Thank you for the opportunity to comment on the fast-track regulation for Brain Injury Services Targeted Case Management.

No Limits Eastern Shore supports incorporating this service into the Virginia Administrative Code. We respectfully request several clarifications to ensure that the regulation, Virginia’s CMS-approved Medicaid State Plan, and the current DMAS provider manual are administered consistently.

First, proposed 12VAC30-50-492 defines severe traumatic brain injury as an MPAI-4 T-score of 50 or above. The current provider manual imposes additional eligibility requirements, including item-level criteria for individuals scoring 50–59. Because these additional requirements may determine whether an individual is eligible for the service, DMAS should identify the controlling standard and align the regulation, State Plan, and provider manual. Eligibility should not depend upon criteria that are stated only in the manual and are not apparent in the regulation or approved State Plan.

Second, subsection B should be corrected and clarified. The phrase “up to 180 days consecutive days of a covered stay” is unclear and does not expressly connect the service to transition from an institution to a community setting. We recommend language stating that case management may be provided during the final 180 consecutive days of an institutional stay when furnished to assist the individual’s transition to the community.

Third, DMAS should clarify that the required 90-day activity is a review and update of the individual service plan, rather than a complete reassessment of eligibility, which the provider manual describes as occurring annually.

Finally, the provider manual requires the initial evaluation visit to occur where the individual resides, although that requirement does not appear in the proposed regulation or State Plan. DMAS should clarify whether this is an absolute site-of-service requirement and whether exceptions or alternative arrangements are available when an in-residence visit is impracticable or creates an access barrier.

These targeted revisions would not alter the purpose of the benefit. They would provide clearer notice, promote consistent eligibility determinations, and reduce uncertainty for individuals, families, and providers.