Adult Brain Injury Program Provider Manual

The ABI Service Coordinator is the entry point for new participants to enroll in the ABI Program.

Referrals should be made directly to the ABI Service Coordinator responsible for the county in which the participant resides.

Upon referral the ABI Service Coordinator will:

• Contact the participant or family member;
• Complete an ABI Screener Form
• Schedule a face-to-face visit;
• Conduct an initial assessment of needs and goals;
• Explain the program and benefits available;
• Obtain a signed Application for Enrollment Form (CC-1);
• Obtain a signed Authorization for Disclosure of Consumer Medical/Health Information (MO 650-2616) to gather written documentation of Traumatic Brain Injury (TBI);
• Obtain a signed Rights & Responsibilities Acknowledgement Form
• Obtain a signed Privacy Policies Form
• Supply to participant a Role of Service Coordination Form
• Enroll in service coordination
• Determine financial eligibility (185% of federal poverty guidelines) by one of the following two methods:
  1. Obtaining a copy of the participant’s current income year, federal income tax form, if the form is reflective of the participant’s current income. The adjusted gross income and the number of family members are used to determine eligibility; and
  2. Obtaining a signed statement of the participant’s family income for the last three months and projected income for the remainder of the year.
• Refer the participant to any other public or private resources for which the participant may be eligible;
• Identify key persons for the Person-Centered Planning Team; and
• Develop an initial Treatment Plan.

Until the participant’s medical and financial eligibility are documented and the enrollment process is complete, no rehabilitative services shall be approved.

If a requested service is also covered by a third party payer for which the participant may be eligible, no rehabilitative services will be approved until determination of eligibility for such service has been resolved and provided to the ABI Program in writing.