Virginia Regulatory Town Hall
Department of Medical Assistance Services
Board of Medical Assistance Services
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6/9/23  2:45 pm
Commenter: Daniela Pretzer The BridgeLine

Eligibility Determination

Diagnosis: 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.

It should read severe traumatic brain injury because Medicaid billable TCM is not reimbursing for clients who have a mild or moderate traumatic brain injury.

Intake process: In our 20+ years’ experience, a diagnosis often includes a Neuropsychological Evaluation. If that is needed, it should be covered my Medicaid. Furthermore, to perform the MPAI-4 screening, an additional support person (family/caregiver/guardian, etc.) should be present. Severe brain injury means typically severe cognitive challenge and is not a good tool when the client is unsupported.


CommentID: 217166