AMOUNT OF FUNDING PAID TO PIHPs July 10, 2008

AMOUNT OF FUNDING PAID TO PIHPs
(FY2008 Appropriation Bill - Public Act 123 of 2007)
July 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.
July, 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: 8/29/2008
12:08 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: 8/29/2008
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
12:08 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
July, 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
$
53,411,304.35 $
3,614,066.04
$
5,567,088.96
$
11,571,297.81
$
13,182,222.25
$
15,536,188.03
$
3,940,441.26
TANF
$
9,048,904.81 $
5,864,994.86
$
918,882.40
$
1,494,121.20
$
642,623.71
$
128,281.91
$
0.73
DAB
$
45,335,296.49 $
3,067,530.76
$
4,725,327.09
$
9,821,578.46
$
11,188,947.41
$
13,187,146.19
$
3,344,766.58
TANF
$
1,408,156.66 $
912,534.40
$
142,944.30
$
232,672.33
$
100,018.55
$
19,986.36
$
0.72
DAB
$
98,746,600.84 $
6,681,596.80
$
10,292,416.05
$
21,392,876.27
$
24,371,169.66
$
28,723,334.22
$
7,285,207.84
TANF
$
10,457,061.47 $
6,777,529.26
$
1,061,826.70
$
1,726,793.53
$
742,642.26
$
148,268.27
$
1.45
$
109,203,662.31 $
13,459,126.06
$
11,354,242.75
$
23,119,669.80
$
25,113,811.92
$
28,871,602.49
$
7,285,209.29
Total MH Capitation (State Plan and 1915(b)(3))
8
Mental Health - HabSupports Waiver Current Payment
$
30,761,163.30 $
225,014.82
$
1,437,694.46
$
6,691,009.45
$
8,387,345.15
$
10,889,272.74
$
3,130,826.68
8a
Mental Health - HabSupports Waiver - Retro Payments FY 2007-2008
$
1,715,874.80 $
62,630.58
$
3,164.13
$
65,512.11
$
336,742.62
$
1,031,958.20
$
215,867.16
8b
Mental Health - HabSupports Waiver - Retro Payments FY 2006-2007
$
4,289.76 $
$
4,289.76
8c
Mental Health - HabSupports Waiver Total Payments Paid
$
32,481,327.86 $
287,645.40
$
1,440,858.59
$
6,756,521.56
$
8,724,087.77
$
11,921,230.94
$
3,350,983.60
$
141,684,990.17 $
13,746,771.46
$
12,795,101.34
$
29,876,191.36
$
33,837,899.69
$
40,792,833.43
$
10,636,192.89
DAB
$
1,275,184.35 $
60,875.84
$
141,499.47
$
226,930.96
$
394,174.88
$
433,267.46
$
18,435.74
TANF
$
883,704.46 $
166,506.32
$
159,323.62
$
353,381.12
$
166,554.18
$
37,938.50
$
0.72
DAB
$
511,708.14 $
24,327.97
$
56,727.30
$
91,031.51
$
158,184.26
$
173,924.18
$
7,512.92
TANF
$
397,453.71 $
75,199.87
$
71,658.66
$
158,697.76
$
74,846.61
$
17,050.09
$
0.72
DAB
$
1,786,892.49 $
85,203.81
$
198,226.77
$
317,962.47
$
552,359.14
$
607,191.64
$
25,948.66
TANF
$
1,281,158.17 $
241,706.19
$
230,982.28
$
512,078.88
$
241,400.79
$
54,988.59
$
1.44
3,068,050.66 $
326,910.00
$
429,209.05
$
830,041.35
$
793,759.93
$
662,180.23
$
25,950.10
14,073,681.46
$
13,224,310.39
$
30,706,232.71
$
34,631,659.62
$
41,455,013.66
$
10,662,142.99
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: 8/29/2008
12:08 PM
144,753,040.83
$
-
$
-
$
-
$
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
Summary
-
$
-
Page 4 of 79
Medicaid Capitation Summary
July, 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+
40,249
24,465
23,995
25,735
37,447
26,046
Female
224,648
28,107
20,720
24,635
30,037
54,019
67,130
402,585
68,356
45,185
48,630
55,772
91,466
93,176
Male
416,487
362,319
22,126
19,281
9,476
3,242
43
Female
555,890
356,073
75,276
92,955
26,076
5,481
29
972,377
718,392
97,402
112,236
35,552
8,723
72
1,374,962
786,748
142,587
160,866
91,324
100,189
93,248
Male
4,183
64
265
979
1,143
1,362
370
Female
2,963
29
132
622
763
1,086
331
7,146
93
397
1,601
1,906
2,448
701
Male
200
15
7
8
33
112
25
Female
177
11
(3)
2
39
107
21
377
26
4
10
72
219
46
-
-
-
-
-
-
-
-
-
-
-
-
1
Male
Female
32
18 - 25
177,937
Total TANF Population
24
0 - 17
Male
Total DAB Population
TANF Population
Total Population
1
1
7,524
-
-
119
401
-
-
-
1,611
1,978
2,667
1
748
* SP & B3 Population figures do not include Retroactive Eligibles
Report Generated: 8/29/2008
12:08 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*
July, 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
08/29/2008
$
1,624,104
Subtotal
$
5,924,889
MH(SP)&(b3)
SA(SP)&(b3)
$
$
102,960
4,194,932
December
HSW As of
08/29/2008
$
1,615,535
Subtotal
$
5,913,427
MH(SP)&(b3)
SA(SP)&(b3)
$
$
104,400
4,225,022
HSW As of
08/29/2008
$
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
$
1,929,948
$
4,799,616
$
2,806,615
$
60,591
$
1,921,438
$
4,788,644
$
2,832,756
$
61,335
$
1,930,240
$
4,824,331
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
$
5,633,204
$ 31,273,315
$ 24,583,615
$
935,142
$
5,625,974
$ 31,144,732
$ 24,671,724
$
941,129
$
5,628,343
$ 31,241,196
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
$
1,014,978
$
5,043,306
8
1712229
00GV
Lifeways
$
2,077,111
$
60,823
$
599,150
$
2,737,084
$
2,060,150
$
59,439
$
593,470
$
2,713,059
$
2,079,802
$
60,477
$
594,619
$
2,734,899
9
3396315
00GX
Macomb County CMH Services
$
8,933,203
$
220,520
$
1,610,289
$ 10,764,012
$
8,962,414
$
220,971
$
1,662,034
$ 10,845,418
$
9,024,883
$
223,517
$
1,709,340
$ 10,957,740
10
1724945
00HJ
Northcare
$
4,540,143
$
69,713
$
1,786,491
$
$
4,552,243
$
69,584
$
1,812,450
$
$
4,577,460
$
70,373
$
1,799,541
$
6,396,347
6,434,277
6,447,374
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
$
778,989
$
3,731,633
13
1705289
0058
Oakland County CMH Authority
$ 12,534,592
$
198,640
$
4,221,516
$ 12,520,102
$
198,162
$
4,216,164
$ 16,934,427
$ 12,553,837
$
200,239
$
4,242,298
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
$
2,726,001
$
7,687,385
$
4,849,509
$
110,367
$
2,738,099
$
7,697,976
$
4,913,707
$
112,713
$
2,715,212
$
7,741,632
$ 16,954,748
$ 16,996,373
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
$
1,624,532
$
6,541,428
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
$
1,462,580
$
5,483,871
18
2920843
00HR
Venture Behavioral Health
$
4,485,605
$
124,988
$
1,329,084
$
5,939,676
$
4,461,192
$
123,731
$
1,329,423
$
5,914,346
$
4,495,621
$
125,600
$
1,339,469
$
5,960,690
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: 8/29/2008
12:08 PM
$ 109,950,612
$ 32,783,664
$ 142,734,276
$ 32,784,261
$ 142,561,565
$ 109,777,304
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
YTD-Summary
$ 32,880,534
$ 143,320,731
$ 110,440,197
Page 6 of 79
Capitation Summaries - Paid To Date By Month by PIHP*
July, 2008
Revenue - Mental Health - State Plan, 1915(b)(3) & HSW
January
February
HSW As of
08/29/2008
HSW As of
08/29/2008
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
$
1,701,621
$
7,681,724
$
3
4344340
00GG
CMH for Central Michigan
$
2,839,329
$
61,934
$
1,932,782
$
4,834,045
$
4
4483587
00GS
CMHSA Network of West Michigan
$
6,054,644
$
159,528
$
598,014
$
6,812,186
$
6,014,898
5
3119549
00GJ
Detroit Wayne County CMH Agency
$ 24,698,422
$
944,024
$
5,624,156
$ 31,266,602
$ 24,595,544
$
940,508
$
5,592,569
$ 31,128,621
$ 24,588,363
$
943,228
$
5,571,307
$ 31,102,897
6
1705233
0028
Genesee County CMH Services
$
5,849,222
$
256,709
$
1,330,153
$
7,436,083
$
5,824,314
$
254,525
$
1,320,960
$
7,399,799
$
5,854,313
$
256,818
$
1,338,432
$
7,449,563
7
1712452
00HA
Lakeshore Behavioral Health Alliance
$
3,928,491
$
106,737
$
1,001,318
$
5,036,547
$
3,916,897
$
106,171
$
997,902
$
5,020,970
$
3,939,842
$
107,840
$
997,902
$
5,045,584
8
1712229
00GV
Lifeways
$
2,084,764
$
61,232
$
592,594
$
2,738,590
$
2,075,749
$
60,986
$
590,026
$
2,726,761
$
2,089,576
$
61,105
$
584,165
$
2,734,846
4,246,960
HSW As of
08/29/2008
March
$
1,605,002
Subtotal
$
5,957,232
Subtotal
SA(SP)&(b3)
$
$
106,329
5,849,327
$
112,762
$
1,712,408
$
7,674,498
2,846,896
$
62,293
$
1,931,537
$
4,840,726
$
160,665
$
600,735
$
6,828,620
SA(SP)&(b3)
$
$
105,100
5,841,129
$
111,835
$
1,696,793
$
7,649,756
$
2,829,384
$
61,579
$
1,934,649
$
4,825,612
$
$
158,311
$
597,095
$
6,770,304
$
6,067,220
4,229,635
$
1,604,793
$
5,939,528
Subtotal
MH(SP)&(b3)
MH(SP)&(b3)
4,247,570
$
1,604,117
$
5,958,016
9
3396315
00GX
Macomb County CMH Services
$
9,067,514
$
225,629
$
1,731,399
$ 11,024,542
$
9,073,548
$
226,144
$
1,721,941
$ 11,021,633
$
9,136,574
$
229,429
$
1,733,282
$ 11,099,285
10
1724945
00HJ
Northcare
$
4,597,707
$
71,187
$
1,803,894
$
6,472,788
$
4,580,291
$
70,931
$
1,792,393
$
$
4,609,146
$
71,689
$
1,795,782
$
6,476,618
11
4476125
00HF
Northern Affiliation
$
2,391,050
$
75,786
$
2,194,337
$
4,661,173
$
2,385,561
$
75,811
$
2,187,658
$
4,649,031
$
2,393,928
$
76,639
$
2,193,982
$
4,664,549
12
4540048
00HC
Northern Lakes
$
2,899,843
$
66,547
$
787,323
$
3,753,713
$
2,903,635
$
67,017
$
804,771
$
3,775,424
$
2,924,594
$
67,879
$
804,399
$
3,796,872
13
1705289
0058
Oakland County CMH Authority
$ 12,590,001
$
202,467
$
4,226,031
$ 12,528,887
$
201,411
$
4,243,395
$ 12,600,387
$
203,670
$
4,206,711
14
1712541
00HQ
Saginaw County CMH Authority
$
2,453,067
$
100,406
$
589,683
$
3,143,156
$
2,442,936
$
99,770
$
590,844
$
3,133,550
$
2,454,221
$
100,489
$
596,088
$
3,150,799
15
4390138
00HU
Southeast Partnership
$
4,934,091
$
113,583
$
2,713,575
$
7,761,249
$
4,912,974
$
112,942
$
2,690,848
$
7,716,764
$
4,952,048
$
114,556
$
2,709,289
$
7,775,893
16
3402136
00GR
Southwest Alliance
$
4,805,216
$
134,194
$
1,631,708
$
6,571,117
$
4,777,672
$
133,203
$
1,631,457
$
6,542,332
$
4,793,319
$
134,803
$
1,614,767
$
6,542,888
17
1708164
00HO
Thumb Mental Health Alliance
$
3,965,313
$
72,547
$
1,492,717
$
5,530,578
$
3,948,392
$
72,579
$
1,500,556
$
5,521,528
$
3,962,695
$
73,424
$
1,495,313
$
5,531,433
18
2920843
00HR
Venture Behavioral Health
$
4,505,064
$
126,413
$
1,342,402
$
5,973,880
$
4,479,164
$
125,072
$
1,339,746
$
5,943,982
$
4,482,282
$
126,532
$
1,340,644
$
5,949,458
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: 8/29/2008
12:08 PM
$ 110,774,995
$ 32,898,709
$ 17,018,499
$ 143,673,703
$ 32,838,397
6,443,615
$ 16,973,693
$ 143,182,903
$ 110,344,506
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
YTD-Summary
$ 32,830,859
$ 17,010,768
$ 143,633,312
$ 110,802,452
Page 7 of 79
Capitation Summaries - Paid To Date By Month by PIHP*
July, 2008
Revenue - Mental Health - State Plan, 1915(b)(3) & HSW
April
May
HSW As of
08/29/2008
HSW As of
08/29/2008
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
$
113,925
$
1,737,813
$
7,730,669
$
3
4344340
00GG
CMH for Central Michigan
$
2,848,867
$
62,581
$
1,938,429
$
4,849,877
$
4
4483587
00GS
CMHSA Network of West Michigan
$
6,110,351
$
162,499
$
611,653
$
6,884,503
$
6,071,786
5
3119549
00GJ
Detroit Wayne County CMH Agency
$ 24,594,727
$
944,961
$
5,600,708
$ 31,140,397
$ 24,491,545
$
940,324
$
5,578,211
$ 31,010,079
$ 24,621,688
$
947,458
$
5,551,796
$ 31,120,942
6
1705233
0028
Genesee County CMH Services
$
5,883,719
$
259,190
$
1,350,432
$
7,493,342
$
5,879,018
$
258,409
$
1,357,711
$
7,495,138
$
5,919,961
$
261,272
$
1,338,831
$
7,520,065
7
1712452
00HA
Lakeshore Behavioral Health Alliance
$
3,972,722
$
109,134
$
1,027,896
$
5,109,751
$
3,965,420
$
108,349
$
1,026,449
$
5,100,219
$
3,968,870
$
108,964
$
1,028,846
$
5,106,681
8
1712229
00GV
Lifeways
$
2,094,028
$
61,601
$
588,119
$
2,743,747
$
2,095,524
$
61,146
$
585,846
$
2,742,517
$
2,109,164
$
61,493
$
583,383
$
2,754,040
4,258,870
HSW As of
08/29/2008
June
$
1,593,376
Subtotal
$
5,959,565
Subtotal
SA(SP)&(b3)
$
$
107,299
5,887,478
$
113,848
$
1,733,619
$
7,734,946
2,861,755
$
62,543
$
1,911,420
$
4,835,717
$
162,907
$
613,491
$
6,898,807
SA(SP)&(b3)
$
$
107,074
5,871,424
$
113,307
$
1,738,176
$
7,722,908
$
2,849,350
$
62,324
$
1,935,254
$
4,846,928
$
$
161,233
$
608,933
$
6,841,951
$
6,122,410
4,263,595
$
1,584,566
$
5,955,235
Subtotal
MH(SP)&(b3)
MH(SP)&(b3)
4,285,307
$
1,571,188
$
5,963,793
9
3396315
00GX
Macomb County CMH Services
$
9,199,435
$
232,323
$
1,742,155
$ 11,173,912
$
9,245,784
$
232,538
$
1,728,095
$ 11,206,418
$
9,279,542
$
234,905
$
1,725,915
$ 11,240,362
10
1724945
00HJ
Northcare
$
4,603,626
$
71,789
$
1,802,449
$
6,477,864
$
4,610,967
$
71,847
$
1,804,713
$
$
4,607,132
$
71,908
$
1,803,581
$
6,482,621
11
4476125
00HF
Northern Affiliation
$
2,408,530
$
77,311
$
2,225,084
$
4,710,926
$
2,411,361
$
77,378
$
2,213,930
$
4,702,669
$
2,425,143
$
77,827
$
2,195,552
$
4,698,522
12
4540048
00HC
Northern Lakes
$
2,931,468
$
68,124
$
809,965
$
3,809,558
$
2,945,149
$
68,092
$
800,076
$
3,813,317
$
2,951,831
$
68,935
$
790,963
$
3,811,729
13
1705289
0058
Oakland County CMH Authority
$ 12,679,896
$
205,436
$
4,245,989
$ 12,672,213
$
205,133
$
4,229,000
$ 12,748,542
$
207,286
$
4,193,765
14
1712541
00HQ
Saginaw County CMH Authority
$
2,466,629
$
100,835
$
599,320
$
3,166,784
$
2,478,847
$
101,249
$
599,320
$
3,179,416
$
2,490,822
$
101,934
$
608,182
$
3,200,938
15
4390138
00HU
Southeast Partnership
$
4,986,454
$
115,874
$
2,748,556
$
7,850,884
$
4,968,457
$
115,224
$
2,730,362
$
7,814,042
$
5,013,219
$
116,682
$
2,728,633
$
7,858,534
16
3402136
00GR
Southwest Alliance
$
4,808,275
$
135,605
$
1,655,604
$
6,599,484
$
4,793,306
$
134,774
$
1,653,446
$
6,581,526
$
4,822,114
$
135,892
$
1,639,782
$
6,597,788
17
1708164
00HO
Thumb Mental Health Alliance
$
3,988,444
$
74,391
$
1,488,978
$
5,551,814
$
4,002,058
$
74,788
$
1,490,583
$
5,567,429
$
4,026,782
$
75,036
$
1,491,744
$
5,593,563
18
2920843
00HR
Venture Behavioral Health
$
4,505,226
$
127,870
$
1,352,264
$
5,985,359
$
4,490,267
$
126,756
$
1,355,355
$
5,972,378
$
4,512,806
$
127,867
$
1,345,825
$
5,986,498
State Subtotals $ 108,220,199
$
3,030,768
$ 108,106,073
$
3,019,947
$ 108,654,567
$
3,044,056
*HSW Payments are reflected by service month. The amounts will
be updated as retro/recovery payments occur for each service
month.
Report Generated: 8/29/2008
12:08 PM
$ 111,250,967
$ 33,118,790
$ 17,131,322
$ 144,369,757
$ 33,020,026
6,487,527
$ 17,106,347
$ 144,146,045
$ 111,126,019
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
YTD-Summary
$ 32,856,516
$ 17,149,593
$ 144,555,139
$ 111,698,623
Page 8 of 79
Capitation Summaries - Paid To Date By Month by PIHP*
July, 2008
Revenue - Mental Health - State Plan, 1915(b)(3) & HSW
July
Provider ID
Billing
Agent
Affiliation DBA
MH(SP)&(b3)
SA(SP)&(b3)
1
1705322
00GE
Access Alliance of Michigan
$
$
108,317
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
$
5,907,635
$
3
4344340
00GG
CMH for Central Michigan
$
2,867,820
$
4
4483587
00GS
CMHSA Network of West Michigan
$
6,161,463
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
$
4,300,712
August
HSW As of
08/29/2008
Subtotal
HSW As of
08/29/2008
SA(SP)&(b3)
5,959,454
Subtotal
$
MH(SP)&(b3)
HSW As of
08/29/2008
SA(SP)&(b3)
-
Subtotal
$
1,550,425
114,385
$
1,705,417
$
7,727,437
$
-
$
-
62,795
$
1,895,833
$
4,826,449
$
-
$
-
$
164,734
$
606,212
$
6,932,409
$
-
$
-
$ 24,721,952
$
953,342
$
5,513,998
$ 31,189,293
$
-
$
-
$
$
263,219
$
1,342,471
$
7,553,848
$
-
$
-
3,986,715
$
109,912
$
1,019,733
$
5,116,360
$
-
$
-
2,123,658
$
62,363
$
576,459
$
2,762,480
$
-
$
-
5,948,158
$
MH(SP)&(b3)
September
$
-
9
3396315
00GX
Macomb County CMH Services
$
9,335,528
$
237,908
$
1,646,699
$ 11,220,135
$
-
$
-
10
1724945
00HJ
Northcare
$
4,637,889
$
71,882
$
1,797,191
$
6,506,961
$
-
$
-
11
4476125
00HF
Northern Affiliation
$
2,428,212
$
78,077
$
2,155,298
$
4,661,586
$
-
$
-
12
4540048
00HC
Northern Lakes
$
2,961,060
$
68,925
$
781,849
$
3,811,834
$
-
$
-
13
1705289
0058
Oakland County CMH Authority
$ 12,809,945
$
209,335
$
4,047,376
$ 17,066,656
$
-
$
-
14
1712541
00HQ
Saginaw County CMH Authority
$
2,504,841
$
103,340
$
597,695
$
3,205,876
$
-
$
-
15
4390138
00HU
Southeast Partnership
$
5,035,246
$
117,279
$
2,638,164
$
7,790,688
$
-
$
-
16
3402136
00GR
Southwest Alliance
$
4,867,543
$
137,406
$
1,626,201
$
6,631,150
$
-
$
-
17
1708164
00HO
Thumb Mental Health Alliance
$
4,071,996
$
75,918
$
1,491,638
$
5,639,553
$
-
$
-
18
2920843
00HR
Venture Behavioral Health
$
4,533,288
$
128,914
$
1,322,450
$
5,984,653
$
-
$
-
State Subtotals $ 109,203,662
$
3,068,051
$
-
$
-
*HSW Payments are reflected by service month. The amounts will
be updated as retro/recovery payments occur for each service
month.
Report Generated: 8/29/2008
12:08 PM
$ 112,271,713
$ 32,315,109
$ 144,586,822
$
-
$
-
$
-
$
-
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*
July, 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
$
3
4344340
00GG
CMH for Central Michigan
$
4
4483587
00GS
CMHSA Network of West Michigan
$
60,614,752
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)
$
42,449,698
HSW As of
08/29/2008
SA(SP)&(b3)
$
1,057,757
58,619,233
$
28,391,501
$
Total
$
15,960,336
1,126,029
$
17,126,058
$
76,871,320
618,913
$
19,261,530
$
48,271,943
$
1,602,343
$
6,016,213
$
68,233,308
$ 246,266,506
$
9,431,303
$
55,920,265
$
311,618,073
$
$
2,566,952
$
13,371,418
$
74,478,923
39,391,408
$
1,072,476
$
10,149,536
$
50,613,420
20,889,527
$
610,664
$
5,887,832
$
27,388,023
58,540,553
$
59,467,791
9
3396315
00GX
Macomb County CMH Services
$
91,258,425
$
2,283,883
$
17,011,149
$
110,553,457
10
1724945
00HJ
Northcare
$
45,916,605
$
710,903
$
17,998,484
$
64,625,992
11
4476125
00HF
Northern Affiliation
$
23,976,983
$
763,407
$
21,972,765
$
46,713,155
12
4540048
00HC
Northern Lakes
$
29,153,930
$
672,674
$
7,893,654
$
37,720,258
13
1705289
0058
Oakland County CMH Authority
$ 126,238,403
$
2,031,779
$
42,072,244
$
170,342,426
14
1712541
00HQ
Saginaw County CMH Authority
$
24,590,922
$
1,003,732
$
5,936,773
$
31,531,427
15
4390138
00HU
Southeast Partnership
$
49,415,625
$
1,140,683
$
27,138,739
$
77,695,048
16
3402136
00GR
Southwest Alliance
$
47,963,932
$
1,343,650
$
16,379,129
$
65,686,710
17
1708164
00HO
Thumb Mental Health Alliance
$
39,774,373
$
733,605
$
14,834,079
$
55,342,058
18
2920843
00HR
Venture Behavioral Health
$
44,950,516
$
1,263,742
$
13,396,662
$
59,610,920
State Subtotals $1,078,402,891
$
30,034,497
*HSW Payments are reflected by service month. The amounts will
be updated as retro/recovery payments occur for each service
month.
Report Generated: 8/29/2008
12:08 PM
$ 328,326,865
$ 1,436,764,253
$1,108,437,388
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
YTD-Summary
Page 10 of 79
MA Summary - Charts
July, 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: 8/29/2008
26 - 39
12:08 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
July, 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: 8/29/2008
12:08 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
July, 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: 8/29/2008
Female E&P
12:08 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
July, 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
10,603
12,667
25,472
5
3119549
00GJ
Detroit Wayne County CMH Agency
53,158
63,542
114,337
6
1705233
0028
Genesee County CMH Services
10,143
12,292
24,130
7
1712452
00HA
Lakeshore Behavioral Health Alliance
6,245
8,421
8
1712229
00GV
Lifeways
3,885
4,631
00GX
Macomb County CMH Services
9,460
13,527
Affiliation DBA
Male
Female
Male
DAB Capitation
Female
Total
Male
TANF Capitation
Female
Male
Total Capitation
Female
6,500
8,217
16,393
20,617
51,727
$
2,009,537
$
1,675,741
$
289,784
$
325,650
$
4,300,712
10,251
12,867
24,714
31,560
79,392
$
2,750,903
$
2,368,034
$
367,809
$
420,889
$
5,907,635
5,073
6,385
11,540
14,628
37,626
$
1,357,983
$
1,151,637
$
166,975
$
191,225
$
2,867,820
33,615
82,357
$
3,057,609
$
2,622,563
$
221,473
$
259,818
$
6,161,463
163,591
394,628
$
12,457,312
$
9,982,584
$
970,590
$
1,311,466
$
24,721,952
33,669
80,234
$
2,939,369
$
2,550,644
$
199,051
$
259,093
$
5,948,158
17,161
22,024
53,851
$
1,912,937
$
1,801,610
$
127,317
$
144,851
$
3,986,715
8,976
11,513
29,005
$
1,032,390
$
847,860
$
114,442
$
128,966
$
2,123,658
26,186
34,305
83,478
$
4,460,858
$
4,167,842
$
318,644
$
388,184
$
9,335,528
9
3396315
10
1724945
00HJ
Northcare
5,617
7,952
11,824
14,500
39,893
$
2,194,249
$
1,889,523
$
264,367
$
289,750
$
4,637,889
11
4476125
00HF
Northern Affiliation
5,514
7,149
13,149
16,102
41,914
$
1,176,927
$
994,869
$
123,246
$
133,169
$
2,428,212
12
4540048
00HC
Northern Lakes
4,881
6,229
12,228
14,985
38,323
$
1,346,335
$
1,166,660
$
215,037
$
233,028
$
2,961,060
13
1705289
0058
Oakland County CMH Authority
11,998
16,693
25,887
33,794
88,372
$
6,331,536
$
5,590,905
$
404,644
$
482,861
$
12,809,945
14
1712541
00HQ
Saginaw County CMH Authority
5,334
6,379
10,538
15,001
37,252
$
1,275,069
$
1,082,391
$
63,447
$
83,935
$
2,504,841
15
4390138
00HU
Southeast Partnership
7,510
9,798
19,282
25,216
61,806
$
2,426,397
$
2,110,595
$
229,170
$
269,084
$
5,035,246
16
3402136
00GR
Southwest Alliance
7,667
9,735
19,249
25,161
61,812
$
2,329,897
$
2,052,517
$
224,063
$
261,066
$
4,867,543
17
1708164
00HO
Thumb Mental Health Alliance
4,302
5,432
12,569
16,056
38,359
$
1,942,937
$
1,616,469
$
238,137
$
274,454
$
4,071,996
18
2920843
00HR
Venture Behavioral Health
9,796
12,732
22,852
29,553
74,933
$
2,150,828
$
1,921,084
$
214,618
$
246,758
$
4,533,288
19
$
-
20
$
-
State Subtotals
177,937
224,648
402,585
416,487
555,890
972,377
1,374,962
-
$
53,153,072
$
45,593,529
98,746,601
$
4,752,814
$
5,704,248
$
109,203,662
10,457,061
$
109,203,662
-
Report Generated: 8/29/2008
12:08 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
July, 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
16,155
20,385
238
232
37,010
$
285,587
$
322,487
$
4,197
$
3,163
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
24,445
31,320
269
240
56,274
$
363,798
$
418,131
$
4,011
$
2,758
3
4344340
00GG
CMH for Central Michigan
11,395
14,480
145
148
26,168
$
164,876
$
189,533
$
2,099
$
1,691
4
4483587
00GS
CMHSA Network of West Michigan
25,235
33,393
237
222
59,087
$
219,392
$
258,271
$
2,081
$
1,548
5
3119549
00GJ
Detroit Wayne County CMH Agency
113,680
162,883
657
708
277,928
$
964,954
$
1,306,700
$
5,636
$
4,766
6
1705233
0028
Genesee County CMH Services
23,947
33,487
183
182
57,799
$
197,536
$
257,949
$
1,515
$
1,144
7
1712452
00HA
Lakeshore Behavioral Health Alliance
16,953
21,822
208
202
39,185
$
125,759
$
143,681
$
1,558
$
1,170
8
1712229
00GV
Lifeways
8,880
11,418
96
95
20,489
$
113,210
$
128,021
$
1,232
$
945
9
3396315
00GX
Macomb County CMH Services
25,915
34,049
271
256
60,491
$
315,314
$
385,697
$
3,330
$
2,487
10
1724945
00HJ
Northcare
11,582
14,291
242
209
26,324
$
258,929
$
286,085
$
5,437
$
3,664
11
4476125
00HF
Northern Affiliation
12,888
15,853
261
249
29,251
$
120,797
$
131,344
$
2,449
$
1,825
12
4540048
00HC
Northern Lakes
12,028
14,803
200
182
27,213
$
211,514
$
230,584
$
3,522
$
2,444
13
1705289
0058
Oakland County CMH Authority
25,575
33,494
312
300
59,681
$
399,718
$
479,094
$
4,925
$
3,767
14
1712541
00HQ
Saginaw County CMH Authority
10,430
14,888
108
113
25,539
$
62,795
$
83,392
$
652
$
542
15
4390138
00HU
Southeast Partnership
19,067
24,998
215
218
44,498
$
226,585
$
267,029
$
2,584
$
2,055
16
3402136
00GR
Southwest Alliance
19,038
24,957
211
204
44,410
$
221,589
$
259,181
$
2,474
$
1,885
17
1708164
00HO
Thumb Mental Health Alliance
12,390
15,882
179
174
28,625
$
234,749
$
271,870
$
3,388
$
2,584
18
2920843
00HR
Venture Behavioral Health
22,555
29,294
297
259
52,405
$
211,802
$
244,860
$
2,817
$
1,898
412,158
551,697
4,329
4,193
972,377
$
4,698,905
$
5,663,910
$
53,909
$
40,337
Male
Female
Male
Female
Total
Male
Female
Male
Female
19
20
State Subtotals
963,855
Report Generated: 8/29/2008
12:08 PM
8,522
-
10,362,815
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MH TANF by PIHP
94,246
Page 15 of 79
Total TANF
Capitation
$
615,434
$
788,698
$
358,200
$
481,291
$
2,282,057
$
458,144
$
272,168
$
243,407
$
706,829
$
554,116
$
256,415
$
448,064
$
887,505
$
147,381
$
498,254
$
485,129
$
512,591
$
461,377
$
-
$
-
$
10,457,061
$
10,457,061
-
Report Generated: 8/29/2008
12:08 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
July, 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
141
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
200
TANF
Female
292
Male
384
DAB Capitation
Female
470
Total
Male
1,346
$
TANF Capitation
Female
41,741
$
Male
37,992
$
Total Capitation
Female
3,629
$
3,989
$
87,351
163
246
340
373
1,122
$
57,586
$
56,032
$
7,641
$
7,536
$
128,796
1,442
1,882
4,451
5,459
13,234
$
425,353
$
370,836
$
51,705
$
54,815
$
902,709
758
981
1,334
1,724
4,797
$
174,087
$
151,287
$
12,507
$
14,543
$
352,424
412
485
1,037
1,334
3,268
$
83,207
$
64,928
$
9,662
$
10,587
$
168,383
431
531
801
953
2,716
$
133,358
$
109,159
$
14,182
$
15,258
$
271,957
260
388
492
1,281
$
54,783
$
59,461
$
8,730
$
9,981
$
132,955
660
940
2,078
2,584
6,262
$
141,940
$
138,342
$
19,562
$
21,265
$
321,109
2,050
2,732
4,853
6,359
15,994
$
655,990
$
568,541
$
85,850
$
101,975
$
1,412,357
284
370
722
765
2,141
$
73,950
$
64,868
$
10,662
$
9,998
$
159,478
BERRIEN
3,538
4,723
7,381
10,116
25,758
$
754,773
$
694,075
$
69,031
$
85,182
$
1,603,061
BRANCH
762
956
2,178
2,615
6,511
$
167,086
$
138,666
$
20,479
$
21,462
$
347,694
3,243
4,088
7,014
9,164
23,509
$
735,264
$
643,858
$
65,957
$
77,062
$
1,522,141
CASS
949
1,150
2,327
3,051
7,477
$
280,215
$
226,172
$
27,151
$
32,520
$
566,058
CHARLEVOIX
309
440
1,019
1,152
2,920
$
60,677
$
56,700
$
9,471
$
9,070
$
135,919
16
CHEBOYGAN
536
722
1,493
1,756
4,507
$
111,268
$
101,488
$
14,017
$
14,368
$
241,141
00HJ
17
CHIPPEWA
701
838
1,498
1,813
4,850
$
269,778
$
223,729
$
33,446
$
35,905
$
562,858
00GG
18
CLARE
896
1,079
1,875
2,334
6,184
$
249,448
$
209,890
$
27,287
$
30,829
$
517,455
00BJ
19
CLINTON
630
767
1,639
2,055
5,091
$
163,764
$
138,356
$
24,372
$
27,052
$
353,545
4540048
00HC
20
CRAWFORD
300
396
698
844
2,238
$
84,582
$
74,717
$
12,324
$
13,438
$
185,061
1724945
00HJ
21
DELTA
749
1,039
1,546
1,930
5,264
$
302,180
$
256,154
$
34,476
$
38,875
$
631,685
22
1724945
00HJ
22
DICKINSON
453
709
1,014
1,289
3,465
$
178,343
$
165,443
$
22,565
$
25,699
$
392,050
23
1708001
00BJ
23
EATON
1,136
1,476
3,048
4,046
9,706
$
297,220
$
255,455
$
45,228
$
53,781
$
651,685
24
4476125
00HF
24
EMMET
477
691
1,500
1,706
4,374
$
93,275
$
86,191
$
13,905
$
13,570
$
206,942
25
1705233
0028
25
GENESEE
10,143
12,292
24,130
33,669
80,234
$
2,939,369
$
2,550,644
$
199,051
$
259,093
$
5,948,158
26
4344340
00GG
26
GLADWIN
581
791
1,319
1,525
4,216
$
158,242
$
140,532
$
19,089
$
19,685
$
337,548
27
1724945
00HJ
27
GOGEBIC
363
573
697
846
2,479
$
142,676
$
132,040
$
15,678
$
17,167
$
307,561
28
4540048
00HC
28
GRAND TRAVERSE
1,245
1,618
3,154
3,993
10,010
$
334,705
$
299,646
$
55,105
$
61,131
$
750,586
29
1708001
00BJ
29
GRATIOT
761
1,042
1,992
2,506
6,301
$
199,014
$
178,335
$
29,734
$
33,322
$
440,406
30
1712229
00GV
30
HILLSDALE
900
1,090
2,116
2,592
6,698
$
239,015
$
187,444
$
27,046
$
28,577
$
482,082
Report Generated: 8/29/2008
12:08 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
July, 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
621
858
1,442
1,686
4,607
$
251,806
$
183,824
$
32,173
$
32,611
$
500,415
32
1705322
00GE
32
HURON
672
847
1,497
1,799
4,815
$
204,783
$
158,727
$
26,405
$
28,082
$
417,996
33
1708001
00BJ
33
INGHAM
4,901
6,036
11,293
14,695
36,925
$
1,324,019
$
1,140,001
$
168,105
$
198,822
$
2,830,947
34
1708001
00BJ
34
IONIA
951
1,207
2,594
3,329
8,081
$
260,676
$
227,141
$
38,541
$
43,118
$
569,477
35
4476125
00HF
35
IOSCO
605
789
1,371
1,694
4,459
$
134,640
$
112,678
$
12,886
$
14,303
$
274,508
36
1724945
00HJ
36
IRON
278
449
547
668
1,942
$
110,849
$
83,781
$
12,267
$
13,362
$
220,260
37
4344340
00GG
37
ISABELLA
965
1,226
2,266
3,022
7,479
$
261,620
$
221,332
$
32,631
$
39,537
$
555,120
38
1712229
00GV
38
JACKSON
2,985
3,541
6,860
8,921
22,307
$
793,375
$
660,416
$
87,396
$
100,389
$
1,641,576
39
3402136
00GR
39
KALAMAZOO
4,124
5,205
9,165
12,424
30,918
$
1,284,740
$
1,152,040
$
106,735
$
130,658
$
2,674,173
40
4476125
00HF
40
KALKASKA
380
494
1,021
1,338
3,233
$
72,360
$
66,306
$
9,545
$
10,890
$
159,100
41
4483587
00GS
41
KENT
10,603
12,667
25,472
33,615
82,357
$
3,057,609
$
2,622,563
$
221,473
$
259,818
$
6,161,463
42
1724945
00HJ
42
KEWEENAW
46
54
68
73
241
$
16,648
$
11,996
$
1,500
$
1,383
$
31,527
43
4540048
00HC
43
LAKE
435
543
619
794
2,391
$
122,205
$
103,676
$
11,029
$
12,536
$
249,447
44
1708164
00HO
44
LAPEER
940
1,217
3,283
3,996
9,436
$
427,609
$
358,051
$
61,884
$
66,706
$
914,250
45
4540048
00HC
45
LEELANAU
46
4390138
00HU
46
LENAWEE
47
4390138
00HU
47
LIVINGSTON
48
1724945
00HJ
48
LUCE
196
236
308
49
1724945
00HJ
49
MACKINAC
175
231
400
50
3396315
00GX
50
MACOMB
9,460
13,527
26,186
34,305
51
1708001
00BJ
51
MANISTEE
537
655
1,020
52
1724945
00HJ
52
MARQUETTE
968
1,386
2,053
53
4540048
00HC
53
MASON
542
722
1,376
1,768
54
4344340
00GG
54
MECOSTA
830
1,075
2,063
55
1724945
00HJ
55
MENOMINEE
381
551
843
56
4344340
00GG
56
MIDLAND
1,280
1,596
2,894
3,702
57
4540048
00HC
57
MISSAUKEE
237
280
646
58
4390138
00HU
58
MONROE
1,693
2,402
4,566
59
1705322
00GE
59
MONTCALM
1,234
1,439
3,263
60
4476125
00HF
60
MONTMORENCY
257
317
501
Report Generated: 8/29/2008
12:08 PM
Male
Female
Male
Female
Total
Male
Female
Male
Female
126
168
403
479
1,176
$
30,246
$
25,898
$
7,068
$
7,193
$
70,405
1,423
1,920
3,757
4,839
11,939
$
452,183
$
418,584
$
44,667
$
50,614
$
966,047
953
1,210
3,206
3,935
9,304
$
299,405
$
250,705
$
38,059
$
41,169
$
629,338
407
1,147
$
72,432
$
57,235
$
6,883
$
8,112
$
144,662
440
1,246
$
61,959
$
59,652
$
8,959
$
8,478
$
139,048
83,478
$
4,460,858
$
4,167,842
$
318,644
$
388,184
$
9,335,528
1,190
3,402
$
145,099
$
123,942
$
15,283
$
15,894
$
300,219
2,561
6,968
$
394,345
$
351,851
$
45,957
$
52,519
$
844,672
4,408
$
147,151
$
134,149
$
24,138
$
27,588
$
333,027
2,633
6,601
$
215,567
$
198,461
$
29,972
$
34,469
$
478,469
1,124
2,899
$
136,017
$
126,198
$
18,824
$
22,717
$
303,756
9,472
$
340,819
$
271,645
$
41,707
$
48,012
$
702,183
742
1,905
$
60,834
$
46,647
$
11,360
$
11,373
$
130,213
6,092
14,753
$
562,735
$
528,326
$
54,363
$
64,634
$
1,210,057
4,111
10,047
$
374,504
$
302,062
$
57,651
$
63,951
$
798,168
608
1,683
$
56,725
$
45,506
$
4,736
$
5,259
$
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MH by County
112,225
Page 18 of 79
Mental Health - Capitation by County
July, 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
4,360
5,766
9,913
13,545
33,584
$
1,355,952
$
1,267,765
$
73,855
$
91,344
$
2,788,916
62
1708001
00BJ
62
NEWAYGO
1,051
1,314
2,406
2,974
7,745
$
287,159
$
239,935
$
35,883
$
38,902
$
601,879
63
1705289
0058
63
OAKLAND
11,998
16,693
25,887
33,794
88,372
$
6,331,536
$
5,590,905
$
404,644
$
482,861
$
12,809,945
64
4540048
00HC
64
OCEANA
557
701
2,036
2,203
5,497
$
161,329
$
127,147
$
35,831
$
33,648
$
357,955
65
4476125
00HF
65
OGEMAW
606
741
1,304
1,570
4,221
$
140,126
$
110,556
$
12,371
$
13,506
$
276,559
66
1724945
00HJ
66
ONTONAGON
166
236
253
310
965
$
62,629
$
52,714
$
5,717
$
6,025
$
127,086
67
4344340
00GG
67
OSCEOLA
521
618
1,123
1,412
3,674
$
132,288
$
109,776
$
16,290
$
18,692
$
277,045
68
4476125
00HF
68
OSCODA
266
333
460
556
1,615
$
60,116
$
47,295
$
4,353
$
4,753
$
116,517
69
4476125
00HF
69
OTSEGO
443
537
1,259
1,618
3,857
$
93,178
$
73,531
$
11,836
$
13,724
$
192,269
70
1712452
00HA
70
OTTAWA
1,885
2,655
7,248
8,479
20,267
$
556,985
$
533,844
$
53,463
$
53,507
$
1,197,799
71
4476125
00HF
71
PRESQUE ISLE
265
327
466
576
1,634
$
55,528
$
40,411
$
4,328
$
4,606
$
104,873
72
4540048
00HC
72
ROSCOMMON
650
850
1,357
1,655
4,512
$
188,901
$
169,092
$
24,079
$
27,179
$
409,251
73
1712541
00HQ
73
SAGINAW
5,334
6,379
10,538
15,001
37,252
$
1,275,069
$
1,082,391
$
63,447
$
83,935
$
2,504,841
74
1708164
00HO
74
ST CLAIR
2,542
3,178
6,993
9,154
21,867
$
1,142,993
$
973,558
$
132,597
$
158,472
$
2,407,621
75
3402136
00GR
75
ST JOSEPH
1,152
1,498
3,306
4,227
10,183
$
339,589
$
303,469
$
38,472
$
43,073
$
724,603
76
1708164
00HO
76
SANILAC
820
1,037
2,293
2,906
7,056
$
372,335
$
284,860
$
43,655
$
49,276
$
750,125
77
1724945
00HJ
77
SCHOOLCRAFT
216
286
427
488
1,417
$
82,217
$
69,412
$
9,551
$
9,378
$
170,559
78
1705322
00GE
78
SHIAWASSEE
1,110
1,475
3,238
4,113
9,936
$
338,878
$
299,064
$
57,276
$
65,410
$
760,627
79
1705322
00GE
79
TUSCOLA
1,003
1,193
2,741
3,282
8,219
$
302,024
$
238,189
$
48,420
$
50,974
$
639,608
80
2920843
00HR
80
VAN BUREN
1,593
2,025
4,201
5,074
12,893
$
351,765
$
306,143
$
39,589
$
41,787
$
739,284
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
3,441
4,266
7,753
10,350
25,810
$
1,112,074
$
912,980
$
