Adult Brain Injury Program Provider Manual

The following services are available through the ABI Program:

Service Coordination includes:

• Evaluation and assessment of needs;
• Information, education and advocacy (applies to rehabilitation services only) Service Coordination is provided to all ABI Program participants, regardless of financial status.
• Development, regular evaluation and updates of a service plan (applies to rehabilitation services only)
• Assistance in locating and accessing resources such as medical care, housing, counseling, transportation, rehabilitation, vocational training, and cognitive/ behavior training
• Information, education and advocacy (applies to rehabilitation services only) Service Coordination is provided to all ABI Program participants, regardless of financial status.

Rehabilitation Services

Rehabilitation services are provided to participants who meet financial guidelines and when it has been determined the services are necessary to facilitate a long-term goal as indicated in the Treatment Plan. Rehabilitation services as listed in this manual are available to individuals who are medically eligible and whose income is 185% of Federal Poverty Guidelines or lower. Certain limitations apply and this manual outlines operational procedures for use of Department of Health and Senior Services (DHSS) ABI funds. No more than two services may be authorized for a participant during the same time period. All rehabilitation services must be prior authorized. All resources must be exhausted prior to accessing program funded services. ABI Service Coordinator will assist the participant to apply for any other payment resources before submitting request for use of program funds.

Rehabilitation services include:

• Neuropsychological Evaluation and Consultation
• Adjustment Counseling
• Transitional Home and Community Support Training
• Pre-vocational/Pre-employment Training
• Supported Employment/Long Term Follow Along
• Special Instruction
• Consultation Visit

Neuropsychological Evaluation and Consultation

Service Description

Neuropsychological evaluation and consultation consists of the administration and interpretation of a standardized battery of neuropsychological tests to provide information about a participant’s cognitive strengths and weaknesses following a Traumatic Brain Injury (TBI). This service includes consultation with the participant, family, or other significant key person designated by the participant, and ABI Service Coordinator for information gathering and/or interpretation of results.

Evaluations must be adapted to the cultural, ethnic, linguistic and communication background of the participant and family.

Service Guidelines

Neuropsychological evaluation may be provided under the following circumstances subject to the availability of funds:

• A neuropsychological evaluation has not been previously completed, and information is needed by the planning team to assist in identifying a feasible long-term goal; and
• Significant changes in participant’s functional status have occurred and information from a previous neuropsychological evaluation is not representative of present functioning, and information is needed by the planning team to assist in identifying a feasible long-term goal.

Written assessment questions will be developed by the planning team and submitted at the time of referral for neuropsychological evaluation.

Provider Requirements

The Provider must:

• Have a Department of Health and Senior Services (DHSS) Provider Participation Agreement for the provision of Neuropsychological Evaluation and Consultation services;
• Be licensed as a Psychologist with the State of Missouri with a specialty in neuropsychological, and
• Have one year’s experience in working directly with persons with TBI.

Unit Of Service

One Complete Battery Of Testing*

*The following tests are approved as usual and customary:

• Wechsler Adult Intelligence Scale (WAIS-IV)
• Stroop
• Test of Premorbid Functioning (TOPF)
• Trails A & B
• Symbol Digit Modality Test (SDMT)
• Wechsler Memory Scale (WMS-IV)
• California Verbal Learning Test (CVLT-2)
• Category Test
• Brief Memory Test (BVMTR)
• Judgement of Line Orientation (JOLO)
• Rey Complex Figure (Copy)
• Grooved Peg Board
• Finger Agnosia
• Grip Strength
• Boston Naming Test (BNT)
• Controlled Oral Word Association Test (COWAT)
• Animal Naming
• Beck Depression Inventory (BDI-II)
• Halstead-Reitan Battery
• Luria-Nebraska Battery
• NEPSY

*The following abilities must be addressed in the evaluation report:

• Intelligence
• Academic functions
• Memory
• Attention
• Language
• Visual-Spatial skills
• Executive functions
• Motor skills
• Sensory perception
• Emotional-behavioral functioning
• Speed of information processing

Reimbursement Flat Fee: $625.00

Service Product

Written detailed evaluation report that includes a thorough review of all assessment and treatment records to date. Evaluation report must address written referral questions and must indicate:

• Participant’s functional cognitive strengths/weaknesses;
• Level of effort for testing session;
• Preferred learning style; and
• Specific, individualized recommendations to facilitate accomplishment of long-term goals.

