Newsletter October 2021
Behavioral Health
Todd Lewicki, PhD, LMSW, MBA
Chief Behavioral Health Officer
The 1915(i) State Plan Benefit
In response to guidance from the Centers for Medicare & Medicaid Services (CMS), Michigan transitioned all the specialty behavioral health services and supports that had been covered under the 1915(b)(3) (“B3” services) authority, to an 1115 Behavioral Health Demonstration and 1915(i) Home and Community-Based Services (HCBS) state plan benefit effective October 1, 2019. Michigan developed the HCBS benefit to meet the specific needs of its behavioral health and developmental disabilities priority populations. Now referred to as the 1915(i) State Plan
Amendment (1915(i)SPA), it establishes the provision of behavioral health community-based services along with the evaluation and re-evaluation of eligibility through the Prepaid Inpatient Health Plans (PIHP). Services covered under the 1915(i)SPA include: Community Living Supports, Enhanced Pharmacy, Environmental Modifications, Family Support & Training, Fiscal Intermediary, Housing Assistance, Respite Care, Skill-Building Assistance, Specialized Medical Equipment & Supplies, Supported/Integrated Employment, and Vehicle Modification.
Mid-State Health Network (MSHN) will conduct reviews to ensure that individuals meet all eligibility requirements for the 1915(i) benefit and the Michigan Department of Health and Human Services (MDHHS) will independently determine if needs-based criteria have been met. This includes annually identifying and evaluating individual level of need, reviewing assessments related to the individual’s functional abilities and to ensure that the appropriate services and supports are provided to help the individual reach the expected outcomes of community inclusion and participation, which are key HCBS cornerstones. The new process for the eligibility determination requirement oversight for the 1915(i) benefit will involve evaluation and determination of content provided through the MDHHS Waiver Support Application (WSA), a tool that MSHN has been using for over 7 years to assist appropriate individuals’ initial and ongoing eligibility for other benefits, including the Habilitation Supports Waiver, Children’s Waiver Program, the Waiver for Children with Severe Emotional Disturbance, and the Autism Benefit. All evaluations and re-evaluations of individuals enrolled in and/or seeking 1915(i) HCBS state plan service benefits will be completed by October 1, 2022. MSHN currently has approximately 12,500 individuals that meet this requirement.
For additional information, please contact Todd at todd.lewicki@midstatehealthnetwork.org.