92,081
$
112,668
$
2,229,803
53,158
63,542
114,337
163,591
394,628
$
12,457,312
$
9,982,584
$
970,590
$
1,311,466
$
24,721,952
789
951
1,939
2,507
6,186
$
216,383
$
185,688
$
34,103
$
38,941
$
475,115
177,937
224,648
416,487
555,890
1,374,962
$
53,153,072
$
45,593,529
$
4,752,814
$
5,704,248
$109,203,662
109,203,662
$109,203,662
402,585
972,377
-
-
Report Generated: 8/29/2008
12:08 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
July, 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
6,245
8
1712229
00GV
Lifeways
3,885
4,631
8,976
9
3396315
00GX
Macomb County CMH Services
9,460
13,527
26,186
10
1724945
00HJ
Northcare
5,617
7,952
11,824
14,500
11
4476125
00HF
Northern Affiliation
5,514
7,149
13,149
12
4540048
00HC
Northern Lakes
4,881
6,229
12,228
13
1705289
0058
Oakland County CMH Authority
11,998
16,693
25,887
14
1712541
00HQ
Saginaw County CMH Authority
5,334
6,379
15
4390138
00HU
Southeast Partnership
7,510
9,798
16
3402136
00GR
Southwest Alliance
7,667
9,735
17
1708164
00HO
Thumb Mental Health Alliance
4,302
5,432
12,569
18
2920843
00HR
Venture Behavioral Health
9,796
12,732
22,852
Male
Female
Male
Female
Total
Male
TANF Capitation
Female
Male
Total Capitation
Female
6,500
8,217
16,393
20,617
51,727
$
24,668
$
19,809
$
22,901
$
40,940
$
108,317
10,251
12,867
24,714
31,560
79,392
$
29,793
$
24,935
$
19,934
$
39,722
$
114,385
5,073
6,385
11,540
14,628
37,626
$
18,899
$
15,358
$
10,350
$
18,188
$
62,795
10,603
12,667
25,472
33,615
82,357
$
54,046
$
45,912
$
20,064
$
44,712
$
164,734
53,158
63,542
114,337
163,591
394,628
$
400,175
$
301,034
$
66,413
$
185,721
$
953,342
10,143
12,292
24,130
33,669
80,234
$
70,356
$
60,634
$
39,106
$
93,123
$
263,219
8,421
17,161
22,024
53,851
$
28,718
$
26,544
$
17,693
$
36,957
$
109,912
11,513
29,005
$
14,800
$
11,863
$
12,071
$
23,628
$
62,363
34,305
83,478
$
68,901
$
60,492
$
34,651
$
73,864
$
237,908
39,893
$
20,152
$
15,947
$
12,618
$
23,166
$
71,882
16,102
41,914
$
22,397
$
17,566
$
14,239
$
23,874
$
78,077
14,985
38,323
$
18,631
$
15,386
$
12,738
$
22,171
$
68,925
33,794
88,372
$
65,331
$
54,146
$
27,424
$
62,433
$
209,335
10,538
15,001
37,252
$
33,370
$
27,898
$
11,942
$
30,129
$
103,340
19,282
25,216
61,806
$
29,031
$
24,608
$
20,261
$
43,378
$
117,279
19,249
25,161
61,812
$
40,475
$
34,520
$
19,747
$
42,663
$
137,406
16,056
38,359
$
15,715
$
12,456
$
16,337
$
31,411
$
75,918
29,553
74,933
$
33,570
$
28,757
$
22,145
$
44,442
$
128,914
19
$
-
20
$
-
State Subtotals
177,937
224,648
402,585
416,487
555,890
972,377
1,374,962
-
$
989,028
$
797,864
1,786,892
$
400,634
$
880,524
$
3,068,051
1,281,158
$
3,068,051
-
Report Generated: 8/29/2008
12:08 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
July, 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
16,155
20,385
238
232
37,010
$
22,521
$
40,643
$
380
$
297
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
24,445
31,320
269
240
56,274
$
19,659
$
39,530
$
275
$
193
3
4344340
00GG
CMH for Central Michigan
11,395
14,480
145
148
26,168
$
10,190
$
18,057
$
160
$
131
4
4483587
00GS
CMHSA Network of West Michigan
25,235
33,393
237
222
59,087
$
19,779
$
44,476
$
286
$
236
5
3119549
00GJ
Detroit Wayne County CMH Agency
113,680
162,883
657
708
277,928
$
65,836
$
185,217
$
576
$
504
6
1705233
0028
Genesee County CMH Services
23,947
33,487
183
182
57,799
$
38,716
$
92,864
$
391
$
260
7
1712452
00HA
Lakeshore Behavioral Health Alliance
16,953
21,822
208
202
39,185
$
17,366
$
36,722
$
327
$
234
8
1712229
00GV
Lifeways
8,880
11,418
96
95
20,489
$
11,888
$
23,489
$
183
$
139
00GX
Macomb County CMH Services
25,915
34,049
271
256
60,491
$
34,127
$
73,480
$
524
$
383
Affiliation DBA
Male
Female
Male
Female
Total
Male
Female
Male
Female
9
3396315
10
1724945
00HJ
Northcare
11,582
14,291
242
209
26,324
$
12,274
$
22,931
$
344
$
234
11
4476125
00HF
Northern Affiliation
12,888
15,853
261
249
29,251
$
13,888
$
23,603
$
351
$
271
12
4540048
00HC
Northern Lakes
12,028
14,803
200
182
27,213
$
12,478
$
22,004
$
260
$
167
13
1705289
0058
Oakland County CMH Authority
25,575
33,494
312
300
59,681
$
26,932
$
62,018
$
492
$
415
14
1712541
00HQ
Saginaw County CMH Authority
10,430
14,888
108
113
25,539
$
11,788
$
29,975
$
154
$
154
15
4390138
00HU
Southeast Partnership
19,067
24,998
215
218
44,498
$
19,907
$
43,103
$
354
$
275
16
3402136
00GR
Southwest Alliance
19,038
24,957
211
204
44,410
$
19,438
$
42,403
$
309
$
260
17
1708164
00HO
Thumb Mental Health Alliance
12,390
15,882
179
174
28,625
$
16,065
$
31,177
$
272
$
234
18
2920843
00HR
Venture Behavioral Health
22,555
29,294
297
259
52,405
$
21,711
$
44,172
$
435
$
270
412,158
551,697
4,329
4,193
972,377
$
394,562
$
875,866
$
6,072
$
19
20
State Subtotals
963,855
Report Generated: 8/29/2008
12:08 PM
8,522
-
1,270,428
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
SA TANF by PIHP
4,658
10,730
Page 21 of 79
Total TANF
Capitation
$
63,840
$
59,657
$
28,538
$
64,776
$
252,134
$
132,230
$
54,650
$
35,699
$
108,515
$
35,783
$
38,114
$
34,909
$
89,857
$
42,071
$
63,639
$
62,411
$
47,747
$
66,587
$
-
$
-
$
1,281,158
$
1,281,158
-
Report Generated: 8/29/2008
12:08 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
July, 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
200
292
384
470
1,346
$
812
$
641
$
464
$
748
$
2,664
2
1724945
00HJ
02
ALGER
163
246
340
373
1,122
$
535
$
452
$
383
$
608
$
1,979
3
3402136
00GR
03
ALLEGAN
1,442
1,882
4,451
5,459
13,234
$
7,315
$
6,074
$
4,334
$
8,183
$
25,906
4
4476125
00HF
04
ALPENA
758
981
1,334
1,724
4,797
$
3,323
$
2,784
$
1,480
$
2,741
$
10,329
5
4476125
00HF
05
ANTRIM
412
485
1,037
1,334
3,268
$
1,540
$
1,122
$
936
$
1,702
$
5,301
6
1705322
00GE
06
ARENAC
431
531
801
953
2,716
$
1,682
$
1,299
$
1,187
$
1,949
$
6,117
7
1724945
00HJ
07
BARAGA
141
260
388
492
1,281
$
521
$
491
$
459
$
828
$
2,300
8
2920843
00HR
08
BARRY
660
940
2,078
2,584
6,262
$
2,175
$
2,063
$
2,148
$
3,696
$
10,083
2,050
2,732
4,853
6,359
15,994
$
8,026
$
6,738
$
6,795
$
13,355
$
34,915
284
370
722
765
2,141
$
805
$
667
$
511
$
894
$
2,878
3,538
4,723
7,381
10,116
25,758
$
11,742
$
10,298
$
6,392
$
15,681
$
44,114
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
477
691
1,500
25
1705233
0028
25
GENESEE
10,143
12,292
24,130
26
4344340
00GG
26
GLADWIN
581
791
1,319
1,525
27
1724945
00HJ
27
GOGEBIC
28
4540048
00HC
28
GRAND TRAVERSE
29
1708001
00BJ
29
GRATIOT
Total
Male
Female
Male
Female
762
956
2,178
2,615
6,511
$
2,583
$
2,052
$
2,217
$
3,712
$
10,564
3,243
4,088
7,014
9,164
23,509
$
11,549
$
9,759
$
7,023
$
14,165
$
42,495
CASS
949
1,150
2,327
3,051
7,477
$
4,812
$
3,699
$
2,571
$
5,658
$
16,740
15
CHARLEVOIX
309
440
1,019
1,152
2,920
$
1,138
$
975
$
877
$
1,419
$
4,409
16
CHEBOYGAN
536
722
1,493
1,756
4,507
$
2,127
$
1,775
$
1,684
$
2,513
$
8,099
17
CHIPPEWA
701
838
1,498
1,813
4,850
$
2,542
$
2,007
$
1,550
$
2,824
$
8,923
CLARE
896
1,079
1,875
2,334
6,184
$
3,588
$
2,860
$
1,813
$
2,975
$
11,235
CLINTON
630
767
1,639
2,055
5,091
$
1,758
$
1,459
$
1,267
$
2,472
$
6,956
300
396
698
844
2,238
$
1,205
$
995
$
808
$
1,348
$
4,357
DELTA
749
1,039
1,546
1,930
5,264
$
2,733
$
2,182
$
1,549
$
3,175
$
9,639
DICKINSON
453
709
1,014
1,289
3,465
$
1,590
$
1,412
$
969
$
2,046
$
6,016
1,136
1,476
3,048
4,046
9,706
$
3,159
$
2,633
$
2,309
$
5,024
$
13,125
1,706
4,374
$
1,690
$
1,443
$
1,251
$
2,193
$
6,577
33,669
80,234
$
70,356
$
60,634
$
39,106
$
93,123
$
263,219
4,216
$
2,248
$
1,838
$
1,182
$
1,799
$
7,067
Report Generated: 8/29/2008
12:08 PM
363
573
697
846
2,479
$
1,288
$
1,108
$
793
$
1,424
$
4,612
1,245
1,618
3,154
3,993
10,010
$
4,563
$
3,940
$
2,860
$
5,607
$
16,970
761
1,042
1,992
2,506
6,301
$
2,082
$
1,814
$
1,737
$
3,149
$
8,782
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
July, 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
900
1,090
2,116
2,592
6,698
$
3,464
$
2,535
$
2,974
$
5,015
$
13,988
31
1724945
00HJ
31
HOUGHTON
621
858
1,442
1,686
4,607
$
2,338
$
1,478
$
1,495
$
2,408
$
7,719
32
1705322
00GE
32
HURON
672
847
1,497
1,799
4,815
$
2,584
$
1,803
$
1,996
$
3,406
$
9,789
33
1708001
00BJ
33
INGHAM
4,901
6,036
11,293
14,695
36,925
$
14,472
$
12,162
$
9,168
$
19,358
$
55,160
34
1708001
00BJ
34
IONIA
951
1,207
2,594
3,329
8,081
$
2,778
$
2,401
$
2,017
$
3,829
$
11,024
35
4476125
00HF
35
IOSCO
605
789
1,371
1,694
4,459
$
2,594
$
2,017
$
1,604
$
2,668
$
8,883
36
1724945
00HJ
36
IRON
278
449
547
668
1,942
$
1,079
$
603
$
656
$
1,069
$
3,408
37
4344340
00GG
37
ISABELLA
965
1,226
2,266
3,022
7,479
$
3,513
$
2,965
$
1,871
$
3,808
$
12,157
38
1712229
00GV
38
JACKSON
2,985
3,541
6,860
8,921
22,307
$
11,336
$
9,329
$
9,096
$
18,614
$
48,375
39
3402136
00GR
39
KALAMAZOO
4,124
5,205
9,165
12,424
30,918
$
22,522
$
19,782
$
9,458
$
22,076
$
73,838
40
4476125
00HF
40
KALKASKA
380
494
1,021
1,338
3,233
$
1,372
$
1,146
$
1,099
$
1,890
$
5,506
41
4483587
00GS
41
KENT
10,603
12,667
25,472
33,615
82,357
$
54,046
$
45,912
$
20,064
$
44,712
$
164,734
42
1724945
00HJ
42
KEWEENAW
46
54
68
73
241
$
157
$
96
$
52
$
93
$
398
43
4540048
00HC
43
LAKE
435
543
619
794
2,391
$
1,752
$
1,373
$
788
$
1,237
$
5,150
44
1708164
00HO
44
LAPEER
940
1,217
3,283
3,996
9,436
$
3,409
$
2,733
$
3,785
$
7,209
$
17,136
45
4540048
00HC
45
LEELANAU
46
4390138
00HU
46
LENAWEE
47
4390138
00HU
47
LIVINGSTON
48
1724945
00HJ
48
LUCE
196
236
308
49
1724945
00HJ
49
MACKINAC
175
231
400
50
3396315
00GX
50
MACOMB
9,460
13,527
26,186
34,305
51
1708001
00BJ
51
MANISTEE
537
655
1,020
52
1724945
00HJ
52
MARQUETTE
968
1,386
2,053
53
4540048
00HC
53
MASON
542
722
1,376
1,768
54
4344340
00GG
54
MECOSTA
830
1,075
2,063
55
1724945
00HJ
55
MENOMINEE
381
551
843
56
4344340
00GG
56
MIDLAND
1,280
1,596
2,894
57
4540048
00HC
57
MISSAUKEE
237
280
646
58
4390138
00HU
58
MONROE
1,693
2,402
4,566
Code
County Name
Report Generated: 8/29/2008
12:08 PM
Male
Female
Male
Female
Total
Male
Female
Male
Female
126
168
403
479
1,176
$
408
$
309
$
410
$
611
$
1,738
1,423
1,920
3,757
4,839
11,939
$
5,488
$
4,926
$
4,029
$
7,810
$
22,253
953
1,210
3,206
3,935
9,304
$
3,530
$
2,858
$
3,280
$
6,294
$
15,961
407
1,147
$
633
$
477
$
356
$
649
$
2,116
440
1,246
$
589
$
517
$
437
$
613
$
2,156
83,478
$
68,901
$
60,492
$
34,651
$
73,864
$
237,908
1,190
3,402
$
1,640
$
1,295
$
930
$
1,509
$
5,373
2,561
6,968
$
3,583
$
3,056
$
2,277
$
4,457
$
13,373
4,408
$
1,970
$
1,767
$
1,338
$
2,652
$
7,727
2,633
6,601
$
3,029
$
2,668
$
2,012
$
3,306
$
11,015
1,124
2,899
$
1,222
$
1,046
$
882
$
1,849
$
4,999
3,702
9,472
$
4,701
$
3,554
$
2,418
$
4,480
$
15,155
742
1,905
$
851
$
583
$
675
$
1,044
$
3,153
6,092
14,753
$
6,774
$
6,214
$
4,910
$
10,317
$
28,215
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
July, 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
1,051
1,314
2,406
63
1705289
0058
63
OAKLAND
11,998
16,693
25,887
64
4540048
00HC
64
OCEANA
557
701
2,036
65
4476125
00HF
65
OGEMAW
606
741
66
1724945
00HJ
66
ONTONAGON
166
236
67
4344340
00GG
67
OSCEOLA
521
618
68
4476125
00HF
68
OSCODA
266
333
460
69
4476125
00HF
69
OTSEGO
443
537
1,259
70
1712452
00HA
70
OTTAWA
1,885
2,655
7,248
8,479
71
4476125
00HF
71
PRESQUE ISLE
265
327
466
72
4540048
00HC
72
ROSCOMMON
650
850
1,357
73
1712541
00HQ
73
SAGINAW
5,334
6,379
10,538
74
1708164
00HO
74
ST CLAIR
2,542
3,178
75
3402136
00GR
75
ST JOSEPH
1,152
1,498
76
1708164
00HO
76
SANILAC
820
1,037
77
1724945
00HJ
77
SCHOOLCRAFT
216
286
427
78
1705322
00GE
78
SHIAWASSEE
1,110
1,475
3,238
79
1705322
00GE
79
TUSCOLA
1,003
1,193
2,741
80
2920843
00HR
80
VAN BUREN
1,593
2,025
81
4390138
00HU
81
WASHTENAW
3,441
4,266
82
3119549
00GJ
82
WAYNE
53,158
83
4540048
00HC
83
WEXFORD
Code
County Name
Male
State Subtotals
Female
Male
Female
Total
Male
TANF Capitation
Female
Male
Total Capitation
Female
1,234
1,439
3,263
4,111
10,047
$
4,610
$
3,625
$
4,498
$
7,798
$
20,531
257
317
501
608
1,683
$
1,082
$
821
$
626
$
1,033
$
3,561
4,360
5,766
9,913
13,545
33,584
$
20,697
$
18,880
$
11,256
$
24,838
$
75,670
2,974
7,745
$
3,099
$
2,504
$
1,995
$
3,489
$
11,087
33,794
88,372
$
65,331
$
54,146
$
27,424
$
62,433
$
209,335
2,203
5,497
$
2,262
$
1,644
$
2,136
$
3,039
$
9,081
1,304
1,570
4,221
$
2,680
$
2,009
$
1,739
$
2,647
$
9,075
253
310
965
$
582
$
429
$
312
$
448
$
1,771
1,123
1,412
3,674
$
1,819
$
1,472
$
1,054
$
1,820
$
6,166
556
1,615
$
1,207
$
857
$
586
$
919
$
3,568
1,618
3,857
$
1,786
$
1,300
$
1,482
$
2,644
$
7,214
20,267
$
8,022
$
7,664
$
6,437
$
12,119
$
34,242
576
1,634
$
1,046
$
676
$
411
$
757
$
2,891
1,655
4,512
$
2,635
$
2,282
$
1,724
$
2,908
$
9,550
15,001
37,252
$
33,370
$
27,898
$
11,942
$
30,129
$
103,340
6,993
9,154
21,867
$
9,243
$
7,618
$
9,242
$
18,682
$
44,785
3,306
4,227
10,183
$
5,826
$
4,965
$
3,384
$
6,746
$
20,922
2,293
2,906
7,056
$
3,063
$
2,105
$
3,310
$
5,520
$
13,997
488
1,417
$
759
$
593
$
449
$
673
$
2,474
4,113
9,936
$
4,069
$
3,523
$
4,612
$
8,350
$
20,555
3,282
8,219
$
3,697
$
2,821
$
3,812
$
6,081
$
16,411
4,201
5,074
12,893
$
5,521
$
4,584
$
4,366
$
7,187
$
21,658
7,753
10,350
25,810
$
13,239
$
10,611
$
8,042
$
18,958
$
50,850
63,542
114,337
163,591
394,628
$
400,175
$
301,034
$
66,413
$
185,721
$
953,342
789
951
1,939
2,507
6,186
$
2,984
$
2,492
$
1,999
$
3,725
$
11,201
177,937
224,648
416,487
555,890
1,374,962
$
989,028
$
797,864
$
400,634
$
880,524
$
3,068,051
3,068,051
$
3,068,051
402,585
972,377
-
-
Report Generated: 8/29/2008
12:08 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
July, 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
1,250
915
955
1,050
1,388
942
6,500
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
M
DAB
2,513
1,510
1,458
1,370
1,972
1,428
10,251
3
4344340
00GG
CMH for Central Michigan
M
DAB
1,006
751
676
834
1,127
679
5,073
4
4483587
00GS
CMHSA Network of West Michigan
M
DAB
2,808
1,624
1,474
1,375
1,935
1,387
10,603
5
3119549
00GJ
Detroit Wayne County CMH Agency
M
DAB
11,827
6,788
6,919
7,825
12,510
7,289
53,158
6
1705233
0028
Genesee County CMH Services
M
DAB
2,618
1,495
1,476
1,613
2,057
884
10,143
7
1712452
00HA
Lakeshore Behavioral Health Alliance
M
DAB
1,529
983
910
899
1,198
726
6,245
8
1712229
00GV
Lifeways
M
DAB
1,014
491
567
581
758
474
3,885
00GX
Macomb County CMH Services
M
DAB
2,029
1,313
1,181
1,231
1,772
1,934
9,460
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
10
1724945
00HJ
Northcare
M
DAB
846
704
728
856
1,224
1,259
5,617
11
4476125
00HF
Northern Affiliation
M
DAB
990
748
658
794
1,322
1,002
5,514
12
4540048
00HC
Northern Lakes
M
DAB
951
680
585
758
1,076
831
4,881
13
1705289
0058
Oakland County CMH Authority
M
DAB
2,448
1,546
1,608
1,522
2,220
2,654
11,998
14
1712541
00HQ
Saginaw County CMH Authority
M
DAB
1,438
693
758
847
1,024
574
5,334
15
4390138
00HU
Southeast Partnership
M
DAB
1,648
1,204
1,147
1,019
1,416
1,076
7,510
16
3402136
00GR
Southwest Alliance
M
DAB
1,943
1,083
1,034
1,109
1,561
937
7,667
17
1708164
00HO
Thumb Mental Health Alliance
M
DAB
956
646
590
660
882
568
4,302
18
2920843
00HR
Venture Behavioral Health
M
DAB
2,435
1,291
1,271
1,392
2,005
1,402
9,796
-
19
20
State Subtotals
40,249
24,465
23,995
25,735
37,447
Check Values
Report Generated: 8/29/2008
12:08 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MHSA-Pop
26,046
177,937
-
Page 26 of 79
Mental Health/Substance Abuse Population - PIHP by Age Group - DAB - Female
F
DAB
July, 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
833
774
948
1,169
1,972
2,521
8,217
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
F
DAB
1,735
1,282
1,408
1,720
3,040
3,682
12,867
3
4344340
00GG
CMH for Central Michigan
F
DAB
720
699
712
940
1,573
1,741
6,385
4
4483587
00GS
CMHSA Network of West Michigan
F
DAB
1,849
1,342
1,727
1,777
2,652
3,320
12,667
5
3119549
00GJ
Detroit Wayne County CMH Agency
F
DAB
8,188
5,709
6,668
8,290
16,807
17,880
63,542
6
1705233
0028
Genesee County CMH Services
F
DAB
1,847
1,301
1,576
2,040
3,019
2,509
12,292
7
1712452
00HA
Lakeshore Behavioral Health Alliance
F
DAB
1,056
844
1,056
1,224
1,982
2,259
8,421
8
1712229
00GV
Lifeways
F
DAB
681
461
559
632
1,097
1,201
4,631
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
1,450
1,139
1,234
1,554
3,038
5,112
13,527
10
1724945
00HJ
Northcare
F
DAB
556
611
710
937
1,747
3,391
7,952
11
4476125
00HF
Northern Affiliation
F
DAB
685
591
697
945
1,740
2,491
7,149
12
4540048
00HC
Northern Lakes
F
DAB
661
569
639
919
1,524
1,917
6,229
13
1705289
0058
Oakland County CMH Authority
F
DAB
1,863
1,299
1,520
1,859
3,487
6,665
16,693
14
1712541
00HQ
Saginaw County CMH Authority
F
DAB
918
607
860
946
1,511
1,537
6,379
15
4390138
00HU
Southeast Partnership
F
DAB
1,213
983
1,117
1,306
2,171
3,008
9,798
16
3402136
00GR
Southwest Alliance
F
DAB
1,373
918
1,206
1,359
2,259
2,620
9,735
17
1708164
00HO
Thumb Mental Health Alliance
F
DAB
700
497
570
724
1,317
1,624
5,432
18
2920843
00HR
Venture Behavioral Health
F
DAB
1,779
1,094
1,428
1,696
3,083
3,652
12,732
-
19
20
State Subtotals
28,107
20,720
24,635
30,037
54,019
Check Values
Report Generated: 8/29/2008
12:08 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MHSA-Pop
67,130
224,648
-
Page 27 of 79
Mental Health/Substance Abuse Population - PIHP by Age Group - TANF - Male
M
TANF
July, 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
13,813
939
1,047
467
127
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
M
TANF
21,333
1,265
1,383
593
139
3
4344340
00GG
CMH for Central Michigan
M
TANF
9,503
736
839
362
100
4
4483587
00GS
CMHSA Network of West Michigan
M
TANF
22,738
1,165
996
427
143
3
25,472
5
3119549
00GJ
Detroit Wayne County CMH Agency
M
TANF
100,752
6,405
3,702
2,399
1,057
22
114,337
6
1705233
0028
Genesee County CMH Services
M
TANF
20,634
1,292
1,471
587
144
2
24,130
7
1712452
00HA
Lakeshore Behavioral Health Alliance
M
TANF
15,200
797
736
341
86
1
17,161
8
1712229
00GV
Lifeways
M
TANF
7,866
445
429
191
44
1
8,976
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
-
16,393
1
-
24,714
11,540
9
3396315
00GX
Macomb County CMH Services
M
TANF
22,361
1,430
1,242
794
354
10
1724945
00HJ
Northcare
M
TANF
10,142
663
667
262
90
-
5
11,824
26,186
11
4476125
00HF
Northern Affiliation
M
TANF
11,094
772
813
364
106
-
13,149
12
4540048
00HC
Northern Lakes
M
TANF
10,400
710
718
317
83
-
13
1705289
0058
Oakland County CMH Authority
M
TANF
22,866
1,257
953
550
256
14
1712541
00HQ
Saginaw County CMH Authority
M
TANF
9,120
573
560
222
63
15
4390138
00HU
Southeast Partnership
M
TANF
16,921
959
880
401
120
16
3402136
00GR
Southwest Alliance
M
TANF
17,019
873
935
338
84
-
19,249
17
1708164
00HO
Thumb Mental Health Alliance
M
TANF
10,671
705
761
334
98
-
12,569
18
2920843
00HR
Venture Behavioral Health
M
TANF
19,886
1,140
1,149
527
148
12,228
5
-
25,887
10,538
1
2
19,282
22,852
-
19
20
State Subtotals
362,319
22,126
19,281
9,476
Check Values
Report Generated: 8/29/2008
12:08 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MHSA-Pop
3,242
43
416,487
-
Page 28 of 79
Mental Health/Substance Abuse Population - PIHP by Age Group - TANF - Female
F
TANF
July, 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
13,452
2,872
3,290
858
145
-
20,617
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
F
TANF
20,700
4,225
5,137
1,259
239
-
31,560
3
4344340
00GG
CMH for Central Michigan
F
TANF
9,215
2,194
2,478
645
96
-
14,628
4
4483587
00GS
CMHSA Network of West Michigan
F
TANF
22,521
4,523
5,118
1,217
236
-
5
3119549
00GJ
Detroit Wayne County CMH Agency
F
TANF
100,578
22,078
29,361
9,302
2,256
16
163,591
6
1705233
0028
Genesee County CMH Services
F
TANF
20,456
4,861
6,328
1,718
303
3
33,669
7
1712452
00HA
Lakeshore Behavioral Health Alliance
F
TANF
14,613
3,144
3,368
756
142
1
22,024
8
1712229
00GV
Lifeways
F
TANF
7,756
1,627
1,652
406
71
1
11,513
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
33,615
9
3396315
00GX
Macomb County CMH Services
F
TANF
21,658
4,351
5,917
1,934
443
10
1724945
00HJ
Northcare
F
TANF
9,522
2,007
2,291
565
115
-
2
14,500
34,305
11
4476125
00HF
Northern Affiliation
F
TANF
10,896
2,047
2,373
681
105
-
16,102
12
4540048
00HC
Northern Lakes
F
TANF
10,015
2,016
2,270
570
113
1
14,985
13
1705289
0058
Oakland County CMH Authority
F
TANF
22,283
4,092
5,281
1,750
386
2
33,794
14
1712541
00HQ
Saginaw County CMH Authority
F
TANF
9,185
2,189
2,770
731
126
-
15
4390138
00HU
Southeast Partnership
F
TANF
16,634
3,330
4,054
1,001
197
-
16
3402136
00GR
Southwest Alliance
F
TANF
16,639
3,465
3,998
888
170
17
1708164
00HO
Thumb Mental Health Alliance
F
TANF
10,393
2,209
2,613
714
127
18
2920843
00HR
Venture Behavioral Health
F
TANF
19,557
4,046
4,656
1,081
211
15,001
25,216
1
-
25,161
16,056
2
29,553
-
19
20
State Subtotals
356,073
75,276
92,955
26,076
Check Values
Report Generated: 8/29/2008
12:08 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MHSA-Pop
5,481
29
555,890
-
Page 29 of 79
Mental Health - Revenue by PIHP by Age Group - State Plan - DAB - Male
M
DAB
July, 2008
Detail
Revenue for DAB Male by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
M
DAB
$
75,213
$
124,623
$
256,847
$
287,070
$
288,135
$
55,060
$
1,086,948
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
M
DAB
$
139,195
$
189,324
$
360,972
$
344,788
$
376,849
$
76,826
$
1,487,954
3
4344340
00GG
CMH for Central Michigan
M
DAB
$
52,533
$
88,783
$
157,799
$
197,900
$
203,063
$
34,446
$
734,524
4
4483587
00GS
CMHSA Network of West Michigan
M
DAB
$
169,828
$
222,342
$
398,496
$
377,891
$
403,796
$
81,486
$
1,653,839
5
3119549
00GJ
Detroit Wayne County CMH Agency
M
DAB
$
553,740
$
719,392
$
1,448,008
$
1,664,691
$
2,020,740
$
331,504
$
6,738,075
6
1705233
0028
Genesee County CMH Services
M
DAB
$
149,278
$
192,960
$
376,173
$
417,880
$
404,632
$
48,956
$
1,589,880
7
1712452
00HA
Lakeshore Behavioral Health Alliance
M
DAB
$
94,477
$
137,492
$
251,342
$
252,412
$
255,402
$
43,575
$
1,034,699
8
1712229
00GV
Lifeways
M
DAB
$
54,573
$
59,819
$
136,403
$
142,084
$
140,753
$
24,781
$
558,412
00GX
Macomb County CMH Services
M
DAB
$
205,132
$
300,493
$
533,706
$
565,497
$
618,091
$
189,938
$
2,412,857
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
10
1724945
00HJ
Northcare
M
DAB
$
66,809
$
125,847
$
256,977
$
307,158
$
333,491
$
96,578
$
1,186,860
11
4476125
00HF
Northern Affiliation
M
DAB
$
42,679
$
72,997
$
126,797
$
155,529
$
196,634
$
41,964
$
636,600
12
4540048
00HC
Northern Lakes
M
DAB
$
52,990
$
85,768
$
145,706
$
191,918
$
206,861
$
44,982
$
728,225
13
1705289
0058
Oakland County CMH Authority
M
DAB
$
276,795
$
395,699
$
812,699
$
781,958
$
866,044
$
291,489
$
3,424,684
14
1712541
00HQ
Saginaw County CMH Authority
M
DAB
$
69,182
$
75,482
$
163,023
$
185,171
$
169,984
$
26,829
$
689,671
15
4390138
00HU
Southeast Partnership
M
DAB
$
107,812
$
178,300
$
335,417
$
302,908
$
319,605
$
68,380
$
1,312,423
16
3402136
00GR
Southwest Alliance
M
DAB
$
120,311
$
151,804
$
286,201
$
312,039
$
333,508
$
56,361
$
1,260,223
17
1708164
00HO
Thumb Mental Health Alliance
M
DAB
$
86,241
$
131,920
$
237,918
$
270,547
$
274,523
$
49,774
$
1,050,921
18
2920843
00HR
Venture Behavioral Health
M
DAB
$
110,476
$
132,586
$
257,746
$
286,947
$
313,823
$
61,786
$
1,163,363
$
2,427,264
$
3,385,631
$
6,542,229
$
7,044,388
$
7,725,934
$
1,624,713
$
28,750,158
19
20
State Subtotals
Check Values
Report Generated: 8/29/2008
12:08 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
July, 2008
Detail
Revenue for DAB Female by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
F
DAB
$
34,861
$
80,248
$
191,524
$
236,313
$
282,312
$
81,151
$
906,410
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
F
DAB
$
66,850
$
122,354
$
261,860
$
320,075
$
400,611
$
109,098
$
1,280,847
3
4344340
00GG
CMH for Central Michigan
F
DAB
$
26,158
$
62,903
$
124,849
$
164,932
$
195,445
$
48,626
$
622,914
4
4483587
00GS
CMHSA Network of West Michigan
F
DAB
$
77,787
$
139,863
$
350,736
$
361,104
$
381,623
$
107,402
$
1,418,516
5
3119549
00GJ
Detroit Wayne County CMH Agency
F
DAB
$
266,683
$
460,602
$
1,048,276
$
1,304,017
$
1,872,132
$
447,715
$
5,399,425
6
1705233
0028
Genesee County CMH Services
F
DAB
$
73,252
$
127,823
$
301,725
$
390,782
$
409,527
$
76,525
$
1,379,635
7
1712452
00HA
Lakeshore Behavioral Health Alliance
F
DAB
$
45,387
$
89,861
$
219,099
$
254,102
$
291,374
$
74,660
$
974,483
8
1712229
00GV
Lifeways
F
DAB
$
25,497
$
42,753
$
101,022
$
114,278
$
140,471
$
34,577
$
458,598
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
$
101,964
$
198,425
$
418,906
$
527,847
$
730,761
$
276,457
$
2,254,360
10
1724945
00HJ
Northcare
F
DAB
$
30,541
$
83,145
$
188,271
$
248,605
$
328,244
$
143,236
$
1,022,041
11
4476125
00HF
Northern Affiliation
F
DAB
$
20,543
$
43,899
$
100,891
$
136,874
$
178,472
$
57,442
$
538,121
12
4540048
00HC
Northern Lakes
F
DAB
$
25,620
$
54,630
$
119,557
$
172,046
$
202,037
$
57,146
$
631,035
13
1705289
0058
Oakland County CMH Authority
F
DAB
$
146,525
$
253,084
$
577,083
$
706,197
$
938,073
$
403,099
$
3,024,061
14
1712541
00HQ
Saginaw County CMH Authority
F
DAB
$
30,725
$
50,326
$
138,942
$
152,921
$
172,979
$
39,562
$
585,456
15
4390138
00HU
Southeast Partnership
F
DAB
$
55,204
$
110,814
$
245,371
$
287,059
$
337,916
$
105,250
$
1,141,613
16
3402136
00GR
Southwest Alliance
F
DAB
$
59,135
$
97,951
$
250,764
$
282,740
$
332,818
$
86,774
$
1,110,182
17
1708164
00HO
Thumb Mental Health Alliance
F
DAB
$
43,925
$
77,259
$
172,664
$
219,437
$
282,681
$
78,374
$
874,340
18
2920843
00HR
Venture Behavioral Health
F
DAB
$
56,145
$
85,518
$
217,527
$
258,504
$
332,779
$
88,634
$
1,039,108
$
1,186,802
$
2,181,458
$
5,029,068
$
6,137,835
$
7,810,254
$
2,315,728
$
24,661,146
19
20
State Subtotals
Check Values
Report Generated: 8/29/2008
12:08 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
July, 2008
Detail
Revenue for TANF Male by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
M
TANF
$
205,676
$
14,977
$
18,584
$
9,667
$
1,828
$
-
$
250,731
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
M
TANF
$
268,369
$
17,052
$
20,745
$
10,372
$
1,690
$
-
$
318,228
3
4344340
00GG
CMH for Central Michigan
M
TANF
$
115,461
$
9,583
$
12,157
$
6,114
$
1,174
$
-
$
144,489
4
4483587
00GS
CMHSA Network of West Michigan
M
TANF
$
168,261
$
9,227
$
8,785
$
4,390
$
1,022
$
-
$
191,685
5
3119549
00GJ
Detroit Wayne County CMH Agency
M
TANF
$
727,429
$
49,511
$
31,837
$
24,062
$
7,367
$
-
$
840,207
6
1705233
0028
Genesee County CMH Services
M
TANF
$
143,819
$
9,638
$
12,224
$
5,682
$
969
$
-
$
172,333
7
1712452
00HA
Lakeshore Behavioral Health Alliance
M
TANF
$
95,760
$
5,380
$
5,527
$
2,987
$
524
$
-
$
110,178
8
1712229
00GV
Lifeways
M
TANF
$
85,031
$
5,153
$
5,530
$
2,871
$
460
$
-
$
99,045
00GX
Macomb County CMH Services
M
TANF
$
229,871
$
15,759
$
15,227
$
11,354
$
3,519
$
-
$
275,730
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
10
1724945
00HJ
Northcare
M
TANF
$
191,785
$
13,432
$
15,041
$
6,888
$
1,645
$
-
$
228,792
11
4476125
00HF
Northern Affiliation
M
TANF
$
87,643
$
6,531
$
7,658
$
3,997
$
809
$
-
$
106,638
12
4540048
00HC
Northern Lakes
M
TANF
$
154,336
$
11,289
$
12,709
$
6,543
$
1,191
$
-
$
186,068
13
1705289
0058
Oakland County CMH Authority
M
TANF
$
303,660
$
17,887
$
15,096
$
10,159
$
3,287
$
-
$
350,089
14
1712541
00HQ
Saginaw County CMH Authority
M
TANF
$
46,512
$
3,129
$
3,405
$
1,574
$
311
$
-
$
54,930
15
4390138
00HU
Southeast Partnership
M
TANF
$
170,564
$
10,357
$
10,578
$
5,622
$
1,170
$
-
$
198,291
16
3402136
00GR
Southwest Alliance
M
TANF
$
168,148
$
9,245
$
11,014
$
4,644
$
802
$
-
$
193,853
17
1708164
00HO
Thumb Mental Health Alliance
M
TANF
$
170,523
$
12,070
$
14,505
$
7,421
$
1,514
$
-
$
206,032
18
2920843
00HR
Venture Behavioral Health
M
TANF
$
158,094
$
9,713
$
10,893
$
5,823
$
1,137
$
-
$
185,659
$
3,490,942
$
229,932
$
231,514
$
130,169
$
30,419
$
-
$
4,112,976
19
20
State Subtotals
Check Values
Report Generated: 8/29/2008
12:08 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
July, 2008
Detail
Revenue for TANF Female by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
F
TANF
$
139,094
$
41,127
$
70,538
$
26,830
$
4,182
$
-
$
281,770
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
F
TANF
$
180,918
$
51,123
$
93,082
$
33,275
$
5,827
$
-
$
364,225
3
4344340
00GG
CMH for Central Michigan
F
TANF
$
77,775
$
25,648
$
43,365
$
16,460
$
2,260
$
-
$
165,508
4
4483587
00GS
CMHSA Network of West Michigan
F
TANF
$
115,758
$
32,204
$
54,558
$
18,912
$
3,382
$
-
$
224,814
5
3119549
00GJ
Detroit Wayne County CMH Agency
F
TANF
$
503,896
$
153,221
$
305,061
$
141,018
$
31,539
$
-
$
1,134,735
6
1705233
0028
Genesee County CMH Services
F
TANF
$
99,007
$
32,569
$
63,470
$
25,134
$
4,091
$
-
$
224,270
7
1712452
00HA
Lakeshore Behavioral Health Alliance
F
TANF
$
64,005
$
19,053
$
30,581
$
10,009
$
1,734
$
-
$
125,382
8
1712229
00GV
Lifeways
F
TANF
$
58,248
$
16,921
$
25,722
$
9,216
$
1,487
$
-
$
111,593
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
$
154,638
$
43,031
$
87,631
$
41,774
$
8,829
$
-
$
335,904
10
1724945
00HJ
Northcare
F
TANF
$
125,119
$
36,507
$
62,407
$
22,442
$
4,214
$
-
$
250,689
11
4476125
00HF
Northern Affiliation
F
TANF
$
59,819
$
15,557
$
27,005
$
11,298
$
1,607
$
-
$
115,285
12
4540048
00HC
Northern Lakes
F
TANF
$
103,255
$
28,788
$
48,533
$
17,773
$
3,250
$
-
$
201,598
13
1705289
0058
Oakland County CMH Authority
F
TANF
$
205,672
$
52,296
$
101,026
$
48,825
$
9,932
$
-
$
417,750
14
1712541
00HQ
Saginaw County CMH Authority
F
TANF
$
32,515
$
10,726
$
20,332
$
7,829
$
1,245
$
-
$
72,647
15
4390138
00HU
Southeast Partnership
F
TANF
$
116,604
$
32,301
$
58,905
$
21,201
$
3,849
$
-
$
232,861
16
3402136
00GR
Southwest Alliance
F
TANF
$
114,310
$
32,952
$
56,932
$
18,435
$
3,256
$
-
$
225,884
17
1708164
00HO
Thumb Mental Health Alliance
F
TANF
$
115,466
$
33,974
$
60,151
$
23,969
$
3,933
$
-
$
237,494
18
2920843
00HR
Venture Behavioral Health
F
TANF
$
107,955
$
30,952
$
53,311
$
18,053
$
3,249
$
-
$
213,520
$
2,374,053
$
688,950
$
1,262,608
$
512,454
$
97,863
$
-
$
4,935,928
19
20
State Subtotals
Check Values
Report Generated: 8/29/2008
12:08 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
July, 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
$
63,838
$
105,783
$
218,007
$
243,663
$
244,566
$
46,733
$
922,589
00BJ
CMH Affiliation of Mid-Michigan
M
DAB
$
118,136
$
160,694
$
306,384
$
292,659
$
319,858
$
65,217
$
1,262,949
00GG
CMH for Central Michigan
M
DAB
$
44,596
$
75,355
$
133,943
$
167,976
$
172,352
$
29,238
$
623,460
CMHSA Network of West Michigan
M
DAB
$
144,163
$
188,725
$
338,239
$
320,746
$
342,727
$
69,170
$
1,403,770
M
DAB
$
470,005
$
610,648
$
1,229,022
$
1,412,960
$
1,715,246
$
281,355
$
5,719,237
M
DAB
$
126,711
$
163,777
$
319,288
$
354,699
$
343,457
$
41,557
$
1,349,490
DAB
$
80,196
$
116,702
$
213,331
$
214,241
$
216,778
$
36,990
$
878,238
M
DAB
$
46,320
$
50,774
$
115,781
$
120,598
$
119,468
$
21,036
$
473,978
M
DAB
$
174,108
$
255,050
$
452,996
$
479,992
$
524,636
$
161,218
$
2,048,001
DAB
$
56,707
$
106,818
$
218,116
$
260,712
$
283,062
$
81,973
$
1,007,389
M
DAB
$
36,224
$
61,957
$
107,622
$
132,010
$
166,903
$
35,611
$
540,327
M
DAB
$
44,982
$
72,801
$
123,675
$
162,894
$
175,582
$
38,176
$
618,110
M
DAB
$
234,935
$
335,869
$
689,816
$
663,714
$
735,086
$
247,432
$
2,906,852
Saginaw County CMH Authority
M
DAB
$
58,728
$
64,068
$
138,373
$
157,178
$
144,282
$
22,771
$
585,399
Southeast Partnership
M
DAB
$
91,513
$
151,343
$
284,697
$
257,104
$
271,277
$
58,039
$
1,113,974
M
DAB
$
102,124
$
128,855
$
242,928
$
264,851
$
283,072
$
47,843
$
1,069,674
M
DAB
$
73,201
$
111,978
$
201,939
$
229,634
$
233,016
$
42,248
$
892,015
M
DAB
$
93,772
$
112,536
$
218,765
$
243,558
$
266,384
$
52,449
$
987,464
$
2,060,259
$
2,873,734
$
5,552,923
$
5,979,189
$
6,557,753
$
1,379,056
$
24,402,914
19
20
State Subtotals
Check Values
Report Generated: 8/29/2008
12:08 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
July, 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
$
29,588
$
68,112
$
162,563
$
200,577
$
239,618
$
68,874
$
769,332
00BJ
CMH Affiliation of Mid-Michigan
F
DAB
$
56,735
$
103,855
$
222,267
$
271,674
$
340,054
$
92,602
$
1,087,187
00GG
CMH for Central Michigan
F
DAB
$
22,198
$
53,390
$
105,974
$
139,994
$
165,889
$
41,279
$
528,723
CMHSA Network of West Michigan
F
DAB
$
66,028
$
118,713
$
297,700
$
306,497
$
323,942
$
91,167
$
1,204,047
F
DAB
$
226,316
$
390,952
$
889,778
$
1,106,881
$
1,589,102
$
380,129
$
4,583,158
F
DAB
$
62,170
$
108,490
$
256,100
$
331,684
$
347,608
$
64,958
$
1,171,010
DAB
$
38,523
$
76,272
$
185,972
$
215,681
$
247,314
