COMMCARE Waiver
412-371-7700
The COMMCARE Waiver is a Home and Community-Based program developed for individuals with a medically determined diagnosis of traumatic brain injury (TBI). COMMCARE prevents the institutionalization of individuals with TBI and helps them to remain as independent as possible.
Who is Eligible?
- Pennsylvania residents age 21 and older who experience a medically determinable diagnosis of traumatic brain injury and require a Special Rehabilitative Facility (SRF) level of care.
- The disability must result in substantial functional limitation in three or more of the following major life activities: mobility, behavior, communication, self-care, self-direction, capacity for independent living, and cognitive capacity (judgment, memory and reasoning).
- Total countable resources for persons over the age of 21 must be $8,000 ($2,000 Medicaid limit that includes a $6,000 resource disregard) or less. Resources include, but are not limited to, cash on hand, bank accounts, stocks, bonds, mutual funds, life insurance and vehicles.
- Traumatic brain injury or TBI is defined as a sudden insult to the brain or its coverings, not of a degenerative, congenital or post-operative nature, which is expected to last indefinitely.
- Services under this waiver may be provided to individuals living in community settings.
Contact Information
Individuals interested in receiving COMMCARE Waiver services or providers interested in participating in COMMCARE should contact in Allegheny County, Three Rivers Center for Independent Living, 412-371-7700.
Services Available
- Service Coordination
- Assist consumer to identify, coordinate, and facilitate waiver services, state plan services, and other needed medical, social, and educational services, regardless of the funding source, including: intake, needs assessment or advocacy
- Ongoing monitoring of services included in consumer's service plan.
- Personal Care Services
- Assist with eating, bathing, dressing, personal hygiene, activities of daily living.
- Provides limited prompting to initiate or complete daily activities.
- Hands-on assistance can be provided, as appropriate.
- May include some housekeeping chores.
- Respite Care
- Temporary services offered to consumers to relieve unpaid persons who normally provide the care.
- Respite services may be delivered in an individual's home, or place of residence, Medicaid certified Intermediate Care Facility / Other Related Conditions (ICF/ORC), licensed respite facility, or other community care residential facility approved by the state that is not a private residence. Respite services may also be delivered in a relative or friend's home if the consumer's home is not available.
- Prevocational Services
- Prevocational services are aimed at preparing an individual for paid or unpaid employment, but are not job task oriented. Includes teaching such concepts as compliance, attendance, task completion, problem solving and safety. Provided to persons not expected to be able to join the general work force or participate in a transitional sheltered workshop within one year.
- Supported Employment
- Paid employment for persons for whom competitive employment at or above the minimum wage is unlikely, and who, because of their disabilities, need intensive ongoing support to perform in a work setting.
- Habilitation and Support
- Habilitation and Support Services provide up to a full day (24 hour basis) of services and/or supports which are designed to ensure the health, safety and welfare of the individual, and to assist in the acquisition, retention and/or improvement in skills necessary to support individuals to live successfully in their homes.
- Educational Services
- Educational services consist of general adult educational services, including community college, university or other college-level courses, classes and/or tutoring to receive a GED.
- Environmental Adaptations
- $20,000 per consumer, per lifetime.
- Physical adaptations to the home, required by the consumer's plan of care, necessary to ensure consumer's health, safety, and well-being, or which enable consumer to function with greater independence in the home, and without which consumer would require institutionalization, provided in accordance with applicable state or local building codes.
- All services shall be provided in accordance with applicable state or local building codes. Includes minor modifications to vehicles which will allow the consumer to function with greater independence in the community.
- Non-Medical Transportation
- Enables consumer to gain access to waiver and other community services, activities and resources, specified by the service plan.
- Specialized Medical Equipment/Supplies and Assistive Technology
- $10,000 lifetime maximum, prior authorization required.
- Devices, controls, or appliances, specified in the Personal Support Plan, which enable consumers to increase their abilities to perform activities of daily living, or to perceive, control, or communicate with their environment.
- Items necessary for life support, ancillary supplies, and equipment necessary to the proper functioning of such items.
- Durable and non-durable medical equipment not available under the State Plan. Items reimbursed with waiver funds shall be in addition to any medical equipment and supplies furnished under the State Plan and shall exclude those remedial benefits to the individual.
- All items shall meet applicable standards of manufacture, design and installation.
- Chore Services
- Services needed to maintain the home in a clean, sanitary and safe environment.
- Includes heavy household chores such as washing floors, windows and walls, tacking down loose rug and tiles, moving heavy items or furniture in order to provide safe access and exit, and seasonal chores such as cutting grass and shoveling snow.
- Personal Emergency Response Systems (PERS)
- Electronic device which enables consumers at high risk of institutionalization to secure help in an emergency.
- Limited to consumers who: live alone, or are alone for significant parts of the day; have no regular caregiver for extended periods of time; would otherwise require extensive routine supervision.
- Extended State Plan Services
- Physical Therapy.
- Occupational Therapy.
- Speech Therapy.
- Part-time Nursing.
- Coaching/Cueing
- Provided to consumers needing minimal or no hands on assistance.
- Provides cues and prompts, facilitates environmental changes, and provides training to enable consumers to perform daily living activities themselves.
- Night Supervision
- Includes intermittent or ongoing, awake, overnight supervision to a consumer in his or her residence for a period of eight hours.
- Can include prompting and cueing.
- Can provide assistance with routine functioning and personal care assistance as may be required.
- In congregate living situations, staff person shall provide assistance for up to eight consumers.
- Structured Day Program
- Services take place in a non-residential setting.
- Services may include social skills training, sensory/motor development, and reduction/elimination of maladaptive behavior.
- Services directed at preparing the consumer for community reintegration by teaching concepts such as compliance, attending, task completion, problem solving, safety, and money management.
- Physical, occupational, and speech therapy may also be provided if documented in service plan.
- Behavioral Specialist Consultant
- Services of an expert who advises the members of the treatment team and develops an individual behavior management plan for implementation by the family and professionals working with the consumer.
- Cognitive Therapy
- The process includes attainment/re-attainment of skills through direct retraining, use of compensatory strategies, and use of cognitive orthotics and prostheses.
- Therapy will initially begin with individual sessions with the ultimate goal of moving to a group setting.
- Counseling (Consumer and/or Family)
- Provided to consumers in order to resolve intra-psychic or interpersonal conflicts, family issues and conflicts resulting from the brain injury, previous history of substance abuse or mental health of the consumer.
- Counseling will initially begin with individual sessions with the ultimate goal of moving to a group setting.
- Community Integration
- Assist consumers in acquiring, retaining, and improving self-help, socialization, and adaptive skills necessary to reside in the community.
- Enable consumers to plan for and engage in meaningful adult activities, including domestic and leisure activities.
- Can include: cues, on-site modeling of behavior, supervision (up to 24 hours a day) to assist the consumer in maintaining maximum independent function.
- Community Transition Services
- One time, set-up expenses, for individuals who make the transition from an institution to their own home, apartment or family/friend/foster care living arrangement.
- Categories of expenses are: Equipment, moving expenses, security deposits, set-up fees and personal/environmental health and safety. Expenses cannot exceed $4,000 per consumer.