Gratiot Integrated Health Network
Service Codes: 90792, 992XX
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 Psychiatric Program services is to assist individuals to become self-reliant and improve the quality of their lives through the evaluation and treatment of affective, behavioral and perceptual disorders. These conditions are precipitating circumstances that prompt individuals to seek help or serve as a rationale for a referral. Psychiatric services are provided by Medical Doctors, Physicians Assistants, and Nurse Practitioners, specializing in the practice of Psychiatry and are matched to individual needs through the person-centered planning process that may evolve through the course of treatment to meet the changing needs of the individual.
Services/Scope of Services: Psychiatric evaluation and consults, prescriptions for medication, medication reviews and medication adjustments are included in the Psychiatric Program. The Prescribers provide clinical consultations with Community Mental Health clinicians, assist with crisis intervention, and collaborate with the individual’s Primary Care Physician. The Psychiatrists may also provide first or second Certification for hospitalization.
Populations served include individuals with co-occurring disorders, intellectual developmental disabilities, adults with Serious Mental Illness and children with Serious Emotional Disturbance. Services are provided primarily in the offices of Gratiot Integrated Health Network; however, the Prescribers may also provide services in other locations that meet the needs of the persons served (e.g., hospital, nursing facility, other professional offices, etc.). In addition, Tele-Psychiatry is available on a limited basis.
Services are provided between 8:00 a.m. to 5:00 p.m. Monday through Friday according to the Prescribers’ contractual availability. 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 psychiatric services is individually determined by the individual’s clinical condition; however, medication reviews are conducted on a frequency not less than quarterly.
Services are initiated at the request of the individual, parent or legal guardian. 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 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 evaluation of medical necessity and will be specified in the individual plan of service. 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, specifying a minimum and maximum range of service units. Exceptions to level of care benefit plans will be reviewed by the Utilization Management department.
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.
Eligibility criteria for Psychiatric services include individuals who have/are:
- a primary DSM-V diagnosis of Severe Emotional Disturbance, Serious Mental Illness, Co-occurring Disorder, or Intellectual Developmental Disability
- primary residence in Gratiot County
- Medical Necessity (clinically appropriate; necessary to meet needs; consistent with diagnosis, symptomatology and functional impairments; in the least restrictive environment; and consistent with clinical standards of care)
- the ability to benefit from generally accepted Psychiatric Program practices
- a willingness to participate in treatment planning
- consent to treatment
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. Assistance in contacting alternative services is available upon request.
Transition/Discharge Criteria: An individual may be transitioned or discharged from the Psychiatric Program when one or more of the following occur:
- Individual no longer requires psychotropic medications
- Individual request
- Lack of individual participation in treatment
- Individual requires a different level or type of service based on medical necessity
- Individual can meet his/her needs through alternative community services and supports (i.e. primary care physician or private psychiatrist)
- Individual no longer meets established eligibility criteria
When an individual is discharged or removed from the program for aggressive and/or assaultive behavior, follow-up will occur within 72 hours to insure linkage to appropriate care.
Regardless of discharge status, any individual may reapply for services by contacting GIHN.