$
63,365
$
827,127
F
DAB
$
21,642
$
36,290
$
85,745
$
96,999
$
119,233
$
29,352
$
389,262
F
DAB
$
86,551
$
168,424
$
355,565
$
448,034
$
620,268
$
234,641
$
1,913,482
DAB
$
25,921
$
70,571
$
159,800
$
211,012
$
278,612
$
121,567
$
867,482
F
DAB
$
17,433
$
37,263
$
85,640
$
116,178
$
151,484
$
48,749
$
456,748
F
DAB
$
21,747
$
46,374
$
101,480
$
146,029
$
171,496
$
48,500
$
535,625
F
DAB
$
124,374
$
214,816
$
489,835
$
599,416
$
796,222
$
342,181
$
2,566,843
Saginaw County CMH Authority
F
DAB
$
26,080
$
42,715
$
117,932
$
129,801
$
146,824
$
33,583
$
496,935
Southeast Partnership
F
DAB
$
46,846
$
94,053
$
208,265
$
243,647
$
286,833
$
89,338
$
968,982
F
DAB
$
50,197
$
83,143
$
212,847
$
239,986
$
282,488
$
73,674
$
942,335
F
DAB
$
37,282
$
65,574
$
146,553
$
186,256
$
239,944
$
66,519
$
742,128
F
DAB
$
47,642
$
72,587
$
184,640
$
219,412
$
282,464
$
75,231
$
881,976
$
1,007,272
$
1,851,593
$
4,268,655
$
5,209,758
$
6,629,394
$
1,965,710
$
20,932,382
19
20
State Subtotals
Check Values
Report Generated: 8/29/2008
12:08 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
July, 2008
Detail
Revenue for TANF Male by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
M
TANF
$
32,046
$
2,329
$
2,890
$
1,504
$
284
$
-
$
39,053
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
M
TANF
$
41,813
$
2,657
$
3,236
$
1,613
$
263
$
-
$
49,581
3
4344340
00GG
CMH for Central Michigan
M
TANF
$
17,961
$
1,494
$
1,896
$
952
$
183
$
-
$
22,486
4
4483587
00GS
CMHSA Network of West Michigan
M
TANF
$
26,149
$
1,433
$
1,365
$
683
$
159
$
-
$
29,788
5
3119549
00GJ
Detroit Wayne County CMH Agency
M
TANF
$
112,842
$
7,686
$
4,961
$
3,742
$
1,152
$
-
$
130,384
6
1705233
0028
Genesee County CMH Services
M
TANF
$
22,285
$
1,499
$
1,898
$
886
$
151
$
-
$
26,719
7
1712452
00HA
Lakeshore Behavioral Health Alliance
M
TANF
$
14,896
$
837
$
861
$
464
$
82
$
-
$
17,139
8
1712229
00GV
Lifeways
M
TANF
$
13,215
$
801
$
862
$
447
$
72
$
-
$
15,397
00GX
Macomb County CMH Services
M
TANF
$
35,778
$
2,445
$
2,372
$
1,771
$
549
$
-
$
42,914
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
10
1724945
00HJ
Northcare
M
TANF
$
29,817
$
2,088
$
2,341
$
1,072
$
257
$
-
$
35,575
11
4476125
00HF
Northern Affiliation
M
TANF
$
13,646
$
1,019
$
1,195
$
622
$
126
$
-
$
16,608
12
4540048
00HC
Northern Lakes
M
TANF
$
24,024
$
1,761
$
1,982
$
1,018
$
185
$
-
$
28,969
13
1705289
0058
Oakland County CMH Authority
M
TANF
$
47,333
$
2,778
$
2,354
$
1,579
$
512
$
-
$
54,555
14
1712541
00HQ
Saginaw County CMH Authority
M
TANF
$
7,205
$
487
$
532
$
244
$
49
$
-
$
8,517
15
4390138
00HU
Southeast Partnership
M
TANF
$
26,566
$
1,611
$
1,646
$
874
$
182
$
-
$
30,879
16
3402136
00GR
Southwest Alliance
M
TANF
$
26,209
$
1,440
$
1,711
$
723
$
125
$
-
$
30,209
17
1708164
00HO
Thumb Mental Health Alliance
M
TANF
$
26,571
$
1,882
$
2,260
$
1,156
$
235
$
-
$
32,104
18
2920843
00HR
Venture Behavioral Health
M
TANF
$
24,659
$
1,516
$
1,701
$
906
$
178
$
-
$
28,959
$
543,013
$
35,764
$
36,062
$
20,256
$
4,743
$
-
$
639,837
19
20
State Subtotals
Check Values
Report Generated: 8/29/2008
12:08 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
July, 2008
Detail
Revenue for TANF Female by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
F
TANF
$
21,658
$
6,405
$
10,989
$
4,178
$
651
$
-
$
43,880
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
F
TANF
$
28,152
$
7,943
$
14,486
$
5,174
$
908
$
-
$
56,664
3
4344340
00GG
CMH for Central Michigan
F
TANF
$
12,072
$
3,993
$
6,740
$
2,561
$
351
$
-
$
25,717
4
4483587
00GS
CMHSA Network of West Michigan
F
TANF
$
18,017
$
5,021
$
8,496
$
2,945
$
526
$
-
$
35,005
5
3119549
00GJ
Detroit Wayne County CMH Agency
F
TANF
$
78,451
$
23,844
$
47,565
$
21,953
$
4,918
$
-
$
176,731
6
1705233
0028
Genesee County CMH Services
F
TANF
$
15,342
$
5,055
$
9,872
$
3,917
$
636
$
-
$
34,822
7
1712452
00HA
Lakeshore Behavioral Health Alliance
F
TANF
$
9,937
$
2,955
$
4,749
$
1,557
$
270
$
-
$
19,468
8
1712229
00GV
Lifeways
F
TANF
$
9,075
$
2,636
$
3,998
$
1,433
$
231
$
-
$
17,373
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
$
24,040
$
6,701
$
13,668
$
6,498
$
1,373
$
-
$
52,281
10
1724945
00HJ
Northcare
F
TANF
$
19,520
$
5,680
$
9,714
$
3,492
$
656
$
-
$
39,061
11
4476125
00HF
Northern Affiliation
F
TANF
$
9,262
$
2,415
$
4,200
$
1,757
$
250
$
-
$
17,884
12
4540048
00HC
Northern Lakes
F
TANF
$
16,124
$
4,476
$
7,559
$
2,765
$
506
$
-
$
31,430
13
1705289
0058
Oakland County CMH Authority
F
TANF
$
32,088
$
8,143
$
15,737
$
7,595
$
1,548
$
-
$
65,111
14
1712541
00HQ
Saginaw County CMH Authority
F
TANF
$
5,052
$
1,664
$
3,158
$
1,221
$
194
$
-
$
11,288
15
4390138
00HU
Southeast Partnership
F
TANF
$
18,131
$
5,028
$
9,162
$
3,303
$
599
$
-
$
36,224
16
3402136
00GR
Southwest Alliance
F
TANF
$
17,804
$
5,128
$
8,876
$
2,868
$
507
$
-
$
35,182
17
1708164
00HO
Thumb Mental Health Alliance
F
TANF
$
17,980
$
5,280
$
9,355
$
3,734
$
612
$
-
$
36,960
18
2920843
00HR
Venture Behavioral Health
F
TANF
$
16,819
$
4,815
$
8,288
$
2,811
$
506
$
-
$
33,238
$
369,522
$
107,181
$
196,611
$
79,763
$
15,243
$
-
$
768,319
19
20
State Subtotals
Check Values
Report Generated: 8/29/2008
12:08 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MHB3-TANF
-
Page 37 of 79
Substance Abuse - Revenue by PIHP by Age Group - State Plan - DAB - Male
M
DAB
July, 2008
Detail
Revenue for DAB Male by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
M
DAB
$
913
$
2,169
$
2,722
$
5,177
$
6,302
$
330
$
17,611
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
M
DAB
$
1,508
$
2,960
$
3,426
$
5,576
$
7,395
$
414
$
21,279
3
4344340
00GG
CMH for Central Michigan
M
DAB
$
704
$
1,727
$
1,866
$
3,987
$
4,970
$
231
$
13,485
4
4483587
00GS
CMHSA Network of West Michigan
M
DAB
$
3,005
$
5,684
$
6,206
$
9,996
$
12,965
$
707
$
38,562
5
3119549
00GJ
Detroit Wayne County CMH Agency
M
DAB
$
17,267
$
32,311
$
39,577
$
77,389
$
113,966
$
5,102
$
285,613
6
1705233
0028
Genesee County CMH Services
M
DAB
$
3,508
$
6,533
$
7,749
$
14,646
$
17,197
$
566
$
50,199
7
1712452
00HA
Lakeshore Behavioral Health Alliance
M
DAB
$
1,407
$
2,959
$
3,285
$
5,619
$
6,900
$
319
$
20,489
8
1712229
00GV
Lifeways
M
DAB
$
781
$
1,228
$
1,707
$
3,027
$
3,638
$
175
$
10,556
00GX
Macomb County CMH Services
M
DAB
$
3,186
$
6,736
$
7,275
$
13,122
$
17,401
$
1,451
$
49,170
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
10
1724945
00HJ
Northcare
M
DAB
$
609
$
1,647
$
2,046
$
4,160
$
5,484
$
428
$
14,374
11
4476125
00HF
Northern Affiliation
M
DAB
$
782
$
1,937
$
2,046
$
4,280
$
6,557
$
381
$
15,983
12
4540048
00HC
Northern Lakes
M
DAB
$
713
$
1,666
$
1,720
$
3,858
$
5,046
$
299
$
13,303
13
1705289
0058
Oakland County CMH Authority
M
DAB
$
2,913
$
5,983
$
7,477
$
12,252
$
16,472
$
1,513
$
46,611
14
1712541
00HQ
Saginaw County CMH Authority
M
DAB
$
1,798
$
2,821
$
3,707
$
7,166
$
7,987
$
344
$
23,822
15
4390138
00HU
Southeast Partnership
M
DAB
$
1,302
$
3,082
$
3,533
$
5,431
$
6,953
$
409
$
20,710
16
3402136
00GR
Southwest Alliance
M
DAB
$
2,060
$
3,747
$
4,301
$
7,974
$
10,334
$
478
$
28,894
17
1708164
00HO
Thumb Mental Health Alliance
M
DAB
$
688
$
1,512
$
1,658
$
3,208
$
3,951
$
193
$
11,210
18
2920843
00HR
Venture Behavioral Health
M
DAB
$
1,705
$
2,943
$
3,483
$
6,612
$
8,762
$
463
$
23,967
$
44,847
$
87,644
$
103,782
$
193,479
$
262,280
$
13,803
$
705,835
19
20
State Subtotals
Check Values
Report Generated: 8/29/2008
12:08 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
July, 2008
Detail
Revenue for DAB Female by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
F
DAB
$
308
$
1,331
$
3,138
$
5,167
$
4,062
$
126
$
14,133
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
F
DAB
$
538
$
1,820
$
3,844
$
6,278
$
5,168
$
147
$
17,795
3
4344340
00GG
CMH for Central Michigan
F
DAB
$
259
$
1,167
$
2,286
$
4,033
$
3,146
$
70
$
10,960
4
4483587
00GS
CMHSA Network of West Michigan
F
DAB
$
1,017
$
3,409
$
8,428
$
11,586
$
8,089
$
232
$
32,760
5
3119549
00GJ
Detroit Wayne County CMH Agency
F
DAB
$
6,141
$
19,696
$
44,276
$
73,532
$
69,581
$
1,609
$
214,835
6
1705233
0028
Genesee County CMH Services
F
DAB
$
1,256
$
4,124
$
9,598
$
16,606
$
11,472
$
201
$
43,256
7
1712452
00HA
Lakeshore Behavioral Health Alliance
F
DAB
$
496
$
1,840
$
4,435
$
6,854
$
5,193
$
136
$
18,954
8
1712229
00GV
Lifeways
F
DAB
$
266
$
839
$
1,957
$
2,951
$
2,391
$
60
$
8,464
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
$
1,160
$
4,237
$
8,835
$
14,856
$
13,580
$
511
$
43,180
10
1724945
00HJ
Northcare
F
DAB
$
206
$
1,039
$
2,315
$
4,085
$
3,564
$
170
$
11,378
11
4476125
00HF
Northern Affiliation
F
DAB
$
281
$
1,111
$
2,523
$
4,564
$
3,932
$
125
$
12,536
12
4540048
00HC
Northern Lakes
F
DAB
$
251
$
1,007
$
2,185
$
4,191
$
3,246
$
96
$
10,976
13
1705289
0058
Oakland County CMH Authority
F
DAB
$
1,136
$
3,650
$
8,208
$
13,422
$
11,751
$
467
$
38,634
14
1712541
00HQ
Saginaw County CMH Authority
F
DAB
$
588
$
1,791
$
4,885
$
7,180
$
5,349
$
123
$
19,915
15
4390138
00HU
Southeast Partnership
F
DAB
$
485
$
1,828
$
3,999
$
6,243
$
4,841
$
150
$
17,547
16
3402136
00GR
Southwest Alliance
F
DAB
$
741
$
2,304
$
5,825
$
8,766
$
6,800
$
183
$
24,619
17
1708164
00HO
Thumb Mental Health Alliance
F
DAB
$
259
$
845
$
1,858
$
3,157
$
2,687
$
81
$
8,887
18
2920843
00HR
Venture Behavioral Health
F
DAB
$
640
$
1,816
$
4,555
$
7,225
$
6,135
$
146
$
20,518
$
16,029
$
53,855
$
123,149
$
200,696
$
170,988
$
4,633
$
569,349
19
20
State Subtotals
Check Values
Report Generated: 8/29/2008
12:08 PM
45,593,529
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
July, 2008
Detail
Revenue for TANF Male by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
M
TANF
$
5,525
$
2,263
$
4,638
$
2,620
$
754
$
-
$
15,801
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
M
TANF
$
5,333
$
1,935
$
3,886
$
2,111
$
523
$
-
$
13,789
3
4344340
00GG
CMH for Central Michigan
M
TANF
$
2,281
$
1,060
$
2,215
$
1,213
$
354
$
-
$
7,122
4
4483587
00GS
CMHSA Network of West Michigan
M
TANF
$
6,367
$
1,992
$
3,117
$
1,695
$
601
$
-
$
13,772
5
3119549
00GJ
Detroit Wayne County CMH Agency
M
TANF
$
20,150
$
7,686
$
8,144
$
6,693
$
3,118
$
-
$
45,792
6
1705233
0028
Genesee County CMH Services
M
TANF
$
10,111
$
3,811
$
7,973
$
4,033
$
1,047
$
-
$
26,974
7
1712452
00HA
Lakeshore Behavioral Health Alliance
M
TANF
$
5,472
$
1,706
$
2,892
$
1,702
$
454
$
-
$
12,226
8
1712229
00GV
Lifeways
M
TANF
$
3,540
$
1,197
$
2,115
$
1,196
$
291
$
-
$
8,339
00GX
Macomb County CMH Services
M
TANF
$
8,721
$
3,361
$
5,353
$
4,343
$
2,050
$
-
$
23,827
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
10
1724945
00HJ
Northcare
M
TANF
$
3,347
$
1,306
$
2,408
$
1,200
$
436
$
-
$
8,696
11
4476125
00HF
Northern Affiliation
M
TANF
$
3,439
$
1,459
$
2,821
$
1,605
$
494
$
-
$
9,819
12
4540048
00HC
Northern Lakes
M
TANF
$
3,224
$
1,328
$
2,470
$
1,382
$
383
$
-
$
8,786
13
1705289
0058
Oakland County CMH Authority
M
TANF
$
8,232
$
2,740
$
3,812
$
2,789
$
1,375
$
-
$
18,947
14
1712541
00HQ
Saginaw County CMH Authority
M
TANF
$
3,283
$
1,255
$
2,246
$
1,130
$
339
$
-
$
8,253
15
4390138
00HU
Southeast Partnership
M
TANF
$
5,922
$
2,023
$
3,406
$
1,969
$
624
$
-
$
13,944
16
3402136
00GR
Southwest Alliance
M
TANF
$
5,957
$
1,859
$
3,656
$
1,676
$
440
$
-
$
13,589
17
1708164
00HO
Thumb Mental Health Alliance
M
TANF
$
4,055
$
1,629
$
3,234
$
1,800
$
559
$
-
$
11,277
18
2920843
00HR
Venture Behavioral Health
M
TANF
$
6,165
$
2,143
$
3,964
$
2,308
$
685
$
-
$
15,265
$
111,123
$
40,754
$
68,351
$
41,465
$
14,526
$
-
$
276,218
19
20
State Subtotals
Check Values
Report Generated: 8/29/2008
12:08 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
July, 2008
Detail
Revenue for TANF Female by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
F
TANF
$
2,690
$
5,916
$
13,292
$
5,500
$
851
$
-
$
28,249
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
F
TANF
$
2,691
$
5,535
$
13,151
$
5,112
$
889
$
-
$
27,377
3
4344340
00GG
CMH for Central Michigan
F
TANF
$
1,106
$
2,699
$
5,972
$
2,470
$
337
$
-
$
12,584
4
4483587
00GS
CMHSA Network of West Michigan
F
TANF
$
3,153
$
6,604
$
14,637
$
5,525
$
982
$
-
$
30,901
5
3119549
00GJ
Detroit Wayne County CMH Agency
F
TANF
$
10,058
$
22,520
$
59,016
$
29,673
$
6,588
$
-
$
127,854
6
1705233
0028
Genesee County CMH Services
F
TANF
$
5,114
$
12,250
$
31,260
$
13,486
$
2,179
$
-
$
64,289
7
1712452
00HA
Lakeshore Behavioral Health Alliance
F
TANF
$
2,630
$
5,754
$
12,091
$
4,302
$
741
$
-
$
25,518
8
1712229
00GV
Lifeways
F
TANF
$
1,784
$
3,742
$
7,434
$
2,903
$
465
$
-
$
16,328
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
$
4,332
$
8,746
$
23,254
$
12,088
$
2,534
$
-
$
50,952
10
1724945
00HJ
Northcare
F
TANF
$
1,619
$
3,372
$
7,537
$
2,949
$
551
$
-
$
16,028
11
4476125
00HF
Northern Affiliation
F
TANF
$
1,743
$
3,316
$
7,522
$
3,425
$
484
$
-
$
16,491
12
4540048
00HC
Northern Lakes
F
TANF
$
1,602
$
3,226
$
7,128
$
2,839
$
515
$
-
$
15,310
13
1705289
0058
Oakland County CMH Authority
F
TANF
$
4,011
$
7,611
$
19,276
$
10,133
$
2,050
$
-
$
43,080
14
1712541
00HQ
Saginaw County CMH Authority
F
TANF
$
1,653
$
4,093
$
10,138
$
4,247
$
672
$
-
$
20,804
15
4390138
00HU
Southeast Partnership
F
TANF
$
2,994
$
5,994
$
14,311
$
5,616
$
1,013
$
-
$
29,927
16
3402136
00GR
Southwest Alliance
F
TANF
$
2,995
$
6,306
$
14,233
$
5,026
$
882
$
-
$
29,443
17
1708164
00HO
Thumb Mental Health Alliance
F
TANF
$
2,079
$
4,374
$
10,112
$
4,391
$
715
$
-
$
21,671
18
2920843
00HR
Venture Behavioral Health
F
TANF
$
3,129
$
6,514
$
14,666
$
5,405
$
966
$
-
$
30,681
$
55,383
$
118,570
$
285,030
$
125,089
$
23,413
$
-
$
607,486
19
20
State Subtotals
Check Values
Report Generated: 8/29/2008
12:08 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
July, 2008
Detail
Revenue for DAB Male by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
M
DAB
$
363
$
869
$
1,089
$
2,079
$
2,526
$
132
$
7,057
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
M
DAB
$
603
$
1,178
$
1,371
$
2,233
$
2,958
$
171
$
8,514
3
4344340
00GG
CMH for Central Michigan
M
DAB
$
282
$
691
$
750
$
1,601
$
1,995
$
95
$
5,414
4
4483587
00GS
CMHSA Network of West Michigan
M
DAB
$
1,207
$
2,274
$
2,491
$
4,015
$
5,205
$
291
$
15,484
5
3119549
00GJ
Detroit Wayne County CMH Agency
M
DAB
$
6,860
$
12,965
$
15,845
$
31,065
$
45,787
$
2,041
$
114,562
6
1705233
0028
Genesee County CMH Services
M
DAB
$
1,414
$
2,616
$
3,114
$
5,871
$
6,912
$
230
$
20,157
7
1712452
00HA
Lakeshore Behavioral Health Alliance
M
DAB
$
566
$
1,189
$
1,320
$
2,256
$
2,767
$
131
$
8,229
8
1712229
00GV
Lifeways
M
DAB
$
314
$
496
$
686
$
1,214
$
1,463
$
71
$
4,245
00GX
Macomb County CMH Services
M
DAB
$
1,278
$
2,705
$
2,917
$
5,269
$
6,982
$
580
$
19,731
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
$
662
$
823
$
1,669
$
2,203
$
176
$
5,778
11
4476125
00HF
Northern Affiliation
M
DAB
$
317
$
778
$
823
$
1,715
$
2,631
$
150
$
6,413
12
4540048
00HC
Northern Lakes
M
DAB
$
285
$
666
$
690
$
1,546
$
2,023
$
116
$
5,328
13
1705289
0058
Oakland County CMH Authority
M
DAB
$
1,175
$
2,396
$
3,007
$
4,916
$
6,616
$
610
$
18,720
14
1712541
00HQ
Saginaw County CMH Authority
M
DAB
$
719
$
1,130
$
1,486
$
2,871
$
3,205
$
138
$
9,548
15
4390138
00HU
Southeast Partnership
M
DAB
$
527
$
1,240
$
1,422
$
2,181
$
2,790
$
161
$
8,321
16
3402136
00GR
Southwest Alliance
M
DAB
$
816
$
1,505
$
1,727
$
3,194
$
4,152
$
187
$
11,582
17
1708164
00HO
Thumb Mental Health Alliance
M
DAB
$
277
$
607
$
667
$
1,287
$
1,588
$
80
$
4,505
18
2920843
00HR
Venture Behavioral Health
M
DAB
$
682
$
1,188
$
1,398
$
2,645
$
3,509
$
182
$
9,603
$
17,930
$
35,155
$
41,624
$
77,629
$
105,310
$
5,544
$
283,193
19
20
State Subtotals
Check Values
Report Generated: 8/29/2008
12:08 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
July, 2008
Detail
Revenue for DAB Female Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
F
DAB
$
125
$
534
$
1,261
$
2,069
$
1,637
$
50
$
5,676
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
F
DAB
$
208
$
731
$
1,549
$
2,511
$
2,067
$
74
$
7,140
3
4344340
00GG
CMH for Central Michigan
F
DAB
$
101
$
468
$
918
$
1,617
$
1,258
$
35
$
4,398
4
4483587
00GS
CMHSA Network of West Michigan
F
DAB
$
407
$
1,369
$
3,385
$
4,656
$
3,235
$
100
$
13,151
