COPE Community Services, Inc.

Respite ServicesProtocol

Respite services arethe supervision and/or care of persons residing at home in order to provide an interval of rest and/ orrelief to the primary care giver. Respite services can be provided in a variety of settings and is available to all Title 19 populations and Non-Title 19 SMI populations. Respite is limited to 600 hours per fiscal year.

Referral Process

  1. Client meets with case manager to discuss Respite Services.
  2. Case manager discusses clinical need for respite services with Team Leader.
  3. Team Leader will discuss need with BHMP.
  4. Team Leader contacts Kim Young in UM who will verify availability of respite hours.
  5. Kim Young will email the case manager the referral paperwork to be completed toa COPE respite facility or for the Sub-Contracted Respite Services Provider.
  6. The case manager will forward the completed referral packet to Kim Young in UM.
  7. Kim Young will fax the completed referral packet to a COPE respite facility or a Sub-Contracted Respite Services Provider within 24 hours of receipt of the complete referral packet.
  8. UM will notify Team Leader that completed referral packet was provided to a COPE respite facility or the Sub-Contracted Respite Services Provider.
  9. A COPE respite facility or a Sub-Contracted Respite Services Provider will contact Kim Young with proposed respite services begin date.
  10. The case managerwill schedule ART to updatethe service plan to indicate the respite services frequency and date range.The TL will update the pay-code submission form.
  11. The TL will fax the pay-code submission form (if applicable) and service plan to Kim Young at 792-1746.
  12. Kim Young will submit the pay-code submission (if applicable) form and the service plan to a COPE respite facility or the Sub-Contracted Provider.
  13. Case manager will contact the client and the COPE respite facility or a Sub-Contracted Respite Services Provider to begin respite services.

Continued Respite Services

1.Monthly ART meetings will be scheduled with the client, case manager and team leader to discuss continuation of respite services. This meeting must be scheduled prior to the end date indicated on the previous service plan. If identified in the context of the ART as a continued need, the following must occur:

  1. Update the service plan to include respite services frequency and date range.
  2. Send the updated service planandpay-code submission form(if applicable) toUMAttn: Kim Youngat

792-1746.

2.UM will provide the Sub-Contracted Respite Services Provider with the updated service plan and pay-code submission form

3.UM will notify the team leader that the completed pay-code submission form was provided to the Sub-Contracted Respite Services Provider (if applicable).

COPE Website: Sub-Contracted Respite Services Protocol.doc 1.31.13