This service shall include a follow-up meeting for consultation with the participant, family, or other significant key person designated by the participant, and ABI Service Coordinator for interpretation of results.

Documentation Requirements

Providers must retain for three (3) years, from the last date of service, fiscal and treatment records that coincide with and fully document services billed to DHSS, and must furnish or make the records available for inspection or audit by DHSS or its representative upon request. Failure to furnish, reveal, and retain adequate documentation for services billed to DHSS may result in recovery of the payments for those services not adequately documented and may result in sanctions to the Provider's participation in DHSS programs. This policy continues to apply in the event of the Provider’s discontinuance as an actively participating DHSS Provider through change of ownership or any other circumstance.

Referral Indicators

A Neuropsychological Evaluation may be requested when:

• A Neuropsychological Evaluation has not been previously completed, and information is needed by the planning team to assist in identifying a feasible long-term goal; and
• Significant changes in participant’s functional status have occurred and information from a previous Neuropsychological Evaluation does not represent present functioning.

Desired Outcomes

• Feasible long-term outcome goal is identified; and
• The ABI Service Coordinator will provide direction to the planning team that facilitates long-term goal accomplishments.

Adjustment Counseling

Service Description

Adjustment counseling services are brief, skilled therapeutic face-to-face or telehealth interventions provided to the participant/family to address specific goals related to the experience of adjusting to the effects of Traumatic Brain Injury (TBI). This service may be provided to an individual or an individual and key family/significant other.

Emphasis for this service is on coping with grief and adjustment issues related to loss of function and adjustment to changes required in family/life roles due to the TBI. Counselors may make referrals for medical management of specific behaviors that interfere with function; however, such medical management is not included in this service. Therapy must be adapted to the cultural, ethnic, linguistic and communication background of the participant and family. Therapeutic intervention must be related to specific goals in the individual’s Treatment Service Plan.

Service Limitations

This service:

• Is limited to 26 one-hour sessions lifetime (104 units) per participant. The initial treatment plan shall contain recommendations regarding the schedule of therapeutic sessions;
• These services may be used to address mental health and substance abuse disorders co– occurring with brain injury but due to the limited nature of these services referrals may be needed for ongoing care. The ABI Service Coordinator will refer such individuals to other counseling services, and will arrange for a resource person knowledgeable about TBI to assist the mental health agency’s staff; and

Provider Requirements

The Provider must:

• Have a Department of Health and Senior Services (DHSS) Provider Participation Agreement for the provision of counseling;
• Be licensed as a Psychologist, Social Worker, Addiction or Professional Counselor within the State of Missouri; and
• Have either:
  • One year experience in counseling with persons/families whose lives have been affected by TBI; or
  • 15 hours of in-service training addressing the following:
• Characteristics of TBI;
• Family grief responses to TBI;
• Behavioral techniques effective for persons with TBI;
• Compensatory strategies effective for persons with TBI; and
• General knowledge of TBI programs.

Service Product

• Written detailed, individualized assessment of TBI related issues that include a thorough review of all assessment and treatment records to date.
• Assessment report must contain recommendations for:
  • Brief therapeutic intervention;
  • Methods/strategies to be implemented;
  • Persons to be included in therapy;
  • Proposed schedule;
  • Potential community resources for long-term follow-up and expected outcome with timeframe for accomplishment;
  • Ongoing assessment of participant progress must be reported monthly to the ABI Service Coordinator; and
  • A monthly progress report to the ABI Service Coordinator indicating the participant and/or family’s functional changes in ability to cope with changes due to TBI during the period; successful coping strategies identified, barriers to acquisition of coping strategies, potential indicators for future counseling and intervention/mental health services.

Note: Refer to the Treatment Plan and Monthly Progress Report.

