WV ASO - Traumatic Brain Injury Waiver

The Traumatic Brain Injury (TBI) Waiver Program is a long-term care alternative, 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.

**Atrezzo for Traumatic Brain Injury (TBI) Waiver *New**

Beginning May 3, 2021, TBI Waiver Case Management Providers will utilize Atrezzo Next Generation (ANG) to submit Member’s Service Request. In addition, TBI Waiver Providers and/or PPL who are assigned to an applicant/ member will be able to access and review applicant/member’s case records including the completed Pre-Admission Screening (PAS), the applicable Rancho scale used to determine initial and reevaluation medical eligibility; medical eligibility determination letters; and Selection and Service Delivery Model (SDM), to name a few. Assigned TBI Waiver Providers and/or PPL will have the capacity to review and download attached documents and letters from the Member’s Case records for their files.

Atrezzo User Guides

Provider Training Material

Instructional Videos

Job Aid

Consumer Education Goals

Kepro staff is 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 versus an institution, choice in service delivery model, and service providers
Serving as a resource to assist consumers, families, providers and stakeholders with information about alternative resources, advocacy, transitional living homes, food pantries and more.
Resources:

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 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

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