Brain Injury Services Office of Aging and Disability Services June 8 2016 OADS Orientation State of Maine Brain Injury Services Other Related Conditions Waiver See the MaineCare Benefits Manual Section 20 for a complete outline of eligibility ID: 775907
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Slide1
Kirsten Capeless, Program Manager Brain Injury ServicesOffice of Aging and Disability Services June 8, 2016OADS Orientation
State of Maine
Brain Injury Services
Slide2Slide3Other Related Conditions Waiver
Slide4See the MaineCare Benefits Manual, Section 20, for a complete outline of eligibility.
Eligibility
Slide5ORC WAIVER OVERVIEW
Slide6REQUIREMENTS
Slide7Home Support - 3 OPTIONS
Slide8Therapy Services
*These Services Include Maintenance Services
Slide9Other Support
Slide10Assistive Technology
Slide11Accessibility & Modification
Slide12Getting Started - Members
Slide13Brain Injury Programs
Slide14Needs in Maine
Slide15Outcomes Related to Brain Injuries in Maine
Slide16Recovery: Possible Impacts of Injury
Slide17MaineCare Services
Slide18Waiver Requirements
CMS Home And Community Based Standards
(CMS 2249-F/2296-F)
Overview of the Settings Provision
The final rule requires that all home and community-based settings meet certain qualifications. These include:
The setting is
integrated
in and supports full access to the greater
community
;
Is selected by the individual from among setting
options
;
Ensures individual
rights
of privacy, dignity and respect, and freedom from coercion and restraint;
Optimizes
autonomy
and
independence
in making life choices; and
Facilitates
choice
regarding services and who provides them.
The final rule also includes additional requirements for
provider-owned or controlled
home and community-based residential settings. These requirements include:
The individual has a
lease
or other legally enforceable agreement providing similar protections;
The individual has
privacy
in their unit including lockable doors, choice of roommates and freedom to furnish or decorate the unit;
The
individual controls
his/her own schedule including access to food at any time;
The individual can have
visitors
at any time; and
The setting is
physically accessible
.
Slide19More Waiver Requirements
Commission on Accreditation of Rehabilitation Facilities (CARF)
Certified Brain Injury Specialist (CBIS) or equivalent
Conflict Free Care Coordination
Mayo Portland Adaptability Inventory - 4
Slide20Waiver Eligibility
Is age
eighteen
(18) or older; and
Has a diagnosis of
acquired brain injury
; and
The individual has received an
assessment
by a qualified
neuropsychologist
(as defined in the
MaineCare
Benefits Manual, Rehabilitative Services, Section 102.08-5 B) and/or a licensed physician who is Board certified or Board eligible in Physical Medicine and Rehabilitation, which:
positively indicates the individual: is not in a persistent vegetative state, is able to demonstrate
potential
for physical and/or behavioral and/or cognitive
rehabilitation
;
and shows evidence of moderate to severe behavioral and/or cognitive and/or functional disabilities; and
results in specific
rehabilitation goals
, based upon the findings of the assessment, describing types and frequencies of therapies and expected outcomes and timeframes; and
Has a completed Department-approved
Health and Safety Assessment
administered by the Department with an overall score of 0.1 or higher; and
Has completed
Mayo-Portland Adaptability Inventory – 4
(or current Department approved version of the MPAI) with an item score of 3 or higher for two of the following items; and
Novel Problem Solving
Impaired Self-Awareness
Irritability, Anger, Aggression
Inappropriate Social Interaction
Fund of Information or Attention/Concentration or Memory
Can have his or her
health and welfare
needs assured in the community setting as stated in § 18.08-2(E) (1) and (2).
Slide21Waiver Services
Slide22Waiver Services – A Spectrum of Care
Slide23Getting Started - Members
Slide24Kirsten Capeless
Office
of Aging and Disability Services
Maine Department of Health and Human Services
41 Anthony Avenue
State House Station 11
Augusta, ME 04333-0011
207-287-6656
FAX:
207-287-9229
Kirsten.capeless@maine.gov