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North Carolina Department of Health and Human Services North Carolina Medicaid Division of Health Benefits AGED, BLIND AND DISABLED MEDICAID MANUAL MA-2283

TRAUMATIC BRAIN INJURY (TBI) WAIVER

REVISED 6/10/2024 - CHANGE NO. 11-24

Current Change Notice 11-24 • I.A.1.e. Reside in the Alliance Behavioral Health (Alliance) catchment area of Cumberland, Durham, Harnett, Johnston, Mecklenburg, Orange and Wake counties.

• I.A.2.e. Reside in the Alliance Behavioral Health (Alliance) catchment area of Cumberland, Durham, Harnett, Johnston, Mecklenburg, Orange and Wake counties.

I. INTRODUCTION The North Carolina Traumatic Brain Injury (TBI) Waiver is authorized under Section 1915(c) of the Social Security Act. The Waiver is designed to provide home and community-based services (HCBS) to Medicaid beneficiaries who have suffered a traumatic brain injury and have significant cognitive, behavioral and rehabilitative needs. These services allow beneficiaries, through person-centered planning, to receive home and community-based services necessary to allow them to live in the community and avoid institutionalization.

TBI waiver participants receive an individual support plan (ISP) which provides a community-based alternative to institutional care. The Local Management Entity/Managed Care Organization (LME/MCO) operating as a fully capitated, prepaid inpatient health plan (PIHP) provides all waiver services which are authorized through the annual ISP.

A. TBI Waiver Categories

TBI Waiver services are offered in the following categories:

1. TBI Hospital (BH)

TBI/BH provides HCBS to individuals who:

a. Are age 18 and older

b. Are aged, blind, disabled or both (MAABD, SAABD)

c. Are in need of specialty hospital rehabilitative level of care to support people with a diagnosed brain injury who have significant cognitive, behavioral, and rehabilitative needs (BH)

d. Live in either a private living arrangement (PLA) or in living arrangements of 6 beds or less