The TBI Waiver provides home and community-based services to individuals who, but for the provision of such services, would require institutional care.
Indiana defines a traumatic brain injury as a trauma that has occurred as a closed - or open - head injury caused by an external event that results in damage to brain tissue, with or without injury to other body organs. Traumatic brain injury means a sudden insult or damage to brain function, not of a degenerative or congenital nature. The insult or damage may produce an altered state of consciousness and may result in a decrease in cognitive, behavioral, emotional, or physical functioning resulting in partial or total disability not including birth trauma related injury.
Individuals meeting Nursing Facility Level of Care and Medicaid eligibility requirements must meet at least one of the following criteria to receive services through the TBI waiver:
- Have a diagnosis of Traumatic Brain Injury, or
- Meet intermediate care facility requirements for individuals with intellectual disabilities
Services available through the TBI waiver are:
Adult Day Services (ADS): Adult Day Service (ADS) are community - based group programs designed to meet the needs of older adults who need structured, social integration through a comprehensive and non-residential program. The service plan will identify the need through the person-centered assessment (PCA) process and evident through the assessment tool. The purpose of ADS is to provide health, social, recreational, supervision, support services, and personal care. Meals and/or nutritious snacks are required.
Adult Family Care (AFC): Adult Family Care is a comprehensive service in which the Individual supported resides with an unrelated caregiver. The Participant and up to three (3) other Individuals who have physical and/or cognitive disabilities who are not members of the provider’s or primary caregiver’s family, reside in a home that is owned, rented, or managed by the adult family care provider. AFC provides an environment that has the qualities of a home, including privacy, safe place that is free of environmental hazards such as pests, habitable environment, comfortable surroundings, and the opportunity to modify one’s living area to suit one’s participant preferences.
Assisted Living (AL): Assisted Living Service is defined as personal care, chore, attendant care and companion services, medication oversight (to the extent permitted under State law), therapeutic social and recreational programming, provided in a congregate residential setting in conjunction with the provision of participant paid room and board. This service includes 24-hour on-site response staff to meet scheduled or unpredictable needs. The participant retains the right to assume risk.
Attendant Care Service: Attendant Care services (ATTC) are provided to participants with nursing facility level of care needs. ATTC provides direct, hands-on care to participants for the functional needs with ADLs. ATTC id provided to participant with either nursing facility or ICF/IID level of care needs.
Behavior Management/ Behavior Program and Counseling: Behavior Management includes training, supervision, or assistance in appropriate expression of emotions and desires, assertiveness, acquisition of socially appropriate behaviors, and the reduction of inappropriate behaviors. This service includes observation of the individual and environment for purposes of development of a plan and subsequent revisions and training staff, family members, roommates, and other appropriate individuals on the implementation of the behavior support plan.
Care Management: Care Management is a process of assessment, discovery, planning, facilitation, advocacy, collaboration, and monitoring of the holistic needs of each individual, regardless of funding sources.
Community Transition Services: Community Transition Services include reasonable, set-up expenses for Individuals who make the transition from an institution to their own home where the person is directly responsible for his or her own living expenses in the community and will not be reimbursable on any subsequent move. Reimbursement is limited to a lifetime cap for set up expenses up to $1,500.
Home
Modifications: Home Modifications are physical adaptations to the home, required by the Individual’s Service Plan, which are necessary to ensure the health, welfare and safety of the Individual, or enable the Individual to function with greater independence in the home, and without which the Individual would require institutionalization. Maintenance is limited to $500 annually for the repair and service of environmental modifications that have been provided through the waiver. A lifetime cap of $20,000 is available for home modifications, however, the cap on any single project is $15,000. The cap represents a cost for basic modification of a participant’s home for accessibility and safety and accommodates the participant’s needs for housing modifications.
Integrated Health Care Coordination: Health Care Coordination is to promote improved health status and quality of life, delay/prevent deterioration of health status, manage chronic conditions in collaboration with physicians, and integrate medical and social services. The purpose of Health Care Coordination is development and oversight of a healthcare support plan which includes coordination of medical care and proactive care management of both chronic diseases and complex conditions such as falls, depression and dementia.
Home and Community Assistance: Home and Community Assistance services provide instrumental activities of daily living (IADL) for the participant in their home. The services are provided when the individual is unable to meet their needs or when the informal caregiver/helper is unable to perform these needs for the participant.
Home Delivered Meals: Home Delivered Meals are nutritionally balanced meals. Home delivered meals may include but are not limited to: No more than two meals per day will be reimbursed under the waiver, Diet/ nutrition counseling provided by a registered dietician, Nutritional education based on needs of each participant, Diet modification according to a physician’s order as required meeting the individual’s medical and nutritional needs.
