NURSING FACILITIES (SNF)

An SNF is a residential facility for the individuals who, following rehabilitation, require supervision in all activities, including assistance with medication, meal preparation, bathing, dressing, and moving about. Patients may also require special nursing care and/or ongoing therapy.

Home/Community Based Services

Home/community based services are services provided in the individuals home or community following discharge from: acute medical care, acute rehabilitation, extended TBI rehabilitation, or a skilled nursing facility. Services available in this category vary widely. These services enable individuals to live in the community versus an institutional setting and may be life long.

Personal Care Assistance (PCA)

A personal care assistant provides assistance in activities of daily living for a person with a disability. A physician determines medical eligibility for these services.

1. Certified Home Health Agencies (CHHAs) . Certified home health agencies are licensed by the NYS Department of Health to provide home based nursing, rehabilitation (physical therapy, speech therapy, occupational therapy, nutritional counseling, social work services) and home health aide services. Home health aides are more highly trained than home attendants and provide more specialized care. To be eligible for these services, a person with a disability must have a medical need to receive either home nursing or physical therapy services.
2. Home Attendant Services . Home attendant services provide assistance with and supervision of activities of daily living in the persons home. A physician must approve these services and the person must not require the higher level of care provided by a CHHA.
3. Home Based: Physical Therapy, Occupational Therapy, Speech Therapy, Nursing, and other Rehabilitation Services. (Refer to Certified Home Health Agencies)

Medicaid Service Coordination (MSC)

Medicaid Service Coordination, like case management service, facilitates, for the individual, access to appropriate medical, rehabilitation, waiver and other support programs, and coordination of the delivery of services. This role may involve liaison with various professionals and agencies, advocacy on behalf of the individuals with TBI, and arranging for purchase of services where no appropriate programs are available. This service is available to individuals with TBI who are injured before the age of 22 and are eligible for services through the Office of Mental Retardation and Developmental Disabilities (OMRDD). Contact the local DDSO for more information.

Medicaid Waivers - Medicaid Waivers are a funding source for non-medically based home and community-based support services. While many of the services available to individuals with TBI under these waivers are similar to other types of services and to each other, they are grouped in this section by the funding source because each waiver provides a package of services from which an individual can choose if they are given a waiver opportunity.

Medicaid waivers are available only to individuals who have or are eligible for community Medicaid. What is being waived is having to be in an institution to receive this level of comprehensive care. A Home and Community Based Services Waiver allows states to assemble a package of carefully tailored services to comprehensively meet the needs of a targeted group in a community-based setting. In general, waiver eligibility is contingent upon the use of these services to prevent being placed in an institutional setting. There are three waivers in NYS available to individuals with TBI.

A. Home and Community Based Services Medicaid Waiver - OMRDD

NYS Office of Mental Retardation and Developmental Disabilities (OMRDD) Home and Community Based Services Medicaid Waiver is available to individuals with TBI who are injured and become disabled as a result of that injury before the age of 22 (regardless of their current age), thereby making them developmentally disabled under the NYS Mental Hygiene Law. OMRDD waiver eligibility is contingent upon the use of these services to prevent being placed in an institutional setting.

To be eligible for this Medicaid Waiver onset of TBI must be on or before age 22 the condition is expected to continue indefinitely and the condition constitutes a substantial handicap to a persons ability to function normally within society.

The OMRDD Medicaid Waiver provides:

1. Residential Habilitation - activities of daily living and independent living skills training provided one on one to individuals in their home and in the community. Many also provide supervision and companionship to participate in community-based activities.
2. Day Habilitation - community based rehabilitation and independent living skills training is provided in a day program environment.
3. Supported Work: intensive or extended supported employment services help individuals find and keep meaningful employment. To be eligible an individual must have previously been discharged from a nursing facility or an Intermediate Care Facility and there must be documentation that these services are not available to the individual through the Vocational and Educational Services for individuals with Disabilities (VESID).
4. Prevocational Services: services aimed at providing opportunities for individual with limited work related skills to participate in age appropriate tasks. To be eligible an individual must have previously been discharged from a nursing facility or an Intermediate Care Facility and there must be documentation that these services are not available to the individual through VESID.

OMRDD Waiver Services are accessed through the local OMRDD Developmental Disabilities Services Offices.

B. TBI Program Home and Community Based Services TBI Waiver- New York State Department of Health (DOH)

TBI Program Home and Community Based Services TBI Waiver is available to individuals with TBI who are injured after the age of 18 and are currently between the ages of 18-64. Individuals injured between the ages of 18-22 are asked to seek services from OMRDD before DOH. DOH waiver eligibility is contingent upon the use of these services to prevent being placed in a skilled nursing facility. Individuals who are on the DOH waiver may also be eligible for the DOH Housing Subsidy Program, which helps individuals locate and pay for affordable generic rentals. Services available under the DOH Waiver include:

1. Service Coordination - a case management service facilitating the access of an individual to appropriate medical, rehabilitation, waiver and other support programs, and coordination of the delivery of services. This role may involve liaison with various professionals and agencies, advocacy on behalf of the individuals with TBI, and arranging for purchase of services where no appropriate programs are available.
2. Independent Living Skills Training and Development - To improve and maintain the individuals community living skills so that the individual can live as independently as possible. Training is provided one on one in the individuals home and the community and focuses on practical needs such as shopping, cooking, money management, use of public transportation, etc.
3. Structured Day Program - aimed at improving and maintaining the individuals community living skills in a group setting. Focus is on the development of social, problem-solving and task-oriented skills.
4. Substance Abuse Programs - These full day programs are aimed at providing assistance with both substance abuse and TBI related problems, and to help reduce or eliminate substance abuse, which may interfere with, the individuals ability to remain integrated in the community.
5. Intensive Behavioral Programs - These services are provided one on one to the individual in their home and community to eliminate or reduce an individuals severe maladaptive behaviors which, if not modified, will interfere with the individual’s ability to remain in the community. Training may also be provided to family members and other providers working with the individual.
6. Community Integration Counseling - a counseling service to assist the waiver participant, family and other significant individuals to more effectively manage the stresses and difficulties associated with living in the community.
7. Home and Community Support Services - these are personal aide services meant to compliment medically based personal aide services. Includes supervision, companion and chore services, which can be provided in the individuals residence or in the community.
8. Environmental Modifications - Physical adaptations to the individual’s residence and primary vehicle which ensure the individual’s health, safety and welfare, and which increases the individual’s independence and integration in the community.
9. Respite Care - To provide short-term relief for care givers of individuals who are unable to care for themselves. The service is provided in the individual’s residence.
10. Special Medical Equipment and Supplies - To provide durable and non-durable medical equipment not usually funded under the State Medicaid Plan.
11. Transportation - To provide means to access non-medical services in the community in order to improve the individual’s ability to make use of needed services, and to improve the individual’s integration in the community.

To be eligible for this Medicaid Waiver, an individual must be:

• diagnosed with TBI or a related condition
• eligible for nursing facility level of care
• enrolled in the Medicaid program
• 18-64 years old

Given a choice of living in the community or in a nursing facility; in a living arrangement which meets the individuals needs or be capable of attaining such as arrangement outside the institutional setting; and able to be served under the TBI Waiver and New York State Medicaid Plan.

DOH TBI Waiver Services may be accessed through the DOH Regional Resource Centers.

C. The Long Term Home Health Care Medicaid Waiver

(AKA Nursing Home without Walls; AKA The Lombardi Program). This Medicaid Waiver is overseen by the local Department of Health and accessed through local Certified Home Health Care Agencies (CHHA). The Lombardi Program waiver eligibility is contingent upon the use of these services to prevent being placed in a skilled nursing facility. The following services are provided under this waiver.

• Case Management by R.N.
• Home Delivered Meals
• Housing Improvement
• Respiratory Therapy
• Medical Social Services
• Nutritional/Dietary Services
• Respite Care
• Social Day Care
• Moving Assistance
• Social Transportation
• Congregate Meals

To be eligible for this Medicaid Waiver, an individual must: meet the criteria for care in a Residential Health Care Facility (RHCF); choose to receive services at home instead of the nursing facility; and meet local and regional budgetary caps which total 75% of the region’s average annual cost for placement in a RHCF.

Outpatient Medically Based Rehabilitation Services

These services provide coordinated and integrated evaluation and treatment with an emphasis on improving the functional abilities of the individual with a brain injury. Rehabilitation services are provided by physical, occupational, speech therapists and neuropsychologists. At minimum, these services must include medical supervision, medical support services and consultation, rehabilitation therapies and other services. Some individuals with brain injuries receive cognitive rehabilitation, which aids in the management of specific problems in thinking and perception. Skills are practiced and strategies are taught to help improve function and/or compensate for remaining deficits. New York State licensed rehabilitation professionals provide discrete outpatient rehabilitation services.

Outpatient medically based rehabilitation services are provided in a variety of institutional settings, which include, hospitals, clinics, physician’s practices, and freestanding rehabilitation centers. A variety of specific licenses are available to providers and therefore criteria for admission and service provided may vary.

Adult Day Care

These are services provided in a structured non-residential day program during ordinary working hours for the person with brain injury that requires supervision, including assistance with medication, meal preparation, dressing or moving about. However, the family returns the person to their residence and assumes responsibility for care during the evenings and at night.

Post Acute Transitional Living

These residential programs provide training for living in a setting of greater independence. The primary focus is on teaching functional skills and compensating for abilities that cannot be restored. These services are not licensed in New York State and none exist in New York City.

Vocational Rehabilitation

Vocational rehabilitation provides, in a coordinated manner, those services deemed appropriate to the needs of a person with a brain injury, and designed to achieve objectives directed toward the realization of the individual's maximum physical, social, mental and vocational potential. Employment services may include vocational evaluation, skill training, work adjustment, job training, job placement, job coaching, sheltered and/or supported employment. Vocational and Educational Services for Individuals with Disabilities (VESID) funds vocational rehabilitation in New York State and has offices in all the boroughs of New York City and regionally throughout the rest of the State. VESID contracts with vocational programs to provide vocational rehabilitation services.