5
3119549
00GJ
Detroit Wayne County CMH Agency
F
DAB
$
2,456
$
7,878
$
17,737
$
29,512
$
27,900
$
715
$
86,199
6
1705233
0028
Genesee County CMH Services
F
DAB
$
499
$
1,652
$
3,861
$
6,671
$
4,619
$
75
$
17,377
7
1712452
00HA
Lakeshore Behavioral Health Alliance
F
DAB
$
201
$
734
$
1,774
$
2,754
$
2,081
$
45
$
7,589
8
1712229
00GV
Lifeways
F
DAB
$
109
$
337
$
783
$
1,182
$
965
$
24
$
3,399
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
$
464
$
1,697
$
3,542
$
5,967
$
5,438
$
204
$
17,313
10
1724945
00HJ
Northcare
F
DAB
$
83
$
415
$
930
$
1,640
$
1,433
$
68
$
4,569
11
4476125
00HF
Northern Affiliation
F
DAB
$
110
$
443
$
1,011
$
1,833
$
1,583
$
50
$
5,030
12
4540048
00HC
Northern Lakes
F
DAB
$
99
$
404
$
875
$
1,682
$
1,311
$
38
$
4,409
13
1705289
0058
Oakland County CMH Authority
F
DAB
$
447
$
1,468
$
3,298
$
5,391
$
4,707
$
200
$
15,512
14
1712541
00HQ
Saginaw County CMH Authority
F
DAB
$
239
$
716
$
1,961
$
2,876
$
2,146
$
46
$
7,983
15
4390138
00HU
Southeast Partnership
F
DAB
$
194
$
737
$
1,608
$
2,508
$
1,954
$
60
$
7,061
16
3402136
00GR
Southwest Alliance
F
DAB
$
302
$
927
$
2,340
$
3,520
$
2,733
$
79
$
9,901
17
1708164
00HO
Thumb Mental Health Alliance
F
DAB
$
105
$
338
$
747
$
1,267
$
1,080
$
32
$
3,569
18
2920843
00HR
Venture Behavioral Health
F
DAB
$
249
$
722
$
1,828
$
2,900
$
2,466
$
73
$
8,239
$
6,398
$
21,572
$
49,407
$
80,556
$
68,614
$
1,969
$
228,516
19
20
State Subtotals
Check Values
Report Generated: 8/29/2008
12:08 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
July, 2008
Detail
Revenue for TANF Male by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
M
TANF
$
2,486
$
1,014
$
2,084
$
1,177
$
339
$
-
$
7,100
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
M
TANF
$
2,347
$
873
$
1,743
$
949
$
235
$
-
$
6,146
3
4344340
00GG
CMH for Central Michigan
M
TANF
$
1,045
$
478
$
998
$
547
$
159
$
-
$
3,228
4
4483587
00GS
CMHSA Network of West Michigan
M
TANF
$
2,956
$
897
$
1,404
$
764
$
270
$
-
$
6,292
5
3119549
00GJ
Detroit Wayne County CMH Agency
M
TANF
$
9,068
$
3,459
$
3,665
$
3,023
$
1,406
$
-
$
20,620
6
1705233
0028
Genesee County CMH Services
M
TANF
$
4,539
$
1,718
$
3,589
$
1,814
$
471
$
-
$
12,132
7
1712452
00HA
Lakeshore Behavioral Health Alliance
M
TANF
$
2,432
$
765
$
1,303
$
764
$
204
$
-
$
5,468
8
1712229
00GV
Lifeways
M
TANF
$
1,573
$
538
$
952
$
537
$
131
$
-
$
3,732
00GX
Macomb County CMH Services
M
TANF
$
4,025
$
1,516
$
2,409
$
1,953
$
920
$
-
$
10,824
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
10
1724945
00HJ
Northcare
M
TANF
$
1,521
$
583
$
1,081
$
540
$
196
$
-
$
3,921
11
4476125
00HF
Northern Affiliation
M
TANF
$
1,553
$
656
$
1,268
$
721
$
223
$
-
$
4,421
12
4540048
00HC
Northern Lakes
M
TANF
$
1,456
$
596
$
1,106
$
621
$
172
$
-
$
3,951
13
1705289
0058
Oakland County CMH Authority
M
TANF
$
3,659
$
1,232
$
1,715
$
1,254
$
617
$
-
$
8,477
14
1712541
00HQ
Saginaw County CMH Authority
M
TANF
$
1,459
$
562
$
1,008
$
508
$
152
$
-
$
3,690
15
4390138
00HU
Southeast Partnership
M
TANF
$
2,707
$
911
$
1,531
$
886
$
281
$
-
$
6,317
16
3402136
00GR
Southwest Alliance
M
TANF
$
2,723
$
838
$
1,646
$
754
$
198
$
-
$
6,159
17
1708164
00HO
Thumb Mental Health Alliance
M
TANF
$
1,814
$
733
$
1,454
$
808
$
251
$
-
$
5,060
18
2920843
00HR
Venture Behavioral Health
M
TANF
$
2,784
$
969
$
1,781
$
1,038
$
308
$
-
$
6,880
$
50,148
$
18,340
$
30,737
$
18,658
$
6,533
$
-
$
124,416
19
20
State Subtotals
Check Values
Report Generated: 8/29/2008
12:08 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
July, 2008
Detail
Revenue for TANF Female by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
F
TANF
$
1,211
$
2,671
$
5,955
$
2,471
$
383
$
-
$
12,690
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
F
TANF
$
1,242
$
2,493
$
5,908
$
2,304
$
399
$
-
$
12,345
3
4344340
00GG
CMH for Central Michigan
F
TANF
$
461
$
1,207
$
2,676
$
1,109
$
152
$
-
$
5,605
4
4483587
00GS
CMHSA Network of West Michigan
F
TANF
$
1,351
$
2,985
$
6,551
$
2,483
$
441
$
-
$
13,811
5
3119549
00GJ
Detroit Wayne County CMH Agency
F
TANF
$
5,029
$
10,156
$
26,425
$
13,302
$
2,955
$
-
$
57,867
6
1705233
0028
Genesee County CMH Services
F
TANF
$
2,250
$
5,493
$
14,048
$
6,065
$
979
$
-
$
28,835
7
1712452
00HA
Lakeshore Behavioral Health Alliance
F
TANF
$
1,169
$
2,578
$
5,422
$
1,935
$
334
$
-
$
11,439
8
1712229
00GV
Lifeways
F
TANF
$
776
$
1,676
$
3,337
$
1,303
$
209
$
-
$
7,300
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
$
1,949
$
3,916
$
10,473
$
5,435
$
1,139
$
-
$
22,911
10
1724945
00HJ
Northcare
F
TANF
$
667
$
1,505
$
3,391
$
1,328
$
247
$
-
$
7,137
11
4476125
00HF
Northern Affiliation
F
TANF
$
763
$
1,494
$
3,370
$
1,539
$
217
$
-
$
7,383
12
4540048
00HC
Northern Lakes
F
TANF
$
701
$
1,452
$
3,201
$
1,277
$
232
$
-
$
6,862
13
1705289
0058
Oakland County CMH Authority
F
TANF
$
1,783
$
3,437
$
8,661
$
4,550
$
923
$
-
$
19,353
14
1712541
00HQ
Saginaw County CMH Authority
F
TANF
$
735
$
1,839
$
4,543
$
1,908
$
301
$
-
$
9,325
15
4390138
00HU
Southeast Partnership
F
TANF
$
1,331
$
2,697
$
6,446
$
2,523
$
455
$
-
$
13,451
16
3402136
00GR
Southwest Alliance
F
TANF
$
1,331
$
2,841
$
6,397
$
2,256
$
396
$
-
$
13,221
17
1708164
00HO
Thumb Mental Health Alliance
F
TANF
$
935
$
1,966
$
4,547
$
1,971
$
321
$
-
$
9,740
18
2920843
00HR
Venture Behavioral Health
F
TANF
$
1,369
$
2,913
$
6,612
$
2,432
$
435
$
-
$
13,761
$
25,052
$
53,319
$
127,961
$
56,189
$
10,517
$
-
$
273,038
19
20
State Subtotals
Check Values
Report Generated: 8/29/2008
12:08 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
July, 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
211
133
-
-
344
$
914,434
$
574,157
$
-
$
-
$
1,488,591
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
214
131
-
-
345
$
987,796
$
621,246
$
-
$
-
$
1,609,042
3
4344340
00GG
CMH for Central Michigan
297
210
1
-
508
$
1,060,836
$
739,060
$
2,184
$
-
$
1,802,080
4
4483587
00GS
CMHSA Network of West Michigan
101
60
-
-
161
$
363,319
$
221,057
$
-
$
-
$
584,376
5
3119549
00GJ
Detroit Wayne County CMH Agency
613
497
-
-
1,110
$
2,992,139
$
2,428,915
$
-
$
-
$
5,421,054
6
1705233
0028
Genesee County CMH Services
207
143
1
-
351
$
739,835
$
527,637
$
1,914
$
-
$
1,269,386
7
1712452
00HA
Lakeshore Behavioral Health Alliance
118
103
-
-
221
$
534,443
$
469,223
$
-
$
-
$
1,003,666
8
1712229
00GV
Lifeways
158
93
-
-
251
$
352,933
$
207,000
$
-
$
-
$
559,933
9
3396315
00GX
Macomb County CMH Services
253
181
4
3
441
$
898,661
$
629,388
$
9,917
$
6,243
$
1,544,208
10
1724945
00HJ
Northcare
225
128
2
-
355
$
1,112,965
$
634,711
$
7,084
$
-
$
1,754,760
11
4476125
00HF
Northern Affiliation
247
154
-
-
401
$
1,289,166
$
766,683
$
-
$
-
$
2,055,849
12
4540048
00HC
Northern Lakes
91
72
1
-
164
$
393,863
$
326,733
$
3,547
$
-
$
724,144
13
1705289
0058
Oakland County CMH Authority
422
328
-
1
751
$
2,075,761
$
1,609,676
$
-
$
2,607
$
3,688,044
14
1712541
00HQ
Saginaw County CMH Authority
65
40
-
-
105
$
343,284
$
217,091
$
-
$
-
$
560,375
15
4390138
00HU
Southeast Partnership
371
273
-
1
645
$
1,454,220
$
1,040,387
$
-
$
2,720
$
2,497,327
16
3402136
00GR
Southwest Alliance
251
186
-
1
438
$
905,221
$
670,035
$
-
$
1,788
$
1,577,044
17
1708164
00HO
Thumb Mental Health Alliance
161
92
-
-
253
$
831,567
$
489,123
$
-
$
-
$
1,320,690
18
2920843
00HR
Venture Behavioral Health
169
133
-
-
302
$
733,832
$
566,761
$
-
$
-
$
1,300,593
Male
Female
Male
Total
Enrollees
Female
Male
Female
Male
Female
19
-
$
-
20
-
$
-
State Subtotals
4,174
2,957
7,131
9
6
7,146
15
-
$
17,984,277
$
12,738,882
30,723,158
$
24,646
$
13,359
$
30,761,163
38,005
$
30,761,163
(1.00)
Report Generated: 8/29/2008
12:08 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
July, 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
13
-
13
1708001
00BJ
19
CLINTON
33
INGHAM
1
-
-
14
1708001
00BJ
23
EATON
19
CLINTON
3
1
-
15
1708001
00BJ
23
EATON
23
EATON
37
14
16
1708001
00BJ
23
EATON
33
INGHAM
3
3
17
1708001
00BJ
29
GRATIOT
29
GRATIOT
19
18
1708001
00BJ
33
INGHAM
19
CLINTON
19
1708001
00BJ
33
INGHAM
23
EATON
20
1708001
00BJ
33
INGHAM
33
INGHAM
21
1708001
00BJ
33
INGHAM
37
ISABELLA
22
1708001
00BJ
34
IONIA
11
BERRIEN
-
1
-
23
1708001
00BJ
34
IONIA
34
IONIA
18
12
-
24
1708001
00BJ
34
IONIA
37
ISABELLA
1
-
-
25
1708001
00BJ
34
IONIA
59
MONTCALM
2
1
-
26
1708001
00BJ
34
IONIA
69
OTSEGO
1
-
-
27
1708001
00BJ
51
MANISTEE
10
BENZIE
-
1
-
28
1708001
00BJ
51
MANISTEE
37
ISABELLA
1
-
-
29
1708001
00BJ
51
MANISTEE
51
MANISTEE
23
26
30
1708001
00BJ
62
NEWAYGO
62
NEWAYGO
10
10
31
1705322
00GE
06
ARENAC
06
ARENAC
11
32
1705322
00GE
06
ARENAC
09
BAY
33
1705322
00GE
09
BAY
06
ARENAC
34
1705322
00GE
09
BAY
09
35
1705322
00GE
09
BAY
73
Provider ID
Billing
Agent
Code F
1
1705233
0028
2
1705233
3
1705233
4
Report Generated: 8/29/2008
12:08 PM
Male
Female
207
1
141
Male
Female
1
-
Total
Enrollees
Male
349
$
-
1
$
-
1
$
10
$
-
-
-
323
-
1
-
1
-
12
4
-
TANF Capitation
Female
739,835
Male
Total Capitation
Female
$
517,637
$
1,914
$
-
$
1,259,386
-
$
4,252
$
-
$
-
$
4,252
-
$
5,748
$
-
$
-
$
5,748
19,868
$
13,687
$
-
$
-
$
33,555
-
1
$
3,406
$
739
$
2,052,487
$
$
-
$
-
$
3,406
1,591,433
$
-
$
2,607
$
3,646,527
-
1
$
-
-
16
$
62,698
$
4,557
$
-
$
-
$
4,557
$
20,499
$
-
$
-
$
83,197
-
1
$
3,400
-
7
$
15,952
$
-
$
-
$
-
$
3,400
$
19,368
$
-
$
-
$
35,320
-
1
$
4,928
-
34
$
91,088
$
-
$
-
$
-
$
4,928
$
59,237
$
-
$
-
$
150,325
-
1
$
4,557
-
4
$
13,670
$
-
$
-
$
-
$
4,557
$
4,557
$
-
$
-
$
18,227
-
-
51
$
-
-
6
$
166,419
$
61,493
$
-
$
-
$
227,911
13,660
$
12,520
$
-
$
-
$
7
-
-
26
26,180
$
91,279
$
33,097
$
-
$
-
$
124,377
7
2
-
-
5
1
-
-
9
$
34,179
$
9,113
$
-
$
-
$
43,292
6
$
21,633
$
4,557
$
-
$
-
$
44
31
-
26,190
-
75
$
204,825
$
144,223
$
-
$
-
$
349,048
1
-
-
-
1
$
3,400
$
-
$
-
$
-
$
3,400
-
1
$
-
$
4,153
$
-
$
-
$
4,153
-
30
$
82,137
$
62,646
$
-
$
-
$
144,783
-
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
13
-
-
24
$
45,679
$
52,936
$
-
$
-
$
98,615
1
1
-
-
2
$
5,192
$
4,153
$
-
$
-
$
9,345
1
-
-
-
1
$
4,153
$
-
$
-
$
-
$
4,153
BAY
80
59
-
-
139
$
353,479
$
262,871
$
-
$
-
$
616,350
SAGINAW
-
1
-
-
1
$
$
5,244
$
-
$
-
$
5,244
415
-
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
July, 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
DAB Capitation
Total
Enrollees
TANF Capitation
Total Capitation
Provider ID
Billing
Agent
Code F
36
1705322
00GE
09
BAY
79
TUSCOLA
1
-
-
-
1
$
5,748
$
-
$
-
$
-
$
5,748
37
1705322
00GE
32
HURON
32
HURON
35
16
-
-
51
$
142,830
$
60,116
$
-
$
-
$
202,946
38
1705322
00GE
59
MONTCALM
33
INGHAM
-
1
-
-
1
$
-
$
6,307
$
-
$
-
$
6,307
39
1705322
00GE
59
MONTCALM
34
IONIA
-
1
-
-
1
$
-
$
4,928
$
-
$
-
$
4,928
40
1705322
00GE
59
MONTCALM
41
KENT
1
3
-
-
4
$
3,639
$
11,215
$
-
$
-
$
14,854
41
1705322
00GE
59
MONTCALM
59
MONTCALM
17
5
-
-
22
$
71,950
$
21,102
$
-
$
-
$
93,052
42
1705322
00GE
78
SHIAWASSEE
33
INGHAM
-
1
-
-
1
$
-
$
5,698
$
-
$
-
$
5,698
43
1705322
00GE
78
SHIAWASSEE
78
SHIAWASSEE
28
15
-
-
43
$
132,977
$
70,042
$
-
$
-
$
203,019
44
1705322
00GE
79
TUSCOLA
79
TUSCOLA
36
17
-
-
53
$
148,786
$
69,546
$
-
$
-
$
218,332
45
4344340
00GG
18
CLARE
18
CLARE
39
35
-
-
74
$
131,720
$
118,373
$
-
$
-
$
250,093
46
4344340
00GG
18
CLARE
37
ISABELLA
1
-
-
-
1
$
3,400
$
-
$
-
$
-
$
3,400
47
4344340
00GG
18
CLARE
67
OSCEOLA
1
1
-
-
2
$
2,542
$
3,400
$
-
$
-
$
5,942
48
4344340
00GG
26
GLADWIN
18
CLARE
2
-
-
-
2
$
6,800
$
-
$
-
$
-
$
6,800
49
4344340
00GG
26
GLADWIN
26
GLADWIN
18
10
-
-
28
$
65,434
$
36,819
$
-
$
-
$
102,252
50
4344340
00GG
26
GLADWIN
40
KALKASKA
-
1
-
-
1
$
-
$
4,957
$
-
$
-
$
4,957
51
4344340
00GG
37
ISABELLA
18
CLARE
1
-
-
-
1
$
3,400
$
-
$
-
$
-
$
3,400
52
4344340
00GG
37
ISABELLA
25
GENESEE
-
1
-
-
1
$
-
$
4,551
$
-
$
-
$
4,551
53
4344340
00GG
37
ISABELLA
37
ISABELLA
92
77
-
-
169
$
332,392
$
278,119
$
-
$
-
$
610,511
54
4344340
00GG
37
ISABELLA
54
MECOSTA
1
-
-
-
1
$
3,400
$
-
$
-
$
-
$
3,400
55
4344340
00GG
54
MECOSTA
26
GLADWIN
1
-
-
-
1
$
3,678
$
-
$
-
$
-
$
3,678
56
4344340
00GG
54
MECOSTA
54
MECOSTA
35
27
-
-
62
$
117,885
$
87,471
$
-
$
-
$
205,356
57
4344340
00GG
54
MECOSTA
56
MIDLAND
1
-
-
-
1
$
3,400
$
-
$
-
$
-
$
3,400
58
4344340
00GG
54
MECOSTA
59
MONTCALM
-
-
1
-
1
$
-
$
-
$
2,184
$
-
$
2,184
59
4344340
00GG
56
MIDLAND
18
CLARE
1
-
-
-
1
$
4,252
$
-
$
-
$
-
$
4,252
60
4344340
00GG
56
MIDLAND
26
GLADWIN
-
1
-
-
1
$
-
$
2,542
$
-
$
-
$
2,542
61
4344340
00GG
56
MIDLAND
37
ISABELLA
1
1
-
-
2
$
4,252
$
4,252
$
-
$
-
$
8,503
62
4344340
00GG
56
MIDLAND
54
MECOSTA
1
-
-
-
1
$
3,400
$
-
$
-
$
-
$
3,400
63
4344340
00GG
56
MIDLAND
56
MIDLAND
79
41
-
-
120
$
289,680
$
151,228
$
-
$
-
$
440,907
64
4344340
00GG
56
MIDLAND
80
VAN BUREN
-
1
-
-
1
$
-
$
4,153
$
-
$
-
$
4,153
65
4344340
00GG
67
OSCEOLA
43
LAKE
1
-
-
-
1
$
6,307
$
-
$
-
$
-
$
6,307
66
4344340
00GG
67
OSCEOLA
54
MECOSTA
1
-
-
-
1
$
3,400
$
-
$
-
$
-
$
3,400
67
4344340
00GG
67
OSCEOLA
67
OSCEOLA
20
13
-
-
33
$
71,342
$
39,044
$
-
$
-
$
110,386
68
4344340
00GG
67
OSCEOLA
80
VAN BUREN
1
1
-
-
2
$
4,153
$
4,153
$
-
$
-
$
8,305
69
3119549
00GJ
82
WAYNE
24
EMMET
1
-
-
-
1
$
4,957
$
-
$
-
$
-
$
4,957
70
3119549
00GJ
82
WAYNE
33
INGHAM
2
-
-
-
2
$
9,485
$
-
$
-
$
-
$
9,485
County Name - COFR Code R
Report Generated: 8/29/2008
12:08 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
Page 48 of 79
Habilitation Supports Waiver - Capitation by County
July, 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
37
ISABELLA
1
-
-
-
1
$
4,707
$
-
$
-
$
-
$
4,707
82
WAYNE
50
MACOMB
-
1
-
-
1
$
-
$
2,476
$
-
$
-
$
2,476
00GJ
82
WAYNE
56
MIDLAND
-
1
-
-
1
$
-
$
4,707
$
-
$
-
$
4,707
3119549
00GJ
82
WAYNE
63
OAKLAND
1
2
-
-
3
$
6,198
$
9,066
$
-
$
-
$
15,264
75
3119549
00GJ
82
WAYNE
81
WASHTENAW
-
76
3119549
00GJ
82
WAYNE
82
WAYNE
77
3402136
00GR
03
ALLEGAN
03
78
3402136
00GR
03
ALLEGAN
39
79
3402136
00GR
03
ALLEGAN
80
3402136
00GR
03
81
3402136
00GR
82
3402136
00GR
83
3402136
84
85
Provider ID
Billing
Agent
Code F
71
3119549
00GJ
72
3119549
00GJ
73
3119549
74
Male
Female
Female
Male
Female
Male
Female
1
-
-
1
$
$
2,720
$
-
$
-
$
2,720
608
492
-
-
1,100
$
2,966,793
$
2,409,946
$
-
$
-
$
5,376,739
ALLEGAN
55
52
-
1
108
$
190,042
$
182,412
$
-
$
1,788
$
374,242
KALAMAZOO
-
2
-
-
2
$
-
$
6,793
$
-
$
-
$
6,793
70
OTTAWA
-
1
-
-
1
$
-
$
4,928
$
-
$
-
$
4,928
ALLEGAN
80
VAN BUREN
2
-
-
-
2
$
10,385
$
-
$
-
$
-
$
10,385
14
CASS
14
CASS
8
-
-
19
$
34,925
$
23,873
$
-
$
-
$
58,797
14
CASS
38
JACKSON
1
-
-
-
1
$
2,273
$
-
$
-
$
-
$
2,273
00GR
14
CASS
39
KALAMAZOO
1
-
-
-
1
$
3,400
$
-
$
-
$
-
$
3,400
3402136
00GR
39
KALAMAZOO
03
ALLEGAN
1
-
-
-
1
$
3,678
$
-
$
-
$
-
$
3,678
3402136
00GR
39
KALAMAZOO
12
BRANCH
-
1
-
-
1
$
-
$
5,748
$
-
$
-
$
5,748
86
3402136
00GR
39
KALAMAZOO
18
CLARE
-
1
-
-
1
$
-
$
2,924
$
-
$
-
$
2,924
87
3402136
00GR
39
KALAMAZOO
34
IONIA
-
1
-
-
1
$
-
$
6,307
$
-
$
-
$
6,307
88
3402136
00GR
39
KALAMAZOO
39
KALAMAZOO
100
-
-
251
$
562,813
$
370,116
$
-
$
-
$
932,928
89
3402136
00GR
39
KALAMAZOO
41
KENT
1
-
-
-
1
$
1,914
$
-
$
-
$
-
$
1,914
90
3402136
00GR
39
KALAMAZOO
81
WASHTENAW
1
-
-
-
1
$
3,936
$
-
$
-
$
-
$
3,936
91
3402136
00GR
75
ST JOSEPH
03
ALLEGAN
1
-
-
-
1
$
3,400
$
-
$
-
$
-
$
3,400
92
3402136
00GR
75
ST JOSEPH
12
BRANCH
1
2
-
-
3
$
4,153
$
8,305
$
-
$
-
$
12,458
93
3402136
00GR
75
ST JOSEPH
75
ST JOSEPH
24
18
-
-
42
$
80,150
$
58,628
$
-
$
-
$
138,778
94
3402136
00GR
75
ST JOSEPH
80
VAN BUREN
1
-
-
-
1
$
4,153
$
-
$
-
$
-
$
4,153
95
4483587
00GS
41
KENT
41
KENT
101
60
-
-
161
$
363,319
$
221,057
$
-
$
-
$
584,376
96
1712229
00GV
30
HILLSDALE
30
HILLSDALE
40
20
-
-
60
$
92,267
$
47,122
$
-
$
-
$
139,389
97
1712229
00GV
30
HILLSDALE
38
JACKSON
1
2
-
-
3
$
1,699
$
4,546
$
-
$
-
$
6,244
98
1712229
00GV
38
JACKSON
30
HILLSDALE
2
2
-
-
4
$
5,115
$
4,731
$
-
$
-
$
9,845
99
1712229
00GV
38
JACKSON
38
JACKSON
115
69
-
-
184
$
253,853
$
150,602
$
-
$
-
$
404,454
100
3396315
00GX
50
MACOMB
50
MACOMB
219
158
4
2
383
$
720,780
$
519,988
$
9,917
$
3,485
$
1,254,169
101
3396315
00GX
50
MACOMB
63
OAKLAND
33
23
-
-
56
$
174,310
$
109,400
$
-
$
-
$
283,710
102
3396315
00GX
50
MACOMB
74
ST CLAIR
-
-
-
1
1
$
-
$
-
$
-
$
2,758
$
2,758
103
3396315
00GX
50
MACOMB
79
TUSCOLA
1
-
-
-
1
$
3,572
$
-
$
-
$
-
$
3,572
104
1712452
00HA
61
MUSKEGON
61
MUSKEGON
73
57
-
-
130
$
331,418
