224 HOME AND COMMUNITY-BASED CARE FOR INDIVIDUALS WITH AN ACQUIRED BRAIN DISORDER (HCBC-ABD) (AAM)

224 HOME AND COMMUNITY-BASED CARE FOR INDIVIDUALS WITH AN ACQUIRED BRAIN DISORDER (HCBC-ABD) (AAM)

SR 03-04 Dated 01/03 Previous Policy

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Home and Community-Based Care for Individuals with an Acquired Brain Disorder (HCBC-ABD) offers a variety of community-based services that an individual with an acquired brain disorder may need in order to prevent institutionalization. The Division of Developmental Services (DDS) determines if the individual has an acquired brain disorder. The criteria are provided below only for informational purposes.

An acquired brain disorder is a non-congenital condition affecting the brain or nervous system and presents a severe lifelong disabling condition that impairs a person's ability to function in society. To be considered an acquired brain disorder, the disorder or insult must have happened before age 60 and be due to one or more of the following:

• physical trauma due to a car, motorcycle, bicycle, or other related physical trauma or occurrence;

• an infectious disorder such as encephalitis or meningitis;

• anoxia (lack of oxygen to the brain);

• demyelinating (causing destruction of the myelin, the fatty substance which shields the nerves) and other inflammatory diseases such as multiple sclerosis; or

• other related disorders such as Huntington ’ s disease.

Individuals who meet the program categorical requirements of any DFA financial or medical assistance program may be eligible to receive community-based services if all of the following are met:

• individual is age 22 or older;

• individual ’ s income and resources are within the categorically or medically needy limits. See Part 601 , Income Limits;

• DDS area agency establishes that the individual is appropriate for services;

• DDS determines the individual has a medical necessity to receive skilled nursing or a rehabilitative level of care. See the Medical Assistance Manual , Item 955 ; and

• individual or their representative has chosen appropriate community-based care as an alternative to institutional care.

Exception: QMB, SLMB, and SLMB135 * MA only cases are not eligible for HCBC services.