Enhanced Brain Injury Residential Support is a 24-Hour service that includes a greater degree of supervision and therapeutic intervention for the residents because of the degree of their dependency level or the severity of their brain injury. Individuals with Traumatic Brain Injury (TBI) and Non-Traumatic Brain Injuries (NTBI) may be eligible for this level of residential support..
What Enhanced Brain Injury Residential Support?
Assistive Technology Equipment and Supplies
The assistive technology equipment and supplies service covers purchases, rentals, shipping costs and, as needed, fixes to equipment required to increase, maintain or improve your ability to do daily life tasks. You can spend up to $20,000 over the duration of the NC TBI Waiver for this service and home modifications (combined over five years). The limit does not include nutritional supplements and monthly alert monitoring system charges. The list of items covered includes certain daily living aids, items to help you control your environment, some types of positioning systems, and some types of alert systems. If you need equipment or supplies, let your care manager know and they can help you determine if it can be covered by the NC TBI Waiver, Medicaid or other resources.
Cognitive rehabilitation is an individual therapy to develop thinking skills to improve functional abilities including, but not limited to, attention, memory and problem solving, and to help spot impaired thinking. The first goal of therapy is to improve thinking to the fullest extent possible. Compensatory strategies will be introduced as progress slows. This phase will help to achieve an understanding of your ongoing cognitive limitations, if any, maintain skills learned, teach functional strategies necessary to increase the quality of life, and improve your ability to live successfully in the community of your choice.
Compensatory strategies also include the training of significant people in your life. Cognitive rehabilitation includes a traditional approach that focuses on the individual cognitive impairment and tries to remediate or teach compensatory strategies if restorative objectives are unsuccessful. This approach is most often provided in an office setting. Cognitive rehabilitation also includes a contextual approach that helps individuals achieve their real-world participation in their chosen real-world activities that are blocked by cognitive impairment. This approach is most often provided in the community or in the home.
Community Networking Services
Community networking services include activities that support you in creating a day that is personally meaningful to you, and with people who are not disabled. Community networking services are not provided in your home, anyone else’s home, residential programs, or day programs. Some of the things community networking services can help you do:
- Participate in classes at a community college—for example, take a class in photography.
- Participate in community classes to develop hobbies, leisure, or cultural interests – for example, take a class to learn to knit—other people in the class may later decide to meet weekly at a community center where everyone could work on their own knitting project together.
- Perform volunteer work such as stocking food at a food pantry.
- Join a group that meets regularly in the community—for example, a group that meets at a coffee shop every morning to discuss community events.
- Learn to use public transportation.
- Take classes on self-determination and participate in a self-advocacy group.
- Pay for you to attend a class or conference (but not hotel, meals, transportation to the conference or day care fees) up to $1,000 per year.
Community transition funds are one-time set-up expenses for adult individuals to live in homes of their own. It can help you if you are moving from a developmental center (state-run ICF-IID), community ICF-IID group home, nursing facility, or other licensed living arrangement (such as a group home, foster home or alternative family living home) to a living arrangement where you are directly responsible for your own living expenses. The lease must be in your name, legal guardian, representative or you must own the home.
Crisis Services (Crisis Intervention and Stabilization, Crisis Consultation, Out-of-Home Crisis)
Crisis services help you if a situation is a threat to your health and safety or the health and safety of others. This service could help you if you are at risk for losing your job, your home or other important activity in your life, and it can help prevent you from needing institutional placement or hospitalization. Crisis services are available to help you 24 hours per day, seven days per week. There are three types of crisis services that can help you:
- Crisis intervention and stabilization: Trained staff are available to provide first response crisis services to you. They can help identify the type of help you need, contact other agencies to help you, and help staff or caregivers work with you during the crisis.
- Crisis consultation: Psychologists or psychological associates are available to you if you have challenging behaviors that have resulted in a crisis situation requiring the development of a comprehensive crisis plan.
- Out-of-home crisis: A short-term service that can help you if you experience a crisis and require a period of regular support. The service takes place in a licensed facility or licensed private private home respite setting, separate from your living arrangement.
Day supports help you get, keep or improve socialization and daily living skills and is one option for a meaningful day. If you receive day supports, your day supports provider is responsible for transporting you from your home to and from the day supports facility. Usually you receive day support services in a group. One-on-one day support services are available only if you have special needs that require individual support.
Home modifications are physical changes to the private home where you live or will be living and owned by you or your family (including your foster family, if applicable) that are needed to protect your health, welfare, and safety or to help you be more independent. The adaptations cannot add total square footage to your home and are limited to $20,000 over the duration of the NC TBI Waiver (limit includes assistive technology equipment and supplies).
In-Home Intensive Supports
In-home intensive supports are available to support you in your private home if you need a great deal of supervision and support. Training, support and supervision are provided to help you with positioning, intensive medical needs, delopement and behaviors that would result in injury to you or other people.
Your ISP will include a plan for reducing the amount of in-home intensive supports needed. The need for in-home intensive supports is reviewed for reauthorization every 90 days.
Life Skills Training
Life skills training provides rehabilitation and skill building to allow you to develop and maintain skills, which support more independence. Life skills training gives rehabilitative and skill-building supports if you live in community and home settings. Life skills training adds to your family and friends supports and includes a set of services required to maintain and help you live in community settings.
Life skills training includes:
- Training in interpersonal skills and development and maintenance of personal relationships.
- Skill building to develop community living skills, such as shopping, personal banking, grocery shopping and other community activities.
- Training with therapeutic exercises, supervision of self-administration of medication and other services essential to health care at home, including transferring, ambulation and use of special mobility devices.
- Transportation to support life skills training.
Natural Supports Education
Non-paid supports education provides training to your family and your support network to educate and train them about the nature and impact of your disability,
on strategies for helping you, and specialized equipment and supplies you use. Natural supports are relationships with people that include coworkers, classmates, activity individuals, neighbors, family and others. These relationships are typically developed in the community through associations in schools,
the workplace, and participation in clubs, organizations and community activities. This service will also pay up to $1,000 for enrollment fees and materials related to attendance at conferences and classes by your primary caregiver that help your caregiver develop skills to support you in having greater access to the community.
Occupational therapy services improve quality of life by developing or recovering competence, preventing further injury or disability, and improving your ability of to perform tasks required for independent functioning. Occupational therapy NC TBI Waiver services are provided when the limits of the approved occupational therapy under Medicaid state plan service are used up. Therapeutic treatments above the Medicaid state plan are provided according to your needs as identified by the licensed provider and in keeping with the rehabilitative intent of the NC TBI Waiver.
Personal Care Services
Personal care services help you with eating, bathing, dressing, hygiene and other activities of daily living. These services also include housekeeping chores, such as bed making, dusting and vacuuming if these are incidental to your care and are essential to your health and welfare rather than your family’s needs. Personal care services also include help with monitoring your health and with transferring, walking and using special mobility devices, and providing supervision as needed.
Physical therapy services are necessary to develop functions or skills or to address a loss, impairment or reduction of physical function as a result of an acute or chronic medical condition, congenital anomaly or injury. Through physical therapy, you receive treatment to move and perform functional activities in your daily life and helps prevent conditions associated with loss of mobility through fitness and wellness programs that achieve healthy and active lifestyles. Physical therapy NC TBI Waiver services are provided when the limits of the approved physical therapy state plan service are used up. Therapeutic treatments above the state plan are provided according to your needs as identified by the licensed provider and in keeping with the rehabilitative intent of the NC TBI Waiver.
Residential supports are individually designed training activities, assistance and supervision. Residential supports are provided in licensed/ unlicensed community residential settings that include group homes and alternative family living homes.
Residential supports include:
Habilitation services that help you develop, improve and maintain self-help skills, general household management, meal preparation skills, personal financial management skills and socialization skills.
- Assistance and support in activities of daily living to ensure your health and safety.
- Transportation to/from your residence and community activities/licensed day programs.
Resource facilitation promotes the coordination of medical, behavioral, social and unpaid supports to address your needs. Resource facilitation also informs the planning process. The service includes:
- Compiling and reviewing existing assessments and determining needs and risks.
- Coordinating with the medical, behavioral, social and unpaid supports along with the team and tailored care management to determine the needed services/supports.
- Working with you, your family (as appropriate), and your team as needed to assess, plan, identify, reassess, educate, train, and develop resources, and provide emotional support, outreach and advocacy.
Respite services are provided on a short-term basis to replace absent caregivers or relieve informal caregivers from the daily demands of caring for a participant and to strengthen the informal support system.
Specialized Consultation Services
Specialized consultation services provide training and help in a specialty area. The specialty areas include psychology, behavior intervention, speech therapy, therapeutic recreation, augmentative communication, assistive technology equipment, occupational therapy, physical therapy and nutrition. Family members and other paid/unpaid caregivers are trained by a certified, licensed, and/ or registered professional or qualified assistive technology professionals to carry out therapeutic interventions, increase the effectiveness of the specialized therapy, and participate in your team meetings. This service is very important as it can help your family, caregivers, and paid service providers learn how to provide the right supports for you.
Speech-language therapy is the assessment and treatment of speech and language disorders. Your assessment and treatment may include language (listening, talking, reading, writing), cognition (attention, memory, sequencing, planning, time management, problem solving), motor speech skills, articulation and conversational skills. It may also address issues related to swallowing and respiration. Speech-language therapy is intended to help you regain lost skills and achieve a greater level of independence for skills that have permanently changed. Speech-language therapy NC TBI Waiver services are provided when the limits of the approved speech- language therapy state plan service are used up. Therapeutic treatments above the state plan are provided according to your needs identified by your licensed provider and aligns with the rehabilitative intent of the NC TBI Waiver.
Supported Employment Services
(Initial and Long- term Follow-up)
Supported employment services help you choose, get and maintain a job in settings with people who do not have disabilities. Before you can get supported employment services funded by the NC TBI Waiver, you must first use any services vocational rehabilitation offers you.
Supported employment services include:
- Pre-job training to prepare you to start work and may include career counseling, job shadowing, help using educational resources, training in resume preparation, job interview skills, and help learning skills necessary for keeping the job.
- Training and support to get employment in a group such as an enclave or mobile crew (groups of workers with disabilities who work in a business in the
- Assisting you in starting and running a small business you own.
- Training and support to complete job training or maintain employment.
- Transportation between work/home or between activities related to employment.
- Consultation with your employer to address any problems or needs you may have.
Vehicle modifications are devices, services or controls that can help you increase your
independence or physical safety by enabling your safe transport in and around the
community. The installation, repair, maintenance and training in the care and use of
vehicle modifications are included. You or your family must own or lease the vehicle
being modified. Modifications do not include the cost of the vehicle or lease.
Modifications include door handle replacements, door modifications, installing a
raised roof, lifting devices, devices for securing wheelchairs or scooters, adapted
steering, acceleration, signaling and braking devices, handrail and grab bars, seating
modifications, lowering of the floor of the vehicle, and safety/security modifications.
Vehicle modifications are limited to $20,000 over the duration of the NC TBI Waiver
Supported living services allow you to live in your own home with support that is suited to your individual needs. You can choose who lives with you (up to two other people) and how you want help. The purpose of this service is for you to live independently, so you cannot live with family members, with certain exceptions. This service also cannot pay for your rent or room and board unless to pay for a live-in caregiver.
Supported living services include:
- Direct assistance with daily activities, household chores, budget management, attending appointments and building social skills.
- Training activities, supervision and assistance to help you participate in home or community life.
- Help with keeping track of your health and physical condition.
- Help with transportation, emergencies that require ambulances, and using devices that help you move around.
- T2025 Specialized Consultative Services 15 minutes
- T2025 HO Specialized Consultative Services – BCBA 15
- T2025 22 HT Specialized Consultative Services – BCBA – LIP 15 minutes
Traumatic Brain Injury (TBI)
Alliance Health operates a waiver for Traumatic Brain Injury in Durham, Wake, Cumberland and Johnston counties. The TBI Waiver is expected to become available in Orange and Mecklenburg counties in late Summer 2022.
Traumatic brain injury - Diagnosis and treatment - Mayo Clinic
If a head injury causes a mild traumatic brain injury, long-term problems are rare. But a severe injury can mean significant problems.