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Traumatic Brain Injury Waiver (TBIW) Case Management

Traumatic Brain Injury Waiver (TBIW) Case Management

In West Virginia, members approved to receive Traumatic Brain Injury Waiver services receive personal attendant and case management services. To qualify for services, an individual must be three years of age and have documentation that demonstrates a traumatic brain injury that is caused by a physical force that led to partial or total disability or by a lack of oxygen due to near drowning that has led to difficulty participating in social activities, and the individual must meet the medical requirements for a nursing home level of care. Members must be a permanent resident of West Virginia and meet all financial eligibility requirements for the Medicaid Waiver program. In addition, members must reside in a licensed nursing facility, hospital, or licensed rehabilitation facility to treat a traumatic brain injury or reside in a community setting at the time of application. A safe workplace must be provided for all agency staff, and the member must choose to participate in TBIW services versus care at a nursing facility. A score at Level VII or below on the Rancho Los Amigos Levels of Cognitive Functioning Scale must be achieved unless an applicant is 3 to 17 years of age, in which case they must score at Level II or higher on the Rancho Los Amigos Pediatric Level of Consciousness Scale.

As part of the services received under the TBIW program, case management, CCIL provides a professional to assist in coordinating and advocating for a member’s services. The case manager performs an evaluation, identifies a member's needs, and creates a person-centered service plan while providing linkage and referral to needed services and resources in the community.

Members seeking to apply for Traumatic Brain Injury Waiver personal attendant and case management services must first submit a Medical Necessity Evaluation Request (MNER) form to the Utilization Management Contractor (UMC), Acentra. The MNER is sent to your treating physician (doctor of medicine (MD) or doctor of osteopathic medicine (DO), physician's assistant, neuropsychologist, or nurse practitioner, who will complete, sign, and submit to the Coordinating Council for Independent Living.CCIL will then submit the MNER completed by your healthcare provider to Acentra for review, and Acentra will schedule your TBIW medical assessment. Members must first meet all financial eligibility requirements with the county DHHR nearest them. A funded space must be open for participation in the program. ​

If you are interested in case management services, don't hesitate to contact the Coordinating Council for Independent Living closest to you.