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Community Mental Health programs
in Northern Michigan
C o m m u n ity M en tal Health p ro gram s in N orth ern Mi chigan p rovide or m ake referrals
fo r man m ental h ealth , develop m en tal disabili ties, or su bsta nce use diso rd er services for
p ersons that liv e in N o rth ern M ich igan .
AuSable V alley
Community Mental Health
Administrative Offi ces
N o rth east Michigan
Com m uni ty Mental Health
A dministrative Offices
1199 W. Harris Ave. • P.O . Box 310
Ta was C ity, MI 48764
1-989-362-8636 • T O O 1-800-649-3777
400 J oh nson St.
Alpena, M I 49707
1- 989-356- 2161
T OO 1- 989- 354-8 826 • 1- 888 - 836- 6282
Floyd R . Smit h, Ph.D .•
E XECUTIVE DI RECTO R
Lisa H aston-Fuller, D. O · M EDICAL DIR ECT OR
Wi lliam C hesney > R ECIPIENT R IGHTS OFfI CER
Serving th ese co unties w ith prog ram locations throughout
Iosco • O gemaw • O sco da
C harles A. White ·
EX ECUTIVE D IRE CTOR
M EDICAL D IRECT OR
Paul T . R ajasekh ar, M .D . •
Ru th H ew et t
>
R ECIPIENT RI GHT S O FFICER
Servin g these co unties w ith pr ogram locatio ns thro ugho ut
Alcona • Alpena· M ontmorency· P resqu e Isle
Hours ofopermion: A V C:.\1H offi ces
are open from 8 a.m . to 5 p.m. L'vIonday thru Friday ,
Limited addition al hours of service are available
b), arrangement with )'0111' service provider.
Northern Michigan
Substance Abuse Services, Inc.
A dministrative Offices
North Country
Co m m uni ty Mental Health
A dministrative Offi ces
2090 W est M -32, Sui te C
G aylor d MI 4973 5
1- 989-732- 1791
Acc ess C en ter: 1-8 00-6 86-0 749
One M acD on ald D rive, Suite A
Pe toskey , M I 49770
1- 800-834-3393 • T TY: 711
www .no rcocmh .org
www .nrnsas.ne t
Alexis Kaczy nski>
E XECUT IVE DIRE CTOR
Luis Oxholm, D .O . •
M WI<. AL D IR ECT OR
- • R ECIPIENT RIGHTS
David Schnei der ·
D IREC TOR OF A FFILIATIO N SERVIC ES
Serv ing these coun ties w ith program lo cations thro ugho ut
Ant rim • Charlevoix > C heboygan
Emme t > Kalkaska > O tsego
D e nni s M . P riess·
Sheryl Dey·
E XECUTIVE D IK ECTOR
D EPUTY D IRE CTO R
O F C OMMU NfTY S EKVICES A CCESS C EI T ER SERvrCE
M ike D unn·
R EGI ONAL RECIPIENT R IGHTS A DVISOR
Serving these co unt ies with program locations thro ugho ut
Alcona • Alpen a· Antrim· Benzie
C harlevo ix · C heboygan · C lare · C rawford
Emmet > Gladw in > Grand Traverse > Iosco
Isabella > Kalkaska · Lake > Leelanau
M anistee · Mason · M ecosta· M idland
M issauk ee • Montmorenc y · O ceana
O gern aw • O sceola • O scoda · O tsego
Pr esqu e Isle • R oscomm on · W e2>rford
TIle Northern Affiliation is a division ofN orth Country Community Mental H ealth and serves as the prepaid inpatient health
plan (PIHP) for mental health, developmental disabilities and substance I,/se disorder services. Information regardillg the structure and
operation (eg: organiiationa! chart, annual report, board member list, meeting schedules and minutes} ofthe PIH P is available IIpon
request, The N orthern Aif7liation does /1 0t enter into any phvsician incentive plans or cost sharing arra ngements with its providers.
For more information contact the customer services qfJice at 1-800- 834- 3393 .
CMH Handbook Table of Contents
P A GE
Area Map of Community Mental Health Coverage .. ... ......... ............................. ..... ................ . 3
Welcome to the Northern Affiliation ....................................... ...... ... .................. .. .......... ......... 4
Recovery &Resiliency ..... ...................... ....................... ........ ................ .. .......... .. .. ........ .......... ... 4
Language Assistance
5
Accessibility & Accommodations ... .. ... .. .....
5
What Services are Available?
5
Services for only Habilitation Supports Waiver
& Children's Waiver participants
10
Services for Persons with Substance Use Disorders
11
Department of Human Services Offices
12
Medicaid Health Plan Services
13
What is Managed Care?
14
What is a Provider Network?
14
What Happens if I Move?
14
How to Obtain Care
14
payment for Services
15
How to Access Other Medical Services
16
Customer Services
16
Emergency & After-Hours Access to Services
17
Emergency Rooms uocan
18
Confidentiality &Family Access to Information
18
Can I See My Mental Health Records?
19
Coordination of Care
19
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Contents CONTINUED
PAGE
2
Keeping Your Appointment
20
Person-Centered Planning
20
Topics Covered during Person-Centered Planning
21
What if I Disagree with the Plan?
22
Grievances
22
Appeals
22
If You Have Medicaid or Adult Benefits Waiver
23
If You DO NOT Have Medicaid or Adult Benefits Waiver
23
Medicaid Fair Hearing
24
Recipient Rights
24
Freedom from Retaliation
25
When Receiving Mental Health Care
25
Mental Health Glossary
23
Advocacy Organizations
28
Community Mental Health
E rnrne t C o un ty
Ausable valley
North country
Northeast Michigan
Cheb o y g an Co unty
One M acD onald Drive
Petoskey, M I 49770
825 S. H uro n, Suite 4
Cheboygan, M l 49721
(231) 347 -6701
(23 1) 627-5627
V 0
Pr esque Isle Co un ty
156 N . Fo ur th St .
R ogers C ity, M I 49 779
989-734-7223
Alpena Co unty
Charlevoix Co un ty
400 J oh nso n Street
Alp ena, MI 4970 7
Cheboygan
6250 M -66 N or th
C harlevoix , MI 4072 0
989-35 6-2 161
(231) 547-5 885
Presque Isle
A n t ri m County
on
203 E. C ayuga
Bellaire, M I 49615
(23 1) 533 -8619
Kalkaska
Co un ty
625 C o urt ho use Drive
Kalkaska, M I 49646
or ney
Otsego
A ena
Antrim
Kalkaska
Aeo a
(231) 258- 5 133
Otsego County
Montmorency
County
800 Livin gsto n I3lvd .
Gaylo rd, MI 49735
630 C aring Street
H illm an , M I 49746
(989) 732 - 7558
(989) 732- 6292
989-742- 4549
loseo
O sco da Coun ty
Iosco Coun ty
42 N . Mt. T om Rd .
Mio , M I 48647
1199 W . H arris Ave.
Tawa s City, MI 487 63
989 -826- 3208
989-362-863 6
Ogernaw Co un ty
A lc ona Co un ty
5 11 G riffin
W est Branc h , MI 4866 1
Pr ozrarn C ent er
Lake
989- 345- 557 1
H arrisville, M I 487 40
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B y Appointment Only
3
Welcome to the Northern Affiliation
The N o rth ern A ffiliatio n is the prepaid inpatien t h ealth plan (PI H P) for 13 north ern M ich igan
co u n ties. This means the Northern Affiliation mana ges the Medi caid and Adu lt Benefits W aive r
(AB W) funding for the mental health and subs tan ce use d isord er ser vice s in th e region. T h e
N o rth ern Affiliation contracts with community men tal h ealth services p ro grams (C M H SPs)
to p rov ide mental servi ces to adults with a severe an d p ersistent me n tal illn ess, ch ildren wi th
a severe emo tional d isturban ce, and indi viduals w ith dev elopmental disabili ties. T he N o rth ern
Affiliatio n also contracts with Northern Mi chi gan Substan ce Ab use Service ' (N M SAS). N M SAS,
in tu rn , co ntracts with providers across the re gion . Fo r perso ns wi th co- o ccu rring m en tal h ealt h
an d substan ce use disorders, the N o rth em Affiliation an d th e C MHSPs are committed to p ro vide
in teg rated services.
