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4 <br /> R <br /> BRAIN INJURY WAIVER PROGRAM <br /> ADMISSION CRITERIA: <br /> 1. Must be discharged from an acute care rehabilitation facility or an acute care hospital with a diagnosis <br /> of traumatic or acquired brain injury and must have a prognosis for continued functional improvements. <br /> 2. Must be discharged with a fully developed care plan in place with confirmed viable community <br /> resources scheduled to meet the client's needs. <br /> 3. The client's condition continues to require 24 hour availability of a physician with special training or <br /> experience in the field of brain injury rehabilitation. <br /> n <br /> ( 4. The client continues to require goal oriented therapy with medical management by a physician with <br /> /(11 special training or experience in the field of brain injury rehabilitation and medically necessary <br /> specialized rehabilitation services (must include at least two services, one of which must be a service <br /> provided by the waiver program). <br /> 5. The client cannot be therapeutically managed in the home without 24 hour supervision and structure, <br /> daily specialized therapy and support services. <br /> C NTINUED STAY CRITERIA: <br /> p E \ . The care plan is reviewed by the multidisciplinary team and updated monthly. <br /> C r 2. Admission criteria 4 and 5 must continue to be met. <br /> 1 tf 3. The individual progress in rehabilitation is documented in a weekly note, which is the result of an <br /> interdisciplinary care planning conference and which relates directly to the goals addressed in the <br /> . treatment plan. <br /> DISCHARGE CRITERIA: <br /> 1. Client has achieved goals as outlined in the treatment plan and/or additional services are not likely to <br /> result in further improvement at this time. <br /> PHYSICIAN REVIEWER CONSULT: <br /> 1. A Physician Reviewer, who specializes in brain injury or rehabilitation, is consulted in the event that <br /> screening guidelines are not met. <br /> APPROVAL: - <br /> 1. Assignment of a six month length of stay is given for both Admission and CSR reviews. <br /> DENIAL: <br /> 1. Denial letter, specific to the HCBS -BI Program is sent to the client. Copies will be sent to the <br /> Guardian/Legal Representative, Attending Physician, County Social Services, Case Management <br /> Agency, Provider Case Manager and HCBS -BI Program Administrator. Included will be a copy of the <br /> regulations, appeal rights, appeal request form and a return envelope. <br /> APPEAL: <br /> 1. Will be handled by the CFMC LTC Department. <br />