$
258,581
$
-
$
-
$
589,999
105
1712452
00HA
70
OTTAWA
03
ALLEGAN
-
1
-
-
1
$
$
4,252
$
-
$
-
$
4,252
Report Generated: 8/29/2008
12:08 PM
-
Male
11
151
-
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
July, 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
Male
70
OTTAWA
39
KALAMAZOO
-
1
-
-
1
$
-
$
3,678
$
-
$
-
$
70
OTTAWA
61
MUSKEGON
1
-
-
-
1
$
4,928
$
-
$
-
$
-
$
4,928
70
OTTAWA
70
OTTAWA
43
44
-
-
87
$
193,944
$
$
-
$
-
$
396,657
VAN BUREN
1
-
-
-
1
$
4,153
$
-
$
-
$
-
$
4,153
CRAWFORD
2
7
1
-
10
$
7,963
$
34,248
$
3,547
$
-
$
45,758
1
1
-
-
2
$
3,406
$
3,406
$
-
$
-
$
6,812
Provider ID
Billing
Agent
Code F
106
1712452
00HA
107
1712452
00HA
108
1712452
00HA
109
1712452
00HA
70
OTTAWA
80
110
4540048
00HC
20
CRAWFORD
20
111
4540048
00HC
20
CRAWFORD
72
ROSCOMMON
112
4540048
00HC
28
GRAND TRAVERSE
03
ALLEGAN
113
4540048
00HC
28
GRAND TRAVERSE
28
GRAND TRAVERSE
114
4540048
00HC
43
LAKE
43
LAKE
4
1
-
115
4540048
00HC
43
LAKE
64
OCEANA
1
-
-
116
4540048
00HC
45
LEELANAU
28
GRAND TRAVERSE
1
2
-
117
4540048
00HC
45
LEELANAU
45
LEELANAU
5
3
118
4540048
00HC
53
MASON
53
MASON
8
1
119
4540048
00HC
53
MASON
61
MUSKEGON
-
1
-
120
4540048
00HC
57
MISSAUKEE
57
MISSAUKEE
1
1
-
121
4540048
00HC
64
OCEANA
28
GRAND TRAVERSE
-
1
-
122
4540048
00HC
64
OCEANA
64
OCEANA
9
4
-
123
4540048
00HC
72
ROSCOMMON
09
BAY
-
1
-
124
4540048
00HC
72
ROSCOMMON
30
HILLSDALE
1
-
-
125
4540048
00HC
72
ROSCOMMON
72
ROSCOMMON
6
13
-
126
4540048
00HC
72
ROSCOMMON
83
WEXFORD
1
1
127
4540048
00HC
83
WEXFORD
54
MECOSTA
1
-
128
4540048
00HC
83
WEXFORD
57
MISSAUKEE
9
3
129
4540048
00HC
83
WEXFORD
67
OSCEOLA
5
-
-
130
4540048
00HC
83
WEXFORD
72
ROSCOMMON
-
2
-
131
4540048
00HC
83
WEXFORD
83
WEXFORD
14
6
-
132
4476125
00HF
01
ALCONA
01
ALCONA
12
7
133
4476125
00HF
01
ALCONA
04
ALPENA
1
-
134
4476125
00HF
01
ALCONA
60
MONTMORENCY
1
135
4476125
00HF
04
ALPENA
01
ALCONA
136
4476125
00HF
04
ALPENA
04
ALPENA
137
4476125
00HF
04
ALPENA
09
138
4476125
00HF
04
ALPENA
25
139
4476125
00HF
04
ALPENA
140
4476125
00HF
04
ALPENA
Report Generated: 8/29/2008
12:08 PM
Female
Male
Female
Male
Female
Male
202,712
-
Female
3,678
1
-
-
-
1
$
3,678
$
$
-
$
-
$
3,678
21
24
-
-
45
$
96,015
$
109,924
$
-
$
-
$
205,939
-
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
-
-
9
$
31,585
$
4,557
$
-
$
-
$
36,142
-
1
$
-
$
4,557
$
-
$
-
$
4,557
-
2
$
4,557
$
3,406
$
-
$
-
$
7,963
-
1
$
-
$
4,557
$
-
$
-
$
4,557
-
13
$
41,382
$
18,227
$
-
$
-
$
59,609
-
1
$
-
$
4,153
$
-
$
-
$
4,153
-
1
$
2,458
$
-
$
-
$
-
$
2,458
-
19
$
30,232
$
59,609
$
-
$
-
$
89,841
-
-
2
$
3,406
$
4,557
$
-
$
-
$
7,963
-
-
1
$
3,678
$
-
$
-
$
-
$
3,678
-
-
12
$
41,010
$
13,670
$
-
$
-
$
54,680
-
5
$
17,001
$
-
$
-
$
-
$
17,001
-
2
$
-
$
9,485
$
-
$
-
$
9,485
-
20
$
61,829
$
26,190
$
-
$
-
$
88,019
-
-
19
$
60,785
$
30,942
$
-
$
-
$
91,726
-
-
1
$
4,957
$
-
$
-
$
-
$
4,957
-
-
-
1
$
4,957
$
-
$
-
$
-
$
4,957
2
-
-
-
2
$
9,913
$
-
$
-
$
-
$
9,913
44
19
-
-
63
$
228,374
$
92,315
$
-
$
-
$
320,688
BAY
1
-
-
-
1
$
4,153
$
-
$
-
$
-
$
4,153
GENESEE
-
1
-
-
1
$
-
$
3,639
$
-
$
-
$
3,639
60
MONTMORENCY
-
1
-
-
1
$
-
$
4,957
$
-
$
-
$
4,957
71
PRESQUE ISLE
2
-
-
-
2
$
9,913
$
-
$
-
$
-
$
9,913
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW by County
Page 50 of 79
Habilitation Supports Waiver - Capitation by County
July, 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
05
ANTRIM
05
ANTRIM
20
5
-
-
25
$
$
26,687
$
-
$
-
$
05
ANTRIM
28
GRAND TRAVERSE
-
1
-
-
1
$
-
$
4,928
$
-
$
-
$
4,928
00HF
05
ANTRIM
40
KALKASKA
1
-
-
-
1
$
6,198
$
-
$
-
$
-
$
6,198
4476125
00HF
15
CHARLEVOIX
05
ANTRIM
2
-
-
-
2
$
11,818
$
-
$
-
$
-
$
11,818
4476125
00HF
15
CHARLEVOIX
15
CHARLEVOIX
20
10
-
-
30
$
103,307
$
52,279
$
-
$
-
$
155,586
146
4476125
00HF
15
CHARLEVOIX
16
CHEBOYGAN
-
1
-
-
1
$
-
$
4,957
$
-
$
-
$
4,957
147
4476125
00HF
15
CHARLEVOIX
24
EMMET
3
4
-
-
7
$
19,920
$
18,979
$
-
$
-
$
38,899
148
4476125
00HF
15
CHARLEVOIX
69
OTSEGO
3
2
-
-
5
$
15,679
$
9,913
$
-
$
-
$
25,592
149
4476125
00HF
16
CHEBOYGAN
15
CHARLEVOIX
1
-
-
-
1
$
3,705
$
-
$
-
$
-
$
3,705
150
4476125
00HF
16
CHEBOYGAN
16
CHEBOYGAN
9
10
-
-
19
$
40,855
$
45,811
$
-
$
-
$
86,666
151
4476125
00HF
16
CHEBOYGAN
49
MACKINAC
1
-
-
-
1
$
3,820
$
-
$
-
$
-
$
3,820
152
4476125
00HF
16
CHEBOYGAN
69
OTSEGO
2
1
-
-
3
$
11,818
$
4,957
$
-
$
-
$
16,774
153
4476125
00HF
24
EMMET
24
EMMET
-
1
-
-
1
$
-
$
4,957
$
-
$
-
$
4,957
154
4476125
00HF
35
IOSCO
35
IOSCO
15
8
-
-
23
$
82,199
$
45,858
$
-
$
-
$
128,057
155
4476125
00HF
35
IOSCO
73
SAGINAW
1
-
-
-
1
$
5,244
$
-
$
-
$
-
$
5,244
156
4476125
00HF
40
KALKASKA
05
ANTRIM
1
-
-
-
1
$
3,705
$
-
$
-
$
-
$
3,705
157
4476125
00HF
40
KALKASKA
40
KALKASKA
14
14
-
-
28
$
66,196
$
59,687
$
-
$
-
$
125,883
158
4476125
00HF
60
MONTMORENCY
04
ALPENA
1
1
-
-
2
$
4,957
$
4,957
$
-
$
-
$
9,913
159
4476125
00HF
60
MONTMORENCY
60
MONTMORENCY
16
20
-
-
36
$
82,920
$
101,689
$
-
$
-
$
184,610
160
4476125
00HF
60
MONTMORENCY
71
PRESQUE ISLE
-
1
-
-
1
$
-
$
6,198
$
-
$
-
$
6,198
161
4476125
00HF
65
OGEMAW
35
IOSCO
3
-
-
-
3
$
14,870
$
-
$
-
$
-
$
14,870
162
4476125
00HF
65
OGEMAW
65
OGEMAW
9
12
-
-
21
$
49,563
$
68,156
$
-
$
-
$
117,719
163
4476125
00HF
68
OSCODA
65
OGEMAW
3
-
-
-
3
$
14,870
$
-
$
-
$
-
$
14,870
164
4476125
00HF
68
OSCODA
68
OSCODA
2
-
-
-
2
$
9,913
$
-
$
-
$
-
$
9,913
165
4476125
00HF
69
OTSEGO
24
EMMET
1
-
-
-
1
$
3,705
$
-
$
-
$
-
$
3,705
166
4476125
00HF
69
OTSEGO
28
GRAND TRAVERSE
-
1
-
-
1
$
-
$
4,557
$
-
$
-
$
4,557
167
4476125
00HF
69
OTSEGO
40
KALKASKA
1
1
-
-
2
$
4,957
$
4,957
$
-
$
-
$
9,913
168
4476125
00HF
69
OTSEGO
69
OTSEGO
30
20
-
-
50
$
167,849
$
103,399
$
-
$
-
$
271,249
169
4476125
00HF
71
PRESQUE ISLE
04
ALPENA
2
-
-
-
2
$
9,913
$
-
$
-
$
-
$
9,913
170
4476125
00HF
71
PRESQUE ISLE
34
IONIA
1
-
-
-
1
$
4,557
$
-
$
-
$
-
$
4,557
171
4476125
00HF
71
PRESQUE ISLE
37
ISABELLA
-
1
-
-
1
$
-
$
3,678
$
-
$
-
$
3,678
172
4476125
00HF
71
PRESQUE ISLE
63
OAKLAND
1
-
-
-
1
$
4,957
$
-
$
-
$
-
$
4,957
173
4476125
00HF
71
PRESQUE ISLE
71
PRESQUE ISLE
20
12
-
-
32
$
100,189
$
58,228
$
-
$
-
$
158,417
174
4476125
00HF
71
PRESQUE ISLE
79
TUSCOLA
1
-
-
-
1
$
4,153
$
-
$
-
$
-
$
4,153
175
1724945
00HJ
02
ALGER
02
ALGER
2
3
-
-
5
$
8,931
$
15,332
$
-
$
-
$
24,263
Provider ID
Billing
Agent
Code F
141
4476125
00HF
142
4476125
00HF
143
4476125
144
145
Report Generated: 8/29/2008
12:08 PM
Male
Female
Male
Female
Male
Female
114,282
Male
Female
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW by County
140,969
Page 51 of 79
Habilitation Supports Waiver - Capitation by County
July, 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
Male
52
MARQUETTE
07
BARAGA
Provider ID
Billing
Agent
Code F
176
1724945
00HJ
02
ALGER
177
1724945
00HJ
07
BARAGA
178
1724945
00HJ
17
CHIPPEWA
17
180
1724945
00HJ
17
CHIPPEWA
28
181
1724945
00HJ
17
CHIPPEWA
182
1724945
00HJ
21
DELTA
183
1724945
00HJ
21
DELTA
55
MENOMINEE
184
1724945
00HJ
22
DICKINSON
22
DICKINSON
185
1724945
00HJ
22
DICKINSON
55
MENOMINEE
186
1724945
00HJ
27
GOGEBIC
27
GOGEBIC
187
1724945
00HJ
27
GOGEBIC
28
GRAND TRAVERSE
188
1724945
00HJ
27
GOGEBIC
55
MENOMINEE
189
1724945
00HJ
31
HOUGHTON
07
BARAGA
190
1724945
00HJ
31
HOUGHTON
31
191
1724945
00HJ
36
IRON
36
192
1724945
00HJ
48
LUCE
193
1724945
00HJ
49
194
1724945
00HJ
195
1724945
196
1724945
197
198
Revenue - Habilitation Supports Waiver
TANF Enrollees
Total
Enrollees
Male
TANF Capitation
Female
Male
Total Capitation
Female
Female
Male
-
1
-
-
1
$
-
$
5,111
$
-
$
-
$
5,111
4
2
-
-
6
$
20,443
$
10,221
$
-
$
-
$
30,664
CHIPPEWA
21
12
-
-
33
$
103,104
$
56,889
$
-
$
-
$
159,993
GRAND TRAVERSE
-
1
-
-
1
$
-
$
4,557
$
-
$
-
$
4,557
77
SCHOOLCRAFT
1
-
-
-
1
$
5,528
$
-
$
-
$
-
$
5,528
21
DELTA
36
20
1
-
57
$
182,044
$
104,751
$
2,688
$
-
$
289,483
County Name - COFR Code R
Female
DAB Capitation
2
2
-
-
4
$
10,221
$
10,221
$
-
$
-
$
20,443
19
9
1
-
29
$
88,703
$
43,375
$
4,396
$
-
$
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
1
-
-
-
1
$
5,111
$
-
$
-
$
-
$
5,111
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
41
20
-
-
61
$
204,589
$
100,901
$
-
$
-
$
305,490
00HJ
55
MENOMINEE
55
MENOMINEE
13
8
-
-
21
$
56,949
$
30,720
$
-
$
-
$
87,669
00HJ
77
SCHOOLCRAFT
17
CHIPPEWA
-
1
-
-
1
$
-
$
5,111
$
-
$
-
$
5,111
1724945
00HJ
77
SCHOOLCRAFT
48
LUCE
-
1
-
-
1
$
-
$
5,528
$
-
$
-
$
5,528
1724945
00HJ
77
SCHOOLCRAFT
77
SCHOOLCRAFT
4
6
-
-
10
$
20,860
$
32,361
$
-
$
-
$
53,220
199
1708164
00HO
44
LAPEER
44
LAPEER
31
17
-
-
48
$
163,230
$
91,155
$
-
$
-
$
254,385
200
1708164
00HO
44
LAPEER
76
SANILAC
4
1
-
-
5
$
22,989
$
5,244
$
-
$
-
$
28,232
201
1708164
00HO
44
LAPEER
79
TUSCOLA
-
1
-
-
1
$
-
$
4,153
$
-
$
-
$
4,153
202
1708164
00HO
74
ST CLAIR
30
HILLSDALE
-
1
-
-
1
$
-
$
3,146
$
-
$
-
$
3,146
203
1708164
00HO
74
ST CLAIR
74
ST CLAIR
79
49
-
-
128
$
393,684
$
256,947
$
-
$
-
$
650,631
204
1708164
00HO
76
SANILAC
76
SANILAC
47
23
-
-
70
$
251,665
$
128,479
$
-
$
-
$
380,144
205
1712541
00HQ
73
SAGINAW
34
IONIA
1
-
-
-
1
$
4,557
$
-
$
-
$
-
$
4,557
206
1712541
00HQ
73
SAGINAW
63
OAKLAND
-
1
-
-
1
$
-
$
4,957
$
-
$
-
$
4,957
207
1712541
00HQ
73
SAGINAW
70
OTTAWA
1
-
-
-
1
$
4,557
$
-
$
-
$
-
$
4,557
208
1712541
00HQ
73
SAGINAW
73
SAGINAW
62
38
-
-
100
$
330,018
$
207,982
$
-
$
-
$
538,000
209
1712541
00HQ
73
SAGINAW
79
TUSCOLA
1
1
-
-
2
$
4,153
$
4,153
$
-
$
-
$
8,305
210
2920843
00HR
08
BARRY
08
BARRY
2
2
-
-
4
$
8,305
$
8,305
$
-
$
-
$
16,611
211
2920843
00HR
08
BARRY
34
IONIA
1
-
-
-
1
$
4,557
$
-
$
-
$
-
$
4,557
Report Generated: 8/29/2008
12:08 PM
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
July, 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
11
BERRIEN
11
BERRIEN
11
BERRIEN
70
OTTAWA
00HR
12
BRANCH
12
BRANCH
2920843
00HR
13
CALHOUN
12
BRANCH
-
1
-
2920843
00HR
13
CALHOUN
13
CALHOUN
59
35
-
217
2920843
00HR
13
CALHOUN
14
CASS
-
1
-
-
218
2920843
00HR
13
CALHOUN
33
INGHAM
1
-
-
219
2920843
00HR
13
CALHOUN
39
KALAMAZOO
-
1
-
220
2920843
00HR
80
VAN BUREN
03
ALLEGAN
4
-
-
-
221
2920843
00HR
80
VAN BUREN
39
KALAMAZOO
1
-
-
222
2920843
00HR
80
VAN BUREN
80
VAN BUREN
39
24
-
223
4390138
00HU
46
LENAWEE
46
LENAWEE
50
46
-
224
4390138
00HU
47
LIVINGSTON
25
GENESEE
1
1
-
225
4390138
00HU
47
LIVINGSTON
39
KALAMAZOO
2
-
-
226
4390138
00HU
47
LIVINGSTON
45
LEELANAU
1
-
-
227
4390138
00HU
47
LIVINGSTON
47
LIVINGSTON
61
31
-
228
4390138
00HU
58
MONROE
58
MONROE
61
52
229
4390138
00HU
81
WASHTENAW
40
KALKASKA
1
-
230
4390138
00HU
81
WASHTENAW
46
LENAWEE
-
1
231
4390138
00HU
81
WASHTENAW
63
OAKLAND
-
232
4390138
00HU
81
WASHTENAW
81
WASHTENAW
233
4390138
00HU
81
WASHTENAW
82
WAYNE
Provider ID
Billing
Agent
Code F
212
2920843
00HR
213
2920843
00HR
214
2920843
215
216
State Subtotals
Male
Male
Female
Female
Male
42
44
-
-
86
$
201,208
$
1
-
-
-
1
$
6,307
$
19
25
-
-
44
$
76,891
$
-
1
$
-
-
94
$
1
$
-
1
-
1
193
1
4,174
Female
Total
Enrollees
TANF Capitation
Male
Female
$
-
$
-
$
$
-
$
-
$
6,307
105,831
$
-
$
-
$
182,722
$
3,104
$
-
$
-
$
3,104
$
147,698
$
-
$
-
$
404,074
-
$
3,400
$
-
$
-
$
3,400
$
4,557
$
-
$
-
$
-
$
4,557
$
-
$
3,400
$
-
$
-
$
3,400
4
$
13,020
$
-
$
-
$
-
$
13,020
-
1
$
4,252
$
-
$
-
$
-
$
4,252
-
63
$
158,360
$
100,397
$
-
$
-
$
258,757
-
96
$
181,169
$
174,340
$
-
$
-
$
355,509
-
2
$
4,551
$
3,936
$
-
$
-
$
8,487
-
2
$
6,800
$
-
$
-
$
-
$
6,800
-
1
$
3,406
$
-
$
-
$
-
$
3,406
-
92
$
241,278
$
121,949
$
-
$
-
$
363,227
-
-
113
$
238,495
$
193,412
$
-
$
-
$
431,906
-
-
1
$
5,361
$
-
$
-
$
-
$
5,361
-
-
1
$
-
$
4,551
$
-
$
-
$
4,551
1
-
-
1
$
-
$
4,957
$
-
$
-
$
4,957
141
-
1
335
$
768,232
$
537,242
$
-
$
2,720
$
1,308,194
-
-
-
1
$
4,928
$
$
-
$
-
$
4,928
6
7,146
$
17,984,277
$
$
24,646
$
13,359
$
30,761,163
15
-
38,005
$
30,761,163
2,957
7,131
9
256,376
194,625
Total Capitation
-
12,738,882
30,723,158
395,833
-
Report Generated: 8/29/2008
12:08 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
July, 2008
Current Enrolled Population by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
M
DAB
1
13
44
37
87
29
211
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
M
DAB
5
19
40
47
72
31
214
3
4344340
00GG
CMH for Central Michigan
M
DAB
3
18
59
92
93
32
297
4
4483587
00GS
CMHSA Network of West Michigan
M
DAB
-
10
31
25
34
1
101
5
3119549
00GJ
Detroit Wayne County CMH Agency
M
DAB
3
19
118
170
253
50
613
6
1705233
0028
Genesee County CMH Services
M
DAB
3
15
45
69
60
15
207
7
1712452
00HA
Lakeshore Behavioral Health Alliance
M
DAB
-
8
25
35
44
6
118
8
1712229
00GV
Lifeways
M
DAB
-
14
44
38
44
18
158
00GX
Macomb County CMH Services
M
DAB
7
21
53
78
78
16
253
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
24
48
50
64
26
225
11
4476125
00HF
Northern Affiliation
M
DAB
1
7
46
61
94
38
247
12
4540048
00HC
Northern Lakes
M
DAB
2
7
21
24
30
7
91
13
1705289
0058
Oakland County CMH Authority
M
DAB
7
19
110
152
110
24
422
14
1712541
00HQ
Saginaw County CMH Authority
M
DAB
-
2
19
19
20
5
65
15
4390138
00HU
Southeast Partnership
M
DAB
4
29
132
84
94
28
371
16
3402136
00GR
Southwest Alliance
M
DAB
2
21
63
64
79
22
251
17
1708164
00HO
Thumb Mental Health Alliance
M
DAB
4
4
35
44
60
14
161
18
2920843
00HR
Venture Behavioral Health
M
DAB
1
14
46
54
46
8
169
-
19
20
State Subtotals
56
264
979
1,143
Check Values
Report Generated: 8/29/2008
12:08 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW-Pop
1,362
370
4,174
-
Page 54 of 79
Habilitation Supports Waiver - Population by PIHP by Age Group - DAB - Female
F
DAB
July, 2008
Current Enrolled Population by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
F
DAB
-
7
31
27
47
21
133
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
F
DAB
-
9
25
28
56
13
131
3
4344340
00GG
CMH for Central Michigan
F
DAB
-
7
31
52
96
24
210
4
4483587
00GS
CMHSA Network of West Michigan
F
DAB
-
5
3119549
00GJ
Detroit Wayne County CMH Agency
F
DAB
3
6
1705233
0028
Genesee County CMH Services
F
DAB
2
6
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
12
12
31
2
60
19
90
111
213
61
497
28
43
47
17
143
20
27
41
10
103
23
15
39
11
93
9
3396315
00GX
Macomb County CMH Services
F
DAB
5
10
36
50
61
19
181
10
1724945
00HJ
Northcare
F
DAB
4
7
22
28
50
17
128
11
4476125
00HF
Northern Affiliation
F
DAB
2
4
33
33
53
29
154
12
4540048
00HC
Northern Lakes
F
DAB
1
3
16
20
22
10
72
13
1705289
0058
Oakland County CMH Authority
F
DAB
3
11
77
110
100
27
328
14
1712541
00HQ
Saginaw County CMH Authority
F
DAB
-
1
8
12
13
6
40
15
4390138
00HU
Southeast Partnership
F
DAB
-
16
71
86
74
26
273
16
3402136
00GR
Southwest Alliance
F
DAB
2
9
47
44
67
17
186
17
1708164
00HO
Thumb Mental Health Alliance
F
DAB
-
1
20
27
33
11
92
18
2920843
00HR
Venture Behavioral Health
F
DAB
1
10
31
38
43
10
133
-
19
20
State Subtotals
24
132
621
763
Check Values
Report Generated: 8/29/2008
12:08 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW-Pop
1,086
331
2,957
-
Page 55 of 79
Habilitation Supports Waiver - Population by PIHP by Age Group - TANF - Male
M
TANF
July, 2008
Population - Current Enrollment by Age Group
Provider ID
Billing
Agent
1
4344340
00GG
CMH for Central Michigan
M
TANF
1
-
-
-
-
-
1
2
1705233
0028
Genesee County CMH Services
M
TANF
1
-
-
-
-
-
1
3
3396315
00GX
Macomb County CMH Services
M
TANF
3
1
-
-
-
-
4
4
1724945
00HJ
Northcare
M
TANF
2
-
-
-
-
-
2
5
4540048
00HC
Northern Lakes
M
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
8
1
-
-
Check Values
Report Generated: 8/29/2008
12:08 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW-Pop
-
-
9
-
Page 56 of 79
Habilitation Supports Waiver - Population by PIHP by Age Group - TANF - Female
F
TANF
July, 2008
Population - Current Enrollment by Age Group
Provider ID
Billing
Agent
1
3396315
00GX
Macomb County CMH Services
F
TANF
3
-
-
-
-
-
3
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
-
-
-
-
-
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
1
5
-
6
-
7
-
8
-
9
-
10
-
11
-
12
-
13
-
14
-
15
-
16
-
17
-
18
-
19
-
20
State Subtotals
5
-
1
-
Check Values
Report Generated: 8/29/2008
12:08 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
July, 2008
Revenue for Current Enrolled Population by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
M
DAB
$
2,184
$
55,571
$
186,224
$
162,202
$
381,660
$
126,592
$
914,434
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
M
