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Care at home for beneficiaries with a traumatic brain injury​​

Care at Home
for Mem​​bers with a Traumatic Brain Injury

What is the Traumatic Brain Injury Waiver?

The Traumatic Brain Injury Waiver (TBIW) program provides support at home for members three years and older with a traumatic brain injury. It waives some​ of the rules to allow people who live in West Virginia to receive support to live at home. ​Home and Community-Based Waiver Services are for people who meet the medical and financial requirements for the program. The program promotes choice, independence, respect, dignity and involvement with the community. 

src="https://dhhr.wv.gov/bms/Programs/WaiverPrograms/ADWProgram/PublishingImages/TBIW-50-50%20(1).png" alt="TBIW"

The TBIW is for ​members who meet the following requirements:

  • Is at least three years old and ​​have a documented traumatic brain injury that is caused by physical force leading to total or partial disability and/or difficulty participating socially ​​​or an injury causing lack of oxygen due to near-drowning, and who meets the medical requirements to receive a nursing home level of care. 
  • Is a permanent resident of West Virginia and available for the required services.
  • Meet the financial requirements for the Medicaid W​​aiver program determined by the West Virginia Department of Health and Human Resources (DHHR) county office.
  • Score at a Level VII or below on the Rancho Los Amigos Levels of Cognitive Functioning Scale. 
    • Ages three to 17 years must score at a Level II or higher on the Rancho Los Amigos Pediatric Level of Consciousness Scale.
  • ​Is an inpatient in a licensed nursing facility, hospital or licensed rehabilitation facility to treat traumatic brain injury or living in a community setting at the time of application.
  • Choose to take part in the TBIW program instead of ​care at a nursing facility.
  • Can provide a safe workplace for TBIW program and agency staff. ​
TBIW members cannot be paid caregivers in another waiver program or the West Virginia Medicaid Personal Care Services program. 

Medical and financial eligibility must be evaluated and determined every year. 

The TBIW...

If accepted to the TBIW, you may choose the Traditional (Agency) Model or the Self-Directed Model know​n as Personal Options to receive services. In the Traditional Model, members receive their services from employees of a certified provider agency. In Personal Options, members can hire, supervise and fire their employees. 

TBIW program services include:

  • Case Management Services: A professional who helps coordinate and advocate for services, performs evaluation, identifies needs, develops person-centered service plans, and connects the member with services or resources in the community.
  • Personal Attendant Services: Someone who assists you in your home and community with activities of daily living (eating, bathing, dressing, grooming, mobility and toileting).*
  • TBIW Non-Medical Transportation: Your personal attendant can take you to do essential errands and community activities listed on your Person-Centered Service Plan.*
  • Personal Emergency Response System (PERS): A device used to request help from a monitoring center in the event of an emergency. 
* These are services that the member can direct. 
 
Services provided must conform to the member's Person-Centered Service Plan. ​

To begin the process, you must get a Medical Necessity Evaluation Request (MNER) form from the Utilization Management Contractor (UMC), Kepro. Please have your treating physician (doctor of medicine (MD) or doctor of osteopathic medicine (DO)), physician's assistant, neuropsychologist or nurse practitioner complete, sig​n and submit to:
Kepro
1007 Bullitt Street, Suite 200
Charleston, WV 25301
Phone: 1-866-385-8920
Fax: 1-866-607-9903

Kepro will send you a letter with information and instructions to go to your local DHHR county office to determine if you meet the financial requirements for the TBIW program. After determining that you meet the financial requirements, Kepro will contact you to schedule your TBIW medical assessment.

A funded space must be open for participation in the program. 


For more TBIW information, contact:

Bureau for Medical Services​
350 Capitol Street, Room 251
Charleston, WV 25301
Phone: (304) 352-4240
Fax: (304) 558-4398

Utilization Management Contractor (UMC), Kepro
1007 Bullitt Street, Second Floor
Charleston, WV 25301
Phone (866) 385-8920 or (304) 935-5712
Fax: (866) 607-9903

TBIW Billing Questions:
Gainwell Technology
Phone: (888) 483-0793 or (304) 348-3360​







  1. Can I apply for TBIW services while on another waiver waitlist?
    Yes. However, you cannot be on multiple waivers at the same time. You can be on TBIW and State Plan Personal Care at the same time if you quality, but not another waiver. 
  2. How long can someone remain on the TBIW?
    Medical and financial eligibility must be re-established annually. If a member is eligible in both categories each year, there is no limit to how long someone can remain on the program. 
  3. How long is the TBIW referral process?
    Medical eligibility determination cannot begin until the financial eligibility has been approved. Once that has been completed, medical eligibility is determined within 45 days. If a slot is not immediately available, the approved applicant will be placed on a managed enrollment list (waitlist), which can add to the time before receiving TBIW services. 


TBI​W
Application

Click here for the Medical Necessity Evaluation Request (MNER) Form

Find TBIW
Providers

Click here to find a TBIW provider near you.

Info for
Members

Click here for additional waiver information and benefits for home and community-based members!

Info for
Providers

Click here​ for for home and community-based provider resources.

Fact
Sheet

Click h​ere for the TBIW Fact Sheet.

Non-Emergency Medical Transportation Information

​​​Individuals who have a West Virginia Medical Card may be eligible for transportation to and from your ro​utine medical appointments. For more information, call 1-844-549-8353, Monday - Friday between 7:00 am to 6:00 pm

To learn more please click here.​ ​