Legislative Analysis
Phone: (517) 373-8080
BEHAVIORAL HEALTH AMENDMENTS
http://www.house.mi.gov/hfa
House Bill 4925 (proposed substitute H-1) Analysis available at
Sponsor: Rep. Mary Whiteford http://www.legislature.mi.gov
House Bill 4926 (proposed substitute H-1)
Sponsor: Rep. Abdullah Hammoud
House Bill 4927 (proposed substitute H-1)
Sponsor: Rep. Phil Green
House Bill 4928 (proposed substitute H-1) House Bill 5894 as introduced
Sponsor: Rep. Sue Allor Sponsor: Rep. Felicia Brabec
Committee: Health Policy
Complete to 3-17-22
SUMMARY:
House Bill 4925 would amend the Mental Health Code to authorize the Department of Health
and Human Services (DHHS) to contract with administrative services organizations (ASOs) to
assist in performing certain of its functions and duties. The bill also would amend provisions
concerning recipient rights and certain powers and duties of DHHS and would create the
Behavioral Health Oversight Council in DHHS to advise DHHS in developing and executing
public behavioral health policies, programs, and services. The other four bills would amend
other acts to account for changes proposed by HB 4925.
House Bill 4925 would revise provisions detailing DHHS’s mandate, powers, and duties.
Currently, the code states that DHHS should shift primary responsibility for the services from
the state to a community mental health services program (CMHSP) if the program has adequate
willingness and capacity (the bill would add “ability”). The bill would additionally allow
DHHS to provide, directly or through a contract, any service or set of services and supports to
ensure that Michigan has an adequate network of public behavioral health services in
accordance with state and federal requirements.
The bill would provide that, if DHHS contracts with an administrative services organization
(as described below), DHHS would have to provide operational oversight of the ASO through
contract, policy, administrative rules, or other authorized means, including at a minimum
developing a comprehensive plan for monitoring its performance, establishing policies to
coordinate public behavioral health benefits with other benefits received under Medicaid, and
developing consumer and provider appeal procedures.
Administrative services organization would mean a third-party organization with
special expertise in managing public behavioral health and intellectual disability or
developmental disability that contracts with DHHS to assist in the administration of
the public behavioral health system, including Medicaid specialty supports and
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 services. An ASO that contracts with DHHS under the bill would not provide clinical
services.
DHHS would have to develop equitable public behavioral health reimbursement policies,
procedures, and rates necessary to ensure that Michigan has an adequate network of public
behavioral health services in accordance with state and federal requirements. All policies and
procedures and related documents would have to be posted and maintained on its website.
DHHS would have to use payment models that promote value over volume and also would
have to do all of the following to promote value over volume:
• Develop and fully fund certified community behavioral health clinics at all eligible
sites that meet DHHS certification criteria and use a prospective payment system to
reimburse them for eligible services.
• Develop and fully fund Medicaid health homes at all eligible sites that meet DHHS
requirements for beneficiaries with a mental illness, emotional disturbance, intellectual
or developmental disability, or substance use disorder.
• Apply for all applicable federal and private funding opportunities, seek appropriate
changes or waivers to the Medicaid state plan, and apply for any necessary waivers and
approvals from the Centers for Medicare and Medicaid Services (CMMS) or any other
appropriate federal agency.
Certified community behavioral health clinic would mean an entity certified by
DHHS in accordance with federal criteria and the federal Protecting Access to
Medicare Act or an appropriate change or waiver to the Medicaid state plan.
Prospective payment system would mean a payment methodology that reimburses a
certified community behavioral health clinic for the anticipated costs of providing core
certified community behavioral health clinic services as determined by DHHS in
accordance with federal criteria.
Medicaid health homes would mean an optional Medicaid state plan benefit authorized
under section 1945 of the federal Social Security Act.
DHHS would have to do all of the following to promote self-directed services:
• Contract with a contractor with experience and expertise in managing self-
determination contracts between an individual served and a financial services manager
to ensure network adequacy, equitable access, and choice of self-directed services
consistent with DHHS guidelines.
