RFP 250000002670 - Appendix 5 - SFY 2023 Data Exhibits.docx.pdf

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Prepaid Inpatient Health Plan (PIHP) RFP
Solicitation number
RFP-171-250000002670-3
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Michigan

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The document is a draft and confidential appendix from the State of Michigan's Department of Health and Human Services for the Medicaid Behavioral Health Program Procurement, specifically Appendix 2 - SFY 2023 Data Exhibits. The exhibits provide detailed financial and utilization data for behavioral health services across different regions (Northern, Central, and Metro) and population categories (DAB, TANF, HMP, CWP, SEDW, and HSW) for the state fiscal year 2023, spanning the period from October 1, 2022, to September 1, 2023.

The data exhibits break down service categories into Non-CCBHC (Community Behavioral Health Center) and CCBHC services, including inpatient, outpatient, residential, prevention, autism services, psychotherapy, crisis intervention, medication administration, case management, and community living supports. Each regional and population-specific exhibit presents incurred claims, utilization metrics, and per-member per-month (PMPM) costs. The documents note that the data is derived from service worksheets, excludes health home and non-Medicaid expenses, and uses encounter data submitted as of August 3, 2024. The exhibits also highlight that CCBHC service splits are determined by service codes and do not consider diagnosis criteria, and certain HCPCS codes have been retroactively excluded from CCBHC-eligible services for the fiscal year.

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APPENDIX 5 – SFY 2023 DATA EXHIBITS

Request for Proposal No. 250000002670 Prepaid Inpatient Health Plan (PIHP)

See below for details.

Draft and Confidential 7/25/2025

State of Michigan, Department of Health and Human Services

Medicaid BH Program Procurement

Appendix 2 - Northern - DAB - SFY 2023 Data Exhibit

Service Category Incurred Claims Utilization PMPM

Non-CCBHC Services

Inpatient $ 5,187,840 7,309 $ 9.51

Other 2,245,411 13,396 4.12

SUD Outpatient Services - - -

Residential Services 1,764,467 7,047 3.23

Prevention, E&M, Assessments and Testing 777,890 11,299 1.43

Autism Services 8,347,517 377,608 15.30

Psychotherapy - - -

Crisis - - -

Medication Administration/Medication Assisted Treatment 236,425 12,688 0.43

Case Management / Treatment Planning - - -

Withdrawal Management 222,834 517 0.41

Additional Support Services 275,433 1,339 0.50

Assertive Community Treatment (ACT) - - -

Skill Building/Vocational Supports 1,079,289 50,641 1.98

Community Living Supports 96,402,177 3,725,943 176.73

Subtotal Non-CCBHC Services $ 116,539,282 4,207,787 $ 213.65

CCBHC Services

Inpatient $ 0 - $ 0.00

Other 1,115,652 1,190 2.05

SUD Outpatient Services 264,793 4,444 0.49

Residential Services - - -

Prevention, E&M, Assessments and Testing 8,952,602 25,485 16.41

Autism Services - - -

Psychotherapy 4,370,568 20,207 8.01

Crisis 2,616,718 7,198 4.80

Medication Administration/Medication Assisted Treatment 1,063,014 4,807 1.95

Case Management / Treatment Planning 21,264,246 151,995 38.98

Withdrawal Management - - -

Additional Support Services 7,062,404 631,983 12.95

Assertive Community Treatment (ACT) 7,509,937 49,367 13.77

Skill Building/Vocational Supports 6,092,721 703,292 11.17

Community Living Supports - - -

Subtotal CCBHC Services $ 60,312,655 1,599,968 $ 110.57

Total $ 176,851,937 5,807,755 $ 324.22

Time Period: October 1, 2022 - September 1, 2023

Region: Northern

Population: DAB

Member Months: 545,469

Average Monthly Members: 45,456

Total Unique Recipients: 9,714

Notes:

1. Incurred claims and utilization are derived from the [Service UNC] worksheet of the SFY 2023 Period 3 Behavioral Health

EQI. Health Home and Non-Medicaid expenses from the EQI submissions have been excluded from these exhibits.

2. The encounter data used to determine recipients is based on information submitted as of August 3, 2024.

3. This metric represents the sum of reported units in the SFY 2023 EQI and does not make any considerations for the different reporting units various services codes have within a single service category.

4. The 'Total' row is the sum of the 'Subtotal Non-CCBHC Services' and 'Subtotal CCBHC Services' rows.

5. SFY 2023 incurred encounter data paid through August 3, 2024 was used for Northern Lakes CMH in the absence of an

EQI template for SFY 2023.