Documentation Requirements

Providers must retain for three (3) years, from the last date of service, fiscal and treatment records that coincide with and fully document services billed to DHSS, and must furnish or make the records available for inspection or audit by DHSS or its representative upon request. Failure to furnish, reveal, and retain adequate documentation for services billed to DHSS may result in recovery of the payments for those services not adequately documented and may result in sanctions to the Provider's participation in DHSS programs. This policy continues to apply in the event of the Provider’s discontinuance as an actively participating DHSS Provider through change of ownership or any other circumstance.

Referral Indicators

Adjustment Counseling may be requested when:

• Participant and/or family exhibit difficulty in adjusting to losses associated with TBI;
• Participant demonstrates ability to perform abstract reasoning and has verbal processing skills necessary to benefit from counseling interventions; and
• Participant and/or family demonstrate ability to apply information learned within counseling sessions to daily life.

Desired Outcomes

• Participant/family report improved psychological functioning;
• Participant/family demonstrate improved overall adjustment relative to residual effects of TBI; and
• Long-term follow up community resources have been identified for ongoing needs.

Transitional Home and Community Support Training (THCS)

This service provides training and practice with activities related to daily living and maintenance of a household. The assumption is that the natural environment of a survivor’s home and community can afford effective opportunities for learning and practicing skills. Survivors may acquire and retain functional living skills best when these skills are taught in an environment that most closely resembles, or is the environment in which they will use these skills. Actual home and community-based activities shall be used in training.

Emphasis is on teaching strategies directly to the participant and family so that they can successfully manage roles and responsibilities for daily living and household operations independently.

The family’s ability to assist in this learning process and/or to reinforce the learned skills in the natural environment is considered an integral component of this service.

Services are provided by a Qualified Head Injury Professional (QHIP) directly, or under the supervision of a QHIP. The planning team will determine the composition of the service and assure that it does not duplicate, nor is duplicated by, any other service provided to the individual.

Activities included in this service are:

• Evaluating the family/home environment;
• Identifying strategies that enable the participant to effectively compensate for cognitive and/or physical impairments that are barriers to the performance of the types of activities required for independent living and household management. Examples of strategies are: memory notebooks, systematic calendar notes, alarm watches, timers, tape recorders, adaptive writing instrument, etc.;
• Providing instruction/training in acquisition of strategies and skills the participant requires to independently care for his/her personal needs, to plan, organize and carry out activities appropriate for lifestyle and family role. Examples of training activities are: directing personal care, performing household management chores, menu planning, grocery shopping, meal preparation, budgeting, auto/lawn care, creating and maintaining a weekly schedule, developing emergency contingency plans, arranging and accessing public transportation, scheduling and keeping appointments with social service agencies, attorneys, physicians, etc.;
• Training shall occur in the home and community settings;
• Training the key family member/person how to support the participant in acquisition of habitual use of strategies and self-sufficiency skills; and
• Assisting the family to make adjustments to changes in roles by direct training in techniques, suggesting alternative solutions to common problems, identifying natural supports, or referring family members to appropriate services.

Provider Requirements

The Provider must have a Department of Health and Senior Services (DHSS) Participation Agreement for Professional and Special Services Provider form (DH-74A) and a Provider.

Application (CC-35) for the provision of THCS. Agencies certified by the Department of Social Services or Department of Mental Health for Personal Care Assistance, Day Habilitation, or licensed in Missouri, as Home Health Care Providers will be accepted by DHSS as long as direct care staff fulfills the requirements for direct care staff as listed below. Provider staff serving in the supervisory role:

Must be a Qualified Head Injury Professional (QHIP) with a bachelor’s or master’s degree in Occupational Therapy, Recreational Therapy, Social Work, Psychology, Rehab Counseling, Counseling, Rehab Services, Education, Special Education, and Nursing. (Additional qualifying experience may be substituted on a year-for-year basis for deficiencies in the required education, upon ABI Program Manager approval.)

