1. Aged and Disabled Waiver Serving Individuals with Brain Injury

2. Overview Today’s Presentation and Memo will outline how the A&D Waiver may work for individuals with brain injury: 1) the purpose of this waiver and it’s distinctions from other waivers for serving individuals with TBI 2) how individuals with brain injury qualify for and access the waiver 3) the services provided by the waiver that are useful for individuals with TBI 4) criteria and processes for providers 5) additional resources

3. The A&D Waiver The Aged and Disabled Waiver can provide resources for an individual with brain injury to receive services. Developmental disability service providers may provide services through the Aged and Disabled Waiver. The services needed by individuals with brain injury have characteristics in common with services provided by developmental disability services providers.

4. Purpose The Aged and Disabled Waiver offers and array of services to support people in their homes. It is focused on providing services to individuals that have physically and medically disabling conditions such as stroke, active and terminal cancers, and brain injuries. Services are “rehabilitative” in nature to assist individuals to regain skills from prior to their injury such as assistive technology supports, home modifications, and independent skills building.

5. Eligibility Client eligibility factors - clients must: a. Be eligible for the Nebraska Medical Assistance Program (NMAP); b. Have participated in an assessment with a services coordinator; c. Meet the Nursing Facility (NF) level of care criteria (471 NAC 12-000); – - Nursing facility level of need is defined through an assessment of medical need, risk criteria, and cognition factors. Nursing facility level of care means you have needs which require you to receive services similar to those provided to individuals who live in a nursing home.

6. Eligibility Client eligibility processes: a. Clients must meet with a Service Coordinator, which has a specific role in the Aged and Disabled Waiver: - Adults aged 18-64 receive Services Coordination through the Independent Living Centers in Nebraska. Contact information is found here: http://dhhs.ne.gov/Documents/IndependentLivingCenters.pdf http://dhhs.ne.gov/Documents/IndependentLivingCenters.pdf - Individuals must fill out certain paperwork, including a service provider agreement and rate form with the help of the Services Coordinator b. Referrals: - Service coordinators may provide clients a list of providers. - Individuals choose their providers and meet with providers - Clients work monthly with their service coordinator c. Resources facilitation: - Nebraska has a full time Brain Injury Resource Facilitator in Omaha and one in Lincoln. The Resource Facilitator takes calls from individuals and connects them with services and supports for their needs and following them longer term. Learn more here: http://www.biane.org/welcome.htmlhttp://www.biane.org/welcome.html

7. Services Services should improve functional adaptive skills in the home and work (community) environments, for example, teaching the individual and family how to use the brain book. Some of the funded services include: – Services Coordination – provided by specially trained staff who help match your needs with services and providers, based on your preferences Services Coordination – In-home help, such as: home-delivered meals, cleaning, laundry, getting groceries (chore), maintaining good nutrition, personal emergency response system, special equipment to make tasks easier to perform, or modifying your home to make it easier to get around (assistive technology/home modifications)home-delivered mealschorenutritionpersonal emergency response systemassistive technology/home modifications – Relief time for family caregivers (respite)respite – Training to increase independence in activities of daily living at home (independence skills building)independence skills building – Child care so the caregiver can maintain employment (child care for children with disabilities)child care for children with disabilities – Community supports like adult day services and transportation for essential activities such as medical appointmentsadult day servicestransportation – Assisted Living services Assisted Living

8. Services Explanation of skills building – Independence Skills Management (ISM) is training for adults and children in activities of daily living and training to overcome or compensate for the effects of physical disabilities. Training may occur in the client's home or in the community, and may be provided individually or in a group setting. The caregiver (non- Medicaid paid provider) may be included in this training to promote independence of the waiver client. The need for this service must be reflected in one or more assessment areas of the client's plan of services and supports. – Independent skill management is about skills people previously had – they may continue rehabilitation at home. Providers may look at how to break down a skill and adapt in a different way.

9. Providers – Providers of services under the Comprehensive Developmental Disabilities Waiver would only need to do an addendum under the Aged and Disabled Waiver. Regulatory requirements are similar and relate to administrative requirements regarding background checks, nondiscrimination, reporting of abuse and neglect, ect. – Providers will work with a "Resource Developer" to offer specific services. Resource Developers work with clients, service coordinators, independent living centers, and providers to set up services.

10. Providers Billing and Rates – Rates are developed with Resource Developers. Some are negotiated and some are set. Negotiated rates will consider factors such as the care needs of the individual, the intensity of the service, and a comparison to other rates for services in the area. – Rates: there are flexible rates for some services. Rates must be cost effective and may be contingent upon geographic area. – Rates: there are set rates for some services like individual respite and mileage. – DHHS reimburses monthly, providers must maintain records and submit billing. Quality Assurance: – The Nebraska Medicaid & Long Term Care Home and Community-Based Services (HCBS) Waivers Unit utilizes a Quality Improvement System to ensure the health and well-being of clients through continuous, client-focused monitoring and improvement.

11. Resources a. The Department of Health and Human Services can serve as a resource. To ask questions related to the Aged and Disabled Wavier contact May Faith: – May Faith, Program Specialist, HCBS AD Waiver, Department of Health and Human Services, Medicaid & Long-Term Care, Ph: (402) 471-1670 Fax: (402) 471-9092, May.Faith@nebraska.gov(402) 471-1670(402) 471-9092 May.Faith@nebraska.gov – Handbook: http://local.hhss/Forms/Home.aspxhttp://local.hhss/Forms/Home.aspx b. The Nebraska Brain Injury Advisory Council provides the Nebraska Traumatic Brain Injury Provider Training Manual, which is a comprehensive resource for issues related to complications of brain injury, communication styles for individuals with brain injury, screening tools, and more: http://www.braininjury.ne.gov/docs/Nebraska_Traumatic_Brain_Injury_Provider_ Training_Manual.pdfhttp://www.braininjury.ne.gov/docs/Nebraska_Traumatic_Brain_Injury_Provider_ Training_Manual.pdf c. Relias Learning and College of Direct Support both offer resources to help you develop programs for independence skills building: https://reliaslearning.com/ or http://directcourseonline.com/direct-support/https://reliaslearning.com/ http://directcourseonline.com/direct-support/