Medicaid and meet the criteria for the specialty mental health and substance use disorder services, the total cost of your authorized mental health or substance use disorder treatment will be covered. No fees will be charged to you.

If you are a Medicaid beneficiary with a deductible (spend down), as determined by the Michigan Department of Human Services (MDHS), or an Adult Benefits Waiver enrollee, you may be responsible for the cost of a portion of your services.

 

Service Authorization

Services you request must be authorized or approved by the Thumb Alliance PIHP. The PIHP may approve all, some, or none of your requests. You will receive notice of a decision within 14 calendar days after you have requested the service during the person-centered planning process, or within 3 business days, if the request requires a quick decision.

Any decision that denies a service you request, or denies the amount, scope, or duration of the service that you request, will be made by a health care professional who has appropriate clinical expertise in treating your condition. Authorizations are made according to medical necessity. If you do not agree with the decision that denies, reduces, suspends, or terminates a service, you may file an appeal.

 

Medicaid Fee for Service

If you do not qualify for services through the Thumb Alliance PIHP, or need medical care not covered by the PIHP, and you have Medicaid Fee for Service, call the beneficiary help-line at (800) 642-3195 for information on your benefit plan and the medically necessary services available to you.

 

Thumb Alliance PIHP Current Evidence-Based and Promising Practices

Evidenced-Based Practices (EBP) involve complex and conscientious decision-making which is based not only on the available evidence, but also on an individual's characteristics, situations, and preferences. These practices recognize that care is individualized and ever changing and involves uncertainties and probabilities. EBPs use evidence drawn from scientific study, practitioner expertise, and feedback from individuals who receive the service.

Note: All practices marked with an asterisk (*) have been implemented as a Promising Practice.

Lapeer County CMH

Adult Practices:

  • Assertive Community Treatment (ACT)
  • Dialectical Behavioral Treatment (DBT)
  • Family Psycho-Education (FPE)
  • InSHAPE 
  • Integrated Dual Disorder Treatment (IDDT)
  • Recovery & Illness Management
  • Supported Employment

Children's Practices:

  • Infant Mental Health*
  • Parent Support Partners*
  • Wraparound*

Sanilac County CMH

Adult Practices:

  • Assertive Community Treatment (ACT)
  • Dialectical Behavioral Treatment (DBT)
  • Family Psycho-Education (FPE)
  • InShape
  • Integrated Dual Disorder Treatment (IDDT)
  • Recovery and Illness Management
  • Supported Employment

Children's Practices:

  • Infant Mental Health*
  • Wraparound*

St. Clair County CMH

Adult Practices:

  • Assertive Community Treatment (ACT)
  • Dialectical Behavioral Treatment (DBT)
  • Family Psycho-Education (FPE)
  • InShape
  • Integrated Dual Disorder Treamtent (IDDT)
  • Recovery and Illness Management
  • Supported Employment

Children's Practices:

  • Infant Mental Health*
  • Parent Management Trainings - Oregon Model
  • Parent Support Partners*
  • Trauma Focused Cognitive Behavior Treatment (CBT)
  • Wraparound*