• Must be responsible for development of treatment goals. Activities may be carried out by a direct care staff worker that meets qualifications listed below; and
• Must ensure that the direct care staff worker is trained in intervention methods for specific participants in daily activities identified by the planning team.
• Must submit documentation and billing on time

Provider staff performing direct care:

• Must have a high school diploma or equivalent;
• Must have completed training in the Primary Skills from the Direct Care Worker Competency List within six months of employment.
  
  The Primary skills would include the following six domains:
  1. General Overview;
  2. Working with the Consumer in His/Her Environment;
  3. Professional Role and Job Skills of the Direct Care Worker;
  4. Learning About Community Resources;
  5. Safety and Welfare of the Consumer; and
  6. Policies of the Direct Care Worker’s Organizational System.
• Must complete the quizzes on The Brain Injury Guide & Resources web based training on TBI.
• Must complete a minimum of five hours per year of continuing education specifically related to job duties, after the first year of employment.

Documentation Requirements

Providers must retain for three (3) years, from the last date of service, personnel qualification and training records for services provided, documentation of supervision provided according to the unique needs of the individual, and must furnish or make the records available to inspection or audit by DHSS or its representative upon request.

Providers must retain for three (3) years, from the last date of service, fiscal and treatment records that coincide with and fully document services billed to DHSS, and must furnish or make the records available for inspection or audit by DHSS or its representative upon request. Failure to furnish, reveal, and retain adequate documentation for services billed to DHSS may result in recovery of the payments for those services not adequately documented and may result in sanctions to the Provider’s participation in DHSS programs. This policy continues to apply in the event of the Provider’s discontinuance as an actively participating DHSS Provider through change of ownership or any other circumstance.

Documentation must include evidence of participant and family’s agreement with and participation in goal setting, and must document regular clinical supervision consistent with the overall service plan.

Service Product

Initial written assessment and treatment plan listing specific behavioral objectives directed towards independent living skills. The initial treatment plan must:

• Incorporate information from current and previous assessment of the participant’s independent living skills;
• Show how the Provider plans to work with the family/significant others to train the participant towards mastery in specific skills essential to safe independent living. Documentation must include evidence of the family’s/significant other’s agreement with and participation in activities to ensure sustainable natural supports;
• Include a monthly progress report to the ABI Service Coordinator indicating the participant’s functional changes in targeted independent living skills during the period, successful methods used, barriers to acquisition of skills, and maximum achievement expected;

Note: Refer to Treatment Plan and Progress Report.

• Provide documentation of regular clinical staff supervision directing the development of compensatory strategies consistent with the overall treatment service plan and goals; and
• Include an exit transition plan that represents a discussion with the participant, family/significant other, and ABI Service Coordinator before withdrawing paid supports. A copy of the transition plan shall be provided to the participant/family. The transition plan shall show how the skills acquired through this service will be sustained. The transitional plan shall identify potential areas of ongoing needs that may require lifelong support for consideration by the planning team.
• All billable hours must be provided face to face with the participant.
  • Limited exceptions may be made with ABI Program Manager written prior approval.

Service Limitations

This service:

• Is limited to 4000 lifetime units (1000 hours) per participant;
• May not be authorized more than six (6) hours per week unless an assessment indicates an exceptional short-term need that is approved by the ABI Program Manager, and
• Is not intended to provide personal care services, but rather assist participant in learning strategies to function independently.

Referral Indicators

The typical participant appropriate for this service has:

• Specific needs identified for training in functional tasks necessary for successful independent living in the home and community;
• An assessment that recommends the participant receive training in a home/community based setting rather than a facility-based setting in order to promote the optimal generalization of skills for independent living; and
• Demonstrated the ability to learn and incorporate strategies to make changes in functioning relative to independent living and community participation.

Desired Outcomes

• Participant resumes previous life role, or role activities are redistributed to other family members/natural supports;
• Participant is independent in household management, and/or natural supports are in place;
• Participant has acquired identified adaptive equipment and has demonstrated proficiency in its use;
• Compensatory strategies are identified and incorporated that enable the participant to effectively manage everyday self-care and household management tasks as independently as possible;
• Community transportation access is identified and available to the participant as needed to live independently;
• Participant is able to plan at least one week ahead for normally scheduled events;
• Participant demonstrates ability to adjust plans for unexpected events;
• Participant has developed a plan and identified contact persons for assistance during unusual circumstances and/or emergency situations; and
• Ongoing unmet needs are identified and referrals have been made for lifelong supportive services as indicated.

Pre-Vocational/Pre-Employment Training

Service Description

This service uses actual work experience to promote the participant’s utilization of behavioral and/or cognitive compensatory strategies in a facility-based or a community site work setting. Specific target goals are identified for interventions such as production rate, inappropriate social behavior, or fatigue that are barriers to direct vocational placement or entry into Division of Vocational Rehabilitation (DVR) services. The Qualified Head Injury Professional (QHIP) directly supervises the participant at all times. Supervision may be provided for a group of participants, however, the staff/participant ratio must allow for individualized feedback to each participant regarding specific behavioral objectives.

Service Limitations

This service is limited to 180 lifetime units (3 or 6 hour day) of training per participant. This service is provided to participants who:

• Express an interest in vocational pursuits;
• Are not currently eligible for services through the DVR; and
• Have the capacity to improve function relative to potential competitive employment after completion of training.

Provider Requirements

The Provider must have a Department of Health and Senior Services (DHSS) Participation Agreement for Professional and Special Services Provider form (DH74-A) and a Provider Application (CC-35) for the provision of pre-vocational/pre-employment training services;

• Have a formalized relationship with DVR and/or other local employment agencies; and
• Have documented policies and procedures in place to safeguard the safety and well-being of the participants served.

Provider staff serving in the supervisor role:

• Must be a Qualified Head Injury Professional (QHIP), with a bachelor’s or master’s degree in Vocational Rehabilitation Services or an individual with a degree in Rehabilitation Services, Rehabilitation Counseling, Education, or Special Education, Psychology, Social Work, or closely related field with at least two years’ experience working with persons with brain injury on employment issues. CBIS Certification is preferred.
• Must be responsible for development of treatment goals. Activities may be carried out by a direct care staff worker that meets qualifications listed below; and
• Must ensure that direct care staff receives training on intervention methods in preemployment activities that the planning team identified for specific participants.

Provider staff performing direct care:

• Must have a high school diploma or equivalent;
• Have completed training in the Primary Skills from the Direct Care Worker Competency List within six months of employment.
  
  The Primary Skills would include the following six domains:
  • General Overview;
  • Working with the Consumer in his/her Environment;
  • Professional Role and Job Skills of the Direct Care Worker;
  • Learning About Community Resources;
  • Safety and Welfare of the Consumer; and
  • Policies of the Direct Care Worker’s Organizational System.
• Must complete the quizzes on The Brain Injury & Resources web based training on TBI.
• Must complete a minimum of five (5) hours per year of continuing education specifically related to job duties after the first year of employment.

Service Product

Initial written detailed assessment and treatment plan listing specific behavioral objectives directed toward preparing the participant for potential employment. The initial treatment plan must:

• Incorporate information from current and previous assessment of the participant’s employment readiness; and
• Show how the Provider plans to work with the participant to address specific barriers to readiness for DVR services or direct employment; and
• Show how the Provider plans to incorporate input from the participant, family, and DVR counselor.
• Documentation of regular staff supervision directing the development of compensatory strategies consistent with the overall treatment service plan and goals; and
• Documentation showing ongoing participation by DVR.
• A monthly progress report to the ABI Service Coordinator indicating the participant’s functional changes in work readiness skills during the period, successful methods used, barriers to acquisition of skills, and maximum achievement expected.
• All billable hours must be provided face to face with the participant.

Note: Refer to Treatment Plan and Monthly Progress Report.

Documentation Requirements

Providers must retain for three (3) years, from the last date of service, fiscal and treatment records that coincide with and fully document services billed to DHSS, and must furnish or make the records available for inspection or audit by DHSS or its representative upon request. Failure to furnish, reveal, and retain adequate documentation for services billed to DHSS may result in recovery of the payments for those services not adequately documented and may result in sanctions to the Provider's participation in DHSS programs. This policy continues to apply in the event of the Provider’s discontinuance as an actively participating DHSS Provider through change of ownership or any other circumstance.