6. CCBHC service splits are determined solely by service codes and do not take diagnosis criteria into account.

7. HCPCS codes H0012, H0020, and H0023 have been retroactively excluded from the list of CCBHC-eligible services for

SFY 2023.

8. Services designated as included within the CCBHC Demonstration in SFY 2023 were identified as CCBHC Services in this exhibit. CCBHC service expenses are inclusive of all incurred claims for these services (i.e., broader than the CCBHC

Demonstration program), including non-CCBHC Demonstration providers and services provided to individuals who do not meet CCBHC Demonstration Criteria such as individuals who do not have a mental health or substance use disorder diagnosis. The most up-to-date list of eligible CCBHC services is available in the CCBHC Handbook (CCBHC Handbook.pdf).

Northern - DAB Milliman Page 1 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7

Medicaid BH Program Procurement

Appendix 2 - Northern - TANF - SFY 2023 Data Exhibit

Service Category Incurred Claims Utilization PMPM

Non-CCBHC Services

Inpatient $ 5,434,585 5,585 $ 4.13

Other 262,863 3,548 0.20

SUD Outpatient Services - - -

Residential Services 2,615,386 11,696 1.99

Prevention, E&M, Assessments and Testing 715,192 12,405 0.54

Autism Services 6,318,302 315,577 4.80

Psychotherapy - - -

Crisis - - -

Medication Administration/Medication Assisted Treatment 818,788 43,948 0.62

Case Management / Treatment Planning - - -

Withdrawal Management 267,182 599 0.20

Additional Support Services 100,090 1,225 0.08

Assertive Community Treatment (ACT) - - -

Skill Building/Vocational Supports - - -

Community Living Supports 901,122 28,604 0.68

Subtotal Non-CCBHC Services $ 17,433,511 423,187 $ 13.24

CCBHC Services

Inpatient $ 0 - $ 0.00

Other 413,743 1,656 0.31

SUD Outpatient Services 1,039,114 18,080 0.79

Residential Services - - -

Prevention, E&M, Assessments and Testing 6,474,549 17,067 4.92

Autism Services - - -

Psychotherapy 5,349,787 23,424 4.06

Crisis 2,189,239 6,568 1.66

Medication Administration/Medication Assisted Treatment 46,902 265 0.04

Case Management / Treatment Planning 5,252,717 38,854 3.99

Withdrawal Management - - -

Additional Support Services 3,336,115 65,254 2.53

Assertive Community Treatment (ACT) 238,595 1,424 0.18

Skill Building/Vocational Supports 110,594 6,649 0.08

Community Living Supports - - -

Subtotal CCBHC Services $ 24,451,355 179,241 $ 18.57

Total $ 41,884,865 602,428 $ 31.80

Time Period: October 1, 2022 - September 1, 2023

Region: Northern

Population: TANF

Member Months: 1,317,057

Average Monthly Members: 109,755

Total Unique Recipients: 8,018

Notes:

1. Incurred claims and utilization are derived from the [Service UNC] worksheet of the SFY 2023 Period 3 Behavioral Health

EQI. Health Home and Non-Medicaid expenses from the EQI submissions have been excluded from these exhibits.

2. The encounter data used to determine recipients is based on information submitted as of August 3, 2024.

3. This metric represents the sum of reported units in the SFY 2023 EQI and does not make any considerations for the different reporting units various services codes have within a single service category.

4. The 'Total' row is the sum of the 'Subtotal Non-CCBHC Services' and 'Subtotal CCBHC Services' rows.

5. SFY 2023 incurred encounter data paid through August 3, 2024 was used for Northern Lakes CMH in the absence of an

EQI template for SFY 2023.

6. CCBHC service splits are determined solely by service codes and do not take diagnosis criteria into account.

7. HCPCS codes H0012, H0020, and H0023 have been retroactively excluded from the list of CCBHC-eligible services for

SFY 2023.

8. Services designated as included within the CCBHC Demonstration in SFY 2023 were identified as CCBHC Services in this exhibit. CCBHC service expenses are inclusive of all incurred claims for these services (i.e., broader than the CCBHC

Demonstration program), including non-CCBHC Demonstration providers and services provided to individuals who do not meet CCBHC Demonstration Criteria such as individuals who do not have a mental health or substance use disorder diagnosis. The most up-to-date list of eligible CCBHC services is available in the CCBHC Handbook (CCBHC Handbook.pdf).

