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MRG

UPDATED: JANUARY 2011

727

OTHER ELIGIBILITY REQUIREMENTS WAIVERS TRAUMATIC BRAIN INJURY (TBI) WAIVER

Description: On March 23, 1994, the Medicaid Home and Community-Based Services Waiver for Persons with Traumatic Brain Injuries (HCBS/TBI Waiver) was approved by the Federal Government. This waiver is one component of a comprehensive strategy developed by New York State to repatriate and de-institutionalize individuals with TBIs who reside in nursing facilities (NF) either in or out-of-state and to offer an alternative to NF placement for others currently living in the community who are at significant risk of NF placement. The HCBS/TBI Waiver is designed to provide the necessary services and supports to achieve these objectives.

The TBI Waiver is overseen on a daily basis by 9 Regional Resource Development Center (RRDCs) under contract with the New York State Department of Health. The RRDCs employ Regional Resource Development Specialists (RRDSs) who are responsible for the administration of the daily activities of the TBI Waiver.

Policy: An individual participating or seeking application in the HCBS/TBI

Waiver must be: • Between the ages of 18 and 65 with a primary diagnosis of Traumatic Brain Injury or other related acquired brain injury upon application to the waiver; • Assessed to be eligible for nursing home level of care as a direct result of the brain injury. Nursing home eligibility is determined by using he Patient Review Instrument (PRI) (DOH- 694) and SCREEN (DOH-695), which must be performed by a certified assessor who can conduct a PRI/SCREEN; • In receipt of Medicaid coverage for Community Based Long Term Care services or Outpatient Coverage for Community Based Long term Care; and • Capable of living in the community with the assistance of available informal supports, Medicaid State Plan services and one or more waiver services; and • Part of an aggregate group that can be cared for at less cost in the community than in a nursing home.

An individual cannot be enrolled in the TBI waiver and any of the other HCBS waivers at the same time (i.e. the Long Term Home Health Care Program waiver, the Nursing Home Transition and Diversion