• Provide technical assistance for local self-directed service programs.
• Measure the performance of the relevant entities.
• Annually assess implemented self-directed services to ensure that they are provided in
accordance with DHHS policies.
DHHS could provide for the use of a contractor described above to carry out the management
of a self-determination contract if a CMHSP did not demonstrate the willingness, capacity, or
ability to do so.
Self-directed services would mean that a participant or, if applicable, the participant’s
representative has decision-making authority over certain services and takes direct
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 responsibility to manage the participant’s services with the assistance of a system of
available supports. The self-directed service delivery model is an alternative to
traditionally delivered and managed services, such as an agency delivery model.
In addition, the code currently states that DHHS must direct services to individuals who have
a serious mental illness, developmental disability, or serious emotional disturbance. The bill
would add intellectual disabilities and substance use disorders to the list of service recipients
and remove the word both instances of the word “serious” from the description. It also would
rearrange slightly the description of services provided and allow DHHS to promulgate rules to
carry out the requirements and further describe priority populations to be served.
Contracting with an ASO
To assist in executing its powers and duties, DHHS could enter into a contract, through a
request for proposal, with a single ASO. An ASO so selected would be bound by the same
federal and state laws, regulations, and policies as DHHS, and its employees would have the
same immunity provided for governmental employees under 1964 PA 170. The ASO would
not serve in a fiduciary role or capacity in carrying out its functions. The bill states that DHHS
would retain its ultimate duty, authority, and accountability in executing its powers and
responsibilities.
DHHS would have to ensure that a selected ASO meets at least all of the following:
• It has a full-time chief executive officer, chief financial officer, and medical or clinical
director.
• It is not organized as a for-profit entity.
• It is not a CMHSP, a group of CMHSPs under the Urban Cooperation Act, or any other
group or confederation of CMHSPs.
The contract would have to require the ASO to assist DHHS in performing all of the following
functions and duties:
• Eligibility verification.
• Utilization management.
• Intensive care management.
• Quality management.
• Coordination of physical, behavioral, and social health services, including at least
coordination with health plans, primary care providers, peers, community health
workers, and social service agencies.
• Provider network development and management.
• Critical incident, grievance, and appeals monitoring and reporting.
• Customer services.
• Coordination with recipient rights
• Corporate compliance that includes adherence to all applicable state and federal civil
rights statutes and regulations.
• Clinical management services not retained by DHHS.
An ASO would have to authorize services based on DHHS policy and guidelines, although
exceptions could be made when requested by a recipient of services or a recipient’s legal
guardian or services provider and determined by the ASO to be in the recipient’s best interest.
DHHS would have to make decisions regarding the interpretation of guidelines. An ASO could
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 not have any financial incentive to approve, deny, or reduce services. ASOs would have to
ensure that service providers and individuals seeking services have timely access to
information and timely responses to inquiries, including those concerning clinical guidelines
and expected outcomes.
An ASO would have to use the Michigan Crisis and Access Line (MiCAL)1 to support the
duties and functions described above. (MiCAL is the statewide crisis and access line accepting
all calls and dispatching support based on the assessed need of the caller.)
Subject to DHHS approval, an ASO would have to establish regional or satellite divisions to
ensure geographic and demographic equity in executing the duties and functions described
above.
Incorporating ASOs throughout the code
The bill also would incorporate throughout the code ASOs and their proposed ability to assist
DHHS in providing services, generally by adding DHHS to places where the code now requires
that functions be performed by a DHHS-designated community mental health entity. Under the
bill, if DHHS were to assume responsibility for those functions, it could contract with an ASO
for assistance.
Functions of a CMHSP
The bill would add all of the following to the mental health crisis emergency services that must
be provided by a CMHSP:
• Coordination with MiCAL.
• Providing crisis intervention and stabilization services, such as mobile crisis teams, to
any individual in need of those services from any referral source.
• Providing crisis stabilization units that serve everyone in need from all referral sources.
