The Road to ABI Waiver Services

People are referred to the BISB through the website, BIAK, providers, TBI Trust Fund, hospital social workers, discharge planners, legislators, family, friends, and word of mouth. BISB sends waiting list packet to the person or other identified contact START (800) (toll free BISB number) The Road to ABI Waiver Services

Waiting list applications are accepted year round To be placed on the waiting list, a completed packet is required – this includes the signed doctor’s statement verifying the presence of a brain injury Waiting List Application The Road to ABI Waiver Services

People are placed on the waiting list in chronological order, when their applications are complete People who meet the criteria for emergency status on the waiting list will receive allocations before those who do not Wait until allocation of funding becomes available. The Road to ABI Waiver Services

Stop: Does the person meet the criteria for emergency status? The person currently is demonstrating behavior related to his acquired brain injury that places the recipient or caregiver or others at risk of significant harm The individual is demonstrating behavior related to his acquired brain injury which has resulted in his arrest The Road to ABI Waiver Services

How are decisions made about emergency status? Emergency Review Committee is composed of three people –Not BISB staff or supervised by BISB staff –Includes two family members of people with disabilities, including ABI –Includes one RN –All employed by CHFS The Road to ABI Waiver Services

How are decisions made about emergency status? Emergency Review Committee meets the 15 th of each month Considers all completed emergency applications May find that the person meets or does not meet criteria OR may ask for additional information The Road to ABI Waiver Services

How are decisions made about emergency status? Emergency Review Committee makes decisions based upon the documentation provided Documentation must specify the circumstances which qualify the person for emergency status (more detail is better) The Road to ABI Waiver Services

How are decisions made about emergency status? The regulations state that a written statement by a physician or other QMHP shall be required to support the validation of risk of significant harm to a recipient or caregiver The Road to ABI Waiver Services

Can people be reconsidered for emergency status? People can be reconsidered at any time, if there is a change in circumstances or if additional information becomes available to support an emergency status request The Road to ABI Waiver Services

Allocations are made the 15 th of each month – notice is sent via certified mail (some people refuse services or are not eligible- these places can be given to others) Allocations to fill discharged people’s places can only be made in January Once an allocation is made, the person has 60 days to initiate services The Road to ABI Waiver Services Funding becomes available- receive allocation letter

If the person does not initiate services within 60 days or refuses services, he or she may still request to be placed back on the waiting list The person would be placed at the end of the waiting list The Road to ABI Waiver Services Funding becomes available- receive allocation letter

BISB staff contact the person by telephone within 14 days to assure that the letter has been received and to help the person understand the process BISB staff will make further contact as needed The Road to ABI Waiver Services Funding becomes available- receive allocation letter

If a CM has been identified, a copy is sent to the CM Remember, services must be initiated within 60 days A one time only 60 day extension may be granted for good cause The Road to ABI Waiver Services Contact Case Management Agency from List

Case Manager: Meets with the person and legal guardian Contacts potential selected providers Refers the person to providers Develops the initial plan of care The Road to ABI Waiver Services

Case Manager: The Road to ABI Waiver Services Submits paperwork to PRO for review (30 days) Submits financial information for eligibility determination (30 days)

The Road to ABI Waiver Services Not eligible for program at this time- consider appeal options The person’s allocation is held throughout the appeal process An appeal process can take 90 days or more to complete If the appeal is lost, the allocation is given to the next person on the waiting list

The Road to ABI Waiver Services Once a start date has been established with the provider, services will be prior authorized by the BISB Under some circumstances, CM can be prior authorized as the only service, for short period Meets financial and level of care requirements

The Road to ABI Waiver Services Initially, services are only prior authorized for 30 days Thereafter, services may be authorized until the end of the person’s certification period Meets financial and level of care requirements

The Road to ABI Waiver Services As of January 23, 2006: 95 “active” people in the ABI Medicaid Waiver 71 people on the ABI waiting list. 13 people were discharged from the ABI Medicaid Waiver in people have been recently allocated a slot for the ABI Medicaid Waiver.