Northern - TANF Milliman Page 2 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7

Medicaid BH Program Procurement

Appendix 2 - Northern - HMP - SFY 2023 Data Exhibit

Service Category Incurred Claims Utilization PMPM

Non-CCBHC Services

Inpatient $ 10,091,878 10,157 $ 10.18

Other 245,566 7,556 0.25

SUD Outpatient Services - - -

Residential Services 8,022,211 38,971 8.09

Prevention, E&M, Assessments and Testing 184,448 3,770 0.19

Autism Services 26,507 1,597 0.03

Psychotherapy - - -

Crisis - - -

Medication Administration/Medication Assisted Treatment 1,207,105 64,911 1.22

Case Management / Treatment Planning - - -

Withdrawal Management 1,383,109 3,133 1.40

Additional Support Services 21,565 83 0.02

Assertive Community Treatment (ACT) - - -

Skill Building/Vocational Supports 10,327 519 0.01

Community Living Supports 1,404,049 50,061 1.42

Subtotal Non-CCBHC Services $ 22,596,765 180,758 $ 22.80

CCBHC Services

Inpatient $ 0 - $ 0.00

Other 66,350 283 0.07

SUD Outpatient Services 3,228,519 53,041 3.26

Residential Services - - -

Prevention, E&M, Assessments and Testing 4,400,069 13,540 4.44

Autism Services - - -

Psychotherapy 3,440,953 14,423 3.47

Crisis 2,484,782 6,814 2.51

Medication Administration/Medication Assisted Treatment 322,599 1,382 0.33

Case Management / Treatment Planning 3,774,789 28,055 3.81

Withdrawal Management - - -

Additional Support Services 917,976 62,579 0.93

Assertive Community Treatment (ACT) 1,021,817 7,712 1.03

Skill Building/Vocational Supports 405,066 30,049 0.41

Community Living Supports - - -

Subtotal CCBHC Services $ 20,062,919 217,878 $ 20.24

Total $ 42,659,684 398,636 $ 43.03

Time Period: October 1, 2022 - September 1, 2023

Region: Northern

Population: HMP

Member Months: 991,293

Average Monthly Members: 82,608

Total Unique Recipients: 8,072

Notes:

1. Incurred claims and utilization are derived from the [Service UNC] worksheet of the SFY 2023 Period 3 Behavioral Health

EQI. Health Home and Non-Medicaid expenses from the EQI submissions have been excluded from these exhibits.

2. The encounter data used to determine recipients is based on information submitted as of August 3, 2024.

3. This metric represents the sum of reported units in the SFY 2023 EQI and does not make any considerations for the different reporting units various services codes have within a single service category.

4. The 'Total' row is the sum of the 'Subtotal Non-CCBHC Services' and 'Subtotal CCBHC Services' rows.

5. SFY 2023 incurred encounter data paid through August 3, 2024 was used for Northern Lakes CMH in the absence of an

EQI template for SFY 2023.

6. CCBHC service splits are determined solely by service codes and do not take diagnosis criteria into account.

7. HCPCS codes H0012, H0020, and H0023 have been retroactively excluded from the list of CCBHC-eligible services for

SFY 2023.

8. Services designated as included within the CCBHC Demonstration in SFY 2023 were identified as CCBHC Services in this exhibit. CCBHC service expenses are inclusive of all incurred claims for these services (i.e., broader than the CCBHC

Demonstration program), including non-CCBHC Demonstration providers and services provided to individuals who do not meet CCBHC Demonstration Criteria such as individuals who do not have a mental health or substance use disorder diagnosis. The most up-to-date list of eligible CCBHC services is available in the CCBHC Handbook (CCBHC Handbook.pdf).

Northern - HMP Milliman Page 3 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7

Medicaid BH Program Procurement

Appendix 2 - Northern - CWP - SFY 2023 Data Exhibit

Service Category Incurred Claims Utilization PMPM

Non-CCBHC Services

Inpatient $ 0 - $ 0.00

Other 51,534 179 217.44

SUD Outpatient Services - - -

Residential Services - - -

Prevention, E&M, Assessments and Testing - - -

Autism Services - - -

Psychotherapy - - -

Crisis - - -

Medication Administration/Medication Assisted Treatment - - -

Case Management / Treatment Planning - - -

Withdrawal Management - - -

Additional Support Services 8,388 24 35.39

Assertive Community Treatment (ACT) - - -

Skill Building/Vocational Supports - - -

Community Living Supports 320,505 49,410 1,352.34

Subtotal Non-CCBHC Services $ 380,427 49,613 $ 1,605.18

CCBHC Services

Inpatient $ 0 - $ 0.00

Other 16,733 27 70.60

SUD Outpatient Services - - -

Residential Services - - -

Prevention, E&M, Assessments and Testing - - -

Autism Services - - -

Psychotherapy - - -

Crisis - - -

Medication Administration/Medication Assisted Treatment - - -

Case Management / Treatment Planning - - -

Withdrawal Management - - -

Additional Support Services 89,582 15,635 377.98

Assertive Community Treatment (ACT) - - -

Skill Building/Vocational Supports - - -

Community Living Supports - - -

Subtotal CCBHC Services $ 106,315 15,662 $ 448.59

Total $ 486,743 65,275 $ 2,053.77

Time Period: October 1, 2022 - September 1, 2023

Region: Northern

Population: CWP

Member Months: 237

Average Monthly Members: 20

Total Unique Recipients: 19

Notes:

1. Incurred claims and utilization are derived from the [Service UNC] worksheet of the SFY 2023 Period 3 Behavioral Health

EQI. Health Home and Non-Medicaid expenses from the EQI submissions have been excluded from these exhibits.

