AMOUNT OF FUNDING PAID TO PIHPs May 10, 2008

AMOUNT OF FUNDING PAID TO PIHPs
(FY2008 Appropriation Bill - Public Act 123 of 2007)
May 10, 2008
Section 418: On or before the tenth of each month, the department shall report to
the senate and house of representatives appropriations subcommittee on community
health, the senate and house fiscal agencies, and the state budget director on the
amount of funding paid to the CMHSPs or specialty prepaid health plans to support the
Medicaid managed mental health care program in that month. The information shall
include the total paid to each CMHSP or specialty prepaid health plan, per capita rate
paid for each eligibility group for each CMHSP or specialty prepaid health plan, and
number of cases in each eligibility group for each CMHSP or specialty prepaid health
plan, and year-to-date summary of eligibles and expenditures for the Medicaid
managed mental health care program.
Michigan Medicaid
Mental Health, Substance Abuse and Habilitation Supports Waiver
CAPITATION REPORT
These are the rates calculated under the rate
structure for FY2008.
May, 2008
V2.4
Summary of the Michigan Medicaid capitation data. Including
breakdown of covered lives and revenue by agency providing
services and by county.
For the Mental Health and Substance Abuse programs, only individuals eligible for Medicaid on card cut-off date are
capitated. Therefore, while additional Medicaid eligible individuals are expected for this month, the revenue figures
for payment will not change. Payments for individuals enrolled in the Habilitation Supports Waiver may be paid
retroactively as reflected on the Summary and HSW-Summary pages.
This data does not include any gross adjustments made to the revenue stream. Only revenues paid out through the
capitation system are shown.
Michigan Medicaid Monthly Capitation Summary - Introduction
Section
Page(s)
There are three general types of reports;
Reports with "Capitation" in their titles include both individuals eligible for Medicaid on card cut-off and their revenue data.
Reports with “Population” in their titles include only individuals eligible for Medicaid on card cut-off.
Reports with "Revenue" in their titles include only capitated revenue data.
Generally, if there is a Population report, there is a Revenue report with the same grouping, sorting, and selection criteria.
Generally, each report is first presented at the PIHP level and then at the county level.
SUMMARY - State Level
The first section provides tables and charts of summary totals for the state as a whole.
There are also some Age Profile charts showing the relative shares of the population that is male or female.
SUMMARY - PIHP and County Level
Capitation data summarizing population and revenue by PIHP and county. (Mental Health and Substance Abuse)
Population data by program group and gender for each PIHP and county. (Mental Health and Substance Abuse)
Revenue data by program group and gender for each PIHP and county. (Mental Health and Substance Abuse)
SUMMARY - PIHP and County Level - Habilitation Supports Waiver
Capitation data summarizing population and revenue by PIHP and county. (Habilitation Supports Waiver)
Population data by program group and gender for each PIHP and county. (Habilitation Supports Waiver)
Revenue data by program group and gender for each PIHP. (Habilitation Supports Waiver)
Summary of Payment and Recovery Amounts by PIHP. (Habilitation Supports Waiver)
Summary of Net Enrollees and Net Payments by PIHP. (Habilitation Supports Waiver)
REFERENCE DATA ( Base Rates, Age/Sex Factors, and Geographic Factors)
Notes:
4 - 10
11 - 13
14 - 23
24 - 27
28 - 43
44 - 51
52 - 55
56 - 59
60
61 - 64
65 - 75
While some data is provided at the county level, the actuarial basis for the data is such that revenue numbers are revenues due the PIHP and not the CMH or county. The rates are best
understood as "on average" or "in aggregate" values within any given PIHP. The revenues listed by county are not due that county, nor is that county limited to that revenue from the PIHP.
Revenue distribution within a PIHP is the responsibility of the PIHP.
Approximately the 20th of each month a snapshot of the individuals eligible for Medicaid is taken. This data is the basis for capitation for the following month. It is a prospective determination. Whatever a
person's Medicaid eligibility status is as of that snapshot will be their status for the following month in all published reports, data, and calculations.
If an individual is eligibile for Medicaid on card cut-off, they are capitated for the entire month. No proration of capitation takes place.
Mental Health and Subtance Abuse programs share eligibility determination. Anyone eligible for Medicaid in one program has the same classification and coverage perod in the other program.
Retroactive payments are made only for beneficiaries enrolled in the Habilitation Supports Waiver program. PIHPs are paid at the rate effective in the current month. Habilitation Supports Waiver enrollees
may also have revenue recovery records if a situation arises.
Habilitation Supports Waiver enrollee's capitation is calculated based on the rates applicable to their County of Residence. The capitation is paid to their County of Financial Responsibility.
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
Introduction
Page 2 of 79
Michigan Medicaid Monthly Capitation Summary - Table of Contents
Section
Worksheet
Page
Section
INTRODUCTION
General notes on use of the data
2
SUMMARY
Two page summary table of all data
Summary
4
Five page Year to Date Summary
YTD-Summary
Summary Charts
Summary Charts
11
Enrollment Age Profile Charts
Age Profile Charts
12
6
CAPITATION (Summaries with Population and Revenue)
Mental Health Capitation
by PIHP
MH by PIHP
14
MH TANF by PIHP
15
by County
MH by County
16
by PIHP
SA by PIHP
19
TANF by PIHP
SA TANF by PIHP
20
by County
SA by County
21
Substance Abuse Capitation
POPULATION
by PIHP by Program Group and Age Group
MHSA-Pop Common to MH and SA
24
by PIHP
HSW by PIHP
44
by County
HSW by County
45
HSW-Pop
52
HSW-DAB, HSW-TANF
56
POPULATION - Habilitation Supports Waiver
by PIHP by Program Group and Age Group
REVENUE - Habilitation Supports Waiver
Habilitation Supports Waiver
Summary - Habilitation Supports Waiver
Habilitation Supports Waiver
Summary of Payment and Recovery Amounts by PIHP HSW-Summary
60
Net Enrollees and Payments
HSW Net Enrollees & Payments
61
Affiliations
65
Reference Data
Affiliations and Included Counties
Capitation Base Rates
Cap Base Rates
Mental Health Capitaiton Base Rates
68
Substance Abuse Capitation Base Rates
69
Age/Sex Factors
REVENUE
Mental Health Revenue
by PIHP by Gender/Program Group/Age Group
MHSP-DAB, MHSP-TANF State Plan
28
by PIHP by Gender/Program Group/Age Group
MHB3-DAB, MHB3-TANF 1915(b)(3)
32
Substance Abuse Revenue
by PIHP by Gender/Program Group/Age Group
SASP-DAB, SASP-TANF State Plan
36
by PIHP by Gender/Program Group/Age Group
SAB3-DAB, SAB3-TANF 1915(b)(3)
40
Report Generated: 6/3/2008
Page
CAPITATION - Habilitation Supports Waiver (Summaries with Population and Revenue)
Habilitation Supports Waiver
by PIHP by Gender/Program Group/Age Group
TANF by PIHP
Worksheet
4:35 PM
Mental Health Age/Sex Factors
AgeSex Factors MH
70
Substance Abuse Age Sex Factors
AgeSex Factors SA
71
Mental Health Geographic Factors
Geographic Factors MH
72
Substance Abuse Geographic Factors
Geographic Factors SA
74
Geographic Factors
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
Table of Contents
Page 3 of 79
Medicaid Capitation Summary
May, 2008
Revenue - Funding Group
1
Group
Mental Health - State Plan Capitation
2
3
Mental Health - 1915(b)(3) Capitation
4
5
Combined MHSP and MHB3 Capitation
6
7
Total Capitation
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
DAB
$
52,927,187.36 $
3,603,446.86
$
5,450,245.60
$
11,475,942.86
$
13,139,053.66
$
15,320,097.24
$
3,938,401.14
TANF
$
8,873,627.98 $
5,761,620.82
$
899,906.43
$
1,455,864.17
$
631,012.46
$
125,223.40
$
0.70
DAB
$
44,924,379.41 $
3,058,516.96
$
4,626,150.23
$
9,740,642.23
$
11,152,306.69
$
13,003,728.63
$
3,343,034.67
TANF
$
1,380,877.86 $
896,450.17
$
139,992.50
$
226,713.44
$
98,211.44
$
19,509.62
$
0.69
DAB
$
97,851,566.77 $
6,661,963.82
$
10,076,395.83
$
21,216,585.09
$
24,291,360.35
$
28,323,825.87
$
7,281,435.81
TANF
$
10,254,505.84 $
6,658,070.99
$
1,039,898.93
$
1,682,577.61
$
729,223.90
$
144,733.02
$
1.39
$
108,106,072.61 $
13,320,034.81
$
11,116,294.76
$
22,899,162.70
$
25,020,584.25
$
28,468,558.89
$
7,281,437.20
Total MH Capitation (State Plan and 1915(b)(3))
8
Mental Health - HabSupports Waiver Current Payment
$
30,844,327.24 $
219,941.04
$
1,476,676.50
$
6,792,034.50
$
8,507,272.23
$
10,755,154.64
$
3,093,248.33
8a
Mental Health - HabSupports Waiver - Retro Payments FY 2007-2008
$
1,887,175.68 $
25,793.33
$
47,402.90
$
216,827.36
$
528,202.95
$
913,184.01
$
155,765.13
8b
Mental Health - HabSupports Waiver - Retro Payments FY 2006-2007
$
46,980.95 $
$
46,980.95
$
8c
Mental Health - HabSupports Waiver Total Payments Paid
$
32,778,483.87 $
245,734.37
$
1,524,079.40
$
7,008,861.86
$
9,035,475.18
$
11,715,319.60
$
3,249,013.46
$
140,884,556.48 $
13,565,769.18
$
12,640,374.16
$
29,908,024.56
$
34,056,059.43
$
40,183,878.49
$
10,530,450.66
DAB
$
1,262,577.65 $
60,870.97
$
138,558.04
$
225,371.36
$
392,566.63
$
426,817.09
$
18,393.56
TANF
$
862,711.66 $
163,332.33
$
155,492.46
$
343,948.47
$
162,968.63
$
36,969.08
$
0.69
DAB
$
506,647.21 $
24,325.18
$
55,548.14
$
90,405.38
$
157,538.47
$
171,334.12
$
7,495.92
TANF
$
388,010.03 $
73,764.06
$
69,934.58
$
154,460.74
$
73,235.61
$
16,614.35
$
0.69
DAB
$
1,769,224.86 $
85,196.15
$
194,106.18
$
315,776.74
$
550,105.10
$
598,151.21
$
25,889.48
TANF
$
1,250,721.69 $
237,096.39
$
225,427.04
$
498,409.21
$
236,204.24
$
53,583.43
$
1.38
3,019,946.55 $
322,292.54
$
419,533.22
$
814,185.95
$
786,309.34
$
651,734.64
$
25,890.86
13,888,061.72
$
13,059,907.38
$
30,722,210.51
$
34,842,368.77
$
40,835,613.13
$
10,556,341.52
9
10
Combined Mental Health Capitation
Substance Abuse - State Plan Capitation
11
12
Substance Abuse - 1915(b)(3) Capitation
13
14
Combined SASP and SAB3 Capitation
15
16
Total SA Capitation (State Plan and 1915(b)(3))
$
17
Total MA Capitation
$
Report Generated: 6/3/2008
4:35 PM
143,904,503.03
$
-
$
-
$
-
$
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
Summary
-
-
Page 4 of 79
Medicaid Capitation Summary
May, 2008
Population - Funding Group
18
Gender
DAB Population
19
20
21
22
23
Combined Current Medicaid Population*
25
HabSupports Enrollees Current (included above)
26
27
Total HabSupports Enrollees Current (included above)
28
HabSupports Enrollees Retro - Retro Payments FY 2007-2008
29
30
Total HabSupports Enrollees Retro - Retro Payments FY 2007-2008
31
HabSupports Enrollees Retro - Retro Payments FY 2006-2007
33
34
Total HabSupports Enrollees Retro - Retro Payments FY 2006-2007
Total HabSupports Enrollees
26 - 39
40 - 49
50 - 64
65+
40,186
24,003
23,789
25,619
36,733
25,961
Female
223,555
28,110
20,243
24,490
29,968
53,536
67,208
399,846
68,296
44,246
48,279
55,587
90,269
93,169
Male
408,145
355,566
21,506
18,661
9,244
3,126
42
Female
544,386
349,288
73,557
90,562
25,593
5,359
27
952,531
704,854
95,063
109,223
34,837
8,485
69
1,352,377
773,150
139,309
157,502
90,424
98,754
93,238
Male
4,186
61
269
990
1,149
1,355
362
Female
2,983
29
136
637
784
1,064
333
7,169
90
405
1,627
1,933
2,419
695
Male
261
9
24
33
73
105
17
Female
175
4
(2)
16
45
94
18
436
13
22
49
118
199
35
-
-
-
-
-
-
-
-
-
-
-
10
-
Male
Female
32
18 - 25
176,291
Total TANF Population
24
0 - 17
Male
Total DAB Population
TANF Population
Total Population
10
10
7,615
-
-
103
427
-
-
1,676
2,051
10
2,628
730
* SP & B3 Population figures do not include Retroactive Eligibles
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
Summary
Page 5 of 79
Capitation Summaries - Paid To Date By Month by PIHP*
May, 2008
Revenue - Mental Health - State Plan, 1915(b)(3) & HSW
November
October
1
Provider ID
Billing
Agent
Affiliation DBA
MH(SP)&(b3)
SA(SP)&(b3)
1705322
00GE
Access Alliance of Michigan
$
4,197,095
$
103,689
HSW As of
06/03/2008
$
1,624,104
Subtotal
$
5,924,889
MH(SP)&(b3)
SA(SP)&(b3)
$
$
102,960
4,194,932
December
HSW As of
06/03/2008
$
1,615,535
Subtotal
$
5,913,427
MH(SP)&(b3)
SA(SP)&(b3)
$
$
104,400
4,225,022
HSW As of
06/03/2008
$
1,607,230
Subtotal
$
5,936,652
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
$
5,840,361
$
111,341
$
1,695,959
$
7,647,661
$
5,826,211
$
110,421
$
1,695,818
$
7,632,450
$
5,849,217
$
111,622
$
1,708,433
$
7,669,272
3
4344340
00GG
CMH for Central Michigan
$
2,808,728
$
60,939
$
1,928,160
$
4,797,827
$
2,806,615
$
60,591
$
1,919,649
$
4,786,855
$
2,832,756
$
61,335
$
1,928,452
$
4,822,543
4
4483587
00GS
CMHSA Network of West Michigan
$
5,985,203
$
157,233
$
587,096
$
6,729,532
$
5,985,457
$
156,651
$
591,033
$
6,733,141
$
6,041,319
$
158,583
$
601,951
$
6,801,854
5
3119549
00GJ
Detroit Wayne County CMH Agency
$ 24,698,925
$
941,186
$
5,626,896
$ 31,267,007
$ 24,583,615
$
935,142
$
5,616,261
$ 31,135,018
$ 24,671,724
$
941,129
$
5,459,424
$ 31,072,277
6
1705233
0028
Genesee County CMH Services
$
5,786,603
$
252,090
$
1,337,181
$
7,375,875
$
5,774,846
$
250,820
$
1,326,521
$
7,352,188
$
5,820,399
$
253,900
$
1,328,726
$
7,403,024
7
1712452
00HA
Lakeshore Behavioral Health Alliance
$
3,892,210
$
104,859
$
1,019,535
$
5,016,604
$
3,897,707
$
104,715
$
1,014,978
$
5,017,399
$
3,922,534
$
105,795
$
1,010,421
$
5,038,750
8
1712229
00GV
Lifeways
$
2,077,111
$
60,823
$
601,422
$
2,739,357
$
2,060,150
$
59,439
$
593,470
$
2,713,059
$
2,079,802
$
60,477
$
592,161
$
2,732,441
9
3396315
00GX
Macomb County CMH Services
$
8,933,203
$
220,520
$
1,606,976
$ 10,760,699
$
8,962,414
$
220,971
$
1,650,553
$ 10,833,938
$
9,024,883
$
223,517
$
1,686,413
$ 10,934,812
10
1724945
00HJ
Northcare
$
4,540,143
$
69,713
$
1,780,963
$
$
4,552,243
$
69,584
$
1,806,923
$
$
4,577,460
$
70,373
$
1,783,792
$
6,390,819
6,428,750
6,431,625
11
4476125
00HF
Northern Affiliation
$
2,367,399
$
74,744
$
2,204,785
$
4,646,929
$
2,376,390
$
74,423
$
2,197,768
$
4,648,581
$
2,389,408
$
75,411
$
2,204,370
$
4,669,189
12
4540048
00HC
Northern Lakes
$
2,875,894
$
65,870
$
769,362
$
3,711,126
$
2,873,693
$
65,402
$
765,956
$
3,705,050
$
2,886,763
$
65,882
$
769,875
$
3,722,520
13
1705289
0058
Oakland County CMH Authority
$ 12,534,592
$
198,640
$
4,210,362
$ 12,520,102
$
198,162
$
4,200,053
$ 16,918,316
$ 12,553,837
$
200,239
$
4,219,989
14
1712541
00HQ
Saginaw County CMH Authority
$
2,423,410
$
98,070
$
585,601
$
3,107,081
$
2,429,206
$
97,997
$
580,357
$
3,107,560
$
2,446,942
$
99,641
$
589,683
$
3,136,266
15
4390138
00HU
Southeast Partnership
$
4,849,920
$
111,463
$
2,721,451
$
7,682,834
$
4,849,509
$
110,367
$
2,729,909
$
7,689,786
$
4,913,707
$
112,713
$
2,707,022
$
7,733,442
$ 16,943,593
$ 16,974,065
16
3402136
00GR
Southwest Alliance
$
4,758,425
$
132,803
$
1,653,886
$
6,545,114
$
4,754,206
$
131,933
$
1,647,746
$
6,533,884
$
4,783,857
$
133,039
$
1,621,991
$
6,538,886
17
1708164
00HO
Thumb Mental Health Alliance
$
3,935,095
$
71,718
$
1,470,472
$
5,477,285
$
3,924,394
$
71,114
$
1,449,498
$
5,445,006
$
3,949,203
$
72,088
$
1,458,661
$
5,479,952
18
2920843
00HR
Venture Behavioral Health
$
4,485,605
$
124,988
$
1,329,084
$
5,939,676
$
4,461,192
$
123,731
$
1,320,375
$
5,905,298
$
4,495,621
$
125,600
$
1,324,738
$
5,945,959
State Subtotals $ 106,989,922
$
2,960,690
$ 106,832,882
$
2,944,422
$ 107,464,453
$
2,975,744
*HSW Payments are reflected by service month. The amounts will
be updated as retro/recovery payments occur for each service
month.
Report Generated: 6/3/2008
4:35 PM
$ 109,950,612
$ 32,753,296
$ 142,703,908
$ 32,722,402
$ 142,499,706
$ 109,777,304
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
YTD-Summary
$ 32,603,331
$ 143,043,528
$ 110,440,197
Page 6 of 79
Capitation Summaries - Paid To Date By Month by PIHP*
May, 2008
Revenue - Mental Health - State Plan, 1915(b)(3) & HSW
January
February
HSW As of
06/03/2008
HSW As of
06/03/2008
Provider ID
Billing
Agent
Affiliation DBA
MH(SP)&(b3)
SA(SP)&(b3)
1
1705322
00GE
Access Alliance of Michigan
$
$
105,270
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
$
5,867,521
$
112,582
$
1,717,531
$
7,697,634
$
3
4344340
00GG
CMH for Central Michigan
$
2,839,329
$
61,934
$
1,935,323
$
4,836,586
$
4
4483587
00GS
CMHSA Network of West Michigan
$
6,054,644
$
159,528
$
604,374
$
6,818,546
$
6,014,898
5
3119549
00GJ
Detroit Wayne County CMH Agency
$ 24,698,422
$
944,024
$
5,648,123
$ 31,290,569
$ 24,595,544
$
940,508
$
5,611,333
$ 31,147,385
$ 24,588,363
$
943,228
$
5,595,645
$ 31,127,236
6
1705233
0028
Genesee County CMH Services
$
5,849,222
$
256,709
$
1,335,191
$
7,441,121
$
5,824,314
$
254,525
$
1,340,347
$
7,419,185
$
5,854,313
$
256,818
$
1,342,072
$
7,453,202
7
1712452
00HA
Lakeshore Behavioral Health Alliance
$
3,928,491
$
106,737
$
1,016,119
$
5,051,348
$
3,916,897
$
106,171
$
1,017,260
$
5,040,328
$
3,939,842
$
107,840
$
1,008,146
$
5,055,828
8
1712229
00GV
Lifeways
$
2,084,764
$
61,232
$
601,297
$
2,747,292
$
2,075,749
$
60,986
$
599,112
$
2,735,847
$
2,089,576
$
61,105
$
592,683
$
2,743,363
4,246,960
HSW As of
06/03/2008
March
$
1,608,270
Subtotal
$
5,960,500
Subtotal
SA(SP)&(b3)
$
$
106,329
5,849,327
$
112,762
$
1,720,365
$
7,682,455
2,846,896
$
62,293
$
1,925,596
$
4,834,784
$
160,665
$
610,734
$
6,838,619
SA(SP)&(b3)
$
$
105,100
5,841,129
$
111,835
$
1,700,193
$
7,653,156
$
2,829,384
$
61,579
$
1,935,500
$
4,826,463
$
$
158,311
$
604,374
$
6,777,583
$
6,067,220
4,229,635
$
1,598,369
$
5,933,104
Subtotal
MH(SP)&(b3)
MH(SP)&(b3)
4,247,570
$
1,595,136
$
5,949,035
9
3396315
00GX
Macomb County CMH Services
$
9,067,514
$
225,629
$
1,694,516
$ 10,987,659
$
9,073,548
$
226,144
$
1,695,643
$ 10,995,335
$
9,136,574
$
229,429
$
1,680,570
$ 11,046,572
10
1724945
00HJ
Northcare
$
4,597,707
$
71,187
$
1,803,894
$
6,472,788
$
4,580,291
$
70,931
$
1,797,504
$
$
4,609,146
$
71,689
$
1,800,033
$
6,480,869
11
4476125
00HF
Northern Affiliation
$
2,391,050
$
75,786
$
2,212,950
$
4,679,787
$
2,385,561
$
75,811
$
2,197,676
$
4,659,049
$
2,393,928
$
76,639
$
2,192,720
$
4,663,287
12
4540048
00HC
Northern Lakes
$
2,899,843
$
66,547
$
786,173
$
3,752,562
$
2,903,635
$
67,017
$
786,544
$
3,757,197
$
2,924,594
$
67,879
$
781,616
$
3,774,089
13
1705289
0058
Oakland County CMH Authority
$ 12,590,001
$
202,467
$
4,203,619
$ 12,528,887
$
201,411
$
4,176,384
$ 12,600,387
$
203,670
$
4,137,284
14
1712541
00HQ
Saginaw County CMH Authority
$
2,453,067
$
100,406
$
594,926
$
3,148,399
$
2,442,936
$
99,770
$
596,088
$
3,138,794
$
2,454,221
$
100,489
$
590,844
$
3,145,555
15
4390138
00HU
Southeast Partnership
$
4,934,091
$
113,583
$
2,743,298
$
7,790,972
$
4,912,974
$
112,942
$
2,711,895
$
7,737,811
$
4,952,048
$
114,556
$
2,704,367
$
7,770,971
16
3402136
00GR
Southwest Alliance
$
4,805,216
$
134,194
$
1,645,487
$
6,584,897
$
4,777,672
$
133,203
$
1,642,132
$
6,553,007
$
4,793,319
$
134,803
$
1,637,127
$
6,565,249
17
1708164
00HO
Thumb Mental Health Alliance
$
3,965,313
$
72,547
$
1,473,067
$
5,510,928
$
3,948,392
$
72,579
$
1,467,824
$
5,488,795
$
3,962,695
$
73,424
$
1,453,417
$
5,489,537
18
2920843
00HR
Venture Behavioral Health
$
4,505,064
$
126,413
$
1,351,385
$
5,982,863
$
4,479,164
$
125,072
$
1,345,625
$
5,949,861
$
4,482,282
$
126,532
$
1,345,266
$
5,954,080
State Subtotals $ 107,778,218
$
2,996,776
$ 107,360,613
$
2,983,893
$ 107,792,302
$
3,010,151
*HSW Payments are reflected by service month. The amounts will
be updated as retro/recovery payments occur for each service
month.
Report Generated: 6/3/2008
4:35 PM
$ 110,774,995
$ 32,975,544
$ 16,996,087
$ 143,750,539
$ 32,823,802
6,448,726
$ 16,906,682
$ 143,168,308
$ 110,344,506
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
YTD-Summary
$ 32,713,620
$ 16,941,341
$ 143,516,072
$ 110,802,452
Page 7 of 79
Capitation Summaries - Paid To Date By Month by PIHP*
May, 2008
Revenue - Mental Health - State Plan, 1915(b)(3) & HSW
April
Provider ID
Billing
Agent
Affiliation DBA
MH(SP)&(b3)
SA(SP)&(b3)
1
1705322
00GE
Access Alliance of Michigan
$
$
107,319
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
$
5,878,930
$
3
4344340
00GG
CMH for Central Michigan
$
2,848,867
$
4
4483587
00GS
CMHSA Network of West Michigan
$
6,110,351
5
3119549
00GJ
Detroit Wayne County CMH Agency
6
1705233
0028
Genesee County CMH Services
7
1712452
00HA
Lakeshore Behavioral Health Alliance
$
8
1712229
00GV
Lifeways
$
4,258,870
May
HSW As of
06/03/2008
Subtotal
5,919,646
SA(SP)&(b3)
$
$
107,074
$
1,553,456
113,925
$
1,694,690
$
7,687,545
$
5,871,424
$
62,581
$
1,915,395
$
4,826,843
$
2,849,350
$
$
162,499
$
608,014
$
6,880,864
$
6,071,786
$ 24,594,727
$
944,961
$
5,486,481
$ 31,026,170
$
$
259,190
$
1,335,875
$
7,478,784
3,972,722
$
109,134
$
1,004,740
$
5,086,596
$
2,094,028
$
61,601
$
586,999
$
2,742,627
$
5,883,719
$
MH(SP)&(b3)
4,263,595
June
HSW As of
06/03/2008
Subtotal
HSW As of
06/03/2008
SA(SP)&(b3)
5,882,572
Subtotal
$
1,511,903
113,307
$
1,613,556
$
7,598,288
$
-
62,324
$
1,823,895
$
4,735,569
$
-
$
161,233
$
580,736
$
6,813,755
$
-
$ 24,491,545
$
940,324
$
5,362,752
$ 30,794,621
$
-
$
$
258,409
$
1,299,481
$
7,436,908
$
-
3,965,420
$
108,349
$
1,003,294
$
5,077,064
$
-
2,095,524
$
61,146
$
571,664
$
2,728,334
$
-
5,879,018
$
MH(SP)&(b3)
$
-
9
3396315
00GX
Macomb County CMH Services
$
9,199,435
$
232,323
$
1,600,934
$ 11,032,691
$
9,245,784
$
232,538
$
1,525,678
$ 11,004,001
$
-
10
1724945
00HJ
Northcare
$
4,603,626
$
71,789
$
1,789,392
$
6,464,807
$
4,610,967
$
71,847
$
1,754,602
$
6,437,416
$
-
11
4476125
00HF
Northern Affiliation
$
2,408,530
$
77,311
$
2,170,911
$
4,656,752
$
2,411,361
$
77,378
$
2,052,393
$
4,541,132
$
-
12
4540048
00HC
Northern Lakes
$
2,931,468
$
68,124
$
782,625
$
3,782,218
$
2,945,149
$
68,092
$
734,398
$
3,747,639
$
-
13
1705289
0058
Oakland County CMH Authority
$ 12,679,896
$
205,436
$
3,978,236
$ 12,672,213
$
205,133
$
3,709,893
$ 16,587,240
$
-
14
1712541
00HQ
Saginaw County CMH Authority
$
2,466,629
$
100,835
$
580,357
$
3,147,821
$
2,478,847
$
101,249
$
555,463
$
3,135,559
$
-
15
4390138
00HU
Southeast Partnership
$
4,986,454
$
115,874
$
2,612,429
$
7,714,757
$
4,968,457
$
115,224
$
2,513,678
$
7,597,359
$
-
16
3402136
00GR
Southwest Alliance
$
4,808,275
$
135,605
$
1,612,303
$
6,556,183
$
4,793,306
$
134,774
$
1,595,984
$
6,524,064
$
-
17
1708164
00HO
Thumb Mental Health Alliance
$
3,988,444
$
74,391
$
1,431,352
$
5,494,188
$
4,002,058
$
74,788
$
1,343,830
$
5,420,676
$
-
18
2920843
00HR
Venture Behavioral Health
$
4,505,226
$
127,870
$
1,344,339
$
5,977,434
$
4,490,267
$
126,756
$
1,291,126
$
5,908,149
$
-
State Subtotals $ 108,220,199
$
3,030,768
$ 108,106,073
$
3,019,947
$
-
*HSW Payments are reflected by service month. The amounts will
be updated as retro/recovery payments occur for each service
month.
