By Martha A. Churchill
108 E. Main St., Milan, MI 48160

You may have a vague feeling that things are not as good as they should be. CMH can’t help you with vague feelings. You need to have specific goals in mind that relate to your disability. Here are some examples:

(A) Residential. Needing a home of your own. Needing support staff so that you can be successful living in the place of your choice.

(B) Vocational. Needing a job, or activity, during the day, so that you can be productive and perhaps even earn a few extra dollars.

(C) Recreational. Needing a social life, friends, fun activities that are within your budget.

(D) Medical. Being able to choose a doctor who is the most helpful to you, personally. Transportation to get to your doctor. Appropriate therapy. Support groups related to addiction, illness, or whatever concerns you have.

It is not reasonable to expect CMH to provide extravagant items such as a yacht, or cute chicks. It is reasonable to expect help with simple recreational activities such as going on a fishing trip, or social gatherings where you might meet someone you like.

Under Medicaid rules, the CMH provider is required to assist with the things that are "medically necessary" so that you can live in the "least restrictive environment." A trip to Disney World may not be medically necessary, but transportation to your doctor is, and assistance with certain daily activities if you are unable to take care of household tasks yourself due to your disability.

The CMH providers in Michigan are expected to have a panel of "providers" who help consumers with the things they need. Investigate the names of providers who work in your area of concern, and find out "who" can help you achieve your goals.

Do not volunteer yourself, your family members, or your friends unless they honestly have the time and inclination to do what you need. If you keep jumping in with ideas about how your mother can drive you to the doctor, how your neighbor can take you on social outings, and how your sister can help you fill out your application for a Section 8 housing voucher, do not be surprised if you are sitting there afterwards wondering why everyone in your life is burned out and has left town.

Under federal Medicaid law, the CMH providers can and will help you. But you have to ask for them. If you don’t ask, you won’t get the help you need.

Do you need help with your apartment rent, right this minute, in order to avoid eviction? If so, you have an emergency and you need to get someone’s attention quickly. If you are thinking about the future, and hope to move out of your parent’s house by next year, remember that your goal is a tall order and it can be broken down into smaller steps, some of which need to be taken now.

In order to have your own place a year from now, for example, you need to start immediately with looking at possible places, saving the first/last months rent, collecting furniture and dishes, choosing a housemate, etc. Do not sell yourself short on the time frame-- if you are in danger of becoming homeless, or being incarcerated, on account of having no place to live, do not be shy. Say so, up front. You do not have to "cry wolf" about every little thing, but do not minimize the needs that you honestly have.

Where is a good place to ask for the things you need? The PCP meeting, or Person Centered Planning meeting.

Some people underestimate the power of a PCP meeting. Some consumers think that it is just a waste of time, a place to rubber-stamp whatever the CMH case manager wants to do with you.

Under current federal law, the Department of Community Health made an agreement with HCFA (Health Care Financing Administration, or Medicaid) promising that consumers who receive Medicaid will receive the services that are medically necessary, without a wait. That means that if something is written into your PCP plan, the CMH provider is obligated to do whatever it promised in the plan.

The PCP system is also found in Michigan laws, in the Mental Health Code. This is a good thing, because if the CMH fails to follow PCP guidelines, they are violating both state and federal law.

Most consumers find that they can ask for what they need any time, whether at a PCP meeting or not. But if the help is not forthcoming it is a good idea to ask for a PCP meeting. The meetings are often held once a year, but can be held more often if requested. So, call up your case manager and say "I want a PCP meeting, how about next week?"

During the meeting, make sure you have expressed yourself. Who, what, and when. After the meeting, check to make sure the written report is accurate. If not, ask that the report be corrected.

If you were involved in a fender-bender, you would keep lots of written records. You would write down the date of the accident, name and address of the other driver, and their insurance company. You would make a police report, and keep a copy of it for yourself. You would contact your insurance company, and have records of your claim. Then there are the names of the repair shops, their quotes, and so on.

You would go to all that trouble to keep records over a small fender-bender, and achieve your goal of being reimbursed by your insurance company.

When it comes to life-changing issues, such as where the consumer is going to live or work, isn’t it worth while to keep records of everything that happens in reaching that goal?

Every time you have contact with the consumer, the provider, or CMH about the goals you are working towards, you should make a note. The "journal" can be nothing more than a cheap note pad. Or your regular date book, if you keep it afterwards.

Your notes, kept at about the same time as the events, are "contemporaneous" as the lawyers say. These records are more valuable than gold or diamonds. Your penciled scribbles written down within a day or so of the conversation, is excellent in terms of evidence in case you need to appeal your case later on. And even if you don’t appeal, it will help you talk to the agency or the provider and cut through the run-around.

If someone tells you to call the Department X office, you can save a lot of time by stating truthfully "I called Department X on May 4, 2001 and spoke to Ellen, and Ellen said she couldn’t help me."

It is not unusual for people who work for a large corporation, or a large agency, to not really know who does what. Once you have your written notes, you might know more than they do! Your written record will spare you the trouble of walking down the same blind alley more than once. Plus, you will be in a better position to help other consumers and family members cut through the red tape.

The CMH provider has quite a few notes about you. Do you want to see them? Ask to see your records. As a consumer, you have an absolute right to read all the medical reports and handwritten notes they have about you, and there are plenty. You can go to their office during normal business hours and read the whole thing at your leisure. Or you can sign a "release" allowing a family member, friend, or advocate to read them.

Some people feel that a consumer should be able to advocate for himself or herself, and there should be no necessity for an outside advocate. However, it doesn’t hurt to bounce your ideas off someone who has experience with the agency you are working with.

CMH is a large agency and it has a daunting bureaucracy. There is nothing wrong about establishing a small corps of volunteers -- consumers, family members -- within your regional area who have experience dealing with the CMH, and who can give advice about what works, and what doesn’t.

• An advocate should be willing to speak up. "Squeaky Wheel."
• An advocate should be polite. Do not be confrontational.
• An advocate should be familiar with Chapter III of the Medicaid Manual.
• An advocate should be familiar with certain portions of the Michigan Mental Health Code, such as the definition of "developmental disability." Some people with mental illness miss out on benefits they are entitled to because they don’t realize they fit the definition for "developmentally disabled." Under current law, a consumer can be very intelligent and still be developmentally disabled!
• An advocate should stay informed. Attend CMH board meetings, talk to providers.
• An advocate does NOT have to be an attorney.
• An advocate does NOT have to be a family member.

Anyone who receives Medicaid, or who qualifies for Medicaid, is eligible to file a request for an administrative law judge hearing in case your PCP plan was not followed by the CMH provider.

Before filing a complaint, check to make sure you have done all of the following items:

1. Expressed yourself clearly to CMH about what you need.
2. Identified a need which is "medically necessary." Something you need, due to your disability, so that you can live in the community, in the least restrictive environment. Something you need to stay out of jail, stay out of the hospital, stay out of the homeless shelter, or just to stay alive!
3. Discussed your goal at a PCP meeting, or at least requested a PCP meeting which they refused to hold for you.
4. Gotten your need written up into your PCP plan, or at least asked for it to be written up and they refused.

If you want to request help from the Administrative Tribunal, here is the information:

Administrative Tribunal
Michigan Department of Community Health
P.O. Box 30195, Lansing, MI 48909
Phone: (877) 833-0870. (517) 335-8911
Fax: (517) 335-9180

 

 

Conrad Consumer 456 Maple Street Mytown, MI 45678 (616) 123-4567 Administrative Tribunal Michigan Department of Community Health P.O. Box 30195 Lansing, MI 48909 Fax: (517) 335-9180 The Haveman County CMH office refused to hold a PCP meeting when I asked for one. I need CMH to provide me with paid staff to assist me with shopping, cooking, laundry, and other household tasks so that I can live independently in the community. I am about to be evicted and I have a history of being hospitalized. (OPTIONAL) I appoint John Goodheart to represent me at the hearing. /s/______________________ Date: _________________ Conrad Consumer

If you have an emergency situation, do not wait to mail them a request for a hearing. Call them, or fax them your problem in writing. The judges at the administrative tribunal do not want any CMH office to accidentally deny services to you or your loved one, especially if it is an urgent situation.

