Local Obligations - Requirement Exceptions. The following services shall not require the CMHSP to provide a local obligation:
A. Residential programs as defined in Section 309 of the Michigan Mental Health Code. Specialized residential services, as defined in Section 100d (6) of the Michigan Mental Health Code, includes mental health services that are expressly designed to provide rehabilitation and therapy to a recipient, that are provided in the residency of the recipient, and that are part of a comprehensive individual plan of services.
B. Services provided to people whose residency is transferred according to the provisions in Section 307 of the Michigan Mental Health Code.
C. Programs for which responsibility is transferred to the CMHSP and the state is responsible for 100% of the cost of the program, consistent with the Michigan Constitution.
D. Services provided to an individual under criminal sentence to a state prison.
Local Obligations - Requirement Exceptions. Pursuant to the MDHHS/PIHP Contract, the Payor and the Provider shall not be required under this Agreement to provide a local obligation for the Medicaid specialty supports and services that the Payor purchases and the Provider provides hereunder, as follows:
(1.) Programs for which responsibility are transferred by the State to the PIHP and the State is responsible for 100% of the cost of the program, consistent with the Michigan Mental Health Code, Public Health Code and Administrative Rules, including, but not limited to, Section 307 transfers and Medicaid hospital-based services.
(2.) Other Medicaid covered specialty services, provided under the current Medicaid program waivers approved by the Federal government and implemented concurrently by the State of Michigan, as determined by the MDHHS
(3.) Services provided to an individual under criminal sentence to a State prison.
Local Obligations - Requirement Exceptions. The following Medicaid covered services shall not require the PIHP to provide a local obligation:
A. Programs for which responsibility is transferred to the PIHP and the state is responsible for 100% of the cost of the program, consistent with the Michigan Mental Health Code, for example 307 transfers and Medicaid hospital-based services
B. Other Medicaid covered specialty services, provided under the Concurrent 1915(b)/(c) Program, as determined by MDCH.
C. Services provided to an individual under criminal sentence to a state prison
Local Obligations - Requirement Exceptions. The following Medicaid covered services shall not require the PIHP to provide a local obligation:
A. Programs for which responsibility is transferred to the PIHP and the state is responsible for 100% of the cost of the program, consistent with the Michigan Mental Health Code, for example 307 transfers and Medicaid hospital-based services
B. Other Medicaid covered specialty services, provided under the Concurrent 1915(b)/(c) Program, as determined by MDCH
C. Services provided to an individual under criminal sentence to a state prison MDCH funding includes both Medicaid funds related to the 1915(b) Waiver and funds connected to the 1915(c) Habilitation Supports Waiver. The financing in this contract is always contingent on the annual Appropriation Act. CMHSPs within a PIHP may, but are not required to, use GF formula funds to provide services not covered under the 1915(b) and 1915(c) Medicaid Habilitation Supports waivers for Medicaid beneficiaries who are individuals with serious mental illness, serious emotional disturbances or developmental disabilities, or underwrite a portion of the cost of covered services to these beneficiaries. MDCH reserves the right to disallow such use of General Funds if it believes that the CMHSP was not appropriately assigning costs to Medicaid and to General Funds in order to maximize the savings allowed within the risk corridors. Specific financial detail regarding the MDCH funding is provided as Attachment P 7.0.1.
Local Obligations - Requirement Exceptions. The following Medicaid covered services shall not require the PIHP to provide a local obligation:
Local Obligations - Requirement Exceptions. Pursuant to the MDHHS/PIHP Contract, the Payor and the Provider shall not be required under this Agreement to provide a local obligation for the Medicaid specialty supports and services that the Payor purchases and the Provider provides hereunder, as follows:
(1.) Programs for which responsibility are transferred by the State to the PIHP and the State is responsible for 100% of the cost of the program, consistent with the Michigan Mental Health Code, Public Health Code and Administrative Rules, including, but not limited to, Section 307 transfers and Medicaid hospital-based services.
(2.) Other Medicaid covered specialty services, provided under the current Medicaid program waivers approved by the Federal government and implemented concurrently by the State of Michigan, as determined by the MDHHS
(3.) Services provided to an individual under criminal sentence to a State prison. Also, the parties hereto agree that the Provider shall retain, as unrestricted local funds of the Provider, any interest income on Medicaid subcapitation funding that the Provider receives under this Agreement, except as otherwise restricted by generally accepted accounting principles (GAAP) for governmental units or Federal OMB Circular 2 CFR 200 Subpart E Cost Principles.
Local Obligations - Requirement Exceptions. The following Medicaid covered services shall not require the PIHP to provide a local obligation:
A. Programs for which responsibility is transferred to the PIHP and the state is responsible for 100% of the cost of the program, consistent with the Michigan Mental Health Code, for example 307 transfers and Medicaid hospital-based services
B. Other Medicaid covered specialty services, provided under the Concurrent 1915(b)/(c) Program, as determined by MDCH.
C. Services provided to an individual under criminal sentence to a state prison MDCH funding includes both Medicaid funds related to the 1915(b) Waiver and funds connected to the 1915(c) Habilitation Supports Waiver. The financing in this contract is always contingent on the annual Appropriation Act. The PIHP may use GF formula funds to provide services not covered under the 1915(b) and 1915(c) Medicaid Habilitation Supports waivers for Medicaid beneficiaries who are individuals with serious mental illness, serious emotional disturbances or developmental disabilities, or underwrite a portion of the cost of covered services to these beneficiaries if Medicaid payments for services to the CMHSP is exhausted. PIHP affiliate members (CPSSNs) that are under subcontract with the PIHP may use GF formula funds to provide services not covered under the 1915(b) and 1915(c) Medicaid Habilitation Supports waivers for Medicaid beneficiaries who are individuals with serious mental illness, serious emotional disturbances or developmental disabilities, or underwrite a portion of the cost of covered services to these beneficiaries that when the contract with the PIHP stipulates conditions regarding such use of General Funds. MDCH reserves the right to disallow such use of General Funds if it believes that the PIHP-CMHSP contract conditions were not met, or if it believes that the CMHSP was not appropriately assigning costs to Medicaid and to General Funds in order to maximize the savings allowed within the risk corridors. CMS approved the actuarial soundness of the capitation rates as specified in the rules contained in the Balanced Budget Act for Managed Care via an approval letter on December 22, 2003. CMS has required that BBA compliant, actuarially sound rates, and capitation payments be made since January 1, 2004. Since FY 2011, the MDCH has provided the PIHP two managed care payments each month for the Medicaid covered specialty services. One payment is based on all Medicaid eligibles within the PIHP region. This pay...
