Language added to the state budget to trigger the statewide implementation of blended physical and mental health services is designed to put to rest the debate about how the blending of care should be done, according to the state’s health plans that favor the language.

“Everybody is tired of the issue. They’re tired of the persistent debate. They want action, they want integration, and they want, more importantly, improved outcomes,” said Dominick Pallone, executive director of the Michigan Association of Health Plans (MAHP), adding later, “The boilerplate debate is getting pretty old for everybody.”

But the state’s community mental health (CMH) organizations see the language as paving the way to “a full state carve in to a privatized system” and the abandonment of the “core premise” of pilot programs testing the integration model that were approved last year.

Bob Sheehan, CEO of Community Mental Health Association (CMHA) of Michigan, said the “constant debate” is about the health plans wanting “to hold the money and walk away with the savings and walk away with the profit” and that is what is causing the “logjam.”

For the past few years, MAHP and the CMHs have been duking it out in a particular piece of boilerplate language deep within the Michigan Department of Health and Human Services budget – Section 298.

It pertains to the policy goal of integrating physical and mental health services—but how it’s paid for and how it works has been the subject of debate.

The Section 298 drama started in earnest when in 2016, the Snyder administration proposed in that piece of boilerplate to send behavioral healthcare dollars through the same HMOs in charge of the physical health care side of Medicaid.

The CMHs have regarded the proposal as a privatization of mental health services. On the mental health side, the Medicaid dollars for mental health services flow from the state to what is called prepaid inpatient health plans (PIHPs). Those entities then in turn contract with local community mental health (CMH) boards.

While the mental health groups were able to get the language out of that particular budget in 2016, the two sides have continued to go back-and-forth over the years as a number of pilots test out the potential integration of health services in certain regions of the state.

The CMHs say have been working in “good faith” since 2017 to look into a “holistic health care approach to service that would pioneer an alignment of mental, physical, and social outcomes,” according to a statement from late last month signed by the CMHA as well as HealthWest, West Michigan CMH and Genesee Health System.

In the latest iteration of Section 298 for Fiscal Year 2020, language was added calling for a progress report on a list of measures related to the blending of physical and mental health services, and if those measures were met, it would “trigger” an “implementation statewide of integrated care provided through managed care.”

The conference report backed up the original timelines proposed for that trigger, bumping the integration trigger to January 2022 and implementation in October 2023, rather than January 2021 and October 2022.

The CMHs said the plan put forth in boilerplate “goes against nearly every core premise of the pilots called for in last year’s approved budget. It destroys the idea of a pilot and moves to a full state carve in to a privatized system—long before the pilots are completed and fully evaluated.”

Sheehan called the trigger language “more than premature, it’s presumptuous” in that it is assuming the “experiment” is going to turn out the way the health plans want it to. He said the three-year pilot in question doesn’t start exchanging money until the fall of 2020, so the language would “call it quits” in the middle of that pilot.

Pallone said all parties would have to agree to the metrics by which to measure the pilot projects—including the CMHs.

The idea with the Section 298 language is not to go back to the way it was as the stakeholders argue over whether the pilots worked, Pallone said.

“The idea here, by us and by the Legislature, is that if it’s succeeding, let’s expand it. If it’s helping people, it’s improving care, it’s meeting pre-determined goals, then we shouldn’t . . . hit stop,” Pallone said.

This story courtesy of MIRS, a Lansing-based news and information service.