Gratiot Integrated Health Network
Program Description
OBRA Program
(Omnibus Budget Reconciliation Act of 1987)
Service Codes: T1017 SE, H0031
Program Philosophy: Gratiot Integrated Health Network provides services to build resilience, and to support the recovery or well-being of individuals and the integration of individuals served into the community. Through service provision, symptoms or needs will be reduced and individuals will experience an improvement in level of functioning in their environment. The program strives to continually improve service provision in order that individuals served experience an enhanced quality of life.
Program Goals: The goal of the OBRA Program is to ensure that persons with mental health needs who are admitted to or are residing within long-term care facilities receive the mental health services appropriate to their condition. Gratiot Integrated Health Network provides this expertise in the areas of assessment, program development, training direct contact staff to implement programs as designed, monitoring of resident progress, and modification of such programs.
Services/Scope of Services: Crisis Intervention, Individual Therapy, Group Therapy, Pharmaco- Therapy, Behavior Modification, Nursing Home Mental Health Monitoring, Case Consultation and Program Consultation are included in the OBRA Program services.
Eligibility for OBRA services is defined by Federal Regulations specified in the OBRA of 1987. The individual must have a diagnosis or evidence of a mental illness or intellectual developmental disability/mental retardation and meet the criteria for OBRA services as indicated on the Federal Form #3877.
OBRA services are, by their nature, provided in the nursing facility environment. For some limited services (e.g., Psychiatry appointment), the individual may access those in a community-based setting.
OBRA services are provided Monday through Friday from 8:00 a.m. to 5:00 p.m. and by appointment. The frequency of services received by persons served is based on individual need and is outlined in the individual plan of service. The intensity of OBRA services are recommended in the Level II Evaluation process and supported by the State of Michigan’s Determination for General or Specialized Mental Health Services.
Services are initiated by a hospital’s completion of the DCH 3877 form as part of the discharge planning process, or by a community mental health services program (CMHSP) staff, home care agencies or physicians seeking to admit an individual to a nursing facility from other than an acute care setting. Information from referral sources will be accepted after proper consent for release of information is obtained. Services will not be denied based on an individual’s inability to pay for services.
Admission/Re-Admission Criteria: The OBRA professional staff determine the first level of admission to the OBRA Program with consideration of a completed Preadmission Screening (PAS)/ Annual Resident Review (ARR) form (DCH-3877), indicating a diagnosis or evidence of a mental illness or intellectual developmental disability. If the presence of mental illness or intellectual developmental disability/mental retardation is confirmed, Level II evaluations by appropriately credentialed personnel are completed. Those evaluations will subsequently authorize admission into one of the following categories:
- Nursing Facility/Specialized Mental Health Services
- Nursing Facility/Other Mental Health Services
- Nursing Facility/No Mental Health Services
- No Nursing Facility/Specialized Mental Health Services
- No Nursing Facility/Other Mental Health Services
- No Nursing Facility/No Mental Health Services
It is the policy of Gratiot Integrated Health Network Service Program to provide services to all eligible consumers in a manner that is sensitive to the cultural and socio-economic needs of the individual in a nondiscriminatory and/or non-threatening manner. Services are provided to eligible individuals without regard to race, religion, color, national origin, age, sex, marital status, sexual preference, handicap, juvenile justice status or any other protected status as required by law. The agency endeavors to accommodate individuals with special needs, or refers to providers equipped to meet their needs.
When individuals are found to be ineligible for services, they are given the reason(s) and are directed to alternative or more appropriate services. Assistance in contacting alternative services is available upon request. In addition, the OBRA rules allow individuals and/or their family specific appeal rights.
Transition/Discharge Criteria: An individual may be transitioned or discharged from OBRA Program services when one or more of the following occur:
- The individual does not maintain eligibility for services under the OBRA Act
- Death
- A dementia certification (3878) has been completed and signed by the appropriate health care professionals
- Individual moves out of the nursing home to a less restrictive environment (i.e. AFC or private home)
Regardless of discharge status, an individual previously served may reapply for services through the regular DCH 3877 process.