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TBI Waiver Services Information

Learn about the TBI waiver program, eligibility requirements, services provided, and how families can access support for individuals with TBI. Find out how this waiver differs from the Innovations Waiver and how agencies approach rehabilitation for TBI.

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TBI Waiver Services Information

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  1. TBI Waiver Services Information May 11, 2018

  2. Alliance’s Role in the TBI Waiver Alliance was selected in 2016 by the NC Department of Health and Human Services to operate a pilot Waiver for Traumatic Brain Injury (TBI) in its four-county service region The TBI waiver application was recently approved by the Centers for Medicare and Medicaid Services TBI waiver services will begin in August, 2018

  3. Purpose and Rehabilitation Philosophy Download this PowerPoint presentation to view video, or go to https://www.bing.com/videos/search?q=Brain+Injury+After+Accident&&view=detail&mid=5E97A21BE20F5F9B2C795E97A21BE20F5F9B2C79&&FORM=VRDGAR

  4. Message from Alliance CEO “Alliance joins with the TBI community in welcoming the long-awaited approval of this waiver. It will make available an array of services that provides the potential for people with traumatic brain injury to live independent, satisfying lives. We look forward to collaborating closely with DHHS to create a model that can be successfully replicated across the state.” -Alliance CEO Rob Robinson

  5. Purpose and Rehabilitation Philosophy The waiver is designed to: Provide a variety of community-based rehabilitative services and supports as an alternative to nursing facility care or specialty rehabilitation hospital care for eligible individuals with a traumatic brain injury Support rehabilitation and promote choice and community involvement Help support adults with cognitive, behavioral and or physical support needs

  6. Minimum Eligibility Requirements For those interested in participating in the waiver: His/her injury must have occurred on or after their 22nd birthday He/she must meet specialty rehabilitation hospital care or skilled nursing care, and who meet financial eligibility requirements, may be eligible to participate in this waiver *A formal eligibility determination process for each person will be followed as outlined in the approved TBI waiver

  7. Purpose and Rehabilitation Philosophy Up to 49 individuals may be served in the first year of the pilot, expanding to 99 in the second year and 107 by the third year Five slots to serve individuals meeting acute rehab facility level of care and 44 slots to serve individuals meeting skilled nursing level of care

  8. How Families Can Learn More Encourage Families to go to our Alliance TBI webpage: www.AllianceBHC.org and type TBI in the search field OR To be placed on our interest registry call the 24-hour Alliance Access and Information Center at (800) 510-9132

  9. Habilitation vs. Rehabilitation:Your Agency’s Approach “Habilitation and rehabilitation both focus on the act of learning skills. The primary difference between the two is that habilitationfocuses on learning new skills whereas rehabilitation focuses on regaining skills lost.”

  10. Habilitation vs. Rehabilitation:Your Agency’s Approach QUESTION 1: Describe your rehabilitative approach when supporting individuals with Traumatic Brain Injury

  11. Habilitation vs. Rehabilitation:Your Agency’s Approach QUESTION 2: How do you feel this waiver differs from the Innovations Waiver?

  12. Habilitation vs. Rehabilitation:Your Agency’s Approach QUESTION 3: What types of approaches would you encourage your staff to use when supporting individuals on the TBI Waiver?

  13. Habilitation vs. Rehabilitation:Your Agency’s Approach QUESTION 4: Does an individuals unique story of how and when they sustained their TBI play a role in their treatment planning process, and if so why?

  14. FROM RFP Service Procurement Process TO CREDENTIALING TO CONTRACTS

  15. Allied Health Professionals Credentialing with Alliance PT/OT/ST Enrollment in NCTracks Plan in advance of State Plan benefit exhaustion Questions: ProviderNetwork@AllianceBHC.org

  16. Allied Health Service Procurement Plan Many practitioners may already be supporting and individual with a TBI Goal will be to provide continuity of care for these members and enroll their practitioners as the member’s State Plan Medicaid benefits are exhausted Remember! State Plan Medicaid benefits must be exhausted prior to TBI Waiver benefits service authorization requests may be submitted

  17. Allied Health Service Procurement Plan Allied Health Practitioners may be solo practitioners or working under the umbrella of a larger agency All practitioners must hold current licensure and be enrolled to provide Medicaid services through NCTracks

  18. Service Procurement Plan Two major RFPs to be released in early June 1 RFP for In-Network Providers only 1 RFP for In- or Out-of-Network Providers

  19. RFP for In- or Out-of-Network Providers Cognitive Rehabilitation Resource Facilitation

  20. Supported Employment • Community Networking • Natural Supports Education • Specialized Consultative Services • Personal Care • Crisis Services RFP for In-Network Providers Adult Day Health Life Skills Training In Home Intensive Support Day Supports Residential Supports Respite Community Transition

  21. Minimum Qualifications Must meet all provider requirements as outlined in the approved TBI waiver Demonstrate experience and staffing that have expertise in treating Traumatic Brain Injury Demonstrate experience with the Proposed Services Policies and Procedures and Program Descriptions will be required as part of the RFP response

  22. Minimum Qualifications Services to be delivered in the Alliance catchment area Demonstrated ability to collaborate with MCOs and other stakeholders in the development of innovative services

  23. Minimum Qualifications Assistive Technology Home Modifications Vehicle Modifications *Vendors will be identified and reimbursed following the current process for Innovations waiver vendors

  24. HCBS Compliance Required Supported Employment Day Supports Adult Day Health Residential Supports

  25. Timelines RFP release Late May Two weeks to respond Awards end of June for one RFP Early July award for second RFP

  26. Up-to-Date Information for the General Public

  27. Up-to-Date Information for the General Public

  28. How to Ask Provider Questions Agency-specific questions Email TBIinfo@AllianceBHC.org Questions after the RFP is released Email AllianceRFP@AllianceBHC.org

  29. Links to Resources Federal links www.medicaid.gov/ State links https://files.nc.gov/ncdma/documents/files/TBI_Waiver_Draft-for_Public_Comment_2016_01.pdf https://dma.ncdhhs.gov/

  30. Links to Resources Relevant associations https://www.ncrehabassociation.org/ http://www.ncota.org https://www.ncshla.org http://www.ncpt.org https://ncpsychology.org http://gncc-arn.org http://www.bianc.net/ http://www.bianc.net/about/biaa

  31. Links to Resources Alliance links www.Alliancebhc.org www.alliancebhc.org/providers/credentialing-enrollment/ www.alliancebhc.org/provider-operations-manual-effective-dec-16-2017/ www.alliancebhc.org/consumers-families/traumatic-brain-injury-tbi/ www.alliancebhc.org/about-alliance/rfps-rfis-qas

  32. Links to Resources Alliance links www.alliancebhc.org/category/provider-news/ http://alliancebhc.us3.list-manage2.com/subscribe?u=5b13b3bfafc28a5fdf4a11dfc&id=bb4c4ac331

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