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Contac t Information :
N ort he rn Affiliatio n
One Ma c D o n ald D rive, Su ite E, Petoskey, M I 49770
23 1- 487 - 9 144 Fax 23 1- 48 7-9059
D irecto r of Affiliation Servi c s: Da ve Sch neid er
Recipie n t Righ ts: Marie M acC ord
M edical Di rector: Luis Oxh olm, D .O .
C ustomer Services: Dave Schn eider
Recovery &Resiliency
M en tal health recovery is a journ ey of healing an d transfo rm ation enab ling a perso n 'with a mental
he alth di agn osis to live a meaningfu lIife in a com m unity of h is/h er ch oice w h ile strivin g to
achieve his/ h er po te ntial.
Reco ve ry is an in di vid ual j o u rn ey th at follows diffe rent pa ths an d leads to differen t lo catio ns .
Recovery is a process and a life lon g attitude. R ecovery is uni qu e to each individu al an d ca n tru ly
only be de fined by the individ ual him/her elf. W hat m ight be re cov ery
for o n e pe rso n m ay only be pa rt o f the pro cess for anoth er. R ecovery m ay also be de fine d as
w elln ess. Men tal health suppo rts and services hel p peo ple wi th mental illn ess in th eir rec overy
j o u rney . The pe rson- centered p lann ing pro cess is used to identify th e sup ports an d servi ces n eeded
for individual reco very.
In re covery th ere ma y be relapse . A relaps e is n o t a failu re, b u t a h allenge. If a relapse is
prepa red fo r, and th e to ols and skills th at ha ve been learn ed thro ugh o u t the re co very j o u rn ey are
used , a pe rsoll can overcome and emerge a stro nger in div id ual. It takes tim e an d th at is wh y
re cov ery is a p rocess that will lead to a futur e that h o lds days of pleasure an d the en er gy to
persevere thro ugh the trials o f life.
Resiliency and development are the guiding prin cipl es for ch ildren w it h serio us em o tion al
dis turbance. Resilien cy is the ab ility to bounce back, a ch aracteristic im po rt ant to nu rt ure in
children w ith serious emotional disturbances an d their fam ili es. It refers to an individ ual's abili ty
to become successfu l despite challen ges he / sh e m ay face throu gh ou t his/ h er life.
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Language Assistance
Persons w ith a hearing im pairm ent can contact the C ustomer Services O ffice at th e followi ng TTY
pho ne number: 711. H e/ she w ill be directed to prov ide th e 1-800- 834-3393 ph on e number.
If a sign language interpreter is nee ded. contact th e C ustom er Services O ffice at 1-800 -834-3393
as soon as possible so that we call mak e certain that one is available. Sign language interpreters are
available at no cost.
If a language int erp reter is needed. contact the Custom er Services O ffice at 1-800-8 34-3393 so th at
we can arrange o ne for you. Language interp reters are available at no cost.
Accessibility &Accommodations
In accordance with federal and state laws, all buildings and progra ms of th e C MHSPs are
req uired to be ph ysically accessible to ind ividu als w ith disabilities. An y individual w ho
receives em otional, visual, or mobility support fro m a service animal, such as a dog, will be
given access (alo ng w ith th e s rvice animal) to all buildings and programs of the CMHSPs .
If you need more informa tion, or if you have qu estions abo ut accessibility or service/ support
animals, contact the Customer Services Offi ce at 1- 800- 834-3393.
If you need to request a reasonable acco mm odation on beh alf of yourself, a fami ly m ember,
or a friend , you can contact the C ustomer Services O ffice at 1-8 00-8 34-3393. Yo u will
be told how to request an accommoda tion (this can be done over the p hone, in person
and/o r in writing) and you will be told who at the agency is responsible for handling
accommodation requests.
What Services are Available
N ote: If you are a Medicaid or Adult Benefits ~Va ive r beneficiary and have a serious mental illness,
serious emotional dis turbance, developmental disabilities, or substance use disorder, you may be eligib le
f or some of thef ollowing Mental H ealth Medicaid Specialty Supports and Services. Befo re services can
be started you will take part in an assessment to l ind out if you are eligiblef or services. It will also
identify the services that can best meet your needs. You need to know that not all people who request
services are eligible, and not all services are available to everyone. if a service cannot help you, the
CiHHSP will not pay f or it. Medicaid and A dul t Bencjits IVaivcr will not pay f or services that are
otherwise available to youf ront other resources in the cotnmunitv ,
During the person-centered planning process you will be helped to identify the medically necessary
services that you need and the slifficient amo unt, scope, and duration required to achieve the purpose of
the services. You will also be able to choose who provides the supports and services . You will receive an
individual plan of service that provides all of this information.
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I II addition to meeting nscdicall» necessary criteria, services listed below marked with an asterisk *
require a physician's prescription.
Note : The M ichi gan M edic aid Provid er Man ual co ntains complet e defi nitio ns of the follo wi ng
services as w ell as the eligibility criteria and the pro vid er qu alificatio ns. The M anual can
be accessed at www.ml.us/dch·m edicaid/manuals/MedlcaldProviderManual.pdf.
Assertive Community Treatment (ACT> p rovides basic servi ces and supports essen tial
for people w it h serio us m ental illn ess to m aintain independen ce in the co m m u nity. A n A C T
tea m wi ll provide menta l health th erapy and help with m edi catio ns. The team m ay also help
access .o m m uniry reso ur ces an d suppo rts needed to ma in tain wellness and par ticipate in
so cial, ed uca tio nal, and vo cational activities.
Assessment includes a comp rehensive psychiatric eva luation, psychological testing,
subs tance use diso rder screening, o r other assessm ent (except ph ysical he alth) conducted to
determi ne a person 's level o f functio nal and men tal h ealth treatment needs .
*Assistive Technology includ es adaptive devices and su pplies tha t are no t covered un der
the Medicaid H ealth Plan o r by o ther co m m u nity resources. Th ese devices help in divid uals
to b tte r tak e care of themselves, or to b etter interact in th e place ' where th ey live, wo rk,
an d pla y.
Behavioral Management Review: If a p erson 's illness o r disability in vol ves beh aviors
that he /she or others w h o w ork with them W~U1 t to change, th e in dividual plan m ay
includ e a plan to address th e beha vio r. T his plan is called a beha vior man agement pl an .
T h e behavioral manage m ent plan is develop d duri ng perso n- ce n tered planning and th en is
app roved and revie w ed regularly by a tea m of spec ialists to ma ke sure th at it is effective and
dignified and contin ues to meet the person 's n ee ds.
Clubhouse programs are programs where me m b ers (co nsum ers) and staff w o rk side by
side to ope rate th e cl ubh ouse an d to encour age pa rticipatio n in the greater comm unity .
C lu bh ouse programs foc us OJ ! fo stering recovery, com peten cy, and so cial sup ports, as w ell as
vo catio nal skills and op po rt un ities.
Community Inpatient Services are hospital services used to stabilize a m ental h ealth
condition in th e event o f a igni ficant change in symptom ' o r in a mental health emergen cy.
Commu ni ty hospi tal services are provide d in licensed psych iatric hospitals and in licensed
psychiatric uni ts of gen eral ho spitals.
Community Living Supports (ClS) are activities provided by paid staff th at h elp adults
with eith er serious mental illness or develo pm ental disab ilities live indep enden tly and
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part icipate acri 'ely in th e community. C ommunity living suppo rts may also help fa m ilies
w ho ha 'e child ren with special nee ds such as developm ental disabilities or serious emotional
distur bance.
Crisis Interventions are unscheduled ind ividual or grou p services aim ed at reducin g or
elim inating the impac t of unexp ected even ts n m ent al health and w ell-b eing.
Crisis Residential Services are a short-term altern ative to in patien t hospi talization
pro vided in a licensed residential setting.
*Enhanced Pharmacy includes doctor ordered n on-p rescrip tion o r ov er-the-co un ter
item s (such as vitamins or cough syru p) nccessary to m anage a health cou dition is). A
person's Medicaid H ealth Plan does no t cover th ese items.
*Environmental Modifications are physical changes to a person 's hom e, car, o r work
environm ent that pro vide direct m edical or rem edial be nefit to the per on. M odifications
ensure access, protect health and safety, or en able grea ter independence for a perso n with
physical disabilities. O th er so urces of funding m ust be explored befo re usin g M edicaid funds
for env iro nm ental modifications.
Extended Observation Beds (or 23- h ur stay u nits) are used to stabilize a m en tal he alth
emergency w hen a person ne eds to b e in the hospital for only a sho rt time . An extended
obs rvatio n beel allows ho spit al staff to o bserv e and tr eat th e perso n's condition for up to
one day before disch arged to anothe r comm unity- based ou tpatient service or admi tted to the
hospi tal.
Family Skills Training is educatio n and training for fam ilies w ho live w ith and/o r care fo r
a fam ily m ember vho is eligible for specialty services or the C hildren' s W aiver Pr ogram .
Fiscal Intermediary Services help individuals ma nage their services and supports, b udget
their m on ey, and pay providers if they are using a self- de ten ni nation approac h .
Health Services include assessm ent, treatment, and professional mon itoring of health
cond itions that are related to , or impacted by, a person 's me ntal health co nditio n . A n
individual' s pri mary doc tor will tr eat any o ther health conditions he/she may have.
Home-Based Services for Children and Families are pro vided in the fami ly h ome or
in ano ther community sett ing. Servic es are individually designed for each family, and can
in clude things like m ental health therapy, crisis interven tion , servic e coordination , o r other
related supp orts.
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Housing Assistance is assistance w ith short- term , transitional, o r o ne - tim e- only expens es
associa ted with an individu al's ow n h om e that his/h er reso ur ces and other com m unity
resources cou ld not co ver.
Int ensive Crisis Stabilization is an ot h er sh ort- ter m altern ative to inpatient
h ospitalization . lntensive crisis stabilizatio n services are struc tured treatmen t and support
activities provid d by a men tal he alth crisis team in th e p rso ri' home or in ano the r
com m unity sett ing.
Int ermediat e Care Facility f or Person with Mental Retardation (ICF/MR) pro vides
24 ho ur in tensive supervisio n, health and reh abilitative servi ces, an d basic ne eds to persons
wi th developmen tal disab ilities.
Medication Administration is wh en a do ctor, nurse, or othe r licensed medical provider
gives an injection , oral medication, o r topical medication .
Medication Review is the evaluation and monitori ng of m edicines used to treat a person 's
mental he alth condition, thei r effects, an d the need for co ntin uing or ch anging th eir
medicines.
Mental Health Therapy and Counseling for AdUlts, Children and Families
includ es therapy or cou nseling designed to help im prove functioni ng and relatio nships w it h
o th er people.
Nursing Home Mental Health Assessm ent and Monitoring incl ud es a re iew of
a nursing home resident's need for, and response to, mental he alth tre atm en t, along wit h
consultations with nursing ho m e staff
*Occupat ional Therapy in clud es the evaluatio n by an occupational therapist of an
indi vidual's abilities to do thi ngs in order to take care of him / herself e 'ery day. and
treatm en ts to help in crease these abilities.
Partial Hospital Services incl ude psych iatric, psy ch ological, social, oc cupatio nal, nursing,
m usic therapy. and therap eu tic recreatio nal services in a h ospital setting under a doct or's
supervision . Partial ho spi tal services are pro vided during th e day w ith participa nts ret urn ing
ho m e at n igh t.
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peer-Delivered or Peer Specialist Services such as dr op-in centers are entirely ru n
b, co nsum ers of me n tal health serv ices. They offer help w ith food, clo thing, soci alization,
hou sing, and support to begin o r main tain me ntal hea lth treatment . Pee-r Spe cialist servi e
are designe d to help perso ns with serious mental illness in their individual recovery journey
and are pro vided by individu als who are in recovery from serio us men tal illn ess.
Personal Care in Specialized Residential Settings assists an adu lt w ith m ental illness
or develop m en tal d isabilities with activities o f daily living, self- care, and basic needs w hile
th ey are living in a specializ d residential setti ng in th e comm unity.
*Physical Therapy includes the evaluation by a physical therapist of a person 's phys ical
abilities (suc h as the way he/ she m oves, uses his/ her arms or hands, or holds his/h
and treatments to help impro ve physical abilities.
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body)
Prevention Service Models (such as Infa nt Mental Hea lth, School Success, etc. ) use both
individual and group in terv entions designed to redu ce the likelih ood in dividuals will nee d
treatment from th e p ublic me ntal health system.
Respite Care Services provide short- term relief to the unpa id pri mary caregiv ers of
individua ls eligible for spec ialty serv ices. R espite p rovides te mporary altern ative care eith er in
the fam ily h ome or in anoth er comm unity sett ing chosen by the family.
Skill-BUilding Assistance includes supp o rts, services, and training to help a person
participate activel y at school. work, vo lun teer or communi ty settings, or to learn soc ial skills
he/she may need to support him / he rself or to get aro u nd in the community.
*Speech and Language Therapy incl udes the evaluatio n by speech therapists of a
person 's ability to use and und erstand langu age and co mmu nicate with others , or to manage
sw allowi ng or related condit ions, and treatmen ts to help enhance speech , communicatio n, or
swallowing.
Substance Use Disorder Treatment Services (descriptions fol/ow the mental health
services)
Supports Coordination or Targeted Case Management: A Supports Coordinato r
or Case Ma nager is a staff person w ho helps w rite an individ ual plan of ervice and makes
sure the services are delivered. His/ he r ro le is to listen to a person 's goals and he lp him /her
find th e services anJ provid er' within or outs ide the local co mm unity mental he alth serv ices
program that will h elp achi eve the goals. A Supports C oordinato r or Case M anager may
also co n nect a pe rson to resources in the com mu nity for empl oyment, comm unity livin g,
ed uca tion , public benefits, and recreatio nal activities.
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Supported/Integrated Employment Services p ro vide initial an d o n going sup po rts,
serv ices , and train ing , usually p rovided at the j ob site , to h elp ad ults w ho are eligible for
m en tal health services fin d and k eep p aid em ploym en t in th e co m mu n ity.
Transportation m ay be provided to and fr om a perso n 's home' in order fo r h im/ her to
take part in a n on-m edical Medi caid co vere d service.
Treatment Planning assists th e co nsu m er and th ose of his/her c ho osing in th e
de velo pment and p erio d ic revi ew o f the individual plan o f service .
Wraparound Services for Children and Adolescents are com munity- based services,
offere d to fam ilies o f children diagn osised as having a serious emo tio nal d isturban ce, th at
provide individuali zed su pp o rt n ecessary to m aintain the ch ild in the family h om e.
Services for Habilitation Supports Waiver
(HSW) & Children's Waiver particpants Only
So me Medi caid b nefi cia ries are eligib le for special serv ices that help th em avo id h aving
to go to an in sti tu tio n fo r p eopl e with de velopmen tal disabili ties o r go to a n ursing h ome.
T h ese spe cial services are called Hab ilitatio n Supports W aiv er and th e C hildren 's Waiver. In
order to recei ve th ese servi ce s, peop le w ith de vel opmental disabili ties n eed to b e enrolled in
one of these wa ive rs. The ava ilabili ty o f the se w aivers i ve ry lim ited . P eopl e enro lled in the
wai vers ha ve access to th e services listed ab o ve as well as th ose listed below :
Chore Services (for Habilitation Supports Waiver enrollees) are provided b y paid
staff to help keep the person 's home clea n and safe.
Non-Family Training (for Children's Waiver enrollees) is custo m ize d training fo r the
p aid in-home sup po rt staff th at provide care for a ch ild enrolled i n the wa iver.
out-of-Home NOn-Vocational Supports and Service (for HSW enrollees) is
assista n ce to gain , re tain , o r improve in sel f-h elp , soc ializatio n , or adap tive skills
Personal Emergency Response Devices (for HSW enrollees) help a perso ll m aintain
indep endence and safety in his/ her own h ome o r in a commu nity setting. Th ese are devic es
th at are used to call h elp in an emcrgency.
Prevocational Services (for HSW enrollees) i n clude su ppo r ts, services, an d train ing to
prepa re a p er son fo r pa id emplo ym ent o r co mm u n ity vol u n teer work.
private Duty Nursing (for HSW enrollees) is in divi du alized nursin g service provided in
the h ome as nec essary to m eet sp ecialized health need s.
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Specialty Services (f or Children's Waiver enrollees) are m usic, re creatio n , art , or
massage therapies that m ay be provided to help red uce or manage th e sympto ms o f a ch ild 's
men tal hea lth co nd ition or developmental disabilities. Specialty services migh t also incl ude
spe cialized child an d family trainin g, coach ing, staff su per vision , or m o nito ring of pro gram
go als.
Services for Persons with Substance Use
Disorders
T he su bstance use diso rder treatm en t services listed below are co vered by M edicaid an d
Adult B enefits W aiver. T hes e services are available th ro ugh N orth ern Michigan Su bstan ce
Ab use Serv ices (N M SAS).
Access Assessment and Referral (AAIZ) determines th e need fo r substance use diso rder
services and vill assist in getting individ uals to th e li gh t services an d p roviders.
Outpatient Treatment incl ud es in dividual, fami ly , and gro up co uns eling in an office
settin g.
Intensive outpatient (lOP) i a service that pro vides m o re frequent and lo nge r cou nselin g
sessions each w ee k and may incl ude day or evening programming.
Methadone and LAAM Treatment is provided to people wh o have h ero in or o th er
o piate depend ence. The treatm en t consists of opiate sub stitu tio n m o nitored by a do ct o r as
w ell as n ursing serv ices an d lab tests. T hi s treat m ent is usua lly p rovided alo ng w ith oth er
o utpatient substan ce use disorder treatm ent.
Sub-Acute Detoxification is medical care in a residential set tin g for pe ople w h o are
w ithdraw in g fro m alcohol o r other drugs.
Residential Treatment is intensive ther apeutic services wh ich in clu de overn ight stays in a
staffe d , licensed facility .
Note: if you receive Medicaid or Adult Benefits r-Vaiver, you may be entitled to other medical services not listed.
Services necessary to maintain YOllr physical health are provided or ordered by your primary ca re doctor. l] yoII receive
community mental health services) the community mental health services p rogram will work with your primary ca re
doctor to coordinate your physical and mental health services. if you do not have a primary ca re docto r, the local
community mental health services pro.l!ram will help yOIl [iu d one.
11
Department of Human Services Offices
Home Help Program is ano the r serv ice ava ilable to Medi caid or Adult Benefits Waiver
beneficiaries w ho re quire in-h ome assistanc e w it h activities of daily living an d ho usehold
chores. III o rder to learn mo re ab ou t this serv ice an d o th er co m m un ity, resou
rces, vou
.
,
m ay call th e local Mi chigan Department of Hum an Servi ces n um ber belo w or co n tact th e
Cu stomer Servic es O ffice fo r assistan ce at 1-800- 834-3393.
Alcona County DHS
Cheboygan County DRS
Oscoda County DRS
PO Bo x 586
205 North State
Harrisville, MI 48740
(989) 724-2 100
827 S. Huron Street
Cheboygan, MI 4972 1
(23 J) 627-8500
PO Drawer 849
200 W. Fifth Street
Mio, MI 48647
(989) 826-4000
Emmet County DRS
Alpena County DRS
7 11 W. Chisholm
Alpena , MI 49707
(989) 354-7200
2229 Summit Park Dri ve
Petos key, M1 49770
(231 ) 348 - 1600
Ogemaw County DRS
PO Box 307
444 E. Houghton Avenu e
W est Branc h, MI 4866 1
(989) 345-5 135
Iosco County DRS
Antrim County DRS
PO Box 3 16
203 E. Cayuga Street
Bellaire , MI 496 15
(23] ) 533-8664
2 145 W. Huron Road
East Tawas. MI 48730
(989) 362-0300
Otsego County DRS
800 Liv ingston Blvd., Suit e 3
Gaylord, MI 49735
(989) 732 -1702
Kalkaska County DRS
Charlevoix County DRS
2229 Summit Park D rive
Petoskey, MI 49770
(23 1) 348 -1600
503 North Bir ch Street
Ka lkaska, MI 49646
(231) 258-8606
Montmorency County DR S
PO Box 42 7
11 636 M-32, Wes t
Atlanta, MI 49709
(989) 785-4218
12
Presque Isle County DRS
1242 W . Third Stre et
Rogers City, MI 49779
(989) 734-2 108
edicaid Health Plan Services
If you are enrolled in a M edicaid H ealth Plan the follow ing kinds of physical healthcare
ervices are available to yo u whe n your medical condition req uires th em .
Ambulance
Chiropractic
D octor Visits
Fam ily Planning
H ealth Check U ps
H earing Aids
H earing and Speech T hera py
H ome H ealth Ca re
Immu nizations (sho ts)
Lab and X -ray
N ursing H ome Care
Medical Supplies
Medicine
M ental H ealth (lim it 20 outpatient visits)
Physical and O ccupational Therapy
Prenatal C are and D elivery
Surgery
T ransportation to M edical
App ointments
Vision
If you are already enrolled in one of the h alth plans listed belo w yo u can contact the health
plan directly for more infor ma tion about the services listed above. If you are not enrolled in
a health plan, or do not kn o w the nam e of your he alth plan , you can contact the C ustomer
Services Office at 1-800-834- 3343 for assistance.
CareSource
McLaren Health Plan
2369 Woodlake D rive
Okemos, MJ 48864
(517) 349-9922
(800) 390-7 102
G 3245 Bee cher R oad, Suite 200
Flint, M f 48532
(888) 327- 0671
www.mclarenhealthplan .org
www.ccmhmo.org
Health Plan of Michigan, Inc .
Molina Healthcare of Michigan
777 W oodward Avenue, Suite 600
Detroit, M[ 48226
(3 13) 324-3700
(888) 437-0606
100 W. Big Beaver R oael , Suite 600
Tr oy, M J 48084
(248) 925- 1700
(888) 898-7969
www.hpm ich .co rn
www.m olinahealthca re .com
13
What is anaged Care?
In i higan . public mental health and substance use di o rder service s are pro vided through
man. ged car mode l. T his means that people getting services can choose a provider from
withi n a ne tw ork. Prepaid inp atient health plans, like the N orthern Affiliation , h ave to make
sure tha t servi es are available to their con sum ers.
,I
In addi tion to making sure that services are available, the N orthern Affiliation must w atch
ov er the quality o f care given to co nsum ers and con trol costs. Each CMHSP, and the
N orthern Affiliation as a who le, monitors the services and providers in its 13 county area.
T o fi nd ou t more about Mic higan's pu blic behavioral health service delivery system you can
visit the Mi chigan D epartment of Comm unity H ealth at www.michigan .gov /mdch.
What isa Provider Network?
A provid er netw ork is a gro up of agencies and p rofessionals that work wi th a C MHSP to
provid e services to con sum ers. Yo ur local C MH (AuSable Valley CMH , N orth C ou ntry
CMH, or N ortheast Michigan CMH ) typically operates th e services it provides and does no t
have a large number of con tract agencies.
T he N o rthern Affiliation has a Pro vider Directory of the agen ies with which it w orks. A
listing of all available providers, their location, telephone number, and languages spok en is
available fro m the Customer Service O ffi ce or can be found online at www.norcocmh.org .
If you have service needs that can not be addressed by the CMHSP pro vider netw ork , you
can ask your CMHSP to get services 6'0111 a pro vider ou tside of the network. T o access an
Out of N etwork Provid er, contact the Custom er Services O ffice at 1- 800- 834-3393.
What Happensif I Move?
If you mo ve, tell yo ur CM HSP and provider agen cy if you have one. Yo u may need to
change to a new C MHSP and/or provider. Y our C MHSP or provider can help yo u with
referrals. If you are a M edicaid o r Adult Be ne fits W aiver benefici ary, call your D epartmen t
of H uman Services casework er to let him / her know that 'a u mov ed and to provide your
new address.
How to Obtain Care
Everyo ne at some point in life needs a little help and support. T he local C MH specializes
in offering m any services for the prevent ion and tre atment of mental illne ss, developm ental
disabilities, and substance usc disorders. ~
14
You and your farnily shou ld receive the right car e at th e right place and at the right
tirne ,
To obtain m en tal health servi ces in nor th rn M ichigan , call th e Access C enter. T he Acc ess
C ent -r alTanges serv ices fo r persons w ith M edicaid or Adult Benefits W aiver and can assist
you in ob taining in fo rmatio n and an appo intm en t with a mental health pro vider in or near
yo ur ho m e co mm unity.