Nutritional Supplements: Nutritional Supplements include liquid supplements, such as “Boost” or “Ensure” to maintain an Individual’s health in order to remain in the community. Supplements should be ordered by a physician, physician assistant, or nurse practitioner. Reimbursement for approved Nutritional Supplement expenditures are reimbursed through the local AAA or an approved DA provider, who maintains all applicable receipts and verifies the delivery of services. There is an annual cap of $1,200.
Personal Emergency Response Systems (PERS): Personal Emergency Response Systems (PERS) are electronic devices which enable certain Participants at high risk of institutionalization to secure help in an emergency. The Participant may also wear a portable help button to allow for mobility. The system is connected to the person’s phone and programmed to signal a response center once a “help” button is activated. The response center is staffed 24 hours daily/ 7 days per week by trained professionals.
Pest Control: Pest Control services are designed to prevent, suppress, or eradicate anything that competes with humans for food and water, injures humans, spreads disease and/or annoys humans and is causing or is expected to cause more harm than is reasonable to accept. Pests include but are not limited to insects such as roaches, mosquitoes, and fleas; insect-like organisms, such as mites and ticks; and vertebrates, such as rats and mice. Reimbursement for approved Pest Control expenditures is reimbursed through the local AAA or other approved DA provider, who maintain all applicable receipts and verifies the delivery of services There is an annual cap of $4,000.
Residential Based Habilitation: Residential Based Habilitation service provides training to regain skills that were lost secondary to the traumatic brain injury. Residential Based Habilitation services must follow a written service plan addressing specific measurable goals and objectives to help with the acquisition, retention, or improvement of skills that were lost secondary to the TBI. Residential Based Habilitation services must be monitored monthly. Habilitation services must be performed by persons who are supervised by a Certified Brain Injury Specialist (CBIS) or Qualified Mental Retardation Professional (QMRP) or a physical, occupational, or speech therapist licensed by the state of Indiana and have successfully completed training or have experience in conducting habilitation programs.
Respite Care: Respite Care services are those services that are provided temporarily or periodically in the absence of the usual caregiver. Respite occurs in home and community-based settings. For those Individuals receiving the service of Adult Family Care or Assisted Living waiver service, funding for respite is already included in the per diem amount and the actual service of respite may not be billed.
RHHA: A participant who is eligible for State Plan Home Health Services (HOHE) should be considered for respite home health aide under the supervision of a registered nurse.
RSKNU: A participant who is eligible for State Plan Nursing Services (SKNU) must be considered for respite nursing services.
Authorized hours will roll over month to month through the duration of the Annual Service Plan. If a request for an increase in Respite during the annual care plan is needed the CM must coordinate with the agency to verify unused hours before requesting the additional hours. If there are unused hours they must first be used before requesting additional hours
Specialized Medical Equipment & Supplies: Specialized Medical Equipment and Supplies are medically prescribed items required by the participant's service plan, which assist the participant in maintaining their health, welfare and safety, and enable the participant to function with greater independence in the home. Individuals requesting authorization for this service through the waiver must first exhaust eligibility of the equipment or supplies through the Indiana Medicaid State Plan. There should be no duplication of services. Maintenance is limited to $1000.00 annually for the repair and service of items that have been provided though the HCBS waiver.
Structured Day Program: Structured Day Program is assistance with acquisition, retention, or improvement in self-help, socialization, and adaptive skills, which takes place in a non-residential setting, separate from the home in which the Individual resides. The program services shall focus on enabling the Individual to attain or maintain his or her functional level. Structured Day Program services serve to reinforce skills or lessons taught in school, therapy, or other settings. The services are normally furnished four (4) or more hours per day on a regularly scheduled basis, for one (1) or more days per week unless provided as an adjunct to other day activities included in an Individual’s Service Plan.
Supported Employment: Supported Employment Services consist of paid employment for persons for whom competitive employment at or above the minimum wage is unlikely, and who, because of their disabilities, need intensive ongoing support to perform in a work setting. Supported Employment is conducted in a variety of settings, particularly work sites where persons without disabilities are employed. The service includes activities needed to sustain paid work by Individuals receiving waiver services, including supervision and training.
Transportation: Transportation Services enable Individuals supported under the waiver to gain access to waiver and other non-medical community services, activities, and resources, specified by the Service Plan.
Transportation services under the waiver shall be offered in accordance with an Individual’s Service Plan and whenever possible, family, neighbors, friends, or community agencies which can provide this service without charge will be utilized. This service is offered in addition to medical transportation required under 42 CFR 431.53 and transportation services under the State plan, if applicable and shall not replace them.
Vehicle Modifications: Vehicle Modifications are the addition of adaptive equipment or structural changes to a motor vehicle that will empower a participant to be safely transported in a motor vehicle. Maintenance is limited to $1000 annually for repair and services of items that have been funded though the HCBS waiver. A lifetime cap of $15,000.00 is available for one (1) vehicle per every ten (10) year period for a participant’s household.
