Virginia Regulatory Town Hall
Department of Medical Assistance Services
Board of Medical Assistance Services
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6/8/23  1:14 pm
Commenter: Christine Baggini

Brain Injury Services Targeted Case Management

Page 2

Definition of Family (for the purpose of receiving individual and family/caregiver training

Services) includes a statement that it shall not include persons who are compensated to care for an individual. However in some rural areas, where caregiving providers are in short supply, spouses, parents and/or other relatives may be paid through Consumer Directed Care as a matter of necessity.


Page 3

Definition of Mayo Portland Adaptability Inventory: at the end it cites “three clinical areas” Recommend listing the subscales: Ability, Adjustment and Participation


Page 4

“Qualified Brain Injury Support Provider (QBISP)” A more comprehensive training is required for Targeted CMs. The Brain Injury Association of Virginia has curriculum expertise and can be contracted to create an appropriate training program.


Page 6

Qualifications for BIS Case Managers should include that within 6 months of employments, a TCM provider should attain a higher certification than QBISP - The Brain Injury Association of Virginia can provide this training


Page 7

Case manager must have skills in:

  • Gathering information from other sources, such as family members, medical providers,(Add Mental Health providers), social workers, and educators (if necessary) to conduct a complete needs assessment of the eligible individual.
  • Observing, recording, and reporting and documenting an individual's behaviors (Add Physical, emotional and cognitive challenges)


Page 9

As part of the intake process, the case manager must collect existing medical documentation that demonstrates the member’s diagnosis of a traumatic brain injury. If there is no documented diagnosis, then the case manager shall assist the member in accessing a physician who can document whether the member has a diagnosis that is eligible for receipt of the brain injury case management service. – This can include a Neuropsychological Evaluation. An evaluation needed to confirm a BI diagnosis will be (should be) covered by Medicaid.


Additionally, the case manager must complete the Mayo-Portland Adaptive Index-4 screening to determine whether the member meets the required severity threshold for BIS case management service. The MPAI-4 screening should be done in person with the support of family member(s) or others who know the individual well. This is not an appropriate tool for someone with severe cognitive impairment.


Page 10

Exclusions are contradictory to the state definition of brain injury as defined in the Code of VA:

    § 37.2-403. Definitions.

"Brain injury" means any injury to the brain that occurs after birth that is acquired through traumatic or non-traumatic insults. Non-traumatic insults may include but are not limited to anoxia, hypoxia, aneurysm, toxic exposure, encephalopathy, surgical interventions, tumor, and stroke. "Brain injury" does not include hereditary, congenital, or degenerative brain disorders, or injuries induced by birth trauma.


Page 14

Person Centered Planning Requirements

  • At a minimum, the BIS case manager must review the plan of care every 90 days* to determine whether service goals and objectives are being met, and whether any modifications to the plan of care are necessary.  * Inconsistent requirement: on page 10 a face to face contact is required every 60 days – recommend this contact should be every 60 days
CommentID: 217102