T he typ es o f services you receive w ill be based on w hat is me dically ne cessary to help you
feel be tt er.
You c an c o nta c t th e Ac c ess Center at:
1- 800-834- 3393
M ond ay- Friday: 8:00 a.m . to 5:00 p .m .
W he n yo u phone the Acc ess C en ter, a m ental health pro fessional will ask you a series of
qu estio ns to evaluate yo ur ne eds and eligib ility. O nce screened, you w ill be connected w ith
a m ental health provider in or near yo ur hom e com m unity.
• If yo u are denied access to services, yo u hav e th e right to a second op inion .
• If yo u are den ied a second o pinion, you hav e the right to file a co mplaint with th e O ffice
o f R ecipient Righ ts.
• If yo u need assisranc , call the Customer Serv ices O ffice at 1- 800 -8 34- 3393.
Serv ices you re qu st r11U t be au th orized or app ro ved by com m unity mental healt h services
pro grams. T he agency may approv e all, some, or non e of you r request. T here are tim e
fram es fo r these au tho rizations . You w ill receive no tice of au thor izatio n w ithin 14 calendar
days after you have requested the service during person- ce ntered planning, o r 'w ithin 3
business days if the request requ ires a quic k deci ion.
Any decision tha t deni es a service you request, or denies the am ou nt, scope, or dur ation of
the service that yo u request, wi ll be ma de by a healt h care professional wh o has app ro p riate
clinical expertise in treating your conditi n. Aut ho rizatio ns are m ade accordin g to m edical
necessity. If you do no t agree with a decisio n that deni es, red u ces, suspends, or terminates a
service , yOLl may file an appea l.
Payment for Services
If you are enrolled in Medicaid or Adult Benefits W aiver and m eet th e criteria for sp ecialty
mental health and substance use disorder .erv ices, the total cost of your authorized m en tal
he alth or substance use disord r treatm ent will be covered.
[f you are in a M edi caid D eductible (Spend Do wn) prog ram , as determined by the Mi chigan
D epartm en t of Hu man Scr ices, yo u may be responsibl for the cost of a portion of yo ur
servic es.
Staff will work with you and yo ur insur ance co m pany to make paymen t arrangemen ts and
answ er yo u r qu estions about costs and paym ent.
~
15
How to Access Other Medical Services
If yo u h ave M edica id or Adult Benefits W aiver, you may be eligib le for other m edical hea lth
care serv ices. T o learn more about additional benefits you m ay be en titl ed to an d available
transportatio n serv ices, co ntact your Departm ent of Human Services caseworker, your health
plan , or th e State of Michi gan Recip ien t Hotlin e at 1- 800- 642- 3195 .
For fu rt her information on Publi c T ransportation please con tact:
Antrim C o un ty T ransp ortatio n
4700 S. M-8R H ighway, P.O. Box 120 •
Bellaire, M I 49615
(231) 533- 8644
1036
Kalka ska C o un ty Transi t
1251 Island Lake R oad N W
Kalkaska, M l 49646
(231) 258-6 808
Charlevo ix C o un ty Trans it
1050 Brockway Street
Boyne City , M I 49712
(231) 582-6900
Friendship Center Tran sit
1322 Anderson R d. • Petoskey, Ml 49770
(231) 347- 32 11
Ios co Trans it C o rp
ulerich· East T awas, M l 48730
(989) 362-6 681
Otsego County Bus System
1254 Energy Drive > Gaylord MI 49735
(989) 732- 6224
Straits Regi onal Ride Bus System
1520 Levering R oad • C heboygan, M I 4972 1
(23 1) 597-9262 · (866) 73 1- 1204
O-CATS
1226 S. M- 72· Mi o, MI 48647
(989) 826-5 078
T h und er Bay Transportation Authority
3020 US- 23 South· Alpena , MI 49707
(989) 354- 2487
Ogem aw County Public Transit
1383 Airpo rt R oad· W est Branch, MI 48661
(989) 345 -5790
if you have M edicaid or A dult Benefits
W aiver, transp ortatio n assistance is available through your DHS offi ce.
You may discuss your needs with your community mental health services provider who may be able to assist you in
arranging transportation.
Customer Services
TIle Focus of Customer Services is Cu stomer Satisfaction,
Services Include:
• Info rmation about services
• How to access .erv ices
• Eligibility and finan cial issues
• Problems resoluti on
• Co nsu m er in vo lvem ent
• C om m unity informa tion and education
For mo re info rmati on con tact:
Behavioral h ealth w ellness
Public relations
Region al Grievance & App eals issues
Imple mentation of the consu m erism /
custo m er service gui delin es
• In depe ndent facilitators for
person- centered planni ng
•
•
•
•
(CustO/l/ <,/, Sf/vice Slai Fare available NI-Ff rolll 8:30 am to 5:00 pm .)
AuSable Valley CMH
Lois Gartlan d 1-989-362-863 6
Northeast Michigan CMH
N o r th Country C M H
R uth H ew ett 1- 989-358- 7847
M arie M acCord 1- 23 1-347- 0740
N o rt h er n Affiliation
Da ve Schn eider 1-800-834-3393
Contact the Customer Serv ice Office after-hours bye- mail: customerservice srgznorcocmh. org
16
Emergency &After-HoursAccess to Services
A rnental health etnergency is when: (1 ) A person is exp erien cing a serio us me ntal illness o r
developmental disabilities, or a chi ld is experien cing a serious emoti onal distu rbance and can
reasonably be expected in the near future to harm h im / herself or an ther; (2) Because of his/ her
inability to me et his/her basic needs, is at risk of harm ; (3) T he person's j udgm ent is so im paired
tha t he/sh e is unable to understand the need for treatmen t and that his/ her co ndition is
expected to result in harm to him /herself or ano ther individual in the near fu tu re. Yo u have
th e right to receive em ergency services at any time, 24- hours a day, seven-days a week, without
prior authorizatio n for payment of care.
If you have a mental health emergency. you shoul d see k help right away. At any tim e d uring
the day or night call: Third Level Crisis C en ter at 1-800-442-7315
If you ha ve a m en tal health emergency, get help .
1/1 summary, a sit u ation is considered a mental health c/lwgency when:
• A person is at immediate risk (2f intentionally or unintentionally harming him/h erself or others.
• A person has a mental illness but docs not understand the needfo r treatment.
If you have a life-threatening etnerg ency. y o u should call 911 right away.
]f you are experiencing a mental health nisi ' and you ne ed help :
During normal business hours:
• Yo u can co ntact the Access Center at 1- 800-834-3393 .
• You can call o r go dire ctly to your local community mental health office, or
• You can go to the nearest ho spital emergen cy roo m, or
• Yo u can call 911 tor assistan ce.
For after hours assistance:
• You can contact Thi rd Level Crisi s C en ter at 1- 800- 442- 731 5, or
• YOll can go to a crisis cent er or to a hospital emergency ro om , or
• You can call 911 for assistance.
Don't w ait until yOll have an eme rgency to get help . Ac ting early can kee p problems from
becoming bigger. Qualified assistance is always available to help you any tim e of th e day or night .
]fyo u have M edicaid or Adult Be ne fits W aiver, th ere is no requirement for prior authorizatio n
for em ergency serv ices and yo u may USe any hospital or ot her setting to access emergency care.
Post Stabilization Services
After you receive emergency men tal health care and your condition is u nder control, yo u may
receive me ntal health serv ices to make sure your co ndition continu es to stabilize and improv e.
Exa mples of post-stabilization services are crisis residential, case manage m ent , outpati ent therapy,
and/or medicatio n reviews.
17
Emergency Rooms
The lo ca tio ns of lo cal hospital etn ergency roorns are:
Alpena Regional
Medical C en ter
1501 W . C hisholm
Alpena, M I 49707
1-989-3 56- 7390
Northern Michigan Regional
H o spital
416 Connable Street
Petoskey, M I 49770
1-231-487-4000
Charlevoix Area
H o spital
14700 Lake Shore D rive
C harlevoix, MI 49720
1-23 J-547-40 24
O tsego
Memorial Hospital
825 N . Center Ave.
Gaylord, MI 49735
1-989-731-2100
Ch eb oygan
Memorial Hospital
748 Main Street
C heboygan, M I 4972 1
1-23 1-627- 5601
T aw as St . Joseph
H o sp ital
200 H emlock
T awas City, MI 48763
1- 989-362-3411
Kalkaska
Memorial Health Center
419 S. Coral
K alkaska , M I 49646
1-23 1.-258- 7500
West Branch Regional
Medical C en te r
2463 S. M-30
W est Branch, MI 48661
1-989-345-3660
If there is no hospital nearby or if you do not know where one is, call 911 for assistance.
Confidentiality & Family Access to Information
You have the righ t to have info rmation abo ut yo ur m en tal h ealth treatm ent kept private .
Information abou t you can only be give n to o th ers with your perm issio n . Y ou also h ave th e
righ t to lo ok at y ur o w n clinical reco rd and add a fo rma l statement if you w ish . There are
tim es however, w hen yo u r info rm atio n is shared in o rde r to coo rdinate your trea tm ent o r
when it is required by law .
Family members have th e righ t to p rovide informa tio n to the commu nity m ental h ealth
services program abo u t you . W ith out a signed Release of Information fro m yo u however,
the c mmunity m ental he alth p ro gram m ay no t give info rmatio n abo ut you to a fam ily
m em ber. For m inor child ren (u nder th e age of 18 years), parents are provided info rm atio n
about th eir child and mus t sign a Release of Inform atio n to sh are w ith oth ers.
18
If yo u receive substan c use disorder services, you h ave specific rights related to
co nfidentiality.
U nder HIP.I\A (Health Insura nce Portability and Ac countab ility Ac t), you w ill be
provided with an official Notice of P rivacy from yo ur comm unity m en tal he alth services
program. This no tice will tell you all th e w ays that informatio n about yo u can be used or
disclosed. It will also include a listing of your rights provided und er I-lIPAA and how yo u
can file a complaint if yo u feel your righ t to pri vacy as be en violated.
If you feel your confidentiality rights have been vio lated , yo u can call th e R ec ipient Ri gh ts
O ffice w he re you receiv e services.
Can I See My Mental Health Records?
If you arc at least 18 years ol d and do no t ha ve J guardian , you ma y see yo ur reco rds. If yo u
are not yet 18, you and yo ur parents or gu ardia n ma y see your rec ords unle ss it would be
h armful to you or them. If you want a copy of all or part of your records, the C M HSP may
charge you a fee.
If you think something in yo ur records is wro ng, yo u can add a statement about w hat yo u
think is wrong. The CMHSP ho 'lever, cann o t change or take anything out of yo ur re ords.
If you have qu estions, ask th e staff at the co m m unity m en tal health program . T hey vill help
you get more information .
Coordination of Care
T o improve service quality, th e community men tal h ealth program w ants to co ord inate
yo ur care with the medical pro vid er who cares for your physical health. [f yo u are also
rec eiving substanc e use disorder serv ices, coo rdination of your me nta l health care wi th those
services is im portant. Bein g able to coordinate with all provider in 0 ] -ed in treating you
im proves your ch ances for recov ery, relief of sym p toms, and im proved func tion ing . You
are en courag .d to sign R elease of Info rmatio n form s w ith yo ur in dividual mental h ealth
prov ider (s) so th at in formation can be shared w ith the medi cal doctor, and if applicable, the
substan ce usc disorder providers. If you do not have a medical do ctor and n ee d O Il C, contact
the Custo mer Services Offi ce at 1-800- 834-3393 for assistance.
19
Keeping Your Appointment
In order to receive the best care possibl , you are enco uraged to tell the C MH staff about
past men tal heal th treatment, such as hospitalizations, medicatio ns, or anything else abo u t
yo ur mental he alth .
W hen it is time for yo ur appo intmen t, please rem ember to:
• Be on time
• Bring your insurance and/or y o ur Medicaid or Adult Benefits Waiver card
• Bring proof of income
• Give 24-hour notice if you need to change or cancel your appointment
Person-Centered Planning
The process used to design your individual plan of m ental health suppo rts, services or
treatm ent is called person-centered planning. Pe rson- cent ered plan ning is your righ t and
is p ro tected by the M ichiga n M ental Health C od e. T he perso n- cen tered process begins w ith
pre-planning. Pre-planning i w hen decisio ns ar ma de abo ut the plan of ervice meeting
suc h as who , o th er than yo ur elf (family me mb ers or frien ds), you w ould like to attend , w hat
staff from th e C MHSP yo u wo uld like to attend, and w hen and w here th e plan of service
meeting w ill take place. Y ou w ill also decide what assistance you migh t ne ed to help yo u
particip ate in and u nde rstand the meeting. D uring person- centered planning, you w ill be
a ked to ident ify yo ur hopes a id dream s, your stren gt hs, needs, abilities, and preferen es
fo r services. Y ou will be helped to de velo p goals or outcomes yo u w an t to achieve. The
pe ople attending th e m eeti ng will help yo u de cide vhat supports, services, or treatme nt are
app rop riate, w ho would b st provide the services, how often you need th e servic es, an d
wh ere th e services w ill be pro vide d. Y ou have the righ t under federal and state laws to a
choice of providers.
After yo u begin recei ving services. yOll will be asked from time to time how yo u feel
about the supp orts, services. or treatm en t yo u are receiving and w h eth er or not changes to
them ne ed to be made. Yo u have the righ t to ask, at any time, for a new person-c en tered
plannin g- meeting if you want to talk abo ut chan ging your indi ridual plan of service.
You hav e th e righ t to independ ent facilitation of the pe rson- cen tered planning process.
T his means that you may request that som eone o ther than the commu nity m ental health
pro gram staff conduct your planning meeting. You have the righ t to ch oose from available
indep ende n t facilitators. You m ay co ntact the C ustomer Services O ffice at 1-800-834-3393
for m ore inform ation .
20
C hildren under the age of 18 with developm ental disabilities or serious emo tio nal
disturbance also have the right to person- centered p lanning. P erson- cen tered planning m ust
recognize th e im portan ce of the family and the fact that suppo rts and services impact the
entire family. T he parents or gu ardians of the childre n will be involved in the pre- planning
and person - centered plann ing using family-center ed practice in the delivery of supports,
services, and treatment to th eir chil dre n.
Topics Covered During Person-Centered
Planning
D ur ing person- centered planning, you will be told abou t psychiatric advance directives, th e
right to a crisis plan, and the op tion of self-determination (see the descriptio ns below). You
have the righ t to ch oose to de velop any , all, or no ne of th ese.
psychiatric Advance Directive
Adults have the right under M ichi gan law to a psychiatric advance directive. A psychiatric
advance directive is a too l tor mak ing dec isions before a crisis durin g wb ich you may
become un able to make a decision about the kind of treatm ent you want and the kind of
trea tmen t you do not wan t. T his lets o ther people, including family, friends, and service
providers, kn ow w hat you wan t when you canno t speak for yourself
Crisis Plan
You also have the righ t to develop a crisis plan. A crisis plan is in tended to give direct
care if you begin to hav e problems managing your life, or you be come un able to make
decision s abo ut, andlor care fo r, yo urself T he crisis plan gives information and directio n
to others abo ut w hat yOll wo uld like do ne during a time of crisis (m ends andl or relatives
to be contacted , preferr ed medicines, or care of chil dren, p ts, o r bills.)
Self - determination
Self-determ ination is an op tion for payment of medically necessary services you might
request if you are an adult beneficiary receiving m ental health services in Mi chigan . It
is a process that w ou ld help yo u to design and exercise cont rol over yo ur own life by
directing a fi xed amo unt of do llars that will be spent on your autho rized supports and
services, often referred to as an individual budget. Yo u w ould also be supported in your
managem ent of providers, if you choose such control.
21
What if I Disagree with the Plan?
Sometim es you and your worker wo n 't agree in the pro cess of developing your perSOll­
centered treatmen t plan. If/ when this happens, w e can neg otiate to see w h ther there are
o th er ways to mee t your goals and ou tcom es.
Here are so me helpful h ints to keep in mind:
• W hen an agreement can' t be reached, take a break and agree to talk in a few days.
• W hen nego tiating, evely one needs to keep a positive and open mind.
• R equest the inpu t of someone you trust to help you work out the plan.
• C ustomer services staff can provide you wi th an in dependent facilitator at no cost to y o u ,
• Discuss co nflict as a positive op po rtunity
to
increase inv olvement of others.
• Sugge. t, com pro mise, and discuss a trial period.
• Listen with respect to each other' s opinions
Yo" can also talk to a supervisor or fil e a grievance.
Grievances
Yo u have the righ t to say tha t you are un h appy with yo ur services or supports, or the staff
w ho provide them, by filing a grieva nce. You can file a grievance any tirne by calling,
visiting, or wr iting to the Custom er Services O ffice. Assistance is available w ith the filing
process by contacting Ca rol Balous ek at 1-800- 834- 3393 . Y ou will be given de tailed
information about grievance and appeal processes when you first start services and th en again
annually . You may ask tor this info rmati o n at any time by contacting the C ustomer Service
O ffice. Your grievance vill be resolved w ithin 60 days.
Appeals
Yo u will be given notice w hen a decision is made that denie your requ est for services or
reduces, suspe nds, or termi nates the services you already receive. You have the righ t to file
an appeal vhen you do not agree with such a decision. T here are tw o ways yo u can app eal
these d cisions. There are also time limits on when yo u can file an appe al on ce you receive
a decisi n about your services.
22
If you have Medicaid or Adult Benefits waiver
• You may talk to your CMH worker and/or his/her supervisor.
• You may file J rights complaint,
• You l11Jy requ est a review verbally or in writing (within 45 days) through the Local
Appeals process.
• You InJy request J Medicaid Fair Hearing within 90 days from the date of the action.
• You mav ask for the se reviews in anv order or at the same time.
,
J
In most cases, you wi ll be able to con tin ue to receive your M edicaid or Adult Benefits Waiver
cov ered. services durin g the appeals process. If you continue to receive the services and your
local or state level appeal is denied. you can be charged (up to your monthly ability to pay) for
the services that you r .ceived during the time of the appeal,
If you are satisfied. with the outcome of the Local Appeals process and you have already filed for
an Administrative Fair H earing, your C M H worker can assist you in withd rawin g your reque t
for J hearing.
If you DO NOThave Medicaid or Adult Benefits Waiver.
• You may talk to your CMH worker and /or his/her sup ervisor.
• You may file a rights complaint.
• You may, request a review verbally or in writing (w it hin 45 days) th ro ugh th e Local
Appeal. Process.
• Y all may, aficr the Local Appeals Process, access the state level Alternative Disput e Resolution
Process. You must mak e this request within 5 days fro m the date of the written notice .
• You may access the state level Alternative Dispu te Resolu tion Process by writing to :
Departmen t of Community Health
Divisio n of Program Development, Consultation and Contract
Bureau o f Community M ental H ealth Services
ATT N : Request to r DCH Level Dispu t Resolu tion
Lewis Ca ss Building - 6th Floor
Lansing, M I 48913
In revie v, if yo u have M edicaid or Adu lt Ben efits W aiver, you may :
• Ask to r a L cal App eal by contacting the C usto mer Services O ffice at
'1- 800- 834- 3393.
• Ask at any tim e fo r a M ed icaid Fair H earing before an Ad m in istrative Law J udge (a
state appeal).
Y our appeal will be com pleted quickly, and yOll wi ll have the chance to provide information
or have som eone speak for yo u regarding the appeal. Y ou may ask fo r assistan ce fro m the
C ustom er Services Offi ce to file an app eal.
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23
Medicaid Fair Hearing
Y Oll can ask the State of M ichigan to review any problem at an time. T his type of review is
called an Administrative Fair Hearing.
T o obtain an Administrative H earing Form, yo u can con tact your comm unity mental health staff
person or the C ustome r Services Offic e at 1-800-834-3393.
Mail yo ur com pleted fonn to:
A dministrative Tribunal Mi chigan Departmen t of Community H ealth
P.O. Box 30763 • Lansing, MI 48909 1- 877-8 33-0870
After the Administrative Tri bunal receives your request for a hearing, your hearing will be
scheduled and a noti ce will be mailed to you or your representative w ithin 30 days.
Your appea l wi ll be com pleted qu ickly and you will have th e chance to provide information
or have someone speak for yo u regarding th appeal. You ma y ask for assistance from the
Customer Services O ffi ce to file an appeal.
Staff that can help with a grievanc e or appeal are :
AuSable V alley CMH
J ohn Moran: 1-989- 362- 8636
Northeast Mi chigan CMH
Ru th H ewett: 1- 989-358- 7847
N o rth Co untry CMH/ N o rthern Affiliation
Carol Balo usek: 1-23 1-4 87- 9144
Recipient Rights
Every person who receives public mental health services has certain rights. The Mi chi gan
M ental Health C od e protects these rights.
Som e
• T he
• The
• T he
• T he.
of yo ur
rig ht to
righ t to
right to
right to
righ ts includ e:
be free from abuse and n eglect
confidenti ality
b treated w ith dignity and resp ect
treatment suited to co nditio n
M ore informatio n abo ut your li ghts is contained in th e bo oklet pu blished by the MDCH
titled Your Rights. Y ou will be given thi s bo oklet and have yo ur rights explained to yo u
wh en you first start service , and anually th ereafter. You may also ask to r this booklet at any
tim e.
Yo u may file a recipient rights com plaint any time you think your rights have been
violated. Y o u can make a rights complaint eithe r verbally or in w riting.
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24
If yo u rece ive substance use disorder ser 'ices, you have rights protected by the Public
Health C de. T hese rights will also be explained to yo u wh en yo u start serv ice s and then
annually. You can find more in form ation abou t righ ts for substance use disorder
services in the Know Yo ur R ights pamphlet.
You may o ntac t your local co mmunity mental health services program to talk with a
Recip ient Rights Officer w ith any qu estions you may have about your righ ts or to get
help to m ak e a complain t. The C ustomer Ser vices Office can also he lp you make a
co mplaint .
Local Recipient Rights Offi ces:
AuSable V alle y CMH
Bill Ch esney
1-800-763-9518
Northeast Michi g an CM H
Ru th Hewett
1-800-968- 1964
North Country CMH
M arie M acCord
1-800-281-0481
Northern Mic higa n Substance Abuse Services
Mike Dun n
1-877-255-6226
Freedom from Retaliation
If yo u use pu blic mental he alth or sub stan ce use disorder services, you are free to exercise
your righ ts and to use the rights protectio n system with o ut fear of retaliation, harassment, or
discriminatio n. In add itio n, under no circumstance s w ill the pu blic men tal health system use
seclusio n o r restrain t as a means of coerc ion , discipline , convenience, or retal iation .
When Receiving Mental Health Care
Y ou are encour aged to play an active role in yo ur mental he alth care. Y ou can do this by:
• Keeping yo ur appointments
• Being on time
• Following thro ugh with treatm ent during sessio ns and be tw een sessions
• Asking questio ns when you do n' t understand or agree wi th any part of your care
• R ep orting changes in the way you fed or problems that yo u are having wi th the treatmen t
You have the righ t to refuse treatment if it do es not pu t you or someone else in danger. Y ou cannot
re fuse tr atment that is ordered by a court of law .
O ur goal is to provide a sate enviro n me nt. T o this end, no one is allowed to bring weapons or dru gs
into co m mu nity men tal health pro grams or facilities.
25
Mental Health Glossary
Access: T he en try poi nt to the p repaid inpatien t health plan (P IH P) , som etimes called an
Access C enter, whe re M edicaid or Adu lt Benefits Waivers bene ficiaries call or go to request
mental health .ervices.
Adult Benefits Waiver: A spec ial M ichig an M edicaid pro gram for certain low-i ncome
adults w ho are no t eligible for th e standard M edicaid program . Cont act yo ur local D epartm en t
of H uma n Services for m ore info rmation (see page 12 of thi s booklet fo r a listing). T his is a
narro wly define d benefi t that en titles yo u only to th e Al3W services described in this broch ure.
Amount, Duration. and Scope: H ow m uch, how long, and in what ways the Medicaid
or Adult Benefits Waiver servic es that are listed in a person 's individual plan of service will be
provided .
Beneficiary: An individual w ho is eligible fo r and enrolled in th e Me dicaid or Adult Be nefi ts
Waiver progra m in Mic higan .
CA: An acro nym for sub stance use disorder coordin ating agency. T he CAs in M ichigan manage
services for people w ith substanc e use d isorder .
