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Traumatic Brain Injury

TBI Waiver

tbi-waiver

The Home and Community-Based Services Medicaid Waiver for Individuals with Traumatic Brain Injury (HCBS/TBI) was developed by the New York State Department of Health to allow persons with a traumatic brain injury to receive services in community settings rather than institutional settings.

The TBI Waiver was created in response to New York’s transferring of individuals with TBI to out of state nursing homes in the late 1970’s and 80’s, and the realization that, by the late 1980’s, over 500 people were in those out of state facilities. The realization of this cost, in conjunction with the advocacy efforts by persons with TBI and their families, allowed for the creation of this Waiver. This provided the means to persons already in institutions to come home, as well as prevent people from having to go in the first place. In the community, each participant receives “person centered” care based on their goals and desires for remaining as independent as possible for as long as possible.

The Waiver was developed with the following philosophy:

That a person with TBI has the same right to be in control of his or her life as anyone else in our society, being able to choose who provides their services, where to live, and with whom. By living in the community you regain the right to incur and manage risks associated with your independence, and learn from the experiences of, both, successes and failures.

To be eligible for the TBI Waiver a person must:

  • Have a diagnosis of TBI or a related diagnosis (e.g. Stroke or CVA, Anoxia)
  • Be eligible for nursing facility level of care
  • Be 18 to 64 years of age at the time of enrollment
  • Choose to live in the community rather than in a nursing facility
  • Have or find a living arrangement which meets the individual’s needs

TBI Waiver services offered:

Referral process

  • Allwel will forward referral inquiries to the appropriate region’s Regional Resource Development Center (RRDC-Single Point of Entry)
  • RRDC will set appointment with individual and/or family (if desired) to assess eligibility based on medical documentation of disability and anticipated level of care
  • Individual and/or family is provided a list of provider agencies to interview for services
  • Individual selects a provider agency or agencies for the desired service(s)
  • Agency’s Service Coordinator develops an Initial Service Plan (ISP)
  • Agency sends a nurse to complete an evaluation to determine the level of needs
  • Nurse works with family and individual to develop a plan of care and assess the number of hours
  • During the ISP development process, the Service Coordinator interviews the participant and any family to select the appropriate/desired program supports, as well as review all other available community supports
  • Agency submits the ISP for review by the RRDC and for approval/authorization
  • Upon approval of ISP, the Agency will begin services with the participant

The process from selection of Service Coordinator to first day of service generally takes between 30 and 60 days, depending on how quickly medical and supporting documentation can be obtained, housing is located (if needed and if available in the location requested), and the availability of the individual and family to provide their time during the ISP information gathering process.

What to expect

  • Agency’s Schedulers work with the individual and family to adjust the service schedule as needed
  • When services begin, the nurse introduces the staff and provides training on the plan of care in the home
  • Agency care team reviews the progress of the participant on a weekly basis during team meetings and recommends solutions to any challenges or adjustments to services as necessary
  • Service Coordinator and Nurse facilitate ongoing communication with family and medical providers as requested/necessary
  • Service Coordinator provides an updated plan of care to the RRDC for the review process every 180 days. Agency and RRDS certification of continued need every 180 days is a requirement of the program

How can we help?

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Some of Our Team

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Debbie McDermitt, LCSW

Debbie oversees the implementation of Waiver Services throughout our New York City region. Debbie has extensive social work experience including in-home counseling and crisis intervention services, as well as educational advocacy and training for prospective Foster and Adoptive Parents. In addition, Debbie has provided Clinical Supervision services to Illinois Department of Children and Families staff. Debbie had a private practice for several years, providing therapy services to individuals, couples, and families, as well as having worked with the US military being a Military and Family Life Consultant at military installations domestic and abroad. Debbie holds a Masters in Social Work from the University of Illinois at Chicago’s Jane Addams College of Social Work, and received her License in Clinical Social Work in 1998.

Director of Waiver Services
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Thane Schulz, MA MSW

Thane has significant experience with behavioral health in acute and outpatient settings, as well as patient advocacy in a trauma setting. Thane firmly believes in the trauma-informed, human rights philosophy in social work, and applies a solution-focused approach with his participants.

As our agency’s Director of Programs, he is the liaison between our programs and the community. Thane is also involved in program and organizational development, assisted with founding the TBI Reading Club at ECMC’s Outpatient Rehab Unit in 2012, and is a member of the Headway of WNY, Inc. Advisory Committee.

Director of Programs
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Julie Krieger, MADS, CBIST

Julie has over 18 years of experience working with adults who have acquired brain injuries, neurological disorders, dementia, and children with autism spectrum disorders. Julie co-authored a chapter in a recently published textbook “Genetic Syndromes and Applied Behavior Analysis”. While training staff is her “second heartbeat”, she has significant experience in program management, clinical supervision, training, compliance, and accreditation in multiple facilities (post-acute and long term rehabilitation, residential and community-based environments) across the United States and Canada. She began her service at Allwel as the Director of Waiver Services in January 2003 and transitioned in June 2008 to Chief Compliance and Privacy Officer, where she ensures our Agency’s adherence to the regulations, best practices, and privacy requirements throughout our programs.

Corporate Compliance and Privacy Officer
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Meghan Canfield, MSW

Meghan is Allwel’s western New York Senior Service Coordinator, and is responsible for ensuring partnerships between our participants and their families, friends, and any other caregivers or service providers to create comprehensive person-centered service plans. Meghan oversees the Service Coordination team in their building these partnerships through being advocates, educators, brokers, and facilitators.

Meghan graduated from the University at Buffalo with her Master’s in Social Work in 2013, and is also currently working on the Clinical Foundations of Trauma-Informed Care Certificate Program. Meghan also draws from experience with the Buffalo Schools providing counseling to adolescents using Solution Focused Therapy, as well as working in a residential setting providing direct care for adolescents with severe mental illnesses.

Senior Service Coordinator