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West Virginia Income Maintenance Manual Chapter 24

West Virginia Income Maintenance Manual Page 149 Chapter 24 Long Term Care

24.47 CASE MAINTENANCE 24.47.1 COUNTY TRANSFER When a Traumatic Brain Injury (TBI) waiver client moves from one county to another, the case record must be transferred to the new county of residence. 24.47.2 CHANGES IN INCOME When the client's income increases to above 300% of the Supplemental Security Income (SSI) payment level, he is no longer eligible for TBI waiver services. The Worker must: • Notify the case management agency (CMA) or the Bureau for Medical Services (BMS) contract agency listed in Appendix E; • Notify the client or his authorized representative by providing 13 days’ advance notice; • Update the eligibility system; and, • Evaluate the client for all other Medicaid coverage groups. 24.47.3 CHANGE IN MEDICAL CONDITION When the client's medical condition improves to the extent that TBI services are no longer required, he is ineligible for the TBI coverage group. If this is the method by which he qualified for Medicaid, he must be evaluated for all other Medicaid coverage groups. TBI services are no longer paid under Medicaid. If the TBI client’s condition changes to the extent that care in a nursing facility is required, the following conditions must be met before Medicaid can pay for nursing facility services: • A valid Pre-Admission Screening (PAS) was completed on the date the client entered the nursing facility or within the 60-day period prior to entering the facility. • The post-eligibility process to determine the client’s contribution to his cost of care was completed. See Section 24.7 for instructions.

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Page 2074

Official source

West Virginia Income Maintenance Manual Chapter 24

West Virginia Income Maintenance Manual Page 149 Chapter 24 Long Term Care

24.47 CASE MAINTENANCE 24.47.1 COUNTY TRANSFER When a Traumatic Brain Injury (TBI) waiver client moves from one county to another, the case record must be transferred to the new county of residence. 24.47.2 CHANGES IN INCOME When the client's income increases to above 300% of the Supplemental Security Income (SSI) payment level, he is no longer eligible for TBI waiver services. The Worker must: • Notify the case management agency (CMA) or the Bureau for Medical Services (BMS) contract agency listed in Appendix E; • Notify the client or his authorized representative by providing 13 days’ advance notice; • Update the eligibility system; and, • Evaluate the client for all other Medicaid coverage groups. 24.47.3 CHANGE IN MEDICAL CONDITION When the client's medical condition improves to the extent that TBI services are no longer required, he is ineligible for the TBI coverage group. If this is the method by which he qualified for Medicaid, he must be evaluated for all other Medicaid coverage groups. TBI services are no longer paid under Medicaid. If the TBI client’s condition changes to the extent that care in a nursing facility is required, the following conditions must be met before Medicaid can pay for nursing facility services: • A valid Pre-Admission Screening (PAS) was completed on the date the client entered the nursing facility or within the 60-day period prior to entering the facility. • The post-eligibility process to determine the client’s contribution to his cost of care was completed. See Section 24.7 for instructions.