CMHSP: An acronym for conunu niry m ental heal th services program. T here are 46 CMHSPs in
M ichigan that provide services ill the ir local areas to people with m en tal illness and
de velopm ental disabilities.
Deductible (or Spend Down): A term used w h en individuals qualify for M edicaid coverage
eve n tho ugh the ir coun table incom es are higher tha n the usual Medicaid incom e standard.
U nde r this pro cess, the medical expenses tha t an individua l incurs during a m ont h are sub tracted
from the indivi du al's in com e du ring that month . O nce the individua l's inco me In s been redu ced
to a state-s pecified level, the individu al qua lifies for M edi caid benefits for the rem aind er of the
. m omh.
Developmental Disability: D efined by th e Michigan M ent al H ealth C ode and means either
of the follo wing: (1) If app lied to a person olde r tha n five years, a seV TC ch ro nic con dition that
is attrib utable to a me nt al or physical im pairment or both, and is ma nifested befo re th e age of 22
ye ar' , is likely to con tin ue ind efinitely, and results in substan tial functional lim itations in three or
m ore areas of the following major life activities: self- care, recep tive and exp res ive b ngu age,
learnin g, mobility, self- direction , capacity for indep enden t living, and eco nomic self-sufliciency;
and re flects th e ne ed for a comb ination and sequence of special, in terdisciplina ry, or gene ric
care, treatm en t, or other ser vices th at are of life long or exten ded duratio n: (2) If applied to a
minor fro m birth (0 age five, a substanti al de velop m en tal delay or a specific co ngenital or
acguire d conditio n wi th a h igh p ro babili ty o f resulting in a develop m ental disability.
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26
Fair Hearing: A state level rev iew of a beneficia ry 's d isagreement w ith his/ h er h ealth plan 's
denial, re du ction, susp ension, or termination of Medi caid o r Ad ult Benefits W aiv er services. A
State Ad mi nistat ive Law Judge w ho is independent o f the Mich igan Departm en t of C om m u nity
Health p er forms the reviews.
Health Insurance portability and Account ability Act of 1996 (HIPAA): Legislatio n aim ed ,
in p art , at p ro tecting the privacy and confiden tiality of pati en t informatio n . A patien t is any
rec ipie n t of publ ic o r private h ealth care, in cluding m ental h ealth care servi ce s.
MOCH: A n acron ym fo r Michigan Department of Commu n ity H ealth. This state departm en t,
lo cated in Lansing, o ve rsee s public- funded serv ices provide d in local com m uni ties and state
r;lCilities to people with m ental illn ess, developm ental d isabilities, and subs tan ce use diso rd ers.
Med ically Necessary: A term used to describ e o ne o f th e criteria that m u st be m et in orde r
for a beneficiary to re ceive Medicaid o r Ad ult B en efits W aiver service s. It means tha t the speci fic
service is expec ted to help the beneficiary w ith his/her mental health, de -elopm n tal disabili ties,
or substan ce use (o r any other medical) con di tio n . Some services assess needs and so m e serv ices
help mainta in or im pro ve fiin ctioning.
Michigan Mental Health Code: T h e state law tha t govelllS public m ental health services
provided to adul ts and children w ith men tal illness, serio us emo tional disturbance, an d
d ev elo p m ental disabilities by local community mental he alth servi ce pro grams and in state facilities,
MIChild: A Michigan health care program tor lo w - in co m e children w h o are not eligible for th e
M edicaid pro gram. This is a lim ited ben efit. C o ntact yo ur lo cal D ep art m ent o f Human Servi ces
Office for m o re in formatio n . (See p age 12 o f this booklet fo r a listing.)
PIHP: An acro nym for prep aid inpa tient h ealth plan. T h ere are 18 P IHPs in M ichigan that
manage th e Medicaid and Adult Bene fits W aiver m en tal h ealth , developm en tal disabiliti es, and
substance use diso rder servic es in th eir geograp h ic areas. All 18 P IHPs are also co mmu nity m en tal
health serv ic s programs,
Recovery: A j o u rn ey of heali ng and cha n ge allo wi n g a perso n to live a m eaningful life in a
commun ity o f his/ her choi ce while working tow ard his / h er full p o ten tial.
Resiliency: The ability to bounce back. T his is a characteristic im po rtan t to n urt ure in chi ldren
w ith serio us emotio nal disturbance and their fam ilies. It re fers to the in divid ual's ab ility to becom e
su ccessful desp ite challenges he /she may face throu ghout his/ h er life .
Specialty supports and Services: Is a term that m eans M ed icaid or Ad ult Ben efits W aiver
fu nded m ental h ealth , develo pm ental d isab ilities, an d su bstance use disorder supports and servic s
that are m anage d by th e p repaid inp at ien t healt h plans (P IH Ps).
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27
Glossary CONTINUED
SED: An acronym for serio us em otional disturbance. As define d by the M ichigan M en tal Hea lth
Code. SED is a diagnosable men tal, b havioral, or emotional disorder affecting a child that exists
or has existed during the past year fo r a period of time sufficient to me et diagnostic criteria
specified in th e mos t recent Diagnostic and Statistical M anual of Mental Disorders, and has resulted
in functio nal imp airment th: t substanti ally interferes with, or limits, th e child's role
or functioning in family, school, or com munity activities.
Serious Mental Illness: Is de fined by the M ichigan M ent al H ealth Co d to mean a
diagnosable mental, behavioral , or emotional disorder affecting an adu lt that xists, or has
existed, within th e past year for a period of time sufficient to me et diagnos tic criteria specified in
the m ost recent D iagnostic and Statistical Manual if Mental D isorders, that has resulted in func tion
impairm ent that substantiall y interferes wi th , or lim its, one or more m ajor life activities.
Substance Use Disorder: Defin ed in th e Mi chigan P ublic Hea lth C ode to mean the
taking of alcohol or other drugs at dosages: (1 ) T hat place an indi -idual's social, economic,
psych ological, and/o r physical welfare in po tential harm ; (2) T o th e exte nt that an ind ividu al
loses the power of self.. . control as a result of th e use of alco hol or drugs; (3) That while habitually
under the influ ence of alcohol or drugs, endangers pu blic safety, health, and/ or welfare.
Advocacy Organizations
O the r organizations that can assist in yo ur recovery pro cess:
ARC / Michigan
1325 So uth W ashington Ave.,
Lansin g, M r, 48910
(517) 487- 5426
Michigan Protection and
Ad vocacy Services, Inc.
106 W . Allegan. Ste. 300
Lansing. MI 48933
(800) 288.. . 5923
U n ited Cerebral Palsy-Michigan
4970 orthwind Drive . Ste. 102
East Lansing, ~l I . 48R23
(800) 828- 271 4
Asso ci a tio n for Children's
M en tal H ea lt h
National Al lian c e for the Mentally III (N AM I)
6017 W est St. J oseph H wy ., Ste. 200 92 1 N orth W ashingto n
Lansing, M I, 48917
Lansin g, M r 48906
(517) 372-4016
(800) 33 1- 4264 or (517) 485.. . 4049
Michigan D isab ili ties Rights
Local Chap ters:
Coalition
NAMI - Northeas t Miclligan (989) 471-5 105 or ( 9 ~ l)) 255-07 35
3498 East Lak e Lansing R d ., Sre. 100
NAMI - Nort hern Lo wer Micl,igan (231) 347-1 8t\7
East Lansing, M I. 48823
N A M I - Northwest Michiga» (231) 256-0 152
(517) 333-2477
T his handbook is available on a cassette tapc and CD. If you w ant a copy of the cassette or CD,
please contact the Customer Services Offi ce at 1-800-834-3393.
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28
Important Names and Phone Numbers
Ple a e till out an d keep this in a place where you can find it easily.
(I nclude nam e an d phone numb er)
Mental Health Provider
_
Psychiatrist
_
Medical Doctor
_
Pharmacy
_
I am allergic to
_
I take th e following m ed ications on a regular basis:
N am e of Medication
Dosag e
24-hour Crisis Line
1-800-442-7315
Instructions
M any op p rt unities exist for co nsume rs to
hare the ir . uggestion for im pr ov ing
services . I f yo u would be w illin g to serve ill
thi s ray, pleas contact the C ustom er Service:
O ffice at
1-800-834-3393
TTY: 711
Funding for thi s publi cation was pro vided by the
Mi chi gan Department of Com m unity Health
Revised 11/1 0