Report Generated: 6/3/2008
4:35 PM
$ 111,250,967
$ 32,088,528
$ 16,863,569
$ 143,339,495
$ 30,844,327
$ 141,970,346
$ 111,126,019
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
YTD-Summary
$
-
$
-
$
-
$
-
Page 8 of 79
Capitation Summaries - Paid To Date By Month by PIHP*
May, 2008
Revenue - Mental Health - State Plan, 1915(b)(3) & HSW
July
August
HSW As of
06/03/2008
HSW As of
06/03/2008
Provider ID
Billing
Agent
Affiliation DBA
1
1705322
00GE
Access Alliance of Michigan
$
-
$
-
$
-
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
$
-
$
-
$
-
3
4344340
00GG
CMH for Central Michigan
$
-
$
-
$
-
4
4483587
00GS
CMHSA Network of West Michigan
$
-
$
-
$
-
5
3119549
00GJ
Detroit Wayne County CMH Agency
$
-
$
-
$
-
6
1705233
0028
Genesee County CMH Services
$
-
$
-
$
-
7
1712452
00HA
Lakeshore Behavioral Health Alliance
$
-
$
-
$
-
8
1712229
00GV
Lifeways
$
-
$
-
$
-
MH(SP)&(b3)
HSW As of
06/03/2008
September
SA(SP)&(b3)
Subtotal
MH(SP)&(b3)
SA(SP)&(b3)
Subtotal
MH(SP)&(b3)
SA(SP)&(b3)
Subtotal
9
3396315
00GX
Macomb County CMH Services
$
-
$
-
$
-
10
1724945
00HJ
Northcare
$
-
$
-
$
-
11
4476125
00HF
Northern Affiliation
$
-
$
-
$
-
12
4540048
00HC
Northern Lakes
$
-
$
-
$
-
13
1705289
0058
Oakland County CMH Authority
$
-
$
-
$
-
14
1712541
00HQ
Saginaw County CMH Authority
$
-
$
-
$
-
15
4390138
00HU
Southeast Partnership
$
-
$
-
$
-
16
3402136
00GR
Southwest Alliance
$
-
$
-
$
-
17
1708164
00HO
Thumb Mental Health Alliance
$
-
$
-
$
-
18
2920843
00HR
Venture Behavioral Health
$
-
$
-
$
-
$
-
$
-
$
-
State Subtotals $
*HSW Payments are reflected by service month. The amounts will
be updated as retro/recovery payments occur for each service
month.
Report Generated: 6/3/2008
4:35 PM
-
$
-
$
-
$
-
$
-
$
-
$
-
$
-
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
YTD-Summary
$
-
$
-
$
-
$
-
Page 9 of 79
Capitation Summaries - Paid To Date By Month by PIHP*
May, 2008
Revenue - Mental Health - State Plan, 1915(b)(3) & HSW
Year to Date
Provider ID
Billing
Agent
Affiliation DBA
1
1705322
00GE
Access Alliance of Michigan
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
$
46,824,120
$
897,796
$
13,546,546
$
61,268,462
3
4344340
00GG
CMH for Central Michigan
$
22,661,926
$
493,575
$
15,311,969
$
38,467,470
4
4483587
00GS
CMHSA Network of West Michigan
$
48,330,879
$
1,274,703
$
4,788,312
$
54,393,894
5
3119549
00GJ
Detroit Wayne County CMH Agency
$ 196,922,865
$
7,530,503
$
44,406,916
$
248,860,283
6
1705233
0028
Genesee County CMH Services
$
$
2,042,461
$
10,645,392
$
59,360,287
7
1712452
00HA
Lakeshore Behavioral Health Alliance
$
31,435,823
$
853,600
$
8,094,494
$
40,383,916
8
1712229
00GV
Lifeways
$
16,656,705
$
486,808
$
4,738,807
$
21,882,321
MH(SP)&(b3)
$
33,863,679
46,672,434
HSW As of
06/03/2008
SA(SP)&(b3)
$
842,142
$
12,714,003
Total
$
47,419,824
9
3396315
00GX
Macomb County CMH Services
$
72,643,354
$
1,811,070
$
13,141,284
$
87,595,708
10
1724945
00HJ
Northcare
$
36,671,584
$
567,113
$
14,317,102
$
51,555,799
11
4476125
00HF
Northern Affiliation
$
19,123,628
$
607,504
$
17,433,574
$
37,164,705
12
4540048
00HC
Northern Lakes
$
23,241,039
$
534,814
$
6,176,549
$
29,952,402
13
1705289
0058
Oakland County CMH Authority
$ 100,679,916
$
1,615,159
$
32,835,819
$
135,130,894
14
1712541
00HQ
Saginaw County CMH Authority
$
19,595,258
$
798,458
$
4,673,320
$
25,067,036
15
4390138
00HU
Southeast Partnership
$
39,367,160
$
906,723
$
21,444,049
$
61,717,932
16
3402136
00GR
Southwest Alliance
$
38,274,275
$
1,070,352
$
13,056,656
$
52,401,283
17
1708164
00HO
Thumb Mental Health Alliance
$
31,675,595
$
582,651
$
11,548,120
$
43,806,365
18
2920843
00HR
Venture Behavioral Health
$
35,904,422
$
1,006,961
$
10,651,938
$
47,563,321
State Subtotals $ 860,544,662
$
23,922,390
*HSW Payments are reflected by service month. The amounts will
be updated as retro/recovery payments occur for each service
month.
Report Generated: 6/3/2008
4:35 PM
$ 259,524,850
$ 1,143,991,903
$ 884,467,052
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
YTD-Summary
Page 10 of 79
MA Summary - Charts
May, 2008
Note: The Y axis scales are not the same for these two charts.
Medicaid Population
$18
Thousands
Millions
Medicaid Revenue
$16
800
700
$14
600
$12
500
$10
400
$8
300
$6
MH-State Plan
200
MH-1915(b)(3)
$4
Total DAB
Population
SA-State Plan
$2
SA-1915(b)(3)
Total TANF
Population
100
Total HabSupports
Enrollees
Hab Supports
$-
-
0 - 17
18 - 25
Report Generated: 6/3/2008
26 - 39
4:35 PM
40 - 49
50 - 64
65+
0 - 17
18 - 25
26 - 39
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
Summary Charts
40 - 49
50 - 64
65+
Page 11 of 79
MA Age Profile - by Gender - Charts
May, 2008
Note: The Y axis scales are not the same for the three populations.
Age Profile - Mental Health Population
60,000
55,000
50,000
45,000
40,000
35,000
30,000
25,000
20,000
15,000
10,000
5,000
Male Mental Health
Report Generated: 6/3/2008
4:35 PM
Female Mental Health
105
100
95
90
85
80
75
70
65
60
55
50
45
40
35
30
25
20
15
10
5
0
-
Mental Health - M and F
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
Age Profile Charts
Page 12 of 79
MA Age Profile - by Gender - Charts
May, 2008
Note: The Y axis scales are not the same for the three populations.
Age Profile - Habilitation Supports Waiver Enrollees
Age Profile - DD (E&P)
7,000
250
240
6,500
230
220
6,000
210
200
5,500
190
180
5,000
170
4,500
160
150
4,000
140
130
3,500
120
110
3,000
100
90
2,500
80
2,000
70
60
1,500
50
40
1,000
30
20
500
10
-
Male E&P
Report Generated: 6/3/2008
Female E&P
4:35 PM
E & P - M and F
Male HSW Enrollees
Female HSW Enrollees
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
Age Profile Charts
90
80
70
60
50
40
30
20
10
0
90
80
70
60
50
40
30
20
10
0
-
HSW Enrollees - M and F
Page 13 of 79
Mental Health - Capitation by PIHP
May, 2008
Summary by Population by Gender
Paid Population
DAB
Revenue - Mental Health Capitation - State Plan and 1915(b)(3)
TANF
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
3
4344340
00GG
CMH for Central Michigan
4
4483587
00GS
CMHSA Network of West Michigan
10,466
12,565
24,665
5
3119549
00GJ
Detroit Wayne County CMH Agency
52,771
63,247
112,267
6
1705233
0028
Genesee County CMH Services
10,048
12,249
23,623
7
1712452
00HA
Lakeshore Behavioral Health Alliance
6,193
8,382
8
1712229
00GV
Lifeways
3,826
4,636
00GX
Macomb County CMH Services
9,366
13,481
Affiliation DBA
Male
Female
Male
DAB Capitation
Female
Total
Male
TANF Capitation
Female
Male
Total Capitation
Female
6,464
8,131
16,226
20,402
51,223
$
1,996,412
$
1,658,423
$
286,739
$
322,022
$
4,263,595
10,143
12,851
24,363
31,218
78,575
$
2,725,867
$
2,366,734
$
362,436
$
416,387
$
5,871,424
5,031
6,381
11,387
14,458
37,257
$
1,345,378
$
1,149,952
$
164,784
$
189,236
$
2,849,350
32,668
80,364
$
3,008,256
$
2,596,490
$
214,364
$
252,675
$
6,071,786
159,948
388,233
$
12,338,309
$
9,919,253
$
952,904
$
1,281,079
$
24,491,545
32,922
78,842
$
2,900,230
$
2,530,908
$
194,824
$
253,056
$
5,879,018
16,815
21,544
52,934
$
1,903,035
$
1,796,026
$
124,725
$
141,634
$
3,965,420
8,753
11,307
28,522
$
1,010,704
$
846,542
$
111,514
$
126,765
$
2,095,524
25,528
33,117
81,492
$
4,416,655
$
4,144,491
$
310,579
$
374,060
$
9,245,784
9
3396315
10
1724945
00HJ
Northcare
5,576
7,919
11,923
14,603
40,021
$
2,173,851
$
1,878,541
$
266,474
$
292,101
$
4,610,967
11
4476125
00HF
Northern Affiliation
5,451
7,147
12,996
15,947
41,541
$
1,164,594
$
993,160
$
121,840
$
131,766
$
2,411,361
12
4540048
00HC
Northern Lakes
4,873
6,272
11,896
14,700
37,741
$
1,343,449
$
1,163,389
$
209,135
$
229,177
$
2,945,149
13
1705289
0058
Oakland County CMH Authority
11,848
16,586
25,289
33,037
86,760
$
6,245,819
$
5,560,701
$
395,068
$
470,625
$
12,672,213
14
1712541
00HQ
Saginaw County CMH Authority
5,287
6,326
10,247
14,593
36,453
$
1,266,486
$
1,069,212
$
61,677
$
81,472
$
2,478,847
15
4390138
00HU
Southeast Partnership
7,376
9,744
18,836
24,673
60,629
$
2,384,494
$
2,096,532
$
223,832
$
263,599
$
4,968,457
16
3402136
00GR
Southwest Alliance
7,585
9,648
18,619
24,498
60,350
$
2,289,125
$
2,033,196
$
216,870
$
254,115
$
4,793,306
17
1708164
00HO
Thumb Mental Health Alliance
4,229
5,362
12,405
15,929
37,925
$
1,906,581
$
1,588,753
$
235,005
$
271,718
$
4,002,058
18
2920843
00HR
Venture Behavioral Health
9,758
12,628
22,307
28,822
73,515
$
2,139,799
$
1,900,218
$
209,488
$
240,762
$
4,490,267
19
$
-
20
$
-
State Subtotals
176,291
223,555
399,846
408,145
544,386
952,531
1,352,377
-
$
52,559,045
$
45,292,522
97,851,567
$
4,662,257
$
5,592,249
$
108,106,073
10,254,506
$
108,106,073
-
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MH by PIHP
Page 14 of 79
Mental Health - TANF Capitation by PIHP
May, 2008
Summary by Population by Gender
Paid Population - TANF
TANF Non-Healthy Kids
Revenue - Mental Health Capitation - State Plan and 1915(b)(3)
TANF - Healthy Kids
TANF Non-Healthy Kids Capitation
TANF Healthy Kids Capitation
Provider ID
Billing
Agent
Affiliation DBA
1
1705322
00GE
Access Alliance of Michigan
15,992
20,173
234
229
36,628
$
282,608
$
318,899
$
4,131
$
3,123
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
24,113
30,981
250
237
55,581
$
358,709
$
413,648
$
3,728
$
2,739
3
4344340
00GG
CMH for Central Michigan
11,245
14,332
142
126
25,845
$
162,736
$
187,808
$
2,048
$
1,428
4
4483587
00GS
CMHSA Network of West Michigan
24,424
32,446
241
222
57,333
$
212,246
$
251,134
$
2,118
$
1,541
5
3119549
00GJ
Detroit Wayne County CMH Agency
111,616
159,266
651
682
272,215
$
947,319
$
1,276,497
$
5,585
$
4,582
6
1705233
0028
Genesee County CMH Services
23,434
32,747
189
175
56,545
$
193,263
$
251,945
$
1,561
$
1,112
7
1712452
00HA
Lakeshore Behavioral Health Alliance
16,606
21,369
209
175
38,359
$
123,165
$
140,626
$
1,560
$
1,008
8
1712229
00GV
Lifeways
8,662
11,222
91
85
20,060
$
110,343
$
125,907
$
1,170
$
858
9
3396315
00GX
Macomb County CMH Services
25,259
32,862
269
255
58,645
$
307,279
$
371,613
$
3,299
$
2,447
10
1724945
00HJ
Northcare
11,677
14,393
246
210
26,526
$
260,946
$
288,445
$
5,528
$
3,656
11
4476125
00HF
Northern Affiliation
12,750
15,706
246
241
28,943
$
119,533
$
130,024
$
2,308
$
1,743
12
4540048
00HC
Northern Lakes
11,707
14,518
189
182
26,596
$
205,805
$
226,710
$
3,330
$
2,467
13
1705289
0058
Oakland County CMH Authority
24,990
32,755
299
282
58,326
$
390,358
$
467,091
$
4,711
$
3,534
14
1712541
00HQ
Saginaw County CMH Authority
10,149
14,492
98
101
24,840
$
61,088
$
80,999
$
590
$
473
15
4390138
00HU
Southeast Partnership
18,623
24,461
213
212
43,509
$
221,272
$
261,605
$
2,559
$
1,994
16
3402136
00GR
Southwest Alliance
18,413
24,295
206
203
43,117
$
214,452
$
252,259
$
2,417
$
1,856
17
1708164
00HO
Thumb Mental Health Alliance
12,227
15,755
178
174
28,334
$
231,634
$
269,154
$
3,371
$
2,564
18
2920843
00HR
Venture Behavioral Health
22,009
28,570
298
252
51,129
$
206,658
$
238,899
$
2,830
$
1,864
403,896
540,343
4,249
4,043
952,531
$
4,609,414
$
5,553,261
$
52,843
$
38,988
Male
Female
Male
Female
Total
Male
Female
Male
Female
19
20
State Subtotals
944,239
Report Generated: 6/3/2008
4:35 PM
8,292
-
10,162,675
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MH TANF by PIHP
91,831
Page 15 of 79
Total TANF
Capitation
$
608,760
$
778,823
$
354,020
$
467,039
$
2,233,983
$
447,880
$
266,359
$
238,278
$
684,638
$
558,575
$
253,607
$
438,312
$
865,693
$
143,149
$
487,431
$
470,985
$
506,723
$
450,250
$
-
$
-
$
10,254,506
$
10,254,506
-
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MH TANF by PIHP
Page 16 of 79
Mental Health - Capitation by County
May, 2008
Summary by Population by Gender
Paid Population
Revenue - Mental Health Capitation - State Plan and 1915(b)(3)
DAB
Provider ID
Billing
Agent
Code
1
4476125
00HF
01
ALCONA
2
1724945
00HJ
02
ALGER
3
3402136
00GR
03
ALLEGAN
4
4476125
00HF
04
ALPENA
5
4476125
00HF
05
ANTRIM
6
1705322
00GE
06
ARENAC
7
1724945
00HJ
07
BARAGA
145
8
2920843
00HR
08
BARRY
9
1705322
00GE
09
BAY
10
1708001
00BJ
10
BENZIE
11
2920843
00HR
11
12
2920843
00HR
12
13
2920843
00HR
13
CALHOUN
14
3402136
00GR
14
15
4476125
00HF
15
16
4476125
00HF
17
1724945
18
4344340
19
1708001
20
21
County Name
Male
201
TANF
Female
300
Male
382
DAB Capitation
Female
476
Total
Male
1,359
$
TANF Capitation
Female
42,609
$
Male
38,915
$
Total Capitation
Female
3,620
$
4,022
$
89,166
158
253
334
384
1,129
$
56,659
$
58,432
$
7,505
$
7,659
$
130,256
1,409
1,838
4,251
5,270
12,768
$
412,359
$
364,197
$
49,404
$
53,009
$
878,969
745
994
1,298
1,703
4,740
$
170,416
$
152,265
$
12,168
$
14,390
$
349,239
409
477
1,040
1,331
3,257
$
84,142
$
64,214
$
9,696
$
10,456
$
168,509
433
525
830
983
2,771
$
133,764
$
108,043
$
14,705
$
15,694
$
272,207
257
397
468
1,267
$
55,221
$
58,563
$
8,926
$
9,532
$
132,242
656
946
2,063
2,552
6,217
$
140,323
$
138,611
$
19,426
$
21,137
$
319,498
2,059
2,715
4,741
6,297
15,812
$
661,274
$
566,945
$
83,842
$
100,698
$
1,412,759
280
367
723
770
2,140
$
73,749
$
64,455
$
10,666
$
10,037
$
158,908
BERRIEN
3,544
4,685
7,184
9,799
25,212
$
755,104
$
689,232
$
67,139
$
82,694
$
1,594,169
BRANCH
748
949
2,146
2,566
6,409
$
163,604
$
138,024
$
20,215
$
20,962
$
342,804
3,230
4,050
6,931
9,045
23,256
$
731,747
$
633,777
$
65,231
$
75,651
$
1,506,406
CASS
932
1,130
2,209
2,946
7,217
$
273,089
$
220,207
$
25,790
$
31,219
$
550,305
CHARLEVOIX
309
444
999
1,146
2,898
$
61,050
$
56,488
$
9,279
$
9,024
$
135,841
16
CHEBOYGAN
531
710
1,483
1,755
4,479
$
108,825
$
98,684
$
13,912
$
14,356
$
235,776
00HJ
17
CHIPPEWA
699
844
1,527
1,855
4,925
$
268,567
$
223,943
$
34,087
$
36,570
$
563,167
00GG
18
CLARE
890
1,070
1,794
2,254
6,008
$
247,476
$
207,675
$
26,051
$
29,767
$
510,970
00BJ
19
CLINTON
624
768
1,588
1,991
4,971
$
163,774
$
137,455
$
23,600
$
26,091
$
350,920
4540048
00HC
20
CRAWFORD
298
390
680
844
2,212
$
84,723
$
72,940
$
12,010
$
13,330
$
183,004
1724945
00HJ
21
DELTA
736
1,025
1,569
1,901
5,231
$
294,166
$
252,984
$
34,955
$
38,211
$
620,316
22
1724945
00HJ
22
DICKINSON
448
707
1,006
1,316
3,477
$
175,252
$
163,498
$
22,387
$
26,591
$
387,728
23
1708001
00BJ
23
EATON
1,143
1,496
3,075
4,093
9,807
$
297,996
$
260,645
$
45,664
$
54,301
$
658,605
24
4476125
00HF
24
EMMET
476
699
1,498
1,684
4,357
$
93,165
$
86,587
$
13,878
$
13,362
$
206,992
25
1705233
0028
25
GENESEE
10,048
12,249
23,623
32,922
78,842
$
2,900,230
$
2,530,908
$
194,824
$
253,056
$
5,879,018
26
4344340
00GG
26
GLADWIN
587
780
1,280
1,510
4,157
$
159,637
$
139,258
$
18,546
$
19,529
$
336,970
27
1724945
00HJ
27
GOGEBIC
370
560
701
865
2,496
$
144,448
$
128,851
$
15,751
$
17,598
$
306,648
28
4540048
00HC
28
GRAND TRAVERSE
1,244
1,635
3,137
3,983
9,999
$
333,417
$
299,986
$
54,806
$
61,177
$
749,386
29
1708001
00BJ
29
GRATIOT
747
1,055
1,954
2,491
6,247
$
197,716
$
178,611
$
29,168
$
33,018
$
438,513
30
1712229
00GV
30
HILLSDALE
887
1,095
2,070
2,527
6,579
$
233,606
$
188,229
$
26,426
$
27,638
$
475,899
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MH by County
Page 17 of 79
Mental Health - Capitation by County
May, 2008
Summary by Population by Gender
Paid Population
Revenue - Mental Health Capitation - State Plan and 1915(b)(3)
DAB
TANF
DAB Capitation
TANF Capitation
Total Capitation
Provider ID
Billing
Agent
Code
County Name
31
1724945
00HJ
31
HOUGHTON
608
861
1,473
1,729
4,671
$
249,288
$
185,733
$
32,851
$
33,596
$
501,468
32
1705322
00GE
32
HURON
658
824
1,479
1,794
4,755
$
199,426
$
152,846
$
26,098
$
28,049
$
406,419
33
1708001
00BJ
33
INGHAM
4,852
6,017
10,969
14,409
36,247
$
1,312,516
$
1,137,692
$
163,184
$
195,280
$
2,808,672
34
1708001
00BJ
34
IONIA
943
1,205
2,545
3,256
7,949
$
258,729
$
227,759
$
37,773
$
42,194
$
566,454
35
4476125
00HF
35
IOSCO
587
779
1,363
1,666
4,395
$
131,911
$
111,781
$
12,820
$
13,984
$
270,496
36
1724945
00HJ
36
IRON
286
447
540
661
1,934
$
113,221
$
82,381
$
12,138
$
13,288
$
221,029
37
4344340
00GG
37
ISABELLA
943
1,220
2,221
2,949
7,333
$
255,827
$
220,666
$
31,969
$
38,602
$
547,064
38
1712229
00GV
38
JACKSON
2,939
3,541
6,683
8,780
21,943
$
777,098
$
658,313
$
85,087
$
99,127
$
1,619,625
39
3402136
00GR
39
KALAMAZOO
4,109
5,197
8,956
12,141
30,403
$
1,274,899
$
1,149,023
$
104,386
$
127,631
$
2,655,939
40
4476125
00HF
40
KALKASKA
371
489
953
1,261
3,074
$
69,635
$
64,470
$
8,925
$
10,369
$
153,399
41
4483587
00GS
41
KENT
10,466
12,565
24,665
32,668
80,364
$
3,008,256
$
2,596,490
$
214,364
$
252,675
$
6,071,786
42
1724945
00HJ
42
KEWEENAW
47
55
62
65
229
$
17,460
$
12,152
$
1,361
$
1,207
$
32,180
43
4540048
00HC
43
LAKE
423
544
622
767
2,356
$
118,197
$
103,497
$
11,079
$
12,137
$
244,909
44
1708164
00HO
44
LAPEER
931
1,192
3,221
3,974
9,318
$
423,926
$
346,176
$
60,710
$
66,292
$
897,104
45
4540048
00HC
45
LEELANAU
46
4390138
00HU
46
LENAWEE
47
4390138
00HU
47
LIVINGSTON
48
1724945
00HJ
48
LUCE
200
234
301
49
1724945
00HJ
49
MACKINAC
175
228
398
50
3396315
00GX
50
MACOMB
9,366
13,481
25,528
33,117
51
1708001
00BJ
51
MANISTEE
520
637
1,019
52
1724945
00HJ
52
MARQUETTE
956
1,380
2,103
53
4540048
00HC
53
MASON
547
728
1,368
1,776
54
4344340
00GG
54
MECOSTA
800
1,077
2,022
55
1724945
00HJ
55
MENOMINEE
376
554
838
56
4344340
00GG
56
MIDLAND
1,290
1,613
2,957
3,768
57
4540048
00HC
57
MISSAUKEE
236
286
651
58
4390138
00HU
58
MONROE
1,657
2,391
4,401
59
1705322
00GE
59
MONTCALM
1,237
1,426
3,267
60
4476125
00HF
60
MONTMORENCY
248
318
501
Report Generated: 6/3/2008
4:35 PM
Male
Female
Male
Female
Total
Male
Female
Male
Female
126
173
386
470
1,155
$
29,390
$
27,025
$
6,774
$
7,153
$
70,341
1,394
1,901
3,715
4,785
11,795
$
443,290
$
414,930
$
44,143
$
50,015
$
952,377
949
1,198
3,126
3,802
9,075
$
297,465
$
248,530
$
37,153
$
40,033
$
623,180
412
1,147
$
73,526
$
56,684
$
6,744
$
8,225
$
145,179
432
1,233
$
62,437
$
58,998
$
8,917
$
8,373
$
138,725
81,492
$
4,416,655
$
4,144,491
$
310,579
$
374,060
$
9,245,784
1,215
3,391
$
140,016
$
120,141
$
15,250
$
16,137
$
291,544
2,588
7,027
$
389,703
$
350,038
$
47,040
$
52,989
$
839,770
4,419
$
149,277
$
134,463
$
23,961
$
27,636
$
335,337
2,560
6,459
$
205,486
$
199,453
$
29,402
$
33,481
$
467,823
1,101
2,869
$
132,435
$
125,058
$
18,673
$
22,182
$
298,349
9,628
$
344,354
$
272,935
$
42,680
$
49,010
$
708,979
755
1,928
$
60,476
$
48,143
$
11,453
$
11,637
$
131,709
5,867
14,316
$
551,264
$
523,900
$
52,359
$
62,319
$
1,189,843
4,075
10,005
$
374,126
$
300,224
$
57,690
$
63,493
$
795,533
615
1,682
$
53,675
$
46,120
$
4,744
$
5,304
$
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MH by County
109,844
Page 18 of 79
Mental Health - Capitation by County
May, 2008
Summary by Population by Gender
Paid Population
Revenue - Mental Health Capitation - State Plan and 1915(b)(3)
DAB
TANF
DAB Capitation
TANF Capitation
Total Capitation
Provider ID
Billing
Agent
Code
County Name
61
1712452
00HA
61
MUSKEGON
4,328
5,736
9,763
13,299
33,126
$
1,348,842
$
1,262,015
$
72,701
$
89,436
$
2,772,994
62
1708001
00BJ
62
NEWAYGO
1,034
1,306
2,490
2,993
7,823
$
281,372
$
239,976
$
37,132
$
39,329
$
597,808
63
1705289
0058
63
OAKLAND
11,848
16,586
25,289
33,037
86,760
$
6,245,819
$
5,560,701
$
395,068
$
470,625
$
12,672,213
64
4540048
00HC
64
OCEANA
558
702
1,795
1,980
5,035
$
160,120
$
125,822
$
31,600
$
30,196
$
347,738
65
4476125
00HF
65
OGEMAW
610
748
1,311
1,596
4,265
$
140,850
$
112,401
$
12,431
$
13,731
$
279,412
66
1724945
00HJ
66
ONTONAGON
164
228
259
329
980
$
61,959
$
51,312
$
5,865
$
6,529
$
125,665
67
4344340
00GG
67
OSCEOLA
521
621
1,113
1,417
3,672
$
132,599
$
109,963
$
16,135
$
18,847
$
277,544
68
4476125
00HF
68
OSCODA
261
328
443
543
1,575
$
58,476
$
47,101
$
4,210
$
4,648
$
114,435
69
4476125
00HF
69
OTSEGO
440
536
1,248
1,592
3,816
$
94,457
$
73,591
$
11,730
$
13,489
$
193,268
70
1712452
00HA
70
OTTAWA
1,865
2,646
7,052
8,245
19,808
$
554,192
$
534,011
$
52,024
$
52,198
$
1,192,426
71
4476125
00HF
71
