Kirsten Capeless, Program Manager Brain Injury Services Office of Aging and Disability Services June 8, 2016 OADS Orientation State of Maine Brain Injury Services

Brain Injury Waiver Outpatient Neurorehabilitation Clinics ABI Nursing Facility programs TBI State Partnership Grant Other Related Conditions Waiver PASRR Gero-Psychiatric Nursing Facility Services OADS Constituent Services Brain Injury Services

Other Related Conditions Waiver

See the MaineCare Benefits Manual, Section 20, for a complete outline of eligibility. Is At least 21 Years Old Has a Related Condition: a. Cerebral Palsy or Epilepsy; or b. Any other condition, other than mental illness, found to be closely related to Intellectual Disabilities It is manifested before the person reaches age twenty two (22). It is likely to continue indefinitely. Results in substantial functional limitation in 3 or more of the following areas of major life activity: Self-care Understanding & use of language Learning Mobility Self-direction Capacity for independent living Eligibility

ORC WAIVER OVERVIEW Comprehensive Package Self Design Program to Meet Needs and Personal Goals Health and Welfare

REQUIREMENTS Care Coordination Conflict Free Service Provider Choice Select Providers for Each Service Members Pay Rent Food

Home Support - 3 OPTIONS Group Home Up to 4 People Per Diem 24/7 Support Your Own Home or Apartment with Assistive Technology Remote Support Home Support Personal Care Your Own Home or Apartment Home Support Personal Care

Therapy Services Physical Therapy Up to 2 Hours per Week Speech Therapy Up to 2 Hours per Week Occupational Therapy Up to 2 Hours per Week *These Services Include Maintenance Services

Other Support Work Support Up to 16 hours per week Intensive, On- going Support Employment Specialist Services Up to 18 hours per year Identifying Opportunities and Acclimating to New Job Community Support Up to 16 hours per week Self-Help, Socialization and Adaptive Skills

Assistive Technology Assessment Safety and Support Communications Environmental Controls

Accessibility & Modification Non-Traditional Communication Assessment Home Accessibility Adaptations Equipment Specialized Medical Equipment Communication Aids

Getting Started - Members Complete ORC Application and submit to OADS Assessment by Goold Health Systems to Determine Eligibility If Eligible Assigned OADS Care Monitor Select Service Package

Brain Injury Programs

Needs in Maine Significant public health issue touching the lives of more than 10,000 individuals, their families and communities each year. Falls 57.0% Motor Vehicle Crashes 24.7% Other (Assaults, Bicycle Crashes, Sports, Other Transportation Incidents) 18.3%

263 Deaths 998 Hospital Discharges 9,222 Outpatient ER Visits Unknown Additional Medical Treatments Outcomes Related to Brain Injuries in Maine

Recovery: Possible Impacts of Injury

Skilled Specialized Brain Injury Nursing Care 2 Facilities Brain Injury Waiver Home and Community Based Residential Programs Other Services Outpatient Neurorehabilitation Treatment Clinics 9 Clinics Statewide Up to 18 hours per week MaineCare Services

Waiver 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.

More 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

Waiver 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 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 § (E) (1) and (2).

Services that assist participants in gaining access to needed waiver and other State plan services, and medical, social, education and other services. Care Coordination Assists with acquisition, retention, or improvement in skills related to living in the community. Home Support Functional improvement and reinforcement of community and work reintegration for member. Community/Work Reintegration Functional improvement and reinforcement of community and work reintegration for member. Self Care/Home Reintegration Item or piece of equipment that increases, improves, maintains functional capabilities of member; Evaluation; Purchase/lease of device; Maintaining/Repairing device; Training; Transmission Assistive Technology Designed to help individuals build skills specific to a work environment with the added benefit of social engagement and relearning the interpersonal skills required to be successful in a work setting Work Ordered Day Club House Individually provide ongoing support to obtain and maintain an individual job in competitive, customized, or self- employment Work Support, Employment Specialist Services, Career Planning Waiver Services

Waiver Services – A Spectrum of Care Residential Services Individually tailored supports that assist with the acquisition, retention, or improvement in skills related to living in the community 24/7 Neurobehavioral 24/7 Habilitation Home Support – less than 24/7 Remote Support

Completed Neuropsychological or Physiatrist Evaluation Brain Injury Waiver Assessment by Goold Health Systems to Determine Eligibility If Eligible Completed Application to OADS Assigned OADS Care Monitor and Select Service Package and Providers Getting Started - Members

Questions? Kirsten Capeless Office of Aging and Disability Services Maine Department of Health and Human Services 41 Anthony Avenue State House Station 11 Augusta, ME FAX: