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IN ADDITION TO THE BASIC MEDICAID DEDUCTIBLE RULES, THE FOLLOWING APPLIES TO TBI: 1. All TBI deductibles are calculated monthly.

2. Expenses listed on the Level of Care (Medicaid) column are allowed in addition to other allowable Medicaid expenses.

For keying instructions refer to NC FAST job aid: Managing Spend Down Evidence IV. TBI PARTICIPATION

A. The effective date for TBI waiver participation is the level of care effective date.

B. Certification Period

1. 12-month certification period 2. SSI TBI Waiver certification periods are controlled by the Social Security Administration (SSA).

V. TBI RECERTIFICATION

A recertification must be completed:

A. Once every 12 months B. Continued Need Review (CNR) must be current. C. Apply the Ex - parte process. SSI beneficiaries do not require recertification.

VI. CHANGES IN SITUATION This section addresses how to handle ongoing Medicaid case maintenance when a change in situation occurs. A. TBI Waiver Services Terminated

When a change in situation results in an individual’s ineligibility for Medicaid authorization for the TBI Waiver program:

1. Re-compute the budget for the remainder of the certification period. 2. Apply spouse-for-spouse or parent-for-child responsibility. 3. Evaluate other Medicaid aid programs.