PRESQUE ISLE
263
325
477
579
1,644
$
55,385
$
40,542
$
4,427
$
4,631
$
104,985
72
4540048
00HC
72
ROSCOMMON
659
856
1,328
1,607
4,450
$
192,124
$
166,407
$
23,547
$
26,373
$
408,451
73
1712541
00HQ
73
SAGINAW
5,287
6,326
10,247
14,593
36,453
$
1,266,486
$
1,069,212
$
61,677
$
81,472
$
2,478,847
74
1708164
00HO
74
ST CLAIR
2,480
3,151
6,855
8,989
21,475
$
1,113,229
$
962,892
$
129,962
$
155,298
$
2,361,381
75
3402136
00GR
75
ST JOSEPH
1,135
1,483
3,203
4,141
9,962
$
328,778
$
299,770
$
37,288
$
42,256
$
708,093
76
1708164
00HO
76
SANILAC
818
1,019
2,329
2,966
7,132
$
369,426
$
279,685
$
44,333
$
50,128
$
743,573
77
1724945
00HJ
77
SCHOOLCRAFT
208
286
415
497
1,406
$
79,507
$
69,914
$
9,274
$
9,549
$
168,244
78
1705322
00GE
78
SHIAWASSEE
1,086
1,450
3,219
4,047
9,802
$
331,404
$
292,939
$
56,980
$
64,443
$
745,766
79
1705322
00GE
79
TUSCOLA
991
1,191
2,690
3,206
8,078
$
296,416
$
237,427
$
47,424
$
49,645
$
630,912
80
2920843
00HR
80
VAN BUREN
1,580
1,998
3,983
4,860
12,421
$
349,021
$
300,574
$
37,476
$
40,318
$
727,390
81
4390138
00HU
81
WASHTENAW
82
3119549
00GJ
82
WAYNE
83
4540048
00HC
83
WEXFORD
Male
State Subtotals
Female
Male
Female
Total
Male
Female
Male
Female
3,376
4,254
7,594
10,219
25,443
$
1,092,475
$
909,172
$
90,177
$
111,233
$
2,203,057
52,771
63,247
112,267
159,948
388,233
$
12,338,309
$
9,919,253
$
952,904
$
1,281,079
$
24,491,545
782
958
1,929
2,518
6,187
$
215,724
$
185,106
$
33,904
$
39,539
$
474,273
176,291
223,555
408,145
544,386
1,352,377
$
52,559,045
$
45,292,522
$
4,662,257
$
5,592,249
$108,106,073
108,106,073
$108,106,073
399,846
952,531
-
-
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MH by County
Page 19 of 79
Substance Abuse - Capitation by PIHP
May, 2008
Summary by Population by Gender
Paid Population
DAB
Revenue - Substance Abuse - State Plan and 1915(b)(3)
TANF
DAB Capitation
Provider ID
Billing
Agent
Affiliation DBA
1
1705322
00GE
Access Alliance of Michigan
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
3
4344340
00GG
CMH for Central Michigan
4
4483587
00GS
CMHSA Network of West Michigan
5
3119549
00GJ
Detroit Wayne County CMH Agency
6
1705233
0028
Genesee County CMH Services
7
1712452
00HA
Lakeshore Behavioral Health Alliance
6,193
8
1712229
00GV
Lifeways
3,826
4,636
8,753
9
3396315
00GX
Macomb County CMH Services
9,366
13,481
25,528
10
1724945
00HJ
Northcare
5,576
7,919
11,923
14,603
11
4476125
00HF
Northern Affiliation
5,451
7,147
12,996
12
4540048
00HC
Northern Lakes
4,873
6,272
11,896
13
1705289
0058
Oakland County CMH Authority
11,848
16,586
25,289
14
1712541
00HQ
Saginaw County CMH Authority
5,287
6,326
15
4390138
00HU
Southeast Partnership
7,376
9,744
16
3402136
00GR
Southwest Alliance
7,585
9,648
17
1708164
00HO
Thumb Mental Health Alliance
4,229
5,362
12,405
18
2920843
00HR
Venture Behavioral Health
9,758
12,628
22,307
Male
Female
Male
Female
Total
Male
TANF Capitation
Female
Male
Total Capitation
Female
6,464
8,131
16,226
20,402
51,223
$
24,501
$
19,637
$
22,529
$
40,407
$
107,074
10,143
12,851
24,363
31,218
78,575
$
29,529
$
24,928
$
19,504
$
39,345
$
113,307
5,031
6,381
11,387
14,458
37,257
$
18,682
$
15,364
$
10,225
$
18,052
$
62,324
10,466
12,565
24,665
32,668
80,364
$
53,002
$
45,390
$
19,313
$
43,528
$
161,233
52,771
63,247
112,267
159,948
388,233
$
395,544
$
299,114
$
64,695
$
180,971
$
940,324
10,048
12,249
23,623
32,922
78,842
$
69,360
$
60,076
$
38,169
$
90,804
$
258,409
8,382
16,815
21,544
52,934
$
28,554
$
26,490
$
17,227
$
36,079
$
108,349
11,307
28,522
$
14,430
$
11,843
$
11,622
$
23,253
$
61,146
33,117
81,492
$
68,180
$
60,039
$
33,504
$
70,815
$
232,538
40,021
$
19,943
$
15,859
$
12,661
$
23,384
$
71,847
15,947
41,541
$
22,141
$
17,529
$
14,155
$
23,553
$
77,378
14,700
37,741
$
18,596
$
15,258
$
12,298
$
21,940
$
68,092
33,037
86,760
$
64,403
$
53,893
$
26,430
$
60,407
$
205,133
10,247
14,593
36,453
$
33,138
$
27,540
$
11,468
$
29,103
$
101,249
18,836
24,673
60,629
$
28,519
$
24,462
$
19,653
$
42,589
$
115,224
18,619
24,498
60,350
$
39,769
$
34,160
$
19,319
$
41,526
$
134,774
15,929
37,925
$
15,398
$
12,222
$
16,199
$
30,969
$
74,788
28,822
73,515
$
33,313
$
28,418
$
21,570
$
43,455
$
126,756
19
$
-
20
$
-
State Subtotals
176,291
223,555
399,846
408,145
544,386
952,531
1,352,377
-
$
977,002
$
792,223
1,769,225
$
390,542
$
860,180
$
3,019,947
1,250,722
$
3,019,947
-
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
SA by PIHP
Page 20 of 79
Substance Abuse - TANF Capitation by PIHP
May, 2008
Summary by Population by Gender
Paid Population - TANF
TANF Non-Healthy Kids
Revenue - Substance Abuse - State Plan and 1915(b)(3)
TANF - Healthy Kids
TANF Non-Healthy Kids Capitation
TANF Healthy Kids Capitation
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
15,992
20,173
234
229
36,628
$
22,146
$
40,114
$
383
$
293
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
24,113
30,981
250
237
55,581
$
19,249
$
39,148
$
256
$
197
3
4344340
00GG
CMH for Central Michigan
11,245
14,332
142
126
25,845
$
10,082
$
17,946
$
144
$
107
4
4483587
00GS
CMHSA Network of West Michigan
24,424
32,446
241
222
57,333
$
19,018
$
43,298
$
295
$
231
5
3119549
00GJ
Detroit Wayne County CMH Agency
111,616
159,266
651
682
272,215
$
64,125
$
180,491
$
570
$
480
6
1705233
0028
Genesee County CMH Services
23,434
32,747
189
175
56,545
$
37,785
$
90,537
$
384
$
267
7
1712452
00HA
Lakeshore Behavioral Health Alliance
16,606
21,369
209
175
38,359
$
16,927
$
35,883
$
300
$
196
8
1712229
00GV
Lifeways
8,662
11,222
91
85
20,060
$
11,439
$
23,117
$
183
$
136
00GX
Macomb County CMH Services
25,259
32,862
269
255
58,645
$
33,004
$
70,458
$
500
$
357
Affiliation DBA
Male
Female
Male
Female
Total
Male
Female
Male
Female
9
3396315
10
1724945
00HJ
Northcare
11,677
14,393
246
210
26,526
$
12,311
$
23,158
$
350
$
226
11
4476125
00HF
Northern Affiliation
12,750
15,706
246
241
28,943
$
13,827
$
23,311
$
328
$
242
12
4540048
00HC
Northern Lakes
11,707
14,518
189
182
26,596
$
12,051
$
21,762
$
248
$
178
13
1705289
0058
Oakland County CMH Authority
24,990
32,755
299
282
58,326
$
25,982
$
60,021
$
449
$
386
14
1712541
00HQ
Saginaw County CMH Authority
10,149
14,492
98
101
24,840
$
11,337
$
28,984
$
130
$
119
15
4390138
00HU
Southeast Partnership
18,623
24,461
213
212
43,509
$
19,305
$
42,325
$
348
$
264
16
3402136
00GR
Southwest Alliance
18,413
24,295
206
203
43,117
$
19,010
$
41,283
$
309
$
243
17
1708164
00HO
Thumb Mental Health Alliance
12,227
15,755
178
174
28,334
$
15,925
$
30,746
$
274
$
223
18
2920843
00HR
Venture Behavioral Health
22,009
28,570
298
252
51,129
$
21,121
$
43,179
$
449
$
276
403,896
540,343
4,249
4,043
952,531
$
384,642
$
855,759
$
5,900
$
19
20
State Subtotals
944,239
Report Generated: 6/3/2008
4:35 PM
8,292
-
1,240,401
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
SA TANF by PIHP
4,421
10,321
Page 21 of 79
Total TANF
Capitation
$
62,936
$
58,850
$
28,278
$
62,841
$
245,666
$
128,972
$
53,306
$
34,874
$
104,319
$
36,045
$
37,708
$
34,238
$
86,837
$
40,571
$
62,242
$
60,845
$
47,168
$
65,025
$
-
$
-
$
1,250,722
$
1,250,722
-
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
SA TANF by PIHP
Page 22 of 79
Substance Abuse - Capitation by County
May, 2008
Summary by Population Group and Gender
Revenue - Substance Abuse - State Plan and 1915(b)(3)
Paid Population
TANF
DAB
DAB Capitation
TANF Capitation
Total Capitation
Provider ID
Billing
Agent
Code
1
4476125
00HF
01
ALCONA
201
300
382
476
1,359
$
832
$
652
$
485
$
745
$
2,714
2
1724945
00HJ
02
ALGER
158
253
334
384
1,129
$
528
$
476
$
397
$
601
$
2,001
3
3402136
00GR
03
ALLEGAN
1,409
1,838
4,251
5,270
12,768
$
7,074
$
5,955
$
4,200
$
7,968
$
25,197
4
4476125
00HF
04
ALPENA
745
994
1,298
1,703
4,740
$
3,259
$
2,790
$
1,425
$
2,723
$
10,197
5
4476125
00HF
05
ANTRIM
409
477
1,040
1,331
3,257
$
1,569
$
1,110
$
958
$
1,633
$
5,270
6
1705322
00GE
06
ARENAC
433
525
830
983
2,771
$
1,698
$
1,286
$
1,251
$
1,988
$
6,224
7
1724945
00HJ
07
BARAGA
145
257
397
468
1,267
$
526
$
479
$
461
$
791
$
2,257
8
2920843
00HR
08
BARRY
656
946
2,063
2,552
6,217
$
2,148
$
2,072
$
2,139
$
3,728
$
10,087
2,059
2,715
4,741
6,297
15,812
$
8,116
$
6,751
$
6,625
$
13,102
$
34,593
280
367
723
770
2,140
$
798
$
664
$
506
$
892
$
2,860
3,544
4,685
7,184
9,799
25,212
$
11,749
$
10,218
$
6,136
$
15,281
$
43,384
County Name
Male
Female
Male
Female
9
1705322
00GE
09
BAY
10
1708001
00BJ
10
BENZIE
11
2920843
00HR
11
BERRIEN
12
2920843
00HR
12
BRANCH
13
2920843
00HR
13
CALHOUN
14
3402136
00GR
14
15
4476125
00HF
16
4476125
00HF
17
1724945
00HJ
18
4344340
00GG
18
19
1708001
00BJ
19
20
4540048
00HC
20
CRAWFORD
21
1724945
00HJ
21
22
1724945
00HJ
22
23
1708001
00BJ
23
EATON
24
4476125
00HF
24
EMMET
476
699
1,498
25
1705233
0028
25
GENESEE
10,048
12,249
23,623
26
4344340
00GG
26
GLADWIN
587
780
1,280
1,510
27
1724945
00HJ
27
GOGEBIC
28
4540048
00HC
28
GRAND TRAVERSE
29
1708001
00BJ
29
GRATIOT
Total
Male
Female
Male
Female
748
949
2,146
2,566
6,409
$
2,520
$
2,047
$
2,265
$
3,598
$
10,430
3,230
4,050
6,931
9,045
23,256
$
11,449
$
9,581
$
6,985
$
13,768
$
41,783
CASS
932
1,130
2,209
2,946
7,217
$
4,723
$
3,592
$
2,448
$
5,376
$
16,139
15
CHARLEVOIX
309
444
999
1,146
2,898
$
1,143
$
965
$
866
$
1,412
$
4,386
16
CHEBOYGAN
531
710
1,483
1,755
4,479
$
2,070
$
1,717
$
1,677
$
2,508
$
7,972
17
CHIPPEWA
699
844
1,527
1,855
4,925
$
2,535
$
2,005
$
1,562
$
2,838
$
8,941
CLARE
890
1,070
1,794
2,254
6,008
$
3,536
$
2,828
$
1,689
$
2,867
$
10,919
CLINTON
624
768
1,588
1,991
4,971
$
1,759
$
1,447
$
1,214
$
2,357
$
6,778
298
390
680
844
2,212
$
1,208
$
967
$
774
$
1,320
$
4,268
DELTA
736
1,025
1,569
1,901
5,231
$
2,657
$
2,162
$
1,538
$
3,102
$
9,459
DICKINSON
448
707
1,006
1,316
3,477
$
1,570
$
1,382
$
977
$
2,172
$
6,101
1,143
1,496
3,075
4,093
9,807
$
3,161
$
2,705
$
2,347
$
5,061
$
13,274
1,684
4,357
$
1,689
$
1,447
$
1,239
$
2,141
$
6,515
32,922
78,842
$
69,360
$
60,076
$
38,169
$
90,804
$
258,409
4,157
$
2,270
$
1,829
$
1,177
$
1,793
$
7,068
Report Generated: 6/3/2008
4:35 PM
370
560
701
865
2,496
$
1,308
$
1,080
$
793
$
1,474
$
4,655
1,244
1,635
3,137
3,983
9,999
$
4,564
$
3,923
$
2,844
$
5,646
$
16,977
747
1,055
1,954
2,491
6,247
$
2,077
$
1,806
$
1,687
$
3,093
$
8,662
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
SA by County
Page 23 of 79
Substance Abuse - Capitation by County
May, 2008
Summary by Population Group and Gender
Revenue - Substance Abuse - State Plan and 1915(b)(3)
Paid Population
TANF
DAB
DAB Capitation
TANF Capitation
Total Capitation
Provider ID
Billing
Agent
30
1712229
00GV
30
HILLSDALE
887
1,095
2,070
2,527
6,579
$
3,361
$
2,558
$
2,854
$
4,753
$
13,526
31
1724945
00HJ
31
HOUGHTON
608
861
1,473
1,729
4,671
$
2,319
$
1,500
$
1,504
$
2,509
$
7,832
32
1705322
00GE
32
HURON
658
824
1,479
1,794
4,755
$
2,500
$
1,732
$
1,993
$
3,421
$
9,646
33
1708001
00BJ
33
INGHAM
4,852
6,017
10,969
14,409
36,247
$
14,347
$
12,142
$
8,798
$
19,105
$
54,392
34
1708001
00BJ
34
IONIA
943
1,205
2,545
3,256
7,949
$
2,774
$
2,405
$
1,980
$
3,752
$
10,911
35
4476125
00HF
35
IOSCO
587
779
1,363
1,666
4,395
$
2,534
$
2,006
$
1,609
$
2,579
$
8,728
36
1724945
00HJ
36
IRON
286
447
540
661
1,934
$
1,098
$
589
$
659
$
1,074
$
3,420
37
4344340
00GG
37
ISABELLA
943
1,220
2,221
2,949
7,333
$
3,430
$
2,961
$
1,820
$
3,724
$
11,935
38
1712229
00GV
38
JACKSON
2,939
3,541
6,683
8,780
21,943
$
11,069
$
9,284
$
8,768
$
18,499
$
47,620
39
3402136
00GR
39
KALAMAZOO
4,109
5,197
8,956
12,141
30,403
$
22,346
$
19,700
$
9,357
$
21,542
$
72,945
40
4476125
00HF
40
KALKASKA
371
489
953
1,261
3,074
$
1,322
$
1,104
$
1,070
$
1,836
$
5,332
41
4483587
00GS
41
KENT
10,466
12,565
24,665
32,668
80,364
$
53,002
$
45,390
$
19,313
$
43,528
$
161,233
42
1724945
00HJ
42
KEWEENAW
47
55
62
65
229
$
161
$
100
$
39
$
76
$
375
43
4540048
00HC
43
LAKE
423
544
622
767
2,356
$
1,705
$
1,366
$
790
$
1,203
$
5,064
44
1708164
00HO
44
LAPEER
931
1,192
3,221
3,974
9,318
$
3,361
$
2,641
$
3,709
$
7,149
$
16,860
45
4540048
00HC
45
LEELANAU
46
4390138
00HU
46
LENAWEE
47
4390138
00HU
47
LIVINGSTON
48
1724945
00HJ
48
LUCE
200
234
301
49
1724945
00HJ
49
MACKINAC
175
228
398
50
3396315
00GX
50
MACOMB
9,366
13,481
25,528
33,117
51
1708001
00BJ
51
MANISTEE
520
637
1,019
52
1724945
00HJ
52
MARQUETTE
956
1,380
2,103
53
4540048
00HC
53
MASON
547
728
1,368
1,776
54
4344340
00GG
54
MECOSTA
800
1,077
2,022
55
1724945
00HJ
55
MENOMINEE
376
554
838
56
4344340
00GG
56
MIDLAND
1,290
1,613
2,957
57
4540048
00HC
57
MISSAUKEE
236
286
651
58
4390138
00HU
58
MONROE
1,657
2,391
4,401
Code
County Name
Report Generated: 6/3/2008
4:35 PM
Male
Female
Male
Female
Total
Male
Female
Male
Female
126
173
386
470
1,155
$
392
$
324
$
382
$
631
$
1,729
1,394
1,901
3,715
4,785
11,795
$
5,385
$
4,897
$
3,941
$
7,702
$
21,926
949
1,198
3,126
3,802
9,075
$
3,536
$
2,846
$
3,269
$
6,199
$
15,850
412
1,147
$
638
$
470
$
353
$
668
$
2,129
432
1,233
$
586
$
510
$
436
$
615
$
2,148
81,492
$
68,180
$
60,039
$
33,504
$
70,815
$
232,538
1,215
3,391
$
1,579
$
1,246
$
909
$
1,515
$
5,249
2,588
7,027
$
3,525
$
3,048
$
2,332
$
4,484
$
13,389
4,419
$
2,000
$
1,764
$
1,288
$
2,650
$
7,702
2,560
6,459
$
2,872
$
2,688
$
1,995
$
3,202
$
10,756
1,101
2,869
$
1,185
$
1,035
$
838
$
1,784
$
4,842
3,768
9,628
$
4,759
$
3,572
$
2,514
$
4,613
$
15,458
755
1,928
$
848
$
605
$
692
$
1,079
$
3,224
5,867
14,316
$
6,621
$
6,160
$
4,628
$
9,940
$
27,349
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
SA by County
Page 24 of 79
Substance Abuse - Capitation by County
May, 2008
Summary by Population Group and Gender
Revenue - Substance Abuse - State Plan and 1915(b)(3)
Paid Population
TANF
DAB
DAB Capitation
Provider ID
Billing
Agent
59
1705322
00GE
59
MONTCALM
60
4476125
00HF
60
MONTMORENCY
61
1712452
00HA
61
MUSKEGON
62
1708001
00BJ
62
NEWAYGO
1,034
1,306
2,490
63
1705289
0058
63
OAKLAND
11,848
16,586
25,289
64
4540048
00HC
64
OCEANA
558
702
1,795
65
4476125
00HF
65
OGEMAW
610
748
66
1724945
00HJ
66
ONTONAGON
164
228
67
4344340
00GG
67
OSCEOLA
521
621
68
4476125
00HF
68
OSCODA
261
328
443
69
4476125
00HF
69
OTSEGO
440
536
1,248
70
1712452
00HA
70
OTTAWA
1,865
2,646
7,052
8,245
71
4476125
00HF
71
PRESQUE ISLE
263
325
477
72
4540048
00HC
72
ROSCOMMON
659
856
1,328
73
1712541
00HQ
73
SAGINAW
5,287
6,326
10,247
74
1708164
00HO
74
ST CLAIR
2,480
3,151
75
3402136
00GR
75
ST JOSEPH
1,135
1,483
76
1708164
00HO
76
SANILAC
818
1,019
77
1724945
00HJ
77
SCHOOLCRAFT
78
1705322
00GE
78
SHIAWASSEE
79
1705322
00GE
79
TUSCOLA
80
2920843
00HR
80
81
4390138
00HU
81
82
3119549
00GJ
82
WAYNE
83
4540048
00HC
83
WEXFORD
Code
County Name
Male
Female
Male
Female
Total
Male
TANF Capitation
Female
Male
Total Capitation
Female
1,237
1,426
3,267
4,075
10,005
$
4,596
$
3,609
$
4,455
$
7,761
$
20,420
248
318
501
615
1,682
$
1,029
$
839
$
632
$
1,038
$
3,538
4,328
5,736
9,763
13,299
33,126
$
20,574
$
18,803
$
10,929
$
24,147
$
74,454
2,993
7,823
$
3,033
$
2,513
$
2,064
$
3,571
$
11,180
33,037
86,760
$
64,403
$
53,893
$
26,430
$
60,407
$
205,133
1,980
5,035
$
2,242
$
1,620
$
1,884
$
2,719
$
8,466
1,311
1,596
4,265
$
2,682
$
2,054
$
1,729
$
2,694
$
9,158
259
329
980
$
573
$
419
$
336
$
512
$
1,840
1,113
1,417
3,672
$
1,816
$
1,486
$
1,031
$
1,854
$
6,186
543
1,575
$
1,170
$
863
$
587
$
904
$
3,523
1,592
3,816
$
1,796
$
1,300
$
1,462
$
2,578
$
7,136
19,808
$
7,979
$
7,686
$
6,297
$
11,932
$
33,895
579
1,644
$
1,048
$
682
$
417
$
761
$
2,908
1,607
4,450
$
2,691
$
2,220
$
1,650
$
2,812
$
9,373
14,593
36,453
$
33,138
$
27,540
$
11,468
$
29,103
$
101,249
6,855
8,989
21,475
$
9,001
$
7,521
$
9,101
$
18,241
$
43,863
3,203
4,141
9,962
$
5,626
$
4,913
$
3,314
$
6,640
$
20,492
2,329
2,966
7,132
$
3,036
$
2,061
$
3,389
$
5,579
$
14,065
208
286
415
497
1,406
$
733
$
604
$
434
$
686
$
2,457
1,086
1,450
3,219
4,047
9,802
$
3,954
$
3,447
$
4,626
$
8,256
$
20,283
991
1,191
2,690
3,206
8,078
$
3,637
$
2,813
$
3,579
$
5,880
$
15,909
VAN BUREN
1,580
1,998
3,983
4,860
12,421
$
5,448
$
4,501
$
4,044
$
7,079
$
21,072
WASHTENAW
3,376
4,254
7,594
10,219
25,443
$
12,978
$
10,560
$
7,814
$
18,748
$
50,100
52,771
63,247
112,267
159,948
388,233
$
395,544
$
299,114
$
64,695
$
180,971
$
940,324
782
958
1,929
2,518
6,187
$
2,945
$
2,469
$
1,994
$
3,881
$
11,289
176,291
223,555
408,145
544,386
1,352,377
$
977,002
$
792,223
$
390,542
$
860,180
$
3,019,947
3,019,947
$
3,019,947
State Subtotals
399,846
952,531
-
-
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
SA by County
Page 25 of 79
Mental Health/Substance Abuse Population - PIHP by Age Group - DAB - Male
M
DAB
May, 2008
Detail by Gender by Population by Age Group
Population - by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
M
DAB
1,243
904
954
1,029
1,392
942
6,464
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
M
DAB
2,488
1,477
1,442
1,374
1,950
1,412
10,143
3
4344340
00GG
CMH for Central Michigan
M
DAB
1,000
754
674
832
1,095
676
5,031
4
4483587
00GS
CMHSA Network of West Michigan
M
DAB
2,805
1,563
1,469
1,349
1,887
1,393
10,466
5
3119549
00GJ
Detroit Wayne County CMH Agency
M
DAB
11,920
6,620
6,913
7,757
12,300
7,261
52,771
6
1705233
0028
Genesee County CMH Services
M
DAB
2,621
1,490
1,451
1,591
2,014
881
10,048
7
1712452
00HA
Lakeshore Behavioral Health Alliance
M
DAB
1,507
985
907
910
1,171
713
6,193
8
1712229
00GV
Lifeways
M
DAB
1,022
486
560
571
720
467
3,826
00GX
Macomb County CMH Services
M
DAB
1,993
1,307
1,169
1,224
1,744
1,929
9,366
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
10
1724945
00HJ
Northcare
M
DAB
845
692
723
847
1,210
1,259
5,576
11
4476125
00HF
Northern Affiliation
M
DAB
984
736
649
806
1,286
990
5,451
12
4540048
00HC
Northern Lakes
M
DAB
948
682
580
760
1,071
832
4,873
13
1705289
0058
Oakland County CMH Authority
M
DAB
2,414
1,502
1,572
1,539
2,163
2,658
11,848
14
1712541
00HQ
Saginaw County CMH Authority
M
DAB
1,430
694
752
855
1,000
556
5,287
15
4390138
00HU
Southeast Partnership
M
DAB
1,619
1,159
1,115
1,041
1,366
1,076
7,376
16
3402136
00GR
Southwest Alliance
M
DAB
1,959
1,061
1,004
1,082
1,542
937
7,585
17
1708164
00HO
Thumb Mental Health Alliance
M
DAB
941
622
580
652
861
573
4,229
18
2920843
00HR
Venture Behavioral Health
M
DAB
2,447
1,269
1,275
1,400
1,961
1,406
9,758
-
19
20
State Subtotals
40,186
24,003
23,789
25,619
36,733
Check Values
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MHSA-Pop
25,961
176,291
-
Page 26 of 79
Mental Health/Substance Abuse Population - PIHP by Age Group - DAB - Female
F
DAB
May, 2008
Detail by Gender by Population by Age Group
Population - by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
F
DAB
822
734
941
1,184
1,927
2,523
8,131
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
F
DAB
1,740
1,242
1,418
1,729
3,034
3,688
12,851
3
4344340
00GG
CMH for Central Michigan
F
DAB
712
714
705
954
1,545
1,751
6,381
4
4483587
00GS
CMHSA Network of West Michigan
F
DAB
1,834
1,298
1,713
1,753
2,643
3,324
12,565
5
3119549
00GJ
Detroit Wayne County CMH Agency
F
DAB
8,276
5,565
6,630
8,294
16,633
17,849
63,247
6
1705233
0028
Genesee County CMH Services
F
DAB
1,853
1,278
1,572
2,020
2,981
2,545
12,249
7
1712452
00HA
Lakeshore Behavioral Health Alliance
F
DAB
1,058
862
1,043
1,222
1,978
2,219
8,382
8
1712229
00GV
Lifeways
F
DAB
684
465
559
633
1,084
1,211
4,636
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
00GX
Macomb County CMH Services
F
DAB
1,445
1,109
1,234
1,534
3,034
5,125
13,481
10
1724945
00HJ
Northcare
F
DAB
555
596
705
943
1,724
3,396
7,919
11
4476125
00HF
Northern Affiliation
F
DAB
695
566
699
949
1,735
2,503
7,147
12
4540048
00HC
Northern Lakes
F
DAB
662
562
655
895
1,511
1,987
6,272
13
1705289
0058
Oakland County CMH Authority
F
DAB
1,837
1,256
1,517
1,867
3,462
6,647
16,586
14
1712541
00HQ
Saginaw County CMH Authority
F
DAB
905
594
832
943
1,503
1,549
6,326
15
4390138
00HU
Southeast Partnership
F
DAB
1,197
978
1,101
1,313
2,142
