Requests for Traumatic Brain Injury Funding
Partners Behavioral Health Management (Partners) has recently received its annual allocation for Traumatic Brain Injury (TBI) funding. In order to best serve consumers with a TBI and deliver services efficiently and effectively, Partners has revised our procedure for requesting TBI funding.
Providers and organizations who wish to request funding must complete the Partners’ Traumatic Brain Injury Funding Request Application. Please complete the application and submit it and all corresponding documentation to email@example.com by October 22, 2017 to ensure consideration of review. Because we often have more need than there is funding, careful consideration will be taken as we review these requests.
Management and Use of Traumatic Brain Injury Funding:
All TBI funds allocated to Partners shall be used exclusively to support TBI services and supports. Within the funding guidelines listed below, Partners will use a portion of the annual allocation to support residential programs that are specifically designed to serve individuals with TBI. Any other funds available will be used to support requests submitted by or on behalf of individual consumers for assistance with home modifications, adaptive equipment/supplies, transportation, and other requests deemed necessary by the consumer’s LME/MCO and physician ordering the service.
The following guidelines will be used in considering requests for TBI funding:
- Priority for funding will be given to consumers who do not have access to home and community based waiver services and supports.
- Funding will not be used for services and supports covered by the consumer’s current insurance coverage, Medicaid, or Medicare
- Funding will not be used for services and supports, coverable by Medicaid, Medicare, or Private Insurance, but already deemed to not be medically necessary.
- Funding to support residential programs will not result in any consumer’s total cost of care exceeding $135,000 per fiscal year.
- Requests for direct service delivery will be considered only if time-limited and not to exceed the end of the current fiscal year
- For consumers who sustained the TBI prior to the age of 22 years old, TBI funding will be used only if the consumer is on the Registry of Unmet Needs (RUN) or, at a minimum, the process has been initiated to add the consumer to the RUN.
The following procedures should be used when submitting requests for TBI funds:
- Requests for TBI funding cannot be processed prior to receipt of funding allocation by the Division of Mental Health/Developmental Disabilities/Substance Abuse Services.
- All requests must be submitted using Partners’ Traumatic Brain Injury Funding Request Application, corresponding service order or Letter of Medical Necessity, and Cost Finding Form or quotes for one-time purchase. Requests are not considered complete without required documentation.
- Submit completed TBI application and Cost Finding form by email to firstname.lastname@example.org
- Requests will be completed within 30 days.
- If additional information is requested and not received, the request will be closed as Unable to Process on the 30th day from the original submission
- If approved, the signed TBI application will be distributed per the routing workflow on the form. If denied, a notice with Grievance instructions will be sent to the consumer and provider notifying of the decision.
The Associate Intellectual Developmental Disabilities Clinical Director will be notified of approved funding requests and will collaborate with Partners’ Finance Department to ensure that the provider contract is updated as applicable, or payment arrangements are established.
As related to #2 and #3 specified above, Partners reserves the right as a Managed Care Organization to approve/deny TBI requests at the local level that are not medically necessary and fiscally appropriate.
Please note: TBI funding is not an entitlement and therefore, no appeal rights will accompany this decision. However, Partners’ grievance procedure does apply.
If you have questions, please contact either: