How Do I Apply - Brain Injury Services

The State of Maine requires both a financial and medical review to determine an individual’s eligibility for Brain Injury Services.

Brain Injury Waiver Services

Step 1. If you are not already receiving Maine Care Benefits please apply for MaineCare Services. You must complete a Long Term Care application. You can access the Long Term Care application here.

Step 2.   As part of the application process you will need to submit documentation stating that the waiver services are medically necessary from a qualified neuropsychologist and/or a licensed physician who is Board certified or Board eligible in Physical Medicine and Rehabilitation. The documentation for medical necessity needs to:

  • Positively indicate the individual is not in a persistent vegetative state;
  • Demostrate the individual has potential for physical and/or behavioral and/or cognitive rehabilitation
  • Show evidence of moderate to severe behavioral and/or cognitive and/or functional disabilities; and
  • Result in specific rehabilitation goals, based on the findings of the assessment, describing types and frequencies of therapies and expected outcomes and timeframes

Step 3. Applications can be mailed or faxed. Fax your application to (207) 287-9229. Mail your application to:

DHHS- OADS

Attn: Neurobehavioral Services

41 Anthony Avenue, SHS #11

Augusta, Maine 04333-0011

You can call (207) 287-9200 and ask to speak to a Brain Injury Care Monitor to ensure your application has been received.

Step 4. Once Neurobehavioral Services receives a completed application then they will make a referral on the individual's behalf to Maine's Assessing Services Agency. There is no charge and the assessment is private. If Maine's Assessing Services Agency determines that a face-to-face assessment is needed, you will be contacted by a Maine's Assessing Services Agency assessor to schedule the assessment.

Step 5. Once the assessment is completed then you will be determined medically eligible or not. Medical eligibility does not ensure you have funding under the waiver. You will be contacted by letter and or telephone if you have a funded offer under the Brain Injury Waiver. A funded offer does not guarantee that services will start. Services are dependent on a service provider being able to provide the necessary services and accepting the applicant into their program.

Outpatient Neurorehabilitation Services

Services Offered: Assessments, physical therapy, occupational therapy, speech and language therapy, recreation therapy, and community re-integration.

Step 1.  Set up an appointment for a Clinical Assessment at a qualified clinic.  MaineCare will reimburse for the Clinical Assessment to confirm the diagnosis of brain injury, even if the member is not found eligible for MaineCare Outpatient Neurorehabilitation Services.

Step 2.  If you are found eligible, the clinic will set up an outpatient rehabilitation program for you.

Nursing Facility Acquired Brain Injury Services

Step 1. Apply for acceptance to a nursing facility that is qualified to provide acquired brain injury services.

Step 2.. If you have not already had a functional assessment by Maine's Assessing Services Agency at 1-833-525-5784 or by fax at 1-844-356-7500, you will be asked several questions about the help a person is looking for and what the financial circumstances are for this person. Maine's Assessing Services Agency then decides whether or not a face to face assessment will be done. There is no charge, and the assessment is private. If Maine's Assessing Services Agency determines that a face-to-face assessment is needed, you will be contacted by a Maine's Assessing Services Agency assessor to schedule the assessment.

If you proceed to a face-to face assessment, this may be done in your home, in the hospital or nursing home by a Registered Nurse. The nurse uses a laptop computer to collect the information to complete the assessment. The nurse will ask about the kinds of tasks you can do by yourself, what kinds of medications you take, what kinds of help you need, whether you have friends and family members or neighbors who can help you, what your income is, and other questions. You may request that a family member or other person be present at the assessment.

Step 3.  You will need to submit documentation from a qualified neuropsychologist and/or a licensed physician who is Board certified or Board eligible in Physical Medicine and Rehabilitation that the wavier services are medically necessary which:

  • positively indicates the individual: is not in a persistent vegetative state;
  • is able to demonstrate potential for physical and/or behavioral and/or cognitive rehabilitation;
  • shows evidence of moderate to severe behavioral and/or cognitive and/or functional disabilities; and
  • results in specific rehabilitation goals, based upon the findings of the assessment, describing types and frequencies of therapies and expected outcomes and timeframes; and

For additional information, please visit our FAQ Section