Referral Indicators

The typical participant appropriate for this service meets the following guidelines:

• Stated interest in vocational pursuit is expressed by participant/family;
• Participant is of working age (21-65);
• Participant is able to provide independent routine self-care, or arrangements have been made for assistance during time at the training facility;
• Assessments indicate potential to identify specific vocational goal;
• Assessments indicate ability to learn with constructive feedback, modeling, behavioral interventions; and
• Assessments indicate ability to improve performance rate to the level of competitive employment.

Desired Outcomes

• Identification of performance relative to competitive employment standards, and recommendation for an appropriate work setting for the future;
• Clarification of feasible vocational goal and specific occupational areas for further exploration;
• Participant’s current specific work related strengths and weakness are identified for consideration by DVR and planning team when making future vocational plans;
• Identification of accommodations necessary to obtain and maintain competitive employment; and
• Entrance into DVR services such as Supported Employment Program, or competitive employment within a year from entry into this service.

Supported Employment/Long Term Follow Along

Service Description

Supported Employment/Long Term Follow Along is a service that provides continued support and training in an integrated work setting for participants who have completed the Supported Employment Program through the Division of Vocational Rehabilitation (DVR) and require additional intervention. Written documentation of the participant’s completion of the DVR Supported Employment Program, Employment Services Plus (ESP), or have a DVR accepted business plan.

Activities included in this service are:

• Problem solving specific on-the-job situations;
• Job coaching/training in required duties;
• Educating employer/coworkers on strategies/support techniques, including behavioral management;
• Participant advocacy that will enhance job retention, for example, evaluating the work environment for possible task sharing with coworkers; and
• Monitoring job performance including spot-checking, ongoing contact with employer to assure success.
• Self-Employment: assistance with organization, financial management, marketing Emphasis is on:
• Maintenance of skills acquired through the time-limited DVR Supported Employment Program;
• Extended support and follow along while completing on-the-job skill training; and
• Development of natural supports in the workplace that will ultimately replace paid supports and assure successful long-term job retention.

This service may also include preventive assistance when the participant’s job is in jeopardy because of a failure to adjust to changing circumstances, such as the following:

• A change has occurred within the work environment, for example, a different supervisor or procedure; and
• The participant’s job duties have changed, for example, because of a promotion or previously unidentified need for accommodation that requires additional training.

Service Limitations

• This service may cover a maximum of 25% of the participant’s hours worked not to exceed a 40 hour work week;
• The DVR Program staff identified specific skills/strategy needs and the participant and/or staff shall receive extended training to assure that the treatment plan refers to long-term job retention.
• It is preferential that service provision occurs in the work setting. Services may occur off site as outlined in the treatment plan. The participant should be re-referred to DVR if they experience significant changes that disrupt their success within the ABI Supported Employment Program that requires more than 25% of service provision.

Recipient Eligibility

Individuals employed by an outside employer or self-employed individuals receiving supported employment services must have applied for services through the DVR and successfully completed the DVR Supported Employment Program, Employment Services Plus (ESP) or have an accepted business plan by DVR.

Documentation of successful completion of DVR program identifying specific unmet needs must be sent with the prior authorization. The name of the participant’s DVR contact must also be submitted.

Provider Requirements

The Provider must

• Have a DHSS Participation Agreement for Professional and Special Services Provider form (DH74-A) and Provider Application (CC-35) for the provision of Supported Employment Services; and be part of an established program that has a formalized relationship with Vocational Rehabilitation.

Provider staff serving in the supervisor role:

• Must be a Qualified Head Injury Professional (QHIP), with a bachelor or masters’ degree in Vocational Rehabilitation Services or an individual with a degree in Rehabilitation Services, Rehabilitation Counseling, Education, Special Education, Psychology, Social Work, or closely related field with at least two years’ experience working with persons with brain injury on employment issues. CBIS Certification is preferred.
• May supervise up to 12 direct care staff;
• Must be responsible for development of treatment goals. Activities may be carried out by a direct care staff worker that meets qualifications listed below; and
• Must ensure that the direct care staff is trained in intervention methods for specific participants in daily activities identified by the planning team.