When in doubt, you can call them and ask for advice. They can’t give you legal advice at the administrative tribunal but they can make suggestions how to get your appeal to them quickly and efficiently.

Under Michigan law, every CMH is required to have an Office of Recipient Rights (ORR). This office is supposed to check up on complaints from consumers about denial of services or poor service. They are supposed to investigate injuries involving CMH people or their provider agencies. This law is known by attorneys as MCL 330.1752.

Anyone can contact their local ORR. You don’t have to be on Medicaid. You don’t even have to be a CMH consumer. If you asked for help from CMH and they turned you down, you can ask for help with the ORR.

If you are asking for an Administrative Law Judge hearing through the Department of Community Health, you can also ask for an investigation through the ORR. You can do both at the same time.

For persons who do not qualify for Medicaid, the ORR may be the only avenue available.

The people at the ORR are actually hired by CMH. So, the fox is guarding the hen house. If you do not get results, you can appeal to the Recipient Rights Appeal Committee. This is a citizen’s group appointed by the CMH director to be a watchdog on the ORR at your local CMH. This is required by the law, MCL 330.1757 and MCL 330.1774.

The law says you can appeal even higher if the Recipient Rights Appeal Committee does not give you satisfaction. You can write to the Department of Community Health about it within 45 days. (MCL 330.1786.) Or you can request mediation.

The local ORR is under the supervision of the Michigan ORR, through the Department of Community Health. This is required by a law known as MCL 330.1754. The people in Lansing are supposed to assist consumers with their ORR problems, and help them with appeals and complaints.

As a practical matter, I am not aware of any consumers who received services from CMH by jumping through all the hoops within the ORR and the Recipient Rights Appeal Committee. If you can file a Medicaid Fair Hearing request, do it.

You could also write a letter immediately to the Department of Community Health, to your Senator or Representative in the Michigan legislature, to Protection and Advocacy, to your elected official on the County Board of Commissioners, to the federal agency responsible for Medicaid, or to the agency which accredited your CMH.

If you write a letter like that, make sure your cover letter is short and simple. Do not send a thick packet of information or bulky documents.

Occasionally someone contacts a newspaper reporter and gets results that way, or at least shines a light on a problem requiring public attention. This involves your consumer’s privacy, though, and there is no guarantee the reporter will see things your way. On the other hand, it may create the publicity you need to make permanent changes for the benefit of all persons with disabilities.

Dealing with CMH is the same as dealing with anyone else. The people who work there are human beings and need to be treated with respect.

It is my experience that the vast majority of the people at CMH are committed to their work. They are loving and caring human beings. I have gotten to know some individuals who work for CMH and have a person in their family with a serious disability. I have found some people at CMH who wear "angel’s wings."

Take every opportunity to compliment someone from CMH about the high quality of services that were given a consumer. "That Valentine’s party was a terrific success, the consumers just loved it! And I realize you did this on your own time." "Jennie is pleased as punch with that bus pass you arranged for her. Thanks for taking the time to get that taken care of!!" etc.

It’s okay to mention occasionally that the Mental Health Code requires a PCP meeting, or to drop a remark about the Housing Best Practice Guidelines. But do not get carried away with your assertiveness. Be firm, but be nice! Do not attack unless there is truly a good reason, and then use good judgment. And even if you have to take the attack mode, do it politely. No name-calling.

 

"Family members of recipients shall be treated with dignity and respect. They shall be given an opportunity to provide information to the treating professionals. They shall also be provided an opportunity to request and receive educational information about the nature of disorders, medications and their side effects, available support services, advocacy and support groups, financial assistance and coping strategies." -- Michigan Mental Health Code, MCL 330.1711