The Office of Specialized Nursing Homes/OBRA Programs was originally established in response to the provisions of the federal Omnibus Budget Reconciliation Act (OBRA) of 1987, which amended the Medicaid program requirements for nursing homes. Its primary function has been to assure the implementation of those provisions of OBRA which address the relationship of nursing facilities to persons who are mentally ill or mentally retarded.

The preadmission screening/annual resident review (PASARR) required by OBRA is the major function of the office. Under the PASARR program, all persons seeking admission to a nursing home who are mentally ill or mentally retarded are required to be evaluated to determine whether the nursing facility is the most appropriate place for them to receive services and whether they require specialized mental health/mental retardation services. In addition, persons residing in a nursing home who are mentally ill or mentally retarded are required to undergo a similar review annually or when there is a significant change in condition to determine whether they continue to require the services of a nursing facility or whether they require specialized services.

This review process begins with the completion of a screening form, usually by a nursing home or a hospital. If the responses to the questions on the form indicate the presence of a mental illness or mental retardation (or a related condition), the person is referred to the local community mental health services program for a comprehensive evaluation. This evaluation and the evaluator's recommendation are reviewed by this office and a determination made as to whether the person is appropriate for nursing home admission/stay and whether specialized services are required. Persons evaluated or their legal representative may appeal the determination if they disagree.

In addition to the PASARR determination process, the office handles contracts and billings with community mental health services programs for the PASARR evaluation process. The Office also provides technical assiatance to local community health services programs in providing mental health and mental retardation services to persons residing in nursing homes.

The department maintains a contract with Birchwood Nursing Center in Traverse City to provide a specialized mental health program to older adults who require both a skilled level of nursing and specialized mental health services. This office manages the department's contract with Birchwood and approves all admissions to and discharges from that special unit.

The office is also responsible for two programs that allow persons living in the community to obtain necessary adaptive equipment and environmental modifications. Prior authorizations for adaptive equipment and environmental modifications under the Medicaid Habilitations Support Waiver is the larger of the two programs. This affects over 7,000 consumers. In addition, the office oversees the Fund to Enhance Self-Reliance which enables consumers to purchase adaptive equipment or make environmental modifications when all other funding sources are unavailable.

Services:

• Approximately 9,000 persons reviewed yearly through PASARR.
• Over 5,000 persons residing in nursing homes receive mental health or mental retardation services.
• Over 3,000 requests reviewed for adaptive equipment and environmental modifications.

Mail to: David Verseput, for information regarding OBRA programs, or Debra Ziegler for information regarding prior authorizations