Provider staff performing direct care:

• Must have a high school diploma or equivalent;
• Must have completed training in the Primary Skills from the Direct Care Worker Competency List within six months of employment
  
  The Primary skills would include the following six domains:
  • General Overview;
  • Working with the Consumer in His/Her Environment;
  • Professional Role and Job Skills of the Direct Care Worker;
  • Learning About Community Resources;
  • Safety and Welfare of the Consumer; and
  • Policies of the Direct Care Worker’s Organizational System.

Service Product

A written detailed assessment and treatment plan listing specific behavioral objectives directed towards job retention skills. The treatment plan must;

• Incorporate information from previous DVR Supported Employment services received;
• Show how the Provider plans to work with the employer and coworkers to decrease the participant’s dependence on state funding;
• Document regular staff supervision directing the development of goals focused on training in compensatory strategies to enhance successful job retention;
• Document continuing information exchange with DVR, if DVR case is opened. Goals must be consistent with the participant’s Treatment Plan.
• Include a monthly progress report to the ABI Service Coordinator indicating:
  • The participant’s functional changes in work-related skills during the period;
  • Successful methods used with individual and coworkers;
  • Barriers to acquisition of skills; and
  • Maximum achievement expected.

Note: Refer to Treatment Plan and Monthly Progress Report

A written exit transition plan will be discussed with the participant, work supervisor, and ABI Service Coordinator before withdrawing paid supports. Copies of the transition plan shall be provided to the participant/family, DVR, and employer, and shall include:

• Potential areas for troubleshooting, including likely solutions;
• Potential behaviors or events that should trigger re-contact with staff; and
• The person to contact in the event of problems requiring intervention.

Documentation Requirements

Providers must retain for three (3) years, from the last date of service, fiscal and treatment records that coincide with and fully document services billed to DHSS, and must furnish or make the records available for inspection or audit by DHSS or its representative upon request. Failure to furnish, reveal, and retain adequate documentation for services billed to DHSS may result in recovery of the payments for those services not adequately documented and may result in sanctions to the Provider's participation in DHSS programs. This policy continues to apply in the event of the Provider’s discontinuance as an actively participating DHSS Provider through change of ownership or any other circumstance.

Referral Indicators

The participant who enters this service:

• Must have successfully completed DVR Supported Employment program, Employment Services Plus (ESP) or have an accepted business plan from DVR;
• Must be in competitive employment in an integrated work setting; and
• Must have specific behaviors and/or job retention skills identified by DVR Supported Employment Program requiring targeted intervention beyond the time-limited DVR services.

Desired Outcomes

• Natural work supports are in place – employer and coworkers consistently demonstrate useful support methods and techniques for typical job situations;
• Quality and quantity of work are within agreed upon expectations;
• Employer reports satisfaction with participant’s work;
• Participant demonstrates good attendance and punctuality;
• Participant demonstrates positive work attitude and work behavior;
• Paid services are weaned gradually until phased out completely; and
• Employer and coworkers have been informed of possible events that may provide challenges for the participant and warrant further contact with DVR;
• Increased independence, resolution of identified barriers, increased productivity/income.

Special Instruction

Service Description

This service consists of tutoring/instruction by qualified staff for specific subjects, targeted compensatory strategies, or skills related to achievement of the long-term goal in Program Treatment Service Plan. Examples of this service include special tutoring for:

• College courses;
• General Education Diploma (GED) preparation,
• An adaptive skill such as one-handed typing;
• Driver’s license exam; and
• Learning the use of assistive technology devices, etc.

Service Limitations

This service:

• Is limited to 1000 lifetime units (250 hours) per participant.
• May not duplicate any service covered by another state agency;
• Does not take the place of general education to improve basic skills, such as reading and mathematics, beyond achievement before injury;
• May include consultation/training with a key family member in order to maximize learning; and
• All billable units must occur face to face with participant.

