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
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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 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: and type TBI in the search field OR
To be placed on our interest registry call the hour Alliance Access and Information Center at (800)

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 habilitation focuses 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. Service Procurement Process
FROM RFP
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:

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

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
Questions after the RFP is released

29. Links to Resources Federal links State links www.medicaid.gov/
for_Public_Comment_2016_01.pdf

30. Links to Resources Relevant associations

31. Links to Resources Alliance links www.Alliancebhc.org

32. Links to Resources Alliance links