32 Miss. Code. R. 1-10.1

Current through December 10, 2024

Section 32-1-10.1 - TRAUMATIC BRAIN INJURY/SPINAL CORD INJURY WAIVER

The Traumatic Brain Injury (TBI)/Spinal Cord Injury (SCI) waiver provides services to clients who, but for the provision of such services, would require the level of care found in a nursing facility. The TBI/SCI Waiver is a Medicaid home and community-based waiver operated jointly with the Division of Medicaid.

Eligibility Criteria

1. Must have a certified traumatic brain or spinal cord injury. See Spinal Cord/Traumatic Brain Injury Verification Form. (Resource Guide)

* Traumatic brain injury is defined as an insult to the skull, brain or its covering resulting from external trauma, which produces an altered state of consciousness or anatomic motor, sensory, or cognitive/behavioral deficit.

* Spinal cord injury is defined as a traumatic injury to the spinal cord or the cauda equina with evidence of motor deficit, sensory deficit, and/or bowel and bladder dysfunction. The lesions must have significant involvement with two of the above three.

2. Must be certified as medically stable by the primary care physician.

Medical stability is defined as the absence of the following:

A. An active, life threatening condition (e.g. sepsis, respiratory, or other condition requiring systematic therapeutic measures);

B. IV drip to control or support blood pressure;

C. Intracranial pressure or arterial monitoring

3. Be certified as meeting nursing home level of care by their primary care physician.

4. Be at risk of nursing home placement in the absence of waiver services;

5. Be able to communicate effectively with Personal Care Attendants, case managers (IL Counselor and Registered Nurse), and others involved in their care;

6. Meet the special income and assets limits (up to 300% of the Supplemental Security Income federal benefit rate) SSI.

Note: All services are provided pursuant to an individualized plan of care approved by the Division of Medicaid and the development of an Independent Living Plan.

Additional Eligibility for Enrollment

The basic eligibility criteria include:

* age - no age limit o financial eligibility the individual must be eligible for Medicaid as described in the waiver

* medical necessity the individual must meet the level of care criteria for nursing facility (NF) care based on Physician Certification form

* waiver specific criteria the individual must meet based on his choice about services and service planning. He must:

- choose home and community based services in lieu of nursing facility care/informed choice;

- have a severe traumatic brain and/or spinal cord injury verified by a physician

- have an on-going need for waiver services;

- needs assistance with one or more of the activities of daily living such as dressing, bathing, eating, toileting, transferring;

- be able to supervise the Personal Care Attendant and direct/communicate their personal care needs

- be at risk of nursing facility placement if services were not available

Enrollment in the TBI/SCI Waiver is limited to:

* the number of individuals approved by the Centers for Medicare and Medicaid Services (CMS) or the availability of state funding

* individuals are enrolled from the Independent Living Waiver Referral List on a "first come, first served" basis

* MDRS suspends enrollment into the waiver program when it is determined that the existing case loads exceed funds within the current budget year.

32 Miss. Code. R. 1-10.1