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Virginia's Medicaid Program
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Brain Injury Services


Overview

DMAS is in the process of developing a targeted case management service for individuals with severe traumatic brain injury and has convened a workgroup with relevant stakeholders to develop program structures and cost estimates for implementing a continuum of treatment and supports for individuals with brain injury and neuro-cognitive disorders; including waiver and facility based neurorehabilitation and neurobehavioral services. 

House Bill 680 directed DMAS to:

Update the State Plan for Medical Assistance to include a provision for the payment of Medicaid targeted case management services for individuals with severe traumatic brain injury.

The Virginia Acts of the Assembly – Chapter 224 Enactment Clause 1, 308 CC.1-2 states:
  1. The Department of Medical Assistance Services (DMAS), in conjunction with relevant stakeholders, shall convene a workgroup to develop a plan for a neurobehavioral science unit and a waiver program for individuals with brain injury and neuro-cognitive disorders. The neurobehavioral science unit shall be considered as one of the alternative institutional placements for individuals needing these waiver services. The workgroup shall make recommendations in the plan related to relevant service definitions, administrative structure, eligibility criteria, reimbursement rates, evaluation, and estimated annual costs to reimburse for neurobehavioral institutional care and administration of the waiver program. The department shall include a rate methodology that supports institutional costs and waiver services.
  2. The department shall submit a report which outlines the recommendations for a neurobehavioral science unit, waiver program, and the service methodology to the Chairs of the House Appropriations and Senate Finance and Appropriations Committees by November 1, 2022.

Program Development and Timeline

While DMAS anticipates the implementation of brain injury services and TCM occurring in two phases, planning and development will occur in parallel tracks.  The workgroup is on target to develop the programmatic components that will inform rate development methodologies for both the brain injury services and TCM. 

To develop cost impacts for waiver and facility based services, DMAS, in conjunction with the workgroup will assess and develop the following service structure rules. DMAS will work with a rate development contractor and technical assistance resource to design the following elements:

  • Service definitions,
  • Administrative structure,
  • Eligibility criteria,
  • Provider participation requirements (licensing/accreditation and staffing qualifications),
  • Population prevalence,
  • Service setting options,
  • Reimbursement rates,
  • Federal evaluation requirements.

DMAS is working toward an implementation for Brain Injury Case Management Services beginning on or after July, 2023 depending upon the available provider capacity to implement the service at that time.  DMAS will also submit a budget package for Fiscal Year 2024 with costs for the waiver services as well as a request for authority to submit a waiver to the Centers for Medicare and Medicaid Services.