Thomas Renwick, the Director of the Michigan Bureau of Community Based Services, has sent a warning to agencies that fund and provide services to people with developmental and other disabilities: Assessment tools that are inappropriately and arbitrarily used to restrict needed services, supplant Medicaid “medical necessity” criteria, and to achieve budget reductions are not allowable by the Michigan Behavioral Health and Developmental Disabilities Administration (BHDDA).
“Please be advised that any assessment or screening tool, including those required by the Department, cannot be utilized…as an arbitrary means for identifying the amount, scope or duration of services that an individual will receive. While such assessments can certainly help inform the person-centered planning process, it is the person-centered planning process and medical necessity criteria that determine the amount, scope and duration of services. With regards to determining medical necessity, I am not aware that any of the assessments or tools in use or proposed for use have any normed or research supported basis for determining an individual’s medical necessity for services and supports. [emphasis added.] It also bears reminding that the PIHP [the regional agency that administers funding of CMH services] is obligated to ensure that medically necessary supports, services or treatment are sufficient in amount, scope and duration to reasonably achieve their purpose.”
Provider networks must also ensure that individuals are provided proper notice of their rights if they are not satisfied with the outcome of their person-centered planning process.
See also Michigan guidance on the use of the Supports Intensity Scale, an assessment tool that the BHHDD encourages with the consent of the individual but advises that it should not be tied to medical necessity criteria and the authorization of services.
This is from the Michigan Department of Community Health (MDCH). Read the documents available on the website and comment. See also the CMS clarification of the HCBS settings rule :
Stakeholder Review of Assessment Tools for the Home and Community-Based Services Program Transition Project
As many of you are already aware, the Centers for Medicare and Medicaid Services released a new rule in 2014 for home and community-based services waivers. The new rule affects 1915 (c) waiver programs. The Department has since developed a statewide transition plan to bring its waiver programs into compliance with the new rule.
As part of the transition process, the Department must determine whether settings under these waivers have “home and community-based” characteristics. For this purpose, the Department developed a set of surveys to assess individual settings for home and community-based characteristics.
The Department has posted the draft assessment tools and associated documents at this website.
The Department will accept feedback and comments on the survey tools until February 20, 2015.
Feedback and comments can be submitted by e-mail to:
HCBSTransition@michigan.gov or by mail at:
HCBS Program Transition Team
Capitol View Building, 7th Floor
201 Townsend Street
Lansing, MI 48913
The Department will also be developing a scoring system for the assessment at a later date to determine the level of compliance of each setting with the rule.
Additional information about the project and statewide transition plan are available on the Department’s website.
Thank you for your continued interest and support in this process.
Regards,
Home and Community-Based Services Program Transition Team
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More from the MDCH website:
Assessment Tools
As part of the transition process, the Department must determine whether settings under these waivers have “home and community-based” characteristics. For this purpose, the Department developed a set of surveys to assess individual settings for home and community-based characteristics....
[See above for where to send comments.]
...Stakeholders should read the “Assessment Tool Cover Letter” and “Home and Community-Based Services Program Transition Frequently Asked Questions” before reviewing the assessment tools.
Cover Letter
Provider Tool
Participant Tool
Prepaid Inpatient Health Plan Tool
