Gratiot Integrated Health Network
Program Description
Wellness
Nursing Services
Service Codes: T1002, 96372, J1631
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 Nursing Services is to assist individuals to become self reliant and improve the quality of their lives through the evaluation and identification of health issues, assisting the individual in resolving health issues, medication education and administration, coordination with primary care physicians, and consultation with CMH staff. Persons served may achieve their personal health goals through nursing education, and consultation/coordination with other service providers. Nursing Services correspond to individual needs through the person-centered planning process and health appraisal, which may evolve through the course of treatment to meet the changing needs of the persons served.
Services/Scope of Services: Nursing Services are available for children with a Severe Emotional Disturbance, adults with Intellectual Developmental Disabilities, and adults with Serious Mental Illness. Services provided may include health screens; nursing evaluations; psychotropic medication administration and dispensing; medication monitoring; medication teaching, education and consent; laboratory test monitoring; and coordination with patient assistance programs, primary care physicians, schools, pharmacies and other agencies. In some situations where the individual has achieved long term stability and requires no other supportive services other than psychotropic medication prescription and monitoring, the Nurse may become the primary clinician.
The intensity of Nursing Services, as indicated in the Person-Centered Plan, is individually determined by need for psychiatric support, acuity, and medication consultation. Nursing staff are normally available from 8:00 a.m. to 5:00 p.m. Monday through Friday; however, time can be adjusted according to the needs of the individual and the hours that the Prescribers are available. The agency’s professional nursing staff provides services in locations that meet the needs of the persons served. Primarily, Nursing Services are considered to be an adjunct support to Psychiatric services; however, services may also include nursing consultation in the consumer’s AFC home, private residence, and/or other locations by mutual arrangement.
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 individuals 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 Nursing 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 Nursing 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 Nursing Services when one or more of the following occur:
- Successful completion of the goals set forth in the Individual Plan of Service
- 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.