3,013
9,744
16
3402136
00GR
Southwest Alliance
F
DAB
1,362
889
1,206
1,339
2,243
2,609
9,648
17
1708164
00HO
Thumb Mental Health Alliance
F
DAB
700
473
553
714
1,304
1,618
5,362
18
2920843
00HR
Venture Behavioral Health
F
DAB
1,773
1,062
1,407
1,682
3,053
3,651
12,628
-
19
20
State Subtotals
28,110
20,243
24,490
29,968
53,536
Check Values
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MHSA-Pop
67,208
223,555
-
Page 27 of 79
Mental Health/Substance Abuse Population - PIHP by Age Group - TANF - Male
M
TANF
May, 2008
Detail by Gender by Population by Age Group
Population - by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
M
TANF
13,692
928
1,033
450
123
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
M
TANF
21,070
1,236
1,352
566
138
3
4344340
00GG
CMH for Central Michigan
M
TANF
9,371
732
826
361
97
4
4483587
00GS
CMHSA Network of West Michigan
M
TANF
22,047
1,125
936
404
149
4
24,665
5
3119549
00GJ
Detroit Wayne County CMH Agency
M
TANF
99,146
6,175
3,581
2,359
986
20
112,267
6
1705233
0028
Genesee County CMH Services
M
TANF
20,218
1,255
1,440
565
142
7
1712452
00HA
Lakeshore Behavioral Health Alliance
M
TANF
14,919
765
728
322
81
8
1712229
00GV
Lifeways
M
TANF
7,696
431
394
182
49
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
-
16,226
1
-
24,363
11,387
3
-
23,623
16,815
1
6
8,753
9
3396315
00GX
Macomb County CMH Services
M
TANF
21,877
1,336
1,183
788
338
10
1724945
00HJ
Northcare
M
TANF
10,223
705
637
263
95
-
11,923
25,528
11
4476125
00HF
Northern Affiliation
M
TANF
10,949
765
809
365
108
-
12,996
12
4540048
00HC
Northern Lakes
M
TANF
10,127
702
695
298
74
-
13
1705289
0058
Oakland County CMH Authority
M
TANF
22,415
1,209
875
531
254
14
1712541
00HQ
Saginaw County CMH Authority
M
TANF
8,913
524
529
222
59
15
4390138
00HU
Southeast Partnership
M
TANF
16,562
919
856
388
110
16
3402136
00GR
Southwest Alliance
M
TANF
16,415
865
911
351
77
-
18,619
17
1708164
00HO
Thumb Mental Health Alliance
M
TANF
10,496
741
742
323
103
-
12,405
18
2920843
00HR
Venture Behavioral Health
M
TANF
19,430
1,093
1,134
506
143
11,896
5
-
25,289
10,247
1
1
18,836
22,307
-
19
20
State Subtotals
355,566
21,506
18,661
9,244
Check Values
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MHSA-Pop
3,126
42
408,145
-
Page 28 of 79
Mental Health/Substance Abuse Population - PIHP by Age Group - TANF - Female
F
TANF
May, 2008
Detail by Gender by Population by Age Group
Population - by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
F
TANF
13,336
2,826
3,254
850
136
-
20,402
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
F
TANF
20,423
4,247
5,072
1,246
230
-
31,218
3
4344340
00GG
CMH for Central Michigan
F
TANF
9,082
2,179
2,462
644
91
-
14,458
4
4483587
00GS
CMHSA Network of West Michigan
F
TANF
21,887
4,398
4,936
1,212
235
-
5
3119549
00GJ
Detroit Wayne County CMH Agency
F
TANF
98,680
21,393
28,530
9,126
2,204
15
159,948
6
1705233
0028
Genesee County CMH Services
F
TANF
20,017
4,741
6,232
1,637
292
3
32,922
7
1712452
00HA
Lakeshore Behavioral Health Alliance
F
TANF
14,323
3,051
3,288
740
141
1
21,544
8
1712229
00GV
Lifeways
F
TANF
7,624
1,570
1,645
393
75
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
32,668
-
11,307
9
3396315
00GX
Macomb County CMH Services
F
TANF
21,052
4,106
5,656
1,879
422
10
1724945
00HJ
Northcare
F
TANF
9,590
2,029
2,274
599
111
-
2
14,603
33,117
11
4476125
00HF
Northern Affiliation
F
TANF
10,828
1,989
2,358
669
103
-
15,947
12
4540048
00HC
Northern Lakes
F
TANF
9,776
2,012
2,220
582
109
1
14,700
13
1705289
0058
Oakland County CMH Authority
F
TANF
21,924
3,941
5,105
1,681
384
2
33,037
14
1712541
00HQ
Saginaw County CMH Authority
F
TANF
8,974
2,137
2,647
719
116
-
15
4390138
00HU
Southeast Partnership
F
TANF
16,260
3,256
3,964
1,000
193
-
16
3402136
00GR
Southwest Alliance
F
TANF
16,184
3,403
3,885
852
173
17
1708164
00HO
Thumb Mental Health Alliance
F
TANF
10,332
2,211
2,559
697
130
18
2920843
00HR
Venture Behavioral Health
F
TANF
18,996
4,068
4,475
1,067
214
14,593
24,673
1
-
24,498
15,929
2
28,822
-
19
20
State Subtotals
349,288
73,557
90,562
25,593
Check Values
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MHSA-Pop
5,359
27
544,386
-
Page 29 of 79
Mental Health - Revenue by PIHP by Age Group - State Plan - DAB - Male
M
DAB
May, 2008
Detail
Revenue for DAB Male by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
M
DAB
$
74,791
$
123,125
$
256,578
$
281,329
$
288,965
$
55,060
$
1,079,848
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
M
DAB
$
137,810
$
185,186
$
357,010
$
345,795
$
372,645
$
75,966
$
1,474,412
3
4344340
00GG
CMH for Central Michigan
M
DAB
$
52,220
$
89,138
$
157,332
$
197,425
$
197,297
$
34,293
$
727,706
4
4483587
00GS
CMHSA Network of West Michigan
M
DAB
$
169,646
$
213,990
$
397,144
$
370,746
$
393,779
$
81,839
$
1,627,144
5
3119549
00GJ
Detroit Wayne County CMH Agency
M
DAB
$
558,094
$
701,588
$
1,446,753
$
1,650,224
$
1,986,819
$
330,230
$
6,673,708
6
1705233
0028
Genesee County CMH Services
M
DAB
$
149,449
$
192,314
$
369,802
$
412,180
$
396,174
$
48,790
$
1,568,710
7
1712452
00HA
Lakeshore Behavioral Health Alliance
M
DAB
$
93,118
$
137,772
$
250,513
$
255,501
$
249,645
$
42,794
$
1,029,343
8
1712229
00GV
Lifeways
M
DAB
$
55,004
$
59,209
$
134,719
$
139,638
$
133,697
$
24,415
$
546,682
00GX
Macomb County CMH Services
M
DAB
$
201,492
$
299,120
$
528,283
$
562,281
$
608,325
$
189,447
$
2,388,948
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
10
1724945
00HJ
Northcare
M
DAB
$
66,730
$
123,702
$
255,212
$
303,929
$
329,677
$
96,578
$
1,175,827
11
4476125
00HF
Northern Affiliation
M
DAB
$
42,420
$
71,826
$
125,062
$
157,879
$
191,280
$
41,461
$
629,929
12
4540048
00HC
Northern Lakes
M
DAB
$
52,823
$
86,021
$
144,461
$
192,424
$
205,900
$
45,036
$
726,664
13
1705289
0058
Oakland County CMH Authority
M
DAB
$
272,951
$
384,437
$
794,505
$
790,692
$
843,808
$
291,928
$
3,378,321
14
1712541
00HQ
Saginaw County CMH Authority
M
DAB
$
68,797
$
75,590
$
161,733
$
186,920
$
166,000
$
25,987
$
685,028
15
4390138
00HU
Southeast Partnership
M
DAB
$
105,915
$
171,636
$
326,059
$
309,448
$
308,320
$
68,380
$
1,289,758
16
3402136
00GR
Southwest Alliance
M
DAB
$
121,301
$
148,720
$
277,897
$
304,442
$
329,448
$
56,361
$
1,238,170
17
1708164
00HO
Thumb Mental Health Alliance
M
DAB
$
84,888
$
127,019
$
233,885
$
267,268
$
267,986
$
50,212
$
1,031,257
18
2920843
00HR
Venture Behavioral Health
M
DAB
$
111,020
$
130,326
$
258,557
$
288,596
$
306,936
$
61,962
$
1,157,398
$
2,418,471
$
3,320,720
$
6,475,505
$
7,016,717
$
7,576,700
$
1,620,739
$
28,428,853
19
20
State Subtotals
Check Values
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MHSP-DAB
-
Page 30 of 79
Mental Health - Revenue by PIHP by Age Group - State Plan - DAB - Female
F
DAB
May, 2008
Detail
Revenue for DAB Female by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
F
DAB
$
34,401
$
76,101
$
190,110
$
239,346
$
275,869
$
81,215
$
897,042
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
F
DAB
$
67,042
$
118,536
$
263,720
$
321,750
$
399,821
$
109,275
$
1,280,144
3
4344340
00GG
CMH for Central Michigan
F
DAB
$
25,867
$
64,253
$
123,622
$
167,389
$
191,966
$
48,905
$
622,002
4
4483587
00GS
CMHSA Network of West Michigan
F
DAB
$
77,156
$
135,278
$
347,893
$
356,227
$
380,328
$
107,531
$
1,404,413
5
3119549
00GJ
Detroit Wayne County CMH Agency
F
DAB
$
269,549
$
448,984
$
1,042,302
$
1,304,646
$
1,852,750
$
446,939
$
5,365,171
6
1705233
0028
Genesee County CMH Services
F
DAB
$
73,490
$
125,564
$
300,959
$
386,951
$
404,373
$
77,623
$
1,368,959
7
1712452
00HA
Lakeshore Behavioral Health Alliance
F
DAB
$
45,473
$
91,777
$
216,402
$
253,687
$
290,786
$
73,338
$
971,463
8
1712229
00GV
Lifeways
F
DAB
$
25,609
$
43,124
$
101,022
$
114,459
$
138,806
$
34,865
$
457,885
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
00GX
Macomb County CMH Services
F
DAB
$
101,612
$
193,199
$
418,906
$
521,054
$
729,798
$
277,160
$
2,241,729
10
1724945
00HJ
Northcare
F
DAB
$
30,486
$
81,104
$
186,945
$
250,197
$
323,922
$
143,447
$
1,016,101
11
4476125
00HF
Northern Affiliation
F
DAB
$
20,843
$
42,042
$
101,180
$
137,453
$
177,959
$
57,719
$
537,197
12
4540048
00HC
Northern Lakes
F
DAB
$
25,659
$
53,958
$
122,551
$
167,553
$
200,313
$
59,232
$
629,266
13
1705289
0058
Oakland County CMH Authority
F
DAB
$
144,480
$
244,706
$
575,944
$
709,236
$
931,347
$
402,011
$
3,007,725
14
1712541
00HQ
Saginaw County CMH Authority
F
DAB
$
30,290
$
49,249
$
134,418
$
152,436
$
172,063
$
39,871
$
578,327
15
4390138
00HU
Southeast Partnership
F
DAB
$
54,475
$
110,250
$
241,857
$
288,597
$
333,402
$
105,425
$
1,134,007
16
3402136
00GR
Southwest Alliance
F
DAB
$
58,661
$
94,856
$
250,764
$
278,579
$
330,461
$
86,410
$
1,099,731
17
1708164
00HO
Thumb Mental Health Alliance
F
DAB
$
43,925
$
73,528
$
167,515
$
216,406
$
279,891
$
78,085
$
859,349
18
2920843
00HR
Venture Behavioral Health
F
DAB
$
55,956
$
83,017
$
214,328
$
256,370
$
329,541
$
88,610
$
1,027,822
$
1,184,976
$
2,129,525
$
5,000,438
$
6,122,336
$
7,743,397
$
2,317,662
$
24,498,334
19
20
State Subtotals
Check Values
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MHSP-DAB
-
Page 31 of 79
Mental Health - Revenue by PIHP by Age Group - State Plan - TANF - Male
M
TANF
May, 2008
Detail
Revenue for TANF Male by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
M
TANF
$
203,874
$
14,802
$
18,336
$
9,315
$
1,770
$
-
$
248,096
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
M
TANF
$
265,061
$
16,661
$
20,280
$
9,899
$
1,678
$
-
$
313,579
3
4344340
00GG
CMH for Central Michigan
M
TANF
$
113,858
$
9,531
$
11,969
$
6,097
$
1,139
$
-
$
142,593
4
4483587
00GS
CMHSA Network of West Michigan
M
TANF
$
163,148
$
8,910
$
8,256
$
4,153
$
1,065
$
-
$
185,532
5
3119549
00GJ
Detroit Wayne County CMH Agency
M
TANF
$
715,834
$
47,733
$
30,797
$
23,661
$
6,872
$
-
$
824,897
6
1705233
0028
Genesee County CMH Services
M
TANF
$
140,919
$
9,362
$
11,966
$
5,469
$
956
$
-
$
168,673
7
1712452
00HA
Lakeshore Behavioral Health Alliance
M
TANF
$
93,990
$
5,164
$
5,467
$
2,821
$
493
$
-
$
107,935
8
1712229
00GV
Lifeways
M
TANF
$
83,194
$
4,991
$
5,079
$
2,735
$
512
$
-
$
96,511
00GX
Macomb County CMH Services
M
TANF
$
224,896
$
14,723
$
14,504
$
11,268
$
3,360
$
-
$
268,750
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
10
1724945
00HJ
Northcare
M
TANF
$
193,317
$
14,283
$
14,364
$
6,914
$
1,737
$
-
$
230,615
11
4476125
00HF
Northern Affiliation
M
TANF
$
86,497
$
6,472
$
7,621
$
4,008
$
824
$
-
$
105,422
12
4540048
00HC
Northern Lakes
M
TANF
$
150,285
$
11,162
$
12,302
$
6,151
$
1,062
$
-
$
180,961
13
1705289
0058
Oakland County CMH Authority
M
TANF
$
297,671
$
17,204
$
13,860
$
9,808
$
3,261
$
-
$
341,804
14
1712541
00HQ
Saginaw County CMH Authority
M
TANF
$
45,456
$
2,861
$
3,216
$
1,574
$
291
$
-
$
53,399
15
4390138
00HU
Southeast Partnership
M
TANF
$
166,945
$
9,925
$
10,289
$
5,440
$
1,073
$
-
$
193,672
16
3402136
00GR
Southwest Alliance
M
TANF
$
162,180
$
9,160
$
10,732
$
4,823
$
735
$
-
$
187,630
17
1708164
00HO
Thumb Mental Health Alliance
M
TANF
$
167,726
$
12,686
$
14,143
$
7,177
$
1,591
$
-
$
203,323
18
2920843
00HR
Venture Behavioral Health
M
TANF
$
154,469
$
9,312
$
10,750
$
5,591
$
1,098
$
-
$
181,221
$
3,429,318
$
224,942
$
223,929
$
126,904
$
29,518
$
-
$
4,034,612
19
20
State Subtotals
Check Values
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MHSP-TANF
-
Page 32 of 79
Mental Health - Revenue by PIHP by Age Group - State Plan - TANF - Female
F
TANF
May, 2008
Detail
Revenue for TANF Female by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
F
TANF
$
137,894
$
40,468
$
69,766
$
26,580
$
3,922
$
-
$
278,630
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
F
TANF
$
178,497
$
51,389
$
91,905
$
32,932
$
5,607
$
-
$
360,330
3
4344340
00GG
CMH for Central Michigan
F
TANF
$
76,652
$
25,473
$
43,085
$
16,435
$
2,142
$
-
$
163,787
4
4483587
00GS
CMHSA Network of West Michigan
F
TANF
$
112,499
$
31,314
$
52,618
$
18,834
$
3,368
$
-
$
218,633
5
3119549
00GJ
Detroit Wayne County CMH Agency
F
TANF
$
494,387
$
148,467
$
296,427
$
138,350
$
30,812
$
-
$
1,108,443
6
1705233
0028
Genesee County CMH Services
F
TANF
$
96,882
$
31,765
$
62,507
$
23,949
$
3,942
$
-
$
219,045
7
1712452
00HA
Lakeshore Behavioral Health Alliance
F
TANF
$
62,735
$
18,489
$
29,855
$
9,798
$
1,722
$
-
$
122,598
8
1712229
00GV
Lifeways
F
TANF
$
57,256
$
16,328
$
25,613
$
8,921
$
1,571
$
-
$
109,688
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
00GX
Macomb County CMH Services
F
TANF
$
150,311
$
40,608
$
83,765
$
40,586
$
8,410
$
-
$
323,682
10
1724945
00HJ
Northcare
F
TANF
$
126,013
$
36,908
$
61,944
$
23,792
$
4,067
$
-
$
252,723
11
4476125
00HF
Northern Affiliation
F
TANF
$
59,446
$
15,116
$
26,834
$
11,099
$
1,576
$
-
$
114,071
12
4540048
00HC
Northern Lakes
F
TANF
$
100,791
$
28,731
$
47,464
$
18,147
$
3,135
$
-
$
198,267
13
1705289
0058
Oakland County CMH Authority
F
TANF
$
202,359
$
50,366
$
97,659
$
46,900
$
9,880
$
-
$
407,163
14
1712541
00HQ
Saginaw County CMH Authority
F
TANF
$
31,768
$
10,471
$
19,429
$
7,700
$
1,146
$
-
$
70,515
15
4390138
00HU
Southeast Partnership
F
TANF
$
113,983
$
31,583
$
57,597
$
21,180
$
3,771
$
-
$
228,114
16
3402136
00GR
Southwest Alliance
F
TANF
$
111,184
$
32,363
$
55,322
$
17,688
$
3,313
$
-
$
219,869
17
1708164
00HO
Thumb Mental Health Alliance
F
TANF
$
114,789
$
34,005
$
58,908
$
23,398
$
4,026
$
-
$
235,126
18
2920843
00HR
Venture Behavioral Health
F
TANF
$
104,858
$
31,120
$
51,239
$
17,819
$
3,296
$
-
$
208,331
$
2,332,302
$
674,964
$
1,231,935
$
504,108
$
95,706
$
-
$
4,839,016
19
20
State Subtotals
Check Values
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MHSP-TANF
-
Page 33 of 79
Mental Health - Revenue by PIHP by Age Group - 1915(b)(3) - DAB - Male
M
DAB
May, 2008
Detail
Revenue for DAB Male by Age Group
Provider ID
Billing
Agent
Affiliation DBA
1
1705322
00GE
2
1708001
3
4344340
4
4483587
00GS
5
3119549
00GJ
Detroit Wayne County CMH Agency
6
1705233
0028
Genesee County CMH Services
7
1712452
00HA
Lakeshore Behavioral Health Alliance
M
8
1712229
00GV
Lifeways
9
3396315
00GX
Macomb County CMH Services
10
1724945
00HJ
Northcare
M
11
4476125
00HF
Northern Affiliation
12
4540048
00HC
Northern Lakes
13
1705289
0058
Oakland County CMH Authority
14
1712541
00HQ
15
4390138
00HU
16
3402136
00GR
Southwest Alliance
17
1708164
00HO
Thumb Mental Health Alliance
18
2920843
00HR
Venture Behavioral Health
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
Access Alliance of Michigan
M
DAB
$
63,480
$
104,511
$
217,779
$
238,790
$
245,270
$
46,733
$
916,563
00BJ
CMH Affiliation of Mid-Michigan
M
DAB
$
116,961
$
157,182
$
303,022
$
293,514
$
316,290
$
64,486
$
1,251,455
00GG
CMH for Central Michigan
M
DAB
$
44,330
$
75,656
$
133,546
$
167,573
$
167,458
$
29,109
$
617,673
CMHSA Network of West Michigan
M
DAB
$
144,009
$
181,636
$
337,091
$
314,681
$
334,225
$
69,469
$
1,381,112
M
DAB
$
473,701
$
595,535
$
1,227,956
$
1,400,681
$
1,686,453
$
280,275
$
5,664,601
M
DAB
$
126,856
$
163,230
$
313,880
$
349,861
$
336,278
$
41,416
$
1,331,521
DAB
$
79,042
$
116,939
$
212,628
$
216,862
$
211,892
$
36,327
$
873,691
M
DAB
$
46,685
$
50,257
$
114,352
$
118,522
$
113,479
$
20,725
$
464,021
M
DAB
$
171,019
$
253,885
$
448,393
$
477,262
$
516,346
$
160,801
$
2,027,707
DAB
$
56,640
$
104,997
$
216,618
$
257,971
$
279,825
$
81,973
$
998,024
M
DAB
$
36,005
$
60,963
$
106,150
$
134,006
$
162,358
$
35,185
$
534,666
M
DAB
$
44,840
$
73,015
$
122,618
$
163,324
$
174,766
$
38,222
$
616,785
M
DAB
$
231,672
$
326,310
$
674,372
$
671,127
$
716,213
$
247,805
$
2,867,498
Saginaw County CMH Authority
M
DAB
$
58,401
$
64,160
$
137,278
$
158,662
$
140,900
$
22,057
$
581,458
Southeast Partnership
M
DAB
$
89,903
$
145,686
$
276,754
$
262,655
$
261,698
$
58,039
$
1,094,736
M
DAB
$
102,965
$
126,238
$
235,880
$
258,403
$
279,626
$
47,843
$
1,050,955
M
DAB
$
72,052
$
107,817
$
198,517
$
226,850
$
227,468
$
42,620
$
875,324
M
DAB
$
94,234
$
110,619
$
219,453
$
244,958
$
260,538
$
52,598
$
982,401
$
2,052,796
$
2,818,637
$
5,496,288
$
5,955,703
$
6,431,084
$
1,375,684
$
24,130,192
19
20
State Subtotals
Check Values
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MHB3-DAB
-
Page 34 of 79
Mental Health - Revenue by PIHP by Age Group - 1915(b)(3) - DAB - Female
F
DAB
May, 2008
Detail
Revenue for DAB Female by Age Group
Provider ID
Billing
Agent
Affiliation DBA
1
1705322
00GE
2
1708001
3
4344340
4
4483587
00GS
5
3119549
00GJ
Detroit Wayne County CMH Agency
6
1705233
0028
Genesee County CMH Services
7
1712452
00HA
Lakeshore Behavioral Health Alliance
F
8
1712229
00GV
Lifeways
9
3396315
00GX
Macomb County CMH Services
10
1724945
00HJ
Northcare
F
11
4476125
00HF
Northern Affiliation
12
4540048
00HC
Northern Lakes
13
1705289
0058
Oakland County CMH Authority
14
1712541
00HQ
15
4390138
00HU
16
3402136
00GR
Southwest Alliance
17
1708164
00HO
Thumb Mental Health Alliance
18
2920843
00HR
Venture Behavioral Health
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
Access Alliance of Michigan
F
DAB
$
29,197
$
64,592
$
161,363
$
203,151
$
234,150
$
68,928
$
761,381
00BJ
CMH Affiliation of Mid-Michigan
F
DAB
$
56,898
$
100,614
$
223,845
$
273,096
$
339,383
$
92,753
$
1,086,590
00GG
CMH for Central Michigan
F
DAB
$
21,951
$
54,535
$
104,932
$
142,079
$
162,936
$
41,516
$
527,950
CMHSA Network of West Michigan
F
DAB
$
65,492
$
114,821
$
295,287
$
302,357
$
322,842
$
91,277
$
1,192,077
F
DAB
$
228,749
$
381,091
$
884,707
$
1,107,415
$
1,572,650
$
379,470
$
4,554,082
F
DAB
$
62,372
$
106,572
$
255,450
$
328,432
$
343,232
$
65,890
$
1,161,949
DAB
$
38,596
$
77,899
$
183,683
$
215,329
$
246,815
$
62,243
$
824,564
F
DAB
$
21,738
$
36,605
$
85,745
$
97,153
$
117,820
$
29,597
$
388,657
F
DAB
$
86,252
$
163,988
$
355,565
$
442,268
$
619,452
$
235,238
$
1,902,761
DAB
$
25,874
$
68,838
$
158,674
$
212,364
$
274,944
$
121,747
$
862,440
F
DAB
$
17,688
$
35,686
$
85,886
$
116,670
$
151,049
$
48,984
$
455,963
F
DAB
$
21,780
$
45,803
$
104,021
$
142,216
$
170,033
$
50,271
$
534,123
F
DAB
$
122,638
$
207,705
$
488,868
$
601,995
$
790,513
$
341,257
$
2,552,977
Saginaw County CMH Authority
F
DAB
$
25,711
$
41,800
$
114,092
$
129,389
$
146,047
$
33,846
$
490,884
Southeast Partnership
F
DAB
$
46,228
$
93,575
$
205,281
$
244,953
$
283,001
$
89,486
$
962,525
F
DAB
$
49,795
$
80,517
$
212,847
$
236,454
$
280,487
$
73,365
$
933,465
F
DAB
$
37,282
$
62,408
$
142,182
$
183,684
$
237,576
$
66,273
$
729,404
F
DAB
$
47,481
$
70,464
$
181,925
$
217,600
$
279,716
$
75,211
$
872,397
$
1,005,721
$
1,807,513
$
4,244,354
$
5,196,604
$
6,572,645
$
1,967,351
$
20,794,188
19
20
State Subtotals
Check Values
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MHB3-DAB
-
Page 35 of 79
Mental Health - Revenue by PIHP by Age Group - 1915(b)(3) - TANF - Male
M
TANF
May, 2008
Detail
Revenue for TANF Male by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
M
TANF
$
31,765
$
2,301
$
2,851
$
1,449
$
276
$
-
$
38,642
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
M
TANF
$
41,297
$
2,596
$
3,164
$
1,540
$
261
$
-
$
48,857
3
4344340
00GG
CMH for Central Michigan
M
TANF
$
17,711
$
1,486
$
1,867
$
949
$
178
$
-
$
22,191
4
4483587
00GS
CMHSA Network of West Michigan
M
TANF
$
25,354
$
1,384
$
1,282
$
646
$
165
$
-
$
28,832
5
3119549
00GJ
Detroit Wayne County CMH Agency
M
TANF
$
111,044
$
7,410
$
4,799
$
3,680
$
1,075
$
-
$
128,007
6
1705233
0028
Genesee County CMH Services
M
TANF
$
21,835
$
1,456
$
1,858
$
853
$
149
$
-
$
26,151
7
1712452
00HA
Lakeshore Behavioral Health Alliance
M
TANF
$
14,621
$
803
$
852
$
438
$
77
$
-
$
16,791
8
1712229
00GV
Lifeways
M
TANF
$
12,929
$
776
$
792
$
426
$
80
$
-
$
15,003
00GX
Macomb County CMH Services
M
TANF
$
35,003
$
2,285
$
2,260
$
1,757
$
524
