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Click ‘Get Form’ to open it in the editor.
Begin by filling out the Consumer Information section. Enter the consumer's name, Medicaid ID number, address, phone number, Social Security Number, and date of birth. Ensure all details are accurate for proper processing.
Indicate the responsible person/contact and their address. This is crucial for communication regarding the referral.
Select the discharge option that applies: Community (HCBS-TBI), Nursing Facility (NF), or Rehabilitation Facility (TBIRF).
Complete the Admission Facility section by answering questions about medical necessity and guardianship status. Attach any required documentation as specified.
In the KDADS section, ensure that you include comments and sign where indicated before submitting your completed form via email to the TBI Program Manager.

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What is the best hospital for brain trauma?

Mayo Clinic experts have expertise and experience in evaluating and treating people who have had a traumatic brain injury.

What is the best hospital for traumatic brain injuries?

Mayo Clinic in Rochester, Minnesota, is ranked among the Best Hospitals for neurology and neurosurgery and rehabilitation by U.S. News World Report.

What is the average payout for traumatic brain injury?

Severe TBI always includes a period of unconsciousness (uhn-KON-shuh s-nis). During this time, the person will not be able to stay awake. He or she will not be able to interact with surroundings in a purposeful way, such as docHubing for an object.

What are two locations for rehabilitation post TBI?

What happens during rehab after traumatic brain injury? Inpatient rehab hospital. Outpatient rehab hospital. Home-based rehab. A comprehensive day program. An independent living center.

What is the 3 hour rule for TBI?

However, another major barrier to accessing rehabilitation is the so-called 3-hour rule. The 3-hour rulea Centers for Medicare Medicaid Services (CMS) practice that requires that patients have sufficient energy and endurance to engage actively in occupational, speech, or physical therapy for 3 hours per day, 5