2. The encounter data used to determine recipients is based on information submitted as of August 3, 2024.

3. This metric represents the sum of reported units in the SFY 2023 EQI and does not make any considerations for the different reporting units various services codes have within a single service category.

4. The 'Total' row is the sum of the 'Subtotal Non-CCBHC Services' and 'Subtotal CCBHC Services' rows.

5. SFY 2023 incurred encounter data paid through August 3, 2024 was used for Northern Lakes CMH in the absence of an

EQI template for SFY 2023.

6. CCBHC service splits are determined solely by service codes and do not take diagnosis criteria into account.

7. HCPCS codes H0012, H0020, and H0023 have been retroactively excluded from the list of CCBHC-eligible services for

SFY 2023.

8. Services designated as included within the CCBHC Demonstration in SFY 2023 were identified as CCBHC Services in this exhibit. CCBHC service expenses are inclusive of all incurred claims for these services (i.e., broader than the CCBHC

Demonstration program), including non-CCBHC Demonstration providers and services provided to individuals who do not meet CCBHC Demonstration Criteria such as individuals who do not have a mental health or substance use disorder diagnosis. The most up-to-date list of eligible CCBHC services is available in the CCBHC Handbook (CCBHC Handbook.pdf).

Northern - CWP Milliman Page 4 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7

Medicaid BH Program Procurement

Appendix 2 - Northern - SEDW - SFY 2023 Data Exhibit

Service Category Incurred Claims Utilization PMPM

Non-CCBHC Services

Inpatient $ 0 - $ 0.00

Other 390 3 1.24

SUD Outpatient Services - - -

Residential Services - - -

Prevention, E&M, Assessments and Testing - - -

Autism Services - - -

Psychotherapy - - -

Crisis - - -

Medication Administration/Medication Assisted Treatment - - -

Case Management / Treatment Planning 432,751 784 1,373.81

Withdrawal Management - - -

Additional Support Services - - -

Assertive Community Treatment (ACT) - - -

Skill Building/Vocational Supports - - -

Community Living Supports 7,555 1,168 23.98

Subtotal Non-CCBHC Services $ 440,696 1,955 $ 1,399.03

CCBHC Services

Inpatient $ 0 - $ 0.00

Other 9,655 35 30.65

SUD Outpatient Services - - -

Residential Services - - -

Prevention, E&M, Assessments and Testing - - -

Autism Services - - -

Psychotherapy - - -

Crisis - - -

Medication Administration/Medication Assisted Treatment - - -

Case Management / Treatment Planning - - -

Withdrawal Management - - -

Additional Support Services 5,236 1,393 16.62

Assertive Community Treatment (ACT) - - -

Skill Building/Vocational Supports - - -

Community Living Supports - - -

Subtotal CCBHC Services $ 14,891 1,428 $ 47.27

Total $ 455,587 3,383 $ 1,446.31

Time Period: October 1, 2022 - September 1, 2023

Region: Northern

Population: SED

Member Months: 315

Average Monthly Members: 26

Total Unique Recipients: 54

Notes:

1. Incurred claims and utilization are derived from the [Service UNC] worksheet of the SFY 2023 Period 3 Behavioral Health

EQI. Health Home and Non-Medicaid expenses from the EQI submissions have been excluded from these exhibits.

2. The encounter data used to determine recipients is based on information submitted as of August 3, 2024.

3. This metric represents the sum of reported units in the SFY 2023 EQI and does not make any considerations for the different reporting units various services codes have within a single service category.

4. The 'Total' row is the sum of the 'Subtotal Non-CCBHC Services' and 'Subtotal CCBHC Services' rows.

5. SFY 2023 incurred encounter data paid through August 3, 2024 was used for Northern Lakes CMH in the absence of an

EQI template for SFY 2023.

6. CCBHC service splits are determined solely by service codes and do not take diagnosis criteria into account.

7. HCPCS codes H0012, H0020, and H0023 have been retroactively excluded from the list of CCBHC-eligible services for

SFY 2023.

8. Services designated as included within the CCBHC Demonstration in SFY 2023 were identified as CCBHC Services in this exhibit. CCBHC service expenses are inclusive of all incurred claims for these services (i.e., broader than the CCBHC

Demonstration program), including non-CCBHC Demonstration providers and services provided to individuals who do not meet CCBHC Demonstration Criteria such as individuals who do not have a mental health or substance use disorder diagnosis. The most up-to-date list of eligible CCBHC services is available in the CCBHC Handbook (CCBHC Handbook.pdf).

Northern - SEDW Milliman Page 5 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7

Medicaid BH Program Procurement

Appendix 2 - Northern - HSW - SFY 2023 Data Exhibit

Service Category Incurred Claims Utilization PMPM

Non-CCBHC Services

Inpatient $ 0 - $ 0.00

Other 496,449 7,727 42.72

SUD Outpatient Services - - -

Residential Services - - -

Prevention, E&M, Assessments and Testing - - -

Autism Services - - -

Psychotherapy - - -

Crisis - - -

Medication Administration/Medication Assisted Treatment - - -

Case Management / Treatment Planning - - -

Withdrawal Management - - -

Additional Support Services 22,554 95 1.94

Assertive Community Treatment (ACT) - - -

Skill Building/Vocational Supports 521,236 21,685 44.85

Community Living Supports 69,225,067 3,913,476 5,956.89

Subtotal Non-CCBHC Services $ 70,265,306 3,942,983 $ 6,046.41

CCBHC Services

Inpatient $ 0 - $ 0.00

Other 32,799 68 2.82

SUD Outpatient Services - - -

Residential Services - - -

Prevention, E&M, Assessments and Testing - - -

Autism Services - - -

Psychotherapy - - -

Crisis - - -

Medication Administration/Medication Assisted Treatment - - -

Case Management / Treatment Planning - - -

Withdrawal Management - - -

Additional Support Services 667,470 132,884 57.44

Assertive Community Treatment (ACT) - - -

Skill Building/Vocational Supports 2,759,843 269,504 237.49

Community Living Supports - - -

Subtotal CCBHC Services $ 3,460,112 402,456 $ 297.75

Total $ 73,725,418 4,345,439 $ 6,344.15

Time Period: October 1, 2022 - September 1, 2023

Region: Northern

Population: HSW

Member Months: 11,621

Average Monthly Members: 968

Total Unique Recipients: 1,096

Notes:

1. Incurred claims and utilization are derived from the [Service UNC] worksheet of the SFY 2023 Period 3 Behavioral Health

EQI. Health Home and Non-Medicaid expenses from the EQI submissions have been excluded from these exhibits.

2. The encounter data used to determine recipients is based on information submitted as of August 3, 2024.

3. This metric represents the sum of reported units in the SFY 2023 EQI and does not make any considerations for the different reporting units various services codes have within a single service category.

4. The 'Total' row is the sum of the 'Subtotal Non-CCBHC Services' and 'Subtotal CCBHC Services' rows.

5. SFY 2023 incurred encounter data paid through August 3, 2024 was used for Northern Lakes CMH in the absence of an

EQI template for SFY 2023.

6. CCBHC service splits are determined solely by service codes and do not take diagnosis criteria into account.

7. HCPCS codes H0012, H0020, and H0023 have been retroactively excluded from the list of CCBHC-eligible services for

SFY 2023.

8. Services designated as included within the CCBHC Demonstration in SFY 2023 were identified as CCBHC Services in this exhibit. CCBHC service expenses are inclusive of all incurred claims for these services (i.e., broader than the CCBHC

Demonstration program), including non-CCBHC Demonstration providers and services provided to individuals who do not meet CCBHC Demonstration Criteria such as individuals who do not have a mental health or substance use disorder diagnosis. The most up-to-date list of eligible CCBHC services is available in the CCBHC Handbook (CCBHC Handbook.pdf).

Northern - HSW Milliman Page 6 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7

