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2002 SESSION


HOUSE JOINT RESOLUTION NO. 235
Urging the Department of Medical Assistance Services to develop a plan by July 1, 2002, in collaboration with the Department of Rehabilitative Services and the Brain Injury Association of Virginia, to consider amending the admission criteria of nursing facility Traumatic Brain Injury (TBI) programs to include persons diagnosed with nondegenerative, nontraumatic injury to the brain or otherwise develop a plan to improve access for persons with TBI.

Agreed to by the House of Delegates, January 24, 2002
Agreed to by the Senate, February 28, 2002

WHEREAS, Virginia's State Plan under Title XIX of the Social Security Act provides methods and standards for establishing payment rates for long-term care that includes an add-on reimbursement rate for nursing facility residents in specialized Traumatic Brain Injury (TBI) programs; and

WHEREAS, individuals must meet five criteria for admission to the nursing facility TBI Program, as follows:

(a) The resident meets the minimum nursing facility criteria as specified in 12 VAC 30-60-300 as well as meets the pre-admission screening requirements for nursing facility level of care;

(b) The resident has a physician's diagnosis of TBI that is also recorded on the Patient Intensity Rating System Review (DMAS-80) form by diagnosis code 85000 (trauma to the brain);

(c) Abusive, aggressive, or disruptive behavior has been documented within 30 days prior to admission and also recorded on the Patient Intensity Rating Review (DMAS-80) form by coding behavior pattern three or four. The review form must also be supported by documentation in the medical record;

(d) The resident is at least 14 years old; and

(e) The resident is appropriate for nursing facility placement and the facility is able to safeguard him such that the resident will not be a physical or emotional danger to himself or other residents of the unit; and

WHEREAS, only one nursing facility within the Commonwealth has established a specialized TBI Program since 1997, when DMAS first included a reimbursement rate add-on for specialized TBI programs in Virginia's State Plan; and

WHEREAS, it is recognized that individuals with brain injuries who have challenging behaviors may be placed inappropriately in state mental health facilities; and

WHEREAS, pursuant to Senate Document No. 16 (1991), "Action Plan for the Appropriate Treatment of Persons with Brain Injuries in the Mental Health System," the Department of Mental Health, Mental Retardation and Substance Abuse Services, recommended that the Department of Rehabilitative Services and DMAS study the use of dedicated brain injury units in nursing facilities, and explore strategies to expand these services where feasible and appropriate; and

WHEREAS, individuals with nondegenerative, nontraumatic brain injury who meet all of the other criteria for admission and continued stay in a nursing facility TBI Program (i.e., criteria a, c, d and e referenced above) have a need for, and could benefit from, the same specialized treatment and services available in a nursing home facility program for residents with TBI; now, therefore, be it

RESOLVED by the House of Delegates, the Senate concurring, That the Department of Medical Assistance Services be urged to develop a plan by July 1, 2002, in collaboration with the Department of Rehabilitative Services and the Brain Injury Association of Virginia, to consider amending the admission criteria of nursing facility Traumatic Brain Injury (TBI) programs to include persons diagnosed with nondegenerative, nontraumatic injury to the brain or otherwise develop a plan to improve access for persons with Traumatic Brain Injury (TBI).