Brain Injury Association of America
SPECIAL EDITION Policy Corner E-Newsletter – May 12, 2011
a weekly update on federal policy activity related to traumatic brain injury
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In This Issue:

National Defense Authorization Act

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The Policy Corner is made possible by the Centre for Neuro Skills and Lakeview Neurorehabilitation Centers & Specialty Hospital.
Brain Injury Association of America gratefully acknowledges their support for legislative action.

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FY12 National Defense Authorization Act

On May 11, 2011, Rep. Todd Russell Platts (R-PA), co-chair of the Congressional Brain Injury Task Force, working in collaboration with the office of Congresswoman Gabrielle Giffords (D-AZ), Task Force members and the Brain Injury Association of America, introduced an amendment to the National Defense Authorization Act that authorizes $1 million for the development of treatment guidelines for post-acute rehabilitation of traumatic brain injury. The amendment was adopted en bloc by the Full House Armed Services Committee by voice vote.

Despite the many advances in science and medicine, medical treatment guidelines for post-acute rehabilitation of moderate and severe TBI do not exist. Currently, there is no compilation of the published evidence and professional consensus to ensure that wounded warriors and the 1.7 million civilians who sustain brain injuries in the U.S. receive the highest quality, most effective post-acute rehabilitation.

“The absence of treatment guidelines contributes to the substantial inconsistencies in health insurance coverage for TBI care, said Dr. Brent Masel, national medical director for the Brain Injury Association of America, adding “the inconsistencies make it difficult for people to get the care they need to live healthy, independent and productive lives.”

The inconsistencies in insurance coverage also create a challenge for the U.S. Department of Health and Human Services. The Patient Protection and Affordable Care Act charges the agency with writing regulations for essential health benefits based on a “typical employer plan.” Since there are no typical insurance plans for TBI, advocates argue the essential benefits for rehabilitation should be based on standardized treatment guidelines that reduce long-term disability and mitigate against the chronic disease processes that result from a traumatic brain injury. 

BIAA would like to thank our congressional partners in this effort including, Congressmen Platts and Pascrell, the office of Congresswoman Giffords and the House Armed Services Committee. BIAA will continue to follow the provision throughout the process of passing the FY12 National Defense Authorization Act and alert grassroots advocates if any action becomes necessary.

In This Post:

Appropriations Update

Health Care Reform Update

TRICARE Coverage of Cognitive Rehabilitation

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The Policy Corner is made possible by the Centre for Neuro Skills and Lakeview Neurorehabilitation Centers & Specialty Hospital. Brain Injury Association of America gratefully acknowledges their support for legislative action.

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Appropriations Update

House appropriators are poised to begin considering their draft fiscal year 2012 spending measures later this month. In preparation, BIAA and NASHIA worked with the Congressional Brain Injury Task Force to issue a letter of support to appropriators urging them to preserve funding for both programs authorized by the TBI Act and the TBI Model Systems of Care Program.

BIAA is monitoring the appropriations process closely and will alert grassroots advocates if action becomes necessary. 

Health Care Reform Update

AHRQ Comparative Effectiveness Review

As some of you may know, BIAA submitted commentsto the Agency for Healthcare Research and Quality (AHRQ) in response to their request for public input regarding an upcoming Comparative Effectiveness Review on Postacute Rehabilitation for Moderate to Severe Traumatic Brain Injury in Adults.

On April 19, 2011, in response to its submission, AHRQ contacted BIAA to solicit expertise in developing a Technical Expert Panel (TEP) to advise the agency on its approach to the review. BIAA is pleased that AHRQ is interested in including many perspectives and is encouraged by its willingness to include all stakeholders.

BIAA will continue to follow the process of the review and update advocates on the progress of the project.

Community First Choice Option

On Tuesday, April 26, 2011, BIAA offered commentsto the Centers for Medicare and Medicaid Services’ (CMS) proposed rule for the Medicaid Program: Community First Choice Option, a program authorized by the Patient Protection and Affordable Care Act.

BIAA expressed support for the consumer control and patient-centered planning processes that support participants as the central decision-maker in a long-term services and supports system.

However, BIAA also pointed out that the stringency of the eligibility criteria for the program may be detrimental to persons with brain injury because some states use nursing home level of care assessments that do not acknowledge that individuals may not be able to conduct activities of daily living without cueing or compensatory strategies. Because these states base functional assessment on direct caregiving needs, they may exclude people with brain injury.

BIAA will continue to monitor the implementation of this program and update advocates as information becomes available.

State Health Benefit Exchanges

On May 2, 2011, BIAA joined with over 50 national organizations to submit a letter to the House of Representatives urging them to oppose HR1213, legislation that would repeal the mandatory funding being provided to states under the health care reform law to establish health benefit exchanges.

The letter contends that “ The creation of state-based American Health Benefit Exchanges is a central element of the ACA’s provisions to make affordable, high-quality health insurance coverage available to American consumers. Exchanges will provide individuals and small

businesses with competitive, consumer-centered marketplaces for purchasing private health insurance, giving them greater choice at a better price than they can currently receive on their own.”

BIAA is monitoring HR1213 closely and will alert grassroots advocates if action becomes necessary.

TRICARE Coverage of Cognitive Rehabilitation Therapy

On April 19, 2011, BIAA and the Wounded Warrior Project (WWP) met with Senate and House staff to discuss next steps in allowing medically retired service members access to the same brain injury care, including cognitive rehabilitation therapy (CRT), as those on active duty. As many of you know, TRICARE is currently contracting with the Institute of Medicine (IOM) to study the efficacy of CRT with results expected next year.

BIAA recognizes the positive steps that TRICARE has taken to make this critical care available and looks forward to Congress facilitating communication with TRICARE Management Authority (TMA) to work towards interim access to CRT.