Currently, part of those emergency services is providing inpatient or other protective
environment for treatment. The bill would specify that the environment is for treatment
provided by DHHS, CMHSPs, and approved service programs.
In addition, the array of mental health services a CMHSP must offer now includes planning,
linking, coordinating, follow-up, and monitoring to assist the recipient in gaining access to
services. The bill would instead require a CMHSP to provide case management, which DHHS
must ensure is provided independently of individuals and entities that provide or pay for other
services and supports.
Case management would mean assistance and advocacy in assessing, planning,
facilitating, coordinating, monitoring, and evaluating services and supports for a
recipient.
CMHSPs would be required to include the choice for self-directed services.
DHHS could promulgate rules or establish Medicaid policy, or both, to carry out the provisions
of section 206 of the code, which prescribes the purpose and requirements of CMHSPs.
1
House Fiscal Agency analysis of 2020 PA 12 (HB 4051), which created the Michigan Crisis and Access Line:
http://www.legislature.mi.gov/documents/2019-2020/billanalysis/House/pdf/2019-HLA-4051-EE6CC87D.pdf
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 The bill also would provide that, in contracting with entities to provide substance use disorder
prevention, treatment, and rehabilitation services, priority must be given to CMHSPs that are
able and willing to provide such services.
Recipient rights
The bill would provide that an individual qualifying for publicly funded mental health services,
the individual’s guardian if applicable, or the individual’s designated representative must be
informed verbally and in writing of the following rights:
• With regard to self-direction options and processes, the rights to do the following:
o Learn about self-direction options and processes.
o Seek to develop a self-directed service and support arrangement.
o Use a service payer or provider other than the involved service payer or
provider to file a grievance or appeal the unsatisfactory structuring of a self-
directed arrangement.
• With regard to person-centered planning, the rights to do the following:
o Engage in person-centered planning.
o Have the person-centered planning process independently facilitated.
o Designate an individual to assist or represent the individual in the person-
centered planning process.
o For children, youth, or families, ensure that the needs of the youth and their
family are considered in the development of the individual plan of service and
are family-driven and youth-guided.
o Use a service payer or provider other than the involved service payer or
provider to file a grievance or appeal the service offered after the person-
centered planning process.
o Be informed about utilization management practices that are used to make
determinations about supports and services identified through the person-
centered planning process, including written information about policies,
procedures, and methods used to make those determinations.
Self-direction would mean the act of selecting, directing, and managing one’s services
and supports as a method of moving away from professionally managed models of
supports and services.
Person-centered planning would mean a collaborative, person-directed process
designed to assist an individual to plan the individual’s life and supports.2
Family-driven would mean an approach that recognizes that services and supports
affect the entire family, not just the identified child or youth receiving mental health
services. In the case of minors, the child, youth, and family would be the focus of
service planning. Family members would be integral to a successful planning process.
Youth-guided would mean a process in which a young individual has the right to be
empowered, educated, and given a decision-making role in his or her own life as well
2
The bill would amend the current definition of person-centered planning, which is “a process for planning and
supporting the individual receiving services that builds upon the individual’s capacity to engage in activities that
promote community life and that honors the individual’s preferences, choices, and abilities. The person-centered
planning process involves families, friends, and professionals as the individual desires or requires.”
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 as the policies and procedures governing all care for all youth in the community, state,
and nation. As the child or youth matures toward transition age, the focus of the
treatment planning, services, and supports would have to be youth-driven, young-
driven, or adult-driven to accommodate the youth as the youth gains skills toward
independence.
The rights listed above could be temporarily suspended during a period of a psychiatric crisis
if the individual has no guardian, legal representative, or advance psychiatric directive that can
safely be implemented during the crisis. The temporary suspension would have to end when
the psychiatric crisis is stabilized.
The bill states that utilization management is not a substitute for, and should not supplant, the
individual plan of service developed through person-centered planning.
Service authorizations would have to be completed within time frames as specified in 42 CFR
438.210.3
Within one business day of a decision to deny a service authorization request or to a