$
-
$
41,828
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
10
1724945
00HJ
Northcare
M
TANF
$
30,056
$
2,221
$
2,236
$
1,076
$
271
$
-
$
35,859
11
4476125
00HF
Northern Affiliation
M
TANF
$
13,467
$
1,010
$
1,189
$
624
$
129
$
-
$
16,419
12
4540048
00HC
Northern Lakes
M
TANF
$
23,393
$
1,741
$
1,918
$
957
$
165
$
-
$
28,174
13
1705289
0058
Oakland County CMH Authority
M
TANF
$
46,399
$
2,672
$
2,161
$
1,524
$
508
$
-
$
53,264
14
1712541
00HQ
Saginaw County CMH Authority
M
TANF
$
7,041
$
445
$
503
$
244
$
45
$
-
$
8,279
15
4390138
00HU
Southeast Partnership
M
TANF
$
26,002
$
1,544
$
1,601
$
846
$
167
$
-
$
30,160
16
3402136
00GR
Southwest Alliance
M
TANF
$
25,279
$
1,427
$
1,667
$
751
$
115
$
-
$
29,239
17
1708164
00HO
Thumb Mental Health Alliance
M
TANF
$
26,135
$
1,978
$
2,204
$
1,118
$
247
$
-
$
31,682
18
2920843
00HR
Venture Behavioral Health
M
TANF
$
24,093
$
1,454
$
1,678
$
870
$
172
$
-
$
28,267
$
533,426
$
34,988
$
34,880
$
19,748
$
4,602
$
-
$
627,645
19
20
State Subtotals
Check Values
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MHB3-TANF
-
Page 36 of 79
Mental Health - Revenue by PIHP by Age Group - 1915(b)(3) - TANF - Female
F
TANF
May, 2008
Detail
Revenue for TANF Female by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
F
TANF
$
21,471
$
6,302
$
10,868
$
4,140
$
611
$
-
$
43,391
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
F
TANF
$
27,775
$
7,984
$
14,303
$
5,121
$
874
$
-
$
56,058
3
4344340
00GG
CMH for Central Michigan
F
TANF
$
11,897
$
3,966
$
6,697
$
2,557
$
333
$
-
$
25,450
4
4483587
00GS
CMHSA Network of West Michigan
F
TANF
$
17,510
$
4,882
$
8,194
$
2,933
$
524
$
-
$
34,042
5
3119549
00GJ
Detroit Wayne County CMH Agency
F
TANF
$
76,970
$
23,104
$
46,219
$
21,537
$
4,805
$
-
$
172,636
6
1705233
0028
Genesee County CMH Services
F
TANF
$
15,013
$
4,931
$
9,722
$
3,732
$
613
$
-
$
34,011
7
1712452
00HA
Lakeshore Behavioral Health Alliance
F
TANF
$
9,740
$
2,868
$
4,636
$
1,524
$
268
$
-
$
19,036
8
1712229
00GV
Lifeways
F
TANF
$
8,920
$
2,543
$
3,981
$
1,387
$
245
$
-
$
17,076
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
00GX
Macomb County CMH Services
F
TANF
$
23,368
$
6,323
$
13,065
$
6,313
$
1,308
$
-
$
50,378
10
1724945
00HJ
Northcare
F
TANF
$
19,660
$
5,742
$
9,642
$
3,702
$
633
$
-
$
39,378
11
4476125
00HF
Northern Affiliation
F
TANF
$
9,204
$
2,347
$
4,174
$
1,726
$
245
$
-
$
17,696
12
4540048
00HC
Northern Lakes
F
TANF
$
15,739
$
4,467
$
7,393
$
2,823
$
488
$
-
$
30,910
13
1705289
0058
Oakland County CMH Authority
F
TANF
$
31,571
$
7,843
$
15,213
$
7,296
$
1,540
$
-
$
63,461
14
1712541
00HQ
Saginaw County CMH Authority
F
TANF
$
4,936
$
1,624
$
3,018
$
1,201
$
179
$
-
$
10,957
15
4390138
00HU
Southeast Partnership
F
TANF
$
17,723
$
4,917
$
8,959
$
3,300
$
587
$
-
$
35,485
16
3402136
00GR
Southwest Alliance
F
TANF
$
17,317
$
5,036
$
8,625
$
2,752
$
516
$
-
$
34,246
17
1708164
00HO
Thumb Mental Health Alliance
F
TANF
$
17,874
$
5,284
$
9,161
$
3,645
$
627
$
-
$
36,592
18
2920843
00HR
Venture Behavioral Health
F
TANF
$
16,337
$
4,841
$
7,966
$
2,774
$
514
$
-
$
32,431
$
363,024
$
105,004
$
191,833
$
78,463
$
14,907
$
-
$
753,232
19
20
State Subtotals
Check Values
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MHB3-TANF
0
Page 37 of 79
Substance Abuse - Revenue by PIHP by Age Group - State Plan - DAB - Male
M
DAB
May, 2008
Detail
Revenue for DAB Male by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
M
DAB
$
907
$
2,142
$
2,719
$
5,073
$
6,320
$
330
$
17,491
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
M
DAB
$
1,493
$
2,895
$
3,389
$
5,592
$
7,313
$
409
$
21,091
3
4344340
00GG
CMH for Central Michigan
M
DAB
$
700
$
1,734
$
1,860
$
3,977
$
4,829
$
230
$
13,330
4
4483587
00GS
CMHSA Network of West Michigan
M
DAB
$
3,001
$
5,471
$
6,184
$
9,807
$
12,643
$
710
$
37,817
5
3119549
00GJ
Detroit Wayne County CMH Agency
M
DAB
$
17,403
$
31,511
$
39,542
$
76,717
$
112,053
$
5,083
$
282,309
6
1705233
0028
Genesee County CMH Services
M
DAB
$
3,512
$
6,511
$
7,618
$
14,446
$
16,837
$
564
$
49,488
7
1712452
00HA
Lakeshore Behavioral Health Alliance
M
DAB
$
1,386
$
2,965
$
3,274
$
5,688
$
6,745
$
314
$
20,372
8
1712229
00GV
Lifeways
M
DAB
$
787
$
1,215
$
1,686
$
2,975
$
3,456
$
173
$
10,291
00GX
Macomb County CMH Services
M
DAB
$
3,129
$
6,705
$
7,201
$
13,048
$
17,126
$
1,447
$
48,656
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
10
1724945
00HJ
Northcare
M
DAB
$
608
$
1,619
$
2,032
$
4,116
$
5,421
$
428
$
14,225
11
4476125
00HF
Northern Affiliation
M
DAB
$
777
$
1,906
$
2,018
$
4,344
$
6,379
$
376
$
15,801
12
4540048
00HC
Northern Lakes
M
DAB
$
711
$
1,671
$
1,705
$
3,868
$
5,023
$
300
$
13,278
13
1705289
0058
Oakland County CMH Authority
M
DAB
$
2,873
$
5,813
$
7,310
$
12,389
$
16,049
$
1,515
$
45,949
14
1712541
00HQ
Saginaw County CMH Authority
M
DAB
$
1,788
$
2,825
$
3,677
$
7,233
$
7,800
$
334
$
23,656
15
4390138
00HU
Southeast Partnership
M
DAB
$
1,279
$
2,967
$
3,434
$
5,549
$
6,707
$
409
$
20,345
16
3402136
00GR
Southwest Alliance
M
DAB
$
2,077
$
3,671
$
4,177
$
7,780
$
10,208
$
478
$
28,390
17
1708164
00HO
Thumb Mental Health Alliance
M
DAB
$
678
$
1,455
$
1,630
$
3,169
$
3,857
$
195
$
10,984
18
2920843
00HR
Venture Behavioral Health
M
DAB
$
1,713
$
2,893
$
3,494
$
6,650
$
8,570
$
464
$
23,783
$
44,822
$
85,970
$
102,950
$
192,421
$
257,335
$
13,757
$
697,255
19
20
State Subtotals
Check Values
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
SASP-DAB
-
Page 38 of 79
Substance Abuse - Revenue by PIHP by Age Group - State Plan - DAB - Female
F
DAB
May, 2008
Detail
Revenue for DAB Female by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
F
DAB
$
304
$
1,262
$
3,115
$
5,233
$
3,970
$
126
$
14,010
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
F
DAB
$
539
$
1,764
$
3,871
$
6,311
$
5,158
$
148
$
17,790
3
4344340
00GG
CMH for Central Michigan
F
DAB
$
256
$
1,192
$
2,263
$
4,093
$
3,090
$
70
$
10,964
4
4483587
00GS
CMHSA Network of West Michigan
F
DAB
$
1,009
$
3,297
$
8,359
$
11,430
$
8,061
$
233
$
32,388
5
3119549
00GJ
Detroit Wayne County CMH Agency
F
DAB
$
6,207
$
19,199
$
44,023
$
73,568
$
68,861
$
1,606
$
213,464
6
1705233
0028
Genesee County CMH Services
F
DAB
$
1,260
$
4,051
$
9,573
$
16,443
$
11,328
$
204
$
42,859
7
1712452
00HA
Lakeshore Behavioral Health Alliance
F
DAB
$
497
$
1,879
$
4,381
$
6,843
$
5,182
$
133
$
18,916
8
1712229
00GV
Lifeways
F
DAB
$
267
$
846
$
1,957
$
2,956
$
2,363
$
61
$
8,449
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
00GX
Macomb County CMH Services
F
DAB
$
1,156
$
4,125
$
8,835
$
14,665
$
13,562
$
513
$
42,856
10
1724945
00HJ
Northcare
F
DAB
$
205
$
1,013
$
2,298
$
4,111
$
3,517
$
170
$
11,315
11
4476125
00HF
Northern Affiliation
F
DAB
$
285
$
1,064
$
2,530
$
4,584
$
3,921
$
125
$
12,509
12
4540048
00HC
Northern Lakes
F
DAB
$
252
$
995
$
2,240
$
4,081
$
3,218
$
99
$
10,885
13
1705289
0058
Oakland County CMH Authority
F
DAB
$
1,121
$
3,529
$
8,192
$
13,480
$
11,667
$
465
$
38,454
14
1712541
00HQ
Saginaw County CMH Authority
F
DAB
$
579
$
1,752
$
4,726
$
7,157
$
5,321
$
124
$
19,659
15
4390138
00HU
Southeast Partnership
F
DAB
$
479
$
1,819
$
3,942
$
6,276
$
4,777
$
151
$
17,443
16
3402136
00GR
Southwest Alliance
F
DAB
$
735
$
2,231
$
5,825
$
8,637
$
6,751
$
183
$
24,362
17
1708164
00HO
Thumb Mental Health Alliance
F
DAB
$
259
$
804
$
1,803
$
3,113
$
2,660
$
81
$
8,720
18
2920843
00HR
Venture Behavioral Health
F
DAB
$
638
$
1,763
$
4,488
$
7,165
$
6,075
$
146
$
20,276
$
16,049
$
52,588
$
122,422
$
200,146
$
169,482
$
4,636
$
565,323
19
20
State Subtotals
Check Values
Report Generated: 6/3/2008
4:35 PM
45,292,522
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
SASP-DAB
-
Page 39 of 79
Substance Abuse - Revenue by PIHP by Age Group - State Plan - TANF - Male
M
TANF
May, 2008
Detail
Revenue for TANF Male by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
M
TANF
$
5,477
$
2,236
$
4,576
$
2,525
$
731
$
-
$
15,545
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
M
TANF
$
5,268
$
1,891
$
3,799
$
2,015
$
519
$
-
$
13,492
3
4344340
00GG
CMH for Central Michigan
M
TANF
$
2,249
$
1,054
$
2,181
$
1,209
$
343
$
-
$
7,036
4
4483587
00GS
CMHSA Network of West Michigan
M
TANF
$
6,173
$
1,924
$
2,930
$
1,604
$
626
$
-
$
13,256
5
3119549
00GJ
Detroit Wayne County CMH Agency
M
TANF
$
19,829
$
7,410
$
7,878
$
6,582
$
2,909
$
-
$
44,608
6
1705233
0028
Genesee County CMH Services
M
TANF
$
9,907
$
3,702
$
7,805
$
3,882
$
1,032
$
-
$
26,328
7
1712452
00HA
Lakeshore Behavioral Health Alliance
M
TANF
$
5,371
$
1,637
$
2,861
$
1,607
$
428
$
-
$
11,903
8
1712229
00GV
Lifeways
M
TANF
$
3,463
$
1,159
$
1,942
$
1,139
$
324
$
-
$
8,029
00GX
Macomb County CMH Services
M
TANF
$
8,532
$
3,140
$
5,099
$
4,310
$
1,957
$
-
$
23,038
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
10
1724945
00HJ
Northcare
M
TANF
$
3,374
$
1,389
$
2,300
$
1,205
$
460
$
-
$
8,726
11
4476125
00HF
Northern Affiliation
M
TANF
$
3,394
$
1,446
$
2,807
$
1,610
$
503
$
-
$
9,760
12
4540048
00HC
Northern Lakes
M
TANF
$
3,139
$
1,313
$
2,391
$
1,299
$
341
$
-
$
8,483
13
1705289
0058
Oakland County CMH Authority
M
TANF
$
8,069
$
2,636
$
3,500
$
2,692
$
1,364
$
-
$
18,261
14
1712541
00HQ
Saginaw County CMH Authority
M
TANF
$
3,209
$
1,148
$
2,121
$
1,130
$
317
$
-
$
7,925
15
4390138
00HU
Southeast Partnership
M
TANF
$
5,797
$
1,939
$
3,313
$
1,905
$
572
$
-
$
13,526
16
3402136
00GR
Southwest Alliance
M
TANF
$
5,745
$
1,842
$
3,562
$
1,741
$
403
$
-
$
13,294
17
1708164
00HO
Thumb Mental Health Alliance
M
TANF
$
3,988
$
1,712
$
3,154
$
1,741
$
587
$
-
$
11,182
18
2920843
00HR
Venture Behavioral Health
M
TANF
$
6,023
$
2,055
$
3,912
$
2,216
$
662
$
-
$
14,869
$
109,008
$
39,632
$
66,130
$
40,411
$
14,079
$
-
$
269,261
19
20
State Subtotals
Check Values
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
SASP-TANF
-
Page 40 of 79
Substance Abuse - Revenue by PIHP by Age Group - State Plan - TANF - Female
F
TANF
May, 2008
Detail
Revenue for TANF Female by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
F
TANF
$
2,667
$
5,822
$
13,146
$
5,449
$
798
$
-
$
27,882
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
F
TANF
$
2,655
$
5,564
$
12,984
$
5,059
$
856
$
-
$
27,117
3
4344340
00GG
CMH for Central Michigan
F
TANF
$
1,090
$
2,680
$
5,933
$
2,467
$
319
$
-
$
12,489
4
4483587
00GS
CMHSA Network of West Michigan
F
TANF
$
3,064
$
6,421
$
14,117
$
5,502
$
978
$
-
$
30,082
5
3119549
00GJ
Detroit Wayne County CMH Agency
F
TANF
$
9,868
$
21,821
$
57,345
$
29,112
$
6,436
$
-
$
124,582
6
1705233
0028
Genesee County CMH Services
F
TANF
$
5,004
$
11,947
$
30,786
$
12,850
$
2,099
$
-
$
62,688
7
1712452
00HA
Lakeshore Behavioral Health Alliance
F
TANF
$
2,578
$
5,583
$
11,804
$
4,211
$
736
$
-
$
24,912
8
1712229
00GV
Lifeways
F
TANF
$
1,754
$
3,611
$
7,403
$
2,810
$
491
$
-
$
16,068
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
00GX
Macomb County CMH Services
F
TANF
$
4,210
$
8,253
$
22,228
$
11,744
$
2,414
$
-
$
48,849
10
1724945
00HJ
Northcare
F
TANF
$
1,630
$
3,409
$
7,481
$
3,127
$
532
$
-
$
16,179
11
4476125
00HF
Northern Affiliation
F
TANF
$
1,732
$
3,222
$
7,475
$
3,365
$
475
$
-
$
16,269
12
4540048
00HC
Northern Lakes
F
TANF
$
1,564
$
3,219
$
6,971
$
2,898
$
497
$
-
$
15,150
13
1705289
0058
Oakland County CMH Authority
F
TANF
$
3,946
$
7,330
$
18,633
$
9,733
$
2,039
$
-
$
41,682
14
1712541
00HQ
Saginaw County CMH Authority
F
TANF
$
1,615
$
3,996
$
9,688
$
4,177
$
618
$
-
$
20,095
15
4390138
00HU
Southeast Partnership
F
TANF
$
2,927
$
5,861
$
13,993
$
5,610
$
992
$
-
$
29,383
16
3402136
00GR
Southwest Alliance
F
TANF
$
2,913
$
6,193
$
13,831
$
4,822
$
898
$
-
$
28,657
17
1708164
00HO
Thumb Mental Health Alliance
F
TANF
$
2,066
$
4,378
$
9,903
$
4,287
$
732
$
-
$
21,366
18
2920843
00HR
Venture Behavioral Health
F
TANF
$
3,039
$
6,549
$
14,096
$
5,335
$
980
$
-
$
30,000
$
54,325
$
115,860
$
277,818
$
122,557
$
22,890
$
-
$
593,451
19
20
State Subtotals
Check Values
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
SASP-TANF
-
Page 41 of 79
Substance Abuse - Revenue by PIHP by Age Group - 1915(b)(3) - DAB - Male
M
DAB
May, 2008
Detail
Revenue for DAB Male by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
M
DAB
$
360
$
859
$
1,088
$
2,037
$
2,533
$
132
$
7,010
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
M
DAB
$
597
$
1,152
$
1,355
$
2,240
$
2,925
$
169
$
8,439
3
4344340
00GG
CMH for Central Michigan
M
DAB
$
280
$
694
$
748
$
1,597
$
1,938
$
95
$
5,352
4
4483587
00GS
CMHSA Network of West Michigan
M
DAB
$
1,206
$
2,188
$
2,483
$
3,939
$
5,076
$
293
$
15,185
5
3119549
00GJ
Detroit Wayne County CMH Agency
M
DAB
$
6,914
$
12,644
$
15,831
$
30,795
$
45,018
$
2,033
$
113,235
6
1705233
0028
Genesee County CMH Services
M
DAB
$
1,415
$
2,608
$
3,062
$
5,791
$
6,767
$
229
$
19,872
7
1712452
00HA
Lakeshore Behavioral Health Alliance
M
DAB
$
558
$
1,192
$
1,315
$
2,284
$
2,705
$
128
$
8,182
8
1712229
00GV
Lifeways
M
DAB
$
317
$
491
$
678
$
1,193
$
1,390
$
70
$
4,138
00GX
Macomb County CMH Services
M
DAB
$
1,256
$
2,692
$
2,887
$
5,239
$
6,871
$
579
$
19,524
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
10
1724945
00HJ
Northcare
M
DAB
$
245
$
650
$
817
$
1,652
$
2,178
$
176
$
5,718
11
4476125
00HF
Northern Affiliation
M
DAB
$
315
$
765
$
811
$
1,741
$
2,559
$
149
$
6,340
12
4540048
00HC
Northern Lakes
M
DAB
$
284
$
668
$
684
$
1,550
$
2,013
$
116
$
5,318
13
1705289
0058
Oakland County CMH Authority
M
DAB
$
1,159
$
2,328
$
2,940
$
4,971
$
6,446
$
611
$
18,455
14
1712541
00HQ
Saginaw County CMH Authority
M
DAB
$
715
$
1,131
$
1,474
$
2,898
$
3,130
$
133
$
9,482
15
4390138
00HU
Southeast Partnership
M
DAB
$
518
$
1,194
$
1,383
$
2,228
$
2,691
$
161
$
8,175
16
3402136
00GR
Southwest Alliance
M
DAB
$
823
$
1,475
$
1,677
$
3,116
$
4,102
$
187
$
11,380
17
1708164
00HO
Thumb Mental Health Alliance
M
DAB
$
273
$
585
$
655
$
1,271
$
1,550
$
80
$
4,414
18
2920843
00HR
Venture Behavioral Health
M
DAB
$
685
$
1,167
$
1,403
$
2,660
$
3,432
$
183
$
9,530
$
17,920
$
34,484
$
41,290
$
77,204
$
103,324
$
5,526
$
279,747
19
20
State Subtotals
Check Values
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
SAB3-DAB
-
Page 42 of 79
Substance Abuse - Revenue by PIHP by Age Group - 1915(b)(3) - DAB - Female
F
DAB
May, 2008
Detail
Revenue for DAB Female Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
F
DAB
$
123
$
506
$
1,252
$
2,096
$
1,599
$
50
$
5,627
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
F
DAB
$
209
$
708
$
1,560
$
2,524
$
2,063
$
74
$
7,138
3
4344340
00GG
CMH for Central Michigan
F
DAB
$
100
$
478
$
909
$
1,641
$
1,236
$
35
$
4,399
4
4483587
00GS
CMHSA Network of West Michigan
F
DAB
$
403
$
1,324
$
3,357
$
4,593
$
3,224
$
100
$
13,002
5
3119549
00GJ
Detroit Wayne County CMH Agency
F
DAB
$
2,483
$
7,680
$
17,636
$
29,527
$
27,611
$
714
$
85,650
6
1705233
0028
Genesee County CMH Services
F
DAB
$
500
$
1,623
$
3,851
$
6,605
$
4,561
$
76
$
17,217
7
1712452
00HA
Lakeshore Behavioral Health Alliance
F
DAB
$
201
$
750
$
1,752
$
2,750
$
2,077
$
44
$
7,574
8
1712229
00GV
Lifeways
F
DAB
$
109
$
339
$
783
$
1,184
$
954
$
24
$
3,393
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
00GX
Macomb County CMH Services
F
DAB
$
462
$
1,652
$
3,542
$
5,891
$
5,431
$
205
$
17,183
10
1724945
00HJ
Northcare
F
DAB
$
83
$
405
$
924
$
1,650
$
1,414
$
68
$
4,544
11
4476125
00HF
Northern Affiliation
F
DAB
$
111
$
425
$
1,014
$
1,841
$
1,579
$
50
$
5,019
12
4540048
00HC
Northern Lakes
F
DAB
$
99
$
399
$
897
$
1,638
$
1,299
$
40
$
4,373
13
1705289
0058
Oakland County CMH Authority
F
DAB
$
441
$
1,419
$
3,292
$
5,414
$
4,674
$
199
$
15,439
14
1712541
00HQ
Saginaw County CMH Authority
F
DAB
$
235
$
701
$
1,897
$
2,867
$
2,134
$
46
$
7,881
15
4390138
00HU
Southeast Partnership
F
DAB
$
192
$
734
$
1,585
$
2,521
$
1,928
$
60
$
7,019
16
3402136
00GR
Southwest Alliance
F
DAB
$
300
$
898
$
2,340
$
3,468
$
2,714
$
78
$
9,797
17
1708164
00HO
Thumb Mental Health Alliance
F
DAB
$
105
$
322
$
724
$
1,250
$
1,069
$
32
$
3,502
18
2920843
00HR
Venture Behavioral Health
F
DAB
$
248
$
701
$
1,801
$
2,876
$
2,442
$
73
$
8,142
$
6,406
$
21,064
$
49,116
$
80,334
$
68,010
$
1,970
$
226,900
19
20
State Subtotals
Check Values
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
SAB3-DAB
-
Page 43 of 79
Substance Abuse - Revenue by PIHP by Age Group - 1915(b)(3) - TANF - Male
M
TANF
May, 2008
Detail
Revenue for TANF Male by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
M
TANF
$
2,465
$
1,002
$
2,056
$
1,134
$
328
$
-
$
6,985
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
M
TANF
$
2,318
$
853
$
1,704
$
906
$
233
$
-
$
6,013
3
4344340
00GG
CMH for Central Michigan
M
TANF
$
1,031
$
476
$
983
$
545
$
154
$
-
$
3,189
4
4483587
00GS
CMHSA Network of West Michigan
M
TANF
$
2,866
$
866
$
1,320
$
723
$
282
$
-
$
6,057
5
3119549
00GJ
Detroit Wayne County CMH Agency
M
TANF
$
8,923
$
3,335
$
3,545
$
2,972
$
1,311
$
-
$
20,087
6
1705233
0028
Genesee County CMH Services
M
TANF
$
4,448
$
1,669
$
3,514
$
1,746
$
464
$
-
$
11,841
7
1712452
00HA
Lakeshore Behavioral Health Alliance
M
TANF
$
2,387
$
734
$
1,289
$
721
$
192
$
-
$
5,323
8
1712229
00GV
Lifeways
M
TANF
$
1,539
$
522
$
875
$
511
$
146
$
-
$
3,593
00GX
Macomb County CMH Services
M
TANF
$
3,938
$
1,416
$
2,295
$
1,938
$
879
$
-
$
10,466
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
10
1724945
00HJ
Northcare
M
TANF
$
1,533
$
620
$
1,032
$
542
$
207
$
-
$
3,935
11
4476125
00HF
Northern Affiliation
M
TANF
$
1,533
$
650
$
1,262
$
723
$
227
$
-
$
4,395
12
4540048
00HC
Northern Lakes
M
TANF
$
1,418
$
590
$
1,070
$
584
$
153
$
-
$
3,815
13
1705289
0058
Oakland County CMH Authority
M
TANF
$
3,586
$
1,185
$
1,575
$
1,211
$
612
$
-
$
8,169
14
1712541
00HQ
Saginaw County CMH Authority
M
TANF
$
1,426
$
514
$
952
$
508
$
143
$
-
$
3,543
15
4390138
00HU
Southeast Partnership
M
TANF
$
2,650
$
873
$
1,489
$
857
$
257
$
-
$
6,127
16
3402136
00GR
Southwest Alliance
M
TANF
$
2,626
$
830
$
1,603
$
783
$
182
$
-
$
6,025
17
1708164
00HO
Thumb Mental Health Alliance
M
TANF
$
1,784
$
771
$
1,417
$
782
$
264
$
-
$
5,018
18
2920843
00HR
Venture Behavioral Health
M
TANF
$
2,720
$
929
$
1,758
$
997
$
297
$
-
$
6,701
$
49,192
$
17,835
$
29,738
$
18,184
$
6,332
$
-
$
121,281
19
20
State Subtotals
Check Values
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
SAB3-TANF
-
Page 44 of 79
Substance Abuse - Revenue by PIHP by Age Group - 1915(b)(3) - TANF - Female
F
TANF
May, 2008
Detail
Revenue for TANF Female by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
F
TANF
$
1,200
$
2,628
$
5,890
$
2,448
$
359
$
-
$
12,525
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
F
TANF
$
1,225
$
2,506
$
5,833
$
2,280
$
384
$
-
$
12,228
3
4344340
00GG
CMH for Central Michigan
F
TANF
$
454
$
1,198
$
2,659
$
1,108
$
144
$
-
$
5,563
4
4483587
00GS
CMHSA Network of West Michigan
F
TANF
$
1,313
$
2,903
$
6,318
$
2,472
$
439
$
-
$
13,446
5
3119549
00GJ
Detroit Wayne County CMH Agency
F
TANF
$
4,934
$
9,841
$
25,677
$
13,050
$
2,887
$
-
$
56,389
6
1705233
0028
Genesee County CMH Services
F
TANF
$
2,202
$
5,357
$
13,835
$
5,779
$
943
$
-
$
28,116
7
1712452
00HA
Lakeshore Behavioral Health Alliance
F
TANF
$
1,146
$
2,502
$
5,294
$
1,894
$
331
$
-
$
11,167
8
1712229
00GV
Lifeways
F
TANF
$
762
$
1,617
$
3,323
$
1,262
$
221
$
-
$
7,184
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
00GX
Macomb County CMH Services
F
TANF
$
1,895
$
3,695
$
10,011
$
5,280
$
1,085
$
-
$
21,966
10
1724945
00HJ
Northcare
F
TANF
$
671
$
1,522
$
3,366
$
1,408
$
239
$
-
$
7,205
11
4476125
00HF
Northern Affiliation
F
TANF
$
758
$
1,452
$
3,348
$
1,512
$
213
$
-
$
7,283
12
4540048
00HC
Northern Lakes
F
TANF
$
684
$
1,449
$
3,130
$
1,304
$
223
$
-
$
6,790
13
1705289
0058
Oakland County CMH Authority
F
TANF