Provider Requirements

The Provider must have a Department of Health and Senior Services (DHSS) Participation Agreement for Professional and Special Services Provider form (DH-74A) and Provider Application (CC-35) for the provision of Special Instruction;

Provider staff serving in the supervisor role:

• Be a Qualified Head Injury Professional (QHIP), with a bachelors or masters’ degree in Education, Special Education, or Speech Therapy; and
• Have one year of experience working directly with persons with brain injury.

Documentation Requirements

Providers must retain for three (3) years, from the last date of service, fiscal and treatment records that coincide with and fully document services billed to DHSS, and must furnish or make the records available for inspection or audit by DHSS or its representative upon request. Failure to furnish, reveal, and retain adequate documentation for services billed to DHSS may result in recovery of the payments for those services not adequately documented and may result in sanctions to the Provider’s participation in DHSS programs. This policy continues to apply in the event of the Provider’s discontinuance as an actively participating DHSS Provider through change of ownership or any other circumstance.

Service Product

A written detailed report that includes a thorough review of all assessment and treatment records to date. Report should include assessment of current functioning relative to desired competency identified in the ABI Treatment Plan. The report must include the scope, frequency, and duration of educational intervention required for acquisition of competency. The monthly report must be forwarded to the ABI Service Coordinator within ten working days of visit. Monthly Progress reports are required for all months of authorized services on the current Treatment Plan and Monthly Progress Report form.

A monthly progress report to the ABI Service Coordinator indicating:

• The participant’s function related to the treatment plan goals and outcomes;
• Successful teaching strategies used;
• Barriers to learning achievement;
• Maximum achievement expected; and
• Identification of available natural supports to sustain learned information and/or skills.

Note: Refer to Treatment Plan and Monthly Progress Report.

Referral Indicators

Participants appropriate for this service have:

• Specific educational intervention indicated as a need in ABI Treatment Plan as intermediate step in accomplishing long-term goal; and
• The ability to incorporate compensatory strategies to facilitate acquisition of new learning.

Desired Outcomes

• Participant is able to participate successfully in college course(s) using targeted compensatory strategies;
• GED is successfully obtained;
• Functional skill such as one-handed typing is acquired at level required for sheltered employment or volunteer placement;
• Driver’s license exam is taken successfully; and
• Participant is able to master assistive technology device/equipment required to facilitate accomplishment of long-term goal.

Consultation Visit

Service Description

This service would allow participants to consult with providers to discuss any of the services they are eligible to receive. The Consultation Visit is applicable to all ABI Program services.

For example, a participant requesting Adjustment Counseling services would be able to consult with the therapist prior to services beginning to schedule visits, develop the Treatment Plan, etc. The visit would allow providers to submit an invoice for the Consultation Visit without affecting the participants’ lifetime units.

The reimbursement rate for this service would be $60.00.

A Prior Authorization is not required for reimbursement of this service. Once the visit has occurred, a claim submission will be made to the ABI Claims email account for reimbursement. See Billing Guidelines.

A related service code must be included within the client id/notes column on the claims submission spreadsheet when billing for the consultation visit.

Consultation Visits may be billed:

• After initial provider selection and/or change of provider, or
• Upon a restart of a paid service with the same provider after a 12 month interruption of service.

Telehealth

ABI Providers may be considered to provide services through telehealth for ABI participants that have the capabilities of doing so.

Telehealth services may be used for Transitional Home & Community Services (THCS), Adjustment Counseling and Special Instruction services.

Approval to deliver telehealth services must be granted by the ABI Service Coordinator as well as the ABI Program Manager.

The Provider must provide a detailed explanation in writing as to how services will be delivered.

The explanation must be submitted to the Service Coordinator for review, who will then send to the ABI Program Manager for approval.

Telehealth approvals will be granted on a month to month basis. If at any time the participant, ABI Service Coordinator, or ABI Program Manager feels that services aren’t being provided appropriately, telehealth services will be terminated effective immediately.