Traumatic Brain Injury Waiver - TBIW

• This is an in-home care program that allows a Personal Attendant to come into your home to assist you with your personal needs. This program is for individuals who need the same type of care provided in a nursing home but want to stay in their own home.

How do I begin the process to apply for this program?

• To start the process, you must get an application called a Medical Necessity Evaluation Request (MNER) from KEPRO and have your treating physician(MD or DO), physician’s assistant, neuropsychologist or nurse practitioner complete, sign and submit it to:
  • KEPRO1007 Bullitt Street Suite 200.
    Charleston, WV 25301
    Toll Free: 1-866-385-8920
    Fax: 1-866-607-99033.

What happens after my physician competes the MNER form?

• You or your treating physician(MD or DO), physician’s assistant, neuropsychologist or nurse practitioner must mail or fax the MNER form to KEPRO. KEPRO will send you a letter with information and instructions to go to your local Department of Health and Human Resources (DHHR) Office to determine if you are financially eligible for the TBI Waiver program. If you are financially eligible the DHHR will notify KEPRO. KEPRO will schedule an appointment with you to come to your home and complete assessments to determine your medical eligibility. One of the assessments is a Pre-Admission Screening (PAS).
• You must have substantial needs in at least 5 areas of activities of daily living in order to be medically eligible. Below are some of these activities:
  • Eating
  • Bathing
  • Dressing
  • Grooming
  • Mobility
  • Toileting
• KEPRO will also use the Rancho Los Amigos Levels of Cognitive Functioning Scale for individuals 18 years or older and they must score at a Level VII or below to be eligible. The Rancho Los Amigos Pediatric Level of Consciousness is used for children ages 3 to17 years old and they must score at a Level ii or higher to be eligible.
• Once you have been found both financially and medically eligible a funded slot must be available for you to begin receiving services. You may be placed on a Managed Enrollment List which is a wait list until a funded slot becomes available.

What services are available through the TBI Waiver program?

• You may receive services through a Traditional TBI Waiver provider who will provide your Case Management Services and/or Personal Attendant Services, or you may choose to self-direct your Personal Attendant services(Personal Options) which means your employees work directly for you. ervices available include:
  • Case Management Services–a licensed professional who helps you identify your needs and plan for your care as well as advocates for and connects you with services or resources in your community.
  • Personal Attendant Services–someone who provides assistance to you in your own home and community with activities of daily living (eating, bathing, dressing, grooming, mobility and toileting) *
  • TBI Waiver Non-Medical Transportation-Your Personal Attendant can transport you to do essential errands and community activities listed on your Service Plan. *
• *Denotes services that can be self-directed.

You may obtain further TBIW information from:

• • Bureau for Medical Services(BMS)
    Telephone: 304-558-1700BMS
    Website:http://www.dhhr.wv.gov/bms/Programs/WaiverPrograms/TBIW/Pages/default.aspx
    You can get an MNER on this website as well.
    
    OR
    
    KEPRO
    Telephone: 1-866-385-8920