What Is OBRA?
OBRA (Omnibus Budge Reconciliation Act of 1987) is a Federal law and a division of the Michigan Department of Community Health (DCH). The Act provides screening for persons seeking admission to Medicaid Certified Nursing Homes.
The Washtenaw County OBRA staff includes psychiatrists, psychologists, nurses, social workers and other health professionals that work to comply with the conditions of the Washtenaw County Health Services contract to complete pre admission screenings and annual resident reviews as described below. Their mission is to provide consultation and mental health services to aging and medically frail persons and their supports systems with the goal of maintaining the persons highest level of functioning in the community in the least restrictive environment.
OBRA Screening Information
If you are your legal representative decides you need to go to a nursing home, a screening will determine if you qualify for nursing home placement and/or if you have mental health issues. OBRA staff will visit you to complete the screening.
First, based upon the decision a nursing home is needed, your health care provider completes a LEVEL I screening, or a checklist that will aid in determining if you meet the criteria for a LEVEL II screening (You should receive a copy of the LEVEL I screening and have it explained to you.
A LEVEL II screening is a comprehensive evaluation. This screening is needed if you are:
- developmentally disabled
- if you have a current diagnosis of mental disorder,
- if you have received mental health treatment
- if you are on a currently prescribed Psychotropic medication
- if you have behavior indicating a need for mental health services
The LEVEL II screening may be bypassed if you have a primary diagnosis of dementia or if you need short term (30 days or less) nursing home placement.
The Michigan Department of Community Health's Lansing office will review the recommendations of the OBRA staff following a screening. This office determines if nursing home placement is allowed. If so, OBRA staff will notify your health care provider.
Once you arrive at the nursing home, OBRA staff will meet with you and explain the results of your LEVEL II evaluation and give a copy of you and the nursing home's social worker.
Once a year you will need an annual review to see whether mental health treatment has been effective or if you need changes. If you have any significant change in your condition, that impacts your mental health, you will receive another LEVEL II screening. OBRA staff will also determine whether you still meet the criteria for continued nursing home placement at that time.
Any decision you do not agree with can be appealed. You or your legal representative must submit your concerns or objections to the recommendations in writing. If your legal representative is filing for you, for medical purposes, he must provide proof of guardianship or durable power of attorney.
Mail appeals to:
Office of Nursing Home/OBRA Programs
Michigan Department of Community Health
Baker-Olin West Building -- Suite 303
3423 Martin Luther King Jr. Blvd.
Lansing, MI 48909
County OBRA Services
3901 Varsity Drive
Ann Arbor, MI 48108
Phone: (734) 222-3400
Fax: (734) 222-3464
While you are in the nursing home, Washtenaw OBRA staff may provide:
- client service management
- individual counseling
- medication review and monitoring
- psychiatric case consultation, and
- Assistance resolving your acute mental health problems based upon need.
Psychiatrists, psychologists, nurses, social workers and other health care professionals provide these services. OBRA also has connections with various agencies that can assist you while you are in the nursing home.
OBRA Federal Law excludes Alzheimer's disease and other types of Dementia from the definition of mental illness. However, OBRA staff provide services to developmentally disabled persons who have a diagnosis of dementia and upon request OBRA psychiatrists are available for medication reviews for persons in nursing homes with a diagnosis of dementia.
To learn more about Alzheimers and Dementia try visiting these websites: