Gratiot Integrated Health Network
Program Description
Community Living Supports
Service Codes: H2015
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 Community Living Supports (CLS) is to increase or maintain self-sufficiency, facilitating the persons served to achieve their goals of community inclusion and participation, independence and productivity.
Services/Scope of Services: CLS services include assisting, reminding, observing, guiding and/or training in the following activities:
- Meal preparation
- Laundry
- Routine, seasonal, and heavy household care and maintenance
- Activities of daily living (e.g., bathing, eating, dressing, personal hygiene)
- Shopping for food and other necessities of daily living
CLS also includes staff assistance, support and/or training with activities such as:
- money management
- non-medical care (not requiring nurse or physician intervention)
- socialization and relationship building
- transportation from the residence of the persons served to community activities, among community activities, and from the community activities back to the residence
- participation in regular community activities and recreational opportunities
- attendance at medical appointments
- acquiring or procuring goods, other than those listed under shopping, and non-medical services
- reminding, observing and/or monitoring of medication administration
- preserving the health and safety of the person served in order that he/she may reside or be supported in the most integrated, independent community setting
Population served includes individuals with co-occurring disorders, intellectual developmental disabilities, adults with serious mental illness, and children with severe emotional disturbance. Priority in provision of services is given to individuals with the most severe need and to those in urgent or emergent situations. Services are provided in the location that best meets the need of the service being provided (i.e., at the agency, individual’s home, community) based on the choices of the person served.
Services are provided according to the choices and needs of the person served and may be at any time seven days a week/24 hours a day. The frequency of services provided is determined by the persons served choices and medical necessity.
Services will not be denied based on an individual’s inability to pay for services.
Admission/Re-Admission Criteria: The Access Coordinator, in conjunction with the program supervisor, is responsible for prioritizing the admission/readmission of eligible individuals based on the severity of needs. Amount, scope, and duration of service provision is determined based upon an evaluation of medical necessity and will be specified in the individual plan of service. Medical necessity is determined based on a thorough psychosocial assessment, standardized functional assessment tools (i.e.SIS, CAFAS, LOCUS, etc.), and the clinical judgment of trained professionals. Based on the aforementioned evaluation, individuals will be assigned a level of care benefit plan, specifying a minimum and maximum range of service units. Exceptions to level of care benefit plans will be reviewed by the Utilization Management department. Individuals must require supports to remain independent in their own home and/or support with daily living skills (e.g. medication administration, self-care).
It is the policy of Gratiot Integrated Health Network 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. In addition, when applicable, the family/support system and/or the referral source are informed as to the reason for ineligibility.
Transition/Discharge Criteria: An individual may be transitioned or discharged from CLS when one or more of the following occur:
- Individual or guardian request
- Completion of treatment goals
- Lack of individual participation
- Individual requires a higher or lower level of service based on medical necessity.
When an individual is discharged or removed from the program for aggressive and/or assaultive behavior, follow-up will occur within 72 hours to ensure linkage to appropriate care.
Regardless of discharge status, any individual may reapply for services by contacting GIHN.
Gratiot Integrated Health Network
Program Description
Personal Emergency Response System
Service Codes: S5160, S5161
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 the 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 Personal Emergency Response System (PERS) is to increase or maintain self-sufficiency, facilitating the persons served to achieve their goals of community inclusion and participation, independence, and productivity.
Services/Scope of Services: Electronic devices that enable beneficiaries to secure help in the event of an emergency. The beneficiary may also wear a portable “help” button to allow for mobility. The system is connected to the person’s phone and programmed to signal a response center once the button is activated. The response center is staffed by trained professionals. This service includes a one-time installation and up to twelve monthly monitoring services per year. PERS coverage should be limited to beneficiaries living alone (or living with a roommate who does not provide supports), or who are alone for significant parts of the day; who have no regular support or service provider for those parts of the day; and who would otherwise require extensive routine support and guidance.
Population served includes individuals with co-occurring disorders, intellectual developmental disabilities, adults with serious mental illness, and children with severe emotional disturbance. Priority in provision of services is given to individuals with the most severe need and to those in urgent or emergent situations. Services are provided in the home via an electronic monitoring device.
Services are provided according to the choices and needs of the person served and may be at anytime seven days a week/24 hours a day. The frequency of services provided is determined by the persons served choices and medical necessity.
Services will not be denied based on an individual’s inability to pay for services.
Admission/Re-Admission Criteria: The Access Coordinator, in conjunction with the program supervisor, is responsible for prioritizing the admission/readmission of eligible individuals based on the severity of needs. Medical necessity is determined based upon a thorough psychosocial assessment, standardized functional assessment tools (i.e. SIS, CAFAS, LOCUS, etc.), and the clinical judgment of trained professionals. Based upon the aforementioned evaluation, individuals will be assigned a level of care benefit plan. Exceptions to level of care benefit plans will be reviewed by the Utilization Management department. Individuals must require supports to remain independent in their own home and/or support with daily living skills (e.g. medication administration, self-care).
It is the policy of Gratiot Integrated Health Network 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. In addition, when applicable, the family/support system and/or the referral source are informed as to the reason for ineligibility.
Transition/Discharge Criteria: An individual may be transitioned or discharged from PERS when one or more of the following occur:
- Individual or guardian request
- Completion of treatment goals
- Lack of individual participation
- Individual requires a higher or lower level of service based on medical necessity.
When an individual is discharged or removed from the program for aggressive and/or assaultive behavior, follow-up will occur within 72 hours to ensure linkage to appropriate care.
Regardless of discharge status, any individual may reapply for services by contacting GIHN.