DAB
$
11,984
$
71,742
$
184,253
$
224,921
$
343,720
$
151,178
$
987,796
3
4344340
00GG
CMH for Central Michigan
M
DAB
$
5,365
$
51,830
$
210,426
$
340,191
$
336,286
$
116,738
$
1,060,836
4
4483587
00GS
CMHSA Network of West Michigan
M
DAB
$
-
$
32,718
$
111,942
$
90,985
$
124,036
$
3,639
$
363,319
5
3119549
00GJ
Detroit Wayne County CMH Agency
M
DAB
$
8,341
$
74,517
$
552,372
$
854,079
$
1,252,654
$
250,176
$
2,992,139
6
1705233
0028
Genesee County CMH Services
M
DAB
$
5,743
$
47,239
$
159,657
$
248,650
$
223,956
$
54,591
$
739,835
7
1712452
00HA
Lakeshore Behavioral Health Alliance
M
DAB
$
-
$
34,143
$
112,690
$
160,590
$
200,831
$
26,190
$
534,443
8
1712229
00GV
Lifeways
M
DAB
$
-
$
29,614
$
94,321
$
86,287
$
101,823
$
40,887
$
352,933
00GX
Macomb County CMH Services
M
DAB
$
13,303
$
65,554
$
179,449
$
289,316
$
290,134
$
60,905
$
898,661
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
10
1724945
00HJ
Northcare
M
DAB
$
39,234
$
104,748
$
246,315
$
263,291
$
326,115
$
133,262
$
1,112,965
11
4476125
00HF
Northern Affiliation
M
DAB
$
2,607
$
34,750
$
239,746
$
316,008
$
496,349
$
199,705
$
1,289,166
12
4540048
00HC
Northern Lakes
M
DAB
$
4,794
$
25,129
$
84,032
$
108,659
$
138,981
$
32,269
$
393,863
13
1705289
0058
Oakland County CMH Authority
M
DAB
$
18,250
$
71,510
$
535,536
$
738,944
$
585,204
$
126,317
$
2,075,761
14
1712541
00HQ
Saginaw County CMH Authority
M
DAB
$
-
$
10,638
$
96,572
$
98,941
$
108,900
$
28,232
$
343,284
15
4390138
00HU
Southeast Partnership
M
DAB
$
7,657
$
109,548
$
508,523
$
333,844
$
376,662
$
117,986
$
1,454,220
16
3402136
00GR
Southwest Alliance
M
DAB
$
5,287
$
65,314
$
223,739
$
236,265
$
292,578
$
82,038
$
905,221
17
1708164
00HO
Thumb Mental Health Alliance
M
DAB
$
12,356
$
17,002
$
171,597
$
233,399
$
321,177
$
76,035
$
831,567
18
2920843
00HR
Venture Behavioral Health
M
DAB
$
2,184
$
52,796
$
200,363
$
247,678
$
195,656
$
35,156
$
733,832
$
139,290
$
954,362
$
4,097,756
$
5,034,249
$
6,096,723
$
1,661,896
$
17,984,277
19
20
State Subtotals
Check Values
Report Generated: 8/29/2008
12:08 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
July, 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
$
116,673
$
198,736
$
96,707
$
574,157
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
F
DAB
$
-
$
35,521
$
111,618
$
136,794
$
274,664
$
62,650
$
621,246
3
4344340
00GG
CMH for Central Michigan
F
DAB
$
-
$
20,644
$
111,835
$
177,551
$
344,912
$
84,118
$
739,060
4
4483587
00GS
CMHSA Network of West Michigan
F
DAB
$
-
$
8,161
$
44,449
$
45,071
$
116,097
$
7,279
$
221,057
5
3119549
00GJ
Detroit Wayne County CMH Agency
F
DAB
$
7,190
$
72,791
$
425,035
$
562,278
$
1,058,828
$
302,794
$
2,428,915
6
1705233
0028
Genesee County CMH Services
F
DAB
$
3,829
$
19,079
$
104,392
$
160,201
$
176,868
$
63,268
$
527,637
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
$
34,435
$
88,394
$
25,547
$
207,000
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
$
8,712
$
30,520
$
115,712
$
185,263
$
222,874
$
66,307
$
629,388
10
1724945
00HJ
Northcare
F
DAB
$
10,753
$
33,194
$
104,692
$
137,926
$
257,010
$
91,137
$
634,711
11
4476125
00HF
Northern Affiliation
F
DAB
$
5,214
$
17,323
$
159,203
$
169,233
$
269,093
$
146,617
$
766,683
12
4540048
00HC
Northern Lakes
F
DAB
$
3,547
$
11,741
$
68,305
$
93,857
$
103,345
$
45,939
$
326,733
13
1705289
0058
Oakland County CMH Authority
F
DAB
$
7,821
$
44,208
$
363,416
$
546,913
$
511,130
$
136,189
$
1,609,676
14
1712541
00HQ
Saginaw County CMH Authority
F
DAB
$
-
$
3,920
$
41,250
$
68,265
$
72,196
$
31,461
$
217,091
15
4390138
00HU
Southeast Partnership
F
DAB
$
-
$
59,271
$
268,734
$
317,000
$
295,475
$
99,908
$
1,040,387
16
3402136
00GR
Southwest Alliance
F
DAB
$
3,577
$
26,103
$
168,038
$
164,015
$
246,129
$
62,173
$
670,035
17
1708164
00HO
Thumb Mental Health Alliance
F
DAB
$
-
$
5,244
$
102,820
$
144,881
$
178,499
$
57,679
$
489,123
18
2920843
00HR
Venture Behavioral Health
F
DAB
$
2,184
$
36,952
$
126,695
$
168,198
$
188,833
$
43,898
$
566,761
$
54,023
$
479,749
$
2,590,533
$
3,353,096
$
4,792,549
$
1,468,931
$
12,738,882
19
20
State Subtotals
Check Values
Report Generated: 8/29/2008
12:08 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
July, 2008
Capitation for Current Enrolled Population by Age Group
Provider ID
Billing
Agent
1
4344340
00GG
CMH for Central Michigan
M
TANF
$
2,184
$
-
$
-
$
-
$
-
$
-
$
2,184
2
1705233
0028
Genesee County CMH Services
M
TANF
$
1,914
$
-
$
-
$
-
$
-
$
-
$
1,914
3
3396315
00GX
Macomb County CMH Services
M
TANF
$
6,334
$
3,583
$
-
$
-
$
-
$
-
$
9,917
4
1724945
00HJ
Northcare
M
TANF
$
7,084
$
-
$
-
$
-
$
-
$
-
$
7,084
5
4540048
00HC
Northern Lakes
M
TANF
$
3,547
$
-
$
-
$
-
$
-
$
-
$
3,547
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
$
-
$
24,646
19
20
State Subtotals
$
21,063
$
3,583
$
-
$
-
$
Check Values
Report Generated: 8/29/2008
12:08 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
July, 2008
Capitation for Current Enrolled Population by Age Group
Provider ID
Billing
Agent
1
3396315
00GX
Macomb County CMH Services
F
TANF
$
6,243
$
-
$
-
$
-
$
-
$
-
$
6,243
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
$
-
$
-
$
-
$
-
$
-
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
$
1,788
5
$
-
6
$
-
7
$
-
8
$
-
9
$
-
10
$
-
11
$
-
12
$
-
13
$
-
14
$
-
15
$
-
16
$
-
17
$
-
18
$
-
$
13,359
19
20
State Subtotals
$
10,638
$
-
$
2,720
$
-
$
Check Values
Report Generated: 8/29/2008
12:08 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
July, 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
1,488,591
$
90,640
$
-
$
1,579,231
$
1,609,042
$
82,646
$
-
$
1,691,688
$
1,802,080
$
88,393
$
-
$
1,890,473
CMHSA Network of West Michigan
$
584,376
$
(97,384) $
-
$
486,992
00GJ
Detroit Wayne County CMH Agency
$
5,421,054
$
90,862
$
-
$
5,511,916
0028
Genesee County CMH Services
$
1,269,386
$
20,646
$
-
$
1,290,033
1712452
00HA
Lakeshore Behavioral Health Alliance
$
1,003,666
$
(33,400) $
-
$
970,266
8
1712229
00GV
Lifeways
$
559,933
$
10,198
$
-
$
570,131
9
3396315
00GX
Macomb County CMH Services
$
1,544,208
$
198,814
$
-
$
1,743,023
10
1724945
00HJ
Northcare
$
1,754,760
$
69,490
$
-
$
1,824,250
11
4476125
00HF
Northern Affiliation
$
2,055,849
$
68,191
$
-
$
2,124,040
12
4540048
00HC
Northern Lakes
$
724,144
$
64,528
$
-
$
788,671
13
1705289
0058
Oakland County CMH Authority
$
3,688,044
$
636,530
$
4,290
$
4,328,864
14
1712541
00HQ
Saginaw County CMH Authority
$
560,375
$
13,083
$
-
$
573,458
15
4390138
00HU
Southeast Partnership
$
2,497,327
$
204,613
$
-
$
2,701,940
16
3402136
00GR
Southwest Alliance
$
1,577,044
$
34,379
$
-
$
1,611,424
17
1708164
00HO
Thumb Mental Health Alliance
$
1,320,690
$
124,507
$
-
$
1,445,197
18
2920843
00HR
Venture Behavioral Health
$
1,300,593
$
49,138
$
-
$
1,349,731
Current Payments
Total Payments
19
$
-
20
$
-
State Subtotals $
Report Generated: 8/29/2008
12:08 PM
30,761,163
$
1,715,875
$
4,290
$
32,481,328
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
July, 2008
HSW Net Enrollees and Net Payments As of 08/29/2008
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
370 $
1,605,002
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
364 $
1,695,959
364 $
1,695,818
368 $
1,708,433
366 $
1,701,621
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
544 $
1,929,948
542 $
1,921,438
544 $
1,930,240
545 $
1,932,782
4
4483587
00GS
CMHSA Network of West Michigan
162 $
587,096
163 $
591,033
166 $
601,951
165 $
598,014
5
3119549
00GJ
Detroit Wayne County CMH Agency
1,154 $
5,633,204
1,151 $
5,625,974
1,150 $
5,628,343
1,151 $
5,624,156
6
1705233
0028
Genesee County CMH Services
370 $
1,337,181
368 $
1,326,521
368 $
1,328,726
369 $
1,330,153
7
1712452
00HA
Lakeshore Behavioral Health Alliance
225 $
1,019,535
224 $
1,014,978
224 $
1,014,978
221 $
1,001,318
8
1712229
00GV
Lifeways
267 $
599,150
264 $
593,470
266 $
594,619
264 $
592,594
9
3396315
00GX
Macomb County CMH Services
451 $
1,610,289
464 $
1,662,034
478 $
1,709,340
488 $
1,731,399
10
1724945
00HJ
Northcare
360 $
1,786,491
365 $
1,812,450
362 $
1,799,541
364 $
1,803,894
11
4476125
00HF
Northern Affiliation
428 $
2,204,785
427 $
2,197,768
428 $
2,204,370
426 $
2,194,337
12
4540048
00HC
Northern Lakes
173 $
769,362
172 $
765,956
175 $
778,989
177 $
787,323
13
1705289
0058
Oakland County CMH Authority
855 $
4,221,516
854 $
4,216,164
859 $
4,242,298
855 $
4,226,031
14
1712541
00HQ
Saginaw County CMH Authority
110 $
585,601
109 $
580,357
111 $
589,683
111 $
589,683
15
4390138
00HU
Southeast Partnership
699 $
2,726,001
703 $
2,738,099
698 $
2,715,212
698 $
2,713,575
16
3402136
00GR
Southwest Alliance
455 $
1,653,886
454 $
1,647,746
448 $
1,624,532
449 $
1,631,708
17
1708164
00HO
Thumb Mental Health Alliance
282 $
1,470,472
278 $
1,449,498
281 $
1,462,580
287 $
1,492,717
18
2920843
00HR
Venture Behavioral Health
308 $
1,329,084
308 $
1,329,423
310 $
1,339,469
310 $
1,342,402
7,582 $
32,783,664
7,583 $
32,784,261
7,607 $
32,880,534
7,616 $
32,898,709
State Subtotals
Report Generated: 8/29/2008
12:08 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
July, 2008
HSW Net Enrollees and Net Payments As of 08/29/2008
February
March
April
May
Provider ID
Billing
Agent
Affiliation DBA
1
1705322
00GE
Access Alliance of Michigan
370 $
1,604,793
370 $
1,604,117
368 $
1,593,376
366 $
1,584,566
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
365 $
1,696,793
368 $
1,712,408
374 $
1,737,813
373 $
1,738,176
3
4344340
00GG
CMH for Central Michigan
547 $
1,934,649
546 $
1,931,537
548 $
1,938,429
547 $
1,935,254
4
4483587
00GS
CMHSA Network of West Michigan
165 $
597,095
166 $
600,735
169 $
611,653
168 $
608,933
5
3119549
00GJ
Detroit Wayne County CMH Agency
1,143 $
5,592,569
1,141 $
5,571,307
1,147 $
5,600,708
1,142 $
5,578,211
6
1705233
0028
Genesee County CMH Services
366 $
1,320,960
370 $
1,338,432
374 $
1,350,432
376 $
1,357,711
7
1712452
00HA
Lakeshore Behavioral Health Alliance
220 $
997,902
220 $
997,902
226 $
1,027,896
226 $
1,026,449
8
1712229
00GV
Lifeways
263 $
590,026
260 $
584,165
263 $
588,119
262 $
585,846
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
486 $
1,721,941
491 $
1,733,282
495 $
1,742,155
489 $
1,728,095
10
1724945
00HJ
Northcare
362 $
1,792,393
363 $
1,795,782
365 $
1,802,449
365 $
1,804,713
11
4476125
00HF
Northern Affiliation
425 $
2,187,658
426 $
2,193,982
434 $
2,225,084
432 $
2,213,930
12
4540048
00HC
Northern Lakes
181 $
804,771
181 $
804,399
182 $
809,965
180 $
800,076
13
1705289
0058
Oakland County CMH Authority
859 $
4,243,395
852 $
4,206,711
860 $
4,245,989
857 $
4,229,000
14
1712541
00HQ
Saginaw County CMH Authority
111 $
590,844
112 $
596,088
113 $
599,320
113 $
599,320
15
4390138
00HU
Southeast Partnership
691 $
2,690,848
696 $
2,709,289
711 $
2,748,556
705 $
2,730,362
16
3402136
00GR
Southwest Alliance
450 $
1,631,457
445 $
1,614,767
459 $
1,655,604
459 $
1,653,446
17
1708164
00HO
Thumb Mental Health Alliance
289 $
1,500,556
288 $
1,495,313
287 $
1,488,978
287 $
1,490,583
18
2920843
00HR
Venture Behavioral Health
310 $
1,339,746
310 $
1,340,644
313 $
1,352,264
314 $
1,355,355
7,603 $
32,838,397
7,605 $
32,830,859
7,688 $
33,118,790
7,661 $
33,020,026
State Subtotals
Report Generated: 8/29/2008
12:08 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
July, 2008
HSW Net Enrollees and Net Payments As of 08/29/2008
June
July
August
Provider ID
Billing
Agent
Affiliation DBA
1
1705322
00GE
Access Alliance of Michigan
363 $
1,571,188
358 $
1,550,425
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
372 $
1,733,619
366 $
1,705,417
3
4344340
00GG
CMH for Central Michigan
541 $
1,911,420
536 $
1,895,833
4
4483587
00GS
CMHSA Network of West Michigan
169 $
613,491
167 $
606,212
5
3119549
00GJ
Detroit Wayne County CMH Agency
1,137 $
5,551,796
1,130 $
5,513,998
6
1705233
0028
Genesee County CMH Services
370 $
1,338,831
371 $
1,342,471
7
1712452
00HA
Lakeshore Behavioral Health Alliance
227 $
1,028,846
225 $
1,019,733
8
1712229
00GV
Lifeways
261 $
583,383
259 $
576,459
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
489 $
1,725,915
468 $
1,646,699
10
1724945
00HJ
Northcare
365 $
1,803,581
364 $
1,797,191
11
4476125
00HF
Northern Affiliation
428 $
2,195,552
422 $
2,155,298
12
4540048
00HC
Northern Lakes
178 $
790,963
176 $
781,849
13
1705289
0058
Oakland County CMH Authority
851 $
4,193,765
824 $
4,047,376
14
1712541
00HQ
Saginaw County CMH Authority
114 $
608,182
112 $
597,695
15
4390138
00HU
Southeast Partnership
704 $
2,728,633
681 $
2,638,164
16
3402136
00GR
Southwest Alliance
455 $
1,639,782
451 $
1,626,201
17
1708164
00HO
Thumb Mental Health Alliance
287 $
1,491,744
288 $
1,491,638
18
2920843
00HR
Venture Behavioral Health
312 $
1,345,825
307 $
1,322,450
7,623 $
32,856,516
7,505 $
32,315,109
State Subtotals
Report Generated: 8/29/2008
12:08 PM
September
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
July, 2008
HSW Net Enrollees and Net Payments As of 08/29/2008
Year to Date
Provider ID
Billing
Agent
Affiliation DBA
1
1705322
00GE
Access Alliance of Michigan
3,684 $
15,960,336
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
3,680 $
17,126,058
3
4344340
00GG
CMH for Central Michigan
5,440 $
19,261,530
4
4483587
00GS
CMHSA Network of West Michigan
1,660 $
6,016,213
5
3119549
00GJ
Detroit Wayne County CMH Agency
11,446 $
55,920,265
6
1705233
0028
Genesee County CMH Services
3,702 $
13,371,418
7
1712452
00HA
Lakeshore Behavioral Health Alliance
2,238 $
10,149,536
8
1712229
00GV
Lifeways
2,629 $
5,887,832
HSW Net Enrollees HSW Net Payments
9
3396315
00GX
Macomb County CMH Services
4,799 $
17,011,149
10
1724945
00HJ
Northcare
3,635 $
17,998,484
11
4476125
00HF
Northern Affiliation
4,276 $
21,972,765
12
4540048
00HC
Northern Lakes
1,775 $
7,893,654
13
1705289
0058
Oakland County CMH Authority
8,526 $
42,072,244
14
1712541
00HQ
Saginaw County CMH Authority
1,116 $
5,936,773
15
4390138
00HU
Southeast Partnership
6,986 $
27,138,739
16
3402136
00GR
Southwest Alliance
4,525 $
16,379,129
17
1708164
00HO
Thumb Mental Health Alliance
2,854 $
14,834,079
18
2920843
00HR
Venture Behavioral Health
3,102 $
13,396,662
76,073 $
328,326,865
State Subtotals
Report Generated: 8/29/2008
12:08 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW Net Enrollees & Payments
Page 66 of 79
Affiliations
July, 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: 8/29/2008
CMH Name
12:08 PM
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
July, 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: 8/29/2008
CMH Name
12:08 PM
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
July, 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: 8/29/2008
CMH Name
12:08 PM
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
July, 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: 8/29/2008
Base Rate X AgeSex Factor X Geographic Factor = Capitation Rate
Date Effective
12:08 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
July, 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: 8/29/2008
Base Rate X AgeSex Factor X Geographic Factor = Capitation Rate
Date Effective
12:08 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
July, 2008
Program
Gender
Code Group
Age
Report Generated: 8/29/2008
Date Effective
12:08 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
July, 2008
Program
Gender
Code Group
AGE
Report Generated: 8/29/2008
Date Effective
12:08 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
July, 2008
Provider ID
Billing
Agent ID
Report Generated: 8/29/2008
Provider Name
12:08 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
July, 2008
Provider ID
Billing
Agent ID
Report Generated: 8/29/2008
Provider Name
12:08 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
July, 2008
Provider ID
Billing
Agent ID
Report Generated: 8/29/2008
Provider Name
12:08 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
July, 2008
Provider ID
Billing
Agent ID
Report Generated: 8/29/2008
Provider Name
12:08 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: 8/29/2008
12:08 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: 8/29/2008
12:08 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
NP - HSW Age Profile Data
Page 79 of 79