Traumatic Brain Injury Waiver

The Traumatic Brain Injury (TBI) Waiver Program is a long-term care alterative, which provides services that enable individuals to live at home rather than receiving nursing facility care. The program provides home and community-based services to West Virginia residents who are medically and financially eligible to participate.

KEPRO, contracted by the Bureau for Medical services (BMS) is responsible for the day to day operations and oversight of the TBI Waiver program. This includes conducting the evaluations that determine medical eligibility for applicants and members, performing provider agency certification and quality/utilization reviews, reviewing requests for prior authorization, providing training and technical assistance to all stakeholders and reviewing requests for prior authorization of TBI Waiver services.

Consumer education goals -KEPRO staff are available for training and technical assistance and to receive complaints about TBI Waiver service provision.

• Empowering persons receiving services with information about their rights and responsibilities in communicating with providers and a utilization management contractor
• Informing people of their rights and responsibilities within the TBI Waiver program
• Informing people of their role/choice in accessing services through Waiver verses an institution, choice in service delivery model, and service providers
• Serving as a resources to assist consumers, families, providers and stakeholders with information about alternative resources, advocacy, transitional living homes, food pantries and more.
• Resources:
  • West Virginia Advocates
  • Center for Excellence in Disabilities at West Virginia University
  • West Virginia Parent Training and Information
  • West Virginia 211
  • US Department of Justice and Civil Rights Division Americans with Disabilities Act
  • US Department of Education Individuals with Disabilities Education Act
  • West Virginia Department of Health and Human Resources
  • Brainline
  • National Resource Center for Traumatic Brain Injury
  • Brain Injury Association of America
  • The Society for Cognitive Rehabilitation

Provider education goals –KEPRO Provider Educators and other UMC staff are available for training and technical assistance to TBI Waiver providers.

• Educating providers about their duties to consumers, families and other stakeholders
• Completing on-site utilization management and quality outcomes reviews to gather data and provide training/technical assistance to improve the quality of service documentation, services provided and consumer outcomes
• Assisting providers with proper submission of requests for prior authorization
• Educating providers about TBI Waiver policy
  • TBI Provider Continuing Certification Application
  • TBI Waiver Provider Continuing Certification Review Tool
  • TBI Waiver On-Site Provider Review Tool
  • TBI Waiver Provider Manual

TBI Waiver Department Contacts:
Phone: 866.385.8920
Fax:  866.607.9903
General Email: WVTBIWaiver@kepro.com

Additional Resources

Bureau for Medical Services
Website:  http://www.dhhr.wv.gov/bms/Programs/WaiverPrograms/TBIW/Pages/default.aspx   
350 Capitol Street, Room 251
Charleston, WV 25301
Phone:  304.558.1700
Fax:  304.558.4398

Fiscal Employer Agent (Personal Options)
Public Partnerships, LLC (PPL)
Website:  http://www.publicpartnerships.com/programs/westvirginia/WVTBI/index.html
Phone:  877.908.1757
EFax: 877-567-0071

Claims Processing
Molina Medicaid Solutions
Website:  https://www.wvmmis.com/default.aspx
For Providers:  888.483.0793
For Members:  304.343.3380
Fax:  304.348.3380

West Virginia Adult and Child Protective Services
Phone:  800.352.6513
Website:  http://www.dhhr.wv.gov/bcf/Services/Pages/default.aspx

WV CARES
Website: https://www.wvdhhr.org/oig/wvcares.html
Phone: 304.558.2018
WV CARES Helpful Tips