$
1,754
$
3,310
$
8,372
$
4,371
$
918
$
-
$
18,725
14
1712541
00HQ
Saginaw County CMH Authority
F
TANF
$
718
$
1,795
$
4,341
$
1,877
$
277
$
-
$
9,008
15
4390138
00HU
Southeast Partnership
F
TANF
$
1,301
$
2,637
$
6,303
$
2,520
$
446
$
-
$
13,207
16
3402136
00GR
Southwest Alliance
F
TANF
$
1,295
$
2,790
$
6,216
$
2,164
$
403
$
-
$
12,868
17
1708164
00HO
Thumb Mental Health Alliance
F
TANF
$
930
$
1,968
$
4,453
$
1,924
$
329
$
-
$
9,603
18
2920843
00HR
Venture Behavioral Health
F
TANF
$
1,330
$
2,929
$
6,355
$
2,401
$
441
$
-
$
13,455
$
24,572
$
52,100
$
124,723
$
55,052
$
10,282
$
-
$
266,729
19
20
State Subtotals
Check Values
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
SAB3-TANF
-
Page 45 of 79
Habilitation Supports Waiver - Capitation by PIHP
May, 2008
Summary by Population Group by Gender
Population - Current Enrollment
DAB Enrollees
Revenue - Habilitation Supports Waiver
TANF Enrollees
DAB Capitation
Total Capitation
TANF Capitation
Provider ID
Billing
Agent
Affiliation DBA
1
1705322
00GE
Access Alliance of Michigan
214
136
-
-
350
$
925,844
$
586,059
$
-
$
-
$
1,511,903
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
212
134
1
-
347
$
979,692
$
631,468
$
2,397
$
-
$
1,613,556
3
4344340
00GG
CMH for Central Michigan
301
212
2
-
515
$
1,075,386
$
744,536
$
3,973
$
-
$
1,823,895
4
4483587
00GS
CMHSA Network of West Michigan
101
59
-
-
160
$
363,319
$
217,417
$
-
$
-
$
580,736
5
3119549
00GJ
Detroit Wayne County CMH Agency
611
488
-
-
1,099
$
2,975,314
$
2,387,438
$
-
$
-
$
5,362,752
6
1705233
0028
Genesee County CMH Services
211
148
1
-
360
$
755,296
$
542,271
$
1,914
$
-
$
1,299,481
7
1712452
00HA
Lakeshore Behavioral Health Alliance
118
103
-
-
221
$
534,072
$
469,223
$
-
$
-
$
1,003,294
8
1712229
00GV
Lifeways
156
99
-
-
255
$
349,536
$
222,128
$
-
$
-
$
571,664
9
3396315
00GX
Macomb County CMH Services
248
182
4
2
436
$
880,101
$
632,176
$
9,917
$
3,485
$
1,525,678
10
1724945
00HJ
Northcare
224
130
1
-
355
$
1,109,562
$
642,352
$
2,688
$
-
$
1,754,602
11
4476125
00HF
Northern Affiliation
243
157
-
-
400
$
1,269,534
$
782,859
$
-
$
-
$
2,052,393
12
4540048
00HC
Northern Lakes
94
71
1
-
166
$
408,674
$
322,177
$
3,547
$
-
$
734,398
13
1705289
0058
Oakland County CMH Authority
424
330
-
1
755
$
2,092,288
$
1,614,998
$
-
$
2,607
$
3,709,893
14
1712541
00HQ
Saginaw County CMH Authority
65
39
-
-
104
$
343,616
$
211,848
$
-
$
-
$
555,463
15
4390138
00HU
Southeast Partnership
372
274
1
1
648
$
1,465,929
$
1,042,196
$
2,833
$
2,720
$
2,513,678
16
3402136
00GR
Southwest Alliance
252
189
-
1
442
$
912,033
$
682,162
$
-
$
1,788
$
1,595,984
17
1708164
00HO
Thumb Mental Health Alliance
160
96
-
1
257
$
830,975
$
510,097
$
-
$
2,758
$
1,343,830
18
2920843
00HR
Venture Behavioral Health
169
130
-
-
299
$
736,452
$
554,674
$
-
$
-
$
1,291,126
Male
Female
Male
Total
Enrollees
Female
Male
Female
Male
Female
19
-
$
-
20
-
$
-
State Subtotals
4,175
2,977
7,152
11
6
7,169
17
-
$
18,007,623
$
12,796,077
30,803,699
$
27,269
$
13,359
$
30,844,327
40,628
$
30,844,327
(1.00)
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW by PIHP
Page 46 of 79
Habilitation Supports Waiver - Capitation by County
May, 2008
Detail by Population Group by Gender
Revenue is calculated based on County of Residence and Paid to Country of Financial Responsibility
Population - Current Enrollment
DAB Enrollees
Revenue - Habilitation Supports Waiver
TANF Enrollees
DAB Capitation
County Name - COFR Code R
County Name Residence
25
GENESEE
25
GENESEE
0028
25
GENESEE
37
ISABELLA
-
1
-
0028
25
GENESEE
78
SHIAWASSEE
-
1
-
1705289
0058
63
OAKLAND
50
MACOMB
6
4
-
-
5
1705289
0058
63
OAKLAND
57
MISSAUKEE
6
1705289
0058
63
OAKLAND
63
OAKLAND
7
1705289
0058
63
OAKLAND
82
WAYNE
8
1708001
00BJ
10
BENZIE
10
BENZIE
9
1708001
00BJ
10
BENZIE
37
ISABELLA
1
-
-
10
1708001
00BJ
10
BENZIE
51
MANISTEE
3
4
-
11
1708001
00BJ
10
BENZIE
83
WEXFORD
1
-
-
12
1708001
00BJ
19
CLINTON
19
CLINTON
21
12
-
13
1708001
00BJ
19
CLINTON
33
INGHAM
1
-
-
14
1708001
00BJ
23
EATON
19
CLINTON
3
1
-
15
1708001
00BJ
23
EATON
23
EATON
36
15
16
1708001
00BJ
23
EATON
33
INGHAM
3
3
17
1708001
00BJ
29
GRATIOT
18
CLARE
-
18
1708001
00BJ
29
GRATIOT
29
GRATIOT
19
1708001
00BJ
33
INGHAM
19
20
1708001
00BJ
33
INGHAM
23
21
1708001
00BJ
33
INGHAM
22
1708001
00BJ
33
23
1708001
00BJ
34
24
1708001
00BJ
25
1708001
26
1708001
27
28
Provider ID
Billing
Agent
Code F
1
1705233
0028
2
1705233
3
1705233
4
Male
Female
211
Female
1
-
Male
358
$
-
1
$
-
1
$
10
$
-
-
-
1
-
1
-
13
3
-
755,296
Female
532,271
$
1,914
$
-
$
1,289,481
-
$
4,252
$
-
$
-
$
4,252
-
$
5,748
$
-
$
-
$
5,748
19,868
$
13,687
$
-
$
-
$
33,555
-
$
3,406
$
$
2,069,014
$
-
1
$
-
-
16
$
68,396
-
1
$
3,400
-
7
$
15,952
-
1
$
4,928
-
33
$
91,088
-
1
$
4,557
-
4
$
13,670
-
-
51
$
-
-
6
$
1
-
-
1
20
8
-
-
CLINTON
6
2
-
EATON
4
1
-
33
INGHAM
45
33
INGHAM
37
ISABELLA
1
IONIA
11
BERRIEN
-
34
IONIA
34
IONIA
16
12
00BJ
34
IONIA
37
ISABELLA
1
-
-
00BJ
34
IONIA
59
MONTCALM
2
1
-
1708001
00BJ
34
IONIA
69
OTSEGO
1
-
-
1708001
00BJ
51
MANISTEE
10
BENZIE
-
1
-
29
1708001
00BJ
51
MANISTEE
37
ISABELLA
1
-
-
30
1708001
00BJ
51
MANISTEE
51
MANISTEE
23
26
-
31
1708001
00BJ
62
NEWAYGO
62
NEWAYGO
10
10
-
32
1705322
00GE
06
ARENAC
06
ARENAC
11
13
-
33
1705322
00GE
06
ARENAC
09
BAY
1
1
-
34
1705322
00GE
09
BAY
06
ARENAC
1
-
35
1705322
00GE
09
BAY
09
BAY
82
60
417
Male
Total Capitation
$
1
4:35 PM
325
Female
743
Report Generated: 6/3/2008
1
146
Male
Total
Enrollees
TANF Capitation
$
-
$
-
$
3,406
1,596,755
$
-
$
2,607
$
3,668,376
$
4,557
$
-
$
-
$
4,557
$
14,801
$
-
$
-
$
83,197
$
-
$
-
$
-
$
3,400
$
19,368
$
-
$
-
$
35,320
$
-
$
-
$
-
$
4,928
$
54,680
$
-
$
-
$
145,769
$
-
$
-
$
-
$
4,557
$
4,557
$
-
$
-
$
18,227
161,862
$
64,899
$
-
$
-
$
226,761
13,660
$
12,520
$
-
$
-
$
26,180
$
-
$
3,400
$
-
$
-
$
3,400
28
$
94,685
$
37,654
$
-
$
-
$
132,339
-
8
$
29,622
$
9,113
$
-
$
-
$
38,735
-
5
$
17,076
$
4,557
$
-
$
-
$
21,633
-
-
78
$
208,241
$
153,336
$
-
$
-
$
361,577
-
-
-
1
$
3,400
$
-
$
-
$
-
$
3,400
1
-
-
1
$
-
$
4,153
$
-
$
-
$
4,153
1
-
29
$
75,183
$
62,646
$
2,397
$
-
$
140,226
-
1
$
4,252
$
-
$
-
$
-
$
4,252
-
3
$
9,901
$
4,153
$
-
$
-
$
14,053
-
1
$
4,957
$
-
$
-
$
-
$
4,957
-
1
$
-
$
4,928
$
-
$
-
$
4,928
-
1
$
2,542
$
-
$
-
$
-
$
2,542
-
49
$
107,028
$
131,136
$
-
$
-
$
238,164
-
20
$
45,291
$
45,567
$
-
$
-
$
90,858
-
24
$
45,679
$
52,936
$
-
$
-
$
98,615
-
2
$
5,192
$
4,153
$
-
$
-
$
9,345
-
-
1
$
4,153
$
-
$
-
$
-
$
4,153
-
-
142
$
360,736
$
$
-
$
-
$
627,203
266,468
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW by County
Page 47 of 79
Habilitation Supports Waiver - Capitation by County
May, 2008
Detail by Population Group by Gender
Revenue is calculated based on County of Residence and Paid to Country of Financial Responsibility
Population - Current Enrollment
DAB Enrollees
Revenue - Habilitation Supports Waiver
TANF Enrollees
DAB Capitation
Total
Enrollees
TANF Capitation
Total Capitation
County Name - COFR Code R
County Name Residence
09
BAY
73
SAGINAW
-
1
-
-
1
$
-
$
5,244
$
-
$
-
$
09
BAY
79
TUSCOLA
1
-
-
-
1
$
5,748
$
-
$
-
$
-
$
5,748
00GE
32
HURON
32
HURON
35
16
-
-
51
$
142,830
$
60,116
$
-
$
-
$
202,946
1705322
00GE
59
MONTCALM
33
INGHAM
-
1
-
-
1
$
-
$
6,307
$
-
$
-
$
6,307
1705322
00GE
59
MONTCALM
34
IONIA
-
1
-
-
1
$
-
$
4,928
$
-
$
-
$
4,928
41
1705322
00GE
59
MONTCALM
41
KENT
1
3
-
-
4
$
3,639
$
11,215
$
-
$
-
$
14,854
42
1705322
00GE
59
MONTCALM
59
MONTCALM
18
5
-
-
23
$
76,103
$
21,102
$
-
$
-
$
97,205
43
1705322
00GE
78
SHIAWASSEE
33
INGHAM
-
1
-
-
1
$
-
$
5,698
$
-
$
-
$
5,698
44
1705322
00GE
78
SHIAWASSEE
78
SHIAWASSEE
28
15
-
-
43
$
132,977
$
70,042
$
-
$
-
$
203,019
45
1705322
00GE
79
TUSCOLA
79
TUSCOLA
36
19
-
-
55
$
148,786
$
77,852
$
-
$
-
$
226,637
46
4344340
00GG
18
CLARE
18
CLARE
39
34
-
-
73
$
131,720
$
114,973
$
-
$
-
$
246,692
47
4344340
00GG
18
CLARE
67
OSCEOLA
1
1
-
-
2
$
2,542
$
3,400
$
-
$
-
$
5,942
48
4344340
00GG
26
GLADWIN
18
CLARE
1
-
-
-
1
$
3,400
$
-
$
-
$
-
$
3,400
49
4344340
00GG
26
GLADWIN
26
GLADWIN
20
10
-
-
30
$
72,234
$
36,819
$
-
$
-
$
109,053
50
4344340
00GG
37
ISABELLA
18
CLARE
1
-
-
-
1
$
3,400
$
-
$
-
$
-
$
3,400
51
4344340
00GG
37
ISABELLA
25
GENESEE
-
1
-
-
1
$
-
$
4,551
$
-
$
-
$
4,551
52
4344340
00GG
37
ISABELLA
37
ISABELLA
93
79
1
-
173
$
337,397
$
284,920
$
1,788
$
-
$
624,105
53
4344340
00GG
37
ISABELLA
54
MECOSTA
1
-
-
-
1
$
3,400
$
-
$
-
$
-
$
3,400
54
4344340
00GG
54
MECOSTA
26
GLADWIN
1
-
-
-
1
$
3,678
$
-
$
-
$
-
$
3,678
55
4344340
00GG
54
MECOSTA
54
MECOSTA
37
27
-
-
64
$
123,073
$
87,471
$
-
$
-
$
210,545
56
4344340
00GG
54
MECOSTA
56
MIDLAND
1
-
-
-
1
$
3,400
$
-
$
-
$
-
$
3,400
57
4344340
00GG
54
MECOSTA
59
MONTCALM
-
-
1
-
1
$
-
$
-
$
2,184
$
-
$
2,184
58
4344340
00GG
56
MIDLAND
18
CLARE
1
-
-
-
1
$
4,252
$
-
$
-
$
-
$
4,252
59
4344340
00GG
56
MIDLAND
26
GLADWIN
-
1
-
-
1
$
-
$
2,542
$
-
$
-
$
2,542
60
4344340
00GG
56
MIDLAND
37
ISABELLA
1
1
-
-
2
$
4,252
$
4,252
$
-
$
-
$
8,503
61
4344340
00GG
56
MIDLAND
54
MECOSTA
1
-
-
-
1
$
3,400
$
-
$
-
$
-
$
3,400
62
4344340
00GG
56
MIDLAND
56
MIDLAND
80
42
-
-
122
$
294,037
$
154,628
$
-
$
-
$
448,664
63
4344340
00GG
56
MIDLAND
73
SAGINAW
-
1
-
-
1
$
-
$
5,244
$
-
$
-
$
5,244
64
4344340
00GG
67
OSCEOLA
43
LAKE
1
-
-
-
1
$
6,307
$
-
$
-
$
-
$
6,307
65
4344340
00GG
67
OSCEOLA
54
MECOSTA
1
-
-
-
1
$
3,400
$
-
$
-
$
-
$
3,400
66
4344340
00GG
67
OSCEOLA
67
OSCEOLA
20
14
-
-
34
$
71,342
$
41,586
$
-
$
-
$
112,927
67
4344340
00GG
67
OSCEOLA
80
VAN BUREN
1
1
-
-
2
$
4,153
$
4,153
$
-
$
-
$
8,305
68
3119549
00GJ
82
WAYNE
24
EMMET
1
-
-
-
1
$
4,957
$
-
$
-
$
-
$
4,957
69
3119549
00GJ
82
WAYNE
33
INGHAM
2
-
-
-
2
$
9,485
$
-
$
-
$
-
$
9,485
70
3119549
00GJ
82
WAYNE
37
ISABELLA
1
-
-
-
1
$
4,707
$
-
$
-
$
-
$
4,707
Provider ID
Billing
Agent
Code F
36
1705322
00GE
37
1705322
00GE
38
1705322
39
40
Report Generated: 6/3/2008
4:35 PM
Male
Female
Male
Female
Male
Female
Male
Female
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW by County
5,244
Page 48 of 79
Habilitation Supports Waiver - Capitation by County
May, 2008
Detail by Population Group by Gender
Revenue is calculated based on County of Residence and Paid to Country of Financial Responsibility
Population - Current Enrollment
DAB Enrollees
Revenue - Habilitation Supports Waiver
TANF Enrollees
DAB Capitation
Total
Enrollees
TANF Capitation
Total Capitation
County Name - COFR Code R
County Name Residence
82
WAYNE
50
MACOMB
-
1
-
-
1
$
-
$
2,476
$
-
$
-
$
82
WAYNE
56
MIDLAND
-
1
-
-
1
$
-
$
4,707
$
-
$
-
$
4,707
82
WAYNE
63
OAKLAND
2
2
-
-
4
$
9,903
$
9,066
$
-
$
-
$
18,969
605
484
-
-
1,089
$
2,946,263
$
2,371,189
$
-
$
-
$
5,317,452
55
52
-
1
108
$
192,505
$
181,553
$
-
$
1,788
$
375,847
KALAMAZOO
-
2
-
-
2
$
-
$
6,793
$
-
$
-
$
6,793
70
OTTAWA
-
1
-
-
1
$
-
$
4,928
$
-
$
-
$
4,928
80
VAN BUREN
2
-
-
-
2
$
10,385
$
-
$
-
$
-
$
10,385
CASS
14
CASS
8
-
-
18
$
31,426
$
23,873
$
-
$
-
$
55,299
CASS
38
JACKSON
1
-
-
-
1
$
2,273
$
-
$
-
$
-
$
2,273
14
CASS
39
KALAMAZOO
1
-
-
-
1
$
3,400
$
-
$
-
$
-
$
3,400
00GR
39
KALAMAZOO
03
ALLEGAN
1
-
-
-
1
$
3,678
$
-
$
-
$
-
$
3,678
3402136
00GR
39
KALAMAZOO
12
BRANCH
-
1
-
-
1
$
-
$
5,748
$
-
$
-
$
5,748
84
3402136
00GR
39
KALAMAZOO
34
IONIA
-
85
3402136
00GR
39
KALAMAZOO
39
KALAMAZOO
86
3402136
00GR
39
KALAMAZOO
41
KENT
1
-
-
87
3402136
00GR
75
ST JOSEPH
03
ALLEGAN
1
-
-
88
3402136
00GR
75
ST JOSEPH
12
BRANCH
1
2
-
89
3402136
00GR
75
ST JOSEPH
75
ST JOSEPH
25
17
90
3402136
00GR
75
ST JOSEPH
80
VAN BUREN
1
-
91
4483587
00GS
41
KENT
41
KENT
92
1712229
00GV
30
HILLSDALE
30
HILLSDALE
93
1712229
00GV
30
HILLSDALE
38
94
1712229
00GV
38
JACKSON
95
1712229
00GV
38
96
1712229
00GV
97
3396315
98
3396315
99
Provider ID
Billing
Agent
Code F
71
3119549
00GJ
72
3119549
00GJ
73
3119549
00GJ
74
3119549
00GJ
82
WAYNE
82
WAYNE
75
3402136
00GR
03
ALLEGAN
03
ALLEGAN
76
3402136
00GR
03
ALLEGAN
39
77
3402136
00GR
03
ALLEGAN
78
3402136
00GR
03
ALLEGAN
79
3402136
00GR
14
80
3402136
00GR
14
81
3402136
00GR
82
3402136
83
Male
Female
10
153
Male
Female
Male
Female
Male
Female
2,476
1
-
-
1
$
$
6,307
$
-
$
-
$
6,307
105
-
-
258
$
571,197
$
389,426
$
-
$
-
$
960,623
-
1
$
1,914
$
-
$
-
$
-
$
1,914
-
1
$
3,400
$
-
$
-
$
-
$
3,400
-
3
$
4,153
$
8,305
$
-
$
-
$
12,458
-
-
42
$
83,551
$
55,228
$
-
$
-
$
138,778
-
-
1
$
4,153
$
-
$
-
$
-
$
4,153
101
59
-
-
160
$
363,319
$
217,417
$
-
$
-
$
580,736
39
21
-
-
60
$
90,568
$
48,821
$
-
$
-
$
139,389
JACKSON
1
2
-
-
3
$
1,699
$
4,546
$
-
$
-
$
6,244
30
HILLSDALE
2
2
-
-
4
$
5,115
$
4,731
$
-
$
-
$
9,845
JACKSON
38
JACKSON
114
73
-
-
187
$
252,154
$
159,878
$
-
$
-
$
412,032
38
JACKSON
80
VAN BUREN
-
1
-
-
1
$
$
4,153
$
-
$
-
$
4,153
00GX
50
MACOMB
50
MACOMB
215
160
4
2
381
$
702,592
$
527,733
$
9,917
$
3,485
$
1,243,726
00GX
50
MACOMB
63
OAKLAND
31
22
-
-
53
$
164,397
$
104,443
$
-
$
-
$
268,840
3396315
00GX
50
MACOMB
74
ST CLAIR
2
-
-
-
2
$
13,113
$
$
-
$
-
$
13,113
100
1712452
00HA
61
MUSKEGON
61
MUSKEGON
74
57
-
-
131
$
335,975
$
258,581
$
-
$
-
$
594,556
101
1712452
00HA
70
OTTAWA
03
ALLEGAN
-
1
-
-
1
$
-
$
4,252
$
-
$
-
$
4,252
102
1712452
00HA
70
OTTAWA
39
KALAMAZOO
-
1
-
-
1
$
-
$
3,678
$
-
$
-
$
3,678
103
1712452
00HA
70
OTTAWA
70
OTTAWA
43
44
-
-
87
$
193,944
$
202,712
$
-
$
-
$
396,657
104
1712452
00HA
70
OTTAWA
80
VAN BUREN
1
-
-
-
1
$
4,153
$
-
$
-
$
-
$
4,153
105
4540048
00HC
20
CRAWFORD
20
CRAWFORD
2
7
1
-
10
$
7,963
$
34,248
$
3,547
$
-
$
45,758
Report Generated: 6/3/2008
4:35 PM
-
-
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW by County
Page 49 of 79
Habilitation Supports Waiver - Capitation by County
May, 2008
Detail by Population Group by Gender
Revenue is calculated based on County of Residence and Paid to Country of Financial Responsibility
Population - Current Enrollment
DAB Enrollees
County Name Residence
Revenue - Habilitation Supports Waiver
TANF Enrollees
Provider ID
Billing
Agent
Code F
106
4540048
00HC
20
CRAWFORD
72
ROSCOMMON
107
4540048
00HC
28
GRAND TRAVERSE
03
ALLEGAN
108
4540048
00HC
28
GRAND TRAVERSE
28
GRAND TRAVERSE
109
4540048
00HC
43
LAKE
43
LAKE
4
1
-
110
4540048
00HC
43
LAKE
64
OCEANA
1
-
-
111
4540048
00HC
45
LEELANAU
28
GRAND TRAVERSE
1
2
-
-
112
4540048
00HC
45
LEELANAU
45
LEELANAU
5
3
-
113
4540048
00HC
53
MASON
53
MASON
9
1
-
114
4540048
00HC
57
MISSAUKEE
57
MISSAUKEE
1
1
115
4540048
00HC
64
OCEANA
28
GRAND TRAVERSE
-
116
4540048
00HC
64
OCEANA
64
OCEANA
11
117
4540048
00HC
72
ROSCOMMON
09
BAY
-
1
-
118
4540048
00HC
72
ROSCOMMON
30
HILLSDALE
1
-
-
119
4540048
00HC
72
ROSCOMMON
72
ROSCOMMON
6
13
-
120
4540048
00HC
72
ROSCOMMON
83
WEXFORD
1
1
-
121
4540048
00HC
83
WEXFORD
57
MISSAUKEE
9
3
-
122
4540048
00HC
83
WEXFORD
67
OSCEOLA
6
-
-
123
4540048
00HC
83
WEXFORD
72
ROSCOMMON
-
2
-
124
4540048
00HC
83
WEXFORD
83
WEXFORD
14
7
-
125
4476125
00HF
01
ALCONA
01
ALCONA
12
7
126
4476125
00HF
01
ALCONA
04
ALPENA
1
127
4476125
00HF
04
ALPENA
01
ALCONA
2
128
4476125
00HF
04
ALPENA
04
ALPENA
129
4476125
00HF
04
ALPENA
09
130
4476125
00HF
04
ALPENA
25
131
4476125
00HF
04
ALPENA
132
4476125
00HF
04
133
4476125
00HF
05
134
4476125
00HF
135
4476125
00HF
136
4476125
137
4476125
138
139
140
Male
Female
Male
Total Capitation
Female
Male
1
1
-
-
2
$
3,406
$
3,406
$
-
$
-
$
1
-
-
-
1
$
3,678
$
-
$
-
$
-
$
3,678
21
23
-
-
44
$
96,015
$
105,367
$
-
$
-
$
201,382
-
5
$
14,916
$
4,557
$
-
$
-
$
19,473
-
1
$
4,557
$
-
$
-
$
-
$
4,557
3
$
3,406
$
7,963
$
-
$
-
$
11,369
-
8
$
22,784
$
13,670
$
-
$
-
$
36,454
-
10
$
37,283
$
4,557
$
-
$
-
$
41,840
-
-
2
$
4,557
$
3,406
$
-
$
-
$
7,963
1
-
-
1
$
-
$
4,557
$
-
$
-
$
4,557
4
-
-
15
$
50,495
$
18,227
$
-
$
-
$
68,722
-
1
$
-
$
4,153
$
-
$
-
$
4,153
-
1
$
2,458
$
-
$
-
$
-
$
2,458
-
19
$
30,232
$
59,609
$
-
$
-
$
89,841
-
2
$
3,406
$
4,557
$
-
$
-
$
7,963
-
12
$
41,010
$
13,670
$
-
$
-
$
54,680
-
6
$
20,679
$
-
$
-
$
-
$
20,679
-
2
$
-
$
9,485
$
-
$
-
$
9,485
-
21
$
61,829
$
30,746
$
-
$
-
$
92,575
-
-
19
$
60,785
$
30,942
$
-
$
-
$
91,726
-
-
-
1
$
4,957
$
-
$
-
$
-
$
4,957
-
-
-
2
$
9,913
$
-
$
-
$
-
$
9,913
45
19
-
-
64
$
233,330
$
92,315
$
-
$
-
$
325,645
BAY
1
-
-
-
1
$
4,153
$
-
$
-
$
-
$
4,153
GENESEE
-
1
-
-
1
$
-
$
3,639
$
-
$
-
$
3,639
60
MONTMORENCY
-
1
-
-
1
$
-
$
4,957
$
-
$
-
$
4,957
ALPENA
71
PRESQUE ISLE
2
-
-
-
2
$
9,913
$
-
$
-
$
-
$
9,913
ANTRIM
05
ANTRIM
19
6
-
-
25
$
107,421
$
32,048
$
-
$
-
$
139,469
05
ANTRIM
28
GRAND TRAVERSE
-
1
-
-
1
$
-
$
4,928
$
-
$
-
$
4,928
05
ANTRIM
40
KALKASKA
1
-
-
-
1
$
6,198
$
-
$
-
$
-
$
6,198
00HF
15
CHARLEVOIX
05
ANTRIM
2
-
-
-
2
$
11,818
$
-
$
-
$
-
$
11,818
00HF
15
CHARLEVOIX
15
CHARLEVOIX
19
11
-
-
30
$
97,946
$
57,236
$
-
$
-
$
155,182
4476125
00HF
15
CHARLEVOIX
16
CHEBOYGAN
-
1
-
-
1
$
-
$
4,957
$
-
$
-
$
4,957
4476125
00HF
15
CHARLEVOIX
24
EMMET
3
3
-
-
6
$
19,920
$
14,023
$
-
$
-
$
33,942
4476125
00HF
15
CHARLEVOIX
40
KALKASKA
-
1
-
-
1
$
-
$
4,957
$
-
$
-
$
4,957
Report Generated: 6/3/2008
4:35 PM
Female
Total
Enrollees
TANF Capitation
Female
County Name - COFR Code R
Male
DAB Capitation
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW by County
6,812
Page 50 of 79
Habilitation Supports Waiver - Capitation by County
May, 2008
Detail by Population Group by Gender
Revenue is calculated based on County of Residence and Paid to Country of Financial Responsibility
Population - Current Enrollment
DAB Enrollees
Revenue - Habilitation Supports Waiver
TANF Enrollees
County Name - COFR Code R
County Name Residence
15
CHARLEVOIX
69
OTSEGO
16
CHEBOYGAN
09
BAY
00HF
16
CHEBOYGAN
16
CHEBOYGAN
9
4476125
00HF
16
CHEBOYGAN
49
MACKINAC
1
-
-
4476125
00HF
16
CHEBOYGAN
60
MONTMORENCY
1
-
-
146
4476125
00HF
16
CHEBOYGAN
69
OTSEGO
2
1
-
-
147
4476125
00HF
24
EMMET
24
EMMET
-
1
-
148
4476125
00HF
35
IOSCO
35
IOSCO
15
8
-
149
4476125
00HF
35
IOSCO
73
SAGINAW
1
-
-
150
4476125
00HF
40
KALKASKA
05
ANTRIM
1
-
-
151
4476125
00HF
40
KALKASKA
40
KALKASKA
14
13
-
-
152
4476125
00HF
60
MONTMORENCY
04
ALPENA
1
1
-
153
4476125
00HF
60
MONTMORENCY
60
MONTMORENCY
15
20
-
154
4476125
00HF
60
MONTMORENCY
71
PRESQUE ISLE
-
1
-
155
4476125
00HF
65
OGEMAW
35
IOSCO
2
-
-
156
4476125
00HF
65
OGEMAW
65
OGEMAW
9
12
-
157
4476125
00HF
68
OSCODA
35
IOSCO
1
-
-
158
4476125
00HF
68
OSCODA
65
OGEMAW
2
-
-
159
4476125
00HF
68
OSCODA
68
OSCODA
2
-
-
160
4476125
00HF
69
OTSEGO
24
EMMET
1
-
161
4476125
00HF
69
OTSEGO
28
GRAND TRAVERSE
-
162
4476125
00HF
69
OTSEGO
40
KALKASKA
1
163
4476125
00HF
69
OTSEGO
69
OTSEGO
30
21
164
4476125
00HF
71
PRESQUE ISLE
04
ALPENA
2
-
165
4476125
00HF
71
PRESQUE ISLE
34
IONIA
1
-
166
4476125
00HF
71
PRESQUE ISLE
37
ISABELLA
-
1
167
4476125
00HF
71
PRESQUE ISLE
63
OAKLAND
168
4476125
00HF
71
PRESQUE ISLE
71
PRESQUE ISLE
169
4476125
00HF
71
PRESQUE ISLE
79
170
1724945
00HJ
02
ALGER
02
171
1724945
00HJ
02
ALGER
172
1724945
00HJ
07
BARAGA
173
1724945
00HJ
17
CHIPPEWA
17
174
1724945
00HJ
17
CHIPPEWA
175
1724945
00HJ
17
CHIPPEWA
Provider ID
Billing
Agent
Code F
141
4476125
00HF
142
4476125
00HF
143
4476125
144
145
Report Generated: 6/3/2008
4:35 PM
Male
Female
DAB Capitation
Total
Enrollees
Male
TANF Capitation
Female
Male
Total Capitation
Female
Female
Male
3
2
-
-
5
$
15,679
$
9,913
$
-
$
-
$
-
1
-
-
1
$
-
$
3,104
$
-
$
-
$
3,104
10
-
-
19
$
40,855
$
45,811
$
-
$
-
$
86,666
-
1
$
3,820
$
-
$
-
$
-
$
3,820
-
1
$
4,957
$
-
$
-
$
-
$
4,957
3
$
11,818
$
4,957
$
-
$
-
$
16,774
-
1
$
-
$
4,957
$
-
$
-
$
4,957
-
23
$
82,199
$
45,858
$
-
$
-
$
128,057
-
1
$
5,244
$
-
$
-
$
-
$
5,244
-
1
$
3,705
$
-
$
-
$
-
$
3,705
27
$
66,196
$
57,080
$
-
$
-
$
123,276
-
2
$
4,957
$
4,957
$
-
$
-
$
9,913
-
35
$
79,215
$
101,689
$
-
$
-
$
180,904
-
1
$
-
$
6,198
$
-
$
-
$
6,198
-
2
$
9,913
$
-
$
-
$
-
$
9,913
-
21
$
49,563
$
68,156
$
-
$
-
$
117,719
-
1
$
4,957
$
-
$
-
$
-
$
4,957
-
2
$
9,913
$
-
$
-
$
-
$
9,913
-
2
$
9,913
$
-
$
-
$
-
$
9,913
-
-
1
$
3,705
$
-
$
-
$
-
$
3,705
1
-
-
1
$
-
$
4,557
$
-
$
-
$
4,557
1
-
-
2
$
4,957
$
4,957
$
-
$
-
$
9,913
-
-
51
$
167,849
$
108,760
$
-
$
-
$
276,610
-
-
2
$
9,913
$
-
$
-
$
-
$
9,913
-
-
1
$
4,557
$
-
$
-
$
-
$
4,557
-
-
1
$
-
$
3,678
$
-
$
-
$
3,678
25,592
1
-
-
-
1
$
4,957
$
-
$
-
$
-
$
4,957
20
12
-
-
32
$
100,189
$
58,228
$
-
$
-
$
158,417
TUSCOLA
1
-
-
-
1
$
4,153
$
-
$
-
$
-
$
4,153
ALGER
2
4
-
-
6
$
8,931
$
19,152
$
-
$
-
$
28,083
52
MARQUETTE
-
1
-
-
1
$
-
$
5,111
$
-
$
-
$
5,111
07
BARAGA
4
2
-
-
6
$
20,443
$
10,221
$
-
$
-
$
30,664
CHIPPEWA
20
12
-
-
32
$
97,993
$
56,889
$
-
$
-
$
154,882
28
GRAND TRAVERSE
-
1
-
-
1
$
-
$
4,557
$
-
$
-
$
4,557
77
SCHOOLCRAFT
1
-
-
-
1
$
5,528
$
-
$
-
$
-
$
5,528
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW by County
Page 51 of 79
Habilitation Supports Waiver - Capitation by County
May, 2008
Detail by Population Group by Gender
Revenue is calculated based on County of Residence and Paid to Country of Financial Responsibility
Population - Current Enrollment
DAB Enrollees
County Name - COFR Code R
County Name Residence
21
DELTA
21
DELTA
21
DELTA
55
MENOMINEE
00HJ
22
DICKINSON
22
DICKINSON
1724945
00HJ
22
DICKINSON
55
MENOMINEE
1724945
00HJ
27
GOGEBIC
27
GOGEBIC
182
1724945
00HJ
27
GOGEBIC
28
GRAND TRAVERSE
183
1724945
00HJ
27
GOGEBIC
55
184
1724945
00HJ
31
HOUGHTON
07
185
1724945
00HJ
31
HOUGHTON
31
186
1724945
00HJ
36
IRON
36
187
1724945
00HJ
48
LUCE
188
1724945
00HJ
49
189
1724945
00HJ
190
1724945
191
1724945
192
Provider ID
Billing
Agent
Code F
176
1724945
00HJ
177
1724945
00HJ
178
1724945
180
181
Male
Revenue - Habilitation Supports Waiver
TANF Enrollees
Female
Male
DAB Capitation
Female
Total
Enrollees
Male
TANF Capitation
Female
Male
Total Capitation
Female
36
20
1
-
57
$
182,044
$
104,751
$
2,688
$
-
$
2
2
-
-
4
$
10,221
$
10,221
$
-
$
-
$
20,443
20
9
-
-
29
$
93,099
$
43,375
$
-
$
-
$
136,474
1
1
-
-
2
$
3,820
$
5,111
$
-
$
-
$
8,931
13
6
-
-
19
$
62,011
$
29,374
$
-
$
-
$
91,384
1
-
-
-
1
$
4,557
$
-
$
-
$
-
$
4,557
MENOMINEE
1
-
-
-
1
$
5,111
$
-
$
-
$
-
$
5,111
BARAGA
2
2
-
-
4
$
10,221
$
10,221
$
-
$
-
$
20,443
HOUGHTON
41
19
-
-
60
$
212,042
$
94,669
$
-
$
-
$
306,712
IRON
11
4
-
-
15
$
54,927
$
20,443
$
-
$
-
$
75,370
48
LUCE
4
7
-
-
11
$
20,443
$
35,775
$
-
$
-
$
56,217
MACKINAC
49
MACKINAC
8
3
-
-
11
$
38,463
$
14,042
$
-
$
-
$
52,504
52
MARQUETTE
52
MARQUETTE
40
20
-
-
60
$
201,901
$
100,901
$
-
$
-
$
302,802
00HJ
55
MENOMINEE
22
DICKINSON
1
-
-
-
1
$
5,111
$
-
$
-
$
-
$
5,111
00HJ
55
MENOMINEE
36
IRON
-
1
-
-
1
$
-
$
3,820
$
-
$
-
$
3,820
1724945
00HJ
55
MENOMINEE
55
MENOMINEE
12
8
-
-
20
$
51,838
$
30,720
$
-
$
-
$
82,558
193
1724945
00HJ
77
SCHOOLCRAFT
17
CHIPPEWA
-
1
-
-
1
$
-
$
5,111
$
-
$
-
$
5,111
194
1724945
00HJ
77
SCHOOLCRAFT
48
LUCE
-
1
-
-
1
$
-
$
5,528
$
-
$
-
$
5,528
195
1724945
00HJ
77
SCHOOLCRAFT
77
SCHOOLCRAFT
4
6
-
-
10
$
20,860
$
32,361
$
-
$
-
$
53,220
196
1708164
00HO
44
LAPEER
44
LAPEER
29
18
-
-
47
$
152,742
$
96,399
$
-
$
-
$
249,141
197
1708164
00HO
44
LAPEER
76
SANILAC
4
1
-
-
5
$
22,989
$
5,244
$
-
$
-
$
28,232
198
1708164
00HO
44
LAPEER
79
TUSCOLA
-
1
-
-
1
$
-
$
4,153
$
-
$
-
$
4,153
199
1708164
00HO
74
ST CLAIR
30
HILLSDALE
-
1
-
-
1
$
-
$
3,146
$
-
$
-
$
3,146
200
1708164
00HO
74
ST CLAIR
74
ST CLAIR
79
52
-
1
132
$
396,321
$
272,677
$
-
$
2,758
$
671,756
201
1708164
00HO
76
SANILAC
76
SANILAC
48
23
-
-
71
$
258,923
$
128,479
202
1712541
00HQ
73
SAGINAW
34
IONIA
1
-
-
-
1
$
4,557
$
203
1712541
00HQ
73
SAGINAW
56
MIDLAND
1
-
-
-
1
$
4,252
204
1712541
00HQ
73
SAGINAW
63
OAKLAND
-
1
-
-
1
$
-
205
1712541
00HQ
73
SAGINAW
70
OTTAWA
1
-
-
-
1
$
206
1712541
00HQ
73
SAGINAW
73
SAGINAW
61
37
-
-
98
207
1712541
00HQ
73
SAGINAW
79
TUSCOLA
1
1
-
-
208
2920843
00HR
08
BARRY
08
BARRY
2
2
-
-
209
2920843
00HR
08
BARRY
34
IONIA
1
-
-
210
2920843
00HR
11
BERRIEN
11
BERRIEN
43
42
211
2920843
00HR
11
BERRIEN
70
OTTAWA
1
-
Report Generated: 6/3/2008
4:35 PM
289,483
$
-
$
-
$
387,402
-
$
-
$
-
$
4,557
$
-
$
-
$
-
$
4,252
$
4,957
$
-
$
-
$
4,957
4,557
$
-
$
-
$
-
$
4,557
$
326,098
$
202,738
$
-
$
-
$
528,837
2
$
4,153
$
4,153
$
-
$
-
$
8,305
4
$
8,305
$
8,305
$
-
$
-
$
16,611
-
1
$
4,557
$
-
$
-
$
-
$
4,557
-
-
85
$
205,699
$
$
-
$
-
$
391,342
-
-
1
$
6,307
$
$
-
$
-
$
6,307
185,642
-
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW by County
Page 52 of 79
Habilitation Supports Waiver - Capitation by County
May, 2008
Detail by Population Group by Gender
Revenue is calculated based on County of Residence and Paid to Country of Financial Responsibility
Population - Current Enrollment
DAB Enrollees
County Name Residence
Provider ID
Billing
Agent
Code F
212
2920843
00HR
12
BRANCH
12
BRANCH
213
2920843
00HR
13
CALHOUN
12
BRANCH
214
2920843
00HR
13
CALHOUN
13
215
2920843
00HR
13
CALHOUN
216
2920843
00HR
13
CALHOUN
217
2920843
00HR
13
CALHOUN
218
2920843
00HR
13
CALHOUN
47
LIVINGSTON
1
-
-
219
2920843
00HR
80
VAN BUREN
03
ALLEGAN
4
-
-
220
2920843
00HR
80
VAN BUREN
39
KALAMAZOO
1
-
-
221
2920843
00HR
80
VAN BUREN
80
VAN BUREN
37
24
-
222
4390138
00HU
46
LENAWEE
46
LENAWEE
50
46
-
223
4390138
00HU
47
LIVINGSTON
25
GENESEE
1
1
-
224
4390138
00HU
47
LIVINGSTON
39
KALAMAZOO
2
-
-
225
4390138
00HU
47
LIVINGSTON
45
LEELANAU
1
-
-
226
4390138
00HU
47
LIVINGSTON
47
LIVINGSTON
58
30
1
227
4390138
00HU
58
MONROE
58
MONROE
62
51
-
228
4390138
00HU
81
WASHTENAW
40
KALKASKA
1
-
-
229
4390138
00HU
81
WASHTENAW
46
LENAWEE
-
1
-
230
4390138
00HU
81
WASHTENAW
63
OAKLAND
-
1
231
4390138
00HU
81
WASHTENAW
81
WASHTENAW
232
4390138
00HU
81
WASHTENAW
82
WAYNE
State Subtotals
DAB Capitation
Male
Female
Male
Total Capitation
Female
Male
19
25
-
-
44
$
76,891
$
105,831
$
-
$
-
$
-
1
-
-
1
$
-
$
3,104
$
-
$
-
$
3,104
CALHOUN
59
34
-
-
93
$
$
144,594
$
-
$
-
$
400,969
14
CASS
-
1
-
-
1
$
-
$
3,400
$
-
$
-
$
3,400
33
INGHAM
1
-
-
-
1
$
4,557
$
-
$
-
$
-
$
4,557
39
KALAMAZOO
-
1
-
-
1
$
-
$
3,400
$
-
$
-
$
3,400
-
1
$
5,038
$
-
$
-
$
-
$
5,038
-
4
$
13,020
$
-
$
-
$
-
$
13,020
-
1
$
4,252
$
-
$
-
$
-
$
4,252
-
61
$
151,451
$
100,397
$
-
$
-
$
251,848
-
96
$
181,169
$
174,340
$
-
$
-
$
355,509
-
2
$
4,551
$
3,936
$
-
$
-
$
8,487
-
2
$
6,800
$
-
$
-
$
-
$
6,800
-
1
$
3,406
$
-
$
-
$
-
$
3,406
-
89
$
232,085
$
117,399
$
2,833
$
-
$
352,317
-
113
$
244,770
$
189,772
$
-
$
-
$
434,543
-
1
$
5,361
$
-
$
-
$
-
$
5,361
-
1
$
-
$
4,551
$
-
$
-
$
4,551
-
-
1
$
-
$
4,957
$
-
$
-
$
4,957
144
-
1
341
$
782,858
$
547,241
$
-
$
2,720
$
1,332,819
-
-
-
1
$
4,928
$
$
-
$
-
$
4,928
6
7,169
$
18,007,623
$
$
27,269
$
13,359
$
30,844,327
17
-
40,628
$
30,844,327
196
1
4,175
2,977
7,152
Female
Total
Enrollees
TANF Capitation
Female
County Name - COFR Code R
Male
Revenue - Habilitation Supports Waiver
TANF Enrollees
11
256,376
12,796,077
30,803,699
182,722
-
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW by County
Page 53 of 79
Habilitation Supports Waiver - Population by PIHP by Age Group - DAB - Male
M
DAB
May, 2008
Current Enrolled Population by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
M
DAB
1
16
44
37
87
29
214
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
M
DAB
4
19
40
50
71
28
212
3
4344340
00GG
CMH for Central Michigan
M
DAB
2
18
65
92
91
33
301
4
4483587
00GS
CMHSA Network of West Michigan
M
DAB
-
10
32
22
35
2
101
5
3119549
00GJ
Detroit Wayne County CMH Agency
M
DAB
4
19
117
172
250
49
611
6
1705233
0028
Genesee County CMH Services
M
DAB
3
15
47
70
62
14
211
7
1712452
00HA
Lakeshore Behavioral Health Alliance
M
DAB
-
8
25
35
44
6
118
8
1712229
00GV
Lifeways
M
DAB
-
13
45
37
42
19
156
00GX
Macomb County CMH Services
M
DAB
8
20
54
76
74
16
248
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
10
1724945
00HJ
Northcare
M
DAB
13
26
45
51
63
26
224
11
4476125
00HF
Northern Affiliation
M
DAB
1
6
49
59
92
36
243
12
4540048
00HC
Northern Lakes
M
DAB
2
7
21
26
32
6
94
13
1705289
0058
Oakland County CMH Authority
M
DAB
7
17
112
154
112
22
424
14
1712541
00HQ
Saginaw County CMH Authority
M
DAB
-
3
17
19
21
5
65
15
4390138
00HU
Southeast Partnership
M
DAB
2
30
136
85
92
27
372
16
3402136
00GR
Southwest Alliance
M
DAB
-
22
63
67
78
22
252
17
1708164
00HO
Thumb Mental Health Alliance
M
DAB
4
5
33
42
62
14
160
18
2920843
00HR
Venture Behavioral Health
M
DAB
1
13
45
55
47
8
169
-
19
20
State Subtotals
52
267
990
1,149
Check Values
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW-Pop
1,355
362
4,175
-
Page 54 of 79
Habilitation Supports Waiver - Population by PIHP by Age Group - DAB - Female
F
DAB
May, 2008
Current Enrolled Population by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
F
DAB
-
7
31
30
47
21
136
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
F
DAB
-
10
26
27
57
14
134
3
4344340
00GG
CMH for Central Michigan
F
DAB
-
7
35
53
93
24
212
4
4483587
00GS
CMHSA Network of West Michigan
F
DAB
-
5
3119549
00GJ
Detroit Wayne County CMH Agency
F
DAB
4
6
1705233
0028
Genesee County CMH Services
F
DAB
3
7
7
1712452
00HA
Lakeshore Behavioral Health Alliance
F
DAB
-
5
8
1712229
00GV
Lifeways
F
DAB
1
4
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
3
13
12
29
2
59
19
91
115
200
59
488
31
46
44
17
148
20
27
41
10
103
23
17
43
11
99
9
3396315
00GX
Macomb County CMH Services
F
DAB
4
11
37
48
62
20
182
10
1724945
00HJ
Northcare
F
DAB
4
7
23
29
50
17
130
11
4476125
00HF
Northern Affiliation
F
DAB
1
4
34
33
55
30
157
12
4540048
00HC
Northern Lakes
F
DAB
1
3
17
21
19
10
71
13
1705289
0058
Oakland County CMH Authority
F
DAB
3
11
79
111
100
26
330
14
1712541
00HQ
Saginaw County CMH Authority
F
DAB
-
1
9
12
11
6
39
15
4390138
00HU
Southeast Partnership
F
DAB
-
18
69
92
69
26
274
16
3402136
00GR
Southwest Alliance
F
DAB
2
8
48
46
65
20
189
17
1708164
00HO
Thumb Mental Health Alliance
F
DAB
-
1
20
28
37
10
96
18
2920843
00HR
Venture Behavioral Health
F
DAB
1
10
30
37
42
10
130
-
19
20
State Subtotals
24
136
636
784
Check Values
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW-Pop
1,064
333
2,977
-
Page 55 of 79
Habilitation Supports Waiver - Population by PIHP by Age Group - TANF - Male
M
TANF
May, 2008
Population - Current Enrollment by Age Group
Provider ID
Billing
Agent
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
1
1708001
00BJ
CMH Affiliation of Mid-Michigan
M
TANF
1
-
-
-
-
-
1
2
4344340
00GG
CMH for Central Michigan
M
TANF
2
-
-
-
-
-
2
3
1705233
0028
Genesee County CMH Services
M
TANF
1
-
-
-
-
-
1
4
3396315
00GX
Macomb County CMH Services
M
TANF
3
1
-
-
-
-
4
5
1724945
00HJ
Northcare
M
TANF
1
-
-
-
-
-
1
6
4540048
00HC
Northern Lakes
M
TANF
1
-
-
-
-
-
1
7
4390138
00HU
Southeast Partnership
M
TANF
-
1
-
-
-
-
1
8
-
9
-
10
-
11
-
12
-
13
-
14
-
15
-
16
-
17
-
18
-
19
-
20
State Subtotals
9
2
-
-
Check Values
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW-Pop
-
-
11
-
Page 56 of 79
Habilitation Supports Waiver - Population by PIHP by Age Group - TANF - Female
F
TANF
May, 2008
Population - Current Enrollment by Age Group
Provider ID
Billing
Agent
1
3396315
00GX
Macomb County CMH Services
F
TANF
2
-
-
-
-
-
2
2
1705289
0058
Oakland County CMH Authority
F
TANF
1
-
-
-
-
-
1
3
4390138
00HU
Southeast Partnership
F
TANF
-
-
1
-
-
-
1
4
3402136
00GR
Southwest Alliance
F
TANF
1
-
-
-
-
-
1
5
1708164
00HO
Thumb Mental Health Alliance
F
TANF
1
-
-
-
-
-
1
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
6
-
7
-
8
-
9
-
10
-
11
-
12
-
13
-
14
-
15
-
16
-
17
-
18
-
19
-
20
State Subtotals
5
-
1
-
Check Values
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW-Pop
-
-
6
-
Page 57 of 79
Habilitation Supports Waiver - Revenue by PIHP by Age Group - DAB - Male
M
DAB
May, 2008
Revenue for Current Enrolled Population by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
M
DAB
$
2,184
$
67,319
$
187,264
$
160,824
$
381,660
$
126,592
$
925,844
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
M
DAB
$
9,587
$
71,742
$
181,961
$
239,732
$
340,914
$
135,757
$
979,692
3
4344340
00GG
CMH for Central Michigan
M
DAB
$
3,577
$
50,323
$
230,239
$
340,765
$
330,344
$
120,138
$
1,075,386
4
4483587
00GS
CMHSA Network of West Michigan
M
DAB
$
-
$
32,718
$
116,500
$
80,066
$
126,756
$
7,279
$
363,319
5
3119549
00GJ
Detroit Wayne County CMH Agency
M
DAB
$
10,738
$
78,428
$
547,742
$
862,185
$
1,232,353
$
243,868
$
2,975,314
6
1705233
0028
Genesee County CMH Services
M
DAB
$
5,743
$
47,239
$
167,847
$
254,598
$
228,918
$
50,951
$
755,296
7
1712452
00HA
Lakeshore Behavioral Health Alliance
M
DAB
$
-
$
34,143
$
112,318
$
160,590
$
200,831
$
26,190
$
534,072
8
1712229
00GV
Lifeways
M
DAB
$
-
$
27,916
$
96,594
$
84,015
$
97,851
$
43,160
$
349,536
00GX
Macomb County CMH Services
M
DAB
$
16,152
$
61,982
$
187,590
$
279,403
$
274,068
$
60,905
$
880,101
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
10
1724945
00HJ
Northcare
M
DAB
$
40,942
$
116,249
$
229,704
$
268,401
$
321,005
$
133,262
$
1,109,562
11
4476125
00HF
Northern Affiliation
M
DAB
$
2,607
$
31,045
$
253,364
$
310,503
$
482,627
$
189,388
$
1,269,534
12
4540048
00HC
Northern Lakes
M
DAB
$
4,794
$
25,129
$
84,032
$
118,914
$
148,095
$
27,712
$
408,674
13
1705289
0058
Oakland County CMH Authority
M
DAB
$
18,250
$
66,295
$
547,354
$
748,868
$
595,117
$
116,404
$
2,092,288
14
1712541
00HQ
Saginaw County CMH Authority
M
DAB
$
-
$
15,195
$
88,096
$
98,941
$
113,152
$
28,232
$
343,616
15
4390138
00HU
Southeast Partnership
M
DAB
$
3,829
$
114,586
$
523,675
$
340,407
$
368,175
$
115,258
$
1,465,929
16
3402136
00GR
Southwest Alliance
M
DAB
$
-
$
69,306
$
222,029
$
249,878
$
288,782
$
82,038
$
912,033
17
1708164
00HO
Thumb Mental Health Alliance
M
DAB
$
12,356
$
20,922
$
163,758
$
224,225
$
333,679
$
76,035
$
830,975
18
2920843
00HR
Venture Behavioral Health
M
DAB
$
2,184
$
49,692
$
197,814
$
251,459
$
200,147
$
35,156
$
736,452
$
132,943
$
980,229
$
4,137,881
$
5,073,772
$
6,064,474
$
1,618,324
$
18,007,623
19
20
State Subtotals
Check Values
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW-DAB
-
Page 58 of 79
Habilitation Supports Waiver - Revenue by PIHP by Age Group - DAB - Female
F
DAB
May, 2008
Revenue for Current Enrolled Population by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
F
DAB
$
-
$
27,234
$
134,807
$
129,123
$
198,189
$
96,707
$
586,059
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
F
DAB
$
-
$
38,927
$
116,174
$
129,940
$
279,220
$
67,207
$
631,468
3
4344340
00GG
CMH for Central Michigan
F
DAB
$
-
$
20,644
$
126,386
$
179,374
$
334,014
$
84,118
$
744,536
4
4483587
00GS
CMHSA Network of West Michigan
F
DAB
$
-
$
8,161
$
48,088
$
45,071
$
108,818
$
7,279
$
217,417
5
3119549
00GJ
Detroit Wayne County CMH Agency
F
DAB
$
11,109
$
71,954
$
431,342
$
584,378
$
995,345
$
293,309
$
2,387,438
6
1705233
0028
Genesee County CMH Services
F
DAB
$
5,743
$
21,800
$
116,222
$
169,289
$
165,949
$
63,268
$
542,271
7
1712452
00HA
Lakeshore Behavioral Health Alliance
F
DAB
$
-
$
19,332
$
90,617
$
124,544
$
189,469
$
45,262
$
469,223
8
1712229
00GV
Lifeways
F
DAB
$
1,195
$
8,512
$
48,917
$
39,166
$
98,791
$
25,547
$
222,128
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
00GX
Macomb County CMH Services
F
DAB
$
6,970
$
32,996
$
120,669
$
175,350
$
226,187
$
70,005
$
632,176
10
1724945
00HJ
Northcare
F
DAB
$
10,753
$
33,194
$
108,512
$
143,037
$
255,719
$
91,137
$
642,352
11
4476125
00HF
Northern Affiliation
F
DAB
$
2,607
$
17,323
$
162,307
$
169,233
$
279,411
$
151,978
$
782,859
12
4540048
00HC
Northern Lakes
F
DAB
$
3,547
$
11,741
$
72,862
$
100,164
$
87,924
$
45,939
$
322,177
13
1705289
0058
Oakland County CMH Authority
F
DAB
$
7,821
$
44,208
$
369,585
$
553,100
$
509,052
$
131,232
$
1,614,998
14
1712541
00HQ
Saginaw County CMH Authority
F
DAB
$
-
$
3,920
$
46,494
$
68,265
$
61,708
$
31,461
$
211,848
15
4390138
00HU
Southeast Partnership
F
DAB
$
-
$
64,711
$
261,463
$
338,828
$
277,286
$
99,908
$
1,042,196
16
3402136
00GR
Southwest Alliance
F
DAB
$
3,577
$
23,179
$
170,579
$
170,808
$
239,784
$
74,235
$
682,162
17
1708164
00HO
Thumb Mental Health Alliance
F
DAB
$
-
$
5,244
$
102,820
$
150,125
$
199,474
$
52,436
$
510,097
18
2920843
00HR
Venture Behavioral Health
F
DAB
$
2,184
$
36,952
$
123,591
$
163,707
$
184,341
$
43,898
$
554,674
$
55,507
$
490,032
$
2,651,433
$
3,433,500
$
4,690,681
$
1,474,924
$
12,796,077
19
20
State Subtotals
Check Values
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW-DAB
-
Page 59 of 79
Habilitation Supports Waiver - Revenue by PIHP by Age Group - TANF - Male
M
TANF
May, 2008
Capitation for Current Enrolled Population by Age Group
Provider ID
Billing
Agent
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
1
1708001
00BJ
CMH Affiliation of Mid-Michigan
M
TANF
$
2,397
$
-
$
-
$
-
$
-
$
-
$
2,397
2
4344340
00GG
CMH for Central Michigan
M
TANF
$
3,973
$
-
$
-
$
-
$
-
$
-
$
3,973
3
1705233
0028
Genesee County CMH Services
M
TANF
$
1,914
$
-
$
-
$
-
$
-
$
-
$
1,914
4
3396315
00GX
Macomb County CMH Services
M
TANF
$
6,334
$
3,583
$
-
$
-
$
-
$
-
$
9,917
5
1724945
00HJ
Northcare
M
TANF
$
2,688
$
-
$
-
$
-
$
-
$
-
$
2,688
6
4540048
00HC
Northern Lakes
M
TANF
$
3,547
$
-
$
-
$
-
$
-
$
-
$
3,547
7
4390138
00HU
Southeast Partnership
M
TANF
$
-
$
2,833
$
-
$
-
$
-
$
-
$
2,833
8
$
-
9
$
-
10
$
-
11
$
-
12
$
-
13
$
-
14
$
-
15
$
-
16
$
-
17
$
-
18
$
-
$
27,269
19
20
State Subtotals
$
20,853
$
6,416
$
-
$
-
$
Check Values
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW-TANF
-
$
-
-
Page 60 of 79
Habilitation Supports Waiver - Revenue by PIHP by Age Group - TANF - Female
F
TANF
May, 2008
Capitation for Current Enrolled Population by Age Group
Provider ID
Billing
Agent
1
3396315
00GX
Macomb County CMH Services
F
TANF
$
3,485
$
-
$
-
$
-
$
-
$
-
$
3,485
2
1705289
0058
Oakland County CMH Authority
F
TANF
$
2,607
$
-
$
-
$
-
$
-
$
-
$
2,607
3
4390138
00HU
Southeast Partnership
F
TANF
$
-
$
-
$
2,720
$
-
$
-
$
-
$
2,720
4
3402136
00GR
Southwest Alliance
F
TANF
$
1,788
$
-
$
-
$
-
$
-
$
-
$
1,788
5
1708164
00HO
Thumb Mental Health Alliance
F
TANF
$
2,758
$
-
$
-
$
-
$
-
$
-
$
2,758
6
$
-
7
$
-
8
$
-
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
$
-
10
$
-
11
$
-
12
$
-
13
$
-
14
$
-
15
$
-
16
$
-
17
$
-
18
$
-
$
13,359
19
20
State Subtotals
$
10,638
$
-
$
2,720
$
-
$
Check Values
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW-TANF
-
$
-
-
Page 61 of 79
Habilitation Supports Waiver - Summary by PIHP
May, 2008
Provider ID
Billing
Agent
Affiliation DBA
1
1705322
00GE
Access Alliance of Michigan
$
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
3
4344340
00GG
CMH for Central Michigan
4
4483587
00GS
5
3119549
6
1705233
7
Retro Payments
FY 2007-2008
Retro Payments
FY 2006-2007
1,511,903
$
54,885
$
$
1,613,556
$
76,345
$
1,823,895
$
139,704
CMHSA Network of West Michigan
$
580,736
$
00GJ
Detroit Wayne County CMH Agency
$
5,362,752
0028
Genesee County CMH Services
$
1,299,481
1712452
00HA
Lakeshore Behavioral Health Alliance
$
8
1712229
00GV
Lifeways
9
3396315
00GX
Macomb County CMH Services
10
1724945
00HJ
11
4476125
12
4540048
13
1705289
0058
14
1712541
15
4390138
16
Current Payments
Total Payments
-
$
1,566,788
$
-
$
1,689,902
$
-
$
1,963,599
54,591
$
-
$
635,327
$
155,786
$
-
$
5,518,538
$
41,758
$
-
$
1,341,239
1,003,294
$
66,082
$
32,762
$
1,102,139
$
571,664
$
11,164
$
-
$
582,828
$
1,525,678
$
110,523
$
14,219
$
1,650,419
Northcare
$
1,754,602
$
52,738
$
-
$
1,807,339
00HF
Northern Affiliation
$
2,052,393
$
133,740
$
-
$
2,186,133
00HC
Northern Lakes
$
734,398
$
37,966
$
-
$
772,364
Oakland County CMH Authority
$
3,709,893
$
475,455
$
-
$
4,185,349
00HQ
Saginaw County CMH Authority
$
555,463
$
26,218
$
-
$
581,681
00HU
Southeast Partnership
$
2,513,678
$
174,625
$
-
$
2,688,303
3402136
00GR
Southwest Alliance
$
1,595,984
$
68,134
$
-
$
1,664,118
17
1708164
00HO
Thumb Mental Health Alliance
$
1,343,830
$
91,435
$
-
$
1,435,265
18
2920843
00HR
Venture Behavioral Health
$
1,291,126
$
116,027
$
-
$
1,407,153
19
$
-
20
$
-
State Subtotals $
Report Generated: 6/3/2008
4:35 PM
30,844,327
$
1,887,176
$
46,981
$
32,778,484
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW-SUMMARY
Page 62 of 79
HSW Net Summaries - To Date By Month by PIHP
May, 2008
HSW Net Enrollees and Net Payments As of 06/03/2008
October
November
December
January
Provider ID
Billing
Agent
Affiliation DBA
1
1705322
00GE
Access Alliance of Michigan
375 $
1,624,104
373 $
1,615,535
371 $
1,607,230
371 $
1,608,270
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
364 $
1,695,959
364 $
1,695,818
368 $
1,708,433
370 $
1,717,531
HSW Net Enrollees HSW Net Payments HSW Net Enrollees HSW Net Payments HSW Net Enrollees HSW Net Payments HSW Net Enrollees HSW Net Payments
3
4344340
00GG
CMH for Central Michigan
543 $
1,928,160
541 $
1,919,649
543 $
1,928,452
546 $
1,935,323
4
4483587
00GS
CMHSA Network of West Michigan
162 $
587,096
163 $
591,033
166 $
601,951
167 $
604,374
5
3119549
00GJ
Detroit Wayne County CMH Agency
1,153 $
5,626,896
1,149 $
5,616,261
1,117 $
5,459,424
1,156 $
5,648,123
6
1705233
0028
Genesee County CMH Services
370 $
1,337,181
368 $
1,326,521
368 $
1,328,726
370 $
1,335,191
7
1712452
00HA
Lakeshore Behavioral Health Alliance
225 $
1,019,535
224 $
1,014,978
223 $
1,010,421
224 $
1,016,119
8
1712229
00GV
Lifeways
268 $
601,422
264 $
593,470
265 $
592,161
268 $
601,297
9
3396315
00GX
Macomb County CMH Services
450 $
1,606,976
461 $
1,650,553
473 $
1,686,413
479 $
1,694,516
10
1724945
00HJ
Northcare
359 $
1,780,963
364 $
1,806,923
359 $
1,783,792
364 $
1,803,894
11
4476125
00HF
Northern Affiliation
428 $
2,204,785
427 $
2,197,768
428 $
2,204,370
430 $
2,212,950
12
4540048
00HC
Northern Lakes
173 $
769,362
172 $
765,956
173 $
769,875
177 $
786,173
13
1705289
0058
Oakland County CMH Authority
853 $
4,210,362
851 $
4,200,053
855 $
4,219,989
852 $
4,203,619
14
1712541
00HQ
Saginaw County CMH Authority
110 $
585,601
109 $
580,357
111 $
589,683
112 $
594,926
15
4390138
00HU
Southeast Partnership
698 $
2,721,451
701 $
2,729,909
696 $
2,707,022
706 $
2,743,298
16
3402136
00GR
Southwest Alliance
455 $
1,653,886
454 $
1,647,746
447 $
1,621,991
455 $
1,645,487
17
1708164
00HO
Thumb Mental Health Alliance
282 $
1,470,472
278 $
1,449,498
280 $
1,458,661
283 $
1,473,067
18
2920843
00HR
Venture Behavioral Health
308 $
1,329,084
306 $
1,320,375
307 $
1,324,738
312 $
1,351,385
7,576 $
32,753,296
7,569 $
32,722,402
7,550 $
32,603,331
7,642 $
32,975,544
State Subtotals
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW Net Enrollees & Payments
Page 63 of 79
HSW Net Summaries - To Date By Month by PIHP
May, 2008
HSW Net Enrollees and Net Payments As of 06/03/2008
February
March
April
May
Provider ID
Billing
Agent
Affiliation DBA
1
1705322
00GE
Access Alliance of Michigan
369 $
1,598,369
368 $
1,595,136
359 $
1,553,456
350 $
1,511,903
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
366 $
1,700,193
370 $
1,720,365
365 $
1,694,690
347 $
1,613,556
3
4344340
00GG
CMH for Central Michigan
547 $
1,935,500
544 $
1,925,596
541 $
1,915,395
515 $
1,823,895
4
4483587
00GS
CMHSA Network of West Michigan
167 $
604,374
169 $
610,734
168 $
608,014
160 $
580,736
5
3119549
00GJ
Detroit Wayne County CMH Agency
1,148 $
5,611,333
1,146 $
5,595,645
1,124 $
5,486,481
1,099 $
5,362,752
6
1705233
0028
Genesee County CMH Services
371 $
1,340,347
371 $
1,342,072
370 $
1,335,875
360 $
1,299,481
7
1712452
00HA
Lakeshore Behavioral Health Alliance
224 $
1,017,260
222 $
1,008,146
221 $
1,004,740
221 $
1,003,294
8
1712229
00GV
Lifeways
267 $
599,112
264 $
592,683
262 $
586,999
255 $
571,664
HSW Net Enrollees HSW Net Payments HSW Net Enrollees HSW Net Payments HSW Net Enrollees HSW Net Payments HSW Net Enrollees HSW Net Payments
9
3396315
00GX
Macomb County CMH Services
480 $
1,695,643
477 $
1,680,570
455 $
1,600,934
436 $
1,525,678
10
1724945
00HJ
Northcare
363 $
1,797,504
364 $
1,800,033
362 $
1,789,392
355 $
1,754,602
11
4476125
00HF
Northern Affiliation
427 $
2,197,676
426 $
2,192,720
422 $
2,170,911
400 $
2,052,393
12
4540048
00HC
Northern Lakes
177 $
786,544
176 $
781,616
176 $
782,625
166 $
734,398
13
1705289
0058
Oakland County CMH Authority
847 $
4,176,384
840 $
4,137,284
809 $
3,978,236
755 $
3,709,893
14
1712541
00HQ
Saginaw County CMH Authority
112 $
596,088
111 $
590,844
109 $
580,357
104 $
555,463
15
4390138
00HU
Southeast Partnership
697 $
2,711,895
696 $
2,704,367
673 $
2,612,429
648 $
2,513,678
16
3402136
00GR
Southwest Alliance
454 $
1,642,132
453 $
1,637,127
447 $
1,612,303
442 $
1,595,984
17
1708164
00HO
Thumb Mental Health Alliance
282 $
1,467,824
279 $
1,453,417
275 $
1,431,352
257 $
1,343,830
18
2920843
00HR
Venture Behavioral Health
311 $
1,345,625
311 $
1,345,266
310 $
1,344,339
299 $
1,291,126
7,609 $
32,823,802
7,587 $
32,713,620
7,448 $
32,088,528
7,169 $
30,844,327
State Subtotals
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW Net Enrollees & Payments
Page 64 of 79
HSW Net Summaries - To Date By Month by PIHP
May, 2008
HSW Net Enrollees and Net Payments As of 06/03/2008
June
Provider ID
Billing
Agent
Affiliation DBA
1
1705322
00GE
Access Alliance of Michigan
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
3
4344340
00GG
CMH for Central Michigan
4
4483587
00GS
CMHSA Network of West Michigan
5
3119549
00GJ
Detroit Wayne County CMH Agency
6
1705233
0028
Genesee County CMH Services
7
1712452
00HA
Lakeshore Behavioral Health Alliance
8
1712229
00GV
Lifeways
9
3396315
00GX
Macomb County CMH Services
1724945
00HJ
Northcare
11
4476125
00HF
Northern Affiliation
12
4540048
00HC
Northern Lakes
13
1705289
0058
Oakland County CMH Authority
14
1712541
00HQ
Saginaw County CMH Authority
15
4390138
00HU
Southeast Partnership
16
3402136
00GR
Southwest Alliance
17
1708164
00HO
Thumb Mental Health Alliance
18
2920843
00HR
Venture Behavioral Health
State Subtotals
4:35 PM
August
September
HSW Net Enrollees HSW Net Payments HSW Net Enrollees HSW Net Payments HSW Net Enrollees HSW Net Payments HSW Net Enrollees HSW Net Payments
10
Report Generated: 6/3/2008
July
0 $
-
0 $
-
0 $
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW Net Enrollees & Payments
-
0 $
-
Page 65 of 79
HSW Net Summaries - To Date By Month by PIHP
May, 2008
HSW Net Enrollees and Net Payments As of 06/03/2008
Year to Date
Provider ID
Billing
Agent
Affiliation DBA
1
1705322
00GE
Access Alliance of Michigan
2,936 $
12,714,003
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
2,914 $
13,546,546
3
4344340
00GG
CMH for Central Michigan
4,320 $
15,311,969
4
4483587
00GS
CMHSA Network of West Michigan
1,322 $
4,788,312
5
3119549
00GJ
Detroit Wayne County CMH Agency
9,092 $
44,406,916
6
1705233
0028
Genesee County CMH Services
2,948 $
10,645,392
7
1712452
00HA
Lakeshore Behavioral Health Alliance
1,784 $
8,094,494
8
1712229
00GV
Lifeways
2,113 $
4,738,807
HSW Net Enrollees HSW Net Payments
9
3396315
00GX
Macomb County CMH Services
3,711 $
13,141,284
10
1724945
00HJ
Northcare
2,890 $
14,317,102
11
4476125
00HF
Northern Affiliation
3,388 $
17,433,574
12
4540048
00HC
Northern Lakes
1,390 $
6,176,549
13
1705289
0058
Oakland County CMH Authority
6,662 $
32,835,819
14
1712541
00HQ
Saginaw County CMH Authority
878 $
4,673,320
15
4390138
00HU
Southeast Partnership
5,515 $
21,444,049
16
3402136
00GR
Southwest Alliance
3,607 $
13,056,656
17
1708164
00HO
Thumb Mental Health Alliance
2,216 $
11,548,120
18
2920843
00HR
Venture Behavioral Health
2,464 $
10,651,938
60,150 $
259,524,850
State Subtotals
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW Net Enrollees & Payments
Page 66 of 79
Affiliations
May, 2008
Provider
PIHP
Provider ID
PIHP
Billing
Agent ID
1
1705322
00GE
Access Alliance of Michigan
Bay-Arenac CMH
2
1705322
00GE
Access Alliance of Michigan
Bay-Arenac CMH
09
Bay
Bay-Arenac Behavioral Health
3
1705322
00GE
Access Alliance of Michigan
Huron Behavioral Health
32
Huron
Bay-Arenac Behavioral Health
4
1705322
00GE
Access Alliance of Michigan
Montcalm Center Behavl. Hlt
59
Montcalm
Bay-Arenac Behavioral Health
5
1705322
00GE
Access Alliance of Michigan
Shiawassee County CMH
78
Shiawassee
Bay-Arenac Behavioral Health
6
1705322
00GE
Access Alliance of Michigan
Tuscola County CMH
79
Tuscola
Bay-Arenac Behavioral Health
7
1708001
00BJ
CMH Affiliation of Mid-Michigan
CEI CMH
19
Clinton
Mid-South CA
8
1708001
00BJ
CMH Affiliation of Mid-Michigan
CEI CMH
23
Eaton
Mid-South CA
9
1708001
00BJ
CMH Affiliation of Mid-Michigan
CEI CMH
33
Ingham
Mid-South CA
10
1708001
00BJ
CMH Affiliation of Mid-Michigan
Gratiot County CMH
29
Gratiot
Mid-South CA
11
1708001
00BJ
CMH Affiliation of Mid-Michigan
Ionia County CMH
34
Ionia
Mink Substance Abuse Coordinating Agency
12
1708001
00BJ
CMH Affiliation of Mid-Michigan
Manistee-Benzie CMH
10
Benzie
Northern Michigan CA
13
1708001
00BJ
CMH Affiliation of Mid-Michigan
Manistee-Benzie CMH
51
Manistee
Northern Michigan CA
14
1708001
00BJ
CMH Affiliation of Mid-Michigan
Newaygo County CMH
62
Newaygo
Mink Substance Abuse Coordinating Agency
15
4344340
00GG
CMH for Central Michigan
Central Michigan CMH
18
Clare
Northern Michigan CA
16
4344340
00GG
CMH for Central Michigan
Central Michigan CMH
26
Gladwin
Northern Michigan CA
17
4344340
00GG
CMH for Central Michigan
Central Michigan CMH
37
Isabella
Northern Michigan CA
18
4344340
00GG
CMH for Central Michigan
Central Michigan CMH
54
Mecosta
Northern Michigan CA
19
4344340
00GG
CMH for Central Michigan
Central Michigan CMH
56
Midland
Northern Michigan CA
20
4344340
00GG
CMH for Central Michigan
Central Michigan CMH
67
Osceola
Northern Michigan CA
21
4390138
00HU
CMH Partnership of Southeast Michigan
Lenawee County CMH
46
Lenawee
Mid-South CA
22
4390138
00HU
CMH Partnership of Southeast Michigan
Livingston County CMH
47
Livingston
Washtenaw County CMH
23
4390138
00HU
CMH Partnership of Southeast Michigan
Monroe County CMH
58
Monroe
Southeast MI Community Alliance
24
4390138
00HU
CMH Partnership of Southeast Michigan
Washtenaw County CMH
81
Washtenaw
Washtenaw County CMH
25
4483587
00GS
CMHSA Network of West Michigan
Kent County CMH
41
Kent
Mink Substance Abuse Coordinating Agency
26
3119549
00GJ
Detroit Wayne County CMH Agency
Detroit-Wayne County CMH
82
Wayne
Detroit Health Department
27
3119549
00GJ
Detroit Wayne County CMH Agency
Detroit-Wayne County CMH
82
Wayne
Southeast Michigan Community Alliance
28
1705233
0028
Genesee County CMH Services
Genesee County Health Dept
25
Genesee
Genesee County Health Dept
29
3402136
00GR
Kalamazoo PHP Affiliation
Allegan County CMH
03
Allegan
Lakeshore CA
Affiliation DBA
Report Generated: 6/3/2008
4:35 PM
CMH Name
County
Code
06
County Name
Arenac
CA Name
Bay-Arenac Behavioral Health
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
Affiliations
Page 67 of 79
Affiliations
May, 2008
Provider
PIHP
Provider ID
PIHP
Billing
Agent ID
30
3402136
00GR
Kalamazoo PHP Affiliation
Kalamazoo County CMH
39
Kalamazoo
Kalamazoo County CMH
31
3402136
00GR
Kalamazoo PHP Affiliation
St. Joseph County CMH
75
St. Joseph
Kalamazoo County CMH
32
3402136
00GR
Kalamazoo PHP Affiliation
Woodlands Behavioral Healthcare
14
Cass
Lakeshore CA
33
1712452
00HA
Lakeshore Behavioral Health Alliance
Muskegon County CMH
61
Muskegon
Lakeshore CA
34
1712452
00HA
Lakeshore Behavioral Health Alliance
Ottawa County CMH
70
Ottawa
Lakeshore CA
35
1712229
00GV
Lifeways
Lifeways CMH
30
Hillsdale
Mid-South CA
36
1712229
00GV
Lifeways
Lifeways CMH
38
Jackson
Mid-South CA
37
3396315
00GX
Macomb County CMH Services
Macomb County CA
50
Macomb
Macomb County CA
38
1724945
00HJ
Northcare
Copper County CMH
07
Baraga
Western U.P. SAS
39
1724945
00HJ
Northcare
Copper County CMH
31
Houghton
Western U.P. SAS
40
1724945
00HJ
Northcare
Copper County CMH
42
Keweenaw
Western U.P. SAS
41
1724945
00HJ
Northcare
Copper County CMH
66
Ontonagon
Western U.P. SAS
42
1724945
00HJ
Northcare
Gogebic County CMH
27
Gogebic
Western U.P. SAS
43
1724945
00HJ
Northcare
Hiawatha Behavioral Health Authority
17
Chippewa
Pathways CA
44
1724945
00HJ
Northcare
Hiawatha Behavioral Health Authority
49
Mackinac
Pathways CA
45
1724945
00HJ
Northcare
Hiawatha Behavioral Health Authority
77
Schoolcraft
Pathways CA
46
1724945
00HJ
Northcare
Northpointe CMH
22
Dickinson
Western U.P. SAS
47
1724945
00HJ
Northcare
Northpointe CMH
36
Iron
Western U.P. SAS
48
1724945
00HJ
Northcare
Northpointe CMH
55
Menominee
Pathways CA
49
1724945
00HJ
Northcare
Pathways CMH
02
Alger
Pathways CA
50
1724945
00HJ
Northcare
Pathways CMH
21
Delta
Pathways CA
51
1724945
00HJ
Northcare
Pathways CMH
48
Luce
Pathways CA
52
1724945
00HJ
Northcare
Pathways CMH
52
Marquette
Pathways CA
53
4476125
00HF
Northern Affiliation
AuSable Valley CMH
35
Iosco
Northern Michigan CA
54
4476125
00HF
Northern Affiliation
AuSable Valley CMH
65
Ogemaw
Northern Michigan CA
55
4476125
00HF
Northern Affiliation
AuSable Valley CMH
68
Oscoda
Northern Michigan CA
56
4476125
00HF
Northern Affiliation
North Country CMHA
05
Antrim
Northern Michigan CA
57
4476125
00HF
Northern Affiliation
North Country CMHA
15
Charlevoix
Northern Michigan CA
58
4476125
00HF
Northern Affiliation
North Country CMHA
16
Cheboygan
Northern Michigan CA
Affiliation DBA
Report Generated: 6/3/2008
4:35 PM
CMH Name
County
Code
County Name
CA Name
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
Affiliations
Page 68 of 79
Affiliations
May, 2008
Provider
PIHP
Provider ID
PIHP
Billing
Agent ID
59
4476125
00HF
Northern Affiliation
North Country CMHA
24
Emmet
Northern Michigan CA
60
4476125
00HF
Northern Affiliation
North Country CMHA
40
Kalkaska
Northern Michigan CA
61
4476125
00HF
Northern Affiliation
North Country CMHA
69
Otsego
Northern Michigan CA
62
4476125
00HF
Northern Affiliation
Northeast Michigan CMH
01
Alcona
Northern Michigan CA
63
4476125
00HF
Northern Affiliation
Northeast Michigan CMH
04
Alpena
Northern Michigan CA
64
4476125
00HF
Northern Affiliation
Northeast Michigan CMH
60
Montmorency
Northern Michigan CA
65
4476125
00HF
Northern Affiliation
Northeast Michigan CMH
71
Presque Isle
Northern Michigan CA
66
4540048
00HC
Northwest CMH Affiliation
Northern Lakes CMH
20
Crawford
Northern Michigan CA
67
4540048
00HC
Northwest CMH Affiliation
Northern Lakes CMH
28
Grand Traverse
Northern Michigan CA
68
4540048
00HC
Northwest CMH Affiliation
Northern Lakes CMH
45
Leelanau
Northern Michigan CA
69
4540048
00HC
Northwest CMH Affiliation
Northern Lakes CMH
57
Missaukee
Northern Michigan CA
70
4540048
00HC
Northwest CMH Affiliation
Northern Lakes CMH
72
Roscommon
Northern Michigan CA
71
4540048
00HC
Northwest CMH Affiliation
Northern Lakes CMH
83
Wexford
Northern Michigan CA
72
4540048
00HC
Northwest CMH Affiliation
West Michigan CMH
43
Lake
Northern Michigan CA
73
4540048
00HC
Northwest CMH Affiliation
West Michigan CMH
53
Mason
Northern Michigan CA
74
4540048
00HC
Northwest CMH Affiliation
West Michigan CMH
64
Oceana
Northern Michigan CA
75
1705289
0058
Oakland County CMH Authority
Oakland County CMHA
63
Oakland
Oakland County Health Div
76
1712541
00HQ
Saginaw County CMH Authority
Saginaw County CMH
73
Saginaw
Saginaw County Health Dept
77
1708164
00HO
Thumb Mental Health Alliance
Lapeer County CMH
44
Lapeer
St. Clair County Health Dept. CA
78
1708164
00HO
Thumb Mental Health Alliance
Sanilac County CMH
76
Sanilac
St. Clair County Health Dept. CA
79
1708164
00HO
Thumb Mental Health Alliance
St. Clair County CMH
74
St. Clair
St. Clair County Health Dept. CA
80
2920843
00HR
Venture Behavioral Health
Barry County CMH
08
Barry
Kalamazoo County CMH
81
2920843
00HR
Venture Behavioral Health
Berrien Mental Health
11
Berrien
Lakeshore CA
82
2920843
00HR
Venture Behavioral Health
Pines Behavioral Health CMH
12
Branch
Kalamazoo County CMH
83
2920843
00HR
Venture Behavioral Health
Summit Pointe CMH
13
Calhoun
Mid-South CA
84
2920843
00HR
Venture Behavioral Health
Van Buren County CMH
80
Van Buren
Kalamazoo County CMH
Affiliation DBA
Report Generated: 6/3/2008
4:35 PM
CMH Name
County
Code
County Name
CA Name
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
Affiliations
Page 69 of 79
Capitation Statewide Base Rates
May, 2008
To avoid problems with transmitting data in HIPAA compliant formats, all capitation rates are set to a minimum of $0.01.
Mental Health
Program
Code Group
Fund Source
Report Generated: 6/3/2008
Base Rate X AgeSex Factor X Geographic Factor = Capitation Rate
Date Effective
4:35 PM
Date Ended
MH Base Rate
Current
Value
Comments
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
Cap Base Rates
Page 70 of 79
Capitation Statewide Base Rates
May, 2008
To avoid problems with transmitting data in HIPAA compliant formats, all capitation rates are set to a minimum of $0.01.
Substance Abuse
Program
Code Group
Fund Source
DAB
1915(b)(3)
DAB
State Plan
TANF
1915(b)(3)
TANF
State Plan
Report Generated: 6/3/2008
Base Rate X AgeSex Factor X Geographic Factor = Capitation Rate
Date Effective
4:35 PM
Date Ended
SA Base Rate
Current
Value
Comments
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
Cap Base Rates
Page 71 of 79
Mental Health Age-Sex Factors (Apply to State Plan and 1915(b)(3) and Habilitation Supports Waiver)
Base Rate X AgeSex Factor X Geographic Factor = Capitation Rate
May, 2008
Program
Gender
Code Group
Age
Report Generated: 6/3/2008
Date Effective
4:35 PM
Date Ended
MH Age Sex
Factor
Current
Value
Comments
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
AgeSex Factors MH
Page 72 of 79
Substance Abuse Age-Sex Factors (Apply to State Plan and 1915(b)(3))
Base Rate X AgeSex Factor X Geographic Factor = Capitation Rate
May, 2008
Program
Gender
Code Group
AGE
Report Generated: 6/3/2008
Date Effective
4:35 PM
Date Ended
SA Age Sex
Factor
Current
Value
Comments
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
AgeSex Factors SA
Page 73 of 79
Mental Health Geographic Factors (Apply to State Plan and 1915(b)(3))
Base Rate X AgeSex Factor X Geographic Factor = Capitation Rate
May, 2008
Provider ID
Billing
Agent ID
Report Generated: 6/3/2008
Provider Name
4:35 PM
Program
Code Group
Effective
Payment
Month
Date Effective
Date Ended
MH
Geographic
Factor
Current
Value
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
Geographic Factors MH
Comments
Page 74 of 79
Mental Health Geographic Factors (Apply to State Plan and 1915(b)(3))
Base Rate X AgeSex Factor X Geographic Factor = Capitation Rate
May, 2008
Provider ID
Billing
Agent ID
Report Generated: 6/3/2008
Provider Name
4:35 PM
Program
Code Group
Effective
Payment
Month
Date Effective
Date Ended
MH
Geographic
Factor
Current
Value
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
Geographic Factors MH
Comments
Page 75 of 79
Substance Abuse Geographic Factors (Apply to State Plan and 1915(b)(3))
Base Rate X AgeSex Factor X Geographic Factor = Capitation Rate
May, 2008
Provider ID
Billing
Agent ID
Report Generated: 6/3/2008
Provider Name
4:35 PM
Program
Code Group
Effective
Payment
Month
Date Effective
Date Ended
SA Geographic
Factor
Current
Value
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
Geographic Factors SA
Comments
Page 76 of 79
Substance Abuse Geographic Factors (Apply to State Plan and 1915(b)(3))
Base Rate X AgeSex Factor X Geographic Factor = Capitation Rate
May, 2008
Provider ID
Billing
Agent ID
Report Generated: 6/3/2008
Provider Name
4:35 PM
Program
Code Group
Effective
Payment
Month
Date Effective
Date Ended
SA Geographic
Factor
Current
Value
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
Geographic Factors SA
Comments
Page 77 of 79
MA - Population by Age - Do Not Print
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
NP - Age Profile Data
Page 78 of 79
HSW - Population by Age - Do Not Print
Report Generated: 6/3/2008
4:35 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
NP - HSW Age Profile Data
Page 79 of 79