Medicaid BH Program Procurement

Appendix 2 - Central - DAB - SFY 2023 Data Exhibit

Service Category Incurred Claims Utilization PMPM

Non-CCBHC Services

Inpatient $ 49,264,875 72,667 $ 15.20

Other 18,539,010 1,275,803 5.72

SUD Outpatient Services 639 22 0.00

Residential Services 11,133,761 47,674 3.44

Prevention, E&M, Assessments and Testing 5,750,908 97,198 1.77

Autism Services 92,291,065 5,337,062 28.48

Psychotherapy - - -

Crisis - - -

Medication Administration/Medication Assisted Treatment 3,246,595 180,787 1.00

Case Management / Treatment Planning - - -

Withdrawal Management 1,114,642 2,845 0.34

Additional Support Services 1,440,546 14,199 0.44

Assertive Community Treatment (ACT) - - -

Skill Building/Vocational Supports 1,761,757 93,528 0.54

Community Living Supports 532,893,291 26,252,650 164.42

Subtotal Non-CCBHC Services $ 717,437,089 33,374,435 $ 221.36

CCBHC Services

Inpatient $ 0 - $ 0.00

Other 3,209,484 32,573 0.99

SUD Outpatient Services 3,039,015 58,842 0.94

Residential Services - - -

Prevention, E&M, Assessments and Testing 49,015,132 164,620 15.12

Autism Services - - -

Psychotherapy 23,621,141 119,218 7.29

Crisis 12,256,489 26,712 3.78

Medication Administration/Medication Assisted Treatment 5,762,974 47,287 1.78

Case Management / Treatment Planning 142,239,678 1,199,662 43.89

Withdrawal Management - - -

Additional Support Services 45,560,790 3,625,487 14.06

Assertive Community Treatment (ACT) 28,859,740 266,491 8.90

Skill Building/Vocational Supports 33,876,191 4,207,196 10.45

Community Living Supports - - -

Subtotal CCBHC Services $ 347,440,634 9,748,088 $ 107.20

Total $ 1,064,877,723 43,122,523 $ 328.56

Time Period: October 1, 2022 - September 1, 2023

Region: Central

Population: DAB

Member Months: 3,241,086

Average Monthly Members: 270,091

Total Unique Recipients: 59,384

Notes:

1. Incurred claims and utilization are derived from the [Service UNC] worksheet of the SFY 2023 Period 3 Behavioral Health

EQI. Health Home and Non-Medicaid expenses from the EQI submissions have been excluded from these exhibits.

2. The encounter data used to determine recipients is based on information submitted as of August 3, 2024.

3. This metric represents the sum of reported units in the SFY 2023 EQI and does not make any considerations for the different reporting units various services codes have within a single service category.

4. The 'Total' row is the sum of the 'Subtotal Non-CCBHC Services' and 'Subtotal CCBHC Services' rows.

5. SFY 2023 incurred encounter data paid through August 3, 2024 was used for Northern Lakes CMH in the absence of an

EQI template for SFY 2023.

6. CCBHC service splits are determined solely by service codes and do not take diagnosis criteria into account.

7. HCPCS codes H0012, H0020, and H0023 have been retroactively excluded from the list of CCBHC-eligible services for

SFY 2023.

8. Services designated as included within the CCBHC Demonstration in SFY 2023 were identified as CCBHC Services in this exhibit. CCBHC service expenses are inclusive of all incurred claims for these services (i.e., broader than the CCBHC

Demonstration program), including non-CCBHC Demonstration providers and services provided to individuals who do not meet CCBHC Demonstration Criteria such as individuals who do not have a mental health or substance use disorder diagnosis. The most up-to-date list of eligible CCBHC services is available in the CCBHC Handbook (CCBHC Handbook.pdf).

Central - DAB Milliman Page 7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7

Medicaid BH Program Procurement

Appendix 2 - Central - TANF - SFY 2023 Data Exhibit

Service Category Incurred Claims Utilization PMPM

Non-CCBHC Services

Inpatient $ 34,313,273 37,415 $ 3.77

Other 5,567,564 144,995 0.61

SUD Outpatient Services 462 21 0.00

Residential Services 8,461,056 37,039 0.93

Prevention, E&M, Assessments and Testing 3,850,950 89,918 0.42

Autism Services 73,974,612 4,312,446 8.13

Psychotherapy - - -

Crisis - - -

Medication Administration/Medication Assisted Treatment 7,216,808 410,486 0.79

Case Management / Treatment Planning - - -

Withdrawal Management 1,189,949 2,950 0.13

Additional Support Services 1,645,463 17,110 0.18

Assertive Community Treatment (ACT) - - -

Skill Building/Vocational Supports 27,460 1,367 0.00

Community Living Supports 4,774,535 289,387 0.52

Subtotal Non-CCBHC Services $ 141,022,132 5,343,134 $ 15.50

CCBHC Services

Inpatient $ 0 - $ 0.00

Other 3,564,708 33,597 0.39

SUD Outpatient Services 5,976,210 112,733 0.66

Residential Services - - -

Prevention, E&M, Assessments and Testing 31,298,842 110,624 3.44

Autism Services - - -

Psychotherapy 27,049,952 129,643 2.97

Crisis 12,364,826 28,029 1.36

Medication Administration/Medication Assisted Treatment 435,462 4,299 0.05

Case Management / Treatment Planning 33,562,043 305,673 3.69

Withdrawal Management - - -

Additional Support Services 28,764,076 786,268 3.16

Assertive Community Treatment (ACT) 984,771 8,564 0.11

Skill Building/Vocational Supports 773,975 20,303 0.09

Community Living Supports - - -

Subtotal CCBHC Services $ 144,774,865 1,539,733 $ 15.92

Total $ 285,796,997 6,882,867 $ 31.42

Time Period: October 1, 2022 - September 1, 2023

Region: Central

Population: TANF

Member Months: 9,095,958

Average Monthly Members: 757,997

Total Unique Recipients: 46,316

Notes:

1. Incurred claims and utilization are derived from the [Service UNC] worksheet of the SFY 2023 Period 3 Behavioral Health

EQI. Health Home and Non-Medicaid expenses from the EQI submissions have been excluded from these exhibits.

2. The encounter data used to determine recipients is based on information submitted as of August 3, 2024.

3. This metric represents the sum of reported units in the SFY 2023 EQI and does not make any considerations for the different reporting units various services codes have within a single service category.

4. The 'Total' row is the sum of the 'Subtotal Non-CCBHC Services' and 'Subtotal CCBHC Services' rows.

5. SFY 2023 incurred encounter data paid through August 3, 2024 was used for Northern Lakes CMH in the absence of an

EQI template for SFY 2023.

6. CCBHC service splits are determined solely by service codes and do not take diagnosis criteria into account.

7. HCPCS codes H0012, H0020, and H0023 have been retroactively excluded from the list of CCBHC-eligible services for

SFY 2023.

8. Services designated as included within the CCBHC Demonstration in SFY 2023 were identified as CCBHC Services in this exhibit. CCBHC service expenses are inclusive of all incurred claims for these services (i.e., broader than the CCBHC

Demonstration program), including non-CCBHC Demonstration providers and services provided to individuals who do not meet CCBHC Demonstration Criteria such as individuals who do not have a mental health or substance use disorder diagnosis. The most up-to-date list of eligible CCBHC services is available in the CCBHC Handbook (CCBHC Handbook.pdf).

Central - TANF Milliman Page 8 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7

Medicaid BH Program Procurement

Appendix 2 - Central - HMP - SFY 2023 Data Exhibit

Service Category Incurred Claims Utilization PMPM

Non-CCBHC Services

Inpatient $ 63,022,540 67,692 $ 10.67

Other 3,544,398 92,611 0.60

SUD Outpatient Services 5,050 109 0.00

Residential Services 32,754,374 167,179 5.54

Prevention, E&M, Assessments and Testing 1,330,037 33,750 0.23

Autism Services 144,979 7,506 0.02

Psychotherapy - - -

Crisis - - -

Medication Administration/Medication Assisted Treatment 14,985,631 855,764 2.54

Case Management / Treatment Planning - - -

Withdrawal Management 5,241,922 13,544 0.89

Additional Support Services 22,902 228 0.00

Assertive Community Treatment (ACT) - - -

Skill Building/Vocational Supports 181,186 7,179 0.03

Community Living Supports 13,819,281 346,412 2.34

Subtotal Non-CCBHC Services $ 135,052,300 1,591,974 $ 22.86

CCBHC Services

Inpatient $ 0 - $ 0.00

Other 1,969,426 33,886 0.33

SUD Outpatient Services 16,922,261 332,052 2.86

Residential Services - - -

Prevention, E&M, Assessments and Testing 25,600,090 109,837 4.33

Autism Services - - -

Psychotherapy 16,647,482 85,293 2.82

Crisis 10,981,856 25,897 1.86

Medication Administration/Medication Assisted Treatment 1,806,937 16,109 0.31

Case Management / Treatment Planning 26,710,023 238,895 4.52

Withdrawal Management - - -

Additional Support Services 7,876,577 454,142 1.33

Assertive Community Treatment (ACT) 5,342,831 44,984 0.90

Skill Building/Vocational Supports 3,435,858 156,988 0.58

Community Living Supports - - -

Subtotal CCBHC Services $ 117,293,341 1,498,083 $ 19.85

Total $ 252,345,641 3,090,057 $ 42.71

Time Period: October 1, 2022 - September 1, 2023

Region: Central

Population: HMP

Member Months: 5,908,211

Average Monthly Members: 492,351

Total Unique Recipients: 44,039

Notes:

1. Incurred claims and utilization are derived from the [Service UNC] worksheet of the SFY 2023 Period 3 Behavioral Health

EQI. Health Home and Non-Medicaid expenses from the EQI submissions have been excluded from these exhibits.

2. The encounter data used to determine recipients is based on information submitted as of August 3, 2024.

3. This metric represents the sum of reported units in the SFY 2023 EQI and does not make any considerations for the different reporting units various services codes have within a single service category.

4. The 'Total' row is the sum of the 'Subtotal Non-CCBHC Services' and 'Subtotal CCBHC Services' rows.

5. SFY 2023 incurred encounter data paid through August 3, 2024 was used for Northern Lakes CMH in the absence of an

EQI template for SFY 2023.

6. CCBHC service splits are determined solely by service codes and do not take diagnosis criteria into account.

7. HCPCS codes H0012, H0020, and H0023 have been retroactively excluded from the list of CCBHC-eligible services for

SFY 2023.

8. Services designated as included within the CCBHC Demonstration in SFY 2023 were identified as CCBHC Services in this exhibit. CCBHC service expenses are inclusive of all incurred claims for these services (i.e., broader than the CCBHC

Demonstration program), including non-CCBHC Demonstration providers and services provided to individuals who do not meet CCBHC Demonstration Criteria such as individuals who do not have a mental health or substance use disorder diagnosis. The most up-to-date list of eligible CCBHC services is available in the CCBHC Handbook (CCBHC Handbook.pdf).

Central - HMP Milliman Page 9 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7

Medicaid BH Program Procurement

Appendix 2 - Central - CWP - SFY 2023 Data Exhibit

Service Category Incurred Claims Utilization PMPM

Non-CCBHC Services

Inpatient $ 0 - $ 0.00

Other 328,658 5,722 110.29

SUD Outpatient Services - - -

Residential Services - - -

Prevention, E&M, Assessments and Testing - - -

Autism Services - - -

Psychotherapy - - -

Crisis - - -

Medication Administration/Medication Assisted Treatment - - -

Case Management / Treatment Planning - - -

Withdrawal Management - - -

Additional Support Services 2,638 32 0.89

Assertive Community Treatment (ACT) - - -

Skill Building/Vocational Supports - - -

Community Living Supports 2,760,858 460,272 926.46

Subtotal Non-CCBHC Services $ 3,092,154 466,026 $ 1,037.64

CCBHC Services

Inpatient $ 0 - $ 0.00

Other 229,193 2,524 76.91

SUD Outpatient Services - - -

Residential Services - - -

Prevention, E&M, Assessments and Testing - - -

Autism Services - - -

Psychotherapy - - -

Crisis - - -

Medication Administration/Medication Assisted Treatment - - -

Case Management / Treatment Planning - - -

Withdrawal Management - - -

Additional Support Services 975,339 165,700 327.29

Assertive Community Treatment (ACT) - - -

Skill Building/Vocational Supports - - -

Community Living Supports - - -

Subtotal CCBHC Services $ 1,204,532 168,224 $ 404.21

Total $ 4,296,686 634,250 $ 1,441.84

Time Period: October 1, 2022 - September 1, 2023

Region: Central

Population: CWP

Member Months: 2,980

Average Monthly Members: 248

Total Unique Recipients: 250

Notes:

1. Incurred claims and utilization are derived from the [Service UNC] worksheet of the SFY 2023 Period 3 Behavioral Health

EQI. Health Home and Non-Medicaid expenses from the EQI submissions have been excluded from these exhibits.

2. The encounter data used to determine recipients is based on information submitted as of August 3, 2024.

3. This metric represents the sum of reported units in the SFY 2023 EQI and does not make any considerations for the different reporting units various services codes have within a single service category.

4. The 'Total' row is the sum of the 'Subtotal Non-CCBHC Services' and 'Subtotal CCBHC Services' rows.

5. SFY 2023 incurred encounter data paid through August 3, 2024 was used for Northern Lakes CMH in the absence of an

EQI template for SFY 2023.

6. CCBHC service splits are determined solely by service codes and do not take diagnosis criteria into account.

7. HCPCS codes H0012, H0020, and H0023 have been retroactively excluded from the list of CCBHC-eligible services for

SFY 2023.

8. Services designated as included within the CCBHC Demonstration in SFY 2023 were identified as CCBHC Services in this exhibit. CCBHC service expenses are inclusive of all incurred claims for these services (i.e., broader than the CCBHC

Demonstration program), including non-CCBHC Demonstration providers and services provided to individuals who do not meet CCBHC Demonstration Criteria such as individuals who do not have a mental health or substance use disorder diagnosis. The most up-to-date list of eligible CCBHC services is available in the CCBHC Handbook (CCBHC Handbook.pdf).

Central - CWP Milliman Page 10 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7 https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/CCBHC/CCBHC_Demonstration_Handbook.pdf?rev=0ea6aa754aad4362ba995ee9f1eebb59&hash=5843DF0390F